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case was too distinct and immediate to cause doubt whetherthe proper and the post had been confounded. A slightly in-creased access of oxygen to the air-cells, a few improved and suc-cessful beats of the heart, and a renewed development of nervepower in the nervous centres, soon recovered the still partiallyasphyxiated person to a conscious, comfortably-breathing indi-vidual. It is immaterial upon which of these three seats oflife-the brain, heart, and lungs-the abstraction of the bloodfirst acts,-perhaps upon all simultaneously. It seems clear, insuch a case, that the relief afforded is, in the first instance,mechanical.

Dr. Little here added his conviction, that the value of vene-section will be determined, in any case, by its power of actingmechanically upon the great centres, so as to relieve conges-tion of them, rather than actual inflammation of mucous and

. serous surfaces, or the parenchyma of organs, inflammationbeing a process composed of many and various elements toocomplicated to be relieved solely by removing one of theseelements; the increased accumulation of blood for example.

ST. MARY’S HOSPITAL.VARICOSE VEINS; TREATMENT BY LIGATURE.

(Under the care of Mr. COULSON.)A GREAT variety of means have been proposed, from time to

time, for the radical cure of varicose veins. They all act, orare intended to act, on the same principle, that of producingobliteration of the enlarged vein; and they are all more or lessopen to the same objection-namely, that of giving rise to apeculiar inflammation of the vein, which ends in suppuration,pyæmia, and death. The principal methods may be dividedinto those by ligature, incisions, and caustics. The use of theknife was the oldest method, but it is now rarely employed,and modern surgeons have recourse either to caustics or liga-tures. The ligature employed in olden times by Actæus andPaulus Ægineta was revived by the late ir Everard Home.It is a quick, easy, and efficacious method, but unfortunatelyit has been sometimes followed by fatal consequences. Theoccurrence of inflammation in the inner coat of the vein not

leading to obliteration, but to suppuration, and subsequentpoisoning of the blood, appears to be connected in somemeasure with the general condition of the patient, and an un-favourable state of his health. Hence, when the subject isstrong, young, and in the enjoyment of good health, manysurgeons, amongst whom we must reckon Mr. Coulson, do nothesitate to employ the ligature. Caustics, or rather the actualcautery, are noticed by Celsus. Pare employed the potentialcautery; and this method has been revived by M. Bonnet, inFrance, and by Mr. Mayo and Mr. Skey in this country. TheFrench surgeon employed caustic potash, but Sir B. Brodiestrongly objects to the use of this substance: " The applicationof the caustic pota sh," says Sir B. Brodie, "is very painful;the slough takes a long time to separate; the sore takes a longtime to heal; and when one cluster is cured another appears.Altogether, it is a very tedious process, and my own experiencedoes not lead me to recommend it." These objections do not,it would appear, apply to the use of the Vienna caustic, whichis made by mixing six parts of lime with five parts of potass,and moistening the powders with alcohol until they form apaste. This method is very extensively employed by Mr.Skey, but it is unnecessary for us to dwell on it, as that

gentleman has explained his views fully on this point in arecent number of this journal.We have seen Mr. Erichsen apply pins under the enlarged

veins, and a twisted suture over a piece of gum-elastic bougieon each pin; this has produced adhesion between the sides ofthe veins, and a subsequent operation of subcutaneous sectionbetween the pins, as recommended by Mr. Henry Lee, has re-sulted in complete obliteration. This is on the principle of theligature, with the use of the knife, when all danger of inflam-mation has subsided.Herry S-, a young man, twenty-three years of age, was

admitted into the hospital on the 6th of March, 1856. Thepatient is by occupation a footman. He has suffered for some ’,time past from a varicose state of the right saphenous vein.The enlarged condition of the veins, which are about the size ofa crow-quill, did not produce much inconvenience until the lastfour months, during which time he has been in service as a,footman, and consequently obliged to remain more on his legs,wearing buckles tied below the knee, and living more freelythan he had been previously accustomed to. The change ofcircumstances at once affected the condition of the veins; theyincreased considerably in size, and the whole limb became so

painful that the man was incapacitated from attending to theduties of his situation.March 8th.-The varicose condition of the veins now ex-

tends up to the lower third of the thigh. They are of the sizeof a large quill. Ligatures were applied at three differentpoints-two below the knee, near the junction between themiddle and upper thirds of the tibia, and one about threeinches above the joint. No accident of any kind occurred, andthe case proceeded favourably. The ligatures were removedon the 8th and 9th of April, after which the limb was carefullybandaged.On the 10th all pains had disappeared, and the man was

able to walk about without any inconvenience. The veins are

greatly reduced in size; in the erect posture, however, somelittle dilatation of the saphena can be perceived at the lower

part of the leg.

On April 16th the patient was discharged cured.

CENTRAL LONDON OPHTHALMIC HOSPITAL.

CASES OF IMPAIRED VISION.

