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15. Sarcocele. M. Maunoir of Geneva has recently recommended to the surgical profession a mode of treating sarcocele, without extirpation of the testicle. This consists in cutting off the main current of blood from the organ, by tying the spermatic arteries. He recommends these vessels to be tied close up to the ring, so as to interrupt the circulation through as many of the small branches as possible. Previous to an operation, however, it is necessary to distinguish sarcocele from medullary fungus of the testicle, with which, he thinks, it is too often confounded.

"In sarcocele," says he, "the tumour is generally more uniform, and more firm; its volume does not exceed twice or thrice that of the healthy testicle; the spermatic cord remains unaffected. In the medullary fungus of the testicle, the organ usually acquires a more considerable size; the body of the testicle and the epididymis becomes soft, and affords a deceptive sensation of fluctuation, which has sometimes caused the case to be mistaken for hydrocele. If the disease is far advanced, the scrotum changes colour, becomes livid, and at length ulcerates. When this happens, the chord commonly participates in the tumefaction, and in the deceptive fluctuation above mentioned. The swelling of the chord continues even up to the abdominal ring, and the abdomen cannot be pressed without causing great pain in the loins." Foreign Journal, p. 560.

In one,

M. Maunoir put this proposal to the test in two cases. the spermatic artery was tied on the 8th of June, 1820, and divided below the ligature. By the 4th July, an evident diminution had taken place in the tumour. On the 20th August the patient quitted the hospital, his testicle being without pain, and not larger than the sound one. Hydrocele was combined with enlargement of the testicle in this case, and the water had been twelve times evacuated, but still returned. The pain ceased the moment the artery was divided, and the hydrocele was radically cured. The suggestion deserves some attention from our surgical brethren.

16. Dislocation of the Patella.* September, 1821. "A coal-heaver fell down so as to allow both the fore and hinder wheels of an empty coal-wagon to pass over his right knee, in a direction from the inner to the outer side of the joint. He was immediately brought to St. Bartholomew Hospital. The patella rested perpendicularly on its internal edge, and its external edge was inclined directly forwards, so that its upper surface was turned inwards, and its under or articular surface outwards; in the same way as the extended hand might rest on its ulnar edge, instead of its palm. I speak of the horizontal position of the body. The bone was placed so nearly in a perpendicular direction, that it was not easy at first to ascertain which was its upper, and which its under or articular surface, but this was distinguished by comparison with the superior surface of

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Mr. Wheeler, Quarterly Journal of Foreign Medicine, No. 12.

the opposite patella. The insertion of the vastus externus into the external edge was the only tendinous attachment which was much stretched. I reduced the dislocation suddenly, but with some difficulty, by bending the thigh very much on the pelvis, drawing downwards the flexor muscles as much as possible, and by forcibly raising the bone at the same time that I turned it in its natural direction. Some inflammation in the joint followed, but was arrested by the usual means." 563.

The following case related by M. Combette, in the JOURNAL GENERALE DE MEDECINE, may be here introduced with propriety.

M. C. thirty years old, dislocated his patella in wrestling by a mo.. tion which he could not describe. There was a projection of the knee; the leg was permanently extended. The patella rested completely on its edge, its articular surface being turned outward. The internal half of its cirumference was fixed in the articular groove; formed by the elevation of the sides of the anterior part of the, condyles of the femur.

"Reduction.-An assistant raised the thigh, and with one hand M. Combette bent the leg on the thigh, while, with the other, he turned the patella from within outward. The reduction was effected in an instant, and was followed by slight swelling and weakness. Six months afterward, in dancing, the same accident happened in a less complete degree; for the patient was able to replace the bone himself. The joint is perfectly well formed." 563.

