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Experiment 1. The holes being closed by small wooden pegs,the instrument, becoming a common hollow stethoscope, con-veyed, when placed over a healthy chest, a full and distinct re-spiratory murmur to the ear.

Exp. 2. The holes being opened one by one, the murmur be-came gradually and, when all the orifices were opened, re- z’

markably diminished in its distinctness and fulness; a weakmurmur did not reach the ear.

.Ep. 3. The insertion of a plug into the shaft at c, onlyslightly impaired the distinctness of the murmur.

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Exp. 4. The plug remaining in the instrument, a remark-able diminution in the intensity of the sound followed uponthe removal of the small pegs.

Exp. 5. When a plug was introduced at A, or a solid ear-piece employed, the respiratory sound became distinctlvaudible. The opening of the orifices, and the closure of B bya plug, in this case produced littie or no difference in the cha-racter or intensity of the sound.Exp. 6. A solid stethoscope was found to communicate

sound very readily to the ear, although not quite so perfectlyas the ordinary form.Exp. 7. The insertion of a plug into the chest end of a

flexible stethoscope, impaired, but did not destroy, the con-ducting power of the instrument.From a consideration of these experiments we gather the

following conclusions regarding the hollow stethoscope :-1. That its conducting power principally depends upon the

column of air confined in its interior, for the opening of theholes in the shaft, by allowing the divergence of vibrations,prevented the communication of the vibratory sounds to theear.

2. That the central column of air is not chiefly set into vi-bration by the portion of the chest wall included under thehollowed end of the instrument, for a thick plug introducedinto the lower end of the shaft only slightly impaired the con-ductingpower of the stethoscope.

3. That the enclosed column of air can only owe its vibra-tions to those which are communicated to it from the solidparts surrounding it, and that the sounds of the chest are there-fore, in the first instance, propagated through the wood to theair within the tube, and thence, by reason of the continuity ofthe columns of air into the interior of the external ear.

I do not mean to assert that the solid walls have no sharethe direct communication of the sound; we have seen that-a solid stethoscope conducts sound very readily, and that theopening of all the orifices does not entirely destroy the powerof the instrument. The experiments which I have made will,however, serve to show that the conditions of the hollow andsolid stethoscopes are not analogous, and that the two formsmust be explained on different grounds.

Lastly, it is evident that the flexible stethoscope conductsthe sounds of the chest to the ear through the containedcolumn of air being set into vibration by the elastic walls whichsurround it.

These remarks upon the theory of the stethoscope concludethe first division of this course of lectures. The second por-tion will embrace an account of the physical diagnosis of thediseases of the heart, which I intend to commence at our nextmeeting.

CLINICAL ILLUSTRATIONSOF

CUTANEOUS SYPHILIS,HAVING ESPECIAL REFERENCE TO ITS PATHOLOGY AND TREATMENT.

BY ERASMUS WILSON, Esq., F.R.S.(Continued from p. 240.)

DR. WALLACE, whose lectures on Constitutional Syphilis, pub-lished in THE LANCET, in 1836, will be read with extreme in-terest by all who have given their attention to this subject;viewing constitutional syphilis as it was made manifest to theeye, and particularly in its relation to the skin, classifiedsyphilis under two great heads, to which he assigned thenames exanthematic and pustular. This classification recom-mends itself to our attention by its simplicity and- not less byIts practical application to the treatment of the disease; andas such, for the present at least, I shall adopt it.The most simple of the manifestations of syphilis on the

cutaneous surface makes its appearance in an exanthematicform-namely, as a patchy and mottled redness or congestionof the skin, not unlike measles. Dr. Wallace calls it a rubeo-loid eruption, but I prefer the designation under which I have

elsewhere described it-namely, roseola syphilit1’ca. The fol-lowing is a case in illustration :-

ROSEOLA SYPHILITICA.

Catarrhal syphilis; subsequently superficial ve7?e)-eal sore, followedby Poseola Syphilitica ; loss of rlrile 1)oice?-, dimness of sight,and emaciation.

