In his ordinary state of health, and when perfectly quiet, the only sensation in the affected part was that of an uncomfortable heat and itching; but on the slightest derangement of the system, and upon any extraordinary exertion, particularly when engaged in his ordinary occupations, which are those of a farmer, an intense burning and stinging sensation was produced not only in the nose itself, but extending to the surrounding integuments, and this often so insupportable as to oblige him to desist from his work, and have recourse to some cold topical application, in order to gain a temporary relief. He has gone through a great variety of treatment, continued for a number of years, but without the slightest alleviation to his sufferings. A year since he had a caustic application made to the part, which destroyed the skin for the space of one or two lines, and the subjacent cartilage, the greater portion of the disease remaining undisturbed.

"He came to Boston under these circumstances, determined to have the part removed, and the loss of substance supplied by the Taliacotian operation. At this period the nose had a very pinched appearance, the skin being of an intense red towards the tip, and having in its substance a number of hard, tubercular bodies. A slight redness extended over the ala nasi of the right side. In the centre was a depression and loss of substance, where the caustic application had been made.

"He was seen, previous to the operation, by a number of medical gentlemen well informed in the diagnosis of diseases of the skin, and the only name which could be given to this affection was that which has been already stated; though it differed materially from lupus in many particulars, especially in its long-continued freedom from ulceration, the great suffering attending it, and the absence of any affection of the mucous membrane of the nose.

"The operation was performed on the 8th of April, in presence of Dr. Salisbury, Dr. Gordon, Dr. Mifflin, and some other medical gentlemen. The disease, which extended up as far as the nasal bones, was very carefully removed, and the cartilages below, not destroyed by the caustic, found to be in a perfectly healthy state.

"The dimensions of the flap necessary to supply this loss of substance were now carefully taken, and marked out on the fore-arm. The traces were made on the radial side of the left arm, about two inches from the styloid process of the radius, and extended over to the space midway between the bones of the fore arm. This flap was dissected up, including, with the skin, the subcutaneous cellular membrane, and was secured in its new situation, in contact with the face, by means of five points of the interrupted suture, the arm being firmly fixed in this position by appropriate bandages. An elastic tube was given to the patient, to use whenever he required to take nourishment-the mouth being so covered up as to prevent food being directly introduced into it. He was placed in bed, and supported in a sitting posture by means of a common bed-chair.

"I saw him in the evening, and found him much less disturbed than could have been expected, considering the very restrained position which it was necessary for him to maintain.

"On the following day, the 9th, there was some appearance of erysipelatous inflammation on the bridge of the nose; he had been pretty quiet, and had slept a little, but required constant watching to prevent him from slipping down and doubling himself up in the bed, to which there was a constant tendency. He complained much of a want of solid support to the elbow, and for this purpose a wooden apparatus was constructed and placed across the bed, which served as a firm resting place for the arm, and enabled him to maintain more easily the proper position. The pulse was 60, and throughout the whole period of his confinement it remained below the ordinary standard. On the 10th he complained less of his arm, but was exceedingly restless. During the day he was removed to an easy chair, and the change afforded great relief.

"The state of things varied little from that already described until the 5th day, the period appointed for separating the connection between the arm and face. On this day the base of the flap was divided, and a perfect adhesion was perceived to have taken place between the parts which had been placed in apposition.

"The wound in the arm was dressed, and a small portion of the skin which projected bound down in its place by adhesive straps. The irregular portions of skin being removed, a slight compression was exercised on the edges around the nostrils, by means of small strips of adhesive plaster.

แ The arm, on being relieved from its confinement, was at first somewhat stiff, but not so painful as might have been expected, and what was not a little curious, obstinately refused to be raised up again to the position it had so long unwillingly occupied. This, in a great measure, arose from a loss of power in the flexor muscles, from want of exercise of their functions; in the course of a few days, however, it regained its healthy state of feeling and motion.

"By the 20th of April the newly transplanted skin had contracted to nearly the natural size, the line of union with the skin of the nose was perfectly lineal, all the abrupt and useless portions of skin on the lower edge of the nose had sloughed off, leaving a perfectly even and rounded edge to the nostrils.

