many cases this method has been tried; for we cannot but suspect that it would prove very dangerous, if generally used. Division of the vein with a valvular wound of the integument is surely no violent injury to the vessel, and yet it is occasionally followed by fatal inflammation; the ligature is notoriously so dangerous, as now to be almost universally abandoned; and excision is almost as much to be dreaded as the ligature. Looking at these facts, we dislike Mr. Mayo's proposal; because the inflammation excited by the caustic may, indeed positively must, be more severe than that which results from either division, excision or the ligature. In many of the cases, we are told that the vessel is seen to slough in all, it must inflame, and that pretty sharply. Perhaps it may be said, the plan has been tried with success in a certain number of cases: but the argument is good for nothing, for so was that worst of the other operations, the ligature. Sir Astley Cooper had run through a considerable part of his professional carcer before he met with one fatal case; but then they came crowding upon him, and induced him to declare, that he himself would rather have a ligature placed on his femoral artery, than upon his saphena vein. Sir Everard Home, we believe, had performed the operation some thirty times before any serious accident occurred, and an eminent surgeon, who, how ever, has wisely abandoned it, declared to us that he often had employed the ligature, and never, in his own practice, witnessed a bad result.

The testimony, or solitary experience, of any one man, in forming an estimate of the safety or danger of these operations on the viens, is positively dust in the balance. A surgeon may go on tying, or dividing, or cauterising, with impunity, till, at length, the day of reckoning arrives, and the death of his patient warns him, when too late, of his mischievous error. The general sense of the profession seems to be, to operate as little on the viens as possible; for, even when we do no harm, we do but little good, and the risk is out of all proportion to the benefit. If one venous trunk is choked up or destroyed, others rise, like the heads of the hydra, in its place, and, having placed the life of the patient in jeopardy, the surgeon too often discovers that, at last, he

must trust to what he should have trusted to at first, compression and palliative meas

ures.

DIAGNOSTIC SYMPTOMS OF DISLOCATION OF THE HEAD OF THE FEMUR INTO THE ISCHIATIC NOTCH. By Dr. BUCHANAN.*

Sir Astley Cooper has observed, that "of all the dislocations of the thigh, this is the most difficult to detect, because the length of the limb is but little altered, and the change in the position of the knee and foot is not so marked as in the dislocation upwards." The symptoms which Sir Astley details as diagnostic are the following.

"The limb is from half an inch to one inch shorter than the sound one, but rarely more than half an inch. The natural projection formed by the trochanter major is diminished, and is inclined towards the acetabulum, but still remains at right angles with the ilium. The head of the bone can only be felt in very thin persons, and then not very distinctly. The knee and foot are turned inwards, and the great toe rests against the ball of the great toe of the sound limb. When the patient is erect, the toe touches the ground, but the heel does not quite reach it, and the knee is bent, and projects a little forwards. The motions of the joint are, in a great degree, prevented, admitting of but slight flexion and rotation."

These symptoms, Dr. Buchanan considers as characteristic of dislocation, when it actually exists, but simulated so far by other affections of the joint, as to lead to error when adopted in every instance, as our guide. A truly diagnostic sign, then, being wanted, the author of the paper believes that he has found it, and proceeds to make it known. In the Summer of 1821, a young woman was brought into the Glasgow Infirmary, after falling from a height, a good deal bruised and affected, soon afterwards, with paralysis of the right leg. These symptoms had nearly disappeared when Dr. Buchanan first saw the case, but others

*Glasgow Medical Journal, No. IV.

were present closely corresponding with those laid down by Sir Astley Cooper, as marking dislocation into the ischiatic notch; an accident which was thought to have happened to the patient. Gradually, however, the limb re-assumed its natural aspect, and showed that the doctors had been taken in.

"In reflecting on the preceding case, it occurred to me, that it would be of much importance in supposed cases of dislocation into the ischiatic notch, to institute a comparison of the limbs, not while resting in the same plane with the body, but when bent to a right angle with the abdomen; the reason of which must be sufficiently apparent, from considering the anatomy of the joint, and the nature of the injury. The head of the femur being thrown almost directly backwards, and very little upward, it is clear, that so long as the limbs remain in the plane of the body, there can be very little difference in their relative length; since that difference is only measured by the extent of the displacement upwards. But if the limbs be slowly bent towards the abdomen, the difference in their length must become greater and greater, till it attain a maximum, when the limbs are at right angles with the body; the luxated limb being then shortened by the whole extent of the dislocation backward. I had no opportunity of verifying this reasoning by actual observation, till the occurrence of the following case, in 1826, and I had then the satisfaction to find, that the mode of examination described above, yielded the only symptoms, which were perfectly unequivocal."

