parisian medical intelligence

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to the case of a "Peculiarly Furred Condition of the Tongue in IDisease of the Bladder," which appeared in your " Mirror ofHospital Practice," published in THE LANCET of Nov. 9th :-Jonathan F-, aged sixty-eight, a collier, was an out-

patient several times during a period extending over threeyears. He invariablv complained of the same thing, difficultyof micturition. His bladder was extensively diseased, and hisurine under the microscope showed blood- corpuscles and cysticepithelium in large quantities. What, however, more espe-cially drew my attention to this man’s case was the "peculiarlyfurred condition of his tongue." This organ was constantlycoated with a thick brown fur, extending along the dorsum towithin an inch of the tip, in a triangular form. Examinedwith a simple lens, it had all the appearance of "rat’s" hair. I,It was most tenacious, and from the man’s own account, whichI had no reason to doubt, was persistent. Unfortunately 1 didnot examine it with the microscope, and consequantly cannotsay whether it contained any vegetable growths or not. Theman’s health, with the exception of the urinary affection, wastolerably good, bowels regular, digestion active, &c. No re-medies seemed to have the slightest effect on the condition ofthe tongue. I had the opportunity of watching this case forupwards of three vears, and the "fur" invariably continued ofthe same colour and consistence.

Tremain- Sir. vnnrs. &c.,

Ripley, November, 1861. J. ALLEN, M.R.C.S.L.

THE MEDICAL ASSISTANTS’ BENEVOLENTASSOCIATION.

To the Editor of THE LANCET.SIR,—I am persuaded by the praiseworthy letter of " A

Surgeon" that the above Society is viewed favourably by prin-cipals, but I must say it somewhat surprises me that themajority of them are blind to the benefit this Association mustultimately be to them individually ; this, however, is evident, orwhy do so few enroll themselves as honorary members? Butas it is just possible that many, though they may have thoughtfavourably of the Society, have been unable, from want of suf-ficient time, to see into the "interior," I will not say anythingfurther about their apparent backwardness; but I must addthat I sincerely trust the letter above alluded to, coming as itdoes directly from a principal who has carefully perused a copyof the rules of the Society, will be sufficient evidence not onlyof the sound principles the committee intend to work upon,but also of the great utility such an Association must of neces-sity prove to those who become connected with it, especiallyprincipals; for, be it remembered, it is impossible for any per-son to become a member who cannot produce such certificatesof gentlemanly conduct from his present or last employer asshall satisfy the committee that he has behaved himself in amanner becoming a member of the profession; and hence thecertainty that must ultimately exist of obtaining a gentlemanlyassistant by applying to the secretary of this Association.In conclusion, I am permitted to say (by authority of the

honorary secretary, Mr. Monckton) that arrangements willshortly be made to carry out the valuable suggestions of yourcorrespondent.

I have much pleasure in being able to state that seldom aweek passes without an addition to our number of members.

I am, Sir, yours obediently,Nov. 27th, 1861. A MEMBER.

PARISIAN MEDICAL INTELLIGENCE.

(FROM OUR SPECIAL CORRESPONDENT.)

M. BOUSSINGAULT read a paper of interest at the Academyof Sciences last Monday, on the subject of vegetable respiration.This communication embodies the details and results of a seriesof experiments made by the author with a view to ascertainthe precise nature of the gases eliminated from the atmosphereby the green tissues of plants under solar influence. The con-clusions arrived at confirm, in a measure, those already ad-vanced by De Saussure, Bonnet, Priestley, Ingen-Houtz, andSennebier, and may be briefly enumerated as follows :-Of theoxygen formed during the decomposition of carbonic acid gasby the leaves of plants in sunlight, part is set free and part isabsorbed by the roots. During the process, in addition to theevolution of oxygen, two inflammable gases, the oxide of carbon

and the protocarburet of hydrogen, are developed; such atleast were the products obtained from plants placed in the raysof the sun, and under water charged with carbonic acid gas.In thus announcing the formation of one of the most deleteriousgases known, the oxide of carbon, by the action of the greentissues of plants upon the atmosphere, M. Boussingault con-trasts his conclusions with those of Priestley, which went toprove the disinfecting and renovating action of vegetable respi-ration, and points to his discovery as likely, at no remote

period, to assist in the detection of the mysterious principle ofmarsh malaria.

