"It is very probable that the membrane lining those cavities in which the concretions are formed, has been at one period or another affected with inflammation. When a serous or synovial membrane becomes inflamed, in place of mere exhalation which is naturally going on, a distinct quantity of fluid is collected, from which an albuminous deposit is formed. In most instances this albuminous matter is reabsorbed; but when a portion remains, it acquires a very considerable degree of firmness, as we observe in adhesions formed by the pleura and peritoneum converted into bone. If a piece of albumen be in this manner left loosely attached to the membrane, and if a quantity of fluid be at the same time collected in the cavity, the albu men will be modelled into a particular shape, from the motion and pressure to which it is exposed, Whilst the albumen remains attached, it may thus undergo various changes in form, and any fresh attack of inflammation, however slight, may add to its bulk; but when it is once detached, by its slender peduncle giving way, no future change can take place, unless that of absorption; for, when loose and unconnected, it must be considered as separated from the system, and liable to be acted on by the absorbents as a foreign substance. It has been briefly noticed, that these concretions are either entirely composed of a soft substance, or of a substance partly soft and partly osseous; or they are altogether composed of bone. The same may be noticed of the common adhesions formed between serous and synovial membranes, and of the changes which those membranes themselves undergo from chronic inflammation. These too are sometimes merely ligamentous, but in other instances they are ossified; thus showing, that adhesions and concretions ought to be considered as the effect of the same morbid action, and merely varieties of disease, in place of distinct-morbid alterations of structure."

III. Case of Hernia Cerebri. By DANIEL PRING, Surgeon.

The points of this case are shortly these:-A man received on the 8th of April a blow on the head, by which a fracture of the cranium was occasioned. No symptoms of cerebral derangement ensued for some days; but the sore in the scalp was ill-conditioned, and by passing a probe into the wound, some spicula of bone were discovered. At this time, the seventh day after the accident, there was great prostration of strength, and the pulse was no more than 50, soft, and extremely weak. On the twelfth day there was great increase of irritation, and symptoms of pressure on the brain had appeared. On the thirteenth day there was a protrusion in the wound esteemed to be fungous, but which proved to be a portion of cerebral substance, constituting the Hernia Cerebri.

As there had been evidently a secretion of pus on the surface of the brain for some distance, within the cavity of the cranium, from the wound, this hernial state of the brain, by shutting up the exit for the pus, became the accidental

cause

cause of the pressure and irritation. By degrees the patient got well, and on the 3d of June the wound was quite cicatrized.

It is presumed by the author, that the spicula of bone, which had inflamed the membranes and subsequently produced sloughing and hernia, should have been early removed, though no symptoms of cerebral derangement were present. In particular instances this may be proper, and where it can be done without much exposure; but as a general principle of practice the propriety of it remains doubtful if not objectionable. It may be a question if exposure of the dura mater is the surest way to prevent its inflaming. The symptoms of pressure arising from the confinement and accumulation of pus within the cranium, may in these cases be removed by pressing down the hernial protrusion with a smooth spatula, so as to give exit to the fluid at sufficiently frequent intervals. Immediate mischief will thus be prevented; and, as far as our experience goes, we can say, that by gentle and judicious pressure the protruded part of the brain will be gradually confined within the cranium. IV. On the good Effect of Ipecacuan and Laudanum in Dysentery. By GEORGE PLAYFAIR, Surgeon.

Half a drachm to a drachm of ipecacuan with from 30 to 60 drops of laudanum were given, confining the patient for some hours to an horizontal posture. It usually happened, that after the medicine was taken, no inclination for stool was experienced for many hours, the patient being, during that time, free from pain; several loose motions then took place, but unmixed with blood, and without tenesmus. It sometimes happened that several loose motions succeeded the medicine in a very short time, and none afterwards; and that the bowels were even costive the day after the medicine had been taken.

