tinued to take the drops: at the end of that time, she applied to me on account of what, on a cursory view, led me to imagine was the effect of mercury-extreme fetor of breath, superficial ulceration of the gums and fauces generally, with increased salivary secretion. She then made the following statement:-After the drops had been taken, with little or no inconvenience, for a fortnight, the menorrhagia gradually subsided into an offensive discharge of a muco-purulent character, which has now left her altogether; at the same time the secretion of saliva increased, and her mouth became slightly affected. Not suspecting that the soreness could be referable to the medicine, she continued its use as long as it lasted. Her mouth continuing to get worse, she then made application for further advice. In about a week or ten days she became convalescent, under the following treat ment. Magnes. sulph. Zi. ; acid. sulph. D. zi. ; aquæ, 3vj. M. partitis vicibus. Sol. soda chlor. Zi. aquæ, 3xi.; M. ft. lotio pro ore sæpe utend. Venereal Affections of Nose.-By Alex. J. Hannay, M. D., Surgeon to the Lock Hospital and the Royal Infirmary.'—I have derived much benefit in six cases of obstinate ulceration of the nose, and neighbouring parts, from the daily application of two, three, or four leeches to the gum on the upper jaw. All of these cases had assumed the inveteracy, obstinacy, and other characters, of that destructive process to which the name of lupus has been given. I had derived so much benefit in cases of venereal inflammation and its consequences from this practice, that I was induced to try it in the cases mentioned; and though they had resisted every method I had ever heard of for months, they yielded to the practice mentioned. The first applications brought relief from pain, reduced the redness and livor of surrounding parts, a gradual amelioration ensued, and, in the worst case, the cure was accomplished in forty-eight days, 140 leeches having been applied. I can, therefore, with great confidence, recommend the above practice in cases of venereal affections either of the soft parts or of the bones of the nose, and, as far as six successful cases authorize me, I would advise the same in cases of lupus. Of course, none of the measures calculated to improve the general health, or local applications likely to do good, are interfered with, and these should be diligently administered. I have been informed of one case of failure of the remedy proposed; but, before I can attach weight to it, I should wish to be quite sure that it was steadily pursued without a single day's interruption. Sincerely do I hope others may derive that benefit from the measure which has fallen to my lot. Translation of Bouillaud on the Heart-We learn that a translation of Bouillaud's valuable work on the heart is in preparation by Dr. Dubarry of the Navy. University of Maryland.-Sixty-five students attended the lectures during the last session. The degree of Doctor of Medicine was conferred on 14. We learn that our friend Professor N. R. Smith is engaged to deliver a course of lectures on surgery at this institution, before he proceeds to fulfil his engagement at the Transylvania Medical School. The session of the University of Maryland will therefore open in September; and during Dr. I Lond. Med. Gaz., May 8, 1840, p. 276. Smith's absence an additional course of lectures on surgery will be delivered by Dr. W. N. Baker. Washington University of Baltimore.-The degree of Doctor of Medicine was conferred on twenty gentlemen at the last commencement of this institution. M. Ricord.-M. Ricord, whose labours in the investigation of the venereal disease are so well known to our readers, has been passing a few days in London, which he has devoted to visiting the hospitals and other medical institutions. Sir C. Bell.'-Sir Charles Bell is in London, on his way to Rome. It has been said that he intends to vacate his Professorial chair in Edinburgh, the University not affording him the position and advantages which were anticipated on his retreat to that city. He has, however, long been anxious to visit Italy, where John Bell, after his residence in Edinburgh, spent some time in study. [In a more recent number, Sir Charles has contradicted the rumour in regard to his dissatisfaction with his present position.-ED.] BOOKS RECEIVED. From the Author.-The Salt Sulphur Springs, Monroe county, Va. By Thomas D. Mütter, M. D., Lecturer on Surgery, &c. 8vo. pp. 32. Philadelphia, 1840. (See Bibliographical Notices.) From the Author.-Rhinoplastic Operations with some remarks on the autoplastic methods usually adopted for the restoration of parts lost by accident or disease. By J. Mason Warren, M. D., (Republished from the "Boston Medical and Surgical Journal.") 8vo. pp. 28. Boston, 1840. From the Author.-An Introductory Lecture to a course on the principles and practice of surgery, delivered in the Vermont Academy of Medicine, March 12, 1840. By James Bryan, M. D., Professor of Surgery in the above Institution, Member of the Philadelphia Medical Society, &c. &c. 8vo. pp. 12. Rutland, 1840. From Professor Bryan.-Catalogue of the Trustees, Faculty, and Students of the Vermont Academy of Medicine, for the Session of March, 1840. 12mo. pp. 12. Rutland, 1840. I London Lancet, May 2, 1840, p. 206. CASE.