being detained 27 days on the passage, the patient suffered much inconvenience, and, on the night before his landing, threw up a quantity of purulent matter by coughing. He complained of great weight in his side, and there was visible enlargement of the liver. It was evident that an abscess had burst into the lungs. There was no external pointing to justify an operation. His strength was supported by nutritious food--a large poultice was applied to the abdomen, and the nitro-muriatic lotion to the side. This plan was pursued for ten days, and with apparent advantage. His strength improved, and the external swelling decreased; but he felt more internal fulness and pain than previously, particularly between the tenth and eleventh ribs, where there was an obscure fluctuation. Mr. Richardson thought an operation advisable; but, in a consultation, this was negatived. But the patient insisted on the operation, and accordingly an incision was made between the tenth and eleventh ribs.

"The wound was made about three inches in extent; and, on introducing my finger, I found the abscess considerably higher than where we had made the opening, although this appeared to be the most depending part of the tumour. From the wound being large, we were enabled to pass two or three fingers, so as to support the tumour, and with the point of a scalpel we opened it, making our hand the medium of conducting the pus, for we found the abscess pendulous and the adhesions doubtful. A considerable quantity of curdled pus was discharged, to the amount of at least sixteen ounces. The wound was afterwards cautiously filled with lint and dressed, and a large poultice was applied over the wound and hypochondriac region. The patient passed a much better night than usual, and the following morning the matter flowed freely from the wound, and was thick, flaky, and curdled. His bowels were very costive, but were attended to, and relieved daily. The pulse was quick, but of good volume; appetite tolerably good. From this time he improved; his sleep became more quiet; cough less troublesome; bloody sputa ceased, though the expectoration continued purulent. No change whatever was made in the treatment; he was dressed twice a day. The discharge from the wound diminished; granulations formed; the pulse was frequent, 100 in a minute, but of good strength; tongue became healthy, clean, and natural; and, in order to avoid the hot season, he embarked on the 6th April, on board the David Scott, for the Cape of Good Hope, with every prospect of recovery. We have since learned that he had a relapse on board ship, and died, either at sea or at the Cape of Good Hope." 660.

This

The credit of the above operation is justly given to Mr. Richardson, whose science and judgment Mr. A. had often occasion to admire. excellent medical officer has since fallen a victim to cholera.

Two cases are next related, where abscess of the liver had burst into the lungs, and yet recovery took place--rare instances, indeed, of good fortune. One of these cases is so remarkable, that we are tempted to extract it.

CASE 4.—Abscess of the Liver breaking into the LunGS.-RECOVERY.

"OWEN KEATING, ætat. 29. His Majesty's 53d Regiment. 3d July, 1819. Admitted this morning into the Madras General Hospital, with dysenteric symptoms; complains also of pains in the right hypochondriac region; stools of a green colour, scanty, no tenesmus, pulse and skin natural; tongue foul; very thirsty.-Sumat. hydr. submur. gr. x. stat. post horas tres; ol. ricin. 3j.

"Vespere.-Bowels freely opened.-Repet. calom. gr. x. cum pulv. antim. gr. iij. h. s. Capiat haust. salin. tertiâ quâque horâ.

"4th.-Feels better this morning; was purged four times in the night; tongue loaded; has pain in the side under his fourth rib, when he drinks any thing; pulse small. Mist. purg.

"5th.-Tongue black and loaded; still feels pain in his side; pulse hurried and quick; face pale; stools clay colour; has taken the saline mixture.-Pilul. hydr. cum calom. three times a day. Haust. amar. cum sennâ, 3ij. nocte maneque.

"6th.-Feels much better; stools green colour, with hardened fæces; tongue black; pulse small and hurried; was only purged twice.—Mist. purg. 3iij. stat. Cont. ut anteà. "7th.-Tongue continues black and furred; stools yellow and watery; pulse small; skin cold.-Enema stat. R Aquæ ammon. 1xxx.; spirit. laven. comp. 3j.; aq. menth. 3ij. M. ft. haust. stat. Repet. pilul. et haust. amar. cum sennâ, ut anteà.

"No change in the symptoms occurred till the 13th.-The pills, enema, and bitter aperient draughts, were continued.

"13th.—Tongue lost the blackness entirely; he is better in every respect.-Cont.

