to attend. The delegates to the American Medical Association, will be appointed at the November meeting.

An address will be delivered by the President-one or more lectures, by persons appointed for the purpose-after which, the nature, pathology, and treatment of congestive fever, will be discussed by the members of the society.

E. ANDREW, Secretary.

Account of a Physical Sign of Pneumonia of the Apex of the Lungs. By WM. M. BOLING, M. D., of Montgomery, Ala.-My experience, so far as it extends, is confirmatory of the opinion that pneumonia, commencing at the apex of the lung, is, in proportion to the number of cases, the most frequently fatal form of the disease. I have met with about six cases of this affection, at least have recog. nized, or identified about that number. They all proved fatal. I will notice three of them :-In one, the subject of which was a powerful and robust Irishman, 30 years old, "fond of a dram," but not decidedly intemperate, and previously in good health,-the disease supervened on an attack of acute bronchitis, about the fifth day, and proved fatal on the fourteenth day, counting from the first of his illness, In the second case, the patient was a rather delicate negro woman about 28 years old,-the attack commenced during a slight indisposition of a catarrhal character, and proved fatal on the thirteenth day. The other patient was a strong and robust negro woman, about 22 years old, previously in good health, and in her case the termination was on the ninth day.

The general symptoms and march of the disease, in these, did not differ in any material point, from those in the more common form of pneumonia, except in the point of commencement, and in this perhaps that the morbid alteration had proceeded to a less extent, at the time of death, than is commonly the case in the latter; that is, death supervened from a less extensive local disease. In the other cases, the lung ran most rapidly into a state of hepatization, the solidification not being preceded by the crepitant bronchus, but by a total absence of the respiratory murmur, while the chest over the affected part remained still resonant on percussion.

My object, however, in the present remarks, is simply to speak of a physical sign that was present, in each of the three cases detailed, which I presume also to be present in others of the same character, the observance of which may probably lead to a correct diagnosis at an earlier period, in some instances, than it would otherwise be made. This is a fine mucous or crepitant rhonchus, seemingly seated in the larynx, loud enough to be heard distinctly at the distance of two or three feet from the patient, and so persistent, that it is not removable, or but momentarily, by any effort to expectorate which the patient may make, while at the same time there are present none of the signs of bronchitis or laryngitis. Though it is exceedingly annoying to the observer to hear it, because it impresses him with the belief that it is distressing to the patient, and he looks with a feeling rather

of impatience for an attempt, by an effort to expectorate, for its removal; the patient seems perfectly indifferent to its presence, which would not be the case were it really produced by the presence of a small quantity of tenacious mucus in the larynx itself. The sound, then, is only seemingly produced in the larynx, for on applying the stethoscope immediately under or just above the clavicles, it will be discovered to proceed from the apex of one or the other lung, which will be found the seat of inflammatory action. It would seem that the sound there produced in the pulmonary vesicles, must be conveyed by the larger bronchial ramifications, numerous and superficial at this point, to the larynx, where, in consequence of the thinness of the tube, or rather the thinness of its covering, and its proximity to the surface, the deceptive impression of its production in this organ, from the presence of a small quantity of viscid mucus, is created.

It is the indifference of the patient to the presence of the sound, but still more especially its persistence, which constitutes its peculiar and distinctive feature, and upon which its value as an evidence of pneumonia commencing in the apex of the lung depends. In other affections of the lungs and air passages, more especially in bronchitis, we may have a somewhat similar sound produced in the larynx itself, by the play of the passing air through a small quantity of viscid mucus there collected; but under such circumstances, it is removable by coughing, or an effort to expectorate, and once removed may not return again, or only after a considerable interval, when a fresh collection of mucus has taken place. The patient, too, does not manifest the same indifference in regard to its presence, but the mucus producing it soon excites an effort for its removal.

As pneumonic inflammation, in the greater number of cases, commences at the base of the lung, the inexperienced stethoscopist, on observing the general symptoms of pneumonia present, may neglect to apply his instrument over the apex of the organ in attempting to discover the location and extent of the disease, and failing to detect any physical evidences of morbid action near the base, might at once attribute the symptoms present to inflammation, somewhat circumscribed, of the central portion of the pulmonary texture; too limited in extent, and too remote from the surface, to give rise to the peculiar physical phenomena. To be sure, were he to examine the entire chest, the disease would be detected. The recollection of the

sign which I have named, leads at once to its locality.

