TREATMENT OF FRACTURE OF THE CLAVICLE.

Two difficulties are met with in the treatment of this accident; the maintenance of the fragments of the bone immoveable, and the procuring a regular callus. Desault's bandage does not entirely fulfil these conditions, but M. Blandin obtains them by rendering this apparatus immoveable by means of dextrine. Six cases have just been treated by him at the Hôtel Dieu, and in one only, this patient being delirious from a wound of his head, was the success incomplete. In the others, when the bandage was removed, it was difficult to point out the side upon which the fracture had occurred, no angle or projection whatever being visible. It might be supposed that an immoveable bandage of this kind would prove very irksome to the patient. It does not for, owing to the fragments being maintained in situ, he suffers less; and there is no necessity to renew or tighten the apparatus every few days, as would otherwise be the case. Care is of course taken to guard the armpits, and other parts which the stiff bandage would irritate, by means of compresses. In private practice, M. Blandin causes the patient to wear a somewhat tight flannel-waistcoat, over which he applies the bandages; and with the skin thus protected, the most delicate females experience no inconvenience from it. -Gazette Medicale, No. 33.

NITRATE OF SILVER IN TRAUMATIC ERYSIPELAS, ARTHRITIS, &c.

Erysipelas frequently shows itself in the St. Louis Hospital, and it is always treated locally (employing purgatives, &c. according to the indication) by M. Jobert with the nitrate of silver ointment, of varying strength, (viz. 4, 8, or 12 parts of the nitrate to 32 of the lard,) according to the degree of action desired to be obtained. He also uses this very advantageously in acute and chronic inflammations of the joints, bones, periosteum, and cellular tissue; violent arthrites, white-swellings, &c. The inunction quickly dissipates the inflammatory symptoms, and especially the pain, so as to be regarded by M. Jobert as one of the most. powerful antiphlogistics. The application of the ointment blackens the skin. This becomes less stretched, wrinkles, and undergoes a kind of desquamation. The blackened epidermis is gradually detached, and the skin resumes its normal colour. When the inflammatory symptoms have disappeared, the disappearance of the blackening may be hastened by washing the skin with a solution of ioduret of potassium. In persons possessing a very delicate skin, slight pustulation, or a pungent pain of short duration, may be produced.-Gazette des Hôpitaux,

No. 96.

In connexion with the above subject, we may mention that M. Robert employs sulphuric acid with great advantage in chronic arthritis. He dips a small pencil in the acid, and makes four or five linear superficial cauterizations. Such marked relief from pain results, that the patients themselves call for a repetition.

M. Hilsenburg has likewise employed the same means after local depletion with equal advantage. He however uses the following formula: Acid. Sulph. Concent. 8 parts, Syrup 15 parts. To be rubbed twice a day.—Abeilie Medicale.

M. VELPEAU ON FLEXIONS AND ENGORGEMENT OF THE UTERUS.

"A proof of how often the term engorgement has expressed an error of diagnosis is found in the fact that of late years, and in proportion to the progress of science, engorgements of the uterus become more and more rare, while the number of vicious flexions is augmented. I do not fear to state, that of 50 women reputed

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to have uterine engorgement, 45 will be found upon examination to be suffering from some deviation from the normal position of the organ. How can we explain this error of diagnosis being committed by well-educated practitioners? The reason is simple. The woman is examined in the recumbent posture, and the finger meets, in a certain direction of the neck, forwards if there be anteflexion and backward if there be retroflexion, with a tumour of considerable size and sensible, which is declared to result from an engorgement. But the tumour is simply the body of the organ bent at a more or less obtuse angle, and sometimes at a right angle. We can easily assure ourselves of this, especially when, as is the case with most women who have borne children, the walls of the abdomen are neither tense nor thick. By gently depressing the hypogastrium, we may grasp the body of the womb between the two hands, and appreciate its volume as accurately as if we could see it. Engorgement is one of the least usual conditions of the organ that we meet with, and on the contrary the body of the organ is often found somewhat atrophied.

