ease. During the last fortnight, the liver was observed to increase greatly in size. The child died of pneumonia. At the autopsy, there was found hepatization of a portion of one lung. There were no tubercles. The mesenteric glands were slightly enlarged. The liver was fatty and greatly enlarged, occupying nearly one half the abdomen.

Two months ago, the only other child of the family died, two years of age. It had never been a healthy child. It had always been troubled with an irritable stomach, and subject to irregularity of the bowels. During the winter it had scarlet fever, from which it was convalescing, had begun to take food, and the attendance of the physician was remitted. Suddenly it was attacked with diarrhoea, and the same symptoms as the other child, under which it sunk and died. In this case, also, the liver was found greatly enlarged and fatty. The mother is a feeble woman, has always been more or less deranged in her bowels, and evidently has now some chronic abdominal trouble.-N. E. Quart. Journal.

Researches into the Physical Causes of Metallic Tinkling, or Amphoric Rhonchus. By, M. de CASTELNAU, House Surgeon (interne) of the Hospitals. The author commences this paper by reviewing the different theories which have been suggested to explain this phenomenon, and pronounces them all more or less unsatisfactory. The hypothesis most usually adopted, and which attributes the sound to the bursting of an air-bubble on the surface of the fluid effused into the pleural cavity, is regarded by him as equally defective with the others. Experiments which he details have led him to the conclusion, that the formation of bubbles of air at the surface of an effusion is almost impossible, even in those cases where the perforation of the pleura is below the level of the fluid, while its occurrence is altogether out of the question when there exist perforations of the pleura above the level of the effusion.

The occurrence of pulmonary fistula, however, above the level of an effusion is by no means unusual; it is even stated by M. Raciborski to be the case in by far the greater number of instances. Laennec, too, had observed that, after the operation for empyema, in which the puncture is made above the level of the fluid, metallic tinkling is frequently heard; while if the wound had been made too large, the respiration acquires an amphoric sound. This phenomenon can be ex

plained only by supposing metallic tinkling to be a variety of the amphoric sound; and M. C's experiments on the dead subject have convinced him that such is really the case. He further deduces from them the following conclusions:

1. That the physical conditions essential to the production of metallic tinkling are: a, The existence of a tolerably large cavity, containing air, either with or without fluid; b, The communication of the external air with this cavity; c, The production of sonorous vibrations in the channels by which this communication is established.

2. The causes which gave rise to these vibrations are identical with those which produce moist sounds in general.

3. Metallic tinkling may be called an amphoric rhonchus, with as much propriety as the term amphoric may be applied to the respiration, voice, or cough.

4. Those cases, if indeed any such exist, in which metallic tinkling occurs independent of the above-mentioned conditions, are exceptions to the rule, as are also the theories advanced in explanation of them.

In confirmation of these views, a case is related in which metallic tinkling was heard, and the respiration, voice and cough had an amphoric sound in a phthisical patient. After death the left lung was found to be occupied by two very large cavities, which destroyed the greater part of its substance. A septum, only three or four lines thick, separated the two cavities from each other. The superior was empty; the other contained about four ounces of broken down tuberculous matter, in a semi-fluid rather than a liquid state, and the openings of the bronchi into the cavity were all, with the exception of two, situated above the level of the softened tubercle. Similar phenomenon were observed in the case of a man in whom fracture of the ribs and clavicle was followed by subcutaneous emphysema and pneumothorax. The metallic tinkling and amphoric respiration disappeared gradually as the man advanced towards convalescence; and there was no reason, at any period of his illness, to suppose the existence of fluid in cavity of the pleura. He likewise alludes to a third case, which a wound in the chest with a knife, though unaccompa nied with subcutaneous emphysema, or even of hæmoptysis, was followed by metallic tinkling and amphoric sounds.

in

In a second paper on the same subject, two other cases are adduced in confirmation of the author's views.-Archives Générales de Médecine. Oct. et Nov. 1841.

