lungs, of minute particles of cotton, wool, metal or stone, which act there as constant promoters of irritation.

In the study of tuberculosis, the fact is too apt to be overlooked, that the cases which usually present themselves of the presence of tubercles in one or other of the tissues or organs, instead of being simple cases of tuberculosis, are rather cases of tubercular deposit complicated with certain other morbid states, which, though they may be essentially modified by the tuberculous condition of the patient, have no direct relation to that condition, either as cause or effect. Tubercle may be deposited to a considerable extent without the production at first of any very decided general symptoms of disease, and with much less disturbance of the organ in which they are seated than would be supposed possible. In one of the lungs there may be deposited a considerable mass of tuberculous matter, which may proceed slowly on to complete softening without the occurrence of any symptoms to excite serious alarm in the patient or his friends. It is in these uncomplicated cases of pulmonary tuberculosis, Dr. C. was persuaded, that most frequently takes place an arrest, for a time at least, of the lung affection, from the contents of the vomica, formed by the softening of the tuberculous matter, deposited in the lungs, being discharged externally, through an opening formed between the cavity of the vomica and one of the bronchial tubes.

The leading symptoms described in the books as those proper to tuberculous disease of certain tissues and organs, are the result rather of some intercurrent phlegmasia. Thus the major portion of those cases of pulmonary disease which occur in this climate, and are described as tubercular phthisis, are cases not of simple tuberculosis of the lungs, but of bronchitis or pneumonia occurring in patients in whose lungs a deposit of tubercular matter has taken place. They are, strictly speaking, phlegmasia of the lungs complicated with and modified by the presence of tubercles. And, if it be proper, as Dr. C. supposed no one would deny, to denominate the sub-acute inflammation which takes place in the meninges of the brain, or in the serous membranes of the thorax and abdomen, in conjunction with tuberculosis of these parts, tubercular meningitis, or pleuritis, or peritonitis, as the case may be, it would seem to him to be equally proper to denominate the inflammatory affections of the mucous membrane of the respiratory

tubes or of the substance of the lungs when complicated with the presence of tubercles, tubercular bronchitis or pneumonia. Such terminology would, at least, indicate with greater precision the true nature of the disease than that now in use.

[Continued in our next number.]

Editorial Translations.

1. M. Gosselin communicated to the Surgical Society of Paris, at its meeting of Sept. 7th, the history of a case of salivary fistula connected with the duct of Steno. He cured the patient by making the operation of Deguise, Sr., with the important modification of Beclard. Some members of the Society desired to know if M. Gosselin had received late news from the patient. He stated that the cure still continued, and that the patient was going on well. The following history of the case and operation was given by M. Gosselin: "The fistula, consecutive to the ablation of a tumor, had existed for five or six months, giving passage to the flow of an enormous quantity of saliva during mastication. It had resisted the employment of divers means.

"About the first of last June, M. Gosselin practiced on the cheek with a trocar two oblique perforations, meeting exteriorly at the level of the fistulous wound, separating, on the contrary, from each other on the buccal face. These two openings received the extremities of an iron wire, which, reaching into the mouth and engaged in a serre-nolud, permitted the practising of ecrasement linéaire and the section of the bridge between the two internal orifices. This section was completed at the end of an hour at most. The cutaneous wound contracted gradually, and the saliva ceased to escape through the check. At the end of ten days, in consequence of a meal, it reappeared in small quantity. It was thought the internal opening had cicatrized too rapidly, when the adherences which had already formed were destroyed with a sound.

"The salivary fluid again flowed into the mouth. Later the same accident occurred. Then, to prevent it more surely, a convoluted sound was passed into the internal wound every morning for two

days. Twenty days after the operation, the external wound was cicatrized, and the natural course of the saliva was reëstablished. The patient returned home. Up to the 30th October, when the last news was received from him, the cure remained perfect."

2. At a meeting of the Imperial Academy of Medicine, Oct. 15, M. Piorry commenced the reading of a memoir "On the Curability and the Treatment of Pulmonary Phthisis and Tubercle." He did not, however, finish.

"Is the symptomatic collection to which authors give the name of pulmonary phthisis susceptible of cure? This question must be answered affirmatively. But in our day it is not a question of stating whether phthisis, considered as a disease, may be cured, but of determining if tubercles, having their seat in the lungs, are susceptible of being removed, or at least of becoming inoffensive; it is in this point of view that I shall consider the question. For a long time tubercles have been considered incurable. It is our illustrious Laennec who first established the possibility of their cure. I have published numerous observations which put this opinion beyond a doubt. Besides, we have every day examples of cure of certain organs attacked with tubercles, (lymphatic ganglions, vertebra, articulations, testicles, etc.)"