, M. rrousseau commenced his course of clinical lectures a fewdays back, at the Hotel Dieu, by some observations on rheu-matoid arthritis, and its amenability to treatment by the in-ternal exhibition of large doses of iodine tincture. Of the twocases which served as text for the discourse, the one was thatof a female, the other a male. The former, a woman aged forty,of feeble constitution, a sempstress by profession, and conse-quently ill-lodged and ill-fed, had stated that no member ofher family had ever suffered from gout or rheumatism, and thatshe herself, previously to the commencement of her presentmalady, had never been seriously unwell, except on one occa-sion, and that eight years ago, when she had scarlet fever. Thelecturer here reminded his audience, that there does exista form of " rhumatisme scarlatin" less severe and less tenaciousfor the most part than ordinary rheumatism, and unaccom-panied by the same train of general symptoms. Another cir-cumstance in the history of this patient noticed by M. Trousseauwas the existence of violent periodic headaches, associated withnausea and vomiting. Such headaches, remarked the Professor,are frequently observed in females affected with rheumatoidarthritis, and remind one of a similar predisposition common togouty men. They are indicative of the existence of the specialdiathesis, and persons who in early life suffer thus, very gene-rally towards its decline experience symptoms of either gout orrheumatism. In the present instance, the articular affectioncommenced when the attacks of cephalalgia began to diminishin violence. The malady first showed itself two years ago,and has since that period progressed steadily without the oc-currence of febrile reaction. The movements of the knee-jointswere first impeded; walking was found to be difficult, in themorning more especially, the stiffness disappearing as the dayadvanced; the wrists then became affected, and later the wholehand, and subsequently nearly every articulation in the bodywas implicated, until the poor creature, become perfectly help-less, presented herself for admission into the hospital. Afterthree months’ treatment by the tincture of iodine, in dosesvarying from twenty to sixty drops daily, a striking ameliora-tion, as evinced by a return of mobility in the joints of thehand, has been attained. In detailing the case of the malepatient, M. Trousseau observed that this malady is compara-tively rare in men, and that in nine cases out of ten thoseattacked are females--a circumstance affording fresh evidence,if such were wanting, that this complaint has nothing to dowith gout. This man, now an attendant in the hospital, wasadmitted seven years ago into the wards as a patient. Thedisorder had followed much the same course in this instance asit had done in the other; its subject had been bedridden forseven months, being bent double and unable to rise. He wasunder treatment for three years. At the end of the first twelve-month he was sufficiently well to undertake the duties of man-nurse, and since that time has remained at the Hotel Dieu inexercise of these functions. The amount of iodine swallowedin this case has been simply enormous; during one year he tookfull doses of the tincture, gradually increased up to a drachmand a half daily, and this without the slightest detriment tothe digestive functions, or other untoward effect. "In rheu-matoid arthritis, observed M. Trousseau in conclusion, "youwill seek in vain for any cardiac lesion, and even in those casesof the longest standing, where patients for twenty years havebeen coerced by this malady into almost total immobility, notthe slightest pathological change can be detected in the heart."

In a subsequent lecture, the same physician has registered aprotest against the indiscriminate use of blisters for the reliefof chronic bronchitis and other obstinate complaints, basinghis objections upon their tendency to set up in debilitated con-stitutions ecthyma, furuncles, anthrax, erysipelas, and suchother complications as are often sufficient of themselves to

jeopardize the patient’s existence.Dr. Marion Sims, the American surgeon, whose skilful per-

formance of the operation for vesico-vaginal fistula I mentionedas having excited much attention at Paris, after a practicalillustration of his method at the Charite last week, gave, atM. Velpeau’s special request, a clinical lecture on the subject.

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" The principal points," said this gentleman, "in which mypractice differs from that usually pursued at the present day, I I

may arrange as follows : 1st, as regards the position of thepatient; 2nd, as concerns the manner in which I pare the-edges of the fistula; and 3rd, the number of sutures I apply,and their distance from the lips of the wound.

