vein by the needle; but this, which was originally introduced by Velpeau, as being the most simple, is that which I have always adopted. The length of time which it will be necessary for the needle to remain will depend on whether it is intended simply to excite suppuration, or to ulcerate out; the last being the course which I have usually followed, as in one or two instances, in which the needle was withdrawn after exciting suppuration, the obliteration of the vein was found not to have been effected. This plan has, however, been objected to as leaving a sore difficult to heal afterwards; but in only one instance have I seen it attended by any such result. For the needle to ulcerate its way out, the time usually required will be from a week to ten days; but it will vary greatly according to the state of the part in which it is applied: in the immediate neighborhood of an ulcer, where the skin is thin and inflamed, a day or two will often suffice to commence the ulcerative action, and three or four for the needle to escape; while, when inserted some distance from the seat of disease, and beneath sound integument, the process will require ten days, a fortnight, or even longer. Thus, in a case lately under my charge, where the needle was inserted beneath a tender sinus on the instep, leading to a small ulcer about an inch above, it ulcerated out in three days: while at the same time, in another case, a needle was placed under each saphena, and one beneath the common vein, at their point of union; the needle on the anterior branch was not removed till the twelfth day, and the other two not till the nineteenth. I have since seen two instances in which the needles were retained till the end of the third week. Generally speaking, when inserted over a bone, they excite ulceration more rapidly than when upon soft parts; and I am inclined to think that, in the last situation, they are more apt to give rise to an undue degree of inflammation; at least, in the only two cases in which their application was followed by troublesome abscesses, they had been inserted beneath sinuses in the calf of the leg. Considerable pain is sometimes excited by the operation, but it usually soon subsides; and I have not, in any instance, known tenderness to extend in the course of the vein above two or three inches from the point of constriction; and in none has it resisted ordinary treatment: indeed, in no instance which I have seen have any serious symptoms resulted from the operation.

The cases in which I have found this treatment applied have been in small irritable sores remaining after the bursting of large varicose sinuses, inveterate ulcers connected with a generally enlarged condition of the veins of the limb, and œdema of the leg and ankle, either simple or attended with a serous discharge from the skin; and in all of the cases but two in which I have seen it had recourse to, the results have been most satisfactory; and in these, as only one needle was inserted, and other sinuses were left unobliterated, success was hardly to be expected. The number of needles which I have generally seen inserted has been three or four in each limb, but, in some instances, five or six have been applied; the rule adopted having been generally to insert in a case of varicose ulcer one under each enlarged vein an inch or so below the ulcer, and again on each trunk a few inches above it, selecting for the points of their insertion the largest sinuses. Sometimes I have adopted the plan mentioned by Mr. Dodd, of placing on each vein two needles an inch or an inch and a half apart, so as to effect adhesion of the sides of the intervening tract; and in these cases the main

trunk will, after the cure is effected, be often found contracted to a firm cord up to the point at which the next large vein communicates with it; while, where a single needle only is inserted, the portion of the sinuses around is often not affected by the operation.

The effect produced on the sore by the obstruction to the course of the large veins in connection with it, is often most rapid; the inflamed margin gradually subsides, the edges become depressed, granulations spring up, and cicatrization quickly proceeds; and sores which have been liable to bleed entirely lose that tendency, the granulations becoming firm. I have, however, observed what has been noticed before by Mr. Dodd, that the healing process was not equally rapid throughout, the good effect produced by the needles sometimes gradually subsiding, and considerable difficulty being experienced in obtaining the entire healing of the sore.

