Extract of a letter from Mr. Bailey, of Thetford, Jan. 30, 1815.

"I was lately called to an accident which happened to a labouring man, at Croxton, a village near Thetford, who, in attending a chaff machine, worked by a horse, entangled his middle finger with the knives, by which the first phalanx was separated completely: he brought it to me, pale and nearly cold; I was willing to try how far union might be effected, and after cleansing the parts, I re-applied them accurately, and secured them by plasters and small pieces of cards by way of splints. I desired the man to call in a week's time, fully expecting to find the end of the finger mortified, but, to my astonishment, reunion had taken place; pulsation was felt at the end of the finger, and its colour was healthy; the end felt numb to him when he touched it; the nail has come away, and I have pleasure in saying, it is quite well and requires no more attendance."-London Med. and Phys. Journal, March, 1815.

MR. CARPUE is preparing for speedy publication, an account of a most interesting and fortunate operation, by which he has restored a nose to a military gentleman who had accidentally lost his original one on foreign service. Mr. C. had mentioned, in some of his lectures, the practice of Gaspar Taliacotius, the Bolognese professor, who, in the sixteenth century, published a book on the restoration of noses, lips, and ears; and also the operations of the Hindoo cast of brickmakers, by which they, for an unknown time, have restored the noses of the victims of despotic barbarism; and had stated his opinion, that the practice was rational, and not fabulous, as many persons had been led to suppose. This doctrine of so eminent a surgeon, coming to the knowledge of the gentleman above alluded to, he determined to submit to the operation, and placed himself under Mr. Carpue's care. Ours is not a medical work; we shall therefore state, in a popular way, that a plaster-model is made of a well shaped nose, which is fitted on the ruin of the former nose. The surface is then measured, by means of paper, and the paper-shape is carried to the forehead, a piece of which is marked of the very shape. This piece is then cut round by an incision, and stripped off in the manner

of a scalp, except the narrow slip, or isthmus, which joins it to the nose, through which isthmus the circulation of the entire system is to be kept up in the scalp, and the piece thereby kept alive. The scalp is turned at the isthmus, so that the cuticle of the scalp may become the cuticle of the nose. Incisions are then made in the cheek on each side the nose, and upper lip, into which the edges of the scalp are inserted, and in which it grows, hardens, and assumes a perfect shape. The nostrils are made afterwards, and the forehead heals while the nose is forming. Such has been the ingenious procedure of Mr. Carpue, and complete success has attended him. In the instance before us the patient has not had occasion to take a single dose of medicine, and has experienced no inconvenience from pain. The cuticle of the forehead is now quite restored, and the nose itself is already so well formed as scarcely to be distinguished from a natural one. It is now three months since the operation; but, in warm weather, Mr. C. is of opinion that the restoration would be completed in two months. His proposed work will inform the faculty of every particular which it is desirable should be known to those who have occasion to perform the same operation, and will be illustrated with several plates. The facts we have stated prove, that although Mr. Carpue has not the happiness to be the original discoverer of the principle which he has practised, yet he has singular merit in conducting the operation so successfully, and is entitled to his country's gratitude for introducing, with so much intelligence, a practice that will restore to society thousands who have been driven from it by their unsightly appearance. For our part, we view in the principle of reproduction, which this experiment so completely developes, new views of the animal economy leading to improvements in the practice both of surgery and medicine; and it justifies a sentiment which we have often pressed on the notice of the public, that there probably still exist, in the hands of the vulgar, meriting the attention of the most enlightened, very numerous discoveries as important as that of the cow-pox.-London Monthly Mag. June, 1815.

Observations on the Plague as it lately occurred in Malta. By A. BROOKE FAULKNER, Physician to the Forces.

[From the London Medical and Surgical Journal for April 1814.]

UPON the pathology and treatment of this most unmanageable of all diseases incident to humanity—the plague—the late experience of medical men in this island, I regret to find, contributes but little to what is already so imperfectly known on the subject. Every attempt to accommodate its phenomena to the operation of general laws, or to discover any thing approaching to a successful method of cure, either by experiment or speculation, has shared the same unfortunate fate as in all former ages.

Such detached notes as I have been enabled to collect from personal observation and practice, I shall here throw together, rather to satisfy the curiosity of my friends who have solicited the offering, than with any expectation of materially benefiting the world by their importance.

