it; this plan saves much trouble and avoids bruising the margins of the cleft.

In every case the principles recommended by Sir W. Fergusson have been carried out, though the plan used for dividing the muscles has been that practised by Mr. Pollock. That is, the levator palati has either been divided (or at all events its division has been attempted) through a puncture in front of the soft palate, the palato-pharyngeus has usually been notched and occasionally the palato-glossus. Where the soft parts were very scanty, and the tension considerable, oblique lateral cuts have been made at the upper angle of the fissure, separating the soft palate from its attachment to the bones for a small extent.

The patients operated upon have been allowed a liberal supply of wine and fluid nourishment after the operation, and have not been confined to their beds.-Medico-Chirurgical Transactions, Vol. 51, 1868, p. 82.

65.-ON THE LOCAL TREATMENT OF DISEASES OF THE THROAT.

By W. M. BANKS, Esq., Liverpool.

The affections of the throat most commonly met with are, speaking very roughly and generally, as follows:-(1) Ulceration of the larynx either of a syphilitic or of a tubercular origin ; (2) chronic follicular disease of the pharyngeal mucous membrane associated with more or less hoarseness and pain in speaking, known as dysphonia clericorum; (3) aphonia, or loss of voice, which when merely temporary is only the result of conqestion of the mucous membrane of the vocal cords after a bad cold or a sore throat, but when permanent generally proceeds from defective action of the laryngeal muscle. This defective action is due, either to some distinct paralysis of the inferior laryngeal nerve, or to extreme general debility. Of course, there are many other affections, which come under the notice of the specialist, but these are the most commonly met with in the general run of practice.

[There have been many plans suggested in order to bring our remedies in contact with the affected air-passages. Inhalation of the steam of warm water impregnated with the medicinal agent was the first idea. Afterwards the use of spray by means of injections was tried, and with success, especially the plan invented by Dr. Bergson, of Berlin, of two glass tubes with capilary points placed at right angles to each other.]

Last year, Dr. Adams, of Glasgow, most ingeniously contrived

VOL. LIX.

to simplify an apparatus, just as Mr. Heath has done with Thudichum's machine, and has reduced its price to a matter of five shillings, rendering it at the same time much smaller and more easy to work.

The instrument, which is made of block tin, and is only about five inches in height, resembles very much a common lamp. It consists of a tubular boiler with an opening into which the water is poured, and which is fitted with a cork which acts quite efficiently as a safety valve, since, should the pressure of the steam prove excessive, it will certainly be blown out before the boiler will burst.. From the position of the opening only the proper quantity of water can be poured into the boiler. The lamp being lit, steam is generated in the upper part of the boiler, and rushing through the upper tube which leads from the boiler, it sucks up the medicated fluid from the bottle along the lower tube, and carries it along with it in the shape of a warm soothing mist. The advantage of the tubular boiler is, that the steam is generated quicker, and a fuller supply kept up, while it is at the same time super-heated and dried. In simplicity and ease of management this instrument, if steam is desiderated, cannot be surpassed, and it may be safely intrusted to the care of the most inexperienced nurse or servant without fear of danger. Dr. Adams's instrument is capable of being used in all diseases of the throat and larynx, but my own impression is that the steam does best when the bronchi are to be reached. Cases of gangrene of the lung and foetid bronchorrhea can be deprived of much of their loathsome nature by this means; and in many cases of chronic bronchitis and phthisis, when the hacking night cough deprives the patient of his sleep, a most soothing effect can be obtained by a good inhalation, before bedtime, of some balsamic or narcotic tincture.

Within the last eighteen months, since the rise of the great sulphurous acid mania, not only the profession, but the general public, have become familiar with the instrument which goes by the name of "The Spray-producer," and which consists of a modification, by Winterich, of Bergson's tubes, having attached to them Dr. Andrew Clark's hand-ball, by which air is employed as the atomising medium. Messrs. Mayer and Meltzer, of Great Portland-street, London, keep the tubes with points constructed to direct the jet of spray either directly backwards against the pharynx, or upwards behind the soft palate, or downwards to the larynx. They also have a smaller tube, intended for the nostrils, the delicate point of which being protected by a small vulcanite ball prevents the patient doing it or himself any harm. Last February, in the Medical Times, a new form was made known to the public by Dr. Brakenridge, which

is intended to be portable, and capable of being carried in the pocket without fear of breakage. The bottle is dispensed with, and the lower tube fulfils the office of a reservoir. The instrument, enclosed in a neatly fitting leather case, is about four inches in length.

The value of the spray-producer is so self-apparent as to account at once for its popularity, and one of its principal merits is, that it can be worked by anybody after a single trial. Very few people, as a rule, can swab out the larynx satisfactorily, and patients, after a little while, are apt to get tired of the trouble of fixing up the larger instruments in which steam is the atomising agent; but this is small, portable, easily managed, and ready at a moment's notice. Of its applicability to cases of disease of the nasal mucous membrane I have already spoken, and its value in chronic throat affections I have thoroughly satisfied myself of; but I am also sure that we have in it a most efficacious weapon in combating such serious acute affections as putrid sore throat, scarlatinal cynanche, and diphtheria itself. Hitherto one of the greatest desiderata has been to obtain some means of getting at the disease after the swelling of the parts has rendered useless our attempts by the ordinary methods of gargling, or swabbing, or touching with solid caustics, while the patient has become too exhausted to undergo the fatigue of inhalation. In such a case, if we can only introduce the nozzle into the patient's mouth and get him to draw down the disinfecting spray as it is poured forth from the instrument, we may not be too late to check the advance of disease. In the August number of the new journal, "The Practitioner," Dr. Beigel, whose labours have tended greatly to popularise the use of atomised fluids by inhalation, has drawn attention to this very point, and strongly advises the use of spray in croup and diphtheria. As to the remedies to be employed, I need say little or nothing, they depend so much on the special case to be treated. As astringents, alum, nitrate of silver, and the glycerine of tannic acid, are in universal use; and as antiseptics, iodine, carbolic acid, and though last, not least, the much-talkedof sulphurous acid, are probably the best. There has been a good deal of writing lately upon the value of iodine inhalation in diphtheria, and I think that the compound of iodine and carbolic acid, which I referred to a short time ago, will be found a very excellent remedy. Dr. Beigel, in the paper just referred! to, gives the preference to lime water (about 1 to 30 of water), (to which is ascribed the power of dissolving the pseudo-mem-branes of croup and diphtheria), and repeats the inhalationss every two hours.-Liverpool Medical and Surgical Reports,, Oct. 1868, p. 116.

