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of insoluble sulphuret. Thus he has found that one-half of the arsenic sought may be lost. To avoid this source of error, after repeated washings with boiling distilled water to remove all the soluble arsenious acid from the carbon, a second washing should be performed with ammoniacal water in order to remove the sulphuret. After careful evaporation to dryness, the residue may be treated by concentrated boiling nitric acid, added several times in small quantities, and the excess of acid having been expelled, a second solution of arsenic may be obtained, which, added to the first, constitutes the suspected liquid to be submitted to Marsh's apparatus.
IX. A Case of Cæsarean Operation performed with success. By M. BORIE.-This was performed at the Maternité, at Tulle, on the person of a ricketty but hardy primipara, aged twenty-nine, in whom the space between the sacro-vertebral angle and the triangular ligament of the symphysis pubis measured but from five to six centimetres at the utmost. A living child was delivered, and the woman recovered rapidly. Chloroform was employed, and a longer incision than usual was practised in opening the cavity of the abdomen.
X. On the Amount of Utility of Permanent Exutories in the Treatment of Chronic Diseases. By M. ZURKOWSKI.—This testimony in proof of the utility of exutories is not derived from original observations made by the author, but from the collection and comparison of cases which have been already recorded. These cases are arranged under three categories.
1. Permanent Exutories in Chronic Phlegmasia.-Lesions which result from chronic inflammation, when exempt from all diathesic influence, are generally, even after a very long period, susceptible of resolution. Such fortunate terminations have frequently been due to the employment of exutories. It is especially in disease of the articulations that the greatest number of successful cases have been observed. Of 58 of the cases of Pott's disease and white swellings, the exutories were the sole means employed in 22; they were used in conjunction with other means in 12, and in 24 they were resorted to after other measures had failed. A no less positive amount of success has attended their use in chronic myelitis and the consequent paralysis-44 instances of recovery from such paralysis, with or without vertebral disease, being on record. Of 20 cases of amaurosis, 7 were treated exclusively by exutories, and 13 after the failure of all other means; permanent success resulting in the whole. So with 30 cases of various descriptions of ophthalmia, the great bulk of which had previously been treated without success. Besides these, may be mentioned old cases of pleuritic and peritoneal effusion.
2. Exutories in Tuberculisation. The author reports 10 instances of pulmonary consumption treated with success by exutories. These individuals were all the issue of healthy parents, with no antecedent phthisis in their families. There were no concomitant or anterior abdominal affections, signs of scrofula, or disease of the bones or joints.
But all the patients had cavities at the upper part of the lung, accompanied by the usual cortege of symptoms.
3. Exutories in Neuroses.Their beneficial effect has been observed in the various forms of these, whether relating to modifications of sensibility, motility, or impressionability, or to aberrations of the perceptions, of the intellectual powers, or of the moral and affective faculties.
Seeing, then, how useful this means may often prove, how comes it that it has fallen into discredit? By reason of the abuse which arose from its indiscriminate employment, whether suitable indications were present or not. Among the conditions which should oppose the use of permanent exutories as a means of treating chronic disease are the following:
1. Deep-seated Alterations of Structure-For example, the atrophy or melting down of an organ, which has already given rise to symptoms of resorption or colliquation. In subjects placed even in the most favourable conditions, if the organs have undergone deep-seated alterations, if the general reaction is continuous, giving rise to disturbance of some important function, and especially if nutrition be already deeply impaired, not only have exutories no longer any chance of success, but they may even hasten the fatal termination.
2. Degenerations.-Without speaking here of primary heteromorphies, for which no one would think of employing exutories, we allude to those insidious transformations of simply indurated or hypertrophied tissues, which are brought about either by the sole effect of chronicity, or under the influence of some diathesie or hereditary condition.
3. Tuberculisation. Although exutories may exert a beneficial action in cases of isolated tubercles, limited to a circumscribed portion of an organ, they offer no chance of success in general tuberculisation that is, when the diseased process has been set up in several organs at once, or even in several parts of the same organ. It is from their having been too frequently employed in cases of this nature, that their credit has become compromised to the extent of causing their utility to be doubted in cases in which they are really indicated.