Under the disadvantage of hindrance from visiting patients in the Maltese pest-hospitals, I am necessarily precluded from communicating many facts from my own experience, which I should otherwise have been enabled to do. This privation, I have, however, attempted to make up for by conferences with some of the most intelligent practitioners in the island; the results of which, together with my own observations and reflections, it will here be my purpose to render some account of.

The plague, above every other distemper with which I am acquainted, either by reading or experience, is one of the most irregular type, modified in its symptoms and appearances to a degree surpassing all belief and every attempt to explain, apparently by difference of constitution, age, temperament, manner of life, and other constitutional peculiarities in its victims. Most usually, however, its first approaches are marked by some of the following signs: headach, sickness, debility, stupor, rigors, vertigo, vomiting (of a vitiated bilious matter); pain of the back opposite to the region of the kidney s; suffusion of the eyes; an appearance of countenance resembling that of

a person fecovering out of a severe fit of intoxication, and inability to stand upright, not unlike what occurs in that state; quick pulse; whiteness of tongue; costiveness; occasionally diarrhea. Fewer or more of these symptoms, for the most part, characterize the disorder very early after its accession. But it sometimes happens, that, without any other previous indication, globular tumours give the first alarm of its pre

sence.

Of the state of the pulse, I regret to say, I am not prepared to give any satisfactory account, as medical men were all alike absolutely interdicted from informing themselves upon the state of this function. By intelligent authorities, I have been confidently informed, that, at an advanced period of the disease, the pulse was so very much accelerated, as to render every attempt to count it almost impossible, the pulsations feeling rather to succeed each other in a continued stream than marked by any distinct intervals.

Apparently modified by the same peculiarities of constitution, &c. the character of the concomitant fever becomes extremely irregular, assuming every shade of variety from synocha down to the lowest degree of typhus; and, in some instances, having accessions of rigor, not unlike an irregular species of intermittent.

Thirst, the never-failing attendant on all other diseases which are accompanied with febrile symptoms, is not invariably present in the plague, even in the most urgent cases. In patients under excruciating distress, and at the very acmè of the disorder, I have known this symptom either wholly wanting or very moderate. The like remark holds of want of appetite. Throughout the disease, this function is not only not impaired, but augmented to a degree bordering on voracity.

The alvine evacuations are commonly of a darker appearance than natural. I have observed them of a greenish tinge, and mixed with scybala. When lumbrici accompany this state of the bowels, which is not unfrequently the case, they indicate a very unfavourable disease. The greenish colour of the stools was particularly remarkable in the patients in whom I observed voracity of appetite, and would seem to show that this symptom was occasioned by the generation of a strong acid in the stomach and primæ viæ.

It is a striking circumstance, that patients, often at the commencement of the disease, are adverse to admit of their being ill, and that they persist tenaciously in holding the same opinion, until matters proceed so far as to render any confession on the subject unnecessary.

The suddenness with which the plague attacks its victims is altogether incredible, persons being known to enjoy every appearance of good health a few minutes before its attack. The fatal termination is often not less rapid, occurring in a few hours. Certain cases, (though comparatively few,) have been protracted for a fortnight or three weeks before the patients have enjoyed any perfect exemption from danger; and, in some rare instances, after every apparent danger was survived, a phthisis or dropsy has supervened and proved fatal. This occurrence takes place, as might be expected, in persons of a very lax fibre and debilitated habit. Yet, seldom do seven days elapse, upon an average, from the first period of confinement, until the prognosis is decided with sufficient certainty.

Death very rarely follows a gradual extinction of the powers of life. In the greater number of cases it is ushered in unexpectedly by some violent delirious effort, or suddenly terminated in convulsions.

Delirium attends the plague in all its varieties and gradations, though in some cases there is no observable disturbance of the mental faculties at any time of the disease. In others this symptom is diversified from a state of the lowest insensibility to the very highest imaginable degree of excitement, resembling the fury, and accompanied with the actions of the maniac.

The state of the urine is various, being sometimes crude, at others high-coloured, and differing alike in point of quantity; but I did not see, nor could I learn, that the remission or aggravation of symptoms was indicated by any visible alteration in the appearance of this evacuation.

The accounts in circulation relative to the interval that passes from the first application of the pestilential poison until the production of the disease, are very discrepant. Whilst some persons are stated to have been attacked almost immediately after the noxious contact, others were represented to have conVOL. V. No. 20.

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