depreciate the character of these tests. There are some very useful remarks upon the operation of these reagents with phosphates, and cautions to operators to avoid false conclusions, in their progress through an enquiry of such consequence to the welfare and safety of society. We are pleased to find, that the test with nitrate of potass may be so modified as to distinguish at once the difference between arsenite of silver and a phosphate of the same metal. This method is fully described at page 159, and deserves the best attention of our readers, especially of those who are conversant in chemical investigation.

Edinburgh Medical and Surgical Journal, No. LI.

July, 1817.

(Continued from p. 155.)

Art. V.-Case of Wounded Bladder, terminating favourably. By J. DOUGLAS, Surgeon, Hawick.

THIS paper contains much interesting and useful information, conveyed with such brevity that we may hereafter be induced to transcribe it.

Art. VI.-History of a Case of Dislocation of the Lower Jaw; with Remarks on the Sentence of a Court Martial held to investigate the Nature of the Causes that produced it. By JOHN FORBES, Esq. Surgeon, Royal Navy.

This paper contains matter of too delicate a nature for us to enter on without a more complete knowledge of all the events connected with the parties.

Art. VIII.-Observations upon Diseased Spine, with a Case. By J. B. ESTLIN, Surgeon, Bristol.

The first part of this paper contains a general analysis of Mr. Baynton's Essay, and of Mr. Earle's remarks on the same. Some incidental observations follow in favour of Mr. Copeland's work on the same subject. In one part, Mr. Estlin seems to express a surprise that Mr. Baynton has not thought proper to reply to Mr. Earle. In our opinion, Mr. B. has acted wisely, for, though there cannot be any question of Mr. Earle's abilities, or of the good sense contained in his paper, yet the difference of opinion is not such as to require explanation. The facts are sufficiently before the medical public to enable them to form a proper estimate. We acknowledge, at the same time, that, from long experience in that school in which the caustic practice, if it did not originate, was carried to the greatest extent, we have often felt doubts of its efficacy; and, even in Mr. Estlin's case, we

should

-9

should have preferred the free use of the cupping glasses to the seatons or issues. From experience, we do not scruple to recommend topical bleeding in similar cases, as a much quicker, pleasanter, and more certain remedy. We own ourselves somewhat at a loss that surgeons of such eminence as were consulted before Mr. Estlin should have advised nothing but the horizontal posture for a disease of so long continuance, and which they considered as inflammation going on in the back. The case is, indeed, so similar to some with which we have lately met, that we might almost transcribe it as one of our own. The following is Mr. Estlin's: "In February, 1811, Miss aged 26, after a ride on horseback of about twenty miles, felt, for the first time, a weakness in the back, and a general sense of languor; to remove which, she was advised to lie down upon her back during a part of every day. She followed this advice, and, in a few weeks, felt no more of the indisposition. In the following winter, she used great exertion, by taking frequent and long walks, for nearly four months, and again felt a local weakness in the back: there was also, she recollects, some degree of tenderness in the vertebra when pressed. These symptoms were also relieved by occasional recumbency and repose from much exercise; but, during the summer (1812), the uneasiness returned so constantly, that she was obliged to lie down the greatest part of the day. She always felt easy while lying down. In September, by the advice of a medical gentleman, she put on a machine, which was constructed to remove the weight from the spine, and throw it upon the pelvis. During the next twelve months, she either lay down, or sat with the assistance of this machine: she used to sit up for one hour, and lie down two or three; then sit up for an hour, and so on. At the expiration of these twelve months, she was, upon the whole, worse: the sensation in the back, which she has uniformly described as more a feeling of weakness than of actual pain, had increased; talking, laughing, or crying, even while lying down, always produced a heat in the back; and she constantly felt a sensation as if bits of horse hair were pricking the back. At this period, September 1814, Mr. Cline was consulted by letter: be said, that he considered the symptoms those of inflammation going on in the back, and recommended rest in a horizontal posture. Another eminent surgeon, residing at a distance, was also consulted by letter, who thought the case was one of diseased spine, and recommended, as Mr. Cline had done, undeviating rest in a horizontal posture. This plan was scrupulously persevered in from September 1814, to April 1815. The patient, lay, for the first two months, upon a hair-mattress, but, fearing it might be too yielding, she had it removed as far as the small of the back, and a board, covered with blankets, upon a level with the upper part of the mattress, was substituted.

"On the 14th of April, 1815, I saw her for the first time since her indisposition. My notes say, that she feels exactly in the same

state

state in which she has been for some months. When perfectly at rest, and not speaking, she experiences no inconvenience. Moving the arms, and talking, affect her most. Yawning, sneezing, laughing, èrying, and coughing, occasion the sensation of weakness and heat between the shoulders, or, as she expresses it, under the lungs.' She describes the general feeling as a want of compactness in the vertebræ.' If she hold up a book for a short time only, her back becomes heated, and she has slight pains, like lines as small as horse hairs, and about an inch in length.' To communicate an idea of her feelings, she also describes them to be as if all the ligaments of the body were suspended by a wooden peg between the shoulders.' An obstinately constipated state of the bowels exists. During the day, her couch is wheeled into an airy drawing-room; and her clothes are contrived so as to be put on and taken off without her removing her back from the mattress. When she feels the uneasiness in the back most, she is able to refer it to a particular and small spot between the shoulders.

"Upon examining the spine attentively, no distortion or curvature was perceptible. Pressure with the fingers upon the cervical vertebræ occasioned no uneasiness, but, when it was applied to the third or fourth dorsal, she started suddenly away, and said her breathing was impeded by it. The sensation thus produced, she said, could not properly be called pain. The same tenderness existed in several of the succeeding bones, but the principal seat of it was between the third and seventh or eighth. There was not the least tenderness in the lumbar vertebræ.