It is altogether probable, that in a number of instances of this kind, the exact seat of morbid action has escaped my own observation, as the peculiar sign which I have spoken of, I considered indicative of the most extreme danger, long before I discovered its connection with inflammation, commencing at the apex of the lung.-American Jour. of Med. Sci.

Case of Ligature of Common Carotid, for removal of Parotid Gland.-By A. B. SHIPMAN, M. D., Professor of Surgery in Indiana Medical College.-(Communicated by Dr. Norris.)-Mrs., ætat.

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70, spare habit, but good general health, had a tumour at the angle of jaw, of four years' standing. (She resided in Tully, Onondaga Co., New York.) The tumour was about the size of an orange, very hard, with lancinating pains through it. Diagnosis, schirrus of the parotid gland. It was determined to extirpate it. Previous to extirpation it was decided to tie the carotid, which was done by myself, and Dr. Narmon Van Dusen, of Tully. At the commencement of the operation, considerable hemorrhage attended, but, the operation was finished, and the patient recovered, the wound healed, and the ligature came away on the 28th day of the operation. The patient was well one year from the operation, but I understood the tumour returned again in the course of two years, and she finally sunk under it. But she recovered perfectly from the operation of tying the carotid. This was in May, 1844, and has never been reported before.—Ibid.

Gase of Excision of the whole of the Genital Organs.-By E. W. H. BECK, Asst. Surg. U. S. A. (Communicated in a letter to the Editor, dated, U. S. Hospital, Matamoras, Mexico, May 8, 1847.)— SIR.-Permit me to report to you a case that lately came under my care, which, from its oddity and interest, is certainly entitled to a page in your excellent journal. J. B., ætat. 31, stout build, bilious temperament, had been a member of the army, but now in the position of bar-beeper in a grocery; on the evening of March 9th, during a fit of delirium tremens, and unmanageable behaviour, was confined in the guard-house. A few minutes after his confinement he borrowed of a fellow-prisoner a short, thick, one-bladed, pocket knife, with which he completely excised the whole of the genital apparatus, close to the body. Flinging them violently into one corner of the room, he very heroically remarked-- Any d-d fool can cut his throat, but it takes a soldier to cut his privates off." This was at seven and a half o'clock. His companion gave the alarm, and the surgeon of the Mississippi regiment, happening to be in the same building, got to him about ten minutes after the accident. Every effort was made to secure the spermatic arteries, but their immediate retraction was so great that he failed in getting them. I was sent for in consultation, but being absent from my room at the time, the courier returned to the doctor stating the fact. The man was bleeding to death, and, in the desperation of the moment, he determined to apply the actual cautery to the bleeding surface.

At eight o'clock, a few minutes after its application, I saw him, and as the bleeding had almost entirely ceased, a large bunch of rags was applied as a compress, and secured by the appropriate bandages; his hips a little elevated; cold applications to the abdomen, and perfect rest and quiet for three hours; at which time he was removed to the General Hospital, and placed in the surgical ward under my care. The amount of blood lost was estimated by all present at near or quite one gallon. One fact worthy of notice here is, that eight or ten minutes after the bleeding commenced, complete consciousness was restored, nor did he exhibit a symptom of delirium tremens, after

wards. On my visit next morning, he lamented his condition as a sensible man, asked my opinion of his danger; complained of no pain; skin cool; pulse slightly jerking, and tremulous; 88 in frequency. I ordered him barley water, and, fearful of hemorrhage, did not disturb the bandages until a disposition to pass water, which was early the following morning. To remove the dressing the more easily, a soft poultice was applied; and after some difficulty in finding the urethra and passing the catheter, evacuated the bladder, with but a little oozing of blood from the surface and one minute artery, which I secured by torsion. Ever after this, his water passed without artificial assistance; his pulse became equal and soft after a gentle aperient, and absolute diet. Dry dressings-until a yellowish sloughy secretion was coming off, when I washed with a solution of chlorinated soda, and applied simple cerate. The too luxuriant granulations, which soon arose, were suppressed with caustic, and the whole had kindly cicatrized in five weeks from the occurrence of the accident.