After having established the curability of tubercles, M. Piorry examined the series of means of treatment which rational medicine must oppose to the accidents united under the name of pulmonary phthisis.

"Before all," said he, "the regimen must be regarded as the preservative, palliative and curative means par excellence. The first indication, in order to combat the tuberculous state, is to nourish the patients. The alimentation ought to be rich and abundant so long as the ingested articles do not produce diarrhoea, which may weaken more than the food can repair. In order to reconstitute the blood, to remedy its discoloration or loss of globules, the least irritating ferruginous preparations must be given-as, for example, the iron by hydrogen-save in cases of hæmorrhage or mucous diarrhoea. The second indication is to evacuate the fluids which may obliterate the bronchiæ. For this purpose we administer tartar emetic and syrup ipecac. There are still two simple means which have been of extreme utility for

several of my patients: the first is the inhalation of the vapor of the infusion of the elder tree, or the flowers of mallow; the other consists in provoking slowly a very profound or deep inspiration, which is to be followed by a very quick, energetic expiration. This should be so managed by the patient, that the air passing out should carry before it the liquids contained in the air passages. The first of these means moistens and softens the too thick sputa, and the second provokes its expulsion. Another pressing indication is to prevent the putrefaction of the secretions in the tuberculous cavities, and to prevent the absorption of the pus or pyoid matter which accumulates in them. It is these matters which, penetrating the circulation, produce hectic fever, night sweats and the rapid weakening of the patient. It is to prevent these accidents that it is so necessary to make the patient expectorate, as has been already said. To prevent the putrefaction of the secretions, the inhaling of the vapors of alcohol are agents of the first order. The putrefied secretions, not only in relation to their absorption, but numerous facts have led me to believe that they produce, by their presence on the gastro-intestinal membrane, diarrhoea, softening, and even ulcerations: it is then extremely useful, in order to avoid tubercular inflammations, that the secretions should be expectorated and by no means swallowed. I have seen diarrhoea arrested when they have avoided the deglutition of expectorated tuberculous matter. It is of the greatest importance to arrest the evacuations from the bowels and skin, which so much weaken consumptives; but there are extreme difficulties in fulfilling this indication. The only means truly efficacious are, the washing out the large intestine with water by the aid of the irrigator of Equisier; of preventing, as has been already said, the deglutition of the expectorated matter; of preventing the altered pus from remaining in the cavities and thus causing pyemia, which is soon followed by diarrhoea; of giving but small quantity of drinks, and of choosing among the aliments those which— as albumen, etc.-do not cause, in general, very liquid stools. Milk for consumptives is an excellent article of food. It does not cause diarrhoea, if care is taken to reduce it one-fourth by prolonged boiling. As to the sweats, the best means of lessening or combatting them is to see that the patient is not covered with heavy clothes, and that he breathes a pure air, frequently renewed VOL. III., No. 1.-3.

and properly warmed. Is there any medication which can act usefully on the indurated masses in the divers degrees which surround or repair tubercles? Some thousands of facts collected in the wards of La Pitie and Charité permit me to solve this question. It is no longer doubtful that the preparations of iodine, administered in fumigations, potions or frictions, etc., do modify very advantageously the destructive process of tuberculization. Under the influence of the iodine medication, combined with profound and reiterated inspirations, I have seen tuberculous indurations diminish in extent, the symptoms of the disease amend very sensibly, the appetite return, the action of the heart increase in force, and the adipose tissue increase. I have seen this relief persist for months and years in certain cases. But it must be avowed that the number of radical cures is very small, and I can only recall a dozen of veritable solid cures. Some persons have opposed the iodine medication in the treatment of phthisis: this is evidently owing to the fact that this precious remedy has not been employed by them in the most advantageous manner. have attributed to iodine the production of inflammation of the mucous membrane of the nares, pharyngitis, etc., softening of the tubercles, and the hastening of the fatal end; analogues to those of phthisis, which cease if we stop the remedy. I fear that some may have confounded, from an incomplete diagnosis, the effects of some accidental or secondary complication-such as a pleuritiswith the phenomena the results of the employment of iodine. I have followed my patients with great attention; they have been numerous, and I have never witnessed any such results."

3. At a meeting of the Academy of Sciences, August 29, M. L. Vella, of Turin, sent in a paper, entitled, "The Employment of Curare (Woorara) in the Treatment of Tetanus." The paper was read, and has given rise to much discussion and experimenting.

"Starting with the experiments made by M. Cl. Bernard since 1850, and with results which had been obtained with curare, which he had shown as a paralytic agent on the motor nervous system, I undertook, in the month of December, 1856, with my friends Professors Ercolani and Tommasi, a long series of experiments, which I have communicated to the Biological Society of Turin. The results of these experiments may be summed up in