Issue 10, pp. 753-832, October 1861, SMSJ

SOUTHERNfttcMcai avto Surgical ImtttutlD BYHENRY F. CAMPBELL, A. M., M. !>..U BFICIA1 iX" roiii-ArATlVi- IXATOXl IN TV.ItOBERT CAMPBELL, A. M., M. D.,1 IX THE Mi"./, prends h bi n ou je U trouve.VOLUME XVII.—X. X 11.— 1861.AUGUSTA, GEORGIA:DH. WILLIAPUBLISHER,1861.

investigationstestimonyuseSOUTHERNMEDICAL AND SURGICAL JOURNALML AUGUSTA, GEORGIA, OCTOBER, 1861. NO. IllORIGINAL AND ECLECTIC.ARTICLE XVIII.[Conci :iber number.]Indi - -of tic Southern Oonfedei % acywhichmayill In in: 7 U of Mala/rial Fever. ByJoskpu Jones, M. D., Professor of Medical Chemistry mthe Medical College of Georgia, and Chemist to the CottonRanters' Convention of Georgia.No. 2.SUMMARY:Wild Uorehound, (Eupatorium rotundifolium.)—Botanical description; geographical distribution ;medical operation and uses; extensivelyemployed in domestic practice in the treatment of intermittent fever :medical properties first brought prominently to the notice of the profession,by George Jones, President of the Georgia Medical Society; testimonyof Dr. Jones, showing that it serves as an excellent substitutefor Peruvian bark;testimony of Dr. Nathaniel Chapman, of Philadelphia,to its value in intermittent fever.BUvk Willow, (Salix nigra.)—Testimony of Michaux to its valuein intermittent fever.Vhite Willow of "Europe, (Salix alba.)—Chemical composition :analysis of M. M. Pelleticx and Caventou ; discovery of the principleicin by Buchner, of Germany ; of M. Fontan a,telli, M. Leroux, upon'the different species of Willow properties;salicin : medical properties and uses of Willow bark;of, by theancients, brought to the notice of the profession in 17.'). by Rev. Mr.of Mr. Stone to its value; testimony of FamesWhite and Wilkin- of by Elaller : of European physiciansto the value of Salicin,48

practical754 i;i'Ji J'oXes, on the Indigenous [October,Yellow Jessamine, (Gclseminum sempervirins.)— Accidental discoveryof its value in malarial fever ;use of in Western States ; testimonyof Drs. Cleveland, Nash, J. A, Mayes and others, to its medicinal propertiesand uses; dose and mode of administration.Milk Weed, or Root of Man, (Asclepias syriaca.)—Testimony ofDr. Richard S. Oauthorn, of Richmond, Va., to its value in intermittentfever.Common Salt, (Chloride of Sodium.)— Dr. Scclle Montdezert thefirst to call i he attention of the profession to the value of Chloride ofSodium in the treatment of intermittent fever ; testimony of Dr. W. P.Lattiinorc to the success of M. Piory with common salt in the treatmentof intermittent fever ;testimony of Drs. Moroschkin and Dr. Hutchinson;dose and mode of administration.Sal Ammqniac, (Ilydrochlorate of Ammonia.)—Testimony of Dr.Felix Jacquot to its value in intermittent fever.Nitric Acid.—Testimony of Drs. George Mendenhall, Bailey, J. C.Thompson, and Dr. William A. Hammond.Arsenic.—Testimony, experiments and investigations of Drs. FelixJacquot upon its relative value in the treatment of malarial fever ; testimonyof M. Boudin.Ligature oj r the Extremities in 1/an miiient Fever.—Testimonyof J. PeDrauw and others to the effects ciligature of the extremities inintermittent fever.Cold Water in tJteTreatment of Malarial Fever.— V^e of by Dr.Wright in 1786 : rules for its use, by Dr. J. Currie, of England; testimony of M. Fleury to the value of cold douches in the treatmentof intermittent fever.WILD IIOEEHOUND1 (EUPATOIUUM EOTUXDI-FOLIUM. Eli..Botanical Description.—Leaves sessile, distinct, deltoid, nearlyround, obtusely serrate, veined, somewhat glaucous; scales of the involucrumacute, Stem two to three feet high, very pubescent. Leavesopposite, decussate, triplinerved, dotted, slightly scabrous, with a somewhatglaucous, or perhaps more correctly, hoary hue. Flowers in a fastigiatecorymb. Involucrum ten leaved, five flowered ; leaves lanceolate,acute, very pubescent. Corolla white. Stamens very short. Stylemuch longer than the Corolla. Seeds angled, Pappus scabrous, longerthan the corolla. Decoctions of this, as well as of the preceding species,used with much success as a tonic febrifuge. I have always suspectedthis plant te be the E, Marrbium of Walter. It is commonlyknown through our low country as the Wild Ilorehound, and its leavesbear more to the Garden Ilorehound, (inarrubiuin vulgare,) thanthose of an) -other of our species.Grows in dry pine barrens.Flower.- from .July to September. Elliott. Sketch cf Botany ofSouth Carolina and Georgia, vol. 2, p 300.

mbined: "In. whow England to Georgia: very abundant in the South examinathat I am aware of, has Qver b< eterinihc thechemical constitution of this plant.M This plant has been extensivelyemployed in domestic practice, in the treatment of intermittentfever, colds, and in debilitated states of the system;The medicinal properties of this plant appear to have beenfirst brought prominently to the notice of the profession, bythe Honorable G [., President of the Georgiathus describes its medical virtues : "It- an excellent substitute for the Peruvian bark, andamoifg the planters in or near the sea-board, itlie bark in the cure of fevers. It is tonic, dialc and mildly cathartic, and does not oppress thethe bark is apt to do—hence it may often he e.\hihited where the cinchona is inadmissable. It is usuallygiven .: of infusion : one ounce of the dried lea*d into a quart of water, may he taken daily, inFour ounces every hour or two. It may he advan;; with Peruvian bark, and. thouglmay sometimes fail of producing the desired effect, I thinkthe articles of the materian Dr. Chapman in his Therapeutics, nt'^v quotingthe : the President of the Georgia Medical :this sentiment I entire! own practicehas not afforded me many opportuniti it, but 1-tate, ir wjin the cases which havecatarrhala hitter tunic,inich. [1 lee'H, inp 437.apdmade ii nip or candy/'

756 Joseph Jones, on the Indigenous [October,I have employed the wild horehound both by itself and inconjunction with Cornus Florida, in the treatment of intermittentfever, colds, and debilitated states of the system, withvery good success. In my native county, Liberty, it has formany years, (as far as I can ascertain from the oldest inhabitants,probably from the first settlement of this portion ofGeorgia,) been employed extensively as a domestic remedy infevers and colds.It may be administered in somewhat larger dosesthan thepreceding species.BLACK WILLOW. (SALIX NIGRA.)This willow, which is the most common of the Americanwillows, and the most analogous to the White willow, (Salixalba) of Europe, is found in all the States from New Englandto Florida, and wesr, nearly to the foot of the Rocky Mountains.According to the younger Michaux, the roots of thistree afford an intensely bitter decoction, which issmallconsideredin some parts of the country as a purifier of the blood, and asa preventative and remedy for intermittent fever. The extensivegenus of willow, which comprises not less than onehundred and thirty species, which, with a few exceptions, arenatives of Europe and North Americo, is especially worthy ofthe attention of Southern physicians, since in several of theEuropean species, a principle resembling quinia, has beenextracted, and upon a fair trial has been found to possess theproperties of quinia.With the exception of the testimony ofthe younger Michaux, which I have just brought forward, Iam not aware that any experiments or medical investigationswith reference to the American species have ever been laidbefore the profession.»WHITE WILLOW OF EUROPE,(SALIX ALBA.)Although not indigenous to the Southern Confederacv, theWhite Willow of Europe has been so extensively introduced,that it is worthy of the consideration of physicians as thosource of salicin.

istryj1861.] Remedies of the Southern Confederacy. 757Chemical Composition.—According to MM. Pelletier andCaventou, the bark of Salix albacontains bitter yellow coloringmatter, green fatty matter, similar to that found in cinchona,tannin, resinous extract, gum, wax, woody fibre,magnesian salt containing an organic acid.and aThese chemists failed to isolate the most important of all itsingredients, salicin,which was most probably mixed with thebitter yellow coloring matter. Subsequently, in 1828,Buchnei, of Germany, discovered a peculiar principle,which has since been discovered in fourteen species of salix,and eight species of populus. M. Fontana and Ttigatelli, ofItaly, discovered this principle shortly after Buchner. M.Leroux, of France, appears to have been the first to accuratelyinvestigate its properties. When pure, salicin presents itselfas white, shining, slender, inodorous, very bitter cystals, insolublein ether and oil of turpentine, soluble in alcohol,much more soluble in boiling than in cold water.According to Merck,- it may be prepared in the followingmanner :Dried or fresh willow bark is cut small, and exhausted byrepeated boiling with water. The decoctions are concentrated,and, while boiling, treated with litharge till the liquorappears nearly colorless. The dissolved oxide of lead isremoved, first by sulphuric acid, afterward- by Biilphuret ofbarium, and after the separation of sulphuret oflead, evaporated,when salicin crystallizes ; and is purified by repeatedsolution and cystallization. From willow bark which is freshand rich in salicin, it may be obtained by cautious evaporationof the cold aqueous infusion. The oxide of lead remfrom the solution gum, tannin and extractive matter whichwould impede the crystallization of the salicin. It also combineswith the salicin, forming a kind of salt, which is decoindby the sulphuric acid and sulphuret of barium. I:latter be carefully added, neither sulphuric acid nor baryta'Turn-I7th ed. p

;7 58 Joseph J ones, on the Indigenous [October,remain in the solution ; and the sulphuret of lead which separates,acts as a decolorizing agent.I'wal Properties and Uses.—The ancients arc said tohave employed the Lark of the willow in the treatment ofdisease ; it fell into disuse, however, until 1703, when it wasbrought into hottce by Rev. Mr. Stone, who published in thePhilosophical Transactions of the Royal Society of London,an article entitled "On the Success of the Bark of the Willowin the cure of Agues by the Rev. Edm. Stone, of Clipping-Norton, Oxfordshire:"' Dated April, 25th, 1763."As his observations are exceedingly interesting at the presenttime, we shall present a full account of them :About six years prior to 1TG3, Mr. Stone tasted the willowbark, and was surprised at its extraordinary bitterness, whichimmediately raised in him a suspicion of its having the propertiesof Peruvian bark. As this tree delights in a moist,wet soil, where agues chiefly abound, the general maxim thatmany natural maladies carry their cures along with them, orthat their remedies lie not far from their causes, was soapposite to this particular case, that he could not helpveryapplyingit ; and that this might be the intention of Providence,he owns had some weight with him. The plenty of this barkfurnished him, in his speculative disquisitions on it, with anargument both for and against these imaginary qualities of itfor on one hand, as intermittents are very common, it wasreasonable to suppose, that what was designed for their cure,should be as common and as easy to be procured. But then,on the other hand, it seemed probable, that if there was anyconsiderable virtue in this bark, it must have been discoveredfrom its plenty. His curiosity prompted him to look into thedispensatories and books of botany, and examine what theysaid concerning it ; but there it existed only byname. Hecould not find that it ever had any place in pharmacy, or anysuc'i qualities as ho Bnspected, ascribed to it by botanists.However, he determined to make some experiments with it;au«! for the purpose he gathered that summer near 1 lb.weight of it, which lie dried in a bag, on the outside of a

'baker'.- oven, re than three monreduced to a powder by pounding and sifting,at'manner that d.It was not long b( fore he had an opportunity of making atrial of il : bn1 being an nature, he gaveit in is, he thinks it was abon :.softhe powder at very tour hoars betweenthe tits, but with great caution and the strictest attentionto its effects : the tits were considerably abated, but didnot entirely ceae perceiving the least ill e< ices,he became bolder with it, and in a few days increased the Ito two Bcruples, and the ague was soon removed. It was thenn to several others with the same success, but he founbetter answered the intention when one drachm of itn every four;rvals of the paroxysilie bad continued to use il with success, as a remedyagues and ii r five years successively.It bad been ailed in thecure, anal and quartan agueu long and severely afflictwhich the \.then reduced, in 2 ree,but did not wholly taloft*. The patient, at the usual time for the return ofn't,felt some smattering of his distemper, vsaut repetition of tl could notseemed as if th

760 Joseph Jones, on the Indigenous [October,only neglected his powders, but meeting with bad weatherrenewed his distemper.One-fifth part was the largest and, indeed, the only proportionof the quinquinia made use of in this composition,and this only on extraordinary occasions ; the patient wasnever prepared cither by vomiting, bleeding, purging, orany medicines of a similar intention, for the reception ofthis bark, but he entered upon it abruptly and immediatelyand it was always given in powders, with any common vehicle,as water, tea, small beer, and such like. This wasdone purely to ascertain its effects, and that he might beassured the changes wrought in the patient could not beattributed to any other thing, though, had there been a duepreparation, the most obstinate intermittents would, probably,have yielded to this bark without any foreign assistance;and by all he could judge from five years' experienceof it on a number of persons, it appeared to be a powerfulabsorbent, astringent, and febrifuge in intermitting cases, ofthe same nature and kind with the Peruvian barks, and tohave all its properties, though perhaps not always in thesame degree. It seemed, likewise, to have this additionalquality, viz :to be a safe medicine, for he never could perceivethe least ill effects from it, though it had been alwaysgiven without any preparation of the patient. The treefrom which this bark was taken, is styled by Ray, in his synopsis,Salix Alba Vulgaris, the common white willow.Philosophical Transactions of the Royal Society of London,abridged bv Ilutton, Shaw and Pearson, vol. xii. 1763-1769,p. 1-3.Messrs. James White, and Wilkinson published strongevidence in favor of the use of the broad-leaved willow inintermittents, foul ulcers and other affections. Dr. Cullenrecommends the willow-bark in his Materia Medica, as asubstitute for Cinchona. I taller was in the habit of using,with success, a decoction of the bark as a bath to dip infantsin.Dr. Closs affirms that the bark of the willow, given in

1861.] Remedies of '1 7*51the do>e of a scruple every three hours, has cured manyeases o£ intermittent and bad scorbutic ulcers; numerousother English physicians have testitied to its value in intermittents;and its great value as a substitute for Peruvianbark is established beyond all doubt.The testimony of numerous European physicians showsthat the active principle of Willow bark, Salicin, is capableof arresting and curing intermittent fever, and standsnext to Quinine as an anti-periodic remedy.According to Buchner, twelve grains, in divided doses,will irenerallv arrest a

762 3EPflJoKfis, bn the Indigenous [October,those of a high gra-de, lie still thinks that it is entitled torank as a coefficient with Quinine in fevers.It has been chiefly used in the form of tincture. Dr. J.\. Mayes, who has published a most valuable paper uponthe Gelseminum in the Charleston Medical Journal andReview for March, 1857, recommends the following formulafor the tincture: " Four ounces of the fresh root clippedsmall to one pint of diluted alcohol, macerate forfourteendays." Dose for adults from twenty to fifty drops, repeatedas frequently as circumstances may require. Dr. Bachelorthus prepares the tincture :" A bottle is loosely filledwith the bark of the fresh root, equal parts of whiskey andwater are added, and the bark is macerated for fourteendays ;twenty to sixty drops of this infusion may be used ata dose, alone or combined with Quinine.""Whether or not the Yellow Jessamine possessesany an-""tiperiodic properties, it certainly possesses valuable sedativeproperties, and is capable by controlling irregular nervousaction,, of aiding greatly the powers of nature in fever, andalso the action of other remedies. The testimony to its sedativepower is unequivocal.Dr. Mayes affirms that he has never been disappointedin a single instance in obtaining a direct sedative actionfrom the use of the gelseminum ;the patient being speedilyquieted, although he may have been excessively agitatedprevious to its administration. Under its influence restlessnessis soon succeeded by calm repose, and the excited,frequent pulse tempers down to tranquility.These favorableimpressions must bo secured, however, by a frequentrepetition of the dose, as its effects arc not very durable,wearing off in two or throe hours.It will be found necessaryto administer the medicine indoses of from twenty tofifty dro i'ding to the severity of the symptoms, cvcrytwo until under the influense of moreradical remedies, the di has boon permanently con-•1. And his ctesire by the |strong advocacy of this

. andfavorableIConfederacy..]medicine, is U) bring it into no1 an admirable agentrolling irregular nervous action and bringing aboutiii 1 i a state of ifor obtaining thefull action of other and more radical treatment. Drs.reland, Branch, Nash, Douglas, and others, have, in likemanner testified to its nn antispasmodic and sedativeeffects.•A6CLEPIAS SYRIACA. THE ROOT OF MAX. T.PLANT. MILK WEED.Dr. Richard S. Cauthorn, of Richmond, Ya., lias giventhe root of this plant with success in six casesof intermittentfever.Dr. Cauthorn has used the root in the form of pills,containing-two or three grains,aes combined with capsicum,sometimes given alone. A cure has followed theme dozen of the pills, two having been taken at intervalsof every two or three hours. He affirms that theroot of this plant produces none of the distressing symptomswhich often attend the administration of Quinine.Monthly Stetho>MMON SALT.CHLORIDE OF SODItJST.Dr. Scelle Montdezert appears to have been the first tocall the attention of the profession to the value of ChlorideSodium in the treatment of intermittent fever; andhowever fanciful his notion that every paroxysmal fevev iscured by the presence of fibrin in the venous blood, whichshould in the normal state be e proceethat th their powerfibrin pr

