platinum tube. This tube is encased in another one, about a quarter of an inch longer than the first, ending in a sharp_trocar-like point, and having, near its extremity, an oblique opening in one side. By rotating the outer tube on the contained one, their apertures may be made to correspond or otherwise, at the will of the operator. Thus, then, the necessity for two instruments is quite done away with. The syringe having been charged, the operator rotates the outer tube, so as to conceal the orifice of the inner one entirely, and protect it from the ingress of blood. In this state the instrument is passed into the centre of the tumour, and, having been stirred about as much as may be thought desirable, the tube is turned back so as to expose the orifice; and the piston being at the same moment depressed, a drop or two of the solution is squeezed out. It may be supposed that the smallness of the whole instrument, and the diminutive size and oblique position of its aperture, will afford considerable guarantee against the injection of too large a quantity, while on its advantages, in case of employment, it is scarcely necessary to insist.--Med. Times and Gazette, Aug. 27, 1853, p. 219.

79.-CURE OF AN ANEURISM OF THE SUBCLAVIAN ARTERY, BY MEANS OF THE EXTERNAL APPLICATION OF THE CHLORIDE OF ZINC.

By M. BONNET, Lyons.

M. Bonnet announces the complete cure of a patient suffering from subclavian aneurism, seen by M. Lallemand upon the 14th day of treatment of the disease, by successive applications of the paste of chloride of zinc. The chloride of zinc, penetrating by imbibition into the deeper parts of the tumour, produced complete coagulation of the blood, which was detached from the walls of the aneurismal cavity without any hemorrhage. The patient quitted the hospital three months and a half from the commencement of the treatment. He could at that time take a walk for half an hour at a time, and presented, as the only trace of his disease, a superficial ulceration, which was nearly healed. The clot, which came away with the eschar, was forwarded to M. Lallemand by M. Bonnet.

The patient, aged 25, had received in the left supra-clavicular region a blow with a knife, which, dividing the whole brachial plexus, and touching either the subclavian artery or one of its branches, was followed by profuse hemorrhage, and subsequently by the formation of an enormous aneurism. The rapid enlargement of the tumour, and the frequent discharge of blood from the wound, threatened the life of the patient, and rendered immediate assistance necessary. The application of a ligature between the inner border of the scaleni muscles and the aorta was rejected by both M. Bonnet and his colleagues, as too dangerous and too difficult. The galvano-puncture was also negatived, because it was impossible to suspend, even for a moment, the pulsations and the bruit de souffle in the aneurisinal pouch. The injections of the perchloride of iron were not then known (January 2); and, possibly, the enormous size of the aneurism, its proximity to the heart, and the impossibility of compressing the artery which conveyed the blood to it, would have counterindicated its employment. In this difficult position, M. Bonnet determined upon cauterization by the paste of chloride of zinc.

The first eschar was produced in the centre of the tumour. Every two or three days, Bonnet removed, with a bistoury, the superficial layers of the slough, and for five weeks he continued a series of applications of the paste, which penetrated daily both in depth and extent. Upon the 14th day, the pulsations of the bruit de souffle ceased; at the end of the second month, the eschar began to detach itself without any hemorrhage. The clot came away with the eschar. Bonnet affirms that modern authors are wrong in attributing this method of treatment to Ambrose Père, Guattani, or Marcus Aurelius Severinus; in none of the original works is it mentioned. The ancients knew nothing of the chloride of zinc, which was introducedinto practice by M. Canquoin.

Bonnet first thought of employing this escharotic in the treatment of aneurism, by observing for the last ten years its power in coagulating blood and arresting hemorrhage. He found, 1837, that it got rid of varicose veins without the occurrence of

bleeding which frequently ensued after the application of potassa fusa. Both he and his colleagues-MM. Barrier, Bouchacourt, Desgranges, and Vallet-have often taken a firm coagulum from vessels exposed to its influence. He has seen it entirely remove hemorrhoids, varicoceles, and erectile tumours, by penetrating into the vessels by imbibition, coagulating the blood, and rendering the whole tumour firm. That it arrests arterial as well as venous hemorrhage, was shown by its action upon goitre, as stated by M. Philipeaux, in a memoir founded upon some of Bonnet's clinical lectures.