CASE 3.-A gentleman of nervous temperament, habituallydyspeptic, of sedentary habits, unmarried, and about forty yearsof age, contracted gonorrhoea; and, two months later, while yetsuffering from gleet, he became the subject of a venereal soreupon the frænum preputii. The connexion from which thesore proceeded had taken place a week previously to its ap-pearance, and the sore itself was of the superficial kind with-out induration-a sore, in fact, such as Dr. Wallace wouldhave termed a primary exanthem, and of which he wouldhave predicted, in the event of the occurrence of secondarysymptoms, an exanthematous eruption.

This gentleman was not under my care for the primary dis-ease, but he appeared to have been treated very judiciously;a weak solution of nitrate of silver was used to the sore, andiodide of potassium with sarsaparilla administered internally.Like all sores involving the frsenum, this was a tedious one,and, although looking clean, and granulating, it was far frombeing healed at the expiration of two months from itsoriginal appearance when he first consulted me. Findingthe frænum perforated, I divided it completely, and orderedhim a lotion containing liquor plumbi and laudanum. Afterthe division of the frænum, the sore healed rapidly, as is com-monlv the case.The object of his application to me, however, was not the

sore, but a patchy redness, of a dull hue, which had shown it-self on various parts of his body, and more particularly on thefront of the trunk, the shoulders, and the inner sides of histhighs. I at once recognised a roseola syphilitica, and the wholeskin exhibited the ordinary characters of syphilitic cachexia;it was sallow, muddy, and dry, and the pores were prominent,as in cutis anserina, and filled with a dry sebaceous sordes.On his face were several dull red pimples, obviously of a sy-philitic character, but he had no enlarged lymphatic glands,and no soreness of throat, although there existed a trifling de-gree of congestion of the fauces. Subsequently, lie sufferedmuch from pains in the head and face, which deprived him ofsleep at night.

My patient’s tongue was of a yellowish-white colour, andthe papilloe long; his pulse was quick and small, and his bowelsrelaxed and irritable. Conceiving that he had taken theiodide of potassium sufficiently long, and thinking that theirritability of his bowels might be partly due to that medicine,I gave him nitro-muriatic acid, with henbane and gentian, butwith little alteration in the appearance of his tongue. I thenprescribed for him the mistura ferri composita, with decoctumaloes compositum, and ammonise sub-carbonas, which he tookwith much benefit, until the roseola and spots on his face hadquite disappeared.The duration of the roseola was three weeks, during which

period it occasionally exhibited exacerbations, and more par-ticularly whenever he made free with his glass. It made itsfirst appearance six weeks after the outbreak of the sore.

I have since seen this gentleman repeatedly, when sufferingunder pains in his head, partial deafness, and partial amaurosis.He is thin, emaciated, depressed in spirits, weak, nervous, andhas totally lost all virile power. These symptoms may presentthemselves in an aggravated form, in consequence of the ex-haustion caused by the syphilitic disease just described; butI do not believe them to have been caused by it; his constitu-tion was originally bad, and there had been, for some timepreviously to his illness, and during its existence, moral causesat work sufficient to explain his debility. I feel more disposedto take this view of the case than to suppose the symptoms tobe those of tertiary syphilis. _ -

Two years have now passed away since the attack of roseola,but he has had no return of secondary disease.

Observations.—The popular synonym of roseola is "falsemeasles;" roseola, in fact, as Dr. Wallace has observed, is arubeoloid, or measly exanthem, and, indeed, it resemblesmeasles very closely; the semilunar form of the patches isthe same; it is, however, somewhat duller in its hue, but, likemeasles, is generally accompanied by sore-throat. It may besaid to be like it also in its origin, from a morbid animal poi-son. As I have before remarked, a roseolous rash is one ofthe most simple of the manifestations of constitutional syphilis,and serves as a bond of alliance between that disease andcachexia arising from any other cause.In the cachexia which is apt to be engendered by long-con-