764 Joseph Jones, on the Indigenous [October,costly, but are liable to adulterations, monopolies, and tofinal destruction from the wasteful and reckless manner inwhich these are gathered and prepared for the market.In his memoir upon the treatment of Intermittent fever?presented to the French Academy of Medicine, July 1850,Dr. Scclle Montdezcrt declared that from the results observedduring several years, with the beneficial effects ofChloride of Sodium in the treatment of interjnittcnt fever,this medicine should share with the salts of Quinia the perogativeof arresting the paroxysms of intermittent fever.He says that half an ounce of salt administered in halfa glass of infusion of Coffee, in the morning before eating,during the apyrexia, will be sufficient to arrest the paroxysm.Its use in this manner should be continued three days.According to the testimony of Dr. W. P. Lattimore, M«Piorry, who was one of the committee appointed by theAcademy to report upon the Memoir of Scelle Montdezcrt,experimented extensively with the Chloride of Sodium inintermittent fever and confirmed the previous observations.This subject is of so much interest that we present the testimonyof Dr. Lattimore to the success of M. Piorry withthe Chloride of Sodium in intermittent fever, in full:" M. Piorry holds that in all paroxysmal fevers the spleenis enlarged ; that the anatomical lesion is the cause, the feveronly the symptom;that whenever the spleen has agreater length (measuring in a line extending from themiddle of the axilla to the anterior superior spenous processof the ileum,) than from 31 to 33 lines, intermittentfever exists. Believing thus, the symptoms for him arezero, while the state of the spleen stands at the other endof the scale, and is everything — percussion (pleximetric) ofcourse, being the ezperimentum cri

1861.] Remedies of the Southern Confederacy. 7G5he thoracic, and with no less success, for he has broughtit to an almost incredible degree oi' perfection. With hisplate of ivory and his flattened fingers 1 ends lie diagnostieverything—tumorsof the abdomen, abscessrerywhere,aneurisms, &c. All acknowledge the delicacyand accuracy oi' his test, while the looker on is lost inadmiration, and wonders whether all his senses are notreally concentrated in the ends of his fingers, which byconstant drumming have at length become the very reverseof tapering." Wishing, then, to experiment with salt, a few cases ofintermittent fevev, (old stagers,) contracted in Algiers wereselected as subjects. Behold, then. Piorry at the bedside.The patient asserts that he contracted the fever and agueseveral years since in Africa ; that he has frequently beencured, but that the disease has constantly reappeared at theend ot fifteen days, or one month at farthest. The type ofthe fever is tertian. The spleen is pei cussed and found tobe abnormally dull throughout its wbole extent;the entiresplenic region is sensitive upon percussion, particularly overthe dullest points ; and each blow is accompanied bymarked contortions of the countenance. The sensibilityextends but little beyond the region of dulness, which lastoccupies an extent of fifty-three lines, measuring in the directionindicated above. To this patient a drachm of salicinis administered without producing any change in thedimensions of the spleen. A few minutes subsequently,half an ounce of salt, mixed with a cup of soup is given,and upon carefully percussing the splenic region at the endof four minutes, this organ is found diminished one inch,from above downwards. The next day the spleen is foundto be of the same size, but upon the administration of asecond dose of salt, it suddenly contracts and measuresnearly three quarters of an inch less than ay. Themance throughout the entire organ has increased whilethe sensibility has diminished. The succeeding day theattack of fever is very slight, and upon giving a third dose

7'!

'.erL] TUTpanying the cure i the curativeemployed."M. Piorry's method of administering the Chloride ofSodium is to give half an ounce in a cup of thin soup duringthe apyrexia and fasting. It usually agrees with theiach perfectly well, but in some few cas< - we have sconit exeite vomiting and diarrhoea. Three doses commonlyFeet a euro : the fin ken on suc-.ceeding davs>and the third after an interval of one day.»Should the spleen be undiminished in volume by the firstwe may be sure that the remedy will not cure theand the same is true of all the anti-periodics. Ex*Lng in rare cases, the diminution of t lie spleen occursimmediately upon the administration of the remedy, (salt,sulphate quinine*) and may frequently be detected withinone minute, after which the organ remains stationary untilond dose of the medicament he administered."—Onthe Employment of Chloride of Sodium in the Treatmentof Intermittent Fever. By W. P. Lattimore, M.D., AmericanJournal of the Medical Sciences, July, 1852, No. xlviiIn . S. pp. 102-104.The observations of Dr. Moroschkiu upon the value ofI in the cure of ague, agree with the testimony of thepreceding obsenHe states that during the prevalence of scorbutus andein the Transcaucasian province of the Black Sea, Quininesometimes entirely lost its power.-. When no veryprpmim»utic affections were present he administeredone ounce of salt in water in tv. 3, daily, during theof the apyrexia. In patients in whom the paroxincomplete,very abundant sweating followed.the skin resumi >rnial appearance, and the variousother signs of ainendn;d in a few

—'.emeticssbfhJohi[Octobameliorated.—Rank':ract of Med. Sciences.January to July. Jahrb. Xo. 6, 1856.witDr. Hutchinson, of Brooklyn, Las placed on record- of intermittent fever which were treated_- iven varied from eightveive drachms during the apyrexia. At first eightdrachms were given, hut the amomv subsequently insedto nine, ten, and even twelve drachms, in one instance,with obvious benefit. Children required somewhatjlarger proportional doses than adult-.Mi -elected as the vehicle, on accountand because it sufficiently disguised theof itsremedy, which was deemed a matter of importance; for itwould have lost much of its efficacy, or have been repudiflier,had the patients known they were takingsimply comma: tie following was the formula:—Chloridi g 3 ij :Ulmi pulv. .".ij ;iij.Infuse ira and strain.Th saturated solution. Dos poonfuly two, three or :-o that five or six doses mayda. It whs not deemed neto precede its employment by evacuants, because thepat' : recent. such remedies during their formerattacks, and. moreover. Dr. Hutchinson preferred toreal value could thus be betletermined.When itits$ary to precede theor cathaiing better for the purpose indinary ly administered idwhich will usually produce sate catfa rt of the the remedy was well

1861.] Remedies of th Southern Confederacy, 760tolerated by the stomach, nausea or vomiting having occuredin but four instances, four cases also had moderate alvineevacuations, unattended with pain. There was considerablethirst in every cum-, hut no other unpleasant effects.When given in the above manner (dissolving it in as smalla quantity of water as possible,) it is less likely to disturbthe stomach than the same or even a less amount, would ina larger proportion of the solvent The taste was objectedto by some, while others disliked it much less than Quinia.The following are Dr.Hutchinson's conclusions:1. Although interior to cinchona and its preparations, ityet forms a very good substitute for them in intermittent fever,having failed, as we have elsewhere seen, to produce aspeedy suspension of the paroxysms in31.8 percent of the- only: in a majority of cases, therefore, it may hesubstituted for quinia."2. It may be used instead of, and, indeed, preferably toquinia: First, in cases, not unfrequently met with, wherethe latter remedy is forbidden by the very unpleasant nervousand cerebral symptoms it produces(delirium, tinnitusaurium, cephalalgia, faintness, &c.) an example of which 1have recently seen in the Xew-York Hospital, where sulphateof copper was substituted.3. It is commended on the score of economy, which is aconsideration of importance to the poor, especially, whoare now, in a measure, debarred from the use of quinia, byits high price. And fourthly, it is always at hand, whilstquinia sometimes cannot be obtained.It has been found to be more energetic in curing aguethan any of the vegetable or mineral tonics commonly usedfor that purpose, excepting bark, and should, therefore, bepreferred to arsenic, which has been ranked by If.Andral.Prof. Wood, and, indeed, most other authorities, next invalue to quinia. And, moreover, I think arsenic shouldnever be used until after quinia and common salt have failedto do good, «Mi account of its unpleasant, and sometimesdisastrous consequences to the general system and Btomach,49

770 Joseph Jones, on the Indigenous [October,and the increased facilities it affords for using the remedyas a toxicological agent.—Rankin's Abstract of the MedicalSciences, Xo. xx, 1854, p. 88. New-York Journal ofMedicine, March 1854.BYDROCHLORATE OF AMMONIA. SALAMMOXIAC.Dr. Felix Jacquot has carefully experimented with IFydroehlorate of Ammonia in the Military Hospitals at Home,with a view to determine its value in the treatment of malarialfever.The doses employed were from eight to twelve grammesThe experiments were made upon twenty-onein the day.subjects with the following results : In six cases the feverwas cut short, giving 28 per cent ; 1 case presented oneparoxysmafter the administration of the medicine, that is,4 per cent, of the whole number ; 1 case presented twoparoxysms, also 4 per cent ; 11 cases, or 52 per cent, presentedthree or more paroxysms in spite of the medicine ;and there were two cases which could not be placed in thesecatagories, but which were not cut short. It will be seenfrom these experiments that more than one-half the caseswere uninfluenced by the Ilydrochlorate of Ammonia, andwhilst the six cases (28 per cent.) of the entire number cutshort, would appear to show a powerful febrifuge operation,it is only apparent and not real, for according to M. Jacqnotmore than one-third ofthe cases submitted to expectationrecover spontaneously.The results of these experiments, as far as they extend,not only show that the greater part of the fevers are unaffectedby this salt, but that where the fever is not arrestedthe marsh cachexia becomes quickly developed and assumesan accelerated course during itsadministration.According to this observer, sulphate of quinia succeedadmirablyin arresting fevers against which sal ammonia \^1>\\. and he concludes that hydrochlorate of ammoniabears no therapeutical pretensions in the intermittents

1801.] //• Ik Southern Confederacy. 771of hot countries, and that there is much doubt of its capacityof rendering any service in those of Europe. " Experimentswith several pretended substitutes for cinchona inthe Military Hospitals at Rome. By Dr. Felix Jacquot,hives Generates, June 1854 p. 678.) Abstract of aReport on Materia Medica, by Edward Ballard, M. D. Brit.ft For. Med. Chir. Rev. vol. xvi. p. 191.NITRIC ACID.Dr. George Mendenhail, of Cincinnati, called the attentionof the profession to the use of Kitric Acid in the treatment ofintermittent fever in 1854 : the facts upon which his paperwas based was chiefly derived from an Inaugural Dissertationby Dr. E. T. Bailey, of Indiana.Dr. Bailey states that inthe section of country in which liele8, there is a large portion of marshy land, and, therefore,the circumstances are favorable to the development of autumnalfevers. His attention was first attracted to the use ofnitric acid in the treatment of intermittent fevers, by noticingitseffects in a case of chronic intermittent, which was attendedwith pmfuse night sweats, and for which complication headministered the remedy. In this case there had been dailyparoxysms for the preceding five days; night BWeats profuse,the tongue coated, and the bowels constipated. Nitric acidwas given in doses of six drops, diluted with water in theevening; and he was agreeably surprised to find that theparoxysm.- did not return on the following day ; and this circumstanceinduced him to try its effects in other cases as ananti-periodic. Since that time he has treated over ninety- of intermittent fever with this article, with remarkablesuccess. Of this number, all recovered promptly except ten :and in every one of these unsuccessful r-a-es, the remedy wasdiscontinued contrary to directions.Fifteen of the whole number were of the tertian type, andnty-five of the quotidian. In fifty cases there was no returnof the chill after commencing the use of the acid. Theothers were rarely attended by more than one paroxysm, and

77-? Joseph Jones, on the Indigenous [October;in no case by a third. When the patient had a paro.after taking the medicine, it was in every case diminished inintensity and duration.In Dr. Bailey's practice, this remedy Lag entirely supercededevery other article for the purpose of interrupting theparoxysms oi intermittents. His mode of proceeding is togive from five to eight drops of the commercial nitric acid,properly diluted, once in six hours, without regard to intermissionsor exacerbations. Cathartics and alterants may benecessary for the purpose of changing certain conditionthe system :but so far as the interruption of the paroxysms igconcerned, the acid may be given without any preparatnthe system whatever, if we choose to do so. American Jour,of the Medical Sciences, October, 1854, pp 581-5 x l'.Dr. J. C. Thompson, of Arkansas, has recorded in theSouthern Journal of the Medical aud Physical Sciences,August, 1857, the successful trials of nitric acid in six cases ofintermittent fever, in which thecustomary remedies had fail-,ed. In one case in which there was menorrhagia, a powderjconsisting of one grain of opium and two grainsof sugarpublished. The cases were troated at Fort Riley, Kansa-lead was given every two hours until the discharge subsidein two others, blue mass was prescribed in conjunction w lththe acid, and in the remaining three cases, pills of sulphate ofiron, aloes and rhubarb were given inaddition to the acid.lie recommends one ounce of the acid to be diluted withsix ounces of water; of this the patient is to take one drachminan ounce of water every two hours during the intermission.The chairman of the Ohio State Medical Society admin]tored nitric acid successfully in 35 cases out of 36,Dr. William A. Hammond has added his strong testimonyto the yalue of nitric acid inintermittent fevers, published iithe Maryland and Virginia Medical Journal tor February1861. Dr. Hammond, after presenting the results of the employmenJ of nitric acid, in tabulated form, remarl"The table forms the basis of a report made about four yearsince to the surgeon general of the army, and has never beei

•and1861.] Remedies of thi Southern Corfederaey. 773territory, in the post hospital, then under my charge, In aweeks in the summer. Upon referring to theable, it will be seen that in all, forty-one cases were treated,on of those being of the quotidian typo, and thirty-one of' tfie[ertian.Thirty-two cases were treated with the nitric acid, and ninewith tlie sulphate of quinia. Of the cases cured by nitricacid, three had previously used quinine without effect}and ofthose in which quinine had proved successful, nitric acid hadbeen employed without benefit in two, and in one other hadto he omitted on account of causing nausea, heartburn, etc.The average period of treatment before the disease waspermanently arrested, was the same witli cacli remedy—threedays. The nitric acid was uniformly given in doses f tenJrops (properly diluted with water) three times per day, theJninine in dose- of eight grains three times a day.Besides the fact that the nitric acid was equallysuccessfulwith quinine in arresting the disease, the difference in the costW the two articles rreatly in favor of the former Bubkanceas to render it an object of importance to make itscurative properties more widely known.going cases were treated, I have very frequentlyemployed nitric acid inthe treatment of intermittentid have rarely been disappointed in my expections ofaction. In fact, in simple uncomplicated internt,I seldom have occasion to use anything else,[n ncnt of the spleen, consequent upon frequentattacks of the ague, the remedy in question has, in mylands, proved very advantageous."Tli ly that nitric acid is avaluable substitute \'->v quinine; and we can readilyby a v powerful alterative effecmercury, that it would be beneficialin remittent, typhoid and typhilfi f

7 74 Joseph Jones, on the Indigenous [October,AESENIC, (AKSENIOUS ACID.)The value of Arsenic in the treatment of malarial fever hasbeen celebrated by numerous reliable observers; and themedicine ranks with many practitioners, second only toquiuia : we shall not, therefore, enter into any extended exanimation of its medicinal properties; but shall content ourselveswith the presentation of the recent andmost valuableinvestigation of Dr. Felix Jacquot in the Military Hospital atHome, premising that arsenic exists in the Southern Confederacy,and only needs an effort for its extraction from theearth.The paper of Dr. Jacquot is a summary of a memoiraddressed to the Conseil de Sante des Armecs, on the employmentof arsenic in the treatment of intermittent fevers ingeneral, and of those of Home in particular, based upon 282observations ;andwe present it without alteration, as it appearedtranslated in the British and Foreign Medico-ChirnrgicalReview, vol. xvi, 1855, pp 189 to 191"1. Mode of' £xperii7ienting.—In order to establish the efficacyof arsenic as a febrifuge, its administration should belimited to those cases which have resisted treatment withoutthe use of quinine. The author of the paper before us hasnot strictly followed this course, since, giving the arsenic atthe outstep in the majority of the cases, he hadno means ofjudging whether the fever was about to proceed steadilywith its paroxysms, or whether, on the other hand, it had atendency to spontaneous disappearance. But as the sulphateof quinia was administered in the same way, it was at least ina position to establish the comparative efficacy of the twomedicines. His researches, too, permit him to consider separatelythe treatment with arsenic alone, and the completetreatment by this remedy, emetics, &c. Arsenic alone cutshort the fever only in S.33 per cent, of the cases, but thecomplex treatment in 16.66.But while the efficacy of the arsenic is doubled by the conjoineduses of emetics, the febrifuge powers of the sulphate ofquinine are so great, that those of emetics simultaneously em-