" In the commencement of my practice I was in the habit ofplacing my patients on their knees and elbows, the head beingdepressed and the pelvis raised. This posture I abandoned ;it presented two great disadvantages-one in rendering theadministration of chloroform impossible or nearly so, the otherin fatiguing the operator by obliging him to remain standing.I now place my patient on her left side, her thighs flexed ata right angle with the pelvis, and maintain the upper part ofthe trunk in pronation, with the sternum towards the bed ortable, on which there must be neither pillow nor cushion. Bythis position of the trunk the organs of respiration are notcompressed, nor are the abdominal viscera pressed into thepelvis so as to displace the bladder or vagina. The speculumof which I make use has a special form; its blades curvetowards each other so as nearly to meet at their distal ex-tremity, an arrangement which prevents the possibility ofinjury to the vaginal coats. 1 divide the operation into threestages: 1st, the paring of the lips of the wound; 2nd, thepassing of the ligatures; and, 3rd, the adjustment and torsion ofthe metallic sutures.

" For the first stage four instruments are requisite-a pairof straight or curved scissors, a bistoury, a tenaculum, and apair of forceps. With the tenaculum I seize the vaginalmucous membrane near one of the angles of the fistula, and withthe bistoury slightly incise the vaginal mucous membrane.Raising this tissue with the tenaculum, I with a pair of straightscissors cut through the whole thickness of the edge of thewound down to the vesical mucous membrane, which it is all-important to avoid wounding. I then proceed to attack aneighbouring portion, and so on until the whole surface isDared.’ 66 In the second stage I use a tenaculum, catch-forceps, andneedles threaded with a double silk, having a loop at oneextremity. Raising a lip of the wound with the tenaculum,and holding the needle by means or the forceps, I insert it intothe tissues near an angle of the fistula, at about a third of aninch from the free margin of the wound, taking care whenbringing it out not to include any of the vesical mucous mem-brane. Guiding the point of the needle on the tenaculum, Iwithdraw the forceps, and draw the point forwards by re-applying the instrument to that extremity. In reapplying theneedle in order to complete the stitch, I commence in thesame way from the lip of the fistula, and cause the needle toemerge at a distance of a third of an inch from the wound.When one suture is thus complete, I hitch both ends into anotch made in a light piece of stick until required, and proceed.The needles, which are nearly straight and fine, should beintroduced obliquely, for fear of wounding the vesical mucousmembrane; and the stitches should be five, six, or even morein number. When all are in situ, I take the loop of the first,pass through it a silver wire, which I twist so as to be securelyfastened, and by gentle traction substitute for each silk sutureone of silver wire.

" In the third stage, the operation is completed by thetwisting of the silver threads or wires. For this purpose Ihave a small metallic conductor, furnished at its extremitywith a square plate somewhat similar to the handle of thecommon grooved director. Into the fissure of this instrumentI insert the two ends of one of the silver sutures, and givea gentle twist to draw the thread tight; which done, theends are to be cut so as to leave a length of about two-thirdsof an inch in connexion with the wound; these I bend back ata right angle, so that the force of the torsion may not act uponthe lips of the fistula but on the wires only, and then completetheir fastening by a few more twists with a forceps.

" Before carrying back the patient to bed, a catheter mustbe introduced; this instrument is shaped like an S, and itsvesical extremity is pierced with little pin-holes. The bladdershould be first washed out with an injection of water, and thecatheter left in situ and changed at least twice a day. Thediet must be generous, and the administration of morphia indoses sufficient to produce constipation is indicated; a quarterof a grain being given twice, the first dose immediately afterthe operation, and the second at night. The sutures may beremoved on the eighth or ninth day; for this purpose thetwisted end is drawn forward by the forceps until the partwhich has been united is brought to view, and then only is thesilver wire to be divided. These details," added Dr. Sims,

" may seem minute and elaborate, but I believe them all-im-portant, more so than the skill of the surgeon or the brilliantmanner in which he may achieve the operation."

Paris. Dec. 3rd. 1861.