"After this examination, I could entertain no doubt that several of the dorsal vertebræ were affected by disease; and, when I considered how long the patient had been indisposed, and how slight a degree of pressure occasioned the sudden starting and uneasiness she complained of, I was led to fear that the progress of the inflammation had been considerable, though no curvature or paralysis had yet appeared. The custom she had so long adopted of lying down whenever the back was uneasy, and of thus relieving pressure, was probably the cause of the complaint's not having manifested any appearance of distortion or palsy.

"As the plan of undeviating rest had been persevered in for seven months, without producing any considerable amendment (though she thinks she felt a little benefit from it,) I did not hesitate to propose the immediate establishment of issues on each side of the affected part of the spine, and could not help feeling regret, with my views of this disorder, that so much time had been suffered to elapse without their having been had recourse to. I had, however, the pleasure of finding that the result did not disappoint my most sanguine anticipations.

"I applied the potassa fasa to a circular space, of about an inch and a quarter in diameter, on each side of the tender vertebræ. She lay upon her face for about twenty minutes while the eschars were forming. The surrounding skin became considerably inflamed. On the evening of the day upon which the caustics were applied, she

said her back felt less uneasy than it had been for some time before, though she had used more exertion than she had done for a considerable preceding period.

"As the lady who is the subject of this case lived at a great distance from Bristol, I was obliged to leave her the day after the application of the caustics; but she was fortunate enough to remain under the occasional observation of a gentleman who is eminent for his professional abilities, to whose judicious co-operation I feel much indebted, as instrumental to the happy termination of a case, where feelings of private friendship added to the interest which, in a professional point of view, I naturally took in it.

"When the escbars formed by the caustic had sloughed away, the openings were kept discharging by the insertion of a large Windsor bean into each; and, on the 15th of May, a month after the caustics had been applied, I received the following account :

"She has not felt lately the heat and irritation she used to have in the back, excepting one day when she coughed a great deal and sneezed. She turns upon her side more easily than she did. Talking does not produce so much local heat as it did.'

June 11. The vertebræ are as tender as they were at first, but the catching of the breath when they are pressed by no means so great. The issues discharge freely,'

"I cannot give a better idea of the immediate good effects of the issues, than by transcribing her own words from an account of her case which she has since favoured me with. Speaking of her state previous to the period of my seeing her, she says,

"From September 1814, to April 1815, I simply lay down, and certainly felt benefit, but still the inflammation in the part continued, on the smallest exertion; even the weight of my hands crossed upon my chest was a burthen; and the least movement of hand or foot seemed to bear on the weak part only. Coughing or sneezing I dreaded, as the jerk seemed to strain the part. In April you applied the caustics; from that time I felt nothing of the pricking: the effect

seemed instantaneous.'

"The symptoms gradually abated. The caustie was applied to a fresh part, and the former openings suffered to close. In all, five issues were made. The fear of producing any recurrence of the symptoms by a premature remission of the plan that had proved so beneficial, was the cause of its being persevered in longer, perhaps, than was absolutely necessary. In February 1816, as no uneasiness was felt upon pressing or knocking the vertebræ, and the catching of the breath having ceased for some months before, on the application of pressure, she began to be raised during the day a little from the horizontal posture, by means of a contrivance in the crib for the purpose. There was a hinge at the part where the bottom of the back came, which enabled the upper part of the trunk to be raised towards the sitting posture. Soon after this, her progress received a little check, owing to a catarrhal attack, attended with cough; and frequently, during her confinement, she had to contend with the depressing influence of mental anxieties. It is not, then, to be won

dered at that she did not venture to sit upright before the December following. On the first day of the present year she stood, and in a fortnight after was able to walk. In the latter end of last March I saw her again, and examined the back. There was no more sensation upon pressing the vertebræ than the soreness of the skin produced by the issues, which were then inflamed, fully accounted for. Her amendment has continued. The issues have been suffered to heal. She goes up and down stairs, walks out, and is able to in dulge in the recreations of playing, singing, and drawing. Her back is free from uneasiness, and her general health unimpaired. It may not be amiss to observe, that the 'suffering' occasioned by the issues was too trifling to be named."

From reiterated experience we do not scruple to recommend the frequent loss of blood by cupping near to the parts affected. In one of our cases, the patient was not able to recline for a considerable part of the day; and in another, from her rank in life, a convenient couch could not be contrived. In this last, the distortion was considerable; yet both recovered in the course of a few months.

Cases of Catarrhus Hepaticus; by JOHN HAY, Esq. Surgeon, 2d Battalion Hon. E. I. Č. Artillery, Madras.

We often hear of "great cry and little wool;" of this paper we should say-Much Latin and little science or information. On the whole, however, we cannot conclude these remarks without expressing our satisfaction at the copiousness and respectability of the communications contained in this number.

MEDICAL AND PHILOSOPHICAL INTELLIGENCE.

I

To the Editors of the London Medical and Physical Journal. GENTLEMEN,

TAKE the liberty of addressing you upon this occasion, in consequence of being unable to obtain the requisite information by any other meaus.

In the autumn of the year 1814, I was bound to a country apothecary for the term of four years; since that time the Apothecaries' Act has passed, which specifies five years, and that all those who have not served that time cannot be admitted to an examination at Apothecaries' Hall. Now, I have been told, that the Act has a retrospective power, which appears to me to be so very absurd that I cannot credit it. I understood, myself, that Act was only put in force on the 1st of August, 1815; in that case, it does not at all interfere with me, and I suppose I may be admitted to an examination as readily as if I had served an apprenticeship of five years. But, on the contrary, I suppose I must be rebound at the expi ration of my present term for another of five years, by which time I shall have attained my twenty-ninth year. If, gentlemen, you will kk

NO.223.

hav