66. ON THE USE OF COFFEE IN STRANGULATED

HERNIA.

We believe that all our English writers on Surgery totally ignore the value of this remedy, trusting to what is no doubt a far more potent therapeutic agent-namely, chloroform. But there are cases where, for certain reasons, chloroforin should if possible be avoided; and these are just the cases in which the other old remedies, such as the hot bath and tobacco enemata, are likewise dangerous. If a remedy could be found which would act in reducing a hernial obstruction without exciting dangerous symptoms of depression, it would obviously be a great boon to surgeons. Dr. Marchand, in an elaborate article on the therapeutic action of coffee, has collected a sufficient number of cases of strangulated hernia in which this simple remedy has proved successful, to warrant us in recommending its further trial. It appears that in the Havana coffee has from time immemorial been employed for the reduction of hernias. A French surgeon, Durand (de Batignolles), when residing there, saw it several times applied with success, and on his return home in 1857, he tried the remedy in France. A hernia of thirteen years' standing became strangulated, and all ordinary means, as the taxis, ice, draughts containing belladonna, &c., proving ineffectual, an operation was decided on, when M. Durand declared that he knew a sovereign remedy, which he begged to be allowed to try. His offer being accepted, he ordered 250 grammes (about half a pound) of powdered roasted coffee to be added to twelve cupfuls of boiling water, and of this a cup was to be taken every quarter of an hour till eight cups were taken, after which half an hour was to elapse between each dose. After the fifth cup the patient felt gurgling in the tumour, and the ninth cup was followed by the spontaneous reduction of the tumour. This case was published by Triger in the Gaz. des Hôpit. for May, 1857, and, as might be expected, not only excited un vif étonnement, but led to further trials. In the following year (1858) Meyer reported the case of a man, aged 62, in whom there was a spontaneous reduction of hernia after the sixth cup; Czernicki reported a similar case which yielded to the fourth cup; and Barasent described the case of a woman to whom, after twenty-four hours' vomiting he gave coffee, and whose hernia yielded to the fourth cup.

In 1859, Rouzier-Jolly, of Clermont-l' Hérault, published two cases in which he combined the coffee treatment with the local application of belladonna ointment. Although there was intestinal hemorrhage, in both these cases, from, as he thinks, the use of too large doses, be adds that we should not, on account of such accidents, renounce a remedy which is "as active as it

is successful." In the same year we are told that "Sammert en Angleterre" reported another successful case. We suspect that some evil has befallen our compatriot's name in the hands of the French author.

In 1860, Paultrier, and in 1861, Lamare-Piquot (of Honfleur), and Cellarius, adduced additional evidence of the value of this remedy; but the two last-named writers differ as to the mode of action. The former holds that it acts by occasioning decongestion of the strangulated part of the intestine, while the latter thinks that it acts by exciting the contraction of the intestinal fibres, which thus gradually liberates the strangulated portion.

[We refer our readers to an article by Dr. Sammert, of Malta, on this subject. Retrospect, Vol. xxxvii, p. 199.]—Medical Times and Gazette, Jan. 2, 1869, p. 18.

67.-ON OPENING THE SAC IN CASES OF STRANGULATED HERNIA.

From a Report on the Practice at St. George's Hospital. The practice of opening the sac in operating for strangulated hernia is much more frequently adopted at some hospitals than at otheis. At St. George's Hospital it is generally done, and the operation without opening the sac forms the exception to the rule. One reason given for this practice is, that the condition of the bowel can in that way be ascertained; but a more important reason, and one lately much insisted upon by Mr. Henry Lee, is, that the fluid contents of the sac (if this be not opened) are returned together with the intestine into the abdomen. These contents consist often of lymph, blood, and serum, in which various alterations are taking place. Now it is well known that decomposing fluids are absorbed with great rapidity from a serous surface, especially if that surface be large. If any bloody fluid or lymph be contained in a hernial sac, and that sac be not opened, then when the bowel is returned the fluid is returned with it into the peritoneal cavity. This fluid. mixed perhaps with decomposing blood, is looked upon by some as a fertile source of peritonitis, and great care is taken to remove it after the sac is opened in the operation for strangulated hernia. In two cases which occurred in St. George's Hospital two weeks ago these facts were particularly dwelt upon. In one of these, a patient seventy-five years of age, when the sac was opened a net-work of white lymph was seen forming a loose kind of inner sac; and in the other case, in which the taxis had been firmly applied. the sac contained a quantity of bloody fluid. The fluid contents of the sac were carefully removed in both these instances before the hernia was reduced, and the patients are both doing well.-Lancet, Jan. 23, 1869, p. 120.