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pain occasioned by this process is much

less, according to the author, than that

which is produced by slow and gradualextension. Contractions of the upper ex-

tremities, and of the fingers from rheumaticor gouty affections, were frequently cured

by division of the tendons; and M. Dieffen-bach remarks that these deformities are

generally cured with much greater facility,than analogous lesions of the lower limbs.In two patients, labouring under organicdisease of the brain, which had occasionedpermanent flexion of the forearm, with

spasmodic contraction of the fingers on thepalm of the hand, M. Dieffenbach dividedthe tendon of the biceps, flexor carpi ra-dialis, flexor carpi ulnaris and flexor

digitorum. A remarkable improvement wasobtained, and patients were enabled to

grasp and hold objects of a certain size.

Finally, in four hundred operations whichhad been performed by the author, up tothe period when the present treatise hadbeen published (1839), he has never seeDany nervous accidents, haemorrhage, on

troublesome suppuration, produced by subcutaneous division of the tendons.

TREATMENT OF VARICOSE VEINS

BY CAUTERISATION WITH

THE VIENNA PASTE.

THE frequent occurrence of varicose veinsin thelower extremities, affecting principallythose persons who, from necessity, are com-pelled to undergo great fatigue, renders thepossibility of radically curing them a subjectworthy of serious consideration. The dis-advantages, or rather dangers, attributed tothe diverse surgical operations generallyemployed, have appeared to some surgeonssufficient to counterbalance any ameliorationthat might result from them, and to autho-rise their total rejection, substituting intheir place a constant and moderate pressure.That compression, methodically applied, soas to give support to the limb generally, canalleviate, to a certain degree, the existinginfirmity, is not to be denied ; but, unfortu-nately, even this is of little avail under cer-tain states of varix, as when, from someadventitious circumstance, or as a conse-quence of inflammation, a solution of conti-nuity has taken place, giving rise to fre-quent, and sometimes alarming haemorrhage,or more generally terminating in an ulcerousstate, difficult in most cases to cure, and insome impossible, at least permanently, un-less, as is a well-known fact, the varicose

state of the surrounding veins, which is theprincipal cause of the ulcers not healing, beremoved. To say that varix does not initself constitute a disease, but is simply aninfirmity, seems to us to be at best a playupon words, for,unfortunately, the differencebetween infirmity and disease cannot alwaysbe distinctly drawn ; and in this case, thatwhich would be simply an infirmity to a

person above the necessity of exertion, be-comes a disease, and a most serious one, tothe individual compelled to daily labour:moreover, to assume as an invariable rule

that, because, in some unfortunate case,death has resulted from our endeavours,we are on that account not justified in at-tempting to cure varicose veins, appears tous to be an unsound maxim, unworthy ofthe surgical art, as will forcibly strike anyone who has had opportunities of witnessingthe miserable state of persons thus affected,and who cry out for some relief, not to theirsufferings but to the infirmity, or, rather,disease, which precludes them from labour.Amongst the various remedies that have

been successfully employed, cauterisationof the varix with the caustic potash, seemsto us to have been cast into an undeserved

I oblivion. First employed by AmbroseParé and Guillemeau, it remained unnoticeduntil Sir B. Brodie re-examined its efficacy ;

but he mentions it only to blame, for accord-ing to him the cure of the varix affords butan inadequate compensation tor the pattlproduced by the caustic, and the inconveni-ence arising from the tedious healing of theulcer, which remains after the slough.More recently, Mr. Bonnet, surgeon of theHospital of Lyons, made several experi-ments, the result of which he published inthe Archives Gen. de Med." of May andJune, 1839 ; but it is not to the merits ofthis plan that we wish to call the attentionof the medical world, but to a modificationwhich to us appears important, recently in-troduced by Mr. Laugier, surgeon of the

Hôp. Beaujon at Paris.As we have already stated, the objections

made by Sir B. Brodie to the use of thecaustic potash are: 1st, the pain; and,2ndly, the length of time required for thehealing of the ulcer resulting from the!, slough. Mr. Laugier imagined, that if, be-fore applying the caustic, the skin shouldbe divided down to the vein, a smaller

quantity of caustic would he required, itsaction more prompt, and the Elough neces-sarity smaller. He also substituted a com-

position, consisting of equal parts of quicklime and caustic potash, to the caustic

potash alone; the advantages he attributes totheir composition, known under the name ofVienna paste, are, lst, a more rapid andcertain action; the caustic potash, whenemployed alone, as was remarked by Mr.Bonnet, sometimes did not cauterise sum-

: ciently deep, and required two er three

620

applications; and, 2ndly, the production ofless pain.