The eschar separates about eight days after the application of the paste; it can, therefore, be easily retained by successive applications for a month, or even longer. MM. Bonnet and Gensoul have lately proved that the chloride of zinc may cure the disease known as aneurism by anastomosis. A tumour, occupying the summit of the head, an inch in thickness, and of rounded surface, about half a foot in diameter (15 centimetres), consisted of an immense number of anastomosing arteries, pulsating with a loud bruit de souffle, and nourished by seven large trunks coming from the frontal, the temporal, and the occipital region, each about the size of the brachial artery. Injection was inefficient and impossible; pressure, continued for a year, failed, and the surgeons were talking of tying the two carotid arteries. The cauterization by the paste of the chloride of zinc effected the separation of the tumour without any hemorrhage whatever, from each of the nutritious arteries. The result of the case, not yet complete, is to be communicated at a future meeting of the Society. Med. Times and Gazette, July 23, 1853, p. 98.

80.-CASE OF ERECTILE TUMOUR OF THE ORBIT.

By DR. DANIEL BRAINARD, Professor of Surgery in Rush Medical Collego, Chicago, Illinois. [On August 1st, 1851, the patient, a farmer, first consulted Dr. Brainard for a tumour of the left orbit, possessing all the aneurismal characteristics. He supposed it to arise from a severe kick from a horse, fracturing the lower jaw. The tying of the common carotid was proposed, but he declined, until the 11th of November, when it was performed in the usual manner. Bags of pounded ice and salt applied to the orbit relieved the acute sensibility of the part. The tumour gradually diminished in size, though a thrill could still be felt.]

On the 11th November, 1852, just one year from the first operation, he returned to me. At this time the entire orbit was filled, the lower lid was concealed by the fungous projection, the eye pressed outwards and downwards, and at the root of the nose and inner part of the superciliary ridge there was an elastic swelling, which had caused the absorption of the bone. It was at that point that the pulsations were strongest and the thrill most distinct. The small vessels of the forehead and side of the nose were greatly enlarged, pulsated strongly, and the latter gave the peculiar thrill of the disease very sensibly. His general health was much impaired, and he had been able to come to the city by railroad only with great difficulty.

The question of the proper treatment to be employed in a case of erectile tumour of the orbit, when the ligature of one carotid has failed to effect a cure, is one of some difficulty. The attention is naturally turned to the other carotid; but even if the ligature of that were likely to succeed, the risk in this case was too great, since it was found that compression of it for a few seconds rendered him perfectly insensible. None of the means resorted to for the purpose of obliterating this vascular tissue had ever been tried on deeply-seated tumours, like those of the orbit. On carefully reviewing them all, it was determined to try puncture with hot needles. This was done first on Nov. 13th, 1852; the needle used was of the size of a common knitting-needle, sharpened to a triangular point and set in a handle of bone. After being heated in the flame of an alcohol lamp, it was plunged into the tumour about an inch from the root of the nose, in the course of the superciliary ridge, and carried downward and backward to a depth of over three inches; on withdrawing it, some bleeding followed, which was readily stopped by slight pressure. For two days there was little pain or swelling; but on the third day the inflammation was acute, the swelling extending over the face, and presenting an erysipelatous appearance. On the fifth day this began to decline, and in a week was nearly gone.

While the inflammation was at its height the tumour was more firm and the thrill less distinct, but as it subsided the elasticity and pulsation rapidly returned.

Nov. 25th I repeated the operation, making the puncture half an inch nearer the nose, and carrying it to a depth of only one inch. The effects corresponded with those before described, but were a little less violent. On the third day the sound was diminished, and the firmness of the tumour very sensibly increased. On a careful examination it was found that the morbid tissue extended over the bridge of the nose and down to the inner canthus of the right eye, where a thrill could be distinctly felt.

Dec. 2nd. A puncture was made on the left side of the bridge of the nose, the needle being carried obliquely upward and to the left side. The inflammation resulting from this puncture was acute, and a superficial suppuration occurred about it. The thrill upon the right side of the nose quite disappeared.

The effect of these three punctures was to limit the spread of the tissue upon the forehead and nose; but the inflammation, although acute and extensive, was superficial, and the mass of the disease at the centre was still unaffected. It was evident that the needles cooled in passing through the tissues, so as not to cauterize much below the surface.

It was therefore determined to change the treatment, and inject a fluid into the centre of the tumour capable of effecting its obliteration. For this purpose a solution of the lactate of iron, of the strength of eight grains to one fluid drachm of distilled water, filtered through paper, was preferred. The reasons for believing in the safety and efficiency of this remedy will be given below.