A child, three years of age, fell from a chair, and when seen by Dr. B. six days after the accident, presented the following appearance. The girl could not walk nor stand without assistance, but, when supported by her mother on the sound limb, the toes alone of the other touched the ground, were a little turned in, and rested in the same transverse line with the metatarsal bones of the opposite foot. The knee was considerably bent, and advanced before its fellow; the shortening of the limb, if any existed, could not have been considerable; the thigh could be bent towards the abdomen with facility, and seemingly with

out producing much pain, whilst abduction and rotation were not only painful, but comparatively difficult; the head of the femur could not be discovered; the trochanter was little displaced; the contour of the haunch not materially altered; and, lastly, the limb altogether had more the appearance of being drawn up by a voluntary effort, than of being actually shortened by displacement. These symptoms were dubious, but uncertainty vanished the instant the patient was placed upon her back upon a table, and both thighs bent to a right angle with the trunk of the body. The shortening immediately became most decided, the affected knee, resting in the hollow below the The trocondyles of the opposite limb. chanter, also, was felt much farther back than on the sound side.

Dr. Watson, Dr. Young, and Dr. Auchincloss, being also satisfied of the nature of the accident, the reduction was effected next day, by placing the patient in a sitting position on a table, to which she was fastened down by a sheet, and secured by a man standing astride it behind her-performing extension by a bandage round the ancle and lifting the head of the femur over the edge of the acetabulum, by means of a handkerchief passed under the thigh. The reduction took place with an audible snap.

This mode of examination, our author considers applicable to dislocation into the foramen ovale, but there is just this slight objection which strikes us, namely, that one of the distinguishing marks of these dislocations is the immobility, at any rate impaired mobility, of the limb. In the dislocation into the ischiatic notch, Sir Astley Cooper expressly states, that the thigh admits of but "slight flexion and rotation," and when the displacement is into the foramen ovale, we should think the want of motion would be greater still. In some cases, however, the one for example detailed by Dr. B., the limb was so mobile, as to admit of the application of the test, and, in such, it may prove a valuable addition to our diagnostic marks. In cases of contusion, or inflammation of the joint, simulating dislocation, such an examination seems perfectly applicable.

LIX.

PERIODICAL VINO-MANIA.

If the "March of Intellect, the Catholic Rent, or the thirst for political freedom, has not refined the tastes of the Hibernian peasantry, there may be occasionally seen among them a periodical disease, which has not yet found a place in any system of nosology. We shall call it the WHISKEYFEVER, on the authority of Dr. Bostock, who designates one of our English annuals, the HAY-FEVER. The disease, or rather disorder to which we allude, is not habitual intemperance, but an ardent paroxysm of whiskey-drinking, lasting from two or three days to as many weeks; in which, drinking and sleeping, enlivened by an Occasional song or a fight, constitute the whole of the phenomena during the paroxysm. This over, the patient comes out of his fever with unenviable feelings of mental remorse and corporeal misery, (not much alleviated by the reproaches of his wife or connexions) during which period, he generally takes an oath not to touch the CREATURE for a year and a day. The oath is strictly kept; but the 366th day is scarcely closed, when a paroysm of the whiskey-fever makes its approach in the shape of a hearty pre-determination

to

"Tak a right gude willy-waught,

"For Auld Lang Syne."

It is probable, however, that, were Goldsmith to revisit his Native Village now, he would have to deplore the decadence of another of those good old customs which annually enlivened the heart of the rustic peasant.

"These were his joys, but all these joys are fled."