Medical News.APOTHECARIES’ HALL.-The following gentlemen passed

their examination in the science and practice of medicine, andreceived certificates to practise, on the 28th ult. :-

Belemore, Alfred John, Harlesdon, Middlesex.Brown, John Woodruffe, Wymeswold, Loughborough.Brfinjes, Martin, London Hospital.Hedley, Edward Anthony, Felton, Northumberland.Rendle, James Davy, Beaminster, Dorset.Tibbets, Edward Thomas, Uttoxeter, Staffordshire.Watts, Edward, Liverpool.

ROYAL COLLEGE OF SURGEONS, EDINBURGH. - Thefollowing gentlemen passed the examinations, and were ad-mitted Licentiates of the College, during the recent sittings ofthe Examiners :-I Bullen, Francis Dennis. Cork.I Chain, Alexander, Co. Down.

Gubbin, Hugh, Co. Down.

ROYAL COLLEGE OF SURGEONS OF ENGLAND. -Ata special meeting of the Court of Examiners of this institutionon the 30th ult., Mr. JAMES EDWARD FAWCETT, of H.M.’s shipClzescepeake, passed his examination for Naval Surgeon. Thisgentleman had previously been admitted a Member of theCollege, his diploma bearing date July 25th, 1855.The Council of the Royal College of Surgeons have expunged

from their list of members the names of John Nichol Watters,of 110, Dover-road, tried at the Central Criminal Court, OldBailey, and sentenced to eighteen months’ imprisonment, withhard labour, for conspiracy to defraud; David Griffiths Jones,of Woburn-place, now undergoing one year’s imprisonment inthe House of Correction, with hard labour, for wilful andcorrupt perjury ; and Daniel de la Cherois Gourley, imprisonedfor six months for breach of trust.

THE BLANE MEDALS.-Two gold medals, founded by thelate Sir Gilbert Blane, have just been awarded to ChristopherKnox Ord, M.D., of H.M.’s ship Hermes, and to Mr. WilliamMacleod, of H. M.’s ship Madagascar.ELECTION OF PROFESSOR OF CHEMISTRY AT THE UNI-

VERSITY OF CAMBRIDGE. - Yesterday (Friday) the office ofProfessor of Chemistry in the University of Cambridge, vacantby the death of Professor Cumming, was filled up by the ap.pointment of Mr. Liveing, of St. John’s College, Lecturer onChemistry, and a distinguished member of the University.There was no other candidate.

THE ALARMING DEATH-RATE IN CHELSEA.—On Tuesday,at the District Board of Management, Dr. Barclay, medicalofficer of health, in his usual sanitary report, made the follow-ing statements with regard to the increased number of deathsin this district:-" The general mortality of the parish hascontinued to increase during the last few weeks, and now con.siderably exceeds the average. On the 12th October the deathsnumbered 54; on the 26th they were 57; on the 9th Novemberthey amounted to 70; while on the 23rd they had reached 82.The corrected average for the last fortnight is 69. During thegreater part of this time the mortality from scarlet fever hasbeen stationary, and very much beyond the ordinary rate. Onedeath from diarrhoea has been recorded, 3 from whooping-cough,and 3 from fever. Those from pulmonary affections, owing tothe recent changes in temperature, form a very considerableproportion of the whole mortality. They number 33 altogether,of which 17 were from consumption, 11 from bronchitis, 3 fromcroup, and 2 from inflammation of the lungs. Infantile mor-tality has been low. Amongst elderly persons, 6 were over 80years of age, and 2 in their 90th year. The births, notwith-standing the high death-rate, were 18 in excess of the deaths."THE DUBLIN LYING-IN HOSPITAL. - The customary

seven years’ service having expired, Dr. M’Clintock retiresfrom office. He retires cheered with the warmest regards ofthe authorities of this celebrated institution-one identifiedmore than any other with the progress of sound British mid-wifery,-and with the universal respect of his professionalbrethren. We shall, doubtless, in due time see the embodi-ment of his work in the issue of a report of the proceedings ofthe hospital during his mastership. His successor is Dr. J.Denham.