of the neck was, however, so much swollen, that it was impossible to feel the trachea; and even the larynx itself was scarcely distinguishable by the touch. She could not swallow more than a teaspoonful of liquid at a time, and even that with extreme difficulty."

P. 182.

Seeing that suffocation was threatened, Mr. C. justly concluded that tracheotomy was the only measure to ward off death in the first instance.

"On making an external incision through the integuments below the larynx, an inch and an half in length, such a flow of blood took place as might be expected from parts in a congested and inflamed state and on continuing the incision through the fascia, I found all the parts lying on the trachea considerably swoln, and pouring out blood at each stroke of the knife. I waited near half an hour, applying sponges dipped in cold water to the part, before the hæmorrhage ceased, when I proceeded to lay bare the trachea, to which I was directed by the touch, as my sight was of little avail, from the difficulty of throwing the light of a candle into a deep and narrow wound. I, however, succeeded under these embarrassing circumstances, in making an opening into the trachea, when an immediate suffocating cough succeeded, caused by the blood finding access into that canal, and which, mixed with bubbles of air, was forcibly expelled through the wound. The bleeding now continued half an hour longer, but as it evidently came from small vessels, I had no apprehension on this account; but the circumstance sufficiently shows the congested state of the parts in front of the trachea. When the bleeding ceased, which probably extended altogether to sixteen or twenty ounces, I left my patient considerably relieved, without attempting to enlarge the wound in the trachea, or even to introduce a canula, for fear of renewing the hæmorrhage." 183.

In the morning the patient was found much amendedher breathing free, and performed principally through the glottis. This tranquil state continued through the day; but in the evening the wound had nearly closed, and little advantage was gained by Mr. Carmichael's attempts to enlarge it by means of a probe. The difficulty of breathing returned. Mr. C. was obliged to enlarge the opening in the trachea with a knife, in doing which an artery was cut that required to be tied. A canula was then introduced, and retained without difficulty, The patient now respired with case, but the most alarming symptom was her total inability to swallow even the smallest drop of liquid. She informed our author, by writing, that she was starving, and felt the most acute pain from hunger. An attempt to pass down an elastic tube through the nostril into the oesophagus failed. Enemata of broths, milk, and opium, were thrown up. She expired the next day, after being reported to have vomited up some purulent matter.

On dissection, an abscesss, containing about six ounces of purulent matter, was discovered, extending from the second or third cervical vertebra as low as the sixth or seventh, situated between the bodies of the vertebra and the posterior boundary of the oesophagus, the walls of the abscess being firm and unyielding. The vertebræ, larynx, pharynx, and œsophagus were natural, as were also the lungs. It was ascertained that the thyroid gland, which was much swelled, had been wounded in the operation, and from this source sprang the hæmorrhage.

"The practical lesson we derive from this case is of the highest importance, for if I could have been aware of the existence of the abscess, a similar puncture into it would, in all probability, have saved the patient's life. About two years since, a case somewhat similar occurred at the Richmond Hospital; a young man was admitted, greatly reduced by previous disease; it was supposed that he laboured under secondary venereal symptoms, for which he had used mercury extensively; he complained of great difficulty in swallowing, attended with stiffness and immobility of the neck; the slightest attempt to rotate the head or raise the chin, was attended with acute pain. On examining the fauces there was nothing unusual; the obstruction was lower than this situation, and opposite the larynx; but every attempt to pass a sound was attended with such extreme pain and convulsive efforts, that all exertions in this way to remove the obstruction were found unavailing. The obstruction gradually increased to such a degree, that the patient could not swallow even a drop of liquid. His respiration also became impeded and croupy, and in this state he expired, but sooner than was anticipated, and rather unexpectedly.

"On examination it was ascertained, that an abscess situated on three or four of the cervical vertebræ opposite the larynx, which were found carious, was the cause of the obstruction to the passage both of food and air, and that a simple puncture might have afforded relief from those urgent symptoms, which were the immediate cause of his death." 188.

Abscesses of this kind, Mr. C. thinks, may be indicated by the precise seat of the pain; the obstruction, in the first instance, to the passage of aliment, and afterward to the current of air; the slow progress of the inflammation compared with laryngitis; and the more rapid, when compared with stricture of the œsophagus, or of chronic tumour pressing upon that canal; the obstruction to the passage of an instrument down the oesophagus; a general swelling on the anterior part of the neck almost approaching cedema; and possibly the accession of irregular shiverings, although unobserved in the case before us.

"The existence of these, or one or more of these symptoms,

should induce an examination with the finger; or if the finger cannot reach the obstruction, a gum elastic bougie or sound should be passed, and the obstruction will point out the situation of the abscess. If we are satisfied on this head, a curved trocar, somewhat similar to that recommended by Sir E. Home for puncturing the bladder through the rectum, may then be passed, the distance at which the sound met the obstruction being previously marked upon it; and here the stilet being made to protude, may be boldly plunged into the tumour, taking care to push it towards the central line of the bodies of the vertebræ, where no danger can arise from the puncture. If matter flows, we will save the life of the patient, but if we are disappointed, no material injury, that I can conceive, will be the consequence of the attempt." 190.

If the practitioner be timorous about passing a trocar down the oesophagus, a silver catheter forced into the abscess may answer the same end, and is more safe and easy.

The cases and observations brought forward in this paper by Mr. Carmichael, are interesting and useful, reflecting great credit on their author, as an operative surgeon, and as a zealous promoter of surgical science in general.