Seldom more than one dose was required, but when any symptoms remained, a repetition' next day was sufficient to cure the disease. This treatment was adopted at the commencement of the disease; afterward it was not beneficial, because the stomach became too irritable to retain the medicine. The following cases will explain, in a measure, the disease, and illustrate the treatment.

66

W. Troy, a private of his Majesty's 65th regiment, was, on the evening of the 11th of April, atacked with dysentery. The symptoms were severe, and accompanied with fever. He had given him half a drachm of ipecacuan, with 35 drops of laudanum, and had several loose easy motions in the course of the night. On the morning of the 12th, the griping pain had almost left him; he felt

L2

easy

-easy in his bowels, and during the whole of the day had only one motion; but he complained of slight head-ache, his pulse was rather quick, and his skin hot. I gave him three grains of calomel, with a little rhubarb, and he had for his diet sago, with an allowance of wine. 14th, He had no griping pain, head-ache almost gone, felt a sensation of soreness all over the abdomen, and had no stool since the 12th. I gave him 15 grains of rhubarb and 30 grains of magnesia, which procured him three easy motions, after which he seemed well in every respect. His head feeling light and giddy, had a few doses of bark and port wine, and on the 16th was discharged well. The medicine in this case caused no nausea what

"Dawson, 24th of April, complained of severe griping and looseness of the bowels, with constant inclination to go to stool, and much tenesmus; his evacuations consisted of mucus mixed with blood. I gave him one drachm of ipecacuan with 60 drops of laudanum. He vomited the first, but retained a repetition of the dose. Had only one stool in the night of the 24th, and the griping had entirely left him. He had for his food a strong decoction of barley. On the 26th he had two or three stools, which he described as consisting entirely of blood, but had none in the evening or during the night. The morning of the 27th complained only of flatulence; his face seemed slightly swelled, and had been so ever since he had the first dose of the medicine. Had complained of head-ache on the 26th, but which had then left him; 28th he had no complaint remaining."

V. VI. Cases of Hydrophobia. By Mr. TYмON, Dr. BERRY, and Dr. SHOOLBRED.

These cases have previously appeared in the preceding volume of our Journal.

VII. VIII. On the Introduction of the Depletory Method of Cure in the Tropical Fever.

In the ardent fever of the tropics, the interruption of inordinate vascular action by the combined powers of bleeding, purging, and the affusion of cold water, forms the general indication of cure. It is the object of the first of these papers to show that this method of treating the early stage of yellow-fever has been long and universally adopted; and that the opinions and practice of Drs. Jackson, Rush, Moseley, Rutherford, and Lempriere, sufficiently contro vert the assumed originality of a paper on this subject by Mr. Parson, reviewed in our preceding volume. The paper No. VIII. is published with the similar view of showing that the practice suggested by Mr. Parson must have been generally known, especially as Dr. Dickson, physician to the fleet, had, in 1810, dispersed a circular on this subject to the surgeons on the Leeward Island station.

IX. On the Brain Fever produced by Intoxication. By JOHN ARMSTRONG, M.D.

The disease here called Brain Fever appears very distinctly to be that which Dr. Sutton describes under the appellation Delirium Tremens (vide the Report at the be ginning of this Number). Dr. Armstrong's description of the disease, and his treatment, justifies this conclusion.

