approach of death. The remedies were continued. Two days afterward, however, Dr. M'K. was gratified to find that the mortified portion of intestine had come away, and that the patient was relieved from all the threatening symptoms. In a short time after this she had a copious discharge of fæces per vaginam. The medicines were continued. She rapidly recovered, with the exception of the artificial anus. Facts of this kind are calculated to inspire hope where reason would despair.

ART. XIII. A Case of diseased Heart, in a Patient who had suffered severely from Acute Rheumatism. By DANIEL FALLOON, M.D.

THIS is one of those melancholy cases of hypertrophia or thickening of the parietes, with dilatation of the cavities of the heart, and pericardiac adhesion, which have, of late years, pressed so much on the attention of the profession. Like many of them too, it was relieved-much relieved, pro tempore, by proper plans of treatment, and when appearances were most promising, disappointed the hopes of patient and practitioner.

The subject of the present case was an industrious mechanic, 43 years of age, of regular habits, but too anxious about his family, in consequence of which he was in the habit of working at his business till one or two o'clock in the morning. He had also suffered from two most severe attacks of acute rheumatism, in .one of which he was jaundiced. His present complaint crept on slowly and insidiously, with palpitation and breathlessness, on any increased exertion, which symptoms continued to augment till at length he became dropsical. The following sketch will show the state of the case when he fell under the care of Dr. Falloon.

"He had not been in bed for the last three weeks, being unable to bear the recumbent posture from the violent action of the heart, and a feeling of impending suffocation. His slumbers were short and broken, attended with frightful dreams, from which he started as if terrified and fatigued. He was universally dropsical, and so large that his ordinary clothes would not meet on him; his face also swoln and puffed, but not livid. The whole arterial action so strong as to shake him in his chair; motion of the heart widely diffused over the chest; action of the carotids most violent. He complained much of a "croaking noise," occasionally very violent at the upper part of the sternum. Pulse very irregular, occasionally pausing,

then fluttering; it would then give two or three very strong beats in tolerably equal time, and again proceed in the same irregular and fluttering manner. The action of the heart was observed to proceed in the same irregular manner. He was much harassed with cough; breathing oppressed, but the inspirations could be made deep; appetite not very bad, but he was always worse after eating; bowels kept open by the pills; urine very scanty and highcoloured." 293.

Our author, after giving the patient some gentle opening medicine, ordered twelve ounces of blood to be taken from the arm, his food to consist chiefly of weak chicken broth, in small quantities, with a little stale bread or toast. Having borne the bleeding well, the operation was repeated for four successive days, all which he bore without inconvenience, the blood exhibiting the most decided marks of inflammation. After the third bleeding the urine became more copious, and the oedematous swellings began to subside. In short, for many months this afflicted patient's complaints were signally mitigated by bleedings, quietude, aperients, diuretics-particularly a combination of calomel, squill, digitalis, and opium, proportioned according to symptoms. His pulse became comparatively steady, being sometimes down to 58 in the minute. After various revolutions of better and worse, he died on the 29th October, 1819, nearly nine months after he first became Dr. Falloon's patient.

On dissection the lungs were found sound on both sides, but adherent to the pericardium-some fluid in each cavity -the heart adherent to the pericardium-the heart itself about thrice its natural size-all the great vessels much dilated-the parietes of the left ventricle much thickened-the auricles proportionally dilated as the ventricles-the heart, when freed from its appendages, weighing 34 ounces-traces of sub-acute inflammation observable on the inner surface of the pericardium-nothing particular in any of the other viscera.

Dr. Falloon has somewhat needlessly extended the details of this case to nearly twenty pages of letter-press. We do not think it an uninteresting case-far from it—but we believe that we have not omitted any part that was worthy of commemoration-if we except an application of leeches to the epigastrium, which relieved the tenderness there, and quieted the gastric irritability. To the readers of this Journal we need not say how often we have recommended this mode of depletion, in cardiac diseases, as preferable to venesection. The suffering organ, in these complaints, is so near the surface of the chest, that local depletion has a

marked and beneficial effect. To this measure, in conjunction with quietude, diruretics, and anti-sanguific regimen, we must almost entirely trust.

XIV. The last article which it is necessary to notice in this volume contains an account of a man to whom oxymuriate of mercury was administered, with the intention of poisoning. The case is stated succinctly by Dr. Charles Lendrick. About half a drachm of the oxymuriate had been swallowed, and was soon followed by the usual symptoms-intolerable pain and heat in the oesophagus and stomach-cold extremities-quick, feeble, and intermitting pulse. An emetic produced no good effect-but the exhibition of whites of eggs, beaten up with water, proved completely successful, and the patient was saved.

The two concluding articles of the volume are on feverone by Dr. Grattan, reviewed in the first number of this series, page 139, et seq.. The other a very able report of the Fever Hospital and House of Recovery, Cork Street, by Dr. O' Brien, which we regret our limits will not permit us to notice in this place. We hope to have some other opportunity of paying our respects to it, when the subject of fever is before us.

