TRACHEOTOMY IN LARYNGEAL DIPHTHERIA;

BY J. W. MACDONALD, M.D., M.R.C.S., EDIN.

The operation of tracheotomy, perhaps more than any other, places in our hands a means of saving lives which would otherwise be most certainly lost. As an instance of the value of this operation, even in the most desperate circumstances, I beg leave to report the following case :-During an epidemic of diphtheria in the beginning of 1877, I attended R, a little girl æt. 12. I first saw her on Jan. 2, the third day of her illness. There was a considerable amount of false membrane about the tonsils, and evidence of the disease having spread to the larynx. As the danger to the respiration did not seem imminent, I applied liq. ferri-perchloride to the throat, and used insuflations of powdered alum, and prescribed quinine and iron internally. Hot fomentations were ordered to be applied to the throat, and steam inhalations containing permanganate of potass were to be freely employed. For the next four days the symptoms improved.

January 7th. —The laryngeal symptoms are not so favorable. I asked the parents to send for me if they found the patient's breathing to become more obstructed. They were very much opposed to the operation; and next day, although the child was in a dying state, they did not send me word. Hearing of this from another source, I drove to the house, a distance of four miles, and found her evidently breathing her last. The surfaces of the body was cold, no pulse could be felt at the wrist. She was totally unconscious, and the breathing consisted of gasps, with long intervals between them. With all possible haste I had her placed upon a table and proceeded to perform tracheotomy. By this time the breathing had completely stopped. I was obliged to hurry through the operation, and without any assistance, as everybody had fled in terror from the room. Having inserted the canula, I immediately commenced artificial respiration, and after persevering for some time, had the satisfaction of seeing the breathing restored. She now began to regain consciousness, and by the motion of her lips we guessed

she wanted water, which was given. Her thirst was insatiable. I placed a piece of gutta-percha tissue between the guard of the canula and the skin, and covered the neck with a woolen cloud. About day-break on the following morning a mesenger came to me with the intelligence that the child had managed to pull the tube out and was choking. I set off at once, and with very little hope of finding her alive; but the father had, in the meantime, plucked up courage to insert the tube, and on my arrival I found her breathing freely.

12th. I removed the canula, and found that she could breathe perfectly by the mouth. The wound was brought together by adhesive plaster. She has a bad cough, and expectorates some blood, with large quantities of mucus. Her appetite is good; pulse 90; temperature 99°.

15th. She has been sitting up all day; eats heartily, and feels well. The wound healed very satisfactorily; by degrees her strength returned, and she has since been quite well. Antigonish, N.S., Dec. 2, 1878.

Reviews and Notices of Books.

The Organic Constituents of Plants and Vegetable-substances, and their Chemical Analysis.-BY DR. G. C. WITTSTEIN, Authorized Translation from the German Original. Enlarged with numerous additions by BARON FERD. VON MUELLER, C.M.G., M. & Ph. D., F.R.S. Melbourne : MCCARRON, BIRD & Co., 37 Flinder's Lane West, 1878.

We believe this is the first time a Canadian Reviewer has been called upon to notice a medical publication issued from the press of Australia. That far off continent has long been famed for its gold fields. It may yet be as well known for its literary possessions. The volume before us is certainly evidence that there are mines there which, when worked, will yield abundance of scientific lore. The German Original of Dr. Wittstein is, in itself, a learned production of high order. To give our readers an idea of its scope, we may mention that it is divided into two

parts. The first is spread over three sections, which are assigned to "proximate constituents of plants and vegetable substances as far as hitherto known; their properties; their mode of preparation and quantitative estimation; molecular weight of organic compounds; synopsis of those plants which yield the proximate constituents under the former, and a catalogue of the vegetable pointed out in them with the order systematically arranged." The second part, likewise, comprises three divisions. The first is devoted to the account of "the apparatus required for the phyto-chemical analysis." The second specifies the chemicals that are needed to perform the foregoing examinations. And the third is taken up with explaining the "general systematic course" of the analysis just named. Lastly, there are added "tables of comparison." Great though the mass of information be which is afforded through these various sources, -and from which the extensive research and Chemico-Therapeutical culture of the author are conspicuously apparentgreater still are the merits of the Australian edition. The translator and editor, who has proved himself well fitted for the task in which he engaged, tells us in his preface that he has supplemented" the original work with many additional notes on new and well-authenticated data, which transpired during the last few years, some claiming local originality here."

more.

