time the patient gradually recovered, and was convalescent by the ninetieth day.

Dr. Gregory, Mr. Lawrence, Mr. Wardrop, Mr. Bacot and others, decided that tracheotomy should not be performed, unless the symptoms of suffocation became very urgent. We are at a loss to know what tracheotomy would have done for a case where the body was lodged in one of the bronchia. Bronchotomy, in the strict sense of the word, could alone have given the means of removing the cherry-stone, and this must have been done by opening the chest. He would have been a bold operator indeed who would have undertaken such a step! The remedy would probably have been at least as bad as the disease.

9. TREATMENt of intermITTENT:"

Agues are not now nearly so prevalent in the fenny parts of Lincoln and Essex as formerly. The drainage of the lands has no doubt been the main cause of the amelioration; but, still ague prevails, and this is owing, Dr. Brown thinks, "to the mixture of salt and fresh water, an ascertained source of infectious miasmata." This, he informs us, arises from two evident causes-soakage, and the influx of the sea at the flowing tide into fresh water channels. The prevalence of intermittents and remittents during the last summer have furnished Dr. Brown with materials for the present Essay, of which we shall lay some of the particulars before our readers.

The principal object of the Essay, as the title imports, is the art of repelling the paroxysm. For this purpose, many means, medicinal, mental, and even mechanical, have been employed, as brandy, laudanum, emeticsligatures, frictions, exercise-amulets and charms. All these have been Occasionally successful, but few or none of them are now in general use. The interval between the paroxysms is almost universally waited for, in order to exhibit tonics-more especially bark or arsenic for the prevention of the succeeding attack. "The practice," says Dr. Brown, "of waiting for the paroxysm, and exercising powers to arrest it in its progress, on the first approach, has never been established." Dr. B. has known an ague resist the sulphate of quinine, with great obstinacy, for several weeks, and an example of this kind has induced our author to participate in the fears of Dr. Paris, "that evil not good would be the result of the new remedies." In this fear we do not participate; for, if any evil is to arise from arresting the progress of an ague, it is far more likely to result from clogging the stomach with a quarter of a pound of the ligneous part of bark, than from the exhibition of twenty or thirty grains of the sulphate of quinine.

Dr. B. does not come forward, however, to depreciate this last medicine, but with the view of "altering the manner of its exhibition, and promoting its operation by the assistance of others, by which its action becomes more uniform and certain." In March, 1824, Dr. B. was himself the subject of an intermittent, of tertian character, and with paroxysms unusually severe. He had been taking the sulphate of quinine, but still he had three attacks, and he looked forward with anxiety to arrest the fourth. For this purpose, he determined to alter his plan. Having taken a laxative medicine, and the attack shewing indications of approach, at one o'clock, the usual period, he commenced, by taking only two grains of the quinine, intending to

A Treatise on repelling the Paroxysm of Intermittent Fevers; illustrated with Cases. By J. Brown, M. D. Boston, 1826, pp. 60. Underwoods'

follow it up with a much larger dose antecedent to the rigor, if the above quantity were not sufficient "But, in a very few minutes, its effects were apparent. The shrinking of the surface, the dejection of spirits, the painful sensibility to cold, head-ache, and thirst, and all unpleasant feelings, progressively subsided." From a dose so small, such influence over symptoms so formidable could hardly have been expected; and a temporary disappointment did succeed. In half an hour the attack returned, and again the same dose was repeated.

"Its influence over the rising symptoms became sensibly felt in a few minutes-the pulse became more full and distinct,—the respiration easy, -the cutis recovered its natural temperature, and, in eleven minutes, not one unpleasant feeling remained. This state, like that produced by the first dose, continued but a short time; in thirty-five minutes, the symptoms returned again in the same order as before, and a third time I repeated the quinine, in a dose of two grains; and now felt some confidence in its powers; and a hope that, by a steady perseverance in exercising this ascendancy I had gained over the approaching paroxysm, I should continue to repel, and ultimately to subdue it altogether. This was effected after the fifth dose, between which and the fourth, there had been an interval of an hour and a half, leaving a slight glow and moisture on the surface." 21.

Our author now proceeds to the narration of 32 cases of intermittent cured in the above manner, with more or less celerity. These we need not detail. A single case, the first on the list, will be a sufficient specimen of the practice pursued.