"Three o'clock, P. M.-Seized with violent pain in the region of the liver, which impedes his breathing, attended with cough and a sudden and great expectoration of pus; skin rather cold, with a profuse perspiration over it; pulse feeble.-R Æthr. vit. 3j.; mist. camph. 3jss. M. ft. haust. stat. cap. Fotus parti dolenti.

"Six o'clock, P. M.-Pulse 122 and small; skin warm, with perspiration; tongue loaded with a yellow mucus; cough continues, with copious expectoration; about three pounds altogether have been discharged; pain particularly felt just under the margin of the ribs of the right side and up towards the breast; breathing still considerably impeded.-Cont. haust. cum æth. sulph. et mist. camph. ut anteà. Repet. fotus.

"Half-past Six o'clock, P. M.-Pain continues very acute about his right breast.—App. hirud. jv. parti dolenti. Cont. fomentation and draught.

"14th.-Pulse 114, small and fluttering; skin cool and with a cold moisture; a rough noise in his chest when he breathes; as if the bronchi were filled with matter; eyes lively; pupils less dilated than they were; expectoration of matter ceased last night at nine o'clock; still feels pain in the right side between the diaphragm and the superior convex surface of the liver; has very little cough, but he is evidently oppressed; has had stools this morning and walked to the commode.-Keep his bowels open with enemata. feels relief from the draughts. Cont. them and the fomentations. Arrow-root, milk, &c.

He

"Evening.-Sputa pure pus; pulse 140 in a minute; skin warm and moist; less expectoration; breathing easier; his belly open; tongue furred and yellow, not dry.-Mist. salin. febrif. cum antim. tart. gr. jss.

"15th.-Difficulty of breathing excessive; there seems fulness over the whole abdomen: pulse 120; skin moist and warm; has not had a stool since yesterday morning.— Enema. Cont. foment. Repet. mist.: and apply a warm plaster over the chest.

"Vespere.-Pulse 116, very weak; skin warm and covered with moisture; less pain, and he breathes better; his bowels have been well opened; stools perfectly good.-Cont. "16th.-Pulse 112, more firm than it was; skin more natural; tongue rather foul, not black; feels easier; some oppression still in his breathing, but he has less pain generally; sputa pure pus, but not so much in quantity as before; bowels regular.-Repet. enema. Cont. ut anteà.

"Vespere. Continues nearly the same; bowels opened by the enema; expectorates occasionally.-Cont. mist. salin.

"Nocte.-Cough rather troublesome.-R Tinct. opii camph. 3ij.; æth. vit. 3j.; stat. Mist. camph. 3jss.

"17th.-Pulse 116, small, and rather weak; skin cool, and a moisture over his forehead; tongue yellow; pain in his breast easier, and he breathes with more freedom; sputa thick tenacious mucous, with spots of pus; bowels very well.-Cont.

"Evening.-A wound which he received in the thigh has broke out and discharged a quantity of pus, with several small stones; pulse 112, very irregular and fluttering; skin of his hands cold, and covered with perspiration, perhaps from exposure to the air, as his

body feels warm; he has much less pain in his chest, and breathes with more freedom; the wound in his thigh was fomented, and a quantity of pus came away, but no stones.R Magnes. sulph. 3v.; aquæ menth. pip. ziij.; tinct. lavend. comp. 3ss. M.; p. m. s. Cont. mist. ut anteà.

"18th.-Pulse very small and weak; skin cold, and rather clammy; says he is much easier; not so free an expectoration; there was a considerable discharge from the wound in his thigh.-Con. Med. Sago and port wine.

Vespere.-Pulse continues quick and small, 120 in a minute; skin warm, but still covered with perspiration; stools copious, feculent, and of a natural colour; tongue rather cleaner; some thirst; cough somewhat troublesome, but very little expectoration; side and breast easy, as also his thigh; took the sago and wine very well to-day for his breakfast and dinner.-R Decoct. cinchon 3jss.; tinct. cinchon. 3ij.; acid. sulph. dilut. Mxx. M. ft. haust. tertiâ quâque horâ sumend.

"19th.-Pulse firmer, 110 in a minute; skin more natural; says he is much better; no matter in his expectoration.-Cont. cort. ut anteà.

