time had skinned over, so that no foreign substance could be seen, but on gentle pressure with the finger, a hard point was perceptible beneath the integument. There was a muco-purulent discharge still issuing from the nostril, proceeding doubtless from the antrum. On incising the imperfect cicatrix, I felt the projecting neck, and supposing that the arrow point, after so long a time, might be somewhat loosened by the efforts of the organism, I attempted its extraction with the dressing forceps of the pocket case, but found them wholly inadequate. I at once supplied myself with instruments of various kinds, and with a powerful forceps succeeded in one or two efforts in extracting the offending body. This was followed by a troublesome bleeding, both from the nostril and the external wound. By rest, opium, cold, hlugging and pressure, this was duly arrested. Several slighter hemorrdages subsequently occurred, but they gave rise to no uneasiness.

The case now progressed favorably, and the patient was able to get about the streets. He walked to my office, and complaining of some inability to separate the jaws, a difficulty, by the way, which had existed all along, I directed him to use gentle and gradual efforts at opening the mouth. In less than an hour his troubles recommenced. The whole cheek and jaw became hot, swollen and painful. Fever, with renewed hemorrhage, set in, and caused me much anxiety. The same means of arrest first tried did not avail. Extensive extravasation of blood took place, and in order to relieve the pain, tension, and possible sloughing, I deemed it proper to make free counter openings, both in the mouth and on the cheek and neck. From these, large grumous clots were turned out, and through the inner opening the finger's point could be carried round the almost denuded bone, and lodged high up in the pterygoid fossa.. The hemorrhage continuing with various and delusive intermissions, the case became critical. Finally, for three successive nights, these came on regularly at midnight, and were copious and exhaustive. From such repeated losses of blood, the patient had now become reduced to the lowest degree, when the further issue of a few ounces more might have turned the scale against him. I then determined to tie the carotid. This was done on the night of the 16th of September, more than two months after the reception of the wound. Such was the extreme condition of the patient that he fainted during the operation, although in a recumbent position. The operation was a delicate and difficult one, as the parts were very much swollen and altered by sanguineous extravasation and inflammatory effusion, and the incision being correspondingly deep, the effect of artificial light in such cases, at all times bad, was only the worse-for while the surface of the wound was well lighted, the sharp, deep shadow rendered its depth almost invisible. The touch, therefore superseded sight. There was no more hemorrhage. Opium and nutritious ingesta were freely given, and the patient continued to do well. From the thoroughly anæmic state, and the effects of interruption of the cerebral circulation, caused by the ligature, the patient's mind was somewhat impaired, and I feared some altered nutrition or softening of the brain. These symptoms, however, gradually yielded, and after several weeks he was again up and about. Being rather impatient and self-willed, he went out before I deemed it prudent for him to do so. The ligature was slow in coming away, and for some weeks after its fall, a small fistulous opening remained. The Lieutenant now left St. Louis for West Point, to which place he was assigned for duty. When on a visit to his family in New Jersey, and travelling by railroad at night between New York and Philadelphia, after much bodily fatigue, a further hemorrhage occurred from the still unclosed fistula of the cervical wound. By rest and moderate pressure this was relieved. This bleeding was the last-the wound healed and the patient recovered his usual health. There always remained, however, an unpleasant fullness of the affected cheek and masseteric portion of his face.

CASE 2. The patient, a stout Irishman, 36 years of age, in an election riot received a severe blow with a club. The stroke was on the right side of the head and neck, obliquely behind the ear. There was a considerable and immediate swelling in the whole surrounding region. On the subsidence of this general tumefaction, a more defined ovoidial tumor was found occupying the upper part of the neck and extending upwardly behind the ear. Its dimensions were about five and a half inches in its longest diameter by three inches in its shortest.

The patient applied to me five weeks after the reception of the injury. There were present all the symptoms of false aneurism-the thrill, bruit and pulsation being distinctly marked. As the tumor was large, I was at a loss to determine the particular artery implicated, and of the various branches of the external carotid, I inclined to the supposition that it was the posterior auricular. I was perhaps led to this from the circumstance that the swelling was most prominent over the site of this vessel, and by the patient's declaration that the main force of the blow was received at that point. In this idea I was mistaken, as the sequel will show.

On compressing the carotid on the transverse process of the sixth cervical vertebra, there was a diminution only, not a suppression of the aneurismal bulk, thrill and bruit. The patient complained of much pain and annoyance by reason of the noise and throbbing constantly perceived in the corresponding ear.

Such, indeed, were his sufferings that the patient declared his anxiety to undergo any operation for his relief. As the preferable alternative, I proposed the ligature of the common carotid artery, to which he at once assented, The operation was performed before the class in the usual way. On tying the ligature I was struck by the circumstance, that the aneurismal symptoms were not at all affected. On the contrary, in a few days there was a very decided aggravation of the case. The tumor now became larger, more tense and painful. The skin was stretched, and of an angry red color, and it was clearly evident that the crisis by ulceration or bursting and hemorrhage could not be long delayed. In view of this imminent danger, and after a candid statement to the patient of his precarious condition, I proposed to him to cut boldly into the swelling, and after emptying it of its contents, to ascertain and secure if possible the ends of the ruptured vessel. With imperturtable coolness and sangfroid, he instantly assented. Nor did one word of complaint ever escape him, even in his last trying hours.