"On the 23d I was surprised, on removing the green cot which covered the dressings, to find that the whole cuticle of the restored part had peeled off, leaving the surface quite raw and covered by the green colouring matter of the silk. This at first seemed a circumstance destined to embarrass the case and prolong the period of recovery, but in its termination proved of material benefit; a slight suppuration commenced, which brought down the skin to a natural thickness, and rounded off, in the most perfect manner, every inequality on its surface, and seemed also to melt the skin into the adjacent integuments so as almost to destroy the traces of the transverse line of union. A new cuticle rapidly formed, and by the end of the month he was quite well, and was presented at one of the meetings of the Society for Medical Improvement. The newly restored part still remains somewhat wanting in colour, but in all probability by exposure to air and sun, it will soon assume the appearance of the surrounding integuments. Even now it requires that attention should be particularly directed to the part, to show that any operation has ever been performed."

"Shortly after the above was written, the patient having exposed himself to the sun during a walk out of town, experienced considerable itching in the right ala of the nose, where, it will be remembered, there was a slight redness remaining. He came to me, very desirous to have the skin of this part at once removed, as he greatly feared that he might be troubled with it hereafter. He was also anxious that the experiment should be tried of cutting a piece of skin from the arm and immediately placing it in the wound to supply the loss of substance. Although I did not consider this part of the operation necessary, as the wound, in all probability, would have filled up by the granulating process, I yielded to his desire and made the attempt. The skin covering the ala nasi was removed so as to leave no appearance of redness remaining, and a piece of skin being immediately dissected from the fore-arm, was confined in the wound by means of lint moistened in blood, which answered a much better purpose than the common adhesive plaster.

"On removing the dressing, at the end of four days, a perfect union was found to have taken place.”

MISCELLANEOUS NOTICES.

Connecticut Medical Society.—At the last meeting of the society held on the 13th of May, 1840, Dr. Silas Fuller was elected President, Dr. E. Middlebrook, Vice President; Dr. Archibald Welch, Secretary, and Dr. Luther Ticknor, Treasurer.

Louisville Medical Institute.-The annual catalogue gives the names and addresses of 204 students, who attended this institution during the last session. At the commencement, the degree of Doctor of Medicine was conferred on 39 gentlemen; after which a few words of impressive exhortation" were given to the graduates by Judge Rowan, President of the Board of Managers; this was followed by a more extended "Doctorate Address" from Professor Drake.

In press, and shortly will be published-" History of Embalming, and of Preparations in Anatomy, Pathology, and Natural History, including an Account of a New Process of Embalming. By I. N. Gannal, Paris, 1938. Translated from the French, with notes and additions, by R. Harlan, M. D. Philadelphia, 1840.

This work contains valuable and interesting matter both for the general reader and medical student.

To a general history of the various methods adopted by different nations, for embalming the bodies of animals, is added a detailed account of anatomical preparations and injections both in a dried and fluid state. The information offered in these pages could only be obtained by referring to the works of numerous authors, some of them very expensive, and others not to be had in this country at all.

A personal acquaintance with Mr. Gannal, and a careful examination of the curious objects contained in his museum, preserved by the new process, enables the translator, to estimate at their true value, the extent and application of the discovery.

The original work consists of an octavo of 349 pages, and costs in Paris one dollar. The translation, with additions, will be sold at $1 25.

BOOKS RECEIVED.

From Dr. Welch.-Proceedings of the President and Fellows of the Connecticut Medical Society, in convention, May, 1840, with a list of the members of the society. 8vo. pp. 12. Hartford, 1840.

From Mr. Mercer, Librarian.-Annual Catalogue of the Officers, Students and Graduates of the Medical Institute of Louisville, for 1839-40. 8vo. pp. 16. Louisville, 1840.

From some other source.-The same.

From the Author.-Rhinoplastic Operations, &c. By J. Mason Warren, M. D. (See Bibliographical Notices.)