•arc: hut,!ammoifediA\ nu dies of the South Iracy.ployed are lost, or absorbed in them ;thus, the per centagcof fevers cut short by sulphate of quinine without emetics is2, and by sulphate of quinine with emetics, 50.47, as calculatedin 210 teveis.2. Formulw, Dose, Duration op Us< of Ars< ,,'(

776 Joseph Jones, on 1 the Indigenous [October,smallness of the dose, its ingestion in divided portions, and thequantity, and perhaps nature, of the vehicle. The local accidentsare nausea, vomiting, diarrhoea malaise, and sometimespinchings at the epigastrium, and an insurmountable disgustat the medicine. Either general or local accidents followed,in 31 out of his 72 cases, or in 43 per cent.5. Autopsies of Individuals treated with A n>enic.—In threesubjects examined, nothing was discovered which could beimputed to the employment of arsenic, either in the heart, orin any other part of the body.6. Degree of the Efficacy of'the Arsenic, Comparison withSulphate of Quinine, die.—The cases in which M. Jacquotiounds his comparison are those which had not received anyprevious treatment calculated to interfere with the accuracyof his experiments. Tie thns tabulates his results :SULPHATE OFQUININE.Fevers cut short, i. e., which have not )presented a single paroxysm from the > 50.00AKSENIC.13. SSthe commencement of the medication, )Fevers which had presented one paroxOysm in spite of the medication, but in > 25.71 22.i!2which the second had been averted. .jFevers which have presented two par- )oxysms, but in which the third has V 7.61 12.50been averted)Fevers which have presented three or [ r QO o 11.42 16.66regarded as not cut short)The arsenic with or without the emetic has cut short thefever 13. SS times per cent.; the sulphate of quinine with orwithout emetic?, 50. times percent.;that is to say, the arseniclias been efficacious as one, the sulphate of quinine three timesand a fraction. The arsenic with emetics cut short the fever16.66 times per cent.; the sulphate of quinine without anemetic, 50.47 times per cent.; that is to say, the arsenic has

1861.] Renu the Southern Confederacy. 777been efficacious as 1, the sulphate of quinine as three and afraction.The arsenic without emetic has cut short the lever vtimes per cent.; the sulphate of quinine without emetic, 49.52times per cent.;the proportion being arsenic as l,to sulphateof quinine as 5 and a fraction. Lastly, in comparing thea the most favorable to the arsenic, viz.: those in which itwas administered in large doses, three to ten centigrammes,accompanied by emetics, and a diet whose only limit was theappetite of the patient, with the cases least favorable to thequinine, we arrive at the following results :Fcvcr< cut short by arsenic, - - - 9.6S per cent.•quinine, - - 49.52 " "As respects the cases not cut short, it will be perceived, onreferring to the first four iigures of the two verticalcolumnsof the table, that in the instance of the fevers treated withquinine, the numbers arc smaller and smaller, according aswe examine the categories of cases more and more refractory,whilst the contrary is noticed in the instance of the arsenicaltreatment. The contrast is perfect.In about 35 cases it was possible to compare the effects ofthe quinine and arsenic, the two medicines having been administeredin succession to the same patient, either for thesame fever, or in two separate attacks. In a sixth of thesenical and quinine treatment were of little efficacy:in another sixth, the two medications were followed by: in the four other sixths, the sulphate of quinineshowed itself the most active, or the only active remedy ofthe two ;and one observation furnished a very marked instanceof fever resisting the sulphate of quinine, and cured bymic. In short, the author concludes that we see morers which resist arsenic, yielding to quinine, than we dofevers, refractory to quinine, disappearing under arsenicaltreatment. lie believes, also, that h< ablished the factof the greater activity of the sulphate of quinine in the caseswhich have received no previous arsenical treatment (T>4 per

778 Joseph Jones, on the Indigenous [October,cent, cut short,) than in those first submitted to the action ofarsenic, (40 per cent, only cut short.)The general conclusion lie draws is, that the sulphate ofquinine is not replaceable by arsenic ; and especially is thistrue in respect to the fevers of hot climates, where it is neesary to apportion the dose to the intensity of the malady ;under the latter circumstances, we are immediately arrestedin the arsenical treatment by the fear of poisoning.In thosecountries where, from one paroxysm to another, the pyreniamay become more severe, remittent and pernicious, arsenicshould not be employed during the endemo-epidemic season.Confirmation of Results by other Observers.—After mentioningMM. Mayer, Cordier, Pasquier and Gouge, as arriving atsimilar conclusions to his own, he states that in the Pontinemarshes, Dr. Minzi, physician to the Central hospital of thatcountry, has experimented with arsenic in more than 400cases, giving it to the extent of three centigrammes a day, andat last abandoning it from want of success. M. SalvagnoliMarchetti also, out of ID cases, found 15 resisting arsenic.Arsenic in Inveterate Cases and inMarsh Cachexia.—Theobservations of M. Jacqnot do not encourage recourse to arsenicin inveterate fevers ;and M. Cordier also concludes fromhis experience in Algeria, that it is the more recent andslighter cases which yield most readily to arsenic. In thepalustrial cachexia he thinks that arsenic may perhaps be usedas an alterative, but that it is incapable of replacing iron andother tonics, which it is necessary to conjoin with it.IZelajiscs.—In preventing relapses, arsenic is inferior to sulphateof quinine. Out of 72 cases treated with arsenic, therelapses w r ere 22 or 20 percent.—certainly a large proportion.They were less frequent in the cases treated with quinine.The relapses occurred even during the period of administrationof the arsenic, which was continued after the cessation ofthe fever.This was not observed in the instances of the quininetreatment.

l.] /;«//. )j Southern Confederacy, WOAr& nic in th>Fngranesa nt and /?< mdttent Fevere.— In five3 it was observed that in spite of and during the employment of arsenic, the simple fever became aggravated remittent,sub-continued and pernicious a fortiori, then, thismedicine would have no action npon a fever already of thischaracter.>-.— Arsenic is not for a moment to be regardeda^ a substitute for sulphate of quinine. It will probably finda limited place in the treatment of indigenous intermittentfevers, but it has absolutely no pretensions against the recentendemo-epidemic fevers of hot countries. We are scarcelyauthorized to employ it except in the fevers which resist allthe preparations of bark.Uncertainty and contradiction reignover almost all points relative to arsenic. It is a medicinewhich we cannot yet handle with the double certainty of obtainingthe effect desired, and of avoiding the dangers connectedwith its administration."These results of the carefnl observations of M. Jaequot, arcworthy of most carefnl consideration by the physicians of theSouth, on account of the similarity of the heldof experimentwith a large portion -o/ the South; and they are especiallyworthy of most careful examination, from their antagonism tothe most astonishing results which M. Bondin, of Paris, claimst have accomplished with arsenic in the treatment of intermittentfever.M. Boudin affirms that in 4,000 cases of intermittentfever treated with arsenic, in the hospitals of Marseil!ailles and Paris, from 1843 to 1851, he had nothad occasion to resort in a >ingle instance to sulphate of quinine;and out of 311 cases treated at Versailles in a period of39 months, If. Boudin had but 10 relapsIt may well be asked whether the intermittent fevenPar [lies do not differ greatly in B

780 Joseph Jokes, on (he Indigenous [October,LKiATI Ki: OF THE EXTREMITIES IX INTEE-MiFEENT FEVERS.J have had no faith in and consequently no experience with thismode of treating intermittent fever. The following summaryof a valuable article by Drs. J. DeBrauw and II. J. Braers,taken from the North American Medico-Chirurgical Review,of March, 1859, presents this method of treatment in a strong,and, in fact, the most favorable light which I have yet seen :'•According to Drs. DeBrauw and Braers, the ligature ofthe extremities is a measure which has been already employedby ancient physicians to aid the treatment of intermittentlever, but has unjustly nearly fallen into oblivion. AlreadyPinius, (Hist. Nat. xxviii, G) knew this antiperiodic, as Pittsclioft(Hufelands Journ. ii, 3, pp 47, 48) states, and in TanSweeten's Commentaries to Boerhaave* Aphorisms, the 'levisbrevisque compresseo venarum in arbutus,' is strongly recommendedas a means to relieve the burning heat of fever. Dr.V. Hildebrand, however, declares the remedy, in his InstitutionesPractico-Medicce, to be unreliable, and in many respectsunsafe, and recommends caution in the use of it.JosFrank, (Prax. Med. TTniv. Precepta,) speaks of it in a verysuperficial manner, like many others, particularly more recentauthors. One of the most enthusiastic commenders of thismethod is George Ecllie, (Duncan's Medical Commentaries,vol. xix,) who, during the seige of Willemstadt, by the Frencharmy, in 1793, cured many cases ofintermittent fever (whichhad resisted the use of quinine) completely, by compression ofthe extremities. Upon this recommendation several physiciansin England—for instance, Veitch and "Wallich, (Mediz..National Zeitung, July, 1798, and in the Netherlands, (Age~mene Yaderl. Lettervefningen, 1808, 5)—tried this methodwith signal success. Of the more recent communications onthis subject, that of Prof. Chladni, (Ilufeland's Journal, xlii,p. 138) is worth particular attention. This celebrated savantbeing attacked il] L813 by an obstinate intermittent fever,used the remedy with much advantage. He discusses it. asquite innocuous, and explains its curative influence by f]\o

l.| Remedies of the Souths leracy. 781supposition, that by ligature of the extremities, the return ofblood to the heart, and to tlie centres in general, is hinderedor partially suspended, an

782 Joseph Jones, on the Indigenous [Octob errecommended cold drinks in the hot stage. From observationsof this kind, the author draws the following conclusions :The ligature of the extremities is a safe and powerful meansof assistance in the treatment of intermittent fever ; it is notonly an adjuvant to other antiperiodics, but also a febrifuge byitself.It cures the febris intermittens simplex and duplex, aswell as the quotidiana. In regard to the quartana no experiencehas been made.The ligatures must be allowed to remain until the laststage begins ; a longer application does not lessen the effect.The method seems to owe its curative property to the disturbanceof the usual course of the fever, (Chladni.)Sometimes the paroxysm is transferred under this treatmentfrom the third day to the second, but generally sothat the tertian type is not interrupted, or that a febris duplexis developed. The compression of the extremities isalways followed by some increase of the heat and perspiration,the signs of an energetic reaction. After repeateduse of this method the fever gradually subsides. Contraindications to it never existed, but may be easily inferredfrom an examination of the modus operandi of the remedy.Dr. DeBrauer generally applied compression to the extremitiesonly, but considers the ligature of all four, farmore efficacious in obstinate cases, and recommends themethod as being capable in some cases to substitute the useof quinine.In cases of relapse of intermittent fever in which the patients complain of that characteristic pain in the lumbarregion, (fifth lumbar vertebrae) against which cups are usedwithout effect, Brocrs recommends the application of thegalvanic current to the mentioned spot as a highly serviceable,though occasionally inefficient means. After the secondor third application of this remedy the cachectic appearance,as well as the depressed feelings of the patients,underwent a favorable change. Relapses of the fever, conlequentupon a return of the patient into the malarious district,yielded quickly to this niodo oi* treatment, even when

:L861.] R dies )f the Southern Confederacy. x ,^quinine was administered without success*" — (NederlandTijdsche, 1858, and Medizinsche Neuigkeiten, 1858,No. 44.COLD WATER IX THE TREATMENT OFRIAL FEVER.MALA-It would be foreign to our purpose to enter into any disjionof the mode of action of water in Fevers, for, asthe most universal of allsolvents in which the elements ofthe blood are dissolved or suspended, and as the largestconstituents ut the solid as well as of the fluid components,and as the great medium of the introduction of the nutritiveelements, and of the chemical changes which developethe forces which work the machinery of the human body,as well as of the removal of the products of these chemicalchanges, water occupies such a prominent position in allthe processes of health and disease, that it would be impossibleto discuss either its value or its mode of action in feverin the limited space now at my command, and must contentourselves with a few practical observations and reliable testimonyto the value of water as an external application, reservingthe extended discussion for a future occasion.Xowthat the old notions with reference to the injurious effectsof water and fresh air, have vanished with the progress ofmedical practice, based upon sound physiological principles,we can scarcely realise the powerful effects of water, in thetreatment of fever, without a careful comparison of thesymptoms, progress and mortality of diseases before andafter its free use.Iexternal application, the value of cold water thoughnot unknown and not unemployed by the ancients, was notappreciated by the profession until after the publications ofDr. William Wright- 1586, and especially of Dr. J. CurofEngland.Formerly of tin- [aland of Jamaica, published an account in tin

:784 Joseph Jones, on the Indigenous [OctoberDr. Wright first adopted the practice in his own case andsucceeding in arresting the progress of the fever after twiceapplying the cold effusion.The success of this trial led other physicians to adoptthis mode of treatment ; and Dr. Carrie eleven years afterwardspublished in Liverpool his valuable Medical Reportsfounded upon accurate observations of the effects of coldwater, which exerted a most beneficial effect in removingthe strong and injurious prejudices against the free use oicold water in fevers.We might adduce numerous testimonies to the value oithe external application of water in various fevers, as Typhus,Typhoid, Intermittent, Remittent, and Congestive,from the time of Dr. Curric to the present, but we must deferthese for a more extended discussion, having roommerely to present a few points of practicalinterestPrecautions recommended by Dr. Curric when the Cold Affusionis contemplated.— 1. This remedy should never be usedwhen there is any considerable sense of dullness, althougheven the thermometer indicate a morbid degree of heatIf the affusion of cold water on the surface of the body 1>

18GL]Remedies qfthsp^ Confederacy, 785specially, If \i haw been brought on by violentexercise, the affusion of / cold w^ter in the naked body, oreven immersion in the cold bath, may be hazarded withlittle risk, and sometimes may he resorted to with greatbenefit. After the sweating has continued some time, andMowed freely, -ally if the body lias remained at rest,either the aifusion or immersion is attended with danger,even though the heat of the body at themoment of usingit be greater than natural. Sweating is always a coolingprocess in itself, but in bed it is often prolonged by artificialmeans, and the body prevented from cooling under itto the natural degree by the load of heated clothes.A\ nenthe heat has been thus artificially kept up, a practitioner,judging by the information of his thermometer only, maybe led into error. In this situation the heat sinks rapidlyon the exposure of the surface of the body even to the externalair, and the application of cokl water, either by affusionor immersion, is accompanied by a loss of heat and adeficiency of reaction which are altogether inconsistentwith safety.—Medical Reports, &c. By J. Curry, 1797.According to the experience of Dr. Carrie, if employedon the first or second day with the precautions recommended,the progress of the fever is often checked, but it is sclsafulwhen applied so late asthe third or fourthday, though when administered about the eighth or tenthday, or even later, it moderates the symptoms and shortensthe duration of the fever.- More recent observations haveshown, however, that whilst Typhus fever may bethus cutshort, this remedy fails almost universally in arresting Typhoidfever, which runs a definite course and is characterbyas definite pathological alterations, as Scarlet fever,and Small Pox.When the fever has rim on for eight or nine days and thepatient is weak, the heat of tin- water should be only a fewbelow that of the patient, and at this period it ispreferable to sponge the body with cold or tepid vinegarand water.

