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head, accompanied with considerable tenderness of the toothand the gum around it. This condition may go on to suppura-tion of the pulp, or to abscess of the alveolus, and consequentdeath of the tooth. Leeches are here useful, conjoined withsome slight constitutional treatment.And, lastly, when we find a black, unsightly tooth lying

loose in its socket, with pain depending upon the irritationproduced by its presence, the cautery will be ineffectual, asthe tooth is in a true state of necrosis, ia quite dead, and hastruly become a foreign body; it must therefore be removed.This condition I have not unfrequently seen to depend uponthe use or abuse of mercury.

If a comparison be now instituted between the electriccautery, as I am in the habit of employing it for destroyingthe tooth-pulp, and the numerous other means recommendedto effect the same purpose, it will be seen that the balance ofmy confirmed judgment is entirely in favour of the former.Thus the great advantage of the cautery is, that the desiredeffect is produced in less time than a minute; whilst it takesdays, and even months, to accomplish destruction of the pulpby the various substances habitually in use: amongst thesemay be mentioned arsenic, used either alone or in combinationwith other substances, as, for instance, a mixture of equal partsof arsenic, morphine, and creosote ; chloride of zinc, in thesolid form, or a combination of it and chloroform ; cobalt,chloroform, creosote, gun-cotton, tannin, and tannate of lead.Nitrate of silver is used; or nitric acid on a gold wire. Manyother substances are employed. The nausea produced by theuse of chloride of zinc, or nitrate of silver, is particularly dis-agreeable. I have, however, the strongest objection to the useof arsenic, more so than to any other substance; and it is notwithout much thought on the subject, that I have come to theconclusion that it ought not to be employed in dental surgery.I have known instances in which this agent has been used, andthe most acute and severe pain-in fact, absolute torture-hasfollowed for several days, before stopping the cavity could beaccomplished. Besides the pain, there is also the dangerarising from its absorption. A few months ago a case of fatalpoisoning appeared in the journals, which depended upon itsabsorption after employment in a dental operation. Added tothe time required to destroy a tooth-pulp by these various sub-stances, there is also the mischief caused by their local appli-cation to the teeth themselves, which should not be lost sightof in the consideration of this question.Condusions.-I have now been in the habit of employing

the electric cautery for upwards of six years, and during thattime have used it in more than five thousand instances, withan amount of success that has surpassed my most sanguine ex-pectations, and without the occurrence of a single accidentworthy of mention. I may truly say, that there are very fewcases of toothache which cannot be relieved by it, when themembrane or tooth-pulp can be got at to destroy it. These

very few cases are the exceptional instances which have alreadybeen referred to. It has been held by writers on diseases ofthe teeth, that the impossibility of instantaneously effectingthe absolute destruction of the tooth-pulp in such teeth as aresituated at the back of the mouth, which possess severaldiverging roots, is a sufficient ground for rejecting the meanswhich were employed for that purpose-namely, the heatingof a wire, in the form of the actual cautery, which cannot atany time be maintained at a white heat. It was in conse-quence of this very great difficulty that the actual cautery hasfallen into disuse. Now the advantage which the electriccautery has over every other conceivable method is, that thewhite heat produced, and which cannot be obtained in anyother manner, effects the purpose desired suddenly and withcompleteness. Besides this, it can be applied with perfect easeand freedom to teeth situated in any part of the mouth withoutthe risk or danger of burning it-a risk almost impossible toavoid, with the greatest care, when the actual cautery orheated iron was employed.

It might be supposed, again, that some imaginary terror islikely to be excited in the patient’s mind, at the idea of theelectric cautery, in the shape of an incandescent body beingused for any purpose in the mouth. I can truly say, that inthe large amount of experience of its use which has fallen to mylot, that there is not the slightest ground for such a supposi-tion. If this be an objection to its employment, then it falls ito the ground, for I can call to mind no instance where this fear was manifested. Sometimes, as has been before men-tioned, the wire is introduced already heated into the mouth,when being applied to the tooth.