The next paper in this volume is a very interesting" Report of the South Fever Asylum, Cork, from December, 1817, to March, 1819, by William Pickels, M.D. one of the physicians." We should have been extremely happy to have presented an analysis of this paper to our readers, but we have dedicated so very large a space in this Journal to the subject of the Irish epidemic, that we really dare not introduce it in the present instance. We can bear testimony to the merits of the article, however, and we entertain a very favourable opinion of Dr. Pickels's talent for observation, as well as his judgment in treating the epidemic which he describes.

ART. VIII. A Case of Gangrene, occasioned by the Use of Mercury. By RICHARD GRATTAN, M.D.

DR. GRATTAN deplores it as the "peculiar misfortune of our profession," that the physician cannot pronounce with certainty as to the effect of medicines. We believe this

misfortune is not so peculiar to our profession as Dr. G. seems to think. There is great uncertainty in almost all the physical operations going on in this globe. And as to the operations of moral causes, they are abundantly uncertain, as the politician, philosopher, divine, poet, and even Vol. II. No. 7. 3 Y

player, can testify! We agree with Dr. Grattan, indeed, "that we have, at best, but a faint glimpse of the truth, and that the instances in which we can decide with certainty are far inferior in number to those of which we are in a great measure ignorant." But while we acknowledge this with sorrow, we cannot approve of certain Socratic philosophers in our profession, who have lately laboured to make medicine one universal chaos of doubt, and by the same sublime and incomprehensible arguments by which they demonstrate the non-existence of a deity. Thus, if to a constipated patient you administer salts and senna, or calomel and jalap, and catharsis follows, the sceptical physician will laugh at your vulgar prejudice, in considering that as an effect which was a mere coincidence. How can you prove, he will triumphantly exclaim, that this relaxation of the bowels was not owing to the efforts of Nature or a thousand other causes than the medicine which you call a purgative? Certainly there is no answering these questions. But we believe, that if these men or this unqualified scepticism came to have any weight with the great body of practitioners, there would be an end to all progress in medicine-nay, it must infallibly cease altogether to exist. Men, however, will not, in general, be argued out of the plain evidence of their own senses by the refined speculations of these gentry, as the almost total neglect of their lucubrations pretty clearly proves.

But to return to the case before us. A girl, ten years of age, was admitted into the Fever Hospital, having been complaining for some weeks previously, but without exhibiting

The author of "LACON" has taken the liberty of casting his little bit of sarcasm, too, on the profession of physic. Speaking of physicians, he says "they have been tinkering the human constitution four thousand years, in order to cure about as many disorders. The result is, that mercury and brimstone are the only two specifics they have discovered. All the fatal maladies continue to be what they were in the days of Paracelsus, Hippocrates, and Galen.-Opprobia Medicorum."

We might retort upon the reverend author of the work cited, by asserting, with much more truth, that his brethren, the priests, bave been preaching up holiness four thousand years, and yet, according to their own confession, the people are now more wicked than ever they were! If this be not a pretty significant opprobium theologorum, we know not what is.

We are reproached by this sapient DIVINE because we cannot cure fatal diseases; but he takes not into account the millions of acute diseases which would prove fatal were it not for the assistance of medicine. We should like to see the author of the above under a smart attack of enteritis. This cobbler of souls would soon cry ont for one of the tinkers of the human Constitution."-Ed.

any well marked evidence of fever. "She became weak and languid, her appetite had declined, and her flesh had fallen away." The child, when visited, obviously laboured under febrile excitement, and appeared to be in the last stage of disease.

"The head seemed to suffer most, and from her general appearance I was led to conclude, that water either had collected in the brain, or was on the point of being effused into the ventricles. Delirium with frequent screaming, alternated with occasional intervals of stupor or heaviness, black dry tongue, pulse seldom under 130, beating of the temples, face sometimes pale and sometimes flushed, were the most prominent symptoms. A two grain pill of calomel was given, succeeded by a draught of the oleum ricini. Leeches were applied to the temples, and the head was shaved. The symptoms were not improved. The temporal artery was then opened, five ounces of blood were taken, and a blister applied to the occiput and nape. A pill, consisting of two grains each of calomel and ipecacuanha, was given twice, and sometimes thrice a day, with the exception of those days on which oil draughts were administered, so that by the end of the sixth day after admission, ten pills had been taken. The gums now became sore, and every alarming symptom disappeared." 239.

Copious ptyalism followed-gangrene took place in the cheek and the girl died.

While peculiarities of constitution are to be borne in mind, we do not think that such exceptions as the above are to at all deter us from that practice which general experience points out to be useful and safe. We agree, therefore, with Dr. Grattan, that—

"Were we to anticipate in every other case a similar result, our practice would become so vacillating and timid, that a great proportion of our patients might die through our hesitation in employing an active remedy until we had first satisfied ourselves by cautious experiment that it was not likely to prove injurious. A few exceptions ought not to preponderate against the great majority of wellestablished cases, in which a particular treatment has been safely and beneficially adopted." 242.

The species of gangrene described above is not always the consequence of mercury.* Among the children in the wards of the House of Industry, a few rare instances of a similar gangrene of the cheeks were observed, and termi

A small vesicle first appeared at the angle of the mouth, which, in a short time, assumed a black colour, and, in a few hours, increased to the size of a sixpence. It was unaccompanied by the slightest perceptible inflamma tion or pain.