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tinued study in young men, particularly if they have been ex-posed to the malaria of close rooms, hospitals, or the impureatmosphere of the abodes of the lower classes, and especiallyin the autumn season, roseola is not an uncommon affection. Ihave seen it repeatedly, and one case in particular presents it-self at this moment to my mind. It was that of a house-pupilof mv own, who had been working very diligently during thewhole summer, and in the autumn had superadded to hisfatigues and anxieties, attendance on midwifery cases. Aftera case of this kind, which had kept him for many hours, duringtwo days, in the stifling and poisonous atmosphere of a smallroom, which served as the sole abode of two adults and fourchildren, and with the additional discomfort of a tediouslabour, he came to me in considerable alarm, in consequenceof having observed a dull-red eruption, covering his wholebody, and finding that he was feeling unwell, and had a sore-throat. He told me that he had been tormented the wholenight with itching of the skin, which scratching only seemed ’,to increase, and lie had made up his mind that he had becomethe victim of a legion of fleas, enraptured at finding a newpasture; but the unusual appearance of his skin, when helooked at it in the morning, and his feelings of illness, hadmade him fear that he was sickening for small-pox. On ex-aming his skin I detected roseola autumnalis, and a few dosesof aperient medicine, and rest, freed him from inconvenience.But the case of this gentleman was not distinguishable fromsyphilitic roseola: there was the sallow, muddy skin; the dirtyconjunctiva; the foul tongue, and congested fauces, and hadI not been sure of his morals, I might have suspected anothercause.

The relation of this case reminds me, that roseola syphiliticais very rarely accompanied by irritation, indeed, it is fre-quently discovered for the first time by the medical man, thepatient not being aware of its existence. In idiopathic ro- ’,seola, on the contrary, itching is a frequent symptom.

’

The anatomcal seat of the congestion in roseola is the ver-tical plexus of capillaries which surrounds the follicles of theskin and the interjacent horizontal plexus; hence, as inmeasles, the red-coloured patch of congestion is studded over ’,with points of a deeper red, corresponding with the aperturesof the follicles. These points offer many degrees of depth ofcolour, being sometimes only detectible by close observation,and at others forming a conspicuous character, while, in a Ithird case, they may be slightly raised above the level of theskin, so as to form ill-defined papules. There is anothercharacter, which is also often found in connexion with thesepatches-namely, an exfoliation of the cuticle; but this doesnot always and necessarily occur, and was absent in the casewhich I have just detailed. The presence of exfoliation im- ’Iplies a somewhat considerable congestion of the blood vessels,one approaching nearly to inflammation; or a weakened stateof the cutaneous tissues. On their decline, the patches ofroseola syphilitica leave behind them brownish-yellow stains.Of a nature akin to roseola syphilitica are certain conges-

tions of parts of the cutaneous surface, which, instead of sub-siding quickly, or passing off by exfoliation of the epiderma,remain in a chronic state, and cause a modification of the pig-mentary element of the skin. Several writers on syphilishave described a discolouration of the skin, of the nature ofephelis or chloasma, as being a constitutional symptom of thatdisease; but I have never yet seen an instance of chloasmathat I could conscientiously attribute to syphilis, although Ihave treated hundreds, in which the idea of syphilis was outof the question. In one case, that of a girl who had sufferedfrom gonorrhoea, and had subsequently a papular eruption onthe skin, chloasma was present on the front of the chest, andwas supposed to be of syphilitic origin; nevertheless, I couldnot trace it to that source, and it remained on the skin forseveral months, after every indication of syphilitic diseasehad disappeared. The treatment, which was effectual in re-moving the papular eruption, failed in its effect when broughtagainst the chloasma, and the discolouration and irritation ofthe skin gave way, at last, to alterative doses of arsenic.The following case, however, is decidedly venereal in ts

origin, and presented an unusually dark discolouration of theskin-so much so, in fact, that I was induced to name it"melanopathia syphilitica." It is a rare form of cutaneousdisease, and the only one of the kind I have ever seen.

MELANOPATHIA SYPHILITICA.

Condyloma; followed by papular eruption, and subsequentlyby melanopathia.