. At one time much dread of the actual cautery arose, fromthe burning of the mouth by the heated handle of the instru-

ment, which was unavoidably employed to keep the wire hot,and this occasioiaed, we believe, its comparative rejection inthis country. With the electric cautery such accidents areavoided ; I may say, they scarcely ever occur, in the hands ofany ordinarily skilful man, for, owing to the extreme finenessof the wire employed, the local heat, though intense, is verylimited in its action, and with due care the tooth substanceneed not suffer any appreciable injury. For the same reason,with the additional and more powerful one, of suddenly break-ing the connexion between the poles of the battery, no injurycan happen to the mouth or gums.

Such, then, are the uses and advantages of this valuableagent in dental practice, and so well known is it becoming to alarge number of the public, that a considerable proportion ofmy patients come recommended to me by medical men andothers, for the express purpose of cauterization by it.

In March, a lady, to two of whose teeth I applied it insteadof extracting them, writes to me, " Neither of my teeth havegiven me the least uneasiness. I am sure I have much to thankyou for. Now, one need not fear the approach of toothache;we are so much more favoured than those who lived a hundred

years ago." These two teeth were, I may observe, cauterizedand stopped at the same sitting.I I can now with still greater confidence, and much larger ex-perience, lay this most valuable and efficient remedy before thenotice of my professional brethren than I did in 1851. Verymany years’ constant trial have only further convinced me, thatfor ingenuity, simplicity of contrivance and application, nothingthat has hitherto been invented can surpass it. And I againconfidently leave it in their hands, gladly availing myself of myconnection with the College of Dentists, as one of its members,as a medium of doing so.Park-square East, Regents-park, 1S57.

A MirrorOF THE PRACTICE OF

MEDICINE AND SURGERYIN THE

HOSPITALS OF LONDON.

CHARING-CROSS HOSPITAL.

BITE OF THE THUMB FROM THE COMMON VIPER, (COLUBERBERUS;) EXTENSIVE SWELLING OF THE ENTIRE ARM, WITHCONSTITUTIONAL SYMPTOMS; RECOVERY.

(Under the care of Mr. CANTON.)

Nulla est alia pro certo noscendi via, nisi quam plurimas et morborum etdissectionum historias, tam aliorum proprias, collectas habere et inter se ccm-parare.-MORGAGNI. De Sed. et Caus. Morb. lib. 14. Proœmium.

IT is not often that an opportunity is afforded in our Londonhospitals for studying the effects of the bites of serpents, yetsome very remarkable instances of a fatal character have pre-sented themselves at different times, which have been inflictedby snakes in our menageries. Fortunately, in this temperateclimate the species of our venomous reptiles are very few, com-prising only the common viper, or adder, the Coluber Berus ofLinnaeus, or Pelius .Berus of Merrem. The other varieties ofthe snake in Britain are perfectly harmless, and free from anypoisonous quality whatsoever, not possessing any tabular fangsor teeth, or poison glands, which render other families so fear-fully formidable.Our readers may recollect the instance of rapid death which

occurred to a keeper in 1852, from the bite of the hooded snake(cobra de capello) in the menagerie of the Zoological Gardens,Regent’s-park. At the time the occurrence created very greatsensation, both amongst the public and our own profession, be-cause the snake and keeper were well known to the visitors tothe Gardens. The community at large were greatly shockedby the death of this poor man, and we felt called upon to re-port his case, which came under Mr. Quain’s care at UniversityCollege Hospital. (THE LANCET, vol. ii., 1852, p. 397.)The bite of the common viper does not possess principles of a

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sufficiently energetic character actually to destroy the life of anadult, although we not uncommonly hear of children, or evenvery delicate and weakly persons falling victims to these bites.One of the best accounts of this reptile has been given by

Mr. Thomas Bell, in his work on British Reptiles, from whichwe take the following:-"The common viper is, happily, the sole British representa-

tive of the poisonous groups of serpents, and, indeed, the onlypoisonous reptile indigenous to this country. It is far morenumerous in Scotland than the common snake, and is found inabundance in all parts of England and Wales, frequentingheaths, dry woods, and banks. In Ireland it has never beenseen, and it may, almost with certainty, be stated that it doesnot exist there. Throughout Europe it is extensively distri-buted. It is everywhere deservedly feared on account of itsvenom, which, although less virulent than that of many otherspecies, is yet sufficiently so to produce severe symptoms, andsometimes, in the warmer climates, even fatal results. In thiscountry I have never seen a case which terminated in death,nor have I been able to trace to an authentic source any of thenumerous reports of such a termination, which have at varioustimes been confidently promulgated. "-p. 60.