The last few days of the healing process, a large silver catheter, and afterwards, an oiled tent, was retained in the urethra, to prevent any contraction, to which there was a great tendency, and around which the orifice closed with a firm callous edge. The superior surface, or that above the urethra, presents a flat, or rather concave appearance, the posterior slightly elevated or ridge-like.—Ibid.

Poisons and Counter-Poisons Therapeutically considered. By M. BOUCHARDAT.-Hôtel Dieu, in consequence of its central location, is the hospital most frequently selected by the administration and people of Paris whenever any accident or case of sudden disease occurs requiring immediate assistance. Among these there are of course a great many cases of poisoning, to which my attention has consequently been frequently directed. I have made also a great many experiments on animals in reference to counter-poisons, so that I think myself capable of giving some very useful information on this subject. I intend in this article to embody the results of such researches which have been as yet unpublished or scattered throughout my "Formulaire," my" Annuaires," the second edition of my "Manuel de Matière Médicale," or any other publications of the last year. I publish this notice in my "Annuaire" of 1847, because it is a work destined for the hands of both physicians and pharmaceutists, for I think that a thorough knowledge of certain parts of therapeutics is as necessary for the latter as the former; in fact, in urgent cases which call for immediate attention requiring a very exact knowledge of their nature, we are obliged to call upon the pharmaceutist, who is always at home, while the physician is very liable to be absent. In this respect there is a great deficit in the education of the pharmaceutist, which can only be remedied at present by publications like the one I here give.

The assistance required by any individual who has been poisoned may be considered under three heads. The poison having been discovered, the first indication is to evacuate it. For this purpose we em

ploy emetics, emetics and cathartics together, purgatives, or the stomach-pump. The second indication is to administer the antidote. The third is to bestow upon the patient those attentions his condition requires, and which may be divided into those suitable in all cases of poisoning, and those adapted to each particular case.

1. To evacuate the stomach of its poison, tartar-emetic is most generally had recourse to; the dose is five centigrammes (3 of a grain) dissolved in half a tumbler full of water, and repeated two or three times after an interval of a few minutes. The patient should drink freely of tepid water, and it is often advantageous to assist the inclination to vomit by tickling the fauces. If tartar-emetic is not at

hand, it may be substituted by the sulphate of copper, twenty centigrammes, (three grains,) dissolved in two table-spoonsful of water, and repeated if necessary; sometimes this emetic is preferable to the former because it acts more promptly.

When the poison is insoluble, and there is reason to believe that it has passed out of the stomach into the small intestines, it is better to administer an emetic and cathartic combined. Twenty centigrammes (three grains) of tartar-emetic may be dissolved with sixty grammes (two ounces) of sulphate of soda or magnesia in two pints of water, and then administered to the patient as rapidly as he can take it. It has been recommended in cases of poisoning from vegetable substances to use a strong solution of table salt, which acts both as an emetic and a cathartic, 50 grammies (an ounce and a half) to to the litre (two pints) of water. This is at times a very valuable therapeutic agent because it is always at hand, and we cannot administer an evacuant too soon.

When the poison has been taken per anum, and has entered the large intestines, we must have recourse to enemata. A very excellent enema may be prepared in these cases composed of twenty grammes (five drams) of senna, fifty grammes (an ounce and a half) of sulphate of soda and five hundred grammes (one pint) of water; this injection is much better than those more drastic in their action; these are slower in their operation, and I have often seen them prescribed without success. When we cannot succeed in procuring emesis, and the poison is still in the stomach, it is best to introduce the stomach tube and pump out the contents.

2. A counter-poison is, according to my view, any substance which will form an insoluble or inoffensive compound with the poison which has been taken. There are some general rules which it is necessary to mention in reference to the employment of these counter-poisons. We ought to give the preference to those which are perfectly innoxious, and which are most likely to be at hand. We should administer a quantity which will more than suffice to neutralize the poison, for the antidote may be rejected almost as soon as it is swallowed, and in the most fortunate cases even the compound is not wholly insoluble; then again we wish to destroy the poison as quickly as possible, and we can do this most readily by having the antidote in excess.