In this way ulcers which had long been under treatment, without deriving any advantage, have, in several instances, been cured, and others which were found to return as soon as the patient resumed his work, have, by the aid of a laced stocking, been kept healed; indeed, not only does it appear to be a rapid method of effecting the cure of these cases, but I am inclined to regard it as also a more permanent one. The first case in which I made trial of the practice was one of œdema of both legs, attended with excoriation of the skin, and a fœtid discharge, connected with a very varicose state of the large veins. The man, by trade a rope-maker, had been repeatedly under treatment before with very partial benefit; and no sooner did he resume work than the disease returned. On this occasion he had been subjected to the ordinary treatment during a month that he had resided in the Infirmary, but with little or no advantage. Under these circumstances, as the case seemed to offer a fair opportunity for treatment with the needles, three were inserted beneath large sinuses in one leg, which was nearly well before the same plan was adopted in the other. He was discharged, entirely cured, on needles being introduced in the other limb, in six weeks from the commencement of the treatment. Two years have now elapsed, and he continues perfectly free from any return of his complaint. Of two men one had suffered from varicose ulcers on both legs for nine years, the other for five; and both had been several times under treatment in neighboring infirmaries, but no sooner did they return to their work, that of cotton-spinning, than the ulcers again broke out. Seven needles were inserted in the legs of one, and three in the other; and both were cured, one in seven, the other in three weeks, and continued so for at least four months, during which I had an opportunity of noticing them. Indeed the absence of any pain, swelling, or weakness in the limbs, which they said, as healed before, they had always found to continue, and the sound appearance of the cicatrices, afforded a fair prospect of permanent cures having been effected. The state of the limb afterwards, and the pale, healthy-looking cicatrices, form a great contrast between cases treated by this and by the ordinary methods. I had a case recently under my charge, in which an ulcer, fully the size of the palm of the hand, was entirely cured in a little more than a month, and this notwithstanding that copious suppuration was excited by the needles in the cellular membrane of the calf of the leg. This patient had previously been subjected to treatment for four months with every advantage of circumstances for the cure of

a sore in the same situation; and the case was further interesting as being attended by severe pain in the sole of the foot--an occurrence which was met with in one of Mr. Dodd's patients-and having been an old man of seventy; while Bonnet, in an essay on this subject published in Paris, has stated that the operation will not be successful after the age of sixty, in consequence of the indisposition of the blood to coagulate, and that it should not be attempted. I heard of the man several months after his discharge; he was following his work, and his limb continued sound. I regret that, in consequence of most of the patients on whom the plan was tried in the Infirmary residing at a distance, I am not able to speak of them after they left the Institution.

The above remarks were written more than twelve months ago. I have now nothing further to add than that additional experience fully confirms the opinion expressed of the safety and rapidity of the cure of disease dependent on varicose veins, by the plan referred to, and I have reason to regard it as also a permanent one, care being of course taken to support the limb by a laced stocking or bandage, as otherwise the same cause which first gave rise to the varicose condition of the veins will lead to the dilatation of fresh ones.-Lon. Med. Gazette.

Reduction of a Strangulated Hernia, apparently effected by Acupuncture. By DR. DASER.

A MAN, fifty years of age, was seized with strangulated hernia, with vomiting of stercoral matter, and all the other usual symptoms. The taxis having failed, Dr. Daser, before having recourse to the operation for strangulated hernia, with the view of trying the effect of acupuncture, for the purpose of evacuating the gaseous contents of the strangulated portion of intestine, made two punctures in it with a long fine needle. No gaseous matters apparently escaped, but the patient complained of acute pain, and loud gurgling sounds were heard in the abdomen, immediately after which the hernia was spontaneously reduced. Dr. Daser attributed this fortunate occurrence to the prick of the needle having excited contractibility of the intestine, causing it to contract on its contents, expel the gaseous matter into the abdominal portions of the gut, and thus facilitate its reduction.— Journal fur Chirurgie und Augenhetlkunke, 1840.

Hæmorrhage after Lithotomy stopped by Creosote. By DR. DASER.

In a case of lithotomy it was found impossible to arrest the hæmorrhage by any of the usual means, and no particular vessel could be discovered from which the blood might flow. The patient was at last reduced to the lowest ebb from the continued loss, and had already lost consciousness, when a sponge dipped in pure creosote was introduced into the wound, and pressed against the bleeding parts for an instant or two. The hæmorrhage was immediately arrested. No particular pain was experienced, no unpleasant symptoms followed: thin eschars were thrown off, and the patient recovered.—Ibid.

Operations for Wry-Neck.

THE following case of wry-neck is taken from a paper by J. Nottingham, Esq., late House Surgeon to the Liverpool Infirmary. The paper also contains notes referring to three cases of division of the tendo Achilles in pes equinus complicated with injuries of the hip joint in childhood and permanent limitation of motion in that joint; the club-foot being, in each case, the consequence of the injury to the hip. As the simple statement of this complication contains all that is particularly interesting to the surgeon in the paper, we will merely add that two of the operations were speedily successful in restoring the foot to its proper position; thus rendering the limb more useful. The results of division of the sterno-cleido-mastoid muscle, together with the character of the changes effected in the cervical vertebræ by their long continued mal-position in torti-collis, is a question on which we have fewer lights of experience; and for this reason we give the case, which was a mild one, in the words of Mr. Nottingham.