—786 Joseph Jones, on the Indigenous [October,Testimony of M. Fleury to the value of Cold, Douches in thetreatment of Intermittent iever.—M. Fleury in his memoiron this subject presented to the>French Academy states thatlie was led to these researches by the assertionof Dr. Curric,that the accessions of ague might be prevented by theaffusion of cold water, and that by its repetition four or fivetimes, the disease might be entirely cured. M. Fleury hasemployed this means one or two hours before the expectedparoxysm in the form of a general douche, and in that ofa local one to the region of the spleen.The ends attained by the above plan he believes to be1 . A shock exerted on the nervous system, and on the genoralcapillary circulation. 2. The opposing of a vigorousreaction and general stimulation of the surface to the coldstage of the fever. 3. A modification of the circulation ofthe spleen, combating congestion of that organ. lie haspursued this treatment in eleven cases of intermittent fever.1 1\ seven of them the disease was recent, and there hadbeen but from three to seventeen paroxysms ;quinine hadnot been administered in any one.In two cases the spleenpreserved its normal size ; in five it was enlarged—a curewas effected in all. In one a single douche sufficed to cutshort the fever. In two others, two affusions were necessaryto do so, and to restore to the spleen its natural dimensions.In the remaining four, affusion was practicedthree times.I n those patients where two of three douches were used,the effects produced were constantly the same. By the firsta] (plication the accession was retarded two or three hours,the rigors loss violent, and shorter by one-half or five-sixthsthe time, the heat and headache were equally lessened, andthe total duration of the lit was diminished at least one-half.Age and the type of the fever did not exercise any appreciableinfluence over the effects of the treatment.Where, however, the volume of the spleen was larger, thetime required for the cure was augmented. Four patientshad Buffered from the disease for from two to eleven months,

i orL] ria. 787baring had several relapses, and resisted the action of sulphateof quinine, and presented the ana?mia, emaciation,anorexia, &c. seen in those who have long been affected byague. Three douch< required in two of these eases,and five in one other to remove the fever, hut from eight toeleven were necessary to cause the splenic engorgement andthe cachectic symptoms to disappear. In one case the liverwas very greatly enlarged, but this condition disappearedby perseverance with the affusions.M. Fleury arrives at the following conclusions : 1. Inthe treatment of recent intermittent fever, simple and withlittle or no engorgement of the spleen, cold douches maybe substituted for quinine.2. In the treatment of old-standing ague, where severalrelapses have occurred, and there is considerable enlargementof the spleen, or of the liver, with a cachectic condition,cold affusions are to be preferred toquinine, for theycut short the fever, restore the viscera to their natural volume,and remove the cachexy more safely than quinine, thelatter in large doses, not unfrequently acting injuriouslyupon the nervous system, or on the digestive organs. — (Bulletindes Aeadem. and Lancet.) Kanking's Half YearlyAbstract of the Medical Sciences, Xo. vii. Jan. to June,1848, p. OS.DiphtJuThe following practical observations upon the treatmentaken from a very interesting paper lead>re the New York Academy of Medicine, by Dr. JamesWynne.After giving an elaborate history of the epidemicsof this affection, he proceeds t}n\< :1) — -It la not a difficult matter generally t give acorrect diagnosis in diphtheria, especially when the practitioneris cognizant of the fact that a false membrane hasis forming. The diseases with which it is possible

788 Dvphtlima. [October,to confound it, are angina maligna and croup. In the firstof these affections, the medical man has the general symptomsof scarlatina to guide him, and especially the eruptionwhichis absent in diphtheria. In scarlatina, the tonsils areof a bright red, resembling the juice of the strawberry, andthe membrane which covers them is simply inflammatory ;while in diphtheria the hue is deeper. The exudation inscarlatina is white, opaque, cheesy and easily furrowed ;while in diptheria it is yellowish, tenacious and not easilyimpressed by the action of a hard body. The inflammatoryaction in scarlatina is observed at the beginning in allthe soft parts of the throat; while in diphtheria it almost invariablyshows itself at the commencement upon the tonsils.As the disease progresses, diphtheria manifests a tendencyto invade the air passages, which is not one of thecharacteristics of scarlatina.The main distinction between croup and diphtheria is tobe found in the part affected. In croup the trachea is primarilythe seat of diseased action ; in diphtheria it is onlyreached after the disease has made considerable progress.In croup the earliest symptom is stridulous breathing; whilein diphtheria the primary symptoms are chiefly observed inIn croup the false membrane onthe organs of deglutition.the tonsils is not present; in diphtheria, it is an invariablesymptom.Complications.—Diphtheria may manifest a dispositiontothe formation of a false membrane in other parts than thoseprimarily affected, as the skin, the mucous membrane of thenose, the ears, the lungs, and the anus ; or it may prevailcoincident with other affections, as influenza, bronchitis,measles, scarlatina, erysipelas, or it may be affected by aparticular epidemic condition, in which it becomes complicatedwith hemorrhage of the nose, skin, and mucous membranesof the intestines or lungs, or a typhoid type oldisease.Prognosis.—When diphtheria is confined to the tonsils, \\usually terminates in a restoration to health ; but when thefalse membranes extends to the nasal cavities or the laryniespecially if accompanied with grave constitutional symptoms, the patient is placed in imminent peril. Even in favorable cases, the prognosis should be given with muclconsideration.Treatment.—The practitioner has three important indicalion to fulfil in the treatment of diphtheria :

1861.] Diphtheria. 7801. To arrest the spread ot' the pseudo membrane.'2. To alter the character of morbid action, upon whichthe formation of this membrane depends ; and'>.To sustain the patient until these shall have benn accomplished.These necessarily involve both a local and generaltreatment.The local treatment consists chiefly in the application ofcaustic and astringent substances, in one form or another,to the affected part. Of these, the most usual are nitrateot" silver, either solid or in solution, powdered alnm, chlorideof lime, chloride of soda, sesqui-chloride of iron, andhydrochloric acid.M. Bretonneau almost invariably employed the last ofthese remedies as a local application in his own practice,with the most marked success.The hydrochloric acid maybe employed very nearly of the strength of the dilute acidof the shops, or considerably reduced in strength—dependentupon the severity or mildness of the attack. The bestmethod of applying it is to moisten a small sponge attachedto a probang, or a camel's hair pencil with the fluid, andwhile depressing the tongue with the left hand, to carry thebrush foiward with the right, until the fauces are reached,when those parts of the tonsils, uvula, or soft palate onwhich the membranous deposit appears, may be moistenedwith the fluid, and the instrument withdrawn. The hydrochloricacid should be applied not only to the membranoussurface, but to the parts immediately surrounding it, bywhich means the spread of the membrane is often arrested.The application should be renewed several times a day.Care, however, must be taken not to apply it of too greatstrength, or too often at the onset of the disease, especiallyif the symptoms are not of an aggravated character; otherwisethe local disease may be enhanced, by the unnecessaryinjury inflicted upon the surrounding parts. The symptomsoften appear momentarily aggravated by the local application,which is not unfrequently followed by an attempt todislodge the membrane by vomiting. Should this latterresult follow, the tonsils and palate will appear ashrunken in substance, and spotted here and there with afew drops of blood upon the surface formerly occupied bythe membrane.When this does occur, the application may hereneweddirectly upon the surface of the gland, in order to arrest tie-

700 Diphtheria. [October,*almost invariable disposition of the membrane to renew itselfupon the abraded part. As the disease progresses, andthe membrane extends towards or into the pharynx, thedifficulty in making local applications becomes greatly enhanced: but 1 he practitioner should not hesitate, for fearof inflicting temporary pain, from thoroughly exploringand covering the parts affected with the solution of hydrochloricacid. For the purpose of effecting this, it is oftennecessary to place the head of the patient upon the knee ofan assistant, and with a spatula to depress the tongue andthe lower jaw firmly at the same time, by which means aview of the whole fauces may be obtained, and an opportunityafforded of making a thorough application of thelocal remedy.Nitrate of silver has been warmly recommended byTrousseau, Gucrsant and Yalleix, in France, and was theapplication almost universally resorted to in England at thecommencement of the epidemic in that country. Theusual mode of using nitrate of silver in England was in solution.Dr. Kingsland advised a solution of 16 grains toan ounce of distilled water, and Dr. Hart, 30 grains to anounce of distilled water. The mode of its use resemblesthat of the hydrochloric acid.When the local application ot nitrate of silver is made ina solid form, care should be taken that it does not slip fromthe holder, or break, as in such an event it might fall intothe stomach. Such an accident actually happened to M.Guersant, fortunately, however, the stomach rejected it, butthis might not always occur, and few medical men wouldbe willing to take so hazardous a risk. Dr. Hauner, ofAustria, considers nitrate of silver as the very best localapplication to the diseased surface, and advises its use in asolution of from a scruple to half a drachm, to an ounce ofwater.*Subsequent experience did not confirm the good opinionentertained for nitrate of silver among the English practitioners,and many who were at first loud in its praises cameto disuse it altogether. A substitute for this was found inrecommended by Dr.the scsquichloride of iron, which isHanking as being very efficacious in its effects upon thefalse membrane. He advises its use in the form of a gargle,of the strength of two drachms to eight ounces ofCEsterrtecliisclie JaftrbTw!) far Kinderheilknnde, 1^50, vol.ii.

1861.] Diphtheria. 701water, to "be applied to the throat by means of a brush.In the United States, opinion appears to he divided as tothe best local application. Dr. Blake, of Sacramento, hasfound the greatest benefit resulting from an application ofstrong hydrochloric acid : a view in which he is sustainedby Dr. Bynum and Dr. Thomas, both of whom have hadmuch experience in the treatment of the disease. f Frof.Comegys, of Cincinnati, is in the habit of applying nitrateof silver, either in substance or strong solution in water.Sometimes when the ulcerations are deep, he touches themwith strong nitric acid, by means of a brush. In somecases he lias employed, with considerable benefit, inhalationsof tannic acid dissolved in sulphuric ether, applied bymeans of a cloth wetted with it, to the mouth. J The formulaisIJ-.—Tannic acid, - - f. 5ij-Sulph. ether, - - f. 5j. M.l>r. Jacobi, of New York, who, as physician to the CanalStreet Dispensary, which treats a large number of Germanchildren, has had a very large experience, says:" The local treatment consists of cauterization of themembranes and surrounding parts with the solid nitrate ofsilver, or with strong or mild solutions of the same salt inwater, (5ss-j.: §j ;) of gargles consisting of solutions of (orapplying in substance,) astringents, such as tannic acid,alum, sulphate of zinc, or claret wine ; in gargling with, orapplying such medicinal agents as are known to have someeffect on the constitution and tissue of the pseudo-membranes,as chloride of potassium, chlorates of potassa andsoda, diluted or concentrated nitric or muriatic acids, liquorof sesquichloride of iron, etc. Astringents will preventmaceration, render the exudation dry and hard, and alterthe consistency of the surrounding hyperaemic and (edematoustissue. It will thus prevent, sometimes, the extensionof pseudo-membranes to the neighborhood of the parts alreadyaffected, and in some cases may accelerate the expulsionof the membrane as a whole. We have thus seen thebest effects from tannic acid, either applied directly to theparts by means of a curved whalebone probaug, or dissolvedRanking on Diphtheria.t Transactions of the Third Session ol" the Medical Society of tin- St;it.-of California, p. 108.*Proceedings Cincinnati Academy of Medicine.

792 Diphtheria. [October,in water as a gargle (5ss-ii : 51.) Of the tinct. sesquichlor.iron we have seen no particular effect. Cauterization withnitrate of silver we have found to be generally of very littleuse when applied to the pharynx. Its effect is superficialonly, it will form a scurf but will destroy nothing. Destructionof 'the parts cannot be effected except by forcingthe caustic into and below the membrane ; this can seldombe done in the pharynx of children, and for this reasoncauterization is unavailing at this point, but will prove beneficial,we believe, by confining the process of exudation toits original locality. Tn cutaneous diphtheria cauterizationmay be exercised to its full extent, but as these cases aregenerally attended with extreme prostration, the generaltreatment will prove both more necessary and successful.If cauterization is to be resorted to, we generally use, andwith good effect, more or less concentrated muriatic, oracetic, or nitro-muriatic acid. Where, however, cauterizationsare made, great caution is necessary not to mistakeafterwards the result of the caustic for pseudo-membrane.This remark is particularly applicable where nitrate of silverhas been used."Alum, chloride of lime, and calomel are sometimes recommended.When their use is deemed advisable, theymay be applied by dipping a brush, or the finger, in the drypowder, and carrying it directly to the affected part, orblowing them through a quill.Prof. Metcalf advises the use of the bromide of iodine,in the form of two drops to an ounce of the mucilage, orgum arable, as a topical application. lie also gives drachm(loses of this mixture internally, with the happiest results.When there is a considerable accumulation in the naresand behind the velum, the debris and foul secretions may beremoved, and much temporary relief obtained by an injectionof an infusion of chamomile with a few drops of creosote,which may be best effected by a laryngeal syringe.The syringe of \>v. Warren, of Boston, answers a very goodpurpose for injecting fluid either into the nares or belowthe epiglottis. It, however, is liable to the objection thatit is likely to produce irritation, by coming in contact withthe irritable portion, exactly at the opening of the glottis,which is found by the researches of Prof. Horace Green, tob€ the seat of sensibility, instead of the epiglottis, as hasheretofore been supposed. The common glass syringe, witheither a curved extremity or a straight one—dependant up-

lMil.] Diphtheria. 793on the part to be reached—answers all ordinary purposes,and s the advantage of being easily obtained at theapothecaries, and is of slight cost.For correcting the foetor of the secretions, the chlorideaoda, in the proportion of one drachm to six ounces ofwater, may he used with much benefit Dr. Banking suggestson the supposition of the presence of some vegetableparasite, the use of sulphurous acid and hyposulphate ofsoda, in the form of a saturated solution.*u The power ofthe latter," he adds, "in destroying the fungoid growth offavus, as well as the oidium which infests the vine, I havemyself experienced, and I strongly recommend it providedthe vegetable origin of diptheria be confirmed by furtherobservations."Much relief is often afforded by inhalation, especially afterthe second or third day of the attack. An excellentmeans of fumigation is to pour boiling water upon catnip,or the leaves of any similar plant, with the addition of alittle vinegar, and to allow the patient to inhale the fumes,either by inclosing the head under a blanket, or by applyingthe mouth to a tube connected with a close vessel containingthe materials from which the vapor is generated.The immediate effect of fumigation is extremely grateful tothe patient. Dr. Ghirdon Buck advises the addition of Labarraque'ssolution of the chloride of soda, in successiveportions of a teaspoonful each, to the liquid used for fumigation.Mr. ('. T. Ilodson recommends the inhalation ofboiling water, to which has been added a tablespoonful ofchlorinated lime.General Dreatrm ni.—The general treatment must be regulatedby the type of the disease. Shortly after the appearanceoiM. Bretoneau's treatise, a great variety of treatmentwas recommended by different practitioners, all, however,with a view to arrest inflammatory action. Leeches to theneck, counter-irritation, especially by means of blisters,active mercuriaiization, and purgative medicines furnishedthe basis of most of the plans advised. Calomel, especially,obtained great celebrity, and was at one time considered asthe most effective remedy in arresting the progress of thedisease. It was first prescribed by Dr. Connolly, who wasling at Tours, at the appearance of the disease; andwas so efficient in his hands, in minute doses, as speedily toRanking on Dipl

704 Diphtheria: [October,find favor with tlie French practitioners. But, whatevermay have been the success attendant upon its administrationat that time, it is now found to require great cautionin its use.Blisters are contra-indicated, and so far from furnishingrelief, tend to increase the danger by assuming an unhealthy,and frequently sloughy appearance. The bites ofleeches often give rise to passive bleeding, extremely difficultto arrest, which greatly reduces the already exhaustedenergies of the patient. Everything, in fact, which tendsto lower the powers of life, or induce prostration, should besedulously avoided, in the type of disease which at presentprevails ;and certainly differs from that for which Bretonneau,Conolly and other medical men in France, at thatperiod, were called upon to prescribe.The type of the disease as it now prevails exhibits a tendencyto extreme prostration from the very beginning, andrequires a tonic treatment to sustain the patient. The mosteffectual method of accomplishing this is by means of quinine,the various preparations of iron and steel, stimulants,in the form of brandy, milk punch and wine whey, and agenerous diet, consisting of beef tea, Liebig's extract ofmeat, and a decoction of coffee. Sulph. quinine may beadministered in grain doses, conjoined to two grains of thesulph. of iron, repeated as often as the symptoms appear torequire—usually every three hours. It is well to alternatethis remedy with doses of chlorate of potassa, which appearsto exercise a beneficial influence upon the disease of themouth and throat. Chlorate of potassa may be given indoses of from five to ten grains, in distilled water, or a bitterinfusion. Prof. Barker, of Xew York, advises the chlorateof potassa, in doses from 5ss. to 5j- The chlorate ofsoda has been recommended with the same intention, butdoes not appear to be equally efficacious with the chlorateof potassa.The tincture of the sesquichloridc of iron has met withfavor among the English practitioners, as a tonic. Dr.Ranking gives it the preference to other tonics, although hefrankly admits that it matters but little which of this classof medicines is used, provided the strength of the patient besustained. "Personally," he remarks, "I give the preferenceto the tincture of the sesquichloridc of iron, not onlyfrom the inference drawn from the analogy of its unquestionableusefulness in the more asthenic forms of erysipelas,

1861.] Diphtheria. 796but al>o from the positive evidence of its benefit derivedfrom the experience of several gentlemen in the country,amongst whom I may mention Mr. Dix, of Smallhurg Mr.;Prentice, ofXorth Walsham and;Mr. Cowles, of Stalham:each of whom lias had unusual opportunities of testing itsadvantages.'" The tincture of the sesquichloride of ironmay he administered in doses of from eight to sixteen dropsin a little water.Whatever may he the success or ultimate failureof thisremedy, its first introduction into the treatment of this diseaseis undoubtedly due to Professor Thomas P. Ilelsop, ofQueens College, Birmingham, who after repeated trials inhis own practice, brought it to the attention of his clinical- at Queens Hospital and the Medico-Chirurgical Societyof Queens College. His own success appears trulyastonishing. *T have given in this disease," he says, "to anadult twenty-five minims of the London tincture of thesesquichloride of iron every two, three, or four hours, andhave conjoined a few drops of dilute hydrochloric acid. Ihave also applied daily, sometimes twice a day, by meansof sponges, a solution of hydrochloric acid, but little weakerthan the dilute acid of the London Pharmacopoeia, andhave always enjoined the regular use of weak gargles of thesame acid. This, with the constant administration of stimulants,beef-tea, milk and jellies, has constituted my treatment; and I repeat here, what I have already stated inother quarters, that since I have become aware of the valueof this medication, nearly ten months, I have not lost oneAn excellent formula for administering a combinationof chloride of potassa and the sesquichloride of iron, is :Chlorate of potassa, from