4. Hereditary Influence. This exerts great pathogenic influence in chronic disease. Next to tubercular affections, it is in the neuroses especially that it plays so immense a part. In the examples of epilepsy and insanity, in which exutories have proved useful, the patients have been exempt from this fatal influence. Unfortunately these are the rarest cases; the immense majority are subjected to hereditary influence, and exutories will fail to exert any salutary effect upon them,
Besides the Memoirs we have noticed, there are in these volumes éloges on Roux and Magendie; Reports on the Mineral Waters of France for 1854 and 1855; and Reports upon the Epidemic Visitations in 1855 and in 1856. In this last, from the pen of M. Trousseau, there is some account of the epidemic of diphtheritis
which prevailed at Boulogne in 1856. We have also passed over a paper by M. Poterin du Motel on Melancholia; another by M. Reynal, on Herpes Tonsurans as observed in the horse and ox; and one by M. Michel, on the Applications of the Microscope to the Diagnosis and Treatment of Disease. This last is an able resume of what is known upon the subject, but defies analysis.
On Wounds and Injuries of the Eye. By WILLIAM WHITE COOPER, F.R.C.S., Ophthalmic Surgeon to St. Mary's Hospital, Senior Surgeon to the North London Eye Infirmary, &c. Three coloured Lithographic Plates, containing seventeen figures, and Forty-one Woodcuts.-London, 1859. 8vo, pp. 330.
In his preface Mr. Cooper states, that although his subject forms part of systematic treatises on the eye, he is not aware of any English work specially devoted to injuries of this organ; and that when in charge of difficult and anxious cases, he has often felt the want of such a book of reference as that which he now endeavours to supply. Those who shall peruse Mr. Cooper's work will readily agree with the author, that to render it interesting and useful no pains have been spared. Believing that cases tend to impress facts upon the memory more strongly than precepts, Mr. Cooper has introduced them freely, although generally in a condensed form, and confining them as much as possible to the illustration of leading points of practice.
The order in which Mr. Cooper takes up the several divisions of his subject is as follows:-1. Foreign Bodies behind the Eyelids. 2. Foreign Bodies in the Eyeball. 3. Gunshot Wounds. 4. Incised and Punctured Wounds. 5. Contusions. 6. Rupture of the Eyeball. 7. Intra-ocular Hæmorrhage. 8. Burns and Chemical Injuries. 9. Sympathetic Inflammation.
In his first chapter, among other causes of irritation, Mr. Cooper notices the exposure of the eyes to the dust and emanations arising from the preparation of drugs of various sorts.
Euphorbium (he tells us) is the plant most dreaded by drug-grinders. It causes so great irritation that it is necessary to protect the face and eyes with a mask, having glasses to see through. Not only does the dust cause violent ophthalmia; but, if inhaled, may produce insanity. Cantharides is very injurious to the eyes of workmen, and even the vapour of cantharidin produces powerful effects. The preparing of oil of mustard, infusion of black mustard, powder of hellebore, gamboge, squills, and veratria, is also injurious. The vapours of iodine, bromine, and chlorine, are very irritating; as are the fumes of ammonia and strong acetic acid. (pp. 5-6.)
Mr. Cooper considers minutely the effects of foreign bodies within the conjunctival sinuses, or fixed in the epithelium of the cornea. One of the consequences of such injuries we think he has omitted, and that is, the occasional formation of pterygium from foreign
particles remaining fixed for a considerable length of time near the margin of the cornea.
Under the head of Foreign Bodies in the Eyeball, Mr. Cooper mentions a number of interesting cases of wounds of the crystalline, either occurring in his own practice, or recorded by others
One of these is a case in which a scale of metal struck the eye of a man, who ten days afterwards applied to Dr. Von Gräfe. Close examination discovered a small cicatrice of the cornea, a wound near the centre of the anterior capsule, and, finally, the foreign body in the posterior cortical substance of the lens. Dr. Von Gräfe passed a cataract-needle in the track of the foreign body, and enlarged the opening in the capsule, hoping that with the increase of imbibition the fragment might descend towards the aperture, and so become more accessible. After fifteen days it had moved to the middle of the crystalline, and eight days later into the anterior chamber, enveloped in cortical substance. A puncture was made, and as the knife was withdrawn, the foreign body escaped. Recovery followed, with as good vision as the loss of the crystalline would allow. (pp. 29-30.)
The following case, quoted from M. Desmarres, while it shows the utility of the ophthalmoscope in the examination of cases of minute deep-seated injuries of the eye, excites suspicion as to its alleged ultimate result-namely, the preservation of good sight with a wounded lens.