I was requested a few months ago, by Doct. Har, a very intelligent young practitioner, to visit Mr. Locker, more on account of some anomalous symptoms" than the apparent illness of the man. Locker, aged 27, strong and athletic, never having been sick, whilst engaged in the vocation of clearing his farmi, was suddenly seized with violent pain in his left side-be retired to his "log cabin," and in a few moments so violent a fit of suffocation came on as to threaten rapid extinction of life. Doct. Har was sent for, and described to me the patient's state as follows:-great and alarming dyspnoea -skin cold and shriveled-profuse leakage from the surface, with a circulation slow but almost imperceptible. The exhibition of stimulants internally and externally alleviated the danger for the time. The next day the Doctor found the left chest dull on percussion, and heard distinctly the dropping of liquid upon change of position. Locker informed the Doctor that when seized in his field he heard something crack in his chest, and then felt the trickling of fluid. On my visit four days after his seizure, we found the integuments over the anterior surface of the left chest dematous, extending to the neck-the veins of the skin full and turgid-left side one iach larger than right-intercostal spaces not obliterated-percussion dull over left chest throughout the infra-mammary region, anterior, lateral and posterior-upper portion clear and strongly manifesting the existence of air -the line of demarcation between the difference of resonance most clearly defined by the nipple. On changing the patient to the left side the fluid was distinctly heard by all in the room, indeed it could be heard four feet from the bed, giving precisely the sound of water poured out of a bottleheart occupying the right cavity immediately under the main ma-its contractions undisturbed-first and second sounds clearly heard. The left lung above the mamma giving the morbidly clear sound of pneumothoraxvesicular murmur in this portion audible-bronchial râle absent. In all the region below the mamma nullity of respiration-cough and voice slightly metallic. Right chest-clavicular region-bronchial râle-vesicular murmur distinct-respiration somewhat puerile: infra-mammary region, vesicular murmur very inaudible-slight sibilaut sound. Here we have all the physical signs of a triple lesion--the pneumothorax unequivocal and the effusion palpable-yet this man had no premonitious of disease-up to the morning of the attack he was in good health, and then only complained of a feeling of weakness until his seizure in the afternoon.

The treatment instituted and continued was hydragogue cathartics—strict

diet and perfect quietude--the metal with squills was finally given until his gums were touched; in four weeks he recovered--the heart is in situ-lungs resonant, and health perfect. I full well know that recovery from pneumothorax with empyema is questioned, and the chances are infinitely against it; but this case would show the possibility.

G. W. BOERStler.

ART. II.-NOTES ON THE EFFECTS OF IODINE, AS A REMEDY FOR CUTANEOUS ERUPTIONS.

BY DR. KENNEDY, of Ashby De-LA-ZOUCH.'

In many cases, most of them old both in standing and treatment, I have found the iodine a most efficacious remedy for those disorders of the excernent system which affect the skin, especially the vesicular and pustulous kinds. Such being my experience, I feel desirous of having the practice tested under the observation of others, with a view to its being rendered more extensively useful.

Sometimes, in mild cases and untainted constitutions, the iodine may be used internally without assistance; but, on all occasions, its external application requires to be accompanied by a course of medicines capable of acting on the skin, bowels, and kidneys, so as to improve their functions by its salutary effects.

As the nosology of these diseases must be familiarly known, it will be sufficient bere to denote in a simple enumeration such of them as have yielded to the iodine under my instructions. These, then, in Dr. Good's nomenclature, are

Exormia lichen.-For such of the lichenous rashes as prevail in this climate, the iodine should be exhibited internally with alteratives; and externally, in a tepid or warm solution.

Ex. prurigo.-For the pruriginous rashes, the external iodinated applications should possess considerable energy, and be often applied; with the internal remedies, a proportion of henbane, hemlock, or other anodyne, may be combined.

Lepidosis pityriasis. For the dandriffs and branny scales, the iodinated lotions must be regulated in strength according to the patient's age: the solution of magnesia, with carminatives, will conduce to their efficiency.

Lep. psoriasis.-The dry scales require frequent ablutions with the remedy in a vigorous form, and its powers may be assisted by a general warm bath in saline mineral water, artificially strengthened with an iodinated impregnation.

Ecphlysis pompholy.r.-The waterblebs, particularly when large, yield more readily when friction and generous tonics accompany the topical applications.

Ecph. herpes. For shingles, ringworm, and the tettery vesicles, the iodine, both in solution and ointment, applied actively, will be materially assisted by the occasional interchange of poultices and emollient embrocations, for the removal of crusts.

Ecph. rhypia.-Blains are best prevented from degenerating into sordid or gangrenous ulcers by frequent gentle excitement of the parts with iodine, and this must be carefully supported by an energetic constitutional treat

ment.

Ecph. eczema.-Heat-spots, with their clustering vesicles, resist the iodine less obstinately when it is attended by a course of cooling alteratives, and a weekly warm bath in mineral water, wherein the chlorides predominate.

'Lond. Med. Gaz., May 8, 1840, p. 260.