-Jno. Keegan, ætat. 19, labourer, of an unhealthy aspect, with dark hair and eyes, and apparently of a scrofulous diathesis, was admitted into hospital, with a prominent tumour at the lower and anterior part of the abdomen on the left side immediately above Poupart's ligament. He referred the commencement of his disease to a period of two years distant: he then found himself unable to walk as well as usual, and felt a degree of uneasiness and weariness about the lumbar region, which was particularly distressing after walking, also if he remained long in the erect posture, or if, when sitting, he would rise up suddenly or incautiously. The same uneasiness was experienced in the attempt to raise any heavy weight, such as carrying a sack, &c. About this period he met with an accident in crossing a loft, by which he slipped, and as he terms it, overreached himself: this produced a temporary aggravation of his sufferings, and obliged him to confine himself to bed for some days. The weakness and uneasiness in the back continuing, he has been compelled to give up his occupation, and he has been moving about with the assistance of a crutch. About five months ago, he observed a colourless swelling about the size of an egg at the lower part of the abdomen on the left side, and refers its first appearance, somewhat nearer the region of the internal ring. Having been told that he laboured under a hernia, he was directed to wear a truss, from which he suffered much, and under the use of which a rapid increase of the swelling took place. His health has been latterly declining, he is in some measure losing flesh-feels hot and feverish towards evening, has occasionally irregular rigors, and partial perspirations-his appetite is in general good-there is some thirst, and his pulse, as far as at present can be learned, being easily excited, ranges about 90, sometimes as high as 100. The lower and anterior part of the abdomen on the left side presents a swelling of considerable magnitude, occupying the space between the os pubis and the anterior superior spine of the ilium, folding over Poupart's ligament, and ascending obliquely across the side of the umbilicus towards the lumbar region. The surface of the tumour is not uniformly even; the integuments covering it being irregularly thinned, and at these points presenting a shining and partly discoloured appearance. It is remarkably tender to the touch, particularly around the circumference, which is well defined. A most distinct fluctuation exists, and a marked impulse is given to the tumour during the act of coughing or sneezing, &c. It is very firm and tense in the erect posture, but flatter, softer, and more lax in the horizontal, is unaccompanied by any derangement of the bowels, and always retains a considerable size: when standing the body is bent forwards, and there is an incapability to raise it, at least without pain. Progression is not attended with any peculiarity, nor does he remark any disposition to trip. Examination, whilst in the horizontal position, discovers a most visible displacement in the direction as well as in the position of the second lumbar vertebra-a remarkable bony projection also exists in the situation of its transverse process, where pressure produces considerable uneasiness. Observations. Before entering into the consideration of the case above related, it may not be amiss to mention that there are two forms of abscess, named with respect to the period of their duration and attendant symptoms, and are distinguished by the terms, "Acute" and "Chronic." The "acute" abscess is exemplified by phlegmon-is attended with heat, pain, redness and swelling-has a great tendency to come on rapidly-is not large-is well circumscribed-the parts between the sac and integuments become engaged, and the parts which are engaged present a reddish or purplish appearance: besides there is this one great characteristic, that when it breaks or is opened, great relief is afforded, and it has a wonderful tendency to heal, as the cavity is soon filled with granulations, and the healing process rapidly progresses towards a cure. This is different from the "chronic" abscess, where there is little or no pain-no phlegmonous inflammation, and when examined there may be either an increased determination of blood to the part, or merely a slight degree of vascularity: the cellular membrane is engaged, and the cavity, which is organised, is endowed with arteries, veins, nerves and absorbents -the arteries designed to secrete the fluid it contains, and the absorbents to remove it, but this office of the absorbents is very rarely indeed performed. The superincumbent parts are not engaged until the disease has arrived at an advanced stage, and they preserve their natural colour, which is not the case in the acute form-the cyst of the abscess may be as thick as sole leather it is hard, firm and resistant. The abscess is inclined to affect parts remote from its original situation, as in psoas abscess, thus it has its seat in the loins, yet it often appears in the thigh; not so in the acute abscess; so that whenever a tumour is presented to the surgeon's view, as in that of Keegan, where it extends to the thigh, it is one continued sac, reaching from its original seat to the point, where it makes its external appearance. Another remarkable circumstance connected with the chronic form of abscess is, that when it breaks, it evinces no tendency to heal, but increased action supervenes, and there is an alteration in the nature of its contents. Its opening is to be dreaded, particularly in deep-seated abscesses, whether this is