therefore, taking this fact in consideration, it appears a fair inference that by exposing the artery as much as may be necessary in the method for applying the ligature, presently to be described, the danger of secondary hemorrhage is, to a considerable extent, lessened.

Some two years ago, I witnessed the operation of the ligature of the femoral artery, for an extensive osseous aneurism in the head of the fibula. The case progressed favorably, the ligature came away at the end of six weeks, and the wound closed. The operation, so far as the cure of the aneurism is concerned, was successful. The man subsequently died from an attack of delirium tremens, and an opportunity was afforded of examining the parts. The ligature had been applied midway between two collateral branches, about an inch and a quarter apart. An organized plug, upon each side of the ligature, had produced complete obliteration of the calibre of the vessel.

The peculiar plan of the operation was as follows:-The artery was exposed in its sheath, to the extent of half an inch; a grooved director was carried obliquely under it, and raised so as to allow the ends of the instrument to rest upon the edges of the wound; the director was then brought round at right angles to the course of the vessels, and an eyed probe, armed with a ligature, carried along the groove. The artery was tied at this point.

The mechanism of the process is very simple. When the direc tor is carried obliquely under the vessel, as the primary step, and subsequently moved round at right angles with it, it will be observed that the position which the instrument holds beneath the artery, is such as to insure the application of the ligature midway between the two nearest points of resistance; which points usually to the connection of the collateral branches. The reason for its occupying this particular position is sufficiently evident: in moving it from a branch the resistance becomes less, while in moving towards one, the resistance is of course increased; the consequence is, that the director, when placed at right angles with and under the vessel, naturally assumes a position where the two forces act equally, that is, equidistant from the two points of re

sistance.

That the danger of destroying the vitality of an artery, is not so great as is usually supposed, may be inferred from the following case. Some time ago, I had occasion to cut down upon, and tie the radial artery for secondary hemorrhage, which occurred from a wound at the wrist. The artery was exposed and separated from its sheath for the distance of an inch, and the ligature applied at the distal extremity of the wound. Everything progressed favorably, the ligature came away about the usual time, the wound healed kindly, and there was no cause to regret having isolated the vessel from its cellular attachments. We see the same indisposition to slough on the part of the arteries frequently mani

fested when they are exposed in deep ulcerating wounds, where the process of destruction has involved almost every structure in the neighborhood, including the cellular tissue immediately around them; and yet, under such adverse circumstances, their integrity is perfectly preserved. If then, nature has endowed these vessels with such remarkable powers of resistance, why should surgeons hesitate to act on the suggestion so plainly thrown out, and reap the obvious advantage which isolation of the artery, and separation from its vascular conduits, will afford them in the operation of ligation for aneurism?-[N. A. Medico-Chirurg. Rev.

On Irregulur Contraction of the Uterus. By Dr. CHANNING.

Dr. Channing observes, that he never now meets with the hour glass contractions he supposed to occur in his earlier practice. The following is his account of the nature and cause of these irregular contractions. "In these cases referred to, the following facts have been observed: They have most generally occurred in first labors. Everything has proceeded naturally, it may be, through all its stages. The after-birth has been expelled, and the patient may have been arranged in her bed. Sometimes, however, before this, pain may have been complained of. This increases until it amounts to agony, with expulsive efforts. The abdomen is examined externally. In about its middle, or higher, a hard ball-like tumor is felt, very sensitive, and easily distinguished from everything about it. Below this the abdomen feels soft, and bears pressure without any complaint. Not a sign of hemorrhage is present. We think of after-pains and of their accidental exaggerations. But it is a first labor-a perfectly natural one-and after-pains are rare under such circumstances. We examine per vaginam. Severe suffering is complained of. We have scarcely entered it when a firm obstruction is encountered. We proceed along one of its sides, and discover a very large coagulum. We go on, and at length feel the firm, contracted portion of the womb above. The open hand is now passed above the coagululum, and slowly presses it downwards and out. Belief is instantaneous. Slowly the hard tumor descends, under regular but insensible contraction, and gets its natural place above the symphysis. Rarely is relief expressed so completely as after this operation; not even when the head is passing the external organs. These cases strikingly resemble each other, and when once seen, they will always afterwards be easily recognized."

This condition may be confounded with retained placenta, inverted uterus, severe after-pains, and internal hemorrhage. Of the first of these the author gives instances, and the characters of inversion of the uterus are sufficiently obvious to prevent error. After-pains do not usually follow first labors, and when present

in severity, they probably depend on irregular contraction, with retention of coagula in the uncontracted portion; while, in other cases, when retention of urine has been present, the uterus takes on pseudo-expulsive action. The internal hemorrhage met with in this case differs from that usually so designated. Thus there is sudden and severe pain, and faintness is very rare, and rather due to prior exhaustion than to the loss of blood, which is much less than in ordinary hemorrhage. There is not the enlargement of the abdomen, and it has not the same firmness, except at the spots, where the contraction exists, where, indeed, it is much firmer. Elsewhere it is soft and is not tumid. The flow is slight at first, and the blood coagulates as it takes place. It is forced down into a solid mass through the dilated os into the vagina, becoming firmer and firmer, until at last it gives rise to strong painful contractions, for the purpose of obtaining its expulsion. The diagno sis is still further aided by the perfect relief that follows the removal of the coagulum. In none of the cases has secondary hemorrhage, so common in ordinary hemorrhage, been met with; and there is here a feeling of safety which does not attach to ordinary cases. [Boston Journal, and Med. Times and Gaz.

On a Singular Species of Neuropathy, the Barking Mania. By M. BOSREDON.

