of muscles even of considerable extent, when the skin over them is not divided. The operation consists in raising a fold of the skin near the tumour, and passing a long thin lancet-shaped knife under it to the left side of the swelling, which is then by a sweep of the instrument split into two portions. The instrument is then withdrawn by the same narrow aperture at which it entered, and care is taken that no air should pass along the track of the wound. The fluid which the cyst contains diffuses itself into the surrounding tissue and soon disappears, leaving, it is presumed, no chance of the relapses which are common after every other mode of treatment. The operation has been performed with success, and with no subscquent ill effect, by MM. Barthelemy, Marechal, and Malgaigne. Cure of an old dislocation of the humerus by division of the pectoralis major, latissimus dorsi, teres major, and teres minor muscles. By Professor Dieffenbach.'-Herr Th. a large landowner, upwards of thirty years old, had his right shoulder dislocated two years ago by a fall from his horse; the nature of the accident was not at first recognised, and afterwards, though all the usual means were adopted by several surgeons, the bone could not be returned to its place. The patient, therefore, came to Berlin; he was of a gaunt, powerful form, with a pale complexion and but little fat, and his muscles were strong and prominent under the skin. The injured right shoulder was an inch higher than the left; the acromion formed a sharp angle; on the outer side the shoulder was deeply hollowed, and the scapula lay flat. The right arm was thinner than the left, and stood out far from the body. The head of the humerus lay on the anterior side of the chest, close to the clavicle, and two inches from the upper portion of the sternum. The patient had a constant sensation of cold in the limb, and the creeping which he had formerly felt had ceased. The pulse in the right radial artery was rather weaker than that in the left. The limb was useless, and only the hand could perform some slight actions. By moving the arm in different directions, severe pain was produced in the part where the head lay surrounded by a thick wall of dense ligament into which it had worked itself. In drawing the arm outwards from the body, the pectoralis major, latissimus dorsi, teres major, and teres minor became tense with extreme pain. The last three of these muscles felt hard. and tense, even when the arm was not drawn outwards. An attempt to reduce such a dislocation without dividing these muscles and the new joint would have been extremely dangerous, and had been found impossible; but (says the professor) I anticipated success from the subcutaneous division of every thing that resisted me. The patient being placed on the table, with one folded sheet passed under the right axilla, and held by six assistants, another fastened round the right hand and held by six more, and a third round the upper part of the humerus held by three more (in the manner usually adopted by me in old luxations), the two first sets of assistants were ordered to pull against each other. Í next bade them make a slowly increased extension, and then stop; I then passed a small scythe-shaped knife through the skin, and divided the most tense portion of the pectoralis major close to its tendon, which yielded with a cracking sound. I then again introduced the knife at the posterior border of the axilla, and divided one after the other the latissimus dorsi, the teres major, and the teres minor. All these muscles gave way with a cracking noise, which was increased by the resonance of the chest. I next passed my knife into three places by the head of the humerus, and divided in a similar manner under the skin the dense and hard false ligaments which surrounded the new joint, and, lessening the extension, I loosened the head by a few rotations. 'Medicinische Zeitung, Dec. 18, 1839; and Br. and For. Med. Rev., April, 1840, p. A powerful extension was now again commenced on both sides, and the three assistants behind the patient pulled suddenly while I conducted the humerus towards the joint, into which it slipped on a sudden, without again springing out. One shoulder looked now just like the other. The thorax, the shoulder, and the arm were enveloped with bandages which were soaked with paste, and after a few hours they all became dry and hard, and prevented any motion of the right side. The bleeding from the wounds, which were not larger than those made in phlebotomy, was at most a few drops. No unpleasant symptoms ensued, and the patient suffered even less than the majority of persons in whom I have reduced old dislocations. On the ninth day I took off the bandage; both shoulders had exactly the same level and form, and there was neither swelling nor pain. The punctures in the axilla had completely healed, and scarcely a trace of them could be found; there was no collection of blood or pus. The arm was already capable of motion, and its actions were far less hindered than they are sometimes after the reduction of recent dislocations; because in them there is often for a long time a sensitive contraction of the unnaturally stretched muscles, while in this case the division of the resisting muscles and of the newly-formed joint not only rendered the reduction possible, but at the same tinie diminished its after consequences. The limb is now again restored to perfect utility. The professor adds, that he had lately occasion to reduce a luxation of the foot backwards of upwards of a year's standing, by dividing the tendo achillis, which forcibly drew the heel upwards. This limb also became useful again. Observations on diffuse inflammation. By Henry Kennedy, M. B.'This is an elaborate essay on a very important subject. We regret that we have only room for the conclusions which Dr. Kennedy considers as warranted by the investigation entered upon by him. They are as follow: 1. That diffuse inflammation will not attack a person in perfect health. 