effected by the natural process or by surgical means. There exists also considerable difference in the nature of the fluid which the chronic and acute abscesses contain: in the chronic it is of a wheyish character, with flocculent matter floating through it—it is not of uniform consistence, but is serum with flakes of lymph; whereas in the acute form it is in general of uniform consistence, is thick, and in appearance resembles cream; this characteristic has been noticed by every author who has written on the subject. Psoas abscess, therefore, is found in every respect to deserve the name of chronic, which is evident from an investigation of the case above detailed, since he has been labouring under it for a period of two years. The first symptoms to attract attention are, an inability to walk as well as usual -weariness in the loins, where the disease is situated-great difficulty in raising up the body when stooping-great distress in the erect posture, in consequence of the interference of the disease in the action of the psoas and iliacus internus muscles-complaining of a sensation of pain in parts very remote from the true seat of the disease, as the hip, groin, knee, &c., and hence arises the difficulty in forming a diagnosis between this affection and morbus coxæ. The tightening in bending the knee sometimes exists to such a degree, that the diagnosis is extremely difficult, particularly in the early stages of the complaint. Pain in the back-want of free motion-pain, stiffness, and constriction in the side are present before there is any external mark of the disease. From the history of this case, it is found, that it is only five months since a tumour was apparent externally, and consequently that a period of one year and seven months had elapsed from the first attack of the affection until it made its external appearance, and that he laboured under it from that time. There are various directions it may pursue, previously to its bursting externally-it may either open in the lumbar region-in the layers of the abdominal muscles, or in the groin, following the direction of the tendon of the psoas magnus muscle so as to appear like a hernia: the reason of this appears to depend upon the part of the muscle, which is first attacked, or where its original seat is :-ex. gr.: if it commenced in the posterior part of the muscle, it will make its appearance in the loins; if in the lateral part, in the layers of the abdominal muscles; and if in the anterior part, it will appear in the groin: hence, its external appearance is owing to its primitive seat. Recovery from the disease may be considered to be more certain, when it shows itself near to its original situation, as it is then smaller, contains less pus, and has not engaged so many parts. The constitutional symptoms depend in a great measure upon the irritability of the patient and his original stamina: sometimes before there is any external appearance of the disease, hectic fever supervenes; at other times, not until it has manifested itself by external symptoms, when the patient is found to be subject to rigors-heat of skin and nocturnal perspirations, and the countenance becomes very pale. In the case under consideration, the fever is not fully formed, as he has not so much of an unhealthy aspect, as he is subject to agitation, when examined; his appetite moreover is good, which is not an usual symptom in hectic fever arising from lumbar abscess, for in surgical hectic there is generally no appetite, but in medical hectic, the appetite is often good to the last. If the fever does not supervene until the abscess breaks or is opened, it will be found to do so when that effect is produced, at which time the hectic symptoms are more clearly marked, the heat of the skin is very great, and the nocturnal perspirations with diarrhoea soon wear down the patient. In the case of Keegan, the fever will soon appear, as the tumour is of a large size, and there is therefore a great destruction of parts: it is not uniform even on its surface, but is prominent in two distinct places, owing to its being irregularly thinned internally by the ulcerative absorption, and if it is not opened, it will break at one of those points, where the thinning process has taken place. These tumours when in the seat of hernia are often mistaken for that disease, and it is surprising that such a mistake can occur. In the foregoing case, however, as may be learned from its history, it was mistaken for a hernia, because it was a tumour which increased by coughing; and the person, who was first consulted, ordered a truss to be applied for its relief, the pressure of which created an additional pain in the symptoms, and it is more than probable, the inequality also of the surface, by exciting the absorbents of the part where the pressure was directly applied. It might be more likely to be mistaken for a hernia, whilst in the groin, as it increases in bulk when in the erect posture, and retires when in the horizontal if pressure is employed, but returns when the pressure is removed; this is not the case in hernia-there is besides a fluctuation constantly existing-but the difference is so great and striking, that it is unnecessary to enter further into detail. It is evident that the tumour is one cyst, extending from its original seat in the loins to the groin, and if the patient is placed in the horizontal position, its external appearance may be obliterated; but in the erect pos |