CASE 4.-A young married woman, twenty-three years ofage, of delicate constitution, and the subject of a constant

leucorrhœa, became affected, four months after marriage, withcondyloma. The condylomata, two in number, were situatedon the perinseum; they were circular in form, flattened,divested of cuticle, and poured out a copious sero-purulentsecretion. They were also very tender, gave her pain whenwalking, and occasionally when at rest; and continued to

annoy her for eight months before they subsided and healed.She had no other symptom of syphilis.Seven months after the first appearance of the condylo-

mata, she became attacked with an eruption of " red, flatspots," probably lichen syphiliticus tuberculatus. The spotswere few in number, and distributed on the face and temples,behind the ears, and on the neck, the back, and the arms. Onthe lower limbs, there were not more than three or four, andthose only on one leg. This eruption got well of itself in twomonths.The last of the " red flat spots" to subside were three

which were situated on the right leg, and these, instead of-disappearing, became of a dark colour, and formed part of adeep brown mottling of the skin, which subsequently tookplace. This mottling had the form of a network, whichseemed to correspond with the distribution of the cutaneousvessels, and extended up the inner side of both legs from theankle to the middle of the thigh. It was thickest at themiddle of the leg, and became less apparent about the knee,to increase again a little above that joint.She informed me that the ground upon which the discoloured

skin rested, was sometimes red, and sometimes blue, provingthe implication of the vessels of the skin, and its original de-pendence on a congestion of the capillaries, similar to thatof roseola. A close inspection of the dark patches showed,.moreover, that the part of the skin where the change hadbeen greatest was the follicles. The apertures of the latterwere marked by a deeper tint of colour than the adjacentparts, which gave a spotted character to the patches.

This discolouration bore a close resemblance to the appear-ance of the legs of the women of France, who are in thehabit of using the chauffrette," as a means of keeping them-selves warm, that form of discolouration being called ephelisignealis. But in the case of my patient there was no suchcause in existence, and the melanopathia was entirely attribut-able to the syphilitic virus.My treatment of this case consisted, in the first instance, of

nitro-muriatic acid, with infusion of hops, and subsequentlyof five-grain doses of the iodide of potassium, in decoction ofsarsaparilla, three times a day. The discolouration speedilyyielded to these measures.

Observations.-l had no means of ascertaining whether the-husband of this patient had contracted syphilis subsequentlyto his marriage. From the shortness of the period that elapsedbefore the appearance of the condylomata, I should infer thatsuch was not the case; and that the virus, from some earlierinfection had remained in his system, and was now, in themodified state attributed to it by Dr. Wallace, transferred tothe wife. The condylomata may therefore have been eithera secondary or a primary symptom, but more probably thelatter. The disease altogether was of a very mild character,and was exactly such as might have been expected from anexhausted virus acting upon a torpid state of constitution.

It is well known to those who have observed eruptions ofthe skin closely, that the red points of measles, like those ofscarlatina, are generally raised above the level of the skin; somuch so, that, to the touch, they give a granular sensation,and often these elevations are distinctly perceptible to theeye. The explanation of this elevation is, that the capillaryvessels which surround the follicles of the skin, or which con-stitute what I have termed the vertical capillary plexus, aremore congested than those forming the horizontal plexus, andbeing at the same time more numerous than the latter, theynecessarily cause an elevation of the mouths of the follicles,when distended with blood. They are in this state in measles,and particularly in scarlatina. In roseola, however, there isless cutaneous congestion, and as a consequence, the mouthsof the follicles are less, if at all prominent. If I were calledupon to state the diagnostic signs of roseola as compared withrubeola, I should say that the former was under, while thelatter was on, the skin; that in the former there was no elevartion, while in the latter the pores were more or less promi-nent; flatness and depth being the special signs of roseola, andparticularly of roseola syphilitica.Some years ago I had under my care a young woman who

was suffering from gonorrhcea, and this was followed by aneruption of the skin, which I then regarded as anomalous, butof which I have seen many instances since. The secondarysymptoms presented the mildest type of the exanthematous,

