the above articles, there is a considerable quantity of a sandlike or gritty substance, which cannot be traced to aliments, and which is probably the result of internal or fortuitous combinations. During the progressive disclosure of the above phenomena, the health of the patient has * very considerably improved. She attributes the removal of the extraneous matters entirely to the use of gin, and artificial. warmth applied to the region of the stomach; and in corroboration of this opinion, she asserts, that none of them are found in the fæces if she uses any kind of drastic or cathartic medicines. It is proper to add, that the habits of the patient are uniformly and rigidly temperate.

In respect to this case, we have to remark, that from its commencement its symptoms have been singular, and its nature could never be satisfactorily ascertained. In the course of her disease, the patient has received the advice of several physicians, and taken a great variety of medicines, without any permanent benefit. The occurrences which have recently taken place, obviously elucidate the character of her complaint. It must now be regarded as having been a case of constipation, or, at least, as complicated, with protracted obstruction of the bowels. By the Germans it would be denominated stypsis; and under this term Dr. Parr observes, that "constipation is relative, and it is inconceivable with how little injury to the general health a long-continued obstruction can be borne. There are well recorded instances of its having continued many weeks, and scybala, as well as other substances, have been retained for many years." Cases of this sort might here be enumerated; but we forbear to dilate on this subject, as they must occur to the recollection of every physician acquainted with the records of medicine. We know of no symptoms which can be considered as certainly diagnostic of this form of disease. Complaints of the stomach and bowels are frequently so anomalous, as to render it difficult, if not impossible, to form a correct opinion of their nature. We may observe, however, that attention to the appear

ance and frequency of the alvine discharges, as recommended by Mr. Abernethy, in his observations on the constitutional origin and treatment of local diseases, will, in general, enable us to proceed judiciously.

A Case of Laryngo-Tracheotomy, successfully performed by A. R. P. DUCHATEAU, Military Surgeon of the Hospital of Arras, &c.

On the evening of the 23d November, 1815, Iphigenia Ansart, aged six and a half years, and of a lymphatic temperament, swallowed, whilst playing with her companions, a plum-drupe. I was immediately sent for, and found her labouring under inexpressible anxiety, with the voice altered, and hissing. The slight cough which attended the accident in the first moments was allayed, but at each strong expiration, the noise of a foreign body striking against the glottis could be heard; she referred, as the seat of her distress, to the superior and lateral part of the thorax; all which indicated the presence of the drupe in one of the bronchiæ. Dr. Leviez and myself agreed to administer ten grains of ipecacuanha, which produced five or six ejections, without the desired result. The child was now greatly fatigued, and fell asleep; in which state she continued very tranquil until near four o'clock in the morning. On awaking she became agitated, convulsed, and extremely feeble. At seven o'clock we found her unable to articulate, and without sense. The eyes were closed, the face pale, the pulse small, and the respiration slow and laborious. We did not conceal from the parents her hazardous situation, and the approaching event, unless the offending substance was removed by an operation. They yielded her wholly to our care, and left the house. We placed her on a mattress, with the head elevated on a pillow, and after drawing aside a fold of the integuments,

the anterior and inferior part of the larynx, and the superior and anterior part of the trachea, were laid bare by a longitudinal incision of an inch and a half long. The laryngeal and tracheal cavities were then opened, by passing the bistoury into the crico-thyroid ligament, and dividing the cricoid cartilage and three of the tracheal rings. Immediately on penetrating into the larynx, the air rushed out with force, and the drupe struck against the point of the knife. After waiting a short time, it again presented at the opening; but could not be expelled, owing to the feebleness of the expiration. I then endeavoured to seize it with the forceps, but was foiled in the attempt, and afterwards searched for it in the larynx with a sound; but found it had refallen into the trachea, where it produced alarming suffocation, and the child appeared on the point of expiring. Whilst deliberating on the steps to be taken under these circumstances, an irritation excited in the nose, produced violent action of the respiratory organs, and the offending body was thrown out by a strong expiration, and bounded on the floor. The child immediately revived, and attempted to speak.-No artery had been divided in the operation. The lips of the wound were · brought together by adhesive straps, and the ordinary dressings applied. A slight cough continued for a few days, the wound was completely cicatrized in two weeks, and the child perfectly recovered, without any change of voice, or other inconvenience, and has since enjoyed good health. The dimensions of the drupe were, in length, nine lines, in breadth four and a half, and in thickness two and a half.

(Nouveau Journal de Médecine.)

INTELLIGENCE.

A Circular Address to the Officers composing the Medical Staff, by Samuel L. Mitchill, M. D. & P. Surgeon General of the Militia in the State of New-York.

GENTLEMEN,

DURING a season of peace and prosperity, when every citizen is occupied in his individual pursuits, more than in guarding against public danger, there appears a peculiar propriety in presenting to you a few subjects for consideration.

Although, at present, there is no field for the great operations of Military Surgery, the Surgeon General believes the talents of the Surgeons attached to the Hospital Department and to regiments, and those of their respective assistants, may be constantly and worthily employed, in promoting the great objects for which they are commissioned, and in contributing to the advancement of the profession at large.

We live in a section of the globe, where, at all times, diseases and painful accidents are frequent, and where the aid of professional men is sought with great solicitude. The deference thus paid to the opinion and character of Doctors, places them on elevated ground. By common consent, they are the guides and directors of health. To the honour of our country it has been remarked, that where to intelligence and activity, there is united a correct morality, a suffering individual and his family rest upon their Physician with perfect confidence; and well they may. A seat in the House and in the Senate; high commands in the Army and Navy; and the dignity of Governor in the States, has frequently been conferred, by the voice of the Vol. 6.

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people, the legitimate source of authority, upon medical

men.

The public sentiment in favour of the faculty, has been strongly expressed in as many places, as there are schools of medicine. It is right, in our condition of society, to adopt the measures necessary for forming able Physicians and Surgeons. No person is exempt from the casualties that may render their help important. All rational creatures pray that the healing powers may be propitious. So they ought.

Distempers often assail with vehemence, domestic and settled life. More severe and formidable are their attacks upon the exposed, and sometimes unsheltered soldier. Both kinds of malady require your particular study. During the absence of tumult and war, you can improve the opportunities afforded for observation. You can watch symptoms with calmness and care. There are none of the marchings nor counter-marchings of a campaign to interrupt you.

In this posture of things, I recommend to you, the observance of EPIDEMIC DISEASES. They come and they go, in a way that is not yet well understood. It ought to be comprehended, if possible, how far they are connected with solar influence, terrestrial effluvia, atmospheric change, corporeal predisposition, or other causes. Your opportunities are excellent. You traverse all the inhabited parts of the commonwealth. The commencement, progress, and termination of such maladies, are open to your view. You know into what they degenerate, when wholly neglected or unskilfully treated.

That my meaning may be comprehended, I offer a few examples.

Our Winter Fevers may possibly visit us again. Though they were skilfully described, among other writers, by North, Gallup, and Wilson, their reappearance deserves the utmost vigilance. It is not their mortality alone that deserves attention. Their obscure origin, when snow and