We have now, we hope, done justice to the third volume of these Transactions, by making known its contents through every quarter of the civilized world. Our readers will have perceived that the work maintains its own interest, and continues to sustain the character of the profession in the Sister Isle.

V.

1. A Practical Essay on Ringworm of the Scalp, Scalled Head, and the other Species of Porrigo. By SAMUEL PLUMBE, Member of the Royal College of Surgeons of London; of the Medical and Chirurgical Society, &c. One vol. 8vo. pp. 104, with two coloured plates. London,

1821.

II. On Tinea. By M. ALIBERT, Diction. des Sciences Medicales, vol. 54, pp. 43, octavo. Paris, 1821.

MUCH has been written on tinea capitis, or porrigo--and especially on that form denominated porrigo scutulata, ringworm of the scalp, scald head, and teigne granulée; but

that little has been effected in respect to a knowledge of the nature and treatment of this disgusting disease, we have (besides the evidence of our own senses) the authorities of Alibert and Bateman-the former the greatest dermologist of the present day. "Que trouve-t-on," says Alibert, "dans les auteurs touchant la nature et le caractère specifique des teignes?-Des renseignemens incertains, des dissertations vaines, des details vagues." Bateman says that this unmanageable form of porrigo often continues for several years. "Whether the circles remain red, smooth, and shining, or become dry and scurfy, the prospect of a cure is still distant -for the pustules will return, and the ulceration and scabbing will be repeated."

Most of the forms of porrigo being contagious, the disease is propagated. by means of schools, to a great extent, even among the higher classes of society; and consequently it becomes a subject of no trifling interest to the practitioner, who, being often foiled in the treatment, has sometimes the mortification of seeing the patient placed under the care of another, and not unfrequently put into the hands of a Charlatan. On this account, we shall be excused in going farther into the subject than is usual in Journals or Reviews, especially as some of the sources, whence we shall draw our information, are inaccessible to the great majority of our readers.

Mr. Plumbe, who has lately directed much attention to the disease under consideration, introduces, in the first chapter of this work, some ingenious remarks, anatomical and physiological, on the hair and integuments which it covers. It has been ascertained that the hairs have their origins completely beneath the under surface of the cutis of the scalp. The layer of adipose membrane there appears partially interwoven with the inner surface of the integument, and firmly attached also to the bulbs of the hair, which seem to be implanted therein. The hair then would seem to be independent of the cutis, as far as regards its nourishmentthe cutis, a vascular and highly sensible structure, being merely penetrated by the hair, which appears to draw its support, and also the oleaginous secretion covering it, from the adipose structure beneath.

"The fact that the scalp is pierced by the hair, and has little or no share in its production or nourishment, I am particularly desirous of pressing upon the attention of my readers. Reasoning from analogy we should be justified by this consideration only, in concluding that the latter may possess when the former is in a state of disease, all the properties of extraneous substances. As regards the common ringworm of this part, it will be uniformly found

evincing these characteristics in the mildest as well as most severe forms of the disease." 16.

Mr. Plumbe, in his 2d chapter, commences with porrigo sculutala, omitting altogether the porrigo larvalis, or crusta lactea, as not naturally belonging to this class of diseases, either as to character or cause.

1. Symptomatology. According to Mr. Plumbe, the falling off of the hair is usually the first symptom which discovers the disease. When the scalp is examined, under such circumstances, it exhibits a somewhat scurfy and slightly reddened appearance. The remaining hair of the diseased part is thin, and irregularly scattered over it; the greater portion appearing to have been broken short off near the scalp, their roots still retaining their situation. Those which remain generally drop off if friction be applied. These are the primary appearances, the achores, or minute straw-coloured pustules, not being necessary, Mr. P. thinks, to constitute the disease, as they are not seen till later, when some degree of itching and irritation of the part has been felt.

"Though the achores mentioned by different authors who have preceded me as being the most important feature of this disease, are not seen at its first commencement, they are usually soon making their appearance after the hair begins to fall off. The itching and irritation commencing at the same time, the child who is the subject of it soon ruptures a few of them, and spreading by the frequently repeated application of the nails to the spot, their contents cover the adjacent parts of the scalp, extends the disease with great rapidity upon it; the same destruction of the hair and subsequent pustulation marking its progress.

"When pustules are noticed, they are uniformly found with hairs growing through them; and if the disease has existed for a considerable length of time, and destroyed the greater part of the hair of the part, such pustules are found proportionately reduced in number; but still surrounding the few straggling hairs which remain each single minute pustule appearing to be dependent on the hair in its centre.

"If the hair, as sometimes happens, be completely eradicated from the spot where the disease first appears, the skin assumes an apparently healthy character: the disease, as regards this particular spot, may be said to have exhausted itself." 23.

That the disease when once formed on the spot spreads only to a small extent, by the application of the infectious matter, (and not from the mere communication of the specific action of the vessels of the part to those adjoining.) is,