it capable of doing so) and yet the inflammation might be cured, and the traces of it in the lungs obliterated, while the tubercles remained. It is remarked by the author, that had he been then acquainted with auscultation and percussion, he would not have fallen into the false diagnosis above mentioned. The treatment might not indeed have been more successful ; but it would have been more rational.

Case 2.-CHRONIC PERITONITIS-PULMONARY EXCAVATION. Dr. , was consulted in the case of a young gentleman aged 14 years, who had, for several weeks been affected with pain and tenderness of the abdomen, particularly low down, the bowels being irregular-pulse quick and hardtongue morbidly red-progressive emaciation-high coloured urine-abdomen fuller than natural, as well as tender, but without fluctuation-ankles oedematous in the evening. No pectoral symptoms had been complained of. He breathed free, and ascended stairs without inconvenience. The abdominal symptoms, in this case, engrossed the reporter's attention, and he attributed them to disease of the mesentery combined with chronic peritonitis. Leeches were applied every third day-a large blister was next put over the abdomen, and the diet was regulated. By these means the symptoms were mitigated-the pain, tenderness, and tension, being much relieved; but the young gentleman did not improve in other respects -the weakness and emaciation progressively increasing. Evening fever came on, with morning perspirations, and he died in six weeks. He never coughed, nor exhibited any symptoms that would lead to suspicion of pulmonary disease.

Dissection. "Abdomen.-On opening this cavity, the Intestines were found generally adhering together, and to the Peritoneal Lining of the Abdominal Muscles. There was not discovered any serous effusion, and the adhesions did not appear to be of very recent origin. In several parts of the Peritonæum, small Tuberculous Depositions were seen, more particularly on the surface of the Serous Membrane, which covers the Liver. The Liver was paler than natural, and enlarged. Some of the Mesenteric Glands were enlarged, but none of them to

any remarkable degree. The Stomach was healthy; nothing worthy of notice appeared in the Mucous Membrane. The Mucous Membrane of the small and large intestines was not diseased, excepting that lining the Cæcum, which was in some degree thickened.

"Thorax.-The Mucous Membrane lining the Larynx, Trachea, and Bronchia, was free from disease. There was softened Tuberculous Matter in the left Bronchus. The right cavity of the Thorax contained a small quantity of serous fluid, but there were no adhesions of the Pleura. The Cellular Membrane of the right Lung shewed no mark of inflammatory action. It had lost none of its usual elasticity, nor was there any congestion of its Blood Vessels. There were some Tubercles, but none of them of a large size, cheesy in their nature; this was more especially the case in the superior Lobe of the Lung. The left cavity of the Thorax contained some serous fluid, and there was very general adhesion of the Pleura, but not of recent occurrence. The superior Lobe of this Lung was almost entirely occupied by Tubercles, which had coalesced, and the centre of them had softened, forming a cavity nearly full of Tuberculous Matter, which communicated with the Bronchia. The inferior Lobe of this Lung also contained many Tubercles, some of large size, but none of these had softened.".

The above case points out, in a very striking manner, how uncertain are the functional symptoms as compared with the physical signs of pulmonary disease. Although neither the patient nor friends observed any cough in this case, yet the reporter did occasionally notice a very trifling dry cough during the last fortnight of the young gentleman's illness. No expectoration, however, was ever detected.

If it be said and doubtless it will be said -that a knowledge of the pulmonary disease would have made no difference in the final issue; we reply that after granting all this, (which, by the way, is not quite proved, since we find marks of inflammation in that side of the chest which was most disorganized) there yet remains an important consideration to be taken into account. Is it likely that the parents and friends of this young gentleman never once asked the

Doctor what was the nature of the patient's disease? What did he say to such enquiries ? "Disease in the abdomen." But, on dissection, the cause of death was found to be in the chest!! If any of the friends were present at the examination, they must have formed a high opinion of the Doctor's discernment, and would, of course, employ him again on all alarming occasions. If no friends were present, the Doctor must have candidly confessed the mistake-or told a falsehood, and gone home with all the pleasant reflexions of self-degradation !