The present treatise purports to be all facts,—and no theories. It is purely descriptive. At a rough guess we should say it touches upon 800 different subjects, at least, if not many This is a formidable array. But, as the book will be chiefly valuable for reference, this comprehensiveness adds greatly to its value. The topics are of necessity not dwelt upon with equal extent. A judicious measure has been observed throughout, and the largeness or scantiness of the account given of each article has been regulated according to its degree of importance or rarity.

To our readers who have not given attention to the modern advances in the branch of science upon which this new work treats, there will be found much to baffle and confound and amaze. The very names of the objects discussed will be stun

ners, e. g., Gardenin, Jurubebin, Nucit, Ostruthin, Picrorocellin, Thevetosin, &c., &c. But with the novelties, they will also find the more familiar substance, all in their place. and carefully described.

The manner in which the painstaking translator has accomplished his task reflects credit upon his abilities. He has spared neither time nor money. While he has devoted much labour to the enterprise, the bringing of it out has been at his own expense. But the only reward to which he looks, is" that local observers in these Southern colonies, as well as in other countries, teeming with on almost endless number of yet novel objects for phyto chemic inquiry for additional resources, may be armed with auxiliary means for extending not only in abstract the science of Chemistry, but also the precincts of Therapeutics." And if this be the result, then our expectations will also be made good of what may yet be yielded by the Australian mines of professional lore.

Cyclopædia of the Practice of Medicinc.-Edited by Dr. H. VON ZIEMSSEN. Vol. xvii. Grand anomalous of Nutrition and Poisons. By Prof. H. IMMERMANN, Prof. R. BOEHM, Prof. B. NAUNYN, and Prof. H. VON BOECK. Translated by W. BATHURST WOODMAN, M.D., and J. BURNEY YEO, M.D., of London; E. S. WOOD, M.D., of Boston; CHAS. EMERSON, of Concord; PORTER FARLEY, M.D. of Rochester, and A. B. BALL, M. D., and E. WALLER, Ph, D. of New York.-ALBERT H. BUCK, M.D., New York, editor of American edition. 8vo. pp. xiv. 968. New York: WILLIAM WOOD & Co., 27 Great Jones Street, 1878.

The first article from the pen of Immermann forms the completion of the subject on the general anamolies of Nutrition. Homophilia, or what he terms the bleeder disease, is the first section of this article, from this we learn that the earliest historical record of the hoemorrhagic diathesis is found in the writings of an Arabian physician who died at Cordova in the 12th century. This writer had no knowledge of this disease except what he had heard from persons who were said to be affected with this idiosyncracy, nevertheless, his descriptions

are so vivid as to be readily recognized to correspond with the same affection as occasionally seen in the present day. After giving an interesting historical record of this disease the author points to the definition of the disease hæmophilia. He considers it to be a congenital and habitual hoemorrhagic diathesis, never seen except in young persons, at least, the tendency to hæmorrhagia is a congenital defect seen in infancy and childhood, and which, as a rule, continues throughout life. He remarks “it is uncommon for an individual who has been a marked bleeder in infancy, and in whom, therefore, the disposition was presumably congenital, to lose the idiosyncracy in early youth and to remain thereafter entirely free from hæmorrhagic attacks."

The author then passes on to a description of the disease, its symptomatology, anatomical changes, complications, nature, diagnosis, duration, prognosis and treatment. An allied affection, scurvy, is the next section taken up, and which is discussed in the same systematic manner, after which we have a description of the disease called Morbus Maculosus Werlhofii. These form the first article in the volume, and it is apparently full and exhaustive, occupying some 280 pages of reading matter. The rest of this volume is devoted to the subject of poisons. Boehm gives the first paper in which he discusses poisoning by the metalloids, mineral and vegetable acids, alkaline earths and their salts; poisoning by anesthetics and other carbon compounds, and poisoning by tainted articles of food.

Naunyn writes an article on poisoning by the heavy metals and their salts: in this article the author includes arsenic and phosphorus.

Vegetable poisons are next discussed by von Boeck. In this article all the poisonous plants and their active principles are considered, the article closing with an account of poison fungi. The edible fungi or mushrooms are likewise given, as also the symptoms induced by eating decomposing fungi. This volume is a most important and useful addition to the series in this cyclopedia, and adds materially to the general interest of the work.