"Case 1. S. T. aged 17 years. This patient came to me the day fol lowing the fifth paroxysm. The ague was of the tertian type. She had been subject to habitual constipation of the bowels, and, under her present affection, it had become of more serious inconvenience to her. I therefore prescribed an active purgative to be taken at intervals, until the bowels were well acted upon, by which she got rid of several dark and offensive dejections.

"At the approach of the fit, she took the sulphate of quinine, beginning with the first dose as soon as she perceived the paroxysm coming on: an hour had elapsed before it became necessary to take another; and, at the expiration of a little longer interval than the first, she took the third and last-the fit subsided, and the ague altogether left her. She took in all only six grains of the quinine." 22.

Active purgation appears to have been an indispensable preliminary to the mode of treatment; for, in one or two cases where this was omitted, the plan failed.

Dr. Brown's present opinion respecting the quinine forms a singular contrast with that which he has quoted from Dr. Paris, and which we have noticed at the beginning of this article.

"If any drug, now in use, is entitled to be considered as a remedy fit only for kings, the sulphate of quinine has a fair claim to the distinction." 60.

Upon the merits of the plan recommended and practised by Dr. Brown, we can pass no opinion, not having given it a trial. But we have now put our readers in possession of the facts, and they can easily test them in their own practice.

10. ENCEPHALIC PHLEBITIS.

The following curious case occurred in the practice of M. Gendrin and Dr. Leveque-Lasource, and is detailed in the REVUE MEDICALE for April, 1826.

1

Case. Madame Maged 22 years, of good constitution, was safely delivered of her third child by Dr. Leveque-Lasource. She was in good health during pregnancy, but had a presentiment that she would not survive her accouchement. She did not suckle her infant. The doctor remarked that a little bouillie occasioned some febrile movement in the system. On the 7th day after delivery, while drawing her nipples with a glass, some blood issued, and frightened the patient very much. She had evinced, for a few days previously, but little regard for her infant. She fainted at the sight of the blood, and, on recovering, complained of cephalalgia of the left side. This pain was not diminished by two applications of leeches. On the 9th day, there was some difficulty of breathing, with pain in the side, which gave way to local bleeding. But the cephalalgia continued. The secretion of milk and of lochia had ceased. 10th day. A new moral commotion, from the fire having caught the curtains. The head-ache still continued, in spite of leechings. 17th day. Increase of head-ache, with pain in the left

ear.

Some symptoms of pneumonia requiring leeches. Sudden loss of power in the right arm, with numbness of the left leg. 18th day. The paralytic symptoms are increased-the tongue is embarrassed. 19th day. The paralysis augmenting a large detraction of blood, local and general, which was cupped and buffed. This evening (1st Feb., 1826) M. Gendrin and M. Landré-Beauvais joined in consultation. The pupils were but little obedient to the light-tongue moist, but could not be pushed out-right arm completely insensible and motionless, but without rigidity-right lower extremity in nearly the same state-incontinence of urine-she appeared to comprehend, but could only say yes and no-sight and hearing undimi nished-skin moist-pulse from 90 to 95, full and resisting. The patient indicated much suffering in the left side of the head. Blister-leeches to the groins. 2d. Feb. A fit of great agitation came on to-day, with entire loss of speech, the pulse quickening to 136 pulsations, with some subsultus tendinum. Leeches to the head-cold applications-sinapisms to the extremities-twenty-four grains of calomel in six doses. 3d. The symptoms evidently more favourable-paralysis diminished-pulse slower and softersame remedies as yesterday. Ath. There were convulsive movements of the voluntary muscles, and other bad symptoms, which went on increasing till the 8th February, when death closed the scene. This event took place on the 26th day after accouchement, 17th from the commencement of the cephalalgia, and 9th day of the paralysis.

Dissection. This was not accomplished till after exhumation, on the fourth day from the patient's decease. A considerable degree of decomposition now obtained. On removing the skull-cap, it was observed that the middle cerebral vein of the right side was very much enlarged and tortuous as it approached the falx, where it opened into the superior longitudinal sinus. It was the size of a writing pen. They found it filled with a puriform substance of a yellow colour. In the tract of this vein the arachnoid membrane was slightly opake. The corresponding vein on the left side was in the same state. The whole of the superior longitudinal sinus itself was converted into a diseased mass which it would be difficult to describe, but which was infiltrated in many places with yellow purulent matter. There was organic disease to a vast extent in various other parts of the brain. Nothing remarkable in the other viscera of the body.