It was only yesterday, that we had an opportunity of seeing an exquisite specimen of tracheal and bronchial inflammation in a child. A practitioner, who was an attentive observer, and who studied his profession rather than scandal and abuse, stated what the disease was; but the friends called in another practitioner, who employed himself more in reforming the profession than curing the bodies of his patients. This gentleman pronounced at once that the other practitioner was wrong, and that the disease was in the head. The patient died, and the radical reformer just raised the sternum, and shut it down close again, affirming that there was no disease there! The first practitioner obtained leave to re-examine the body, and the result was, as stated above, the discovery of intense tracheitis and bronchitis !

Let us now reverse the picture, and shew that the Doctor is sometimes agreeably deceived in his diagnosis of pulmonary disease.

tablished there-calomel and jalap given every third morning, and colchicum three times a day-vegetable diet-abstinence from animal food. These means made not the slightest impression on the complainton the contrary, all the symptoms were increased, and hæmoptysis was added to the list! The treatment was, however, continued; and, as the Summer advanced, the young lady began to rally, and a trip to Malvern, with horse exercise, established the

cure.

With all due deference to the talented reporter, we consider the above case as one of disorder of the digestive organs and uterine system, and not one of real pulmonary disease at all. That the chylopoietic functions were in a very bad state, is evident from the symptoms themselves above detailedand that the catamenial functions are often very much disordered, while they are said to be regular, is well known to every practitioner. That the regulated temperature, bleeding, seton, and vegetable diet, exasperated the complaints there can be no doubt -and that the approach of Summer, the air of Malvern, the horse-exercise, and DAME NATURE, did more towards the cure than all the means and medicines above enumerated, will probably be surmised by most of our readers when they peruse the case.

We shall introduce the particulars of one more example of the uncertainty in question.

Case 3. SUPPOSED PULMONARY PHTHISIS, WITH SEVERE SYMPTOMS, TERMINTING FAVOURABLY. In November, the Doctor was called to a young lady who had been affected, for six months, with cough and emaciation, but without any expectoration. There was heat of face and hands in the evening, preceded by shivering-morning perspiration-pulse from 100 to 120-pain in the left side of the chest, aggravated by coughing-tongue loaded, fauces red, stools offensive and clay-coloured-breathing hurried on the least exertion-catamenia apparently regular. The lady was confined to a regulated temperature, in two rooms, for the space of seven or eight months, while leeches were frequently applied to the side-a seton es

Case. 4.

"SEVERE SYMPTOMS OF PULMONARY PHTHISIS IN A YOUNG LADY TERMINATING FAVOURABLY." A young lady aged 14 years, tall and slender, had enjoyed good health till after an attack of measles, in April, 1820. The disease was severe, and the inflammatory fever ran high, the cough being very harassing. The severity of the symptoms appeared to authorise strict measures. Blood was twice taken from the arm, and once locally, before the eruption went off. The pulmonary affection did not subsubside with the disappearance of the eruption, and repeated venesections were employed, with antimony, and the usual means. At length, the prominent symptoms were subdued, and she was able to go to the sea, where she amended considerably. But the return of Winter brought a return of all the common symptoms of approaching phthisis,

in a regulated temperature-abstinence from all animal food. The hæmorrhage ceased; "but to it succeeded a more frequent cough, a pretty copious muco-purulent expectoration, and a decided increase of the evening paroxysm of fever." The emaciation proceeded, and there was pain in the left side of the chest. A seton was now insertedthe vegetable diet continued-and blue pill, digitalis and colchicum were given. Throughout the Winter and Spring months, all the symptoms went on from bad to worse, and the most desponding views were taken of the case.

"Happily, towards the end of May, there was a mitigation of some of the more dangerous symptoms. The breathing was less hurried on exertion; the cough was not so troublesome, and the expectoration diminished in quantity. The pulse, too, became slower, and there was some little return of flesh. As the Summer advanced, it was truly pleasing to observe, that all the worst symptoms vanished, and, by the close of the month of June, the Young Lady was almost in a convalescent state, having been enabled, early in the above month, to leave her apartments, and to take carriage exercise in the open air. During the Summer, the flesh and strength returned; and though the cough was still occasionally troublesome, it was not accompanied by pain in the side; nor was there any evening fever. An excursion to the Sea side, in the Autumn, seemed still further to confirm this amendment, and she returned home, in the beginning of October, in tolerable health, though thin."