We were under the impression entertained by most people.that cases of fatal poisoning from the bites of vipers had actuallyoccurred, especially in children, and we are confirmed in it orsearching the records of cases of poisoning by vipers. An ac

tually fatal case occurred at St. Bartholomew’s Hospital a femyears since, in which the pain and swelling of the arm werffollowed by erysipelas and sloughing. Felix Fontana describe:upwards of sixty cases of poisoning by the viper,* two of whiclwere fatal; in one of these gangrene set in in the wound on thEthird day, and death ensued in twenty days. But death ha;been known to occur from the bite of a viper in about thirtysix hours. These serious effects are, as we stated before, very rare, unless in children, and in the weak and delicate. Dr

Taylor mentions in his work on Poisons, that he saw a girl : -,few years since, who had been bitten in the lip by a cage(viper, an hour after the occurrence, the upper lip having swolleito nearly the size of the fist, producing great deformity. Somefebrile irritation was present, which disappeared in a few daysThe symptoms of the poisoning were very characteristic in MrCanton’s patient, who was seen three hours after the bitewhich was inflicted on his thumb whilst playing with th,animal. There was great pain,-whether smarting or burnin,the notes do not mention,-and swelling of the entire limb, thswelling not being oedematous, but of a peculiar puffy shiningnature, which sometimeswas so great as almost to burst the skinThe two minute wounds produced by the fangs were not to b

* Felix Fontana, Treatise on the Venom of the Viper, translated by JosephSkinner. Second Elition. London, 1795.

seen, but the course of the lymphatic vessels soon became redfrom inflammation, and there was corresponding constitutionalsuffering, such as depression, anxiety, sickness, and languor.The more dangerous and extremely urgent symptoms were notpresent, and without dwelling upon the case too much, we willobserve that they gradually subsided, although tedious, and agood recovery followed.Death from serpent bites may occur in two ways, either by

syncope from the great depression caused by the poison, thusresembling the effects of some of the narcotics, or else by ex-citing diffuse inflammation of the cellular tissue of the bittenpart. The latter would appear to be the common consequenceof the viper bite, the result more of the irritative effects of asmall quantity of poisonous matter; the poison sac rarely con-tains more than a grain and a half of a yellow viscous liquidwhich will destroy birds and small animals, but may be swal-lowed with impunity by man. The bite of the viper is imme-diately fatal to the smaller animals, but it requires the bites offour or five to kill an ox or a horse. Its bite is poisonous to itsown species, as we have actually witnessed in the rattle-snake.The influence of the poison of snakes is no doubt much greaterin hot weather, and dangerously active if speedily introducedinto the circulation through a small bloodvessel. The blood ofsmall animals destroyed by the venom of serpents is said byDr. Gilman to bear a close resemblance to that of animals de-stroyed by lightning or hydrocyanic acid, not coagulating, andsoon putrefying.We avail ourselves of the notes of the following case, taken

by Mr. Augustin 0. Applin, house-surgeon to the hospital :-G. S-, aged sixteen, was admitted on the 7th of June, 1857.

On the 30th of May he had a snake given to him, since whichperiod he had been in the habit of constantly handling it. Onthe above day he was playing with it, and it seemed morelively than usual, and as he was returning it to its box, it bitthe thumb of his right hand. This immediately began to swell,as did also his hand and arm, and it gradually increased insize, accompanied with great pain. This was shortly followedby sickness, depression, and headache. He applied to the hos-pital on the same evening, about seven o’clock, the accidenthaving occurred at four o’clock in the afternoon. Upon exa-mination, his thumb, hand, and arm, as far as the elbow, werefound considerably swollen. This swelling was of rather a pecu-liar character, being shiny, tense, and elastic, not pitting onpressure. There was no wound observable on the thumb, but apeculiar redness of the arm, which was very diffused; the deepred line of absorbents however could be distinctly traced throughthe whole length of the arm to the axilla, and from thence theyseparated in three distinct lines, which were spread over theanterior surface of the thorax; from the elbow to the axillathey appeared inflamed, in patches. The fingers were verymuch swollen, and unable to be moved. He complained of afull, or bursting, sensation in his hand and arm, also of greatsmarting in his axilla, and on pressure being applied to theglands in that region, and along the line of absorbents, he ex-perienced considerable pain. The pulse was rather weak andsluggish, but all the other constitutional symptoms had sub-sided. He was placed in bed, and fomentations applied to thearm, and a draught given of sal volatile and laudanum.-Half-past eight P.M.: He was seen by Mr. Canton; he then seemedrather easier; the swelling, redness, &c., continues; no depres-sion present; tongue clean. To have a liniment of an ounce ofcamphor in four ounces of olive oil; to be rubbed into the armevery two hours, and to take an ounce of camphor mixture,half a drachm of compound tincture of cardamoms, and fivegrains of carbonate of ammonia every four hours. -Eleven P. M. :The swelling and inflammation continue, but the pain is muchless; there is considerable pain on pressure above and behindthe clavicle; the pulse has much improved. To continue theliniment and mixture.June 8th.-Ten A.M.: Has passed a comfortable night. The