796 Diphtheria. [October,tongue. \)\\ Bigelow has found this remedy valuable inthe disease as it prevails at Park ;and Mr. Thompson wasequally successful with it at Launcestown, England. Dr.Anderson, oi* New Vork, and Dr. Briggs, of Richmond,have employed calomel with marked benefit. It is a question,when calomel and chlorate of potassa are administeredconjointly, whether the effects of the potassa do not entiretyannul those of the calomel. Dr. Bigelow, as the result ofsome recent observations, says that although it may retardor prevent the specific effects on the salivary glands, it doesnot in any way modify its action upon the secretions. Itmay be well, however, when the effect of the calomel isimportant, to intermit the use of chlorate of potassa fortwenty-four hours, or to alternate the use of these medicinesat wide intervals between the administration of the two.Emetics are serviceable when portions of the detachedmembrane are lodged in the throat, without being expelled,or when the disease is making rapid progress, and threatensto invade the larynx. The action of the emetic in this instanceis frequently to detach the pellicle and dislodge thepseudo-membrane. At the same time that the membraneis thus ejected, the throat is relieved of the foul secretionswhich might otherwise be received into the stomach, to thegreat detriment of the patient.But, whatever treatment may be adopted, the fact shouldnever be lost sight of, that the system is laboring under theinfluence of a powerful and most depressing poison ; and itmatters but little, so far as the constitutional treatment isconcerned, whether this poison be at first local, and afterwardsdisseminated through the system, or is from the beginningof a general character, and -incidentally developedm the mucous membranes of the air-passages. In the performanceof her functions in the eliminations of this poison,Nature requires to be sustained, not only by the free use ofthe tonics already indicated, but by a liberal allowance ofthe most concentrated and nutritious articles of diet, inwhich beef tea, milk, cj;'j;>, brandy, wine and coffee standprominent. W"hen there is difficulty in swallowing, notonly these articles of diet, but quinine may be introducedby means of injections ; a resort to which should not bedeferred until it is impossible to administer medicines bythe mouth, but whenever the difficulty of swallowing becomesat all a prominent feature in the complaint. Injectionsshould not be administered in greater quantities than

. alum,1861.] Ul 797two ounces at a time, and Bhould not be often repeated;otherwise they will give rise to a local irritation in the rectum,which will prevent their retention. One or more dropsof tinct. opii, accordingl j of the patient, will greatly;aid in the retention of the injection.A-'- the violence of the disease has been checked, a continuanceof the tonic treatment should he persevered in forsome time, not only to prevent the sequelre liable to follow,but a recurrence of the attack, which often reappears afteran interval of several wn of these agents would

798 Uterine Inflammation. October,be analogous to that of two other important agents, nitrateof silver and tincture of iodine, which are called caustics bycourtesy, but are no more caustics than tincture of cantharides.I wish it to be clearly understood that I hold theseagents sufficient for the surgical treatment of uterine inflammatorydiseases in the large majority of cases, and so doesDr. II. Bennett, although it has been stated that we usestrong caustics in ordinary cases of uterine disease. In acomparatively small number of instances, the structures ofthe womb have been too deeply modified by inflammationor by hypertrophy, are in so low a state of vitality that theabove-named agents are insufficient to bring about a cureof the disease. Then I have recourse to another class ofsubstitutive agents, which arc undoubted escharotics, forthey cause a loss of substance proportionate to the amountof caustic used. Those caustics induce healthy acute inflammationin the tissues tmderlying the eschar, and, byjudicious management of this healthy inflammatory action,the cure of chronic cases is often induced.The caustics of which I shall treat are, the acid nitrateof mercury, potassa fusa cum calce, potassa caustica, andthe actual cautery. At first sight it may seem strange toclass together sulphate of zinc and potassa fusa cum calce,but one is justified in doing so, because the substitutiveaction which I ascribe to a solution of sulphate of zinc ispre-eminently shown in the results of potassa fusa cumcalce, which often so raises the vital endowments of theuterine tissues as to promote rapidly healthy nutritive actionin tissues which had been diseased for many years.Such is my mode of practice, and I am glad to find thatit accords to a certain extent with the practice of all whoseopinion carries weight, and who having in vain tried to cureuterine diseases by nitrate of silver or milder measures,have recourse to one or the other of the strongest caustics.Dr. Fleetwood Churchill depends on nitric and muriaticacids, and on the acid nitrate of mercury, which is also preferredby Dr. E. Kennedy and by Dr. West, and althoughthis distinguished pathologist considers ulceration of thecervix to be a condition of slight pathological importance,when he has to trace out a plan of treatment for his pupils,he has none other to propose than that already long agocarefully laid down by Dr. H. Bennett. The late Dr. Rig-1>\\ though adverse to the surgical treatment of uterineaffections, admitted that there were certain cases of uterine

airs,fusa,L861.]T99ulceration requiring ior potassa fusacum calcr. Jh\ U. Beunett prefers potae a fusa cum calce.This is not energetic enough for Professor Simpson, whoa; while the French strongly advocatea remedy older than Ilippocrates, the actual cautery.These comments upon the treatment of uterine inflammationwill show that i am an eclectic, and that I use allthe valuable agents which I have enumerated in certaines which I shall specify. Again reminding the readerthat I am not writing a treatise, I shall proceed to commenton the use of our principal substitutive agents.Tincture of I •'I'm'.— It is the ordinary tincture of thePharmacopoeia which I mean, not the caustic tincture. Ishall he brief on this agent, having already mentioned it asa revulsive, and having compared it with others then underdiscussion. Tincture of iodine seems to act as an astringentwhen slightly applied to the hypertrophied or inflamedsurface of the neck of the womb, but as a vesciantif several applications are made at one and the same time,and as a resolutive it re-applied every third or fourth day.It is much less useful than nitrate of silver as a topical application,but it suits better some idiosyncracies, and is wellborne in diphtheritica! inflammation, when nitrate of silvershould not be used. The fact that a solution of iodine canbe injected into closed cavities and fistulous passages withoutseverely inflaming them, marks it out as the best liquidto be injected into the bod}' of the womb, in the very rarees requiring such treatment ; for it has less frequently11 rise to the alarming symptoms of peritonitis, whichhave very often followed the intra-urine injection of a solutionof nitrate of silver. I use one drachm of the tinctureto an ounce of distilled water, and inject it by means of aninstrument similar to that devised by Mr. Coxeter for injectingfluids into the larynx.NUtraiiof SUvi r.— --The application of nitrate of silver is ameans, under certain circumstances, of subduing externalinflammation. Might it not, on this principle, be of servicein the treatment of the internal phlegmasia '.'" Suchthe question asked by Mr. Uigginbottom in the prefaceof his admirable little work on u The Lunar Caustic," publishedin 1826. Jlis iquestion answered in theaffirmative by a great many practitioners, who have appliednitrate of silver for the cure of inflammatory affections of•the mucous membrane of themouth, throat,

800 Uterine Inflammation. [October,urethra, the intestines and the rectum. As regards themucous membrane of the genital organs, Dr. Sewel, in1830, strongly advocated its use ; and I have no hesitationin saying that this great agent is quite as useful in curingthe varied inflammatory conditions of the genital organs asin curing those of the skin. It is often necessary to prefacethe use of nitrate of silver by linseed tea, poppy-head, orother cooling injections, in the same way that Mr. Iligginbottomrepeatedly inculcates the utility of cold poulticesprevious to applying nitrate of silver to the inflamed skin.If, after antiphlogistic treatment, the solid nitrate of silverincreases too much habitual pains, or causes the ulceratedsurface to bleed for two or three days afterwards, it is wellto try a solution of from forty to sixty grains of nitrate ofsilver to an ounce of distilled water. In many cases thesolution is sufficient to effect, a cure ; it gives less pain, butit may be necessary to repeat it every third or fourth day.Sometimes I nse a solution of nitrate of silver containingone ounce of the salt to two or three ounces of distilledwater, as an application to ulcerated surfaces. Chronicuterine catarrh, or inflammation of the mucous membranelining the neck of the womb, which has been truly calledan open gland pouring out mucous from ten thousand follicles,seems to me the most frequent of all uterine diseases.Without having the slightest abrasion, the mucous membranelining the neck of the womb and its vaginal surfacemay be of a dusky, livid hue, tender on being touched, andsecreting pus. This condition may last for years, but itgenerally leads to more or less extensive denudation ofthe villi of the uterine mucous membrane, and gives an excoriatedappearance to the neck of the womb. Such cawithor without excoriation, can be cured by the nitrate ofsilver in solution, and every fourth or fifth day, with theoccasional use of the solid nitrate. If the mucous membranelining the cervix be principally affected, it is often soobstinate as to render the painting of it with the solution oflittle use. The solid nitrate must be freely employed, andwhen the cervical canal is usually dilated, I sometimesleave about one-eighth of an inch in the canal ; by which itwill be clear that, so far as my experience goes, should thestick accidentally break in the cervical canal, it need giveno alarm. What cannot be removed will cause more pain,some loss of blood, and perhaps even a return of menstruation: hut the patient may be repaid for greater suffering by

I.ji -/'.893a speedier cure. It has been stated by Nonat that this mod\

802 Uterine Inflammation. [October,hymen—an operation which is very rarely required. I havefrequently made these injections in many cases, and I donot (nice remember having traced monorrhagia to their administration.I mention this as it seems to have oftenoccurred in the practice of Dr. Fleetwood Churchill. Somany serious accidents have followed the injection of thesolution of nitrate of silver into the body of the womb,that I prefer using tincture of iodine in solution wheneverintra-uterine injections may be required. In very rare casesof chronic internal metritis it may even be necessary to applythe solid nitrate of silver to the internal surface of thebody of the womb, as well as to adopt other modes oftreatment, for an account of which I refer the reader to mypapers on the Treatment of Internal Metritis.*In follicular inflammation of the labia in eczema andprurigo pudendum, or pruritus both external and vaginal,a piece of cotton wool should be soaked in the solution ofnitrate of silver, and carefully rubbed for two or three minutesover the diseased portions of the skin and mucousmembrane. I can speak with confidence of this plan, for Ihave lately cured several patients who had been sufferingin this way for four, eight, and thirty years. When caseshave lasted so long the pudendal skin looks and feels likeparchment. It was so in the case of a lady in whom thedisease had lasted tor thirty years, and I first rubbed in thesolution every day, then every other day, then every fourthand fifth day, until the skin became soft and pliable, andthe sleep was no longer disturbed in darts of pain flashingalong the nerves. This patient was cured in three months.and has had no relapse during the last year.I trust I have said enough m praise of nitrate of silver :but in many forms of uterine inflammation much more severeagents are required to restore the womb to a healthystate. This fact is admitted by so many authorities at home,in America, or in foreign countries, that I am surprised tofind the contrary asserted by Dr. Meigs and Dr. TylerSmith. After describing the evil effects of caustics in thetreatment 'of uterine disease, the latter pathologist, in hiswork on "Leucorrhea," (p. 203) gives as his opinion that'•there is no good which can be effected by the more powerfulcaustics which cannot be accomplished by the nitrateThe Lancet, 1853, vol.

1861.] Uierbu Inflammation*ver, or by other moans. It is true that by the prolongedapplication of the nitrate of silver, loss of substance mayaused but this is far less likely;to occur with lunarcaustic than the more powerful escharotics, It is also true,that some practitioners apply the more violent causticslightly that they do not exceed the milder medical action o['the solid nitrate of silver : but in such cases it would bequite as well to use the safer remedy where a caustic is required."And at p. 2(^6, "In applying the nitrate of silver,the aim should he not to produce any slough or loss of sub-Btan< Thus it is clearly stated that the slight applicationof the Btrong caustics is tantamount to the full actionof the nitrate of silver in like cases of uterine disease.My experience, on the contrary, teaches me that nitrateof silver is no more a caustic than tincture of cantharides,a- Mr. Hiffffinbottom PClias lonsr ~ ago o asserted. The distinctionthat Dr. Meigs draws between the antiphlogistictouches and the escharotic action of nitrate of silver, doesnot hear examination. Use it as you may the nitrate ofsilver does not cauterize. Leave it in the neck of thewomb, it will cause more pain, loss of blood and subsequentdischarge, hut no destruction of tissue, unless coagulatedmucus mixed up with epithelial scales and insoluble chloridesof silver can be called such. Even when applied to afungous ulcer, the slight loss of substance is rather due tothe friction of a hard body on a pulpy than to the chemicalcombination of the neutral salt and the diseased tissues, .Vdensely hypertrophied neck of the womb might be whitenedwith the solid nitrate of silver every fourth day untildoomsday, without much reducing its bulk. Indeed I haveseen >\\o}i a plan of treatment injudiciously continued for ayear or longer in a case of hysteralgia, the neck of thewomb 1- althy and of an average size, and the effectswere rather astringent than caustic, condensing the tissues,narrow]' ervical canal, and rendering its dilatationnecessary and difficult Thus, while nitrate of silver mayrepeatedly applied without inducing a loss of Bubstance,the slightest application of the potassa fusa to the neck ofthe womb produces an evident loss of substance ;ami th

elhrai804 me Inflammation. [October,Wade records his twenty-live years' experience of the comparativeadvantages of nitrate of silver and of potassa fusa,and he states :"] cannot let this opportunity pass withoutagain calling attention to the fact, that the effects of theargentum nitraturn and of the potassa fnsa admit of no comparison,as they are totally dissimilar: that the former,when freely used, from its tendency to cause adhesive inflammation,has often been found to increase the urethralobstruction, whilst the remarkably solvent powers of thelatter have no such tendency. "*The too fret' use of the nitrate of silver to the modulartissues of the urethra causes Urethral stricture, as the toofree use of the same agent to the cervical canal causes strictureof the neck of the womb, but without loss of substance.Indeed, if the whole range of diseases in which nitrate ofsilver is now nsed be passed in review, it will be found thatit always acts by its dynamic, astringent and antiphlogisticproperties : whereas escharotics can only raise the standardof vitality of any given tissues by the previous destructionof their superposed surface. I maintain, on the contrary,that there is one good to be done with the more powerfucaustics which cannot be accomplished by the nitrate 01silver; that is, to shorten the treatment of many cases iiwhich it is

1861.]to stop an abundant purulent and bloody discharge froma large varicose ulcer, and 1 have dpne so with the acidnitrate of mercury, after doing more harm than good withthe nitrate of silver. So little are caustic agents and nitrateof silver interchangeable substances or therapeutic equiva-tivelv poisonous, while potassa fusa c.|calce conduces to rerv.lents, that T find nitrate of silver in some cases to BeIn diphtheric intlammation of Jhe uecJs of thewomb and of the vagina, nitrate of silver arts as a poison.in a case now under treatment there is a small patch, offalse membrane on the posterior lip of the os uteri, andaround it are numerous ulcerations. Were I to touch themwith nitrate of silver they would soon be covered with falsemembranes. Tincture of iodine would not produce thiseffect, neither would thq potassa fusa c. calce ;these, therefore,are the best means of curing this most tedious complaint,and of which I have seen two instances, and Dr.Bennet three, and he would endorse what I affirin of suchasionally we meet with cases like two I am nowattending, in which an extensive superficial excoriation ofthe neck of the worn!) bleeds profusely, and for the followingtwo days, even when only touched with the solutionof nitrate of silver, which likewise makes the sore moreangry. In these cases 1 have nearly effected a Cure byjsing the wound with tincture of iodine or the acidnitrate of mercury.The profession is more and more convinced of the greatutility of caustics in many diseases; were it otherwise, surgerywould be deprived of a valuable remedy, and theobstetric art robbed of the only means of curing the mostdistressing cases of uterine inflammation. Patients wouldthus have to drag on from year to year their weary load ofmisery, with the only hope that the cessation of menstruation,by putting an end to the physiological liability of thewomb, might also check its liability to inflammation.Lori' 1 1, io t.