We confess that we entertain great doubts respecting the good effects of the regulated temperature, digitalis, and starvation in the above case. In fact, the young lady got worse under this treatment, and we hesitate to give credit to any medicine but the change of season. To one conclusion, however, we may safely come-that the disease was not tubercular phthisis, otherwise so favourable an issue would not have taken place. The two cases shew how uncertain are functional symptoms, unaided by physical signs. The author promises us another paper on the subject, and we have no doubt

the other and imperfect means of diagnosis.*

ON SMALL DOSES OF OIL OF TURPENTINE

FOR THE CURE OF SCIATICA AND OTHER NEURALGIE. By M. MARTINet, M. D.

The employment of terebinthinates, in affections of the nerves, is of very ancient date; but it is only in modern times that the essential oil of turpentine has been fairly put to the test of experiment in the neuralgiæ, of which sciatica is one of the most ob stinate and intractable. M. Martinet has lately given an exposition of the results of his experience in 70 cases of SCIATICA, or other severe neuralgia of the extremities, where the oil of turpentine was employed, but in small doses-namely, about a fluiddrachm in the 24 hours, and taken at three different times. In this way, it seldom acted on the bowels; but generally produced a sense of heat in the stomach, and throughout the whole line of the intestinal canal, and occasional perspiration. A similar sensation was usually experienced in the nerve affected. The vehicle of exhibition was honey, syrup, or, what was the best of all, a mixture of syrup and calcined magnesia. The yolk of an egg is also a good ingredient in the vehicle. Where the digestive organs were very irritable, a few drops of laudanum were added. The modus agendi of turpentine in the cure of sciatica, or of any of the neuralgiæ, is quite unknown, and, therefore, we shall not waste time in discussing that point. The RESUMEE of our author's experience with this remedy is as follows:Of seventy patients who laboured under

* After this had gone to press, we received the 3d Number of the MIDLAND REPORTER, in which Dr. Hastings has given the finale of his paper. We shall notice it on another occasion. In the mean time, we congratulate the zealous editor on the increasing list of his subscribers and contributors, while we wish his journal every degree of success.

sciatica or other severe neuralgia of the extremities, fifty-eight were cured-namely, three by frictions, and fifty-five by the internal administration of the turpentine. Ten experienced only a more or less durable relief-and five derived no benefit whatever from the medicine. Two out of these last laboured under disease of the hip-joint, under which they ultimately sank. Of these 70 cases, 40 were acute, and 30 chronic. Of the 40 acute cases, 34 were cured-five were relieved-and one received no benefit. Of the 30 chronic cases, 24 were cured-two were relieved-and four remained without any mitigation of their complaints. Of the 58 patients who were completely cured, 34 were cured in less than six days-22 within twelve days-and three within six weeks. Of these 58 cures, 48 were cases of sciatica, two of which were cured by frictions. Three were crural neuralgia-four were brachial

-and three facial. In the 10 cases which were only relieved (all of which were cases of sciatica) the treatment was suspended after the second day. In 21 cases, heat was felt along the tract of the nerve and in the limb affected; and 19 of these were completely cured. In 18 cases, heat was felt in the stomach and bowels. Three were affected with vomiting-but these had taken a larger dose than usual of the oil. Three had diarrhoea and colic. In five instances, the urine was augmented-four had dysury or strangury. In ten instances the perspiration was augmented. In one case, a degree of intoxication was produced-and in two others, a pruritus was experienced over the body.-REVUE MEDICALE.

XXII.

ON THE FORM OF THE FACE AND FOREHEAD; WITH A THEORY OF THEIR FORMATION IN DIFFERENT AGES AND NATIONS. BY DR. MILLIGAN.*

The figure of the face and forehead must, of course, depend upon that of the bones

*We have just received Dr. Milligan's third edition of Magendie's Physiology, greatly enlarged and improved by notes,

beneath, but the mode in which these are developed, and the relation which their development bears to that of other bones of the body form the subject of Dr. Milligan's inquiry. Our ingenious author maintains that the evolution of the facial bones is governed by the following general laws :

1. The external and internal plate of a flat bone are two different, distinct organs, merely connected with each other by diploe, as muscles are by cellular membrane, but each having an office corresponding to the organs contiguous to it.

2. Wherever those contiguous parts follow different laws of growth, the quicker growing bone separates from the slower, and leaves a space which is filled up by diploe, if no mucous membrane is near, and lined by mucous membrane, when that tissue is in the vicinity.