14th. I punctured the tumour at its most prominent part with the infiltrating canula, carrying it to the depth of about an inch'; on withdrawing the stilet arterial blood followed. A fluid drachm of the above-named solution was immediately thrown in with a small syringe, constructed for the purpose, and the canula withdrawn. The immediate effect was an intense pain in the left temporal region and a flushing of the face, which latter only lasted a few seconds. A chill followed, accompanied with nausea and vomiting. Reaction took place in an hour, but the vomiting continued, and for twenty-four hours all drinks were ejected; pulse 63. 15th. Vomiting continues; pain less; upper lid much swollen; pulse 65. 16th. Vomiting less; no pain; has slept well; pulse 60; swelling increased, and so tender as not to bear the slightest touch.

23rd. For the last six days the vomiting has gradually diminished; the pulse is natural; the tumour is less tender, firm, and the pulsation perceived only at the external angle; frequent lancinating pain is felt in the orbit.

During the whole of this treatment, both of punctures and infiltration, the head has been kept enveloped in bladders filled with a freezing mixture of pounded ice and salt, which was very grateful to the patient. He now began to complain of its being too cold. The heat in the head was reduced to a natural standard, and from the time of the infiltration neither thrill nor sound has been perceived. The veins of the face were much diminished in size, and the pulsation of the arteries reduced to its natural state. A slight pulsation was still perceptible at the external angle of the eye, for which a puncture was made at that point with a hot needle, on January 4th, 1853.

Jan. 10th. From the time of the last puncture no pulsation has been perceived, the swelling subsiding. At this time an opening was found to exist on the anterior surface of the globe of the eye, which still remains protruded between the lids. This was followed by severe inflammation of the globe, which lasted several days. The discharge from the opening was at first the humours of the eye, afterwards pus, but ro blood.

Feb. 5th. Swelling gradually sudsiding; tumour firm, no pulsation; but little pain. The patient slept for the first time for more than a year without some one to keep wet cloths upon the eye, dressed himself, and walked about the house; health good.

March 5th. Swelling entirely disappeared; the globe of the eye perfectly collapsed; lids closed.

June 6th. The patient has been pursuing his ordinary occupation for three months; his health appears perfectly restored. The left orbit seems entirely excavated and free from disease.

At this time he was presented at the annual meeting of the Illinois State Medical Society, and examined by a large number of its members, who concurred in the opinion that the case might be regarded as perfect.

Remarks. It will readily be understood that so serious an operation as throwing a fluid ounce of a solution of the lactate of iron, at a point almost to saturation, directly into the current of the circulation, would not be ventured upon without the most satisfactory reasons for regarding it, firstly, as safe; secondly, as effectual. I propose now to offer briefly some of the reasons for so regarding it.

In 1850 I was engaged in making inquiries concerning the effects of this salt in certain diseased states of the system, and was induced, from theoretical views, to try the effect when thrown into the veins. Before doing this upon a human subject, I tried it upon a dog, dissolving, rather imperfectly, ten grains of it in one fluid ounce of distilled water. This was thrown at once into the saphena vein of a middle-sized dog, and the experiment was twice repeated without any ill effect.

In December, 1851, I first used it upon the human subject, using in the course of eight weeks nineteen grains of the salt in solution. The largest amount injected at one time was three grains, dissolved in three drachms of distilled water. The number of times it was employed in this subject was nine. It had no ill effects, but the contrary, what is pertinent to our present subject is, that each of the veins into which it was thrown at the bend of the arm was found after a certain length of time to be obliterated and converted into a firm cord, without there being produced either pain or perceptible inflammation. I have since used it in four other cases,— in two of them once, and in the other two twice each,—without any unfavourable effects. In one of these cases in which it was used twice a vein was opened a second time, three days after the first operation, but it was found filled at that point with coagulum, which of course was not disturbed, but the injection made by another vein. Its tendency to obliterate the veins by a gradual process of thickening the coats and obstructing the circulation, was thus made sufficiently apparent, while its safety, used with requisite precautions, was clearly demonstrated. As these cases related solely to the veins, before using it in the case of tumour of the orbit, in which it might enter directly into the arterial circulation, it was thought proper to try it upon an artery in a dog. Accordingly three grains of the lactate dissolved in three fluid drachms of distilled water, were thrown into the carotid artery of a small dog, and the vessel tied. The only effect was a slight irregularity of the action of the heart, which continued but a few seconds. As this entered directly into the cerebral circulation, its safety when used in much smaller quantity in the human snbject might legitimately be inferred. The result, as used upon the tumour, fully justified its employment, although the effects produced were somewhat severe. They were greatly less so, and less dangerous, than those resulting from the ligature of the carotid artery; and used in smaller quantity, repeated if necessary, it seems to promise relief without the necessity of resorting to that operation.