"20th.-Pulse hurried and confused, 120 in a minute; expectoration difficult; cough troublesome, and some uneasiness in his chest ; voice hoarse; skin natural.-Repet. mist. purg. R Mist. camph. 3jss.; tinct. opii. comp. 3j.; tinct. scillæ, mxx.; sacch. alb. q. s. Ft. haust. stat. sumend. Čont. haust. cinchon. ut anteà.

"21st.-Pulse 108, not strong; feels easy; very little expectoration; oppression less; passed a good night, but seems to breathe quick; skin natural.-Cont.

"22d.-Pulse small and fluttering, 99; is stuffed in his chest, and his countenance is bloated; no pain in his breast, or difficulty of breathing, but has pain in the region of the liver; he cannot lie at all on the left side, and he has a short cough; bowels regular ; stools natural; skin covered with moisture; considerable fullness in the right hypochondriac region, and the appearance of a large tumour, but he has no pain, except along the margin of the ribs to the spine.-Apply a large poultice around the whole hypochondriac and epigastric regions, with unguent. mercur. 3ij. Cont. haust. camph. bis in die. Cont. cort. Per ut anteà. A flannel shirt.

"23d.-Fulness over the whole abdomen, and a tumour formed about three inches from the spine, between the fifth and sixth ribs: he cannot lie on the left side, but can stand up without any difficulty; stools natural; pulse hurried and weak; 110 in a minute.—Cont. poultice. Čont. med. ut anteà.

"25th.-Looks much better; fullness in the hypochondrium, and general swelled appearance of his face, neck, and chest, gone; breathing still rather oppressed; no pain in his chest; short cough continues; pulse hurried and confused; skin cool and moist; bowels regular; stools feculent and natural; tumour in the side seems to be diminished, but there continues an evident fulness.-Cont. ut anteà.

"27th.—Continues much better; the tumour towards the posterior part of the liver considerably decreased; pulse not so irregular, and firmer; skin natural; bowels regular.— Habeat pot. acid. nitros. ad libitum. Cont. omnia.

"30th.-The oppression in his chest is better; his pulse 96, and firm; feels slight pain in the right side,” immediately under the hypochondriac region.-Apply three leeches.Cont. med. omnia.

"31st.-Feels pretty easy; some tension in the epigastric region still; bowels open; felt relieved after the application of the leeches, complained of yesterday.-Cont. omnia. Nitro muriatic wash to be applied to the abdomen.

"August 1st.-Continues much better; bowels regular; pulse 100, and pretty firm; skin natural; tongue clean; cough less; side quite easy-R Decoct. cinchon. 3ij.; tinct. cinchon. 3ij; acid. sulph. dílu. Mxx. M. ft. haust. quartis horis capeind. Cont. acid nitros. at libitum, ut anteâ; nec non nocte maneque, lotio pro abdom. Vin. rub. 3vj.

" 4th.-The oppression in his breast removed, and he is recovering rapidly; cough very slight.-Cont. omnia.

"6th.-Says he feels quite well, although he seems to have some oppression still when he breathes; skin natural; tongue clean; appetite good.-Cont. haust. cinchon. et vin.

ut anteà.

"7th.-perfectly free from pain and uneasinesss; looks greatly improved; bowels regular.--Cont.

"From this date he continued to recover, but was not discharged for a considerable time, in order to prevent any relapse before his health was completely restored. He recovered perfectly. 676.

We have now, in four articles, concluded our analysis of the first volume of this immense and highly valuable work; and shall pursue our labours continuously through the remaining volume. The profession, as well as the author, must be well aware that the contents of these volumes would be comparatively lost to the public, were they not thus diffused through the medium of an analytical review. We shall spare no pains in rendering the results of Mr. Annesley's investigations available by his brethren at large.

XIII

AN ESSAY ON THE USE OF THE NITRATE OF SILVER, IN THE CURE OF INFLAMMATION, WOUNDS, AND ULCERS, By John Higginbottom, Nottingham, Member of the Royal College of Surgeons of London. Second Edition, much improved and enlarged. 8vo. pp. 204. 1829. WE think the work before us presents one of the most remarkable examples of the results of an intelligent and persevering investigation of an individual subject, which has ever fallen under our notice. It is now at least half a dozen years since the appearance of the first edition of Mr. Higginbottom's work. The multitude of interesting facts which are added in this, prove that the author's attention to the subject has been unremitting, and we think, must have conferred, in the course of their discovery, an ample reward of his labours.