Several other objections can also be madeagainst the use of the potassa fusa, accord-ing to the old plan. From the extent and

depth of the sloughs, Mr. Bonnet derivedtwo laws: lst, that the caustic can only beapplied on veins corresponding to muscles,from fear of affecting the periosteum ;2ndly, that, except in cases of spontaneoushaemorrhage, the internal saphena shouldnot be cauterised whenever the external alsowas affected with varices,since the latter, thecirculation in the internal saphena, being in-terrupted, could but increase. Mr. Laugier’splan obviates these inconveniences com-

pletely, the action of the paste being promptand easily localised, the quantity employedbeing small, the sloughs being necessarilylimited, and the loss of skin almost null, weare enabled to operate not only in front of Ithe tibia and of the condyle of the feuzur,but also on both saphenae at the same time,without fear of affecting the bone, or of

depriving the limb of too great an extent ofskin.But the most essential advantage in the

method of Mr. Laugier is, that by the imme-diate and prompt cauterisation of the vein,the danger of severe phlebitis is avoided.In applying the caustic potash according tothe ancient method, it often happens that itsaction does not extend sufficiently, and that Ithe vein is either opened or simply laid bare;circumstances, it is evident, tending to pro-duce diffuse inflammation much more than ifthe vein had been totally disorganised. Bythe immediate application of the paste the Ivein is deeply cauterised, and in twentyminutes, or at most half an hour,a coagulumhas formed, which, according to Mr. Lau-

gier, has the advantage of isolating beforeinflammation of its walls has supervened,the disorganised portion of vein from the

general venous system and the circulatingfluid thus preventing the absorption of pus,if any should form, into the system ; in fact,circumscribing the inflammatory process, andpreventing its becoming diffuse.

Another important consideration is thepossibility of achieving aradical cure. Theeffect of every mechanical injury to a venoustrunk is the production of inflammation ofits lining membrane, more or less severe,known under the term phlebitis ; but puttingaside the severe form of inflammation, andconfining ourselves to the consideration ofwhat is called adhesive inflammation, it willbe seen that the first appearance is the (lepo-sition of a certain quantity of coagulablelymph, extending more or less along thecavity of the vein, according to the extentof the adhesive inflammation itself, neces-sarily producing agglutination of the oppo-site walls of the vein, and, if uninterrupted,obliteration of the venous canal. But, as inthe union of wounds, circumstances may

arise to disturb their beneficial march, andthe agglutination of the venous walls maynot be sufficient to resist the impulse of thecolumn of blood when exertion is made, orthe obliteration of the canal may simply bepartial, extending only for a few lines, theremainder of the canal remaining pervious,and still giving passage to the blood whenbrought by the neighbouring anastomosingbranches. This, as daily experience shows,often happens after treatment of varices bythe ordinary methods, especially after theuse of pins, or after simple division of thevein; but, from the observations of Messrs.Bonnet and Laugier, it would seem that can,terisation, when effectually made, disor.

ganises completely the vein, and determinesa total obliteration of its canal through thewhole extent comprised between the cau-terised spots, and in neighbouring portions ofvein, or, at least, to such an extent, aboveand below the eschars, as to render a returnof the disease in the same veins almost, ifnot totally, impossible.The following is the plan that Mr. Langier

adopts in operating :-A fold of skin, eithertransverse or in the direction of the vein,being raised, a small incision from five tosix lines is made, and the vein laid bare.The slight haemorrhage that results from theincision is immediately arrested by the ni-trate of silver ; for it was remarked by Mr.L.,that the blood diluted the paste and impairedconsiderably its agency. The lips of thewound are then covered with small slips ofcharpie, to defend them from the action ofthe caustic, and the wound is filled with thepaste, generally requiring about the size ofa small hazel-nut: the action of the causticcreates but little pain, and, in fact, most ofthe patients find the application of the nitrateof silver the most painful part of the opera-tion.The number of applications must depend

on the extent of the varices, but generally onthe first day only two are made on the mostprominent varix, about six or seven inchesdistant from each other; the subsequent ap-plications must depend on the state of thelimb. It is requisite that the patient shouldremain perfectly quiet, until the caustic hasformed an eschar, to prevent the paste fromescaping, and destroying the neighbouringskin : this requires from thirty to fortyminutes, and then the eschars, being cleanedof the remaining paste, are covered with dia-chylum. It is, of course, necessary that thepatient should remain in bed until the

sloughs are fallen; he then is allowed tomake moderate exertion, and, when no uu,toward circumstances arise, the cure isgenerally affected in six weeks or two-

months.In a future communication some cases

will be forwarded: already from thirty toforty patients have been operated on by Mr.L. and no accidents have as yet occurred;