swelling continues the same. He describes the pain this morn-ing more as a kind of soreness, the bursting sensation havingleft. The redness is somewhat less, but the line of absorbentsis distinctly visible; tongue clear; appetite good. Continuethe same treatment.-Eleven P.M.: The swelling in the handand arm, extending to the elbow, is somewhat less, but abovethat point, as far as the shoulder, the size has greatly increased,and has the same shiny, tense appearance; the line of inflamedabsorbents exhibited upon the thorax has disappeared; theredness on the basilic side of the arm was much less, but on thecephalic it could be distinctly traced to between the pectoraland deltoid muscles; there was also more pain, on pressurebeing applied on this side than on the basilic. A vesicationhwa appeared on the back of t.hn hand. Ten constitutional

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symptoms have appeared. The boy eats and sleeps well, andthere is considerably more activity exhibited by him than theappearance of the arm would have led a person to suppose. Torepeat the mixture, and to have warm fomentations applied.9th.-Twelve o’clock: He has passed a good night; the sen-

sation of soreness is much less, and the redness is fast disap-pearing. The swelling in the hand and arm appears to besubsiding, but above that point it still remains; there is slightpain on pressure being, applied behind the clavicle; the vesicationon the back of the hand has disappeared. To continue theliniment and mixture.-Ten o’clock P. M.: The arm is evidentlymuch improved, the swelling continues to decrease, and he canmove his fingers with more freedom. He still feels a little painin the course of the cephalic vein. Continue the same treat-ment.10th.-There is considerable diminution of the swelling; and

this now pits on pressure. The arm presents an ecchymosedappearance not distinguishable from that due to an ordinarybruise; it is moved with greater ease and freedom, as also arethe fingers. The pain and soreness has wholly disappeared.Appetite good, and his general appearance bespeaks health.He went out for a walk to-day, and was ordered steel andquinine.llth.-The improvement is more marked to-day; the arm is

assuming its natural form and size.12th.-He was discharged to-day, having regained the per-

fect use of his hand and arm.

Table, showing the different measurements of the hand and armduring treatment:-

The snake was brought to the hospital on the same eveningthat the patient was admitted. There was no doubt of its

being the common,viper. On reference to Bell, " On BritishReptiles ;" it corresponds in every respect with his descriptionof the Pelius Berus, or common viper. The specific characteris brown, with a series of confluent rhomboidal black.spotsalong the back; head almost oval and depressed, and wideningbetween the eyes. It was twenty inches in length.

UNIVERSITY COLLEGE HOSPITAL.

WÜTZER’S OPERATION IN TWO CASES OF INGUINAL HERNIA: ONEOF THEM PROVING SUCCESSFUL, THE OTHER NOT, FROMGETTING UP TOO SOON AFTER THE OPERATION.