All necessary preparations having been made, I made a long incision in the great diameter of the tumor, involving simply the skin. So great was the tension that the dark bloody swelling seemed ready to protrude through the widely separated margins of the cut. By a rapid stroke, I freely opened the sac in the whole extent of the external wound. The gush and hiss of blood which instantly followed was frightful. With fingers and sponge I promptly emptied the sac, the arterial flow being so profuse that I could not at once discern whence it proceeded. Soon, however, in the depth of the opening,I found the rough fragments of a fractured bone, and with the finger's point I could staunch the hemorrhage. On closer examination, I ascertained that the fracture involved the transverse process of the third cervical vertebra (verified by the autopsy), and that there was a concomitant rupture of the vertebral artery, the source of all the trouble. I tried various plans of securing the vessel. Passing a curved needle through the borders of the opening, I threw the noose of a ligature over its convexity, but to no avail. I succeeded at last in arresting the flow by a long piece of cork, appropriately shaped, and held in place by supporting pledgets of lint, and a circular bandage.

The patient bled no more-he had already bled too much-but calmly and resignedly submitted to his fate. He survived twelve hours, and died

without a struggle.

Remarks. On ascertaining the true source of the hemorrhage, I was enlightened as to the cause of my mistake in supposing the aneurism to depend on injury of some one of the branches of the external carotid. On pressing upon the common carotid, during my preliminary examinations, it must have happened that I compressed at the same time the vertebral just before it enters the osseous canal in the vertebral processes. Hence the partial diminution which was observable of the bulk, thrill and bruit of the tumor. By tying the carotid, a greater stress of circulation was thrown on the vertebral, and thus is explicable the aggravation of the symptoms whieh followed that operation. As to tying the vertebral at the site of the injury, it was impracticable, for the artery by no means fills the canal, but lies inward against the bodies of the vertebræ, and is thus difficult of access.

1 believe that the case was necessarily fatal, for such is the free intercommunication between the arteries of the two sides of the neck, at the circle of Willis, that the ligature of any one, or even of three of them, would hardly have sufficed for a cure. It would have been necessary, were it supportable by the patient and practicable by the surgeon, to have tied both carotids and both vertebrals. But such a procedure was hardly to be mentioned. In the standard works on surgery, no method is given for the ligature of the vertebral-the only allusion to the matter being in the advice to tie it in case of a direct wound. Even this, so far as I am aware, has been but rarely done. Maisonneuve, of Paris, reports a case of gunshot injury of this vessel, in which, on account of hemorrhage, he secured it before it enters the vertebral canal.

Then, as to the course pursued in cutting into the tumor, I felt justifled by the circumstance that spontaneous rupture must have very soon occurred, and the patient might have bled to death when no one would have been near to render assistance. I should, in this case, doubtless have reproached myself for not having given him even the doubtful chance of an operation.

I repeat that I regard the case as one beyond surgical relief, and as necessarily mortal.—St. Louis Medical and Surgical Journal.

Arsenical Poisoning.

Two singular cases of Arsenical Disease—One caused by inhalation of the fumes of arsenic; the other by endermic application.

BY WM. S. BARKER, M. D., ST. LOUIS, MO.

CASE 1.-G. W. E

an employee in an iron foundry, previously to my knowledge a perfectly healthy man, and for years exempt from all illness, excepting an occasional attack of intermittent fever. A few months since he applied to me for professional advice. His head and face were greatly swollen, the eyes being nearly closed, the ears puffed out, and the glands of the neck and face enlarged, and the pulse quick and irregular. He was weak and trembling, and complained of a severe headache and vertigo. The tongue was dry. The bowels constipated. His greatest suffering was from pain in the head, and inability to sleep. I observed that the tumefaction of the face did not have the usual appearance of erysipelas, and it occurred to me that it might be ædema arsenicalis. I said, "I think you have been having ague, and have taken some patent medicine containing arsenic." "You are mis

taken, doctor," said he, " as I have not been sick, and have taken no med cine since you prescribed for me six months ago." I was puzzled. He e was an apparent case of arsenical poisoning; but the patient declared that he could not have taken the mineral in either food, drink, or medicine-as he had taken the former only at his own house, and the latter uot at all.

I prescribed an aperient dose, to be followed by an anodyne of morphia. The following day he was no better. In conversing with him, he incidentally remarked that he had worked very hard of late in filing patterns at the foundry. I asked him about the process. He said that after the patterns were cast, they were rough, and covered with sand, and that he poured oil of vitroil over them to detach the sand, after which he filed them.

This explanation fully relieved my mind as to the nature and cause of his disorder. I had understood that sulphuric acid is often manufactured from iron pyrites, which contain arsenic, usually in large quantity. It has been found by chemical analysis that the commercial oil of vitriol, made from iron pyrites, contains not less than thirty-five grains of arsenious acid in twenty ounces, and usually a much greater quantity.