I may add here, that I have since used the same solution upon an erectile tumour of a venous character, of the size of a pigeon's egg, upon the inside of the lower lip, by injecting it at three different times, without any other effect than a slight tenderness, followed by gradual diminution of size and induration of tissue; but the cure is not yet complete.

The applicability of this practice to the treatment of varicose veins and aneurisms will readily suggest itself, but further experiments will be required to determine to what extent it can be relied upon in these cases. The number of the Revue MedicoChirurgicale de Paris for May, 1853, contains some experiments by M. Pravaz, M. Giraldes, and M. Debout, on the coagulation of the blood in the arteries of animals by the injection of the solution of perchloride of iron, and also three cases in which it had been used for the treatment of vascular tumour in the human subject, in each of which suppuration, and in one gangrene, followed. These results are not of a nature to encourage further trials of that substance; but if we take into consideration that the solution of the perchloride of iron is a substance foreign to the normal constitution of the blood, and produces instant coagulation when brought in contact with it, whereas the solution of lactate of iron is composed of elements which enter into the composition of the blood; that when thrown into the living vessels it does not coagulate it, but produces a thickening of the coats and a deposition of coagulable lymph from subacute inflammation; the difference between the two results

will be readily understood. It is probable that the solution of the lactate, when thrown into the vessels, immediately undergoes decomposition, the acid combining with the soda of the blood, and the base passing into a higher state of oxidation in which it naturally exists in that fluid. In no case has this solution, when thrown into the blood or into a vascular tumour, shown a tendency to produce suppuration, but in slow inflammation of an adhesive kind and limited extent. In one case, where it was inadvertently pressed in small quantity into the subcutaneous cellular tissue, instead of into the vein as intended, a hard swelling having all the appearance of a boil or small carbuncle was the result; but even this effect will not be produced by it, when used in that manner, unless the solution be in a certain degree concentrated.-Lancet, August 20, 1853, p. 162.

ORGANS OF RESPIRATION.

81. SYPHILITIC ULCERATION OF THE FAUCES AND LARYNX; TRACHEOTOMY.

Under the care of JOHN HILTON, Esq., F.R.S.

[The importance and value of the operation of tracheotomy in imminent cases need not be insisted upon, but it rarely happens that we meet with a case where an artificial larynx was required for so long a period as in the following one. We owe the details of the case to the kindness of Mr. Stevens, who has watched the case now for a period of some years.]

Sarah C, 28 years of age, and unmarried, whose habits of life have been very irregular, was admitted into Guy's Hospital, June 16, 1847. The patient had been in the hospital one year before admission, when she suffered from severe secondary ulceration of the uvula and soft palate. She remained in the hospital for a week at that period, the treatment adopted being quinine, and the application of nitrate of silver to the ulcers of the throat.

When admitted, on July 16, 1847, as stated above, her person and symptoms were described as follows:-The patient is a sallow, ill-conditioned looking woman, small, and uncleanly, with a countenance expressive of great anxiety. Since she left the hospital (a twelvemonth before this description was written) she has never been well, her mode of life has been very irregular, and she has frequently caught cold. The edge of what remains of the soft palate is swollen and ulcerated, as is also the left tonsil; the throat generally is inflamed, and the epiglottis very irregular in its outline. The breathing is stridulous, 13 per minute; pulse 84, thready; skin cool and moist; tongue pale and white. Mr. Hilton believes the disease to be situated in the arytenoid cartilages. Donovan's solution, in decoction of bark, was prescribed, with morphia at night, and a blister over the larynx.

For the next five days the breathing became more and more difficult, though the patient sedulously used the vapour of hot water to the throat. The peril soon became so imminent that Mr. Hilton performed tracheotomy five days after admission.

An incision, an inch in length, was made as near the middle line as possible, and a conical curved trocar and canula thrust into the trachea about one inch and a half above the sternum. The trocar was then withdrawn, and, to prevent the canula from slipping, it was tied round the neck by a tapo. The operation was rendered somewhat difficult by the head of the patient being forcibly thrown forward on the chest.

Immediately after the opening of the trachea the dyspnoea was extreme, but in about an hour the woman became tranquil, and slept comfortably at intervals during the night. She was ordered wine and beef-tea. For five days after the operation the woman suffered considerable pain in the head and in the wound; several times she was almost choked by the cough and accumulation of mucus in the tube; but on the fifth day the pain abated considerably, and the respiration became easier. She experienced great relief by inhaling the steam from an infusion of conium.

The patient continued taking about six ounces of wine per diem, and on the XXVII.-12.