(Under the care of Mr. HAYNES WALTON.)How seldom do we hear the term " amaurosis" used by the

surgeons of the modern ophthalmic school. According to mostof the standard authors of a past generation, almost all, if notall, of the instances of impaired vision, not attended with pal-pable objective symptoms, are designated amaurotic, the mean-ing of which was very differently received by the differentmasters; but, in the main, is used as synonymous with nervousblindness, or disease of the ocular nervous apparatus. Afterthis came the fashionable theory of choroiditis; and the largemass of the cases that would have been considered amaurotic,were now considered to be so many of

" choroiditis." Every-body seemed to have choroiditis-the over-fed and lazy lady ofwealth, and the starved and over-worked milliner. But thiswas an improvement on what preceded; for although therewas often as great a mistake in the diagnosis, there was notgenerally in the treatment; and the more rational and moresuccessful plan of raising a person who was depressed to ahealthy standard was adopted, instead of the injurious one ofsalivation, bloodletting, setons and starvation, although mer-cury was seldom excluded. A still better state of things exists,for now there is a more certain discrimination of affectionsheretofore little understood, or even recognised; and our reme-dial measures are now more sure. No one has laboured morein his public capacity as an hospital surgeon, or a teacher, tounderstand eye diseases, to render them intelligent to thosewho attend his practice, and to simplify treatment, than Mr.Walton, and the shott notes that we have taken of the follow-ing case, as one of a class that we have seen him treat, may,we hope, be interesting and of use.

ASTHENOPIA, AND LONG SIGHT, OR LOSS OF FOCAL ADJUSTMENT.

A young woman, twenty years old, thin andfeeble, complainedthat after the use of her needle for about an hour the stitches

grew dim, and soon were lost altogether, but by rubbing the eyesthe work was again clear. Besides this, she was obliged tohold the needle at the distance of twelve or fourteen inches.The sight never tired from looking a.t large or distant objects.The defect had been coming on for two years, and had rapidlyincreased. When she worked or read in an artificial light thesymptoms were worse. A couple of months ago she took towearing convex spectacles, and got some temporary relief.Repose of the eyes for a day was attended with much benefit,but her position in life had prevented her from taking any restexcept on Sunday. No objective symptoms whatever could bediscovered; the eyes were bright, and the pupils active.We could not select a better example of this common affec-

tion, and which, in the present state of our knowledge, is wellexpressed by the term "asthenopia," or want of strength ofthe eye or eyes, as it is a disease that attacks both. Althoughfor the most part it is confined to those who overwork theireyes on minute objects, any one may be the subject of it. Mr.Walton has pointed out to us patients of great strength, whoseemployments were of a strictly manual nature, not requiringthe exercise of accurate or at least minute vision, that havebeen so affected. By those who have most investigated thesubject, the conclusion arrived at is, that the retina and theadjusting apparatus of the eye are both at fault. That theformer is not solely influenced, is proved by the ready reco-gnitioi! of objects after a brief repose, even of a few seconds. In

general, persons attribute the relief not to the rest of the eye,but to rubbing it. After a careful examination, Mr. Walton

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decided that the necessity for holding the needle at a distancebeyond that usually required by a person of the p. tient’s age,was not due to mere " presbyopia" or long sight, the kind ofdefective vision incidental to advancing life, but literally to aloss of focal adjustment, a very common accompaniment of"asthenopia." The necessity of a proper discrimination of theaffection must be apparent, and, as a rule, any surgeon who isaware of the nature of its symptoms will readily detect it; butthis is not always the case, and on a future occasion we propose to give a series of cases, with some of the more ordinarycomplications that attend it.We have been induced to select the present example, because

the treatment prescribed was adopted, and was beneficial.The hospital formula for iron, which is merely the sulphate insolution, was prescribed, and the girl’s mother was prevailedon to change her daughter’s description of work to that whichwas less trying to the eyes-namely, the making of coarsegarments of white or light-coloured materials. Besides, sheceased to work by artificial light; exercise was taken daily;the spectacles were discontinued. In six weeks from the com-mencement of this plan, the patient’s whole appearance wasdifferent, and she said that her eyes hardly troubled her. A

systematic temporary rest of the sight was enjoined. It is anessential adjunct in the treatment, and as Mr. Tyrrell intro-duced it, we give him the credit he deserves. In his remarkson the affection which is considered under the head of

"Temporary Congestion of the Choroid," after a system oftreatment in accordance with his idea of the disease, includingbloodletting, irritation, mercury, &c., he writes more

judiciously, -"Supposing a patient could work for an hour, but not

longer, without producing disturbance of vision, he should thenbe directed to work only for half an hour at a time, and toobtain intervals of rest of a quarter of an hour each. He canthus work for two-thirds ot his usual time, while his cureproceeds. The period to be employed at work, and the in-tervals of rest, should be regulated by the character of theaffection: as a principle, it may be stated, that the periodallowed for the employment should be short of that in whichapplication produces the disturbance of vision; and the timedevoted for resting the eyes should never be less than a quarterof an hour."

Medical Societies.ROYAL MEDICAL & CHIRURGICAL SOCIETY.

TUESDAY, JUNE 24TH, 1856.MR. CÆSAR HAWKINS, PRESIDENT.

TWO CASES OF MALFORMATION OF THE HEART.

BY HANNOTTE VERNON, M.D.