;806 Phlegmasia Dolens. [October,The Pathological Lesion of Phlegmasia Dolens. By W. TilburyFord, M. ]>., of London.This paper was an appendix to a former, and its objectwas to solve two main questions : 1. The essential conditionor lesion of the limb in this affection. 2. The mode ofproduction of this lesion.In regard to the first it was maintained that the presenceof fibrinous serosity in, with more or less hypertrophy of,the fibro-cellular tissue, is the essential, the sufficient, pathologicallesion; that the inflammation, the abscess, thesloughing, etc. are not peculiar or necessary parts of theaffection, but common to many diseases, and the result ofan eliminative act to rid the system of some blood-poisonthat the latter may produce lymphatic and venous obstruction,and hence phlegmasia dolens; but it passes beyondthis, giving rise to a distinct disease, such as abscess,pyeemia, etc.Phlegmasia dolens in these cases is a local complicationof the general disease, and the general symptoms are butparts of the phlegmasia. There are then two types of thisdisease :a. The complicated, in which an eliminative process (inflammation,abscess, etc.) takes place, these being the answeracts of the tissue to the blood state ; the epidemicform, in which an effect is produced by a virus, superaddedto what occurs inpJ7;. The other class—the uncomplicated—where the bloodstate does not require any eliminative actions to be performedon the part of the tissues, but where simple obstructionexists, such as pressure by tumor, etc. and simplethrombus; this being the essential, simple, ample disease,all else being superadded and accidental.It having been shown that venous obstructions producedoedema only, and this plus lymphatic obstruction, (phlegmasiadolens,) the second question as to the mode of productionof the lesion in the limb might be stated thus :I low can obliteration of the lymphatics produce the peculiarchange of the limb in phlegmasia dolens ? The lymphaticsbeing obstructed, the three offices of removing waste,of absorption, and of formative power, could not come intoplay.it was then argued at length that the amount of lymphaticdistribution and fibro-cellular tissue are in direct ratio

the\1861.] Termination.es. 807— that fibrin is the pabulum of the Utter tissue —and thatYirehow's views on this point clash with sound doctrine.Lymphatic obstruction being followed by the retention offibrinous serosity iu the cellular tissue, the inference allowedby the foregoing tacts was, that one office of the lymphaticsis to remove all superfluous material from the cellulartissue; to keep the balance of nutrition there correct ;hypertrophyand retention of fibrin in the cellular tissue ensuingupon lymphatic obstruction ; and this explanation isconfirmed by the behavior of the lymphatics in cases i)['cancerous ulceration, etc. (When a blood poison is presentspec'actionSj as abscess and the like, are superadded.)It was attempted to be shown that absorption by the lymphaticsfrom ulcerated surfaces might give rise to thrombusat the entrance of the thoracic duct into the junction of thejugular and subclavian veins, and thus account for phlegmasiadolens occurring in the upper extremity in cases ofdisease of other parts of the body, e. >/

SOS Termination ofNerves. [October,voluntary muscle be found which is not abundantly suppliedwith nerve-fibres. The elementary fibres of the tongueand diaphragm of the white mouse arc nearly covered withnerve-fibres and capillaries ;the sarcolemma indeed appearsto be principally composed of these structures. The muscularfibres of mammalia and birds receive a much largersupply of nerve fibres than those of fishes and reptiles, butin insects the most wonderful structure exists on the surfaceof the muscle. In some muscles the entire surface iscovered by some long, spindle-shaped, and very large nervevesicles, which can be shown to be continuous with^henerves. This beautiful structure is completely destroyedvery soon after death, and not a trace can be discovered ifa little water comes into contact with the muscle.In mammalia, the nerves arc seen to run for a long distancewith the arteries, and their ultimate divisions comeinto very close relation with the capillary vessels.As the nerve-trunks approach their distribution, each individualfibre divides and subdivides, and the fibres resultingfrom this subdivision often pursue a very long #nd complicatedcourse, running for some distance parallel withother fibres derived from different trunks, but it is not possibleto follow any one individual fibre for any greatdistance.Fine trunks, composed of from three to seven or eightfibres, can often be seen traversing the muscle. The fibrespursue different directions ; some dip down between theelementary muscular fibres, some pass over the surface andform with others, from a different source, small compoundtrunks, while others may be traced onwards for some distance: the individual fibres which gradually separate fromeach other being distributed to different parts in succession,of several different elementary muscular fibres. When thefinest nerve fibres can be seen passing round the elementary-cular fibres, they cleailv consist of very delicate flat*tened bands.Of the Oral Bodies or Nuclei.—Connected with all nervesin every part of the \)Oi]\\ sensitive, motor, vascular, and probably in all animals, are little oval bodies or nuclei, wnic"are the organs by which the nerves arc brought into thclosest relations with other textures, and from them nebranches are developed. The nerves multiply at their diti'ibution by the division of these little bodies, and upothem their action and, in all probability, the manifestatio

Bmdcgetoebe-JKprperchen.)il.]Termination of Nerxof the nervous phenomena depend. A great number ofthese little bodies are associated with perfection of nervousactions, aiul vice versa. They are found very freely connectedwith the vascular nerves, and are abundant on thosenerves near the ganglia from which they proceed, and in theganglia themselves. These bodies with the nuclei of capillaryvessels and those of fat vesicles, and probably otherstructures with peculiar cells, which alone deserve the namehave been included under the term " areolar-tissue corpuscles,"( As specimens are usuallyprepared, it is quite impossible to distinguish these structuresfrom each other. Beale believes that the gelatinousfibres, or fibres of Remak are, after all, real nerve fibres,and not a peculiar modification of fibrous tissue, as is nowgenerally believed.The nerves and vessels, and with them, of course, theoval bodies, may be Stripped oil' from the elementary muscularfibre.the manner in which Nervei. terminate.—The fibres connectingthe oval bodies or nuclei form with them a networkthe branches of which are of course, continuous with thesubdivisions of nerve fibres. The arrangement of the network,and especially the number and proximity of the nucleito each other, differs materially in different localities.On sentient surfaces the meshes arc wvy small and the nucleiclose together: but from the complexity and great numberof the fibre- ;from the fact that many fibres which appearto be Bingle can be resolved into three or four individualfibres, and from the circumstances of the network beingimbedded in mosl cases in the midst of fibrous tissue, it isvery difficult to describe \\< exact relations and disposition.However, from the connections of this network with thenerve fibres, it would seem to follow that an' impressionmade upon a given portion of a sentient surface might betransmitted to the nervous centre by contiguous fibres, aswell as by the one which would form, bo to say, the shortestroute, and it is possible that impulse- to notion may beconveyed t

cl Termination of Nerv October,] towers (700 diameters) many fibres which appear to besingle when seen by lower powers, can be resolved intothree or more, all enclosed in the same transparent tissue.As the nerve-fibres approach their distribution, this transparentstructure becomes much spread out. It is intimatelyconnected with nerve-fibres and capillaries, and with themtonus a delicate expansion over the muscular fibres, and inother parts. Delicate libres also, in connexion with thenerves and capillaries, may be observed in it. In somecases this expansion seems to be incorporated with the sareolemma,and it is probable that in certain instances it isreally the structure which has received that name.Axis Cylinder and White Substance.— Beale has been led toconclude that in consequence of the free division of theaxis cylinder and white substance near the point of distributionof the nerve, a single fibre in the trunk of a nervemay earrry impressions to or from a much larger extent ofsurface than is generally supposed. The white substancewhich surrounds the axis cylinder gradually diminishes,until in the finer ramifications it is impossible to say that afibre consists of an axis cylinder and white substance, forits general appearance and refractive power are the same inevery part, except where the nuclei are situated. Bealeconsiders that the definite characters of the axis cylinderand white substance in the trunks of the nerve maybe dueto the gradual growth and altered relations of the fibreswhich occur during the development of the entire organism.In the ultimate ramifications the whole fibre seems to consistof a very transparent and perhaps delicately granularsubstance, but no tubular membrane, medullary sheath, or axiscylinder can be demonstrated as distinct structures.Qf the Formation of New Fibres.—In connexion with theterminal ramifications, new fibres are being continually developedby the division of the nuclei, and old ones undergoremoval. "The remains of the latter may, however, be seenin the form of very delicate fibres, in connexion with activenerve fibres. Beale regards much of the so-called connectivetissues between the elementary libres of muscle and insome other situations, as of this nature—as the remains ofstructures whose period of functional activity was past, andwhich have been removed, with the exception of this smallquantity of insoluble material.The method of preparing the specimens is then brieflydescribed. Observations were conducted principally on

:L861.] Thrminatiqn ttf Ner Mlwhite mice, which wore injected with Prussian blue fluidimmediately alter death. l.eale concludes his paper.which will he published at length in the 'PhilosophicalTransactions,' with the following summary of the mostimportant facts elucidated in the inquiry :'•1. That nerve-fibres in muscle and in many other tissuif not in all, may he traced into, and are directly continuouswith, a network formed of oval nuclei and intermediatetibr«••:2. That the organs by which nerves are brought intorelations with other textures, and the agents concerned inthe development of nerves and the formation of new fibres,are the little oval bodies or nuclei which are present in consrablenumber in the terminal ramifications of all nerves.A -Teat number of these bodies is associated with exaltedaerrous action; while, when they are sparingly found, Avemay infer that the nervous phenomena are only imperfectlymanifested."..That every elementary fibre of striped muscle isabundantly supplied with nerves, and that the fibres ofsome muscles receive a much larger supply than others.••4. That the nerves lie with the capillaries, external to,but in close contact with the sarcolemma. They often crossthe muscular fibre at right angles, so that one nerve-fibremay inline] . reat number of elementary muscularfibres. There is no evidence of their penetrating into theinterior of the fibre."The paper is illustrated with drawings, most of thornmagnified 700 diameters. Brit. S- l r r.31e>?. Chirur. Rev8 at their Periphery and in Differ-By Jacobowitch.f- author, from his observations, comes to the followma1. That each nerve, of whatever nature, takes origin fromThe V ita application t

—812 Development of Bloodvessels. [Octobera iutvous cell in the central nervous organs, and terminatesat the periphery or in the interior of an organ :[a) Either in a nerve-cell, and, in the case of nerves o\sense, in the nucleus itself;(l>) or in the mass of a cell {Hans la masse (rune cellule)in the interior organs in the ease of the ^anplionicnerv

itouchIL] Muscular jR&iplace which gradually grow, form an arch, and return tothe original tituting a new capillary loop. Buise blind terminati found to pass into fine threiand around are seen lying numerous stellate connectivetissuecorpuscles. It' i reads are 1 in connexion withthe latter, they may be looked upon as pro< fromthem, and the capillary network as a metamorphosis ofcellular elements : but it such a connexion does not exist,then the thread-like appendages must be looked apoiial formations preliminary to the future vessels. Theauthor addressed himself with proper precautionstain which • ws was the right one, andcame to the conclusion that the vascular^outgrowths neither; nor avoid the cellular elements. The same animaliseveral times in the course of two or threedays. On one < rascular growths were seento pass without any other connexion, the-. to widen and acquire nuclei in their walls.Here and there slight zig-zag curves were seen at their termination.Some were en partly in evident connexionwith a stellate cell, and in some cases there was undoubtedlyextension of the cell-pro to the wall of acapillary vessel ; then the cell-bodies were exceedingly distended,all proc< rly visible, hi I I obation,the contents appeared to umilated, and a- than the thread-like one was seen. In theof two cells so concerned, it' the direction of the probe in the region of a neighboring cell, the same will participatein the formation of the vascular wall ; hut if it beernal to the adjoining cell territories, then the vasculartakes an apparently i [course. Ibid./ ; ervations concerningthe minute structure of the pulmoBarj cells have differedremely and attracted much attention. In 1845, \ibrift.'. .1 from the Wieiu r

—814 ( orpuscles of the Spleen. [October,Bchott had asserted that their walls contained muscularfibres. Acknowledgment of tins was refused by llossignol,Adriani, Kolliker, llarting, Dondere, Reichert, &c; but< ierlach admitted the fact of their presence, and Molesehott,fortified by this opinion, addressed himself to reverify whatlie had previously stated. Accordingly, the lungs of thepig, of the ox, and of man were examined, adult animalsbeing found the best. The process is as follows : Portionsare to be cut oft' and macerated in tolerably concentratedacetic acid for some months, then macerated for twenty-fourhours in distilled water, and examined, moistened withvery dilute acetic acid. In this way the walls of the pulmonaryvesicles may be seen to contain smooth nucleatedmuscular fibres of a somewhat yellowish hue ; or they maybe seen by inflating and drying the lung, and then makingthin sections, which must be left for three or four hours invery dilute acetic acid; and for more complete isolation ofthe fibres, they should be macerated for half an hour in aweak solution of potash. The first method of preparationbest suits the lung of man and of the ox; the second suitsbest the pig's lung. In the case of the ox lung, fascicles oftwo, or four, or more muscular fibres in juxtaposition maybe seen, but in man, two fibres are but seldom seen united.Molesehott gives minutely tlie form, situation and chemicalreaction of the fibres, as well as of their nuclei, and discriminatesbetween them and other elements, such as fusiformepithelium of small arteries and elastic-tissue cellules,with which thev might be confused. Ibid.On the M(rtpighian Corjniscles of the SpLcn . ByKowalewsky.*N'In his observations, the author made use of the spleens ofthe dog and cat, either in a fresh state, or hardened in anaqueous Bollition of scsipiichloride of iron, as used by Fuhrerand Billroth. According to him, the Malptghian bodies liein the neighborhood of tolerably large arterial and venous\ itvliou\ Arclriv. Band rx. Hefte. 1. 2, p. 208.

L861.J Develop toftk Follicles of the Ovaries, £c. 8151>. They project1with their free surface , which is covered*withthe venous epithelium (the Bpleriic fibres of earlierauthors) into the cavities of the cavernous network ; themeshes, consisting of areolar tissue, go between the epithelialcells with the Malpighian bodies, ami become narrowerwithin them. On each Malpighian corpuscle, beneath thevenous epithelium, runs a small arterial vessel which becomeslost on its surface (in a tuft-like manner) in ;i great number ofcapillary twigs, many of which allow but a r.ingle blood corpuficleto pass. The capillary wsr-ols pass from the surfaceinto the interior of the Malpighian corpuscles, and becomelarger within, owing to the concurrence of many twigs. Aftertheir union in a central vein, this passes out into the surroundingcavernous network to embouchure into a larger vein.etiinee, hut rarely, Bmaller isolated veins also pass fromthese bodies in addition to the central vein. The larger centralvessels are evidently veins, not only from their emptyinginto larger veins, hut also from their walls being thinner thanthose of arteries, and from their having the characteristicepithelial cells of splenic veins on their inner surface. Thespace between the- meshes of the cavernous network in thesplenic corp: filled with white blood-corpuscles, whichonly appear to differ from those in the body generally by theirbeing smaller, and having a BOmewhat clearer outline. Thismay be from the deficiency of fluid. On ligaturing theinic artery of a t\'j:, and killing it some days afterwards, itwill he found that \\ic central vein of each splenic corpusclemay he seen with the naked eye as a red point on a whiteground, and the corpuscles appear enlarged. Moreover, thecentral vein may he seen very clearly in the spleen in c,wherein >oine time previous to death the sympathetic nerveaddressed to the spleen has been divided.— Ibid.•],, J'), /, loprru at of tin Follicli 8 of //>> Ovarii a and of tinOvum in tl- mammalia. By Otto Spiegelberg.The following ations were conducted n the humanenduy... a- well a- on the embryonic and newly-born rabbits,The author was unable t'«» recognise thetKon: Ges : der Wiss. zu Gottiu i,Juli, No. 20; aa quoted inVirchow'fl Arohiv. Band rx. I!. 210.