17. Arteritis and Phlebitis. Dr. S. Sprengel relates the following curious and interesting case of inflammation of veins and arteries from a wound, in the Journal Complementaire des Sciences Medicales: "A young man, lately embarked in the military service, was sent to the hospital for a wound in the right-hand, which he said was accidentally produced by a hatchet, but which was very evidently the result of design. Be that as it may, the wound was properly dressed, and every thing went on well for the first two days; but in the evening of the second day, a violent symptomatic fever was kindled, which, though mitigated for a time by a copious bleeding, came on again with more intensity than ever, accompanied by gastric symptoms. An emetic relieved the latter. The wound now suppurated kindly, and on the fifth day there was every appearance of a speedy cure. His companions at this time persuaded him that he would be severely punished for the attempt at maiming himself, which, joined to the chagrin of being disappointed in his hopes of discharge from the military service, threw him into a low nervous fever, while an erysipelatous inflammation began to spread over the back of the wounded hand, and from that up the arm, in the direction of the great vessels. The fever now assumed the typhoid form, although the wound itself preserved a healthy appearance, and never ceased to discharge good pus. An abscess formed on the wrist and

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was opened, when a great quantity of serosanguineous pus was discharged. On the 18th November, a great hemorrhage took place from the wound, without any apparent cause. This was soon stopped. The process of suppuration was now arrested, and the wound looked dry and shrivelled. The patient died on the 20th November, eighteen days from the infliction of the wound.

Dissection. Nothing remarkable in any of the splanchnic cavities. Sinuses and abscesses were found along the arm. The sheath of the radial nerve was a little inflamed, the radial and ulnar arteries, from the wrist to the middle of the fore-arm being filled with pus. The lining coat of these vessels was thickened, corroded, and covered with coagulable lymph. The brachial, axillary, and subclavian arteries were sound. The veins, on the lower part of the fore-arm, presented the same phlogosed appearances as the arteries. On the clavicle an abscess was found filled with ichorous pus, the bone being denuded of its periosteum, and carious. Yet there was no affection of the vessels in the vicinity of this abscess. No other morbid appearance was found in any part of the body."

The above case offers a good example of the effects of moral emotions over the physical structure of our frames,

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18. Ruptured Perineum, &c. in Parturition. ward accident, and will sometimes occur where the ablest accoucheurs are employed. In our own practice, these ruptures always happened where the perineum was well supported, and we never recollect seeing an instance of it where women were delivered before the arrival of the doctor, (no uncommon incident,) and consequently where the perineum was left to its fate. We do not therefore agree with M. Montain, that the accident is invariably owing to neglect in the accoucheur. Some authors employ the suture, others leave the process of reparation to Nature. But to the case before us, The labour had been a laborious one, and turning was necessary. A month after delivery our author found the woman under fever, with a fetid discharge from the vagina, the latter being found filled with faces, the fourchet, perineum, sphincter, and rectum torn, and forming a great and terrible wound, confounding the two passages. The wound presented no appearances of commencing cicatrization. Suture was therefore determined on, and the needle passed pretty deep, probably including a portion of vagina. One stitch only was employed, and was found sufficient to keep the sides of the wound in contact for a considerable space. To facilitate the discharge from both passages, an elastic gum tube was placed in each, and the thighs brought together, while the patient was ordered to lie on her side, All discharges were carefully washed from the parts, and an amend

Reyne Medicate, M. Montain,

ment soon appeared. The fever subsided, and on the 8th day the compresses were removed. Two days afterward the ligature was also removed, the cicatrization being complete. In a month the patient was considered as perfectly well.

19. A Sketch of Congestive Fever-drawn nearly two centuries ago.

"Sæpo vero medici decipiuntur a putridarum febrium miti ac leni calore in cute observato. Etenim cum natura opprimitur ac fere humorum multitudine suffocatur, quo color nativus alioquin ardens, sese exinde intus contineat, nec foras moveatur, partes corporis exteriores parum calent. Has febres aliqui fumantes magis quam suffocantes appellant, quod in ipsis non flamma, seu ardor calorve, foras per cutis meatus moveatur, sed fumida potius neque ita urens exhalatio, seu fumus, uti in igne lignorum viridium vel temere congestorum copia obruto, et suffocato pro flamma fumum excitari observamus, aut ubi ita natura deficit, ut nisi ex putrefactis succis calor accensus non multus sit; neque ad cutem copiose perveniat."Prosper Alpinus, de Prasagienda Vita et Morte grot. Cap. xiv.