3. That this membrane prevents the formation of diploe or cancelli, and, consequent、 ly, is the immediate cause of those sinuses

that excavate the bones of the face.

4. Dr. Milligan proves, that the difference between the growth of the brain, which stops at the 7th year, and the growth of the face bones, which stops not till the 21st year, is in every case the cause of such separation, admission of mucous membrane, and formation of facial sinuses.

Hence nations or individuals that have the brain soon brought to the full growth, must have these facial sinuses large and the cheek bones wide, and the reverse. Hence, also, the large heads and small faces of Hydrocephalus are easily explained.

We subjoin the passage from the original work, which is now furnished with a copious alphabetical index, and some valuable plates and tables.

"The development of the internal table of the skull, and, consequently, of the frontal bone, follows the development of the brain; but the development of the external table of the frontal bone follows the development of the bones of the face. Now, the brain we have seen, arrives at its full size in the seventh year; which,

engravings, and an alphabetical index. We hasten to notice the above subject, which is a novelty.

therefore is the period of completing the development of the internal table of the frontal bone. But the bones of the face continue growing to the twenty-first year; and hence it is, that anatomists find the dimensions of the frontal sinus go on increasing to that year; and the same authors generally find the sinus commence at the seventh year, because that is the time at which the nutritious arteries of the internal table cease to do more than support its vitality. Suppose that the day, or week, or month, after this has happened, a line in length, and a line in breadth is about to be added to the external table by the arteries, in order to preserve its congruity with the transverse suture, which is still growing. It is manifest, that the arteries which make this new interposit must lay down their bony matter a line farther forward than before; while the absorbents, whose modelling action necessarily accompanies deposition, will remove that part which was in contact with the diploe from the now fixed vitreous table, in which no corresponding tendency to continue the union by diploe will be excited, even should points of diploe be thrown out by the still continued formative efforts of the vessels of the external table. Nay, these efforts soon must become abortive from another cause. Bichat has shown that the cells of diploe are without any membraneous lining-its plates are themselves bony membranes. When, therefore, the arteries of the anterior table advance its position forwards, to make it coincide with the nasal bones, an opening is offered behind, into which creep the vessels of the Schneiderian membrane which is in immediate contact at this point, irritated by the change of position, and at the same time equally rapid in their depositing action with the vessels of the external table. Hence, a membrane is rapidly shot into the nascent hollow, or sinus, which attaching itself to the outer aspect of the vitreous table, and to the inner aspect of the osseous table, forms an insurmountable obstacle to the

rudest diploe that might join these two lay

ers.

For it is a mucous membrane, a class which scarcely ever forms adhesions, and is here almost a shut sac, whose sides are every day brought farther and farther asunder.

"I would rather say, that it is a similar penetration of this mucous membrane that forms the other cavities in the bones of the face, than that this cavity of the forehead is formed according to the model and for the same uses as those of the face, though both views are in some measure true. These

To

cavities augment the sound of the voice, and, by rendering the bones hollow, equipoise the occipital prolongation so exactly upon its condyles that the weight of a small coin is often sufficient to turn the balance. man alone are given posterior lobes of the brain, and he alone requires a projection of the anterior lobes, and corresponding facial bones, to balance the former-a state rendered doubly necessary by his erect position; but had those facial bones been solid, a useless weight of three or four pounds would have been superadded, producing a most injurious preponderance, and defeating the ends of nature.

"Thus, then, we have the true theory of the frontal sinus, and it becemes easy to malies." explain what have hitherto been named ano

XXIII.

ANEURISMAL DILATATION OF THE POSTERIOR AURIS AND TEMPORAL ARTERIES.* By JAMES SYME, Esq.

We are led to notice this case for two good reasons; first, because it is an example of a disease which surgeons are only beginning to understand; and secondly, because it illustrates those principles of treatment on which we have occasionally dwelt with considerable earnestness. John Bell is the only writer who has published any more than an insulated case of the disease in question, and he, as is very well known, has given it the name of "aneurism from anastomosis.” Whether that term be generally proper or improper we need not stop to inquire; our business at present being only with those pulsating tumours which appear on the side of the head. To these particular cases there cannot be a doubt that both the name and

* Edinburgh Med. and Surg. Journal Jan. 1, 1829.