2. That the bad state of health preceding diffuse inflammation is powerfully caused by anxiety of mind, by great bodily fatigue, by shocks of the nervous system, by improper diet, or by any thing which has a tendency to lower the general healthy tone of the system. 3. That this deranged state of the health is shown principally in a vitiated state of the bowels. 4. That when once this unhealthy condition is established, the slightest cause is capable of inducing diffuse inflammation. 5. That venous inflammation does not necessarily cause diffuse inflammation. 6. That venesection may cause diffuse inflammation, the vein, however, remaining healthy. 7. That when venous inflammation does exist, the fever which accompanies it is more likely to be of the typhoid type than when diffuse inflammation exists alone. 8. That diffuse inflammation may attack several parts of the body in rapid succession, or it may be confined to one part, as the hip, or one organ, as the lung. 9. That pus may be poured out into the joints, serous cavities, or cellular structure, without any appearance of surrounding inflammation. 10. That, at the very onset of the attack, the free application of the actual cautery holds out a fair probability of checking the disease; but, when once formed, free and deep incisions are the only treatment on which any reliance can be placed. Dublin Journal, Jan. 1840; and Br. and For. Med. Rev. 1840, p. 578. ART. I.-CASE OF MERCURIAL PERIOSTITIS, TREATED BY THE PHYTOLACCA DECANDRA. BY J. B. JONES, M. D. Circleville, Ohio, August 1st, 1840. Professor R. Dunglison, The following case, which lately occurred in my practice, I send you an account of, thinking you may perhaps judge it worthy of a place in your valuable periodical." Yours, respectfully, JOHN B. JONES, M. D. JP, aged 24, of rather lymphatic temperament, four years ago was exposed and contracted syphilitic disease, as he supposed,-there appearing a small ulcer upon the prepuce about the size of a fourpence, of rather an indolent character. At this time he applied to a physician, who prescribed blue pill, without any benefit to the ulcer; there was nothing like indurated glands, or any discharge from the urethra; he continued the use of the pills for three months, during which time he took upwards of 400 six grain pills, still continuing to work hard on the farm. At the expiration of this time, he became much worse, with loss of appetite, feverishness, pains in his limbs, nodes on both tibiæ and cranium; he would pass from four to six nights without sleeping. At this period, a change took place in his medical attendants, who again treated him with mercurials, guaiacum, and sarsaparilla, with no apparent benefit, except when he took the small doses of calomel; he again changed his physician in hopes of a cure, and was ordered the balsam of copaiba, squills, opium, uva ursi, and mezereon, without any better success. He was visited by a fourth physician, who ordered a decoction of arctium lappa, alternated with mercurial purges and guaiacum, which relieved him somewhat; he again relapsed, when another medical attendant was sought, who, in addition, directed the acetate of morphine and the warm bath. The opiates had the effect of quieting the irritability and lulling the pain, so that he could pass the time more comfortably: this last adviser having moved away, his fourth physician was again called, with two others, who decided upon using small doses of corrosive sublimate, increased to a very considerable extent, which again relieved him somewhat. He continued to pass his time in this manner, when I visited him in company with one of his physicians in May last; he was then much emaciated; face somewhat bloated; pains in both knees and ankles; nodes on the shafts of both tibiæ; his cranium would have bid defiance to the scrutiny of a Gall or Spurzheim, so much was it deformed; appetite bad; respiration natural; skin dry and hard; urine scanty and high coloured; he was in the habit of taking large opiates to procure any alleviation of his suffering, and when the opium was withheld he would cry like a child. This case was viewed as secondary syphilis by all his medical attendants, and treated accordingly, with the result detailed above. After investigating the case from the commencement, I decided it to be periostitis from injudicious use of mercurials, to which two of my medical friends agreed. The next problem to be solved was, what could be done that had not already been done by professional men, eminent for their practical and scientific attainments? I considered this a fair case for the exhibition of the phytolacca decandra. In the first place, I withheld the opiates, and gave the extract of stramonium in grain doses, increasing it half a grain every day as long as the system would bear it, with laxatives; he continued the use of the stramonium pills for three days, when they could no longer be borne, which had the effect of breaking up the habit of taking opium. I then procured ten pounds of the recent root of the phytolacca, and boiled it in half a gallon of water, until about a quart remained. This decoction being strained, and some spirits added to prevent fermentation, I ordered a wine glassful three times a day. This agreed pretty well with the stomach; producing a prickling sensation over the whole surface, and acting slightly on the bowels. He had not taken the decoction more than two days when his appetite returned; the pains were scarcely felt; slept comfortably; he continued their use for one week, then left off for some length of time;-this and exercise on horseback have so far restored his shattered constitution, that he can walk about the farm, ride to town the distance of three miles, and is evidently convales cent. I do not think that the stramonium had any effect but to break in upon the habit of the excessive use of opium; for after its exhibition the patient continued in the same condition until the decoction had time to act:-think physicians have not given the phytolacca in sufficiently large doses. ART. II.