"Accurate diagnosis, in consequence of the treatment it designates, is here of great importance; for when we have to do with a simple deviation we dispense with the use of means proper for resolving a tumefaction which does not exist, of debilitating remedies each more mischievous than the other, and with confining the patient for months in the recumbent posture. We order for her, moderate exercise, a substantial and tonic regimen, antispasmodic, ferruginous drinks, saline baths, astringent vaginal injections, and lastly an abdominal bandage which may support the viscera and prevent their weighing down the deviated organ."Gazette des Hôpitaux, No. 89.

ON PARALYSIS OF THE INSANE. BY M. BAILLARGER.

Incomplete general paralysis is an apyretic disease, generally of long duration, and principally characterised by embarrassment of speech, the progressive paralysis of the limbs, and dementia. Its exact frequency cannot be determined, as many patients who are the subjects of it are retained at home by their families; while it is also often overlooked by medical men, or confounded with diseases of the brain. About one-sixth of the patients admitted into the large asylums of France are affected with this paralysis. More than one-half the cases observed by Bayle were descendants of insane or highly nervous persons, and M. Calmeil believes that hereditariness exists in about a third. The influence of sex is great, for in the French asylums 1 man in 4 admissions is paralytic, while only 1 woman in 12 is so. The sanguine and plethoric temperament is most liable. Of 600 men, the medium age was 42, and of 400 women, 41; the disease very rarely occurring before 30. It is most frequently found in those classes of society which indulge in excess of drink, &c. Although we have found that insanity occurs with a third more frequency in summer than in any other season, the result is different as regards paralysis. Thus, of the 921 paralytic patients received at the Bicetre and Salpêtrière during four years, nearly an equal number were admitted in the six cold as in the six hot months. Contrary to what occurs in simple insanity, the occasional causes are more often physical than moral. Of these, cerebral congestions, suppression of menses, or hæmorrhoidal discharge, excess of drink or of work, &c. are the most common. Sometimes the disease arises from organic cerebral affections; and, in exceptional cases, from anæmia and exhaustion.

Symptoms.-These are exhibited in lesions of motion, sensibility, and the understanding, each being exhibited in three different degrees. Of the Lesions of

Motion we have (1) Embarrassments of speech. These are sometimes scarcely to be observed, being remarkable chiefly by the effort and the suddenness with which the words are articulated. There is a characteristic trembling of the muscles around the mouth, and in a slight degree of the tongue itself. In a second degree there is more hesitation of speech, long intervals separating portions of a sentence, or even of a word, the faulty pronounciation becoming very confused if the patient is excited. In another degree the patient either cannot articulate at all or does so unintelligibly. (2) The defective movements of the limbs usually only manifest themselves after the aboye. The paralysis also observes different degrees, from a hesitation first in walking, and then a want of precision in employing the hand, both hardly to be detected, until the completest loss of power in all the limbs. (3) Tremors of the limbs, which occur in a slight degree in almost all these patients, sometimes prevail to a truly convulsive extent. A remarkable grinding of the teeth is sometimes heard, when no movement of the jaw can be detected. The Lesions of Sensation, very slight at first, gradually increase; so that eventually the skin entirely loses its sensibility, and the functions of the special senses become completely destroyed. Lesions of the Intellect in some patients consist of simple dementia without delirium, while others manifest the latter, which is, however, always, whatever may be its form, accompanied from the commencement with the marks of dementia. The ambitious form of monomania is the most frequent manifestation of delirium in these cases, but it, as well as the other forms, are maintained, owing to the loss of memory, with much less obstinacy and consistency than ordinary monomaniacs exhibit. The affective faculties become effaced, the patient witnessing the joys or sorrows of his friends with like perfect indifference. The Nutritive functions are at first satisfactorily executed, the appetite being, indeed, sometimes voracious. Afterwards this is lost and the patient wastes away. The stools are then passed involuntarily; and sometimes, before the sphincters become paralysed, female patients are only observed to befoul themselves at their menstrual periods.