A mechanic was struck by a chip of metal, which penetrated the crystalline near its border. Inflammation came on, not very intense, but which could not be subdued. The ophthalmoscope revealed in the lens, in a line with the wound in the cornea and iris, which remained visible, a black mass, of the size of an ordinary pin's head, and surrounded by a haze evidently due, it was thought, to commencing traumatic opacity of the crystalline. This state continued four weeks; then the inflammation disappeared, the haze diminished in extent, and there remained little else than the black mass enveloped in a dull spot about double its size; the sight was good, and continued so when the patient was seen three months later by M. Desmarres. (p. 30.)
We certainly have never seen the sight preserved entire in any case where the crystalline capsule was penetrated. Cataract has been the never-failing result of such an injury.
Our author remarks, that if a chip of metal or similar body lodge in the vitreous humour, without wounding the lens or its capsule, it will readily be discovered by the aid of the ophthalmoscope, unless buried in such a position as not to admit of its being brought into view. In illustration he quotes the following case from Dr. E. Jäger:
A workman, engraving steel, was struck by a chip, which, passing through the cornea and iris, lodged in the vitreous humour. Without suspecting the gravity of his wound, he consulted Dr. Jäger at the end of ten days for a slight affection of his sight. There was only a very small trace of a wound in the cornea and iris. On examining the transparent media, a foreign body was seen enveloped in plastic exudation; as a consequence of inflammatory action, the fragment of steel became encysted at the end of a week, and the vitreous
humour recovered transparency, but the sight gradually declined. Five weeks after the accident, separation of the retina was discerned in the neighbourhood of the cyst. The separation soon extended over a third of the inferior and external portion of the retina, whilst the encysted fragment had moved from its first position, and was gravitating towards the middle of the eye. This displacement was attended with a slight pricking in the external parts of the eye. A plastic deposit then formed, raising the retina and hyaloid in the form of a cone, at the summit of which was the encysted body. In three months the fragment had reached the centre of the globe. At first horizontal, it had now become vertical. The eye retained its form, the lens its transparency, and there was some amount of oblique vision. (p. 42.)
Since the publication of Mr. Cooper's work, a case by Mr. Dixon, illustrative of the same sort of injury, has appeared in the 'Ophthal mic Hospital Reports' for January, 1859. The result, however, was favourable; as four weeks after the accident, the chip of iron was extracted from the eye, leaving the lens untouched and the retina sound. Regarding such cases, Mr. Dixon observes, that opaque bodies in the lens or vitreous humour assume very deceptive appearances as to their real position. The foreign body, in the case now referred to, which was really behind the lens, seemed, when viewed upon the illuminated ophthalmoscopic field, to be in front of the lens, and on the plane of the iris. When examined by means of daylight, concentrated through a convex glass, its true position was at once recognised, as it swung to and fro on a level with the equator of the eyeball.
Demonstrative of the remarkable degree in which the eyeball rolls upwards, when the eyelids instinctively close against the intrusion of a foreign body, Mr. Cooper narrates the following case:
While a policeman was cutting a piece of wood with a penknife, his head being bent forward, the knife slipped, flew up, and passed through the upper lid into the eyeball. The lid presented a clean incised wound nearly in its centre, a full quarter of an inch above its margin, while the wound in the eyeball was considerably below the cornea, and somewhat to its nasal side. Sight seemed extinguished. There was a free discharge of vitreous humour through the aperture in the sclerotica, the eye was injected with blood, and the patient complained much of pain. Vitreous humour continued oozing for three days, then gradually ceased, and the wound united; but three weeks elapsed before the cicatrice was firm. The lens was uninjured. It was three weeks before sight began to return, and then very gradually. The treatment was simple, and mercury not used. At the patient's discharge, twenty-five days after the accident, the sight of the injured eye was sufficient for discerning large objects. He continued an out-patient for three weeks longer, by which time the sight of the injured eye was nearly equal to that of the other. The wound in the sclerotic had cicatrized with a dense tissue, apparently as firm as the surrounding membrane. (p. 116.)
In the following directions for the treatment of wounds of the cornea, with prolapsus of the iris, Mr. Cooper seems to us rather too eager to snip off the protruding membrane, and scarcely to appreciate sufficiently the use of belladonna or atropine in such cases:
"If the patient be seen soon after the injury, and prolapse of the iris has taken place, we should direct his face to the light and close and open the lids several times, allowing a pause between each; the sudden exposure to light