Mary Sesnan, aged twelve years, has had wry-neck since she was twelve months old, for which the mother cannot assign any cause; the distortion is considerable, and she complains of inability to move the head with freedom.

The sterno-mastoid of the right side is in a state of permanent contraction; the right ear pulled down towards the corresponding shoulder; the chin twisted to the opposite side; the distance between the meatus of the ear and the top of the sternum is much less on the right side than on the other. It is the true sterno-mastoid, not the clavicular portion of the muscle, that is contracted.

A sharp-pointed, narrow bistoury, was passed under the affected muscle from within outwards, a little below the crossing of the omohyoideus tendon, its edge then directed towards the skin, and the sternal portion of the muscle divided. Its section was accompanied by a sensation communicated to the finger more or less like that the surgeon perceives when the tendo Achillis is cut across.

We immediately observed a difference in the position of the head, and on the affected side it was obvious that the distance between the top of the sternum and the meatus of the ear was about an inch and a half greater than before; but it was thought that further improvement might probably be effected by another division of the muscle near its attachment to the mastoid process, which was made by gliding the bistoury under the integument and cutting down upon the bone. The effect of this section was not so great as that produced by the first.

A little adhesive plaster was applied over the punctures, and two or three turns of a roller round the neck.

It is now five weeks since the muscle was divided; the head can be turned to either side with facility, and the distortion is much diminished; the cervical vertebræ, however, long accustomed to peculiar position, do not at once retain the improved direction, which, by a little artificial support, can be given to them. The patient expresses herself with satisfaction respecting the “easy” manner in which she can now move and hold her neck.

Since the report of the division of the sterno-mastoid was written, improvement has gradually taken place in the neck of the patient; and we have every reason to be satisfied with the results of the operation.-London Lancet, Nov 6, 1841.

MISCELLANEOUS.

Researches into the real Constitution of the Atmosphere. By M. M. Dumas and BOUSSAINGAult.

It is generally admitted that the air is composed of a mixture of oxygen and nitrogen, and its invariableness is explained by supposing that the green parts of plants under the influence of solar light decompose all the carbonic acid developed in the respiration of animals, and the putrefaction of organized bodies. Some, however, regard the air as being not a mixture, but a chemical compound of 20 of oxygen and 80 of nitrogen, (Prout, Dobereiner, Thomson, &c.) Others, and these the majority, consider it as a mixture of 21 of oxygen and 29 of nitrogen; and, lastly, in the opinion of some, (Dalton, Babinet,) the composition of the air varies according to the height in the atmosphere.

The plan employed by the authors in submitting these questions to a fresh examination is distinguished from others in that they estimate the weight instead of the measure of the gases, and thus analyze the air by weighing successively the oxygen and the nitrogen which it contains. We cannot follow them into all the details of their experiments, which, by successive corrections, were rendered more and more exact: we can only point out the results.

They fix the density of oxygen at 1.1057, and that of nitrogen at 0.972; numbers a little different from those given by other chemists. They demonstrate that the relation of the volume of the oxygen to that of the nitrogen in the air is not expressed by simple numbers; and that the air cannot be regarded as a chemical composed of 20 volumes of oxygen and 80 of nitrogen. They admit, as a suffificient approximation, that the atmosphere is composed, by volume, of 20.8 of oxygen, and 79.2 of nitrogen. They presume that the mixture is uniform in all times, in every latitude, and at every height. "If the atmospheric air," they add, "is a reservoir of oxygen for the use of animals, and a reservoir of carbonic acid for the use of plants, it is so considerable a store that the consumption, supposing it not to be compensated, would remain almost insensible after a long series of years." They have calculated that supposing each man to consume a kilogramme of oxygen per day, and that the oxygen disengaged by plants did no more than compensate for the other causes of its absorption, the whole human race, and three times their number, would not consume, in a century, the eight-thousandth part of the oxygen which nature has placed in the respirable air.-Lond. Med. Gaz. Oct. 15, 1841, from L'Examinateur Medical, Aout 20, 1841.

Homœopathy Exposed.

THE papers have been circulating the following paragraph:

"The Duke of Canizarro died from taking three pills at once, ordered to be taken singly, either through his own mistake, or through that of his homeopathic physician, and that these pills contained arsenic. Thus we see a nobleman, in the enjoyment of a large fortune, dying, poisoned like a rat. Considering these pills were prescribed in conformity to homeopathic practice, in which only milVOL. II.-No. 4. 15