Such is a general picture of the symptoms, and, as regards the order in their advent, I agree with Bayle, that a slight hesitation of speech is the first one, and by observing it I have several times been able to announce the supervention of general paralysis in persons who manifested no other. Next we observe a marked tendency to drowsiness, and then a slight dementia, which is first shown by a weakening of the memory. These persons can now no longer fulfil the duties of their station. They are not competent to even the most simple mental combinations, and incoherence is observed in their discourse. In some, a year or more prior to the accession of the disease, the genital faculties are lost. Among most of those menaced with this paralysis, slight tremors of the limbs, and cerebral congestions, inducing momentary loss of speech, are observed. In almost all cases the paralysis precedes the delirium; but, admitting that occasionally the reverse is the case, must we conclude that incomplete general paralysis is always a complication of insanity, which remains the primary and principal disease? We make the following distinction, which we believe an important one. If the lesions of the intellect have only preceded those of motion a short time, and consist only in an ambitious monomania, we must regard the delirium as simply symptomatic of the general paralysis. And we must regard this last as a complication of insanity only in the cases where it follows delirium of several years' duration, and which does not present the special form observed in the paralytic. As to the progress of the disease, it is very irregular. Some patients are detained long at its early periods, and others pass at once to the second stage. Others again, apparently at death's door, recover power of motion surprisingly, only again to relapse. Its mean duration seems to be from 18 months to two years, life being more prolonged in females than males. Among the complica tions, epileptic paroxysms are the most frequent, and are often the instrument of the fatal termination. They are much more frequent in men than in women, who seem more liable to a semi-comatose condition. The prognosis is of the

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gravest character. Among the Anatomical changes observed, the firm adhesion of the membranes to the more or less softened cortical layer of the brain is the most frequent, M. Calmeil having found it 28 times in 35 cases. In another group of cases, instead of meningeal alterations, collections of fluids are found in the cavities of the brain, while its substance is atrophied and hardened. However, the lesions observed are often very various, and the dependence of the disease upon any special one very unlikely. "Considering that among these alterations none is constant, and that each may be met with in other diseases, we agree with M. Calmeil that this affection cannot be explained by the meningo-encephalitis or the hydrocephalus, but that it is due to some identical modification, the intimate nature of which is unknown, a modification which must exist in all these cases, independently of the lesions described."

The Diagnosis is usually not difficult. The cases which may give rise to most embarrassment are, (1) Delirium Tremens, accompanied with ambitious ideas and embarrassed speech; but the cessation of the symptoms after a few days' treatment, will remove all doubt. (2) Diseases of the superior portion of the spinal marrow. Here the upper limbs are as soon or sooner affected than the lower. There is no embarrassment of speech or mental affection. (3) Sudden diseases of the brain, as hæmorrhages, &c., will be distinguished by an ordinary study of the symptoms. There is a class of diseases, which, in our opinion, are identical with general paralysis, and should not be separated from it, viz., the paralysis of the aged, that resulting from the chronic hydrocephalus of adults, or the hydrocephalus following cerebral alterations.

Treatment is of no avail, except in the earliest period, and rarely then. If the patient be strong, local, or even small general, bleeding may be advantageously resorted to; employing at the same time purgatives, revulsives, and exutories. In the second period, leeches may be sometimes used, but we must especially rely upon setons behind the neck. By these means we may frequently delay the progress of the disease, and can rarely do more.-Gazette des Hôpitaux, Nos. 80, 83.