The whiskey-fever of the Irish peasant was brought to our recollection by the narrative of a case of periodical Vinomania, in the JOURNAL DE PROGRES, and to which is given the appellation "IvRESSE INVOLONTAIRE PERIODIQUE." The individual was a very eminent book-bind

er,

of Madrid, who, in consequence of some domestic chagrins, quitted the capital, and settle in Valentia. There he got married again, and carried on his business with much reputation, during the intervals

of his malady. This disorder commenced fifteen years ago, in the shape of an irresistible impulse to swallow wine, day and night, without the possibility of satiety. The paroxysm lasts, usually, from two to three months, with an interval of equal duration, when it returns again, without any prodrome that might intimate its approach. In the intervals, he seems to recollect nothing of the paroxysm--never speaks of the transactions, and either will not, or cannot give any information respecting his feelings on these occasions. The narrator, M. Pierquin, who has watched him for some years, has noted the following particulars. When the vinomania occurs, the man gets up at five or six o'clock in the morning, rifles the TILL of the counter of its contents, repairs to the nearest tavern, and there ingurgitates wine at a tremendous rate, till 10 or 11 o'clock, when he staggers home, goes down to his cellar, brings up some large bottles of wine, and drinks day and night -seldom sleeping, and very rarely eating any food. During the early period of the attack, be usually goes out now and then to the cabaret; but during the last 18 or 20 days of the fit, he never stirs from home. He is then taciturn, choleric, and scolds his wife-avoids the light, and skulks into the darkest recesses of the kitchen where he drinks and grumbles from morning till night. Notwitstanding his ebullitions of temper, he is never delirious or deranged in his intellects, on these occasions; bnt answers correctly, and follows the chain of a discourse, when he can be brought into conversation. The paroxysm ends in a profound sleep, from which he awakes in his sober senses, and resumes his avocations as if he had just quitted them the preceding evening--apparently unconscious of any thing that had passed.

The above is, of course, a very different affection from the periodical WHISKEYFEVER of honest Pat. It bears some analogy to somnambulism, and though the nar. rator avers that there is no proof of mental aberration present in the paroxysm, yet we cannot help viewing it as one of the anomalous forms of mental derangement. The narrator informs us, that he has lately seen the individual alluded to. The com

plaint has now lasted upwards of 15 years, with little alteration in itself, though the sufferer is melancholy, fond of solitude, evincing an increasing degree of hebetude. -Journal de Progrés.

LX.

ISCHURIA RENALIS. DR. BROWN.

This is a formidable complaint at all times. There is probably no excretion which will not bear to be suspended with less inconvenience or danger than the urinary. The following case, which we shall abridge, is interesting, as shewing that Ischuria renalis, even in aged persons, is not always a fatal symptom. It is published in Dr. Brown's recent Essays.

Mr. aged 73, was attacked on the morning of the 8th of Jan. 1827, with severe pain in the left Iliac region, which recurred at intervals till the 11th, when Dr. B. saw the patient. He had made no water during that time. Blood, exhibiting a strong fibrinous coat, had been drawn by the surgeon in attendance, and the bowels bad been freely acted on. There was no pain-no tenderness on pressure over the region of the kidneys-pulse 74, and full. The catheter was introduced, but no urine found in the bladder. Twenty ounces of sizy blood were drawn from the arm-and a catheter was administered. 12. The same state precisely. No urine discharged--none in the bladder. During last night the patient had a severe paroxysm of pain in the direction of the left ureter. Has thirst, and a salt taste in the mouth. Bowels torpid. Another cathartic. 13th. The patient had severe pain in the iliac regions during the night, General state the same as before. pearance of urine. Bowels open. Calomel and squills exhibited. Blister to the loins. 14th. No change. A turpentine injection (which had been given before) to be repeated. At three o'clock this day, there was a mercurial fetor perceived on the breath-and soon afterwards he discharged about four ounces of water. The mercurial and squills to be continued. 15th. Discharged upwards of five pints of water in the last 24 hours. The mouth a good deal affected by the mercury. progress of the cure was, from this time, uninterrupted.

No ap

The

Remarks. We agree with the highly talented narrator of this case, that the disease was a suspension of the urinary secretion, and not a retention of it in the pelvis of the kidneys. We coincide with Dr. Brown on another point, and that a

practical one-namely, that, "the simultaneous occurrence of mercurial fetor on the breath, and restoration of urinary secretion furnished presumptive evidence of the mineral having been beneficial.”

Whether the cause of the suspension of secretion was inflammation of the kidneys (as Dr. Brown thinks) we shall not presume to determine. The sizy state of the blood, and the pain which was occasionally evinced in the regions of the kidneys and direction of the ureters give sanction to the opinion; but the discharge of 5 pints of "clear pale fluid," on the first restoration of secretion, is not very characteristic of renal inflammation. The practice pursued in this case, is highly deserv ing of attention. In the same Essay, there are some other cases, and a dissection, to which we would strongly invite our brethSir Henry Halford, in his very interesting paper on the above subject, has limited to three days the period during which the function of the kidneys can be completely suspended without fatality In one of Dr. Brown's cases the secretion was suspended for six days and six hoursand in another, for eleven days—yet did the patients recover.

ren.