This singular affection, the history of which is lost in the darkness of the middle ages, appears to have originated in Brittany. Dax, a town of Landes, also furnishes some examples. The phenomenon, which is tolerably rare, and the nature of which is little known to the medical world, reappears at more or less distant intervals: it is characterized by a piercing, convulsive cry, occasionally musical, imitating at one time the crowing of a cock or the cry of a peafowl, at another the bleating of sheep, the mewing of a cat, or the yelping of dogs. It is this character which has caused the name of barkers to be given to women labouring under this affection. As medicine has always been unable to combat this extraordinary ailment, the church has had recourse to exorcisms and pilgrimages, but these various expedients have rarely been crowned with success. Chance has just brought under my notice a case of this kind, which, under medical treatment, has resulted in recovery.

Jean Roux, aged 11 years, of a nervous and sanguine temperament, youngest son of a vine-dresser, who died of phthisis three years before his son's illness, living with his mother at SainteCroix-du-Mont, (Gironde) was attacked, without any known cause, on the 1st February, 1846, with an apyrexial cough, tolerably severe during the day, accompanied with a slight mucous expec toration and headache: he was undisturbed during the night.

These symptoms had yielded to suitable treatment, when, on

the 15th of the same month, he began to give utterance to a cry like that of a fowl whose oesophagus was obstructed, and which lasted for seven or eight seconds. These attacks, which were accompanied with a painful and jerking respiration, were repeated eight or ten times during the day. On the approach of night they ceased until seven o'clock in the morning, when they were renewed. Sulphate of quina, chloroform internally and externally, various purgatives, cold baths, and cold immersions, were tried

in vain.

These attacks always following the same course, intermitting at night, became more intense during the day, and fatigued the patient more, without, however, proving very injurious to his health.

Despairing of success by the means above enumerated, I employed a mixture of lime-water, four ounces; acid valeriante of atropine, half a milligramme [.007716 of a grain!!]; simple syrup one ounce. To be taken in spoonfuls during the twenty-four hours.

This mixture produced strong dilatation of the pupils, hallucination, incoherence of ideas; in a word, a decided effect on the whole nervous system, especially its cerebral portion.

In the course of the following twenty-four hours, the system had returned to its normal condition; the disease had completely yielded.

Eight days later, under the influence of a slight impression, this young boy uttered two cries tolerably like the above; to prevent their return I advised, on the 21st of August, the use of the same mixture; but the patient took only a few spoonfuls, on account of the supervention of nervous symptoms.

He has since had no return of the affection, and his health has continued good.

What are the nature and seat of this disease? This I shall not undertake to decide. However, it is to the acid valeriante of atropine that this young patient owes his recovery. It was as a powerful modifier of the nervous system, that I determined to employ it.-[Gazette Médicale de Paris-Dublin Med. Press.

Death after Operation with the Ecraseur.-By L E. DESMOND, Honorary Surgeon to the Liverpool Dispensary.

The écraseur having first been introduced into Liverpool by the medical staff of this dispensary, it was my lot to assist at almost all the operations hitherto performed with it; and having witnessed their successful issue, I had no hesitation in employing it in this case. Five other surgeons, who were with me at the time, were satisfied as to its fitness, and its apparent safety from hemorrhage.

Cath. Egan, aged 41, presented herself at the Northern Dispensary, having suffered great pain, for a length of time, from two

hæmorrhoids just within the anus, one at each side, and a large prolapsed portion of villous mucous membrane anteriorly, from an open vessel in the centre of which she had on each occasion of her going to stool lost considerable quantities of blood; indeed, it sometimes flowed from her as she stood upright, the bleeding point often being outside the anus. She was weak, anæmic, sallow, and altogether cachectic, and was about three and a half months preg nant. I removed first the two hæmorrhoids, occupying three and a quarter and four and a half minutes respectively in their strangulation, and then the prolapsed mucous membrane, of about the size of a Spanish nut; including, of course, the bleeding point, an assistant's finger in the vagina making this part protrude. As this was the largest portion, and looked red and vascular, I spent six and a half minutes in its strangulation. No hæmorrhage followed their removal, and the wounds remained closed, with their edges pinched together, as is usual after using this instrument. She was visited in one hour and a half after the operation, when it was found that having a desire to go to stool, she had sat up and passed a clot of about four ounces. There appeared no bleeding now. A grain and a half of opium was given, the parts kept cool and strict quiet enjoined. 8, P.M. No return of the hæmorrhage, nor any further desire to empty the rectum. Another grain and a half of opium was given, and she was left for the night, which she passed without sleep, being very restless, and getting out of bed two or three times for a drink. She parted with no more blood till nine the next morning, when she passed about twenty ounces of dark clot. She was visited soon afterwards, and twenty drops of Battley's solution, with half a drachm of chloric ether, were given, and brandy and nourishment ordered at intervals. At 2, P.M., she had had no further hæmorrhage; and on examining the state of the rectum, with a finger in the vagina, it was found to be quite empty. She had had some vomiting, was restless, and the pulse 110. Stimulants and nourishment to be continued, with ten-drop doses of Battley's solution and ether, and to be watched. At 9, P.M., her condition was that of great exhaustion, with some stupor; pulse 130. She was evidently sinking, and she died without any further bleeding on the 7th, thirty-seven hours after the operation. No post-mortem was allowed.-[Association Journal.

On a Cause of Vomiting in Pregnancy. By M. BRIAU.

The conclusions arising from the following case are-First, that unmanageable vomitings may be caused by the confinement of the gravid uterus in the hollow of the sacrum; and secondly, that these vomitings may immediately cease upon the correction of this irregular condition. M. Briau mentions that several cases of the kind have occurred in the practice of M. Moreau.

CASE.-Madame X., æt. 25, of lymphatic temperament, well formed, and