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form of disease; there was no soreness of the throat, no affec-tion of the lymphatic glands; but the exanthem was peculiar.At the distance of a few feet it had all the characters ofroseola; upon a nearer inspection, however, each patch of dis-colouration was found to be studded over with slightly elevatedprominences, not sufficiently raised to deserve the name ofpimples, and yet so far protruded as to be perceptible to theeye, more especially in an oblique light, and distinctly appre-ciable by the touch. I took a cast in wax of that eruption, asit awakened my interest at the time, and has since affordedme a clue to the nature of the syphilitic exanthematous erup-tions. It is now before me.

I was taught by this case that roseola was susceptible oftransition from a simple exanthem to a papular state, in otherwords, that roseola might become lichen, and that the twoforms of disease might coexist in the same person; roseolabeing merely a state of uniform congestion, while lichen wasa congestion which affected chiefly the follicles and pores ofthe skin. Since this observation was made, I have repeatedlyseen a syphilitic affection of the skin begin with roseola, andthen pass into a confirmed lichen, and I have also frequentlyseen the two states blended. Roseola, therefore, may be re-garded as an imperfectly developed liclien, and as an indica-tion of an inferior amount, or power, of the syphilitic viruspresent in the system. Hence, roseola is the common sequenceof catarrhal syphilis, or gonorrhoea; of condyloma; or of apoison modified by transmission through the system ofanother.

In my work on " Diseases of the Skin," (second edition,) Ihave already pointed out, in speaking of the pathology oflichen, that " the real seat of morbid change is the vascularboundary of the various excretory tubules of the skin; for ex-,ample, the sudoriferous and sebiferous ducts and hair-fol-licles ;" in other words, the vertical capillary plexus of theskin. Now, I have stated above, that in roseola this verticalcapillary plexus is in a state of congestion, and it only needsthat this congestion should be increased to raise up the poresinto pimples, in other words, to develop a crop of lichen.When the latter process is effected, the redness resultingfrom congestion of the horizontal plexus is passed over, or be-comes a secondary character; and where the inflammatoryaction is concentrated on the vertical plexus, at distant anddistinct points, the affection of the horizontal plexus maysimply be sufficient to constitute a slight areola to thepapulse.A recent perusal of Dr. Wallace’s lectures shows me, that

the transition of one form of eruption into another, in cuta-neous syphilis, was not left unperceived by that acute observer.Thus, he remarks," Notwithstanding the varieties of appear-ance which the exanthematic venereal diseases of the skinpresent, there exist the most satisfactory proofs that they are I,all simply modifications of the same state. Thus, in the first ’,place, we may frequently observe all the appearances which II consider exanthematic on the same patient at the same time,or on the same patient at different periods, but resulting fromthe same infection." Again, he observes, " The milder formsare converted into the severer by impropriety of living, andthe severer changed into the milder by temperance, and by amedicine expectante. Thus, mere stains may be changed intotubercles," &c.To revert to the case I have just described: let me ask the

reader what name he would give to it, by which, in speakingor in writing, it might be distinguished from common roseolasyphilitica, on the one hand, and lichen syphiliticus, on theother ? Will he not agree with me, that the term roseolasyphilitica papulata is both very suitable and very character-istic of such a form of eruption ? So I have named it, and inspeaking of it for the future I shall use this term.

Let me suppose another case; a roseolous rash, followedquickly by the growth of lichenous pimples upon the separatepatches of the rash-that is, a complete state of developmentof the papules referred to in roseola papulata. Will myreader oblige me for a moment by picturing in his mind suchan eruption: the dull-red patches of roseola, perhaps moredistinct in their outline than usual, and upon these patchesa number of red lichenous papules, varying from five to

twenty, and forming a group more or less defined—such aneruption as this has a remarkably striking appearance, and sug-gests the idea of a number of clusters of a small red fruit. Inconformity with this resemblance, I have named it the corym-bose form of lichen, from corymbus, a bunch or cluster, and, inthe precise language of medical nomenclature, lichen syphi-liticus corymbosus. This is a form of exanthematous venerealeruption by no means uncommon, and I will now proceed torelate a case in illustration.