Diagnosis of Gonorrhea, in accusations of Rape.-The following is quoted from a recent work on the venereal disease, by Mr. ACTON, late externe at the Female Venereal Hospital, Paris, of which M. Ricord is the chief medical attendant. "Every tyro in medicine will at once distinguish what he calls a clap, by means of the symptoms above described, but such a person may not be aware, that a surgeon cannot always decide at once whether a man is suffering under a gonorrhoea or not, provided no discharge be observed, and the lips of the urethra be not inflamed and no stains seen on the linen. M. Ricord gives the following instance of the occasional difficulty. He was ordered by a magistrate to give an opinion, whether or not a prisoner, said to have violated a girl, was laboring under gonorrhoea or not. The accused presented no swelling of the lips of the meatus, on pressure, no discharge came from the urethra, and there existed no traces of any secretion on the shirt. When interrogated, he said that he had made water six hours previously to his examination. As M. Ricord had some suspicion, he ordered him to pass his urine at once, and desired one of the goalers to watch his prisoner; in six hours after, M. Ricord returned and then found undoubted marks of an existing gonorrhea; the prisoner confessed that he had made water previously to the first examination, and had taken care to remove the secretion as soon as formed by a piece of lint which he had concealed for that purpose."

The Reviewer justly doubts whether gonorrhoea can be present without an obvious vascular fulness of the mucous membrane. This should be examined with a lens. On everting the lips of the urethra, it is either seen florid, with punctuated redness, and a semi-abraded appearance, as if the epithelium were partially removed, or the veins of the mucous membrane are enlarged and tortuous. Am. Journ. Med. Sci. from Medico Chirurgical Review, July, 1841,

Treatment of Old Fractures by Division of Tendons.-Prof. DIFFENBACH has several times, in old cases of fracture of the patella or the olecranon, where the portions were dragged far apart, divided the adjacent tendons so as to be able to bring the portions together, and, by friction of them one upon the other, to excite such action as might end in the formation of a shorter and firmer bond of union. In some cases, considerable benefit was obtained after all other means had failed; in

others, the result was negative. Two examples are detailed; in one, an old ununited fracture of the ulna, he divided the tendon of the triceps, fixed the upper portion of the bone in its right place by a bandage, and every fourteen days rubbed it well against the lower one: in three months the union was firm. In another example, an old, distantly united fracture of the patella, he divided the ligamentum patella and the rectus femoris about three inches above the patella: then, by an appropriate bandage, and constantly drawing the separated portions more closely together, he obtained, at the end of some months, a complete hardening of the interposed substance, and a considerable amelioration of the patient's state.-British and For. Med. Rev., from Casper's Wochenschrift, Oct. 2, 1841.

On the treatment of Paraphymosis. By J. TOGOOD, Esq., of Bridgewater.--The incision of the stricture in paraphymosis, is pretty generally practised by surgeons, except when this disease occurs in children, and in such the reduction is often effected by pressure. I have seen repeated incisions fail of relieving the stricture, and leave foul and intractable sores, which have been extremely tedious and difficult to heal. I have always succeeded in reducing a paraphymosis, either in an adult or child, however long standing, without having recourse to the knife, by the following method:-I place the patient against a wall, and take care that he is steadily supported by an assistant on each side; a piece of linen cloth is then laid over the glans, and with my thumbs I knead the blood out of it, drawing the prepuce forwards at the same time with two fore fingers of each hand. A steady perseverance in this plan never fails, and, although the operation is a painful one, the patient is amply rewarded by the rapidity of the cure, which requires nothing more than the application of a saturnine lotion for two or three days.-Prov. Med. and Surg. Jan. 15, 1842.

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THE WESTERN JOURNAL.

Vol. VI.-No. II.

1

LOUISVILLE, AUGUST 1, 1842.

STATE OF AMERICAN MEDICINE BEFORE THE REVOLUTION.

American medicine has few abler advocates or ornaments than the Drs. Beck, to one of whom we are indebted for an excellent address delivered before the Medical Society of New York on the progress of Medicine before the revolution. They have contributed a full share to carry a knowledge of their profession beyond the sea, and to make it to be respected in all countries where it is cultivated as an enlightened and liberal calling. Dr. John B. Beck, in the address before us, has vindicated the claims of American physicians to some improvements in practical medicine heretofore generally conceded to Englishmen. We give one example from among a number:

The

“Although the physicians in the colonies generally followed the prevalent practice of the mother country, yet they are entitled to the credit of originating some modes of practice of great value. most important of these is the application of mercury in the treat ment of inflammatory complaints. This practice took its origin as far back as the year 1736, and the credit of originality is generally conceded to Dr. Douglass, a physician of Boston, by whom it was used in the angina maligna which prevailed extensively over the col onies at that period, and committed the most dreadful ravages. By Dr. James Ogden, a respectable physician of Long Island, this prac extensively applied in the same disease about the year 1749.

tice was