A writer in the London Medical Gazette, (February, 1841,) states that a man nearly lost his life from the inhalation of arseniuretted hydrogen, produced in the manufacture of hydrochlolic acid, by the dilute, unpurified pyrites, sulphuric acid acting upon the iron retort unemployed.

I therefore concluded that my patient had been poisoned by the inhalation of arsenical fumes produced in the manner above described.

He was quite ill for ten days, but recovered perfectly. I think the case worthy of notice, as the cause of the disease was at first so obscure, yet so unequivocal when understood.

CASE 2. This was an instance of poisoning by the endermic application of arsenic, used to increase the personal attractions of one of Eve's fair daughters. The poet Cowper described women who

"By vanity's unwearied fingers dress'd.

Forget the blush that virgin fears impart

To modest cheeks, and borrowed one from art."

But there is another class of vain women, whom some satirical poet should appropriately remember. They scorn to resort to " rouge" and "lily white." They look with commiseration on those delicate cheeks where the pure lily and the blushing rose vie with each other. Such delicate carnal glories have no charm for them. Their eagle gaze is fixed on lofty things. They are women of self-presumed intellectual power; as náture has unquestionably given to man a preponderance of in tellect, they would look like men “as far as in them lies." But there are only a few females to whom nature has given a broad and lofty brow. "The dome of thought, the palace of the soul," is a somewhat diminutive tenement. Broad shoulders and a stentorian voice will not avail the strong-minded female, if the hair grows low on the forehead.

My patient, Miss Ophelia McDunder was of this class. I say was, because she has undergone a scientific metamorphosis. She was convinced that nature had committed an outrage on her, in permitting the hirsute growth on the anterior portion of her cranium. She knew that if a clearing could be effected, some important phenological bumps could be brought to view which would challenge the admiration of the world.

But how was this to be accomplished? She had once used a razor, but perverse nature had renewed the growth.

While in a state of mind bordering on distraction, she heard of a depilatory gentleman who could aid her in consummating her heart's desire. She contracted with the hair exterminator for the complete and permanent removal of the objectionable growth, in consideration of her paying him, then and there, the sum of three dollars!

He shaved the hair from her manly brow, after which he presented her with three paper pill-boxes. one of which contained emplastrum cantharides, another arsenic, and the remaining one wax. She was directed to apply the blister to the part shaven, and when the skin was as sore as it could be made, to sprinkle the arsenic thickly on it, and cover it with a coating of the wax, secured by a bandage. After the poison had been applied one day, she went to the operator, who examined the dressing, and told her to keep it on a day or two more. She did so.

The fourth day she sent for me. I found her in a distressing and dangerous condition. Her face was frightfully swollen; she was very weak and constantly trembling; her tongue was dry aud parched. She complained of excruciating pain and great heat. Constipation, vomiting, vertigo, painful and scanty micturation, cardialgia and delirium were among the symptoms. I thought she would die, but happily my fears were not realized. She was in a critical state for several days, and her convalescence was tedious.

She is thankful for her escape from death, and utters maledictions "not loud, but deep," against the cause of her sufferings.

The above case furnishes a warning to quacks who use depilatories, and silly women who would deform themselves with second-story foreheads.— St. Louis Med. and Surg. Journal.

Upon the Administration of Bismuth in the Soluble Form.

BY CHARLES R. TICHBORNE, F. C.S.

UNDER the name of liq. bismuthi there has been introduced to the notice of the faculty a preparation, which purports to possess great advantages over the ordinary basic nitrate. The desirable points in this preparation arefirst, its solubility; second, its slight taste; and third, its alkalinity. It has also the peculiarity of not being precipitable by water.

I felt the desirability of such a mode of exhibiting bismuth, and therefore made an analysis of the solution for my own information; and as it possesses certain phrases of interest, I now take this opportunity of placing it before the members of the Pharmaceutical Society.

A qualitative analysis elicited the following:-The solution contained bismuth, citric acid, and ammonia; not a trace of nitric acid could be detected in the solution. Liq. Bismuthi is therefore probably a solution of a basic salt, having a composition analogous to 3MOCi†MO; one of the bases, MO, being replaced by BiO, in is made from the recently precipitated and wellwashed oxide. From the peculiarity of having to deal with an alkaline bismuthic solution, direct precipitation with sulphide of ammoniun was employed to determine the amount of bismuth present; this gave on was ging and drying, 0.327 grammes of BiS, in the fluid half ounce, which repesents 1.114 grains of the teroxide as being present at the drachm. Now, altough the circular which accompanies the Liq. Bismuthi states that 3j. is equivent to a full dose (fifteen to twenty grains) of the insoluble trisnitrate, I do ot think than such can be the case. The idea evidently is that the metal, wh in the soluble form, is much more active than the ordinary insoluble modi cation, and there can be no doubt that it is so to a certain extent; but I should consider three grains to the drachm as the minimum dose; even more than this quantity may be easily introduced into such a solution as the above. The