LICHEE SYPHILITICUS CORYMBOSCS.

Venereal sore for the second tinz,,-: Rheumatic pains; corymboseform of Syphilitic Lichen; no sore-throat.

CASE 5.-A young man, a carpenter by trade, aged twenty,contracted gonorrhoea and a venereal sore in the month ofJanuary, 1845. The sore got well at the expiration of twomonths, without leaving any after consequences.In February, 1846, he again became the subject of venereal

sore, this time situated in the fossa glandis. He was treatedwith mercury, and the sore was healed in six weeks. Whileunder the mercurial treatment, he was frequently exposed tocold, having, in the prosecution of hislabourto pass from awarmworkshop into the cold air during the prevalence of a strongnorth-easterly wind. In consequence of this exposure, hebecame affected, three weeks after the first appearance of thesore, with severe rheumatic pains in his shoulders and knees,and at the same time, was visited by a papular eruption,which broke out, first upon his face, and then upon the arms,legs, front of the trunk, and back.He was in this state when he first came under my notice.

The pimples offered some variety in point of size, those ofmedium bulk being about equal in magnitude to a millet-seed.They were of a dull-red or purplish hue, and were collectedinto groups or clusters, varying in number from three or fourto thirty. The majority of the clusters contained ten or

twelve of these pimples, and here and there a few solitaryones might be observed dispersed among the clusters. Thepatch of skin on which the clusters were placed was slightlyraised, wrinkled, and of a dull-red hue.

After a week of treatment the greater part of the pimpleshad subsided, and were each covered with a little thin,brownish scale of desiccated epiderma; and there was also anepidermal exfoliation from the altered skin which formed theground of the patch. The patches had become brownish inhue, and contrasted strongly with the colour of the adjacentskin, although the latter presented the muddy and yellowishhue of syphilitic cachexia. Some few of the pimples, how-ever, still lingered, and contained at their summits a whitishpus, and here and there a single fresh pimple showed itself.At the end of another week every pimple was gone, and the

ground of the patches was undergoing a general exfoliation.The patient had no sore-throat throughout the whole courseof the complaint; but, upon inspection, a slight congestion ofthe fauces was evident. He had no tumefaction or tendernessof the inguinal or other lymphatic glands; and the eruption,though somewhat tender upon pressure, was unattended withpruritus.The treatment of this patient consisted in the administra-

tion of a little purgative medicine, to unload the alimentarycanal, and excite the liver and kidneys to a more active stateof function; a vapour-bath, which relieved the rheumaticpains; and the iodide of potassium, in ten-grain doses, threetimes a day. After the first week the iodide was reduced indose to five grains, and taken with the decoction of sarsapa-rilla. This he continued for another fortnight, by which timehe was thoroughly well, and has since had no return of thedisease.

Observations.-The preceding case is another instance of theexanthematous primary syphilis of Dr. Wallace, followed bya mild form of exanthematous secondary disease-an eruptionmerely, without affection of the lymphatic glands or of thethroat. The rheumatic pains I am more inclined to regard asthe effect of cold, acting upon a frame rendered unusuallysusceptible by disease and by the action of mercury, ratherthan of the syphilitic poison. In corroboration of this opinion,I may remark, that the pains were not increased at night, orby the warmth of bed.