—Mi; Ammomcemh. [October,tubes in which the ovarian follicles should be found, describedby Valentin. At the time in which the sexual differentiationbegins to proceed, and the male germ-glands possess seminalcanals, the ovary is seen to be composed of large bright cellswhich, by reason of very delicate areolar-tissue-partitions andbloodvessels extending from. the hiius to the periphery, arearranged into irregularly-shaped heaps. These germ-cellsSpiegelberg terms primary ovarian cells, and their large vesicularnucleated nucleus he designates "germs.'' During thegrowth of the germ-cell the nucleus divides, at first into two,later on to a greater extent, and the wall of the mother-cell sooriginating appears to he doubly contoured. These mothercellsare the primordial follicles, and are very like the spermaticcells. As soon as they are quite tilled with germ, oneof them, generally the central one, greatly enlarges; andbesides the nucleus, a delicate investment and a granular contentsmay be seen within. The germs surrounding alsoincrease meanwhile and form into cells, and become coveredby an investment. The first of these cells is the ovum, thelast forms the element of the "membrana granulosa." Thus,according to our author, is the formation of the ovum in thehigher animals assimilated to that observed by Meissner inthe ascarides, &c. Soon after birth the formation of germcellsinto primordial follicles is complete, the latter being,later in life, no more formed anew. In newly-born animalsthe younger follicles are always found at the periphery of theovary, the older at the deeper parts. .By the growth of areolartissue and vessels the mother-cells become isolated; veryrarely only do two or more become fused into each other.Ibid.Aramonuvhuo. A paper by Professor Jaksch, in the Vierteljahrschriftf. Praktische Heilkunde, 1S60, ii. Translatedby C. A. Hartmann, M. I)., Cleveland, O.The word ammonhmma, first used by Prof. Treitz, shouldbe applied to a kind of uraemia arising from putrescent urinecontaining carbonate of ammonia, being resorbed and introducedinto the blood—a condition which must not be confoundedwith Blight's disease, for it is essentially differentfrom it, although both affections may appear in conjunctionwith each other, drsemic manifestations are not developed,

L861.Jlid. 817in Blight's disease, before the uriuiferous tubes beconie impervious; but true ajnmoniaamia is the consequence of urine,in a - decomposition, being received into the blood ; anoccurrence which may happen either from a torpid or paralyzedstate of the urinary bladder, from dilatation of Malpighi'spyramids and the renal pelvis while the ureters arcimpervious, or from abscess, tuberculosis and other diseases ofthe kidneys. The urine has, in this disease, always a pungent,ammoniacal odor ; hydrops is never connected with ammonisemia,but there is a persistent dryness of the mucousmembrane of the mouth and fauces; the patient feeling as ifeven* particle of humidity had been dried up by someabsorbent. Sometimes this dryness will spread to the Schneiderianmembrane, the conjunctiva of the eye, and the ligamentsof the larynx, producing hoarseness or aphonia. Thereis always a strong and well-marked ammoniacal odor in theair expired by the patient ; and the same odor is perceived bylifting the bedclothes. A great aversion to meat is neverwanting-, and violent intermittent chills arc of frequent occurence; while neither convulsive fits, nor croups, nor diphthericexudations have been observed during the disease we aretreating of, nor have disturbances of the vision been noticed.A constant symptom is a singular grayish discoloration of theface, with progressive emaciation ; very acute cases are accompaniedby a rapid collapse of the features, and a muscularweakness bordering on paralysis. In such acute cases, vomiting,accompanied or followed by diarrhoea, is always present:ldom, or only for a short, time, occurs in the chronic formof the disease. Death is always preceded by a soporous state,lasting fmm a few hours l several days.Acute ammoniaunia runs its course in a few (from two tosix) days, and terminates, if properly attended to, in recovery ;if not, in death. More or Less vomiting is usually the firstsymptom in such cases ;often soon followed by febrile manitestations, rapid collapse and sopor.The chronic form may last weeks, months and years, withtemporary improvements and changes for the Averse ; it canterminate favorably, even after a long time, if recognised andcorrectly treated ; but may induce death in spite of all treatmentwhen its causes cannot be removed. There are alwaysccompanying chronic ammonhemia, butthey are often mistaken for catarrh of the gastric and intestinalmucous membra' may also occur which simulatetyphoid or intermittent fever. On account of these varyingsymptoms, it is rather difficult t give a good description

818 Ammoniamia. [October,v^^%/\yof the* disease, and it appears, therefore, better to describe thedifferent forms according to their cause and predominantsymptoms, after having mentioned what is common to all theforms, and necessary to the diagnosis.Most frequently, ammoniajmia is produced by diseases ofthe urinary bladder—more particularly torpor and paralysis ;a morbid condition of the ureters or kidneys but rarely causesit. Torpor of the bladder may develop itself gradually, turninginto complete paralysis only after a long time, or it mayarise rapidly. Accordingly, the symptoms of ammonisemiawill be either manifest, to a slight degree, but for a long time,so that they are scarcely heeded and easily overlooked ; orthey appear more suddenly and with great intensity, so as togreatly embarrass both the patient and his physician. Thetorpor can be induced by some impediment in the urethra orprostate, or by a want of innervation or change in its texture(hypertrophy, catarrh, inflammation, ulceration, carcinoma.)In consequence of the paralysis, some ulcerative or diphthericprocess, or gangrene may be produced by the stagnant anddecomposing urine in the bladder. The progress of the diseasedoes not, however, depend entirely on pathologicalchanges in that organ, but also on the action of the organsserving to the excretion of ammonia ; the lungs, skin, kidneysand intestinal tract ; further, in the age and constitution ofthe patient, as well as on external influences. A sojourn inthe country, for instance, proves very beneficial in chronicammoniremia.For a correct diagnosis, the following points must be considered:1. The degree of torpor or paralysis of the bladder, and thecause of the same. In the chronic form, sensible and motoryparalysis are generally developed at the same time. Althoughthere is a large quantity of urine accumulated, distending thebladder above the symphysis, and not unfrequently to thenavel, the patient experiences no pain, or some dull, painfulsensation, and no inclination to void his urine, unless thebladder be extended beyond the already habitual measure ;even then, only this surplus of the accumulation is evacuated ;the stagnant quantity remains unchanged, or increases evenwith the torpor. Acute paralysis commonly produces, in thebeginning, violent tenesmus and pain, which decrease whenthe paralysis has reached a certain height, and disappearswith the more developed distension of the bladder.. 2. With the torpor and paralysis, and usually before theyhave been carried to a very great extent, commences the de-

'1861.] vmxmksmia. 819composition of the stagnant urine, and its resorption, ft isevident that the decomposition must be hastened by the presence,in the bladder, or catarrhons secretions, blood, or productsof exsudation. At this stage of the disease, the urine,he it evacuated spontaneously or artificially, presents a pungent,often distinctly anmioniacal odor, ana a mucous or purulentsediment, sometimes mixed with blood. Wherever anammoniacal odor is perceivable in recently-voided urine, wemay pretty certainly diagnosticate ammomsemia.3. The carbonate of ammonia is eliminated through the?lungs and skin soon after its reception into the hlood ;this isproved by the distinct ammoniacal odor of the expired air.and other exhalations. Where this odor is not very distinct,the expired air may be tested with humid litmus-paper, orwith a stick of glass, previously immersed in muriatic acid.The chemical analysis of the hlood would, undoubtedly, furnishthe best basis for a correct diagnosis; but the patientsafflicted with ammoimemia are always in a state which doesnot admit of the depletion of blood.•i. Gastric symptoms, as already described, are always present.The evacuations in acute cases do not, at least not inthe first time, present a distinct ammoniacal odor; but this \-always well marked, when emesis and catharsis appear withan aggravation of the disease. In chronic ammoniaunia theremay be neither vomiting nor diarrhoea, but rather a tendencyto constipation : the appetite is, however, with very rare exceptions,disturbed, and a marked aversion to meat present,such as is not observed in any other disease, even not exceptingcancer of the stomach. Other gastric symptoms, for instance,a sensation of dull pressure or burning pain in theach, accumulation of gases, bad taste, furred tongue, etc.,are not characteristic of ammonisemia. But the dry conditionof the month and fauces is important, and may often lead tothe diagnosis when other prominent symptoms are wanting.The discoloration of the face, the emaciation and collapsethe features, finally the continuous depression of spirits, whichis frequently explained as hypochondriacal, will serve toconfirm the diagnosis. The effect on the mind of the patientmay grow >trnir enough to induce the committing of suicide.In the treatment, stricture- of the urethra, which are frequentlypresent, mnst be removed, and the urine regularlyevacuated by means of the catheter. Milk diet, residence inthe country, generous exercise in the fresh air. are often sufficient,in addition to these mean-, to restore the patient.Daring recovery, a vigorous diet is required, which may bo

820 Arnmoniccraia. [October,combined with the use of some acidulous or ferruginatedmineral water.Strictures of the urethra have often been overlooked ; Ithink they alone have given rise to the haemorrhoids of thebladder, that we used to hear so much about in times notlong gone. Of equal importance with the strictures arediseases of the prostate in connection with ammonisemia.Amongst them are, atrophy in consequence of precedinginflammation, general or partial hypertrophy and developmentof an accessory tumor, pressing on the urethra or theneck of the bladder. They impede, more or less, theevacuation of the urine, cause torpor of the bladder, hypertrophyof its walls, diseases of the ureters and kidneys,and consequently ammoniamiia, which sometimes appearssoon, but often only after a long time. The difficulties ofa successful surgical treatment, in such cases, render theprognosis rather unfavorable. Hypertrophy of the prostatewill often yield to a strong ointment of iodide of potassiumapplied to the perineum, and combined with the internaluse of acidulated waters. With the cautious use of thecatheter, and a decoction of secale cornutum, exhibited internally,the alread} r developed torpor of the bladder, andother symptoms, even of chronic ammonisemia, may be relieved.A long practiced intentional retention of urine is apt toend in the highest development of ammonieemia, withoutany difficulty in, or around the urethra. The greater thechange in the textures, following this cause, the smaller isthe prospect of recovery.That stones in the bladder result fatally through ammoniaemia,has been long known to surgeons; the disease Idesignate by this name is well described, with all its symptomsin their books. It certainly plays a very importantpart in its connection with urinary concretions. Withoutan operation death is certain to follow, while success with asurgical proceeding depends completely upon the presenceand extent of ammoniaBmia. Under the influence of bloodpoisoned by ammonia, diphtheritic processes and exulcerationsin the artificial wounds are unavoidable.Cancer of the bladder is always, in the end, accompaniedby ammonisemia. Medullary carcinoma of the inner surfaceof the bladder induces 'hemorrhage, and thereby decompositionof the urine.Mechanical obstruction of the ureters, or destructive dis-

Ammonimmia. 821a of the kidneys, lead either to ammon"nemia or nramia.A painful anuria, sometimes relieved by copious dischargesof bloody urine, pain and swelling in one or bothsides of the abdomen indicate the primitive cause. If thereis a concretion, the ureter becomes dilated above and aroundit, the walls are pushed outward, and the room thus madeallows the urine to pass until the stone, pressed downwardsis again wedged in. Even large concretions may, in thisway, reach the bladder, and as long as the other kidney isnot disturbed in its functions, there is not much danger..V continued stagnation of the urine in the pelvis of thekidney may, however, result in decomposition and resorption; that is, ammoniaemia. Of course, death may ensuewithout that—for instance, as a consequence of anuria anduremia in 6bl iterationof the ureter.Tuberculosis of the kidneys is also one of the excitingcauses of ammoniremia. How far abscesses of the same,ns may have the same effect, cannot be at present ascertained,besause they were complicated with diseases ofthe bladder, wherever observed with the disease in question.The kidneys may be destroyed by extensive ulceration,ending in death, without one symptom of ammoniaemia.Cancer of the kidneys is also not likely to produceit.Another form of ammonimmia, distinguished by a veryrapid course, arises from the decomposed urine penetratinginto normal tissues. This may happen, for instance, intothe cellular tissue of the peritoneum, by ulcerative ruptureoi* the urethra, or into the tissue of the abdominal wallsafter puncture of the bladder, when the urine was in a statelecomposition in consequence of previous dise;There are violent pains, frequent chills, vomiting and frequentdiarrhea, ending in sopor and death.The senile vesical torpor developes itself, without anydemonstrable morbid affection of the bladder or urethra, inpersona about, or beyond the age of fifty. The circumstancesinfluencing its appearance and development, are notalways easily determined. It is only certain that this torpor.iher from insuiheient innervation or from retrometamorphoHfland fatty degeneration of the fibreslie detrusor muscle. Patients afHicted with this troublecannot pas< their uri ept with strong abdominal pressure,and then only in a short and interrupted stream. Acomplete evacuation of the bladder, if it can be effected at

822 Ammonicemia, [October,all, requires a considerable time. With the torpor advancedto a moderate degree, there remains always a certainquantity of urine in the bladder, although the patient thinksit completely empty. Upon strong and continued pressurehe is astonished to see the flow commence again. Thisstagnant quantity of urine augments in proportion to theincreasing torpor, and frequently forms the basis of acutechronic vesical catarrh. Cinder such circumstances, a slightcold, or an intentional repression of urine, are often sufficientto create complete paralysis of the bladder.This paralysis occasionally occurs as a symptom in otherdiseases, for instance, typhoid fever. Here it happens especially,when the conscience is disturbed, the sensibilitysuppressed and the muscles weakened to nearly paralysis ;if overlooked, an extensive stagnation of urine follows,commonly inducing vomiting in spite of the unconsciousness.This emesis is only removed by evacuation of thebladder, by means of the catheter. Amnioniremia may alsoarise during typhoid fever, in consequence of other morbidprocesses dependant upon the fever, for instance, catarrh ofthe mucous membrane of the bladder, or croupy exudationon its internal surface. In some cases, however, theseconditions are present, without exciting any symptom ofammoniaemia.Next to typhoid fever, acute diseases of the brainsuch as extensive meningitis and cerebri tis, induce not unfrequentlyparalysis of the bladder. A careful examinationhere always prevents the development of ammonioemia.But this cannot se easily be accomplished, where the paralysisfollows diseases of the spinal marrow, and appears inassociation with paralysis of the lower extremities.In vessical paralysis of a peripheric origin, combinedwith cntaneous adynia, from suspended innervation of thedetrusor muscle, I have never observed any symptom ofammoniaemia, but this disease occasionally appears under avery obstinate form in conjunction with dysentery. Thensecale oornutum is the remedy.In all these remarks there is nothing particularly new : Ihave only collected and arranged under a system what waswell known to Boerhaave, Morgagni, Van Swieten, Stoll,Lentin, P. Frank, Soemmering, and others. That they explainedthe symptoms they observed as urinary metastases,don't matter.Although it was not my purpose to give a complete and

1861.] Ringworm. 823exhausting delineation of the disease, I will add a few eonelusions:1. Uraemia and ammomemia are different conditions, producing,in many respects, different symptoms.'2. Both appellations point merely to those constituentsof urine which mix with the blood, being* in the one caseurea, in the other carbonate of ammonia. There may bein the hlood, besides them, some other elements of urine.3. Ammonhemia has been mentioned and described, byformer physicians, under the names : uroplania, urodilyasisischuria, paralysis of the bladder, &c.4. This disease may result either in direct resorption ofdecomposed urine from the urinary organs, or in absorptionof urea changed to carbonate of ammonia, in the intestinalcanal.The excretion of the morbid matter thus accumulatingin the blood, is effected by exhalation through the lungs,the skin, and the mucous membrane of the stomach andintestines. Cincinnati Lancet $ Observer.On Ringworm. By Jonathan Hutchinson, of London.1. True Ringworm, or Tinea tonsurans may be defined as adisease affecting either the scalp or the general surface, inwhich circular patches are formed, on which the hairs breakshort, and a slight, branny desquammation is seen, bothhairs and epidermic scales exhibiting under the microscopethe sporules and thalli of a fungus.2. Ringworm in the scalp is rarely seen, excepting in children: but on the general surface is not very nnfrequeut inyoung adults.-contagious, and spreads by contagion only.4. It is not attended by any peculiar form of dyscrasia,but on the contrary, often attacks children in perfect health.much more easily cm able on the general surfacethan on the scalp, owing to the circumstances, that in thelatter situation the fungus has obtained access to the folic leaof the hair-.G. Being a purely local d ringworm does not require,ay constitutional treatment.

824 Galcano Cautery in Cataract. [October,7. A purely local treatment, if efficiently pursued, is alwaysrapidly successful.8. Epilation, and the use of one or other of the knownparasiticides, arc the measures of treatment required.!>. There is no real difference between ringworm on thescalp and ringworm on the general surface.10. Ringworm, although not unfrequently causing minutevesicles, has no true analogy with herpes.—Medical and Sur.Ga zettc.Qahoano Cautery in Cataract (Academy of Sciences.)M. Tavignot read a short paper on the application of cauterizationby galvanism to the treatment of cataract. Theapparatus used by this occulist is Grenet's pedal batterywith two appropriate conductors. These consist in twoexactly similar ivory rods, terminated at one extremity bya prolongation of the central wire to which is attached theconductor of the battery, and at the other end by a screw towhich is adapted a cataract needle about 8 lines in length.1. The operator holding a conductor in each hand perforatesthe cornea in two different, but not opposite spots; onepuncture corresponds to the transversal, the other to thevortical diameter of the eye. The external puncture is performedffrst, the inferior perforation immediately after.2. Pressure of the pedal of the battery with the foot, atonce causes each ot the needles, when in contact with theother, to glow; by alternately parting and bringing togetherthe points, the anterior capsule may be destroyed with theutmost ease, and the lens itself reduced to a pulp which absorptionwill soon cause to disappear.3. The foot being removed from the pedal, electric communicationis instantaneously broken off, and the needles,} saving cooled, arc. rapidly extracted from the anteriorchamber.The operation is very rapid, moderately painful, and positaccount of t^p perfect immobility of the eye-ball,a remarkable degree of precision. The transparency of thecornea moreovci - the operator to follow distinctlyb movement of he instrument', and to measure andregulate theii fland^ Virqnna Med. Jovr.

l.]Editorial.EDITORIAL AND MISCELLANEOUS.ARMY MEDICAL BOARD.Surgeon General's Office, )Richmond, Va.,gept. 27, 1861. ]"Army Medical Boards, lor the examination of Surgeons and AssistantSurgeous, have been ordered to convene at Norfolk, Richmond, YorktownandManaCandidates for the appointments of Surgeons and Assistant Surgeonswill be examined by these Boards, on presenting an invitation to appearbefore them from the Secretary of War, which may be obtained by forwardingtheir application, with testimonials of moral character, to theAYar Department.Examining Board- will be held at other points further South at aconvenient time."The Board of Medical Examiners, appointed by the Governor of Ohioto examine candidates for the Medical Staff of the army, have adoptedthe rule that no person shall be appointed Surgeon who has not a respectablediploma, and who has not practiced medicine ten years. A diplomaand five years' practice are required for Assistant Surgeons. Theexamination to be made by written questions and answers.The prevalent opinion that Army Surgeons have more to do withsurgical than other affections is a grievous error, as the history of allcampaigns abundantly t< I ndeed, the danger of being wounded isthe least that a soldier should dread. A writer of distinction declaresthat in an army of one hundred thousand men, there will be ten thousandtaken sick in the course of the three first months' service, exclusive ofwounds! And the proportion will be still greater in the event of anepidemic! How important it is, therefore, that those who have to treatthem should be men