LXI.

QUACK MEDICINES.

"They manage these things better in France "

The above epigraph, from Sterne, being in the present tense, is applicable; but it would not have been available three months ago. In the eleventh and thirteenth years of the republic, "one and indivisible," the most severe prohibitory laws against quack medicines and secret nostrums were enacted in France, and apothecaries (pharmaciens) corresponding with our chemists and druggists, were strictly forbidden to keep, sell, or dispense, any medicine not contained in the Pharmacopoeia, or prescribed by a regular physician or surgeon. These wise laws either fell into total disuse--or probably were never put in force; and, up to the autumn of 1828, the trade of quack-medicine vending was full as flourishing in Paris as in London. We believe that the French Government, how

ever, derived but little revenue from the sale of patent medicines and their advertisements; hence probably one cause of the recent revival of the revolutionary edicts against the trade of quackery. The prefect of police has now given a deathblow to the Eadys, the Jordans, the Solomons, &c. of Paris, by prohibting the sale of their invaluable specifics-and not merely the sale, but even the mention of them (by way of advertisement) under the penalty of fine and imprisonment! We hope-or at least we expect, that no such tyrannical laws shall be imported into this country. It would evidently be an infringement on his liberties, as settled by Magna Charta and the glorious revolution, if JOHN BULL were to be prohibited from poisoning himself or his neighbour, in the way of trade-and when no malice prepense as to murder or suicide, could be proved. When, indeed, we consider that both the vendor and the swallower of a patent medicine are entirely ignorant of the nature of the drug and of the disease for which it is taken, nothing can be more innocent than the whole transaction. In such cases, the intention is every thing, and the event nothing. Besides, who is unaware that there is a destiny hanging over us all, from which we cannot escape? If a sparrow falls not to the ground without the permission of Providence, neither does a man. In physic, as well as in war, every bolus and every bullet has its billet-and to that billet it will go in spite of all laws and ordonnances.

Our Government takes a more philosophic and liberal view of the subject of quackery and quack medicines than the governments of the Continent. It is well aware that there is a redundant population in this country-that redundancy leads to penury-penury to crime-crime to transportation-and transportation to a heavy expense. Now, Mr. Malthus has not pointed out a more efficient check to redundancy of population, than quackery and quack medicines--and we maintain, without fear of contradiction, that this salutary check is, of all others, the least shocking to our feelings. It is, in short, a gilded pill, by means of which the KING of TERRORS is made to approach in the attractive shape of the Goddess HYGEIA!

It is disagreeable to descend from these sublime and comprehensive views of an important subject in political economy to the mercenary consideration of the effects of quackery and quack medicines on the

interests of the medical profession. There is a general opinion afloat that quackery and domestic medicine only make serious work for the regular practitioner. Serious it often is! The time for active, and con sequently for effectual treatment, in acute diseases, is very frequently absorbed in the application of domestic or patent medicines, and the practitioner is called in when the resources of art are unavailing. It is hardly necessary to remark that the doctor's revenue is derived from the living, and not from the dead. On the other hand, where disorders are so mild that NATURE Overcomes both them and the unsuitable treatment by the patent nostrum or family medicine-chest, the regular practitioner is still a loser. But

"All partial ill is universal good;"

And therefore we cannot but applaud and admire the philanthropy as well as the philosophy of our Government, in fostering and protecting quack and patent medicines, as engines that roll great revenue into the public exchequer, while they disencumber the community of many thousand unproductive members annually, by translating them to other and better climes than Australia or Canada.

LXII.

AMPUTATION OF FUNGUS HEMATODES OF THE BREAST.

In the Midland Reporter, Mr. Fletcher, surgeon to the Gloucester Infirmary, has published a case of fungus hæmatodes of the breast, which he lately removed by amputation.

The patient was a married lady, aged 35, who consulted Mr. F. in October, 1827, with a tumour in the breast, of considerable size. She had first perceived it, when the size of a walnut, ten years before, but it gave her no pain, and did not perceptibly increase, till the Spring of the year 1825, when she weaned her second child. The tumour was the seat of duli heavy pain, and was subject to periodical attacks of inflammation, when the axillary glands became temporarily swollen. Mr.