I have noticed above in the description of the eruption,that there was some variety in the size of the pimples, andthat among the regular groups there were scattered a fewsingle pimples. I may now mention that situation has much todo in producing their modification; thus on the abdomen andface the pimples are generally larger than on other parts ofthe body, and, moreover, on the face they are rarely congre-gated in the clustered form here described, but are generallydisseminated; so that from the examination of the face aloneit would be impossible to form a correct diagnosis of thiseruption.These modifications are to be expected in a disease which is

capable of taking on a variety of successive forms, as is thecase with cutaneous syphilis. The modifications will always,however, represent stages of development of the typical erup-tion, and may be easily ranged in their proper place in rela-tion to the preponderating form of the disease. Diversity of

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eruption existing in the same individual will therefore esta-blish no contradiction to the views here laid down, but willserve rather to demonstrate their truth, and will be especiallyacceptable to those who are interested in following up thenatural history of syphilitic disease.One other point requires comment. I have stated above that

a few of the pimples, those which were the last to subside,presented in their summits a small collection of white-colouredpus. The occurrence of a sero-purulent fluid or pus is a com-mon character of the lichenous pimple when the eruption issevere or has lasted for a long time, and when the pus driesup it forms a scab of some thickness, and occasionally on thefall of the scab there remains behind a trifling degree ofulceration. I apprehend that the existence of sero-pustuleson the summits of the papules of syphilitic lichen may in someinstances have been mistaken for vesicles, and the purulentformations for pustules; but both the vesicles and the pus-tules of syphilis are vesicular and pustular from the first, andnot solid pustules at their origin, as was the case with these.

I may further remark, that I have never seen pus or apurulent secretion in the summits of lichenous papules, ex-cepting in cases like the present, where mercury has been un-necessarily or injudiciously given, or where the person whiletaking mercury has been exposed to the influence of cold.

CASE OF UTERINE HÆMORRHAGE FROM

PURPURA, AND AN EFFECTUAL MODE OFARRESTING THE FORMER IN ALL CASES.

BY JOHN LYELL, ESQ., Surgeon, Newburgh.THE following case, as illustrating a mode of practice, adoptedby me for many years, in that most terrible of all the casualtiesof childbirth-uterine haemorrhage, will, I trust, find a placein your columns.Mrs. L- consulted me on the 8th of December last; she

was in the beginning of the eighth month of pregnancy; feltvery feeble, with a weak, quick pulse; had pains in her limbs,so as to render her lame in walking, and was marked, invarious parts of the surface, with livid blotches of purpura,varying in size from a shilling to the palm of the hand.On applying the stethoscope, what has been termed the

placental souffle was distinctly audible in the right iliacaspect of the uterus, but the fcotal heart could not be heard.She had been sensible of the fcetal movements for a fewweeks after quickening, subsequent to which period allmaternal impressions of fcetal life had ceased. The childevidently was dead, and the purpura and ill health probablydependent on that death.As the state of pulse and other symptoms precluded general

bloodletting, I prescribed laxatives with quinine and iron;the purpura, however, went on increasing; by the 12th, thegums had commenced bleeding, and continued to ooze outrather freely, in spite of all local styptics, so as to keep herincessantly spitting for two days and nights.On the 14th, labour commenced, but the pains were feeble

and distant, so that the os uteri dilated very slowly. Thegums now gradually ceased to bleed, but a discharge insteadof dark fluid blood took place per vaginam, which increasedin quantity as labour went on; and at last, getting somewhatalarming, I administered ergot to expedite delivery. Thepresentation was normal; satisfactory uterine action tookplace, and in less than an hour after administering the ergot,a blighted foetus’of apparently five months was expelled; theplacenta soon after followed, remarkable only in extensivefibrinous deposit on its maternal aspect. The uterus havingproperly contracted under the special stimulus of the ergot,and hmmorrhage to any appreciable extent having ceased ina short time, I left the patient in a hopeful condition. Somehours after, however, I was called again hurriedly, as she hadsickened and become alarmingly ill; I found her pale, faint,and almost pulseless, evidently, to the least practised eye,prostrate from the loss of blood. There were very few clots,but the bed under the patient was soaked with blood, whichcontinued to escape by a ceaseless and considerable stillicidiumfrom the external parts. Still, the uterus felt well contractedand normal in size, the haemorrhage evidently depending, noton the adynamic condition of that organ, but on the purpuricquality of the blood itself, which thus found means of escapefrom its whole internal surface, where healthy blood wouldhave been restrained in its flow.To prevent further loss of the vital fluid, and arrest the