-CASES OF HYDROPHOBIA, OR RABIES. No cases of hydrophobia had occurred in Aberdeen, or the northeast of Scotland, in the memory of any inhabitant, until the present year, (1839,) when the following cases of it made their appearance. In the month of March considerable alarm was created by a bitch which was running about through the streets, and bit a considerable number of persons; but it was ascertained that the animal had been deprived of her puppies; and her ferocity was ascribed to this as its cause. She was destroyed; but, in consequence of the excitement produced, the magistrates directed that no dog should be allowed to appear on the streets without being muzzled; and those found without the muzzle were taken to the watch-house and destroyed, or their owners fined. The muzzles used were leather straps, a part of which goes round the head of the dog an inch or two above its nose, and prevents it opening its mouth to half its usual extent, or protruding its tongue. To save the expense of a muzzle made by a saddler, many of the poor people had their dogs' heads confined by pieces of cord or tape fastened tightly round them. Those not muzzled were confined at home, being generally tied up; or were led about by their owners on the streets with a string attached to them. In consequence of the alarm, and from the measures of security which were enforced, dogs were shunned, and when met with loose, they were hunted by boys until they were irritated, and then being declared mad, they were pursued until destroyed, or got clear of their pursuers. Whether from this system of hunting and baiting them, or that they 'Edinb. Med. and Surg. Jour. April, 1840, p. 340. really were diseased, and had, as usual when affected with rabies, run them-` selves to death in obscure and unfrequented places, there can be no doubt that several dogs were found dead within a mile or two of the town, and of these some had previously been seen running wildly about the country. Many rumours went abroad of strange dogs having been observed affected with disease, and of their biting others; but nothing could be gathered of a definite nature when these reports were investigated. In the three cases following, the history of the bite is given as far as could be ascertained. The first case, as well as the third, proved fatal at the patients' own houses; the other was admitted into the Infirmary, under the charge of my colleague, Dr. Dyce, who has furnished me with the report. I leave the third case to speak for itself. I did not see the patient in life, but there is no doubt on my mind, nor I believe on that of the medical gentlemen who attended her, that it was a decided case of hydrophobia. I have nothing to offer in regard to the pathology of the disease or its treatment. I believe we are as far as ever from having any satisfactory understanding of the one, as we are from possessing means of ensuring a successful issue in the other. There are two points, however, common to two of these cases, the second and the third, that they took place in individuals of a particularly nervous temperament; and that the most careful post mortem examination in the first case, and in the second to the same extent, except that the spine was not opened, discovered to us absolutely nothing that we could connect with the previous symptoms. Could any thing be gathered, in a physiological view, from the fact that all these patients, when pressed to take fluids, demanded a spoon with which to convey them to the mouth; and that they preferred taking substances in the state of pap, for example, porridge and milk, and bread and milk, or tea with biscuit soaked in it, to either solids or fluids? In Dr. Dyce's patient, I observed, on my carrying a small white earthenware vessel with water in it towards the patient's bed, that he began to move his mouth and throat before I offered it, as if in the process already of deglutition, or rather mastication, and what he took from me was in small mouthfuls, and swallowed as if after mastication, instead of a steady draught. CASE 1.-Thomas Alison, aged 10, residing at Footdee, of a healthy appearance, and described by a most intelligent person in whose vicinity he resided, and who daily saw him, as a remarkably smart and clever but tricky boy, was bit on Friday, the 10th of May, by a dog. The dog had at one time been domesticated in the same neighbourhood, but had afterwards been taken into the country for a few miles, where he had been bitten by another strange dog, and on getting back to town on the day mentioned, had visited his old quarter. There was no reason for supposing at the time that he was diseased, and he was not previously considered vicious. A man in the building-yard, which he entered, was patting him, and the boy Alison put down his hand for the same purpose, when the dog bit him in the wrist. The boy's mother stated that he was much alarmed from the bite, and that, since that time, he has been often disturbed in his sleep, rather fretful, and not as usual amongst the rest of the children. She washed the wound with spirits, and applied poultices. On the 21st May, he went into the harbour in a boat, and losing his oar, became very much excited, and screamed until some persons went out to his assistance, and brought him ashore. But, residing close to the harbour, he was much accustomed to boating in it, and his mother stated that his situation would formerly have been in no way alarming to him. On Wednesday, the 29th May, she observed that he was unusually dull and inclined to sit by the fire. She thought his stomach was disordered, and gave him of her own accord a calomel powder, and on the following morning a dose of senna infusion. On this day, Thursday, the 30th, he was first observed to have spasms. On Friday, at seven in the morning, Dr. Cuddie was sent for, and informed that the boy had hydro |