(Under the care of Mr. ERICHSEN.)WE must confess we should like to see Wutzer’s operation

for the radical cure of inguinal hernia more generally adopted.Of all surgical measures which have ever been brought forwardfor the actual cure of one of the great sources of disablement inthe strongest and most robust, none appear to be so simple, ormore promising than this operation. We fully entered into aconsideration of its probable value in a former " Mirror," whenrecording a case under Mr. Coote’s care at St. Bartholomew’s(THE LANCET, vol. ii. 1856, p. 511); a second instance "underthe same surgeon was noticed in our " Clinical Records" (vol. i.1857, p. 264). We to-day report two cases treated by Mr.Erichsen, the first of which was completely successful, but thesecond was not so, owing to imprudence on the part of thepatient in moving about the ward with the plug in the invagi-nated integument. This proves very forcibly that the utmostquietude and repose are necessary for a certain number of days,till the plug is withdrawn, when a truss should be worn for afew months. The attention of hospital surgeons was muchattracted to the subject when the first record of this operation- in the London hospitals appeared in the " Mirror;" and al-though a desire has been apparent on the part of a great manyt-to try the operation, snch a small number of patients apply for.relief of their ruptures who wear trusses, that it is only when

other causes .have brought them under observa-tion that theyhave been prevailed upun’to submit ’to the operation at all.We say " prevailed upon," because very few patients withinguinal hernia, who sometimes suffer very little nmonveniense,believe any,operation is-necessary to afford relief. With a, viewof again drawing attention to the operation, we present draw-ings of the instruments, which have ah’E!ady been describedin a former "Mirror," and are referred -to in the -snbjoinedcases, the notes of the first of whifih were furnished, by Mr. G.Medcalf, the dresser of the patient.

Henry P-, aged twenty-one, a coal-porter, was admittedMarch 7th. Has always been in .good health. Has been acoal-porter for the last nine years, during which time he hashad to carry very heavy loads.About two days ago he hada violent fit of coughing, and was seized, while sitting, with agnawing, pinching pain in ithe belly and left groin, as if thebelly was being drawn up. He did not feel anything a giveway,but soon afterwards noticed a swelling about the size ofa vA4u-ut in the left groin, and he began to feel sick. He wasmuch troubled with cough in the night , and the swelling in-creased in size and hardness, and descended into the scrotum.The ’pain increased to suon an extent .that he was unable towalk -,home, and was doubled up.When admitted into the hospital at four o’clock in the morn-

ing, a hernial tumour was found in the left side of the scrotum,as large as a fist, very hard and tender. It was reduced with-out any difficulty, and all uneasiness vanished;a spica bandagewas applied, and he returned &bm -i*y* after to his work.The bowel,however ,came down again ,and he was re-admittedand the hernia again reduced.The external abdominal ringwas tolerably patent. On the Ilth of March Mr. Erichson per-formed Wützers operation, under chloroform,the patient re-fusing to submit without it. The left finger was passed,with a pouch of scrotal integument before it, into the inguinalcanal; the finger was then withdrawn,and the box-wood plugof the instrument was pushed up, well into *6he canal,the curv-ed needle was then pushed through the aperture at theend of the plug, passing through the wall of the sac and the in-vaginated scrotum. A piece of cork was then fixed on to theend of the needle, and the cover screwed down to the plug, soas to compress that portion :of iutegument ,and sac betweenthem. This was followed next ’day by some tenderness aboutan inch round the abdominal ring; orn the fourth day, the com-pressed skin was a little inflamed, bazt there was no discharge.The patient said he fel:t quite well. On the seventh day,Mr.Erichsen removed the .3tpptu’ttims and introduced a plug of oiledlint into the inguinal canal. The external ring was covered bya pad, and a double roller was applied over it. The lint wasremoved five days later, and subsequently -a trues was applied,and he was discharged from hospital.James L-, aged twenty-two years, admitted 24th June,

1857. Is a perfectly healthy young man, but the subject ofright inguinal hernia for twelve months, for which he has nevertwvorn a truss. It comes down every day, and continues so, andgoes back of itself every’night on retiring to rest. It was as

large as .his tst. On the 24th June, Mr. Erichsen performedWützer’s operation, as Lin the foregoing case. Owing to thispatient not tremaani-ng quaet m .his ’bed, JhaV.il1g got up andwalked about the ward, the operation was rendered ineffective,as-the bowel L,,tme down in the form of a small knuckle.at the.sffide df the invaginated skin. The plug of the instrument wasxemoved some days later, aid any hopes of,a radical CUl1e.M!e:IJefor the .present abandoned. He was bandaged up, and left .the,hospital, with ’the recommendation of wearing a truss for thepreseixt. The patient believed the bowel came down the sameday; but this was by no meaxis certain. He .got ayp on thethird day. a;t-wlrich ’period the symptoms were such as to showthe bowel had ocune down.