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Repente mutari ad frigidum corpora, nisi accessione id fiat; semper malum :-denique maligni humoris viscus nobile lacessentis, vel vehementis inflammationis actione intus totum collectum esse significat:" Et hinc est quod in morbo summe maligno hujusmodi mutationes, Galen in Prorrhet. dixit esse lethales, easque extinctione naturalis caliditatis fieri.' Pulsus summe inæqualis, prælanquidique contracti. Resolutum conjicimus, si prius resolutionis aliqua causa præcesserit, uti febris vehemens, assidua, vigiliæ item assiduæ dolores ingentes, immodicæque vacuones cum sanguinis tum humorum.". Prosp. A. Ch. xvi.

What Prosper Alpinus faintly sketched, Drs. Jackson and Arm, strong have now distinctly painted. P.

From the great length of several of the analytical articles in this number of the Journal, our PERISCOPE has been somewhat less copious than we intended, notwithstanding the exertion which we have made in compressing the matter and setting it in small type. In this, as in every other number of the Journal, (except No. 1,) we have considerably exceeded the regular limits of the work-often at the extra expense of ten or fifteen pounds sterling. The liberal, we might perhaps say, unprecedented encouragement which the Journal has experienced from the professional public, demands a suitable return. on ours; and we venture to affirm, that no labour or expense will be spared in rendering the work equivalent to the object for which it was instituted the more uniform diffusion of pro. fessional information through all classes of medical society.

XIV.

EXTRA LIMITES.

Dr. Reeder's Reply to the Review of his Work in the 6th Number of this Journal.

I think it proper to observe, regarding what was advanced relative to my Treatise on Diseases of the Heart in the last number of the Medico-Chirurgical Journal, that I consider the review of it imperfect, the analytical account garbled, and the critical remarks illiberal and unjustifiable in their whole tenor. It will obviously appear to every one who has merely glanced over the work, that the review of it is extremely imperfect: in it, for example, there are first a few vague observations on that part of the performance which treats on Inflammation of the Heart; next occur a few cursory remarks on Angina Pectoris, but no mention whatever is made of the views I have taken of that disease, in regard to its various causes, diagnosis, nature, &c. which altogether are very different from those of any preceding writer. The other divisions of the work are also passed over in a manner equally slight. The analytical account, too, is entirely garbled, inasmuch as the annotations are made upon the most unimportant parts of the treatise, and are also calculated to misrepresent. And the illiberal nature of the critical remarks is evinced from beginning to end, in proof of which it may suffice to mention, that because a little h for a great one, and a small g for a large one, (in situations of no importance, and in which their use is sanctioned by the authority of many of the best modern writers) were not considered typographical errors, sufficiently momentous to claim a place in the table of errata, yet they must be deemed worthy of two distinct commentaries not less disingenuous than sarcastic. In the review, moreover, scarcely one word is mentioned respecting the diagnostic part of the work, which sets forth the methods by which the various diseases of the heart may be discriminated, and especially affections of an organic from those of a sympathetic nature, and all which is original, for such I believe had never been attempted in a similar manner. I am perfectly indifferent as to what term the reviewers may bestow upon the volume, whether that of "compilation" or any other name; yet it is such an one as contains a fair proportion of original matter, deduced from personal observation. I am willing to believe too, that it comprizes a larger number of facts in less compass, or in a more condensed and methodical form, than most books that have been published on Diseases of the Heart; and that it comprehends what has been made known, on that subject, in this country, and also a considerable proportion of the really use

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