—826 Editorial. [October,MEDICAL COLLEGE OF TEXAS.An institution with the above title has been organized in Houstonwith the following Faculty .Ashbel Smith, M. D., Prof, of Surgery ; N. N. Allen, M. D., Prof, ofAnatomy; G. A. Fcris, M. D., Prof, of Theory and Practice of Medicine; W. H. Gantt, M. ])., Prof, of Obstetrics ; W. S. Rodgers, M. D,Prof, of Diseases of Women and Children ; J. F. Matchet, M. D., Prof,of Mat. Med. and Therapeutics ; W. P. Itiddell, M. D, Prof, of Chemistryand Med, Jurisprudence ; Thos, E. Brooks, M. D., Prof, of Physiologyand Pathology ; B. P, January, M. D., Demonstrator of Anatomy.Opium and Quinine in Puerperal Fever.—Dr. B. S. Woodworth,of Indiana, says :(Cincinnati Lancet and Obs.)"I have now treated about twenty-five sporadic cases with quinine andopium without any deaths. I am well aware that the number is notsufficient to show the superiority of this treatment over any other, andin an epidemic the result might be different ;still I ieel so well satisfiedwith these results that I shall still continue this treatment, aud I thinkit well worthy a further trial on a more extensive scale.Dr. W. administers, on the appearance of the disease, a powder consistingof two grains of pulverised opium and four grains sulph. quinineevery three hours until the subsidence of symptoms.Prescription fop. Whooping Cougil—By Dr. Benson :Miscc. S.R.—Acid. Hydrocyan, - - vi. drops.Ext. Belladonna, - - ii. grains.Tinct. Opii Camph. - - iii, drachms.Syr. Bals. Tolu. - - ij. ounces.Aquae Font. - - - iij. ounces.One teaspoonful four times a day. Louisville Journal'.Chlorate of Potassa in Gonorrhoea,—Dr. Irwin, (Med. & Surg,lleportcr) thus speaks of this remedy :"I have found it to be such an admirable remedy that I seldom rc-BOrt to any other in the treatment of urethral inflammation. My methodof wring it is as follows : one drachm of the salt dissolved in eight ouncesof water, of which an injection is given every hour for twelve hours, atthe end of which time, the discharge will have become changed and diminished,allowing tin remedy 1 to be gradually discontinued until themd or third day. when the disease will be generally found to haved."

i nun,1861.] MuGororrhcsa.—In a paper "on the successful treatment of Gonorrhoeaand Gleet without copaiba," by T, W. Cooke ; surgeon to the EoyalFree Hospital, &a, London," the author, in the first or inflammatorystage, uses antiphlogistic and antacid remedies, avoiding saline purgatives,and applying cold lotions. Tn the second stage the treatment (andhere comes in what the author lavs claim to as the great modern improvement,)he trusts to injections of chloride of zinc, \ gr. to grs. iii. adounce, with generous diet. Under those means he informs us that feware not cured within a week, and he has only encountered two cases outattacks of some thousands in which the remedies had failed.Asarum Europium a Remedy tor Drunkards.—Dr. Smirnoffstates that he has become convinced, from repeated trials, that theasarum europceum well deserves the reputation it has obtained inRussia of being an excellent remedy for the effects of drinking. Theinfluence of a continuous abuse of alcoholic drinks is first exerted locally,but afterward- dyspepsia is produced ; and the nutrition and functions ofthe entire economy, especially of the central portions of the nervousling interfered with, the blood itself being loaded with aninjurious foreign material, the dyscrasia potat rem is at last completelyestablished.The asarum fulfils various indications, acting beneficiallyon the alimentary canal in those cases in which the digestivepowers are so much at fault. Its aromatic principle confers upon it astomachic power, and regulates the condition of the intestinal discharges,producing vomiting and purging when given in large doses. Its mostbeneficial action, however, is manifested on the defective appetite, andtfl counteracting the invincible longing for alcohol. The horriblesensations with which the drinker awakes in the morning, and whichcompel him to seek temporary and delusive relief from renewed libations,are much blunted and mitigated by means of a-trong infusionof a>arum and some other nervine e. g. valerian. Its immediateeffect is often to produce vomiting, and sometimes purging ; but thepainful sensations at the epigastrium undergo relief, and the appetitebecomes invigorated, Persons who have been long habituated to alcoholicdrinks cannot, however, have these suddenly suppressed with impunity; and in leg the author gives the asarum in brandy, applyingat the same time a blister or an issue to the pit of the stomach. Bythis means the normal activity of the stomach b< I and thelonging for alcohol diminished. The author, however, cannot agreewith those who would still allow a small quantity of spirits to habitualdrink when the morbid desire for ir bac ppeased. Theeven when it does not succeedin extinguishing the de-ire for alcohol, ah:•the patient ; and it is reinarkab!in which the individualshave been long accustomed to periodical intervals of drunkenness, endingin delirium tremens, how much longer those interval-- will become, and

———828 Miscellaneous. [October,how much less likely delirium tremens is to recur. The patients themselvesare sometimes surprised at the comparative impunity with whichthey can continue their drinking. The author prescribes three or fourglasses a day of an infusion made with three ounces of asarum root, oneounce of valerian root, and half an ounce of orange-peel, but he does notstate the quantity of water employed. In cases of drunkenness, anotherformula is composed of decoction of asarum (made by boiling from halfan ounce to one ounce of the root), six ounces; tincture of valerian, twoto three drachms ; Sydenham's laudanum, gtt.xij ; syrup of orange-peel,half an ounce. A tablcspoonful of this is taken every two hours. Hefinds from two to ttve grains of bismuth, taken four times a day, a valuableadjunct. He has also found the following popular Russian remedyof service in cases of drunkenness :—R. Amnion, carb. half an ounce ;aceti vini, lbj ; oxymel scill. half an ounce. Two tablespoonsfuls everytwo hours. Med, Zcit. Rztsslands and PJtarmaccutical Journal."Mortality from Excision of the Knee Joint.—In a memoirread before the New York Academy of Medicine, Dr. Krackowitzer discussesmore particularly the mortality attending excision of the kneejoint,and the objections which have been urged against the operation.He has collected, from various sources, two hundred and thirty-threecases, which give 4a result of sixty-three deaths and twenty subsequentamputations ; the rate of mortality being twenty-seven in a hundred ; or,including the subsequent amputations, the ratio of failures being thirtysixin a hundred. Of the two hundred and thirty-three cases, thirteenoccurred in the practice of American surgeons. Four of the thirteenpatients died, and two were under treatment at the time of the report,with every prospect of recovering a good limb."Times.American MedicalExcision of the Hip-Joint.—In the statistics of resection of the hipjoint collected by Mr. P. 0. Price, mention is made of the operationhaving been done 59 times. Of that number 33 recovered with goodand useful limbs and greatly benefitted constitutions ;11 were partiallysuccessful—i. e., the patients lived for periods varying from three monthsto two years, and then died, more from other causes than from a recurrenceof the disease which demanded interference; 14 deaths resulteddirectly from the operation, and in 1 the result was unknown. A fairconsideration of the question would show the mortality from the operationto be only 14 out of the 59 cases, or about 23 per cent. ProfessorPirrie states in his "Principles and Practice of Surgery," that he wasextremely anxious to obtain accurate statistics of this operation, butfailed to "procure them from some parts of the world where it had beenseveral times performed. So far as he has been able to learn, the opcrationhad been adopted in 70 cases, and death has resulted from it in 25.Sayre, of New York, gives an analysis of 30 cases, of which 20 recoveredand 10 died, 4 of the latter within one week after the operation.Lancet.

1861. "s. 820Labob Obstructed by Hydrocephalus.—Professor Simpson adthatwhen labor is obstructed by a hydrocephalic head, we shouldnot perforate the cranium and to a certainty destroy the child, butshould tap it with the trocar ;thus performing in utero the operationmost calculated to be of service to it in mundo. Again, when it is afootliug casej and the hydrocephalic head cannot be born, he advises, insteadof using great traction or endeavoring in this awkward situation topuncture with trocar, to cut across the spine, when the fluid will immediatelyfind exit. Dropsy may occur in the other cavities of the foetus;especially pleuritic and peritoneal effusions. Amer Med.. Times.Illumination.—It appears that the difference in the illuminatingpower of the same gas may vary twenty per cent, when tested at thehighest and at the lowest points of the barometrical range in this country,from the effect of the rarefaction of the air alone, without taking intoconsideration the different densities of the gas at the opposite decree ofpressure.— British Medical Journal.On Saccharate or Colchicum.—That Colchicum is so frequentlyfound inefficient in cases of articular rheumatism and gout, Dr. Joycuxregards as due mostly to the use of an improper preparation. He considerscolchicum "as certain a specific in gout and acute articular rheumatism,as iodine in goitre, and iron in chlorosis." The best and mostuniform preparations arc the fresh juice rubbed up in the proportion ofone to five with sugar, and dried in vacuo ;or 2, an extract obtainedfrom the fresh juice by evaporation in vacuo. The former preparationhe prefers for internal nsej giving, as an average dose, four grammes(one drachm) daily, in ten divided doses, while he employs the extractto rub on the painful parts. Giving such divided doses prevents allirritation of the bowels and diarrlnva, which so many consider as inseparablefrom the effects of the remedy. Attacks of gout so treated, yield,at the latest, in two or three days ;acute articular rheumatism "afterfourteen to twenty days. In cases of subacute rheumatism, the remedyis not so efficient, though it usually gives considerable relief. Gaz. desHospitauz. Maryland t\- Virginia Med. Jour.Arsenic in Apoplectic Congestion.— 31. Lamare J'icquot, physicianto the Honfleur Hospital, as the result of ten years' observation andtrial upon between forty and fifty cases, including his own among them,strongly recommends the prolonged use of arsenic as an effectual" meansof subduing congestion likely to give rise to apoplexy. In very urgentcases in which hemorrhage seems imminent, he precedes its employmentby a moderate venesection, but this is quite exceptional. In proportionto the severity and menacing danger of the case, the dose requires to belarger ;and although, even after a month, benefit may already result, tobe of permanent benefit it will In ontinued for several month.-.

———830 Miscellaneous. [October,The more urgent the case, the more tolerant docs the system become ofthe arsenic. The author, regarding apoplexy as consisting essentially inan extensive increase of globules of the blood, employs arsenic as a powerfulagent for decreasing these, as well as the plasticity of the blood,It becomes, of course, necessary to assure oneself in a given case of therichness of the blood, for to employ arsenic when the blood is impoverished,would be to do mischief. The author has generally found thedose of one-fifteenth to one-sixth of a grain per diem sufficient. Bull,dc Tlteroj)., tome lvii. pp. 193-252. Ibid.On the Efficacy of Digitalis and Quinia in the Treatment ofHemicrania.—Dr. Debout, who has very severely suffered for manyyears from attacks of hemicrania, testifies to the efficacy of the combineduse of sulphate of quinia and powder of digitalis in the treatment of thiscomplaint. The proportions employed are three grammes (about threefourthsof a drachm) of sulphate of quinia, and one and a half grammeof powdered digitalis, made into thirty pills, of which one is to be takenevery night at bedtime for at least three months. From the beneficialeffects produced on himself, Dr. Debout prescribed the same treatmentfor several patients, and the results in many cases were equally satisfactory.Chemical Gazette. Ibid.Treatment of Old Fissures of the Anus.—M. Gosselin observesthat most of these fissures may be easily cured, whatever be the meansadopted. Still he regards forced dilatation as the most expeditious andthe most convenient for the patient, while incision best guards againstrelapse. In many cases he has combined with advantage these twomodes. First dilating, and then incising the fissure, which is theneasily visible throughout its whole extent. He has observed the fissureand its pains persisting after forced dilatation oftcner in women than inmen. But besides these fissures thus easily cured, there are otherswhich resist various modes of treatment successively employed, or, whencured, are succeeded by new ones, just as painful as the others. After,in such cases, trying the various means one after another, M. Gosselinresorts to daily dilatation, which he has found attended with good results.The index-finger is passed into the anus daily until the pains after defecationhave disappeared or notably diminished Gaz. dcs. Ho]).,No. 91. IbidHoney and Glycerine in Surgery.—Dr. C. F. Moore, MedicalSuperintendent of Middleton Hospital and Infirmary, says (Dub. Med.Press, Dec. 2G, 1860) that several mouths ago he commenced the use ofglycerine to bedsores in bad fever cases, and finding it to excel his expectations,he used it in all cases where a healing dressing was required.It occurred to him, some three or four months since, that honey might

l1861.] Mi 381answer as well ; and as a very great difference in price exists, that animportant saving might thereby be effected by using an equally efficientagent, "as some of the properties of honey previously known to me ledme to think it to be. I have now used it in several cases in hospital andprivate practice, as in ulcers left by scalds, in a wound after the removalof a large tumor presenting some malignant characters from the fascia ofthe leg in a woman of 70 years of age, in a case in which dead bone wasbeing discharged after injuries to a man's leg, bedsore from fracturedthigh, etc. To the readers of your valuable journal I will only nowstate that it seems especially useful in cases where a tendency is manifestin a wound or ulcer to throw up unhealthy granulations insteadof healingkindly. It seems also to protect the skin adjacent by its own conitiveagency, so to speak, as well as by correcting the styptic properties of the discharges. In evidence of this latter property, I may statethat, in cases which I have treated with it, after having used the moreordinary dressings previously, the honey most unquestionably removedall unp easant smell from the discharges, itself no small gain. I mustobserve, however, that honey, when first applied especially, causes someconsiderable degree of pain, indicating its stimulating effects. In onecase I used a wash of tiuct. opii and water on first applying the honeydressing, poured oyer the fine linen which had been applied, saturatedwith fine clear pure honey. In all the cases, however, the patients themselvessoon got reconciled to the pain, considering it indicative of benefitbeing received from the dressing. It is well, however, to bear this pointin mind, especially in cases where a very large surface has to be dealtwith, or a patient is very susceptible of or sensitive to pain. In suchcases, glycerine, which uore soothing qualities, might be preferable.In conclusion, I would insist on the necessity of using pure|clear honey, quite free from any of the numerous articles said to be usedin its adulteration. 1 'Am. Jour, of Med, Sciences.Digital CoMniEssio.x in - . r. —M, Miranlt, of relatedto the Paris Surgical Society the following two cases of aneurism,in which digital compression had been successfully employed :1. A man, aged 23, exhibited an ancurismal tumor at the bend of thearm, some time after being bled. When admitted into the hospital thistumor was about the size of half an egg. Digital compression was madeon the brachial artery, at about the middle of its course, from 11 o'clock,A. M. to 9 P. ML, and next day it was resumed from A. M to 9 P. 31.The tumor became more firm, and the compression was employed againat »j A. M. of the third day ; at 8 the pulsations had become indistinct,and at 12 they had completely disappeared. Thirty-one hours had beenoccupied in makiDg compression._ A child, aged 9, having had the trunk of the temporal arteryopened, just anterior to the ear, an aneurism about the size of a nut appearedeight or ten days after the accident. Direct digital compression

—832 Miscellaneous.was employed for five hours on the first day ; for ten and a half hourson the second ;for eleven hours on the third ; for nine and a half hourson the fourth ; for eleven hours on the fifth ; for ten hours on the sixth ;for ten and a half hours on the seventh ; and for nine and a half hourson the eighth—making a total of eighty-five hours, at the end of whichtime the aneurism had become cured. Med. Times 4* Gaz. Jan. 19,1861, from IS Union Med. No. 1, 18G1.A Substitute for the Catheter.—Sir—Some two years ago, 1had under my care a man who had received a fracture of the spine.Inability to micturate was one of the symptoms, and I expected that Ishould in this case, as I had witnessed in some others, have to use thecatheter very frequently.It occurred to me, however, that by pressingover the region of the bladder, the urine might be discharged, and so itproved ; for when any fluid collected in the bladder the patient wasalways relieved by gentle, equable pressure. He never required theuse of the catheter, and, though he survived his accident about threemonths, no urine ever escaped except under pressure.Your obedient servant,J. Wearne, M. R. C. S,Helston, Cornwell, Nov, 18G0. Lancet,On Iodism.—In a recent discussion on iodism at the Academic Imperialede Medecine, M. Velpeau made the following observations : Hehad treated about fifteen thousand persons with iodine either externallyor internally, but he had never seen anything exactly resembling^ constitutionaliodism. He had observed irritation of the digestive organs,pains in the stomach, dyspepsia, roughness of the throat, irritation of themucous membrane of the mouth and nose, ptyalism, &c ,but he hadnever seen cases of rapid emaciation, with atrophy of the breasts andtesticles, and bulimia, or in short, with symptoms of poisoning. M.Velpeau suggests that the difference of the results observed in Paris andGeneva may be due to the difference in the doses employed, or the varyingqualities of the iodized preparations ; but whatever may be thereasons of the discrepancy, he has never seen in Paris any cases of what31. llilliet has called constitutional iodism.—L1Union Medicale,March 22d, 1860.