"This disease," says Dr. Armstrong, "which I shall continue to designate brain fever, is preceded by restlessness, defective recol lection, paleness of the face, and slight tremors of the limbs; by anxiety, and irregularity of thought. At first the patient's slumbers are short, and interrupted by frightful dreams; but he soon becomes watchful, and passes days and nights without sleep; he dislikes to be alone, and if his friends leave him in private, he is clamorous till they return, or goes about the house in search of them. His appetite is considerably diminished, and he frequently loaths the very sight of animal food. He is more especially sick at the stomach towards the morning; he often vomits his breakfast; and the slightest exercise, or agitation of mind, produces perspiration. As the complaint advances, the skin becomes hot and dry, the tongue parched, and thé pulse weak and rapid. The surface of the body, however, soon grows cooler, and is covered with sweat, and the tongue puts on a cleaner appearance; but the irregularity of mind increases; the patient imagines that his friends are all conspiring against him, or that they have suffered some great misfortune, in which he is himself deeply implicated:-at other times he supposes that his chamber is haunted by spectres, and furiously calls for assistance to drive them away; or supposes that he is in a prison, and that his friends have all deserted him; sometimes, however, he is in high spirits, laughing and talking by turns incessantly. Occasionally, too, he converses with the medical attendant about his ordinary business, with apparent precision; tells him that he has been continually engaged, and walked or rode to several places in the neighbourhood, since he last saw him, when, in reality, he had never left his own room at the next visit he mistakes the physician for some other person, and loads him with abuse. If any one happen to contradict him, he most pertinaciously adheres to his opinion, and becomes highly indignant. If he be soothingly dealt with, he will sometimes answer questions readily and distinctly; but if many interrogations be put to him in succession, he grows confused, and relapses into delirium.

"The symptoms already described continue more or less urgent for four, five, or six, and seldom longer than ten days. If the patient falls into a sound and tranquil sleep, he generally wakens refreshed and collected, and from that time recovers rapidly: but short disturbed slumbers, accompanied with subsultus tendinum, from which the patient starts with affright, and then falls into a low muttering delirium, are amongst the most dangerous indications. I have seen one case accompanied by convulsions from the very beginning of the disease; but they were speedily subdued by a large dose of æther, and the patient recovered very well.

"This kind of brain-fever is distinguished from typhus by not being contagious; by having no petechiae, or cadaverous smell; by the delirium attacking the patient more suddenly, and continuing with more impetuosity; by the heat of the surface of the body not remaining permanently above the natural standard; and by there being less prostration of the muscular powers in the commencement of the complaint, It is known from inflammation of the brain, by the more moderate degree of fever; by the absence of turgescence and redness of the eyes, and impatience of light; by the paleness of the face and weakness of the pulse."

The number of cases treated by Dr. Pearson of Newcastle, who published a small tract on this subject in 1801, and by Dr. Armstrong, justify, perhaps, the positive conclusion, "that this disease invariably arises from intoxication." The treatment which is stated by Dr. Armstrong to be generally successful, is precisely that laid down by Dr. Sutton.

"About 40 or 50 drops of laudanum should be administered on the first attack of the disease, and repeated in doses of 25 drops every five or six hours, till rest be procured. An ingenious friend of mine, who has seen much of this disease, always combines small doses of æther with the laudanum, which he has found an efficacious method of treatment. I have myself witnessed its good effects in three severe cases, and have reason to think that it is an improvement upon the practice here recommended. The common drink of the patient may be barley-water, agreeably acidulated with lemon-juice. From a pint to a bottle of Madeira wine may be allowed in twenty-four hours, regulating the quantity, however, by the state of his constitution and previous habits. Fresh ale or porter may also be moderately allowed him, and, in addition, the system must be supported by strong beeftea and nutritious soups. Madeira is preferable to any other wine, because it rests better upon the stomach, and, in general, restores the tone of that organ in such cases, better than any other stimulus. Coercion must never be used; on the contrary, the feelings of the patient must be soothed by the kindest attentions, and he must be permitted to walk about the house, or even into the open air for a short time, if he desire it, provided the weather be sufficiently temperate. Vene. section is almost invariably inadmissible, and, perhaps, highly dangerous in every case of the kind; at least I have known some instances in which it was attended with fatal consequences. Blisters never do any good, but generally harm, from the irritation which they excite, Drastic purgatives, and even mild aperients, in general, must be avoided in the commencement of the attack; but when the palient has once obtained refreshing sleep, the latter may be administered with safety, and even advantage, but the former must never be given in this disease."

X. On the Nature of the Disease affecting Persons employed in Silvering Mirrors. By EDWARD PERCIVAL, M.D. 3 In a Report of the Carey-street Dispensary, in July 1812, Dr. Bateman, the reporter, states the effects produced by

the