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wound healed readily in the course of a day or two. Fromthe slight inconvenience experienced at the time of puncture,and the length of time which had elapsed between its healingand the existing symptoms, he could not be persuaded thatthe latter had anything to do with the former, and he accord-ingly treated himself for fever, until the appearance of duskyredness under the arm proved his mistake. Free incisionswere made, exposing sloughing cellular tissue; but too lateto save the patient’s life. lIe sank, and died two days after-wards.Early incisions are often of the greatest moment in the

treatment of these cases. We should not wait until matteris formed, or redness of the integuments appears; for we maywait for that which, in many instances, will not come to pass; ’,and in those in which the redness does appear, it is often too ’,late to save the patient. The inflammation resulting fromthese punctured wounds is too prone to terminate in slough-ing, instead of suppuration of the cellular tissue; the con-dition of which, however, will vary with the constitution andstrength of the patient; sometimes being thickened andindurated, as in the case related above; sometimes honey-combed, and the matter contained in distinct cells; sometimesbroken down into shreds, and floating in unhealthy, opaque,serous fluid, and at others, as in the last case, the inflammationat once passes into a state of sloughing. It is to the benefitof the patient that the incisions precede rather than followthe three latter conditions of the cellular t,issue; but when wemake these incisions, we should be most careful to avoid lossof blood, and never leave the patient until we are convincedthat all tendency to haemorrhage has ceased, as individualshave been lost from inattention to this precaution.When we have reason to suspect the inoculation of poison,

where the patient suffers from general constitutional irrita-tion, his whole body should be carefully examined, andincisions made where hardness and pain on pressure arediscovered, even where such indications present in regionsremote from the direct line of absorbents leading from thepoint of inoculation; but where the connexion is direct andcontinuous, as between the subclavian regions and finger,there cannot be a doubt of the propriety of early incision.A gentleman scratched the finger of his left hand against thesharp end of a rib at a post-mortem. In the course of threeor four days, constitutional symptoms set in, and unhealthysuppuration took place in the axilla and leg of that side, thecellular tissue of which was broken down, and floating inopaque, unhealthy serum; incisions gave temporary relief, butthe next day the constitutional symptoms were as bad as

ever; a further examination disclosed a collection of matterin the right or opposite thigh, which having been discharged,the constitutional irritation subsided, and the patient ulti-mately recovered.In connexion with incisions, the irritative fever should be

combated by opiates and good diet; there is always greatdepression of the nervous system, rendering the patient veryunequal to the copious discharge and consequent drain; but,to be of service, the support and stimulant should be of thesame character as that to which the patient has previouslybeen accustomed,-brandy will not supersede gin-gin, beeror wine, or the reverse. And this may in some degree accountwhy, in some instances, the stimulating plan fails of success.A very interesting instance of this occurred in the treatmentof the case last alluded to.The patient was as bad as he well could be-pulse running;

tongue brown and dry; constant restlessness, watchfulness,and picking the bed-clothes ; with intense thirst, and occa-sional wandering delirium. He had been in the habit ofdrinking large quantities of porter ; and accordingly porterboth draught and bottled had been ordered, with the occasionaladdition of small quantities of brandy, but without producingany apparent improvement on the pulse or general symptoms;and indeed, his case appeared hopeless; but, upon inquiry, itwas ascertained that, for the previous month or six weeks,he had been constantly rowing on the river as one of a club,and that upon these occasions he was accustomed to take abeverage composed of ale and gin ; accordingly, as a forlornhope, a bottle of ale was sent for and mixed with a glass ofgin, and he drank the principal part of it; in the course ofan hour he was more composed; his pulse became quicker,and he obtained some sleep ; and from this time lie graduallyimproved. The case of a porter at one of the club-houses,equally proves the importance of attention to this fact. Heaccidentally cut through the ulnar artery in washing a bottle.He was admitted into the hospital, and both ends of theartery were secured. Extensive sloughing of the forearm

ensued ; during which the radial, which had a superficialdistribution, gave way, and most alarming haemorrhage ensued.This was controlled and the vessel secured, but the sloughingprocess still continued. Ale, gin, porter, bottled stout, &c.,were each allowed, but with no effect. The sloughing wenton, and the patient got worse ; until he craved for some ofthe table-ale from the club-house where he worked. Hiswishes were kindly complied with; immediately it arrivedhe drank a good draught, and the next day was manifestlybetter. A fresh supply was sent daily. He recovered, andresumed his situation at the club.

NEWCASTLE-ON-TYNE INFIRMARY.CASE OF PROLAPSUS RECTI SUCCESSFULLY TREATED BY LIGATURE.

(Reported by Mr. H. M. GREENHOW.)

JANE C-, aged three years, admitted under the care ofT. M. Greenhow, Esq., April lst, 1850, with prolapsus recti oftwo years’ duration. The protruding portion of rectum is threeinches in length, and presents a formidable appearance, themucous membrane being much swelled, thickened, and injected ;its reduction has been twice effected, but it appears as thoughthe abdomen will not contain it, for each time intense painwas experienced, and after a few hours it returned to its oldposition. To take, at bed-time, four grains of mercury-and-chalk, and castor-oil in the morning. To apply a lotion ofcamphor mixture, with di-acetate of lead and tincture ofopium, to the part.

April 3rd.-An attempt was made to reduce the protrudedintestine, which proved ineffectual. Continue lotion.

5th.—Suffering from the irritation induced by the attemptat reduction. Continue lotion.

! 9th.-An operation having been determined on, and thechild having been placed under the influence of chloroform,Mr. Greenhow passed a long suture-needle, armed with a stoutdouble thread, antero-posteriorly through the gut. One liga-ture was firmly tied.on each side, so that complete strangula-tion was affected. The tumour was then freely touched withpotassa fusa, a compress of lint applied, and the child removedto bed, without having experienced the slightest pain.

10th.—The patient is comfortable. The part appears to becompletely strangulated. To be again touched with potassafusa.llth.-Doing well. The bowels not having been opened

since the operation, to take a dose of castor oil.13th.-The child remains well, and the part is separating.

Again touched with potassa fusa.14th.—The ligatures having become loose, fresh ones were

introduced as before. To use a lotion of the chloride of lime.20th.-The ligatures again replaced. To apply a lotion of

sulphate of alum.21st.-The ligatured portion has come away; the gut has

a tendency to protrude, but is easily restrained by a compressand bandage.23rd.-The intestine is retained in the abdomen. Slight

discharge and ulceration of the nates. Compress to be reap-plied.May lst.-The child has had an attack of purging, which

lasted three days, but the rectum remains in the abdomen.The purging has been checked by mercury with chalk, andpowdered rhubarb.3rd.-No complaint. The gut does not protrude in the

slightest degree. The ulceration is entirely healed. Themotions are passed easily and without pain. The child walksand sits with comfort, which it has been unable to do for along time past. Dismissed cured.

Reviems and Notices.

A Universal Formulary, containing the Method of Preparingand Administering Officinal and other Medicines ; the wholeadapted to Physicians and Pharmaceutists. By R. EGLES-FELD GRIFFITH, M.D. Philadelphia, United States: Lea& Blanchard, 1850. 8vo, bound, pp. 567..Tais is a very useful work, and a most complete compen-

dium on the subject of Materia Medica. It comprises, in ad-dition to the formularies of the United States Pharmacopoeia,the most important derived from those of Great Britain andthe continent of Europe, all written in our vernacular tongue,