In fact, the nitrate of silver has assumed, in the hands of our author, an importance both as to the efficacy and extent of its application in surgery, of which we did not think it susceptible. That to produce an eschar or vesication along the skin, by means of this remedy, would subdue inflammation, arrest erysipelas, preserved bruised parts,-frequently prevent suppurative-and constantly induce the adhesive inflammation,-are facts surely of the greatest possible interest. This remedy seems, indeed, under proper management, to possess an efficacy in modifying the morbid actions of parts of which it could not, a priori, be suspected.

It appears to us, from the perusal of this little volume, that the nitrate of silver applied along cutaneous and other surfaces, in a solid form, and in a prescribed manner and degree, induces a peculiar condition of the capillary vessels and circulation; and that, when these have been in a morbid state before, this morbid condition yields to that peculiar to the action of the nitrate of silver. The inflammatory, erysipelatous, and sloughing processes are thus changed to the adhesive, and if this remedy be applied, in the gentlest manner of course, even to a recent burn, the peculiarly painful affection which usually follows, is subdued and changed into that benigner condition peculiar to the action of this substance. How these effects are pro

duced it is not easy to conjecture. Something appears to depend upon the union of the nitrate of silver with the animal substances of the part touched by it, by which an eschar is formed which must exclude the action of the atmospheric air. But it is also obvious that some more positive good is effected by the action of this remedy.

But we proceed to our more usual, and we think more useful and satisfactory, course of analysis.

Mr. Higginbottom's little volume is ushered in by a short introduction, in which he points out some advantages of the use of the nitrate of silver over the more usual modes of treatment, in navy, army, hospital, and domestic surgery. These advantages are chiefly its more commodious and portable form, its simpler application, and its prompter and surer efficacy in the cure of bruises or wounds and other injuries. These are indeed advantages; and we think it will well repay the trouble of those who are so situated as to undertake the task, to try the experiment.

In the first chapter we are informed that the application of the nitrate of silver is a cure for external inflammation. This point is further illustrated in chapter II. in which its use in phlegmonous inflammation, in whitlow, in erysipelas, and in inflammation of the absorbents is amply discussed, and illustrated by some truly interesting cases. The next point treated of is the efficacy of the nitrate of silver as a means of inducing the healing process, or adhesive inflammation. This subject is illustrated by cases and further observations in chapters III. and IV. in which the author treats of punctured and bruised wounds at great length. In the third place we have the use of the nitrate of silver in healing ulcers; first, by inducing an adherent eschar, secondly, by the unadherent eschar, and lastly, in its conjunction with poultices. This subject is continued in chapters V. and VI. which treat of the cure of ulcers, and of old ulcers of the legs. The last, or seventh chapter, treats of the use of the nitrate of silver in burns and scalds. Two appendices are added, in the first of which the nitrate of silver is proposed as a vesicatory, and as a cure in gun-shot wounds, in neuralgia, in simple contraction of the rectum, in a peculiar ulcer of the tongue, &c.; and in the second, confirmations of the use of this remedy are given, from Mr. Webster, of Dulwich, and Mr. Tobias Browne, of Camberwell.

We think the following letter of Dr. Storer, particularly interesting. It is the unbiassed evidence of a looker on, who observes with accuracy, and infers with caution.

"Your late treatise had apprised me of your mode of using lunar caustic in the treatment of certain wounds and ulcers. I had not lost sight of the facts there detailed, and have been gratified to find, by repeated inquiries, that this plan of treatment continues to be confirmed by its success in your hands, and by other surgeons who have adopted it. It is now understood that it is capable of being extended with signal benefit, to old and extensively ulcerated legs; of which one case that I have seen is certainly an example. In cases of local disease, such success does not exceed the ordinary bounds of expectation; nor is it without analogy to the general application of this substance. When I heard that for some time past you had adopted the same plan of extinguishing cutaneous inflammation, not merely in symptomatic erysipelatous affection, but also in that constitutional erysipelas, which is often epidemic and always ushered in and accompanied with fever, I confess that I could expect no success from a practice militating so directly against the views generally entertained of the nature of this disease, and would give no ear to it without ocular demonstration of its utility.