progressively fatal tendency of the case, I re-adjusted the cir-

cular roller with increased radding, so as firmly to compressthe uterus from above, and then applied the long bandagewith a properly shaped sufficient compress in the perinseum,so as to afford counter support to the organ below, whenescape of blood from without being impossible, and its collec-tion within equally so, it is almost superfluous to say that thepatient ceased to get worse; in a short time began to getbetter; and now, ten days after delivery, is doing well. Thelong bandage I slackened within twenty-four hours, and inanother like period removed entirely.What I have here designated the long bandage consists

simply of a stripe of stout linen or calico, fully two yards inlength, and about a foot broad; a slit is made in mid-breadth near the one end, through which the patient’s head ispassed, when the bandage rests on the shoulders; the long endis passed down the back, and brought up between the thighs,to meet and partly overlap the short end in front, to which itis pinned or tied. From this arrangement, it is obvious thatwith the shoulders as a counter-point of support, any amountof pressure can be applied to the perinæum, and through themedium of a compress to the uterus itself. The organ thuscompressed within the cavity of the pelvis, without the possi-bility of blood escaping externally, or collecting to any appre-ciable extent internally, uterine hæmorrhage becomes at onceeffectually arrested, at least, so I have found in practice, formany years. I had recourse to it at first from the disagreeablenature and comparative inefficiency of the tampon, which I.have ceased to use for fifteen years or more.A descriptive paper on the use of the long bandage I trans-

mitted to Professor Simpson, was read by that gentleman to-the Obstetric Society of Edinburgh, some time ago; but theabove case being one in which most, if not all other means,.even comprising electro-magnetism, would have been of no.avail, as uterine contraction was not deficient, I have thoughtit proper to bring the subject more prominently before the-profession. The long bandage has the advantage of beingalways at hand, a recommendation not possessed by severalother means, including electro-magnetism; and if I may beallowed to speak of it from experience, it is perfectly efficientfor the arrest of uterine haemorrhage, either post-partum or-from other causes. The abdominal pad I have generallyformed of a common bed-pillow, or flannel petticoats; and theperinaeal, of soft handkerchiefs or towels, made into an ovoidform, like the half-closed hands placed together. When thecompresses of proper size are applied, the woman seems aslarge as at the full period of utero-gestation.

I trust your readers will excuse me for being thus minute,as the subject is a most important one, the means recom-mended exceedingly simple, in accordance with the reco-

gnised rules for the arrest of haamorrhage in general, and per-fectly efficacious, so far as my experience goes.February,1850.

DISLOCATION OF THE PHALANGES.BY A. D. DUNSTAN, ESQ., Surgeon, Holmes Chapel.

IN the night of February 15th, 1849, whilst house-surgeon=to the Middlesex Hospital, I was called to see a woman, who,just previously, had fallen in the street, and dislocated themetacarpal phalanx of the thumb of the right hand, on to thedorsum of the metacarpal bone. Reduction was easily effected-in the following manner :-A nurse steadying the elbow to the side, I raised the hand

so as to bring the points of the fingers as near as possible tothe coracoid process, (i. e., supination of hand and flexion ofhand and forearm.) Supporting the hand with my own righthand, and the metacarpal bone with the ends of my fingers,.I bent the luxated bone with my left hand, over the end of,and at a right angle to, the metacarpal bone; then, with mythumbs on the head of the phalanx, pressed it firmly downwardstowards the palm, and whilst continuing the pressure, quicklyraised the distal end of the finger to a straight line with themetacarpal bone; in doing so, the phalanx slipped into itsnormal position; the whole process being accomplished mostreadily, and almost without pain, so that the patient wasagreeably surprised when she found her thumb "set right."

There was no treatment necessary subsequently, save keep-ing the thumb quiet for a day or two.A few weeks after this, a carpenter applied at the hospital,

having dislocated the metacarpal phalanx of the forefinger back-wards. This was reduced by the same method as the former,and with ease to myself and patient.The last case I had was that of a boy thirteen or fourteea

years old, who fell whilst running, and received a compound