621

nevertheless, two deaths have taken placeduring the treatment, but under circum-stances entirely unconnected with the ope-ration. We will mention them in our next,

as they are interesting, inasmuch as theyshow the state of the venous canal, after theapplication of caustic. Most of the patientsoperated on have been perfectly cured ; andin those cases in which the varices have notbeen totally obliterated, such an ameliora-tion has been effected, as to render thepatients capable of returning to laborious

occupations, which previously they wereforced to desist from.

UNIVERSITY OF LONDON PRIZEEXAMINATIONS.

OF the fifty-two candidates inscribed for

examination, three retired before the ordealcommenced, four disappeared during theexamination, and seven were rejected. Thewritten answers were many of them excel-

lent, and did honour to the teachers underwhom the writers had been educated. Thevivâ voce examination in anatomy was con-ducted with the aid of a well-dissected body,and of a number of beautiful preparations.Several of the candidates who had fallenshort of the rest in the written, were enabledto regain their credit in the viva roce, exami-nation, and in the required demonstrationupon the body and preparations.

Tuesday, July 14, Morning, 10 to 1.ANATOMY AND PHYSIOLOGY.

Examiners, Mr. KIERNAN and Dr. SHARPEY.

CANDIDATES MAY ILLUSTRATE THEIR ANSWERS

BY SKETCHING THE PARTS THEY DESCRIBE.

1. Describe the parts successivelybrought into view in dissecting, from theskin of the perineum to the inferior fundusof the bladder, that space which is boundedanteriorly by the arch of the pubes, poste-riorly by the rectum, and on each side bythe ramus of the ischium and obturator in-ternus muscle.

2. Describe the internal structure of thekidney ; and state what you conceive to bethe relation of the blood vessels to the ducts,adducing the evidence.

3. Describe the intimate structure andchemical composition of interarticular car-tilage, and state in what respects it differsfrom articular cartilage.

Tuesday, July 14, Afternoon, 3 to 6.1. Give the dissection required to expose

the course of the vertebral artery, from thethird cervical vertebra to the foramen mag.num ; commencing at the integuments or,

the back of the neck, and describing theseveral parts successively met with in thedissection.

2. Describe the mucous membrane of thestomach and small intestine ; the descrip.tion to include that of the ultimate arrange-ment of the blood-vessels, the epithelium,the follicles of Lieberkühn, and the glandsof Brunner and Peyer. What recent inves-

tigations have been made into the structureof the last-named bodies? Describe alsothe development of the alimentary canal,with the exception of the mouth and fauces.

3. Describe the erectile tissue, and statewhat recent researches have been made intoits structure. In what other parts of thebody, besides the corpora cavernosa and

! corpus spongiosum, has it been said to exist,

and what is your own opinion upon thispoint?

Wednesday, July 15, Morning, 10 to 1.CHEMISTRY.

Examiner, Mr. DANIELL.1. How may carbonic acid be generated

and condensed into the liquid state ? Ex-plain the phenomena which occur whenliquid carbonic acid is allowed to evaporaterapidly.

2. Explain and illustrate the meaning ofthe term diathermancy : in what do dia-thermanous bodies differ from diaphanousand transparent bodies ?

, 3. What are the principal phenomena of

polarised light ; and how may light be

polarised ?4. How may the diffusion of gases be

measured ; and what is the law of theirdiffusion ?

5. Describe the construction and explainthe action of the electrical condenser.

6. Describe the mode by which a volta-type copy of a medal may be obtained, andexplain the process.

7. What is methylene? How is hydrateof methylene obtained, and what is its rela-tion to alcohol ?

8. What is the constitution of phosphoricacid ? What are its relations to water andsaliflable bases ?

9. What are the principal constituentsand characters of the fusible calculus, themulberry calculus, and of red gravel?

10. Describe the properties of sulphurand selenium ; state their equivalent num-bers, and the principal points of resemblance

between these two elements and their com-pounds.

Wednesday, July 15, Afternoon, 3 to 6.MATERIA MEDICA AND PHARMA-

CEUTICAL CHEMISTRY.

Examiner, Mr. PEREIRA.1. What are the crystals contained in thebottles marked respectively A, B, C, D, E,