(Communicated by SPENCER SMITH, Hon. Sec.)THE first of these cases was that of a child, which exhibited

hardly any indications of life for several minutes after birth.It ultimately respired freely, but gradually became blue, andabout an hour after birth relapsed into its usual feebleness; thepulse became weaker, slower, and intermittent, and two mur-murs, corresponding with the first and second sounds of theheart, were heard. The child died four hours and a half afterbirth, having been previously convulsed. On examination,the septum of the auricles was found imperforate, there beingonly an oval depression in the site of the foramen ovale. The

tricuspid valve was incompetent, forming only a festooneddiaphragm between the auricle and ventricle. The right ven-tricle gave origin to two vessels-one the pulmonary artery,which had no communication with the aorta; the other theaorta itself, and the septum of the ventricles was deficient atthe base. The pulmonary artery was smaller in calibre thanusual. The left auricle was small, and the lungs very imper-fectly inflated. The author remarked that the peculiarity ofthe circulation before birth in this case was, that in conse-quence of the imperforation of the septum of the auricles, thehead and upper extremities received blood of similar qualityto that transmitted to the trunk and lower extremities. Afterbirth there were-1st, regurgitation from tricuspid incom-petency ; 2ndly, admixture in the aorta of venous and arterialblood, from imperfection of the septum ventriculorum; and3rdly, deficient supply of blood to the lungs, from narrowing

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of the pulmonary artery and propulsion of venous blood intothe aorta.CASE 2.-In this case the child died eight days after birth.

After having presented nothing unusual, it was suddenlyseized with difficulty of breathing, became livid, and diedconvulsed. The septum of the auricles was found to be veryimperfect. The left auricle was very small, received only twopulmonary veins, and had no communication with any othercavity than the right auricle, to which indeed it formed a merediverticulum. The ventricular portion of the heart was single,and did not present any appearance of a septum. It gaveorigin to a single vessel, much larger than the aorta generally,from which two pulmonary branches were first given off. Atthe commencement of the arch a third vessel arose, whichshortly divided into the innominata and left carotid and sub-clavian arteries. The aorta then pursued its usual course.A small vessel arose from the innominate artery, which, afterproceeding some distance towards the heart, became imper-forate. The lungs were very imperfectly expanded. Theauthor remarked that the course of the circulation before andafter birth would appear in this case to have been the same.In consequence of the non-communication of the left auriclewith the ventricular cavity, the right auricle was the recipientof aerated blood, whether from the lungs or placenta. Fromthis cavity the blood passed into the general ventricle, andthence through the general aorta. The pulmonary arterieswere wholly inadequate to transmit a sufficient quantity ofblood to the lungs, and, indeed, after birth a small proportiononly of the blood became aerated. The author remarked onthe rarity of malformations of the kinds of which these casesa.fford examples, and concluded his paper with some observa-tions-lst, on the connexion between malformations of theheart and an atelectasic condition of the lungs; 2ndly, on themode of death in cases of malformation of the heart; and 3rdly,on the relation of cardiac abnormalities and cyanosis.

MEDICAL SOCIETY OF LONDON.

SATURDAY, MAY 24TH, 1856.DR. CHOWNE, PRESIDENT, IN THE CHAIR.

Dr. WINN exhibited a specimen of’ ABSCESS OF THE BRAIN,which he had removed from the body of a lady who had beenattacked with puerperal convulsions and coma about a fort-night before death. For the early history of the case he wasindebted to Mr. Halford, with whom he saw the patient.From this gentleman he learned that the patient, a lady thirty-eight years of age, was seized in the first instance with con-vulsions, about six weeks before her confinement. The secondand fatal seizure occurred two days before labour. The con-vulsions were of an epileptiform character, and followed byprofound coma. The labour was unusually rapid, the childhaving been suddenly expelled by the unaided efforts of the! uterus, while the mother was perfectly unconscious. She hadnever suffered from convulsions prior to this last and secondlabour. Dr. Winn saw her for the first time ten days beforedeath. She was then lying in a state of stupor similar to thatarising from concussion of the brain. When roused, she wouldstare wildly, put out her tongue when asked to do so, andthen relapse into a state of unconsciousness. The urine waspassed involuntarily, her milk was scanty, and the lochia veryoffensive. She had lost three sisters, one from phthisis, andher brother was supposed to be insane. A great point ofinterest in the case was the fact that the first seizure super-vened on a moral shock of a peculiar kind. She received theintelligence, at one and the same time, of the death of herchild and of a rich legacy that had been bequeathed to herhusband. As she had been suffering from pecuniary difficultiesfor a long period, and had never been a person of strongintellect, it may naturally be inferred that the conflictingemotions attendant on the receipt of such a singular com-bination of good and bad news, must have acted most in-juriously on a weakly-organized brain. It was worthy ofremark, that, a short time before death, the muscles of thejaw were fixed by a sort of tonic tetanic spasm, and it becameimpossible to feed her. This event probably hastened herdeath. The brain was carefully examined by Mr. Halfordand Dr. Winn about thirty hours after death. The skull was

remarkably thick, and all the bones of the body were largelydeveloped. The membranes of the brain were healthy; and