In reference to this interesting disease a short discussion took place not long since at the Society of Practical Medicine of Paris. M. Brierre de Boismont observed that, in consequence of its having been stated by some medical men that general paralysis may exist without insanity, he had made researches respecting it in all the large hospitals, and arrived at the following conclusions. 1. General paralysis without mental alienation is excessively rare, since, in examining more than 1500 patients only one distinct instance was discoverable, while such cases constitute about a fourth of the inhabitants of asylums. 2. The paralysis of the dirty patients of the Salpêtrière is not identical with this disease. Such patients are all far advanced in age, while general paralysis attacks individuals in the flower of their age, and kills them in a very few years. There is not observed among them, which is an important characteristic so often seen in the insane, those temporary recoveries of power, when even just upon the eve of death. The general paralysis then of the old females of the Salpêtrière is only a general enfeeblement of the nervous system, brought on in the progress of age. M. Colineau observed that he had seen all the symptoms of general paralysis without insanity, there being simply a weakness of the intellect. In one case, the individual retained his faculties unimpaired to the last. M. Baillarger stated that cases of this paralysis are to be met with in the Salpêtrière, accompanied by dementia, but without mental alienation, and that he is occupied in preparing a work distinguishing general paralysis from mental alienation. He thinks progressive paralysis would be a better denomination for the disease than paralysis of the insane.-Gazette Medico-Chirurgicale, No. 24.

CANCER.

Opium Dressing.-M. Tanchou speaks highly of the relief from pain to be obtained from employing the following dressing in cancerous ulcers. Digest, during 24 hours, at a temperature of about 78°, a certain quantity of rough-powdered or bruised opium in a sufficient quantity of water to form a thick paste. Cover the ulcer with this, a line or two in thickness, once or twice a day according to the severity of the pain, and place over it a piece of thin gummed paper or court-plaister to prevent evaporation.

Relapse of Cancer.-True as it is that relapse is much to be feared after operation for cancer, it is no less so that we may sometimes mistake the effects of inflammation for such. M. Lisfranc has made the part which inflammation acts in cancer the subject of very attentive study. A woman had her left breast removed recently. Cicatrization at first took place rapidly; when, all of a sudden, the wound broke out again, the surrounding skin assuming a slate-colour, and lancinating pains reappearing. Here was every appearance of a relapse; but M. Louis ordered a dozen leeches to the margin of the wound, the pains ceased, the slate-colour disappeared, and cicatrization was soon completed.-Gazette des Höpitaux.

ERGOTINE AS A HEMOSTATIC.

On the occasion of M. Bonjean's presenting the Academie des Sciences with an account of an additional experiment he has made with Ergotine, in which the bleeding from the carotid of a horse, divided through a third of its circumference, was at once arrested by the application of ergotine, M. Velpeau delivered the following sensible and pertinent observations:

"What M. Bonjean says of Ergotine has been said by an infinity of other persons concerning different substances. Hæmostatic means of a real efficacy are nevertheless as rare as ever. The error arises from these authors having forgotten two things in their experiments. 1. In animals, the plasticity of the blood is much greater than in man, whence it follows that means which will arrest hæmorrhage in the one, may easily fail to do so in the other. All those who have made experiments on living animals know that, in the horse, the ox, the sheep, for example, the largest wounds of arteries rarely give rise to mortal hæmorrhage. The blood, ceasing to flow almost of its own accord, leads the public and inexperienced authors to believe that it is the means or remedy employed which has closed the artery. Thus, what powders, waters, liquids, what arcana of every kind have been vaunted at first as infallible; and then, after a searching examination, rejected as useless! 2. In man, many arterial hæmorrhages also cease either spontaneously or under the exertion of mere compression, without our being obliged to have recourse to the ligature; so that it is easy to attribute to a pretended hæmostatic substance a result which takes place quite independently of its employment.

I

"I have neither cause nor desire to throw any doubt upon the value of M. Bonjean's experiments; but practice has been so often deceived by similar announcements, that it behoves the Academy to accept them with due reserve. must add, that the practitioners who have tried ergotine or the ergot of rye have as yet derived nothing conclusive from its use. When, in uterine haemorrhage, the ergot proves useful, it does so by inducing contraction of the uterus, and not by any special action it exerts on the blood or on the arteries. Thus we see the question of surgical hæmostatics is at once a very complex and a delicate one: and we should not receive facts concerning it without a certain degree of distrust,