11. MR. CHEVALIER ON BELLADONNA.•

Mr. Bayley, of Harwich, drew the attention of the Profession to the em

* Mr. Chevalier. Med. and Phys. Journal, No. 5.

ployment of belladonna, many years ago, in cases of tic douloureux, and other painful affections; and, more recently, Mr. Blackett has published some interesting papers on the external employment of this medicine.

Mr. Chevalier has now stated his experience of the efficacy of belladonna externally employed, in a number of complaints, all, however, agreeing in one particular-pain or morbid irritability. The first case in which he tried the belladonna was that of a stricture, attended with excessive irritability of the urethra. The extract, at first mixed with opium, and afterwards pure, was introduced on a bougie, and the morbid sensibility was soon reduced. To scrofulous glands, Mr. C. has applied the belladonna ointment, (equal parts of the extract and of some other ointment) with striking advantage. In many cases of inflamed periosteum, venereal nodes, scrofulous diseases of the bones and joints, the extract of belladonna has proved a soothing application. In one case where a tumour had formed on the back of the hand, as large as half an orange, and where the hand was condemned to amputation, the swelling dispersed in less than ten weeks, under the belladonna plaster first, and ultimately the pure extract. In the case of a boy, whose knee was so much diseased that amputation was recommended, but not submitted to-where the knee-joint was imperfectly anchylosed, the condyles enlarged, and the capsular ligament distended with fluid, the belladonna plaster (after the severity of the pyrexial symptoms was abated by proper local and general means) was employed, and, under its use, the joint diminished in size, the boy's health improved-and, by the use of splints and other mechanical means, the joint was brought nearly into a right line. In cutaneous affections, this remedy has proved very useful in our author's hands. Erysipelas, cancers, inflammatory and spasmodic affections of the chest, have all been benefited by the belladonna plaster. Tooth-ache, rheumatism, even of the acute kind, and many other painful affections, have been relieved by this narcotic application in the hands of Mr. Chevalier. In the cases of between two and three hundred persons, in private practice, and in the Westminster Dispensary, there were very few in which the remedy failed to do good-" none in which it appears to have done harm." This is very grateful intelligence to those afflicted with pain; but, like the account of all other favourite remedies, it must be taken cum grano salis. There can be no doubt that belladonna is a powerful sedative, and that it is more effectual than almost any other in reducing morbid sensibility of parts, and morbid contractility of the muscular fibre. It may, therefore, be more frequently used than it is, in cases of pain, irritation, and rigidity. On the Continent it has been much employed, especially by Madame La Chapelle, as an application to the os uteri, where that muscular ring continued too long contracted after labour pains had come on. In this country we believe it is seldom used for this purpose, and we have heard it objected to by an eminent accoucheur as dangerous, lest the paralyzing influence of the belladonna should extend farther than was intended, and render torpid the muscular fibres of the uterus itself. We know not whether this objection be well or ill founded.

12. ON COMPRESSION IN POISONED WOUNDS.

Dr. Bouillaud has been experimenting on the above subject, and has laid the results before the Academy of Medicine, and also before the public, in the September No. of the ARCHIVES GÉNÉRALES.

Dr. B. agrees with Dr. Barry, that we have no evidence of the agency of poisons through the medium of the nervous system, and that, if absorption can be prevented, the animal may be considered safe. The action of the cupping-glass is effected, of course, through the agency of pressure on the

outside, and the removal of pressure on the inside of the glass; and Dr. B. was led to enquire whether simple pressure on a poisoned wound might not produce the same effects as the cupping-glass-and, also, whether a ligature applied above the wound might not have a similar effect. We shall state a few of the experiments made to determine these points.

1st Ex. At 14 minutes past 11 o'clock, he introduced three grains of strichnine into the cellular tissue of a rabbit's thigh, a ligature being placed above the wound. Seventeen minutes afterwards, the animal presented no symptom of poisoning; but at the expiration of 21 minutes, convulsions and cries manifested themselves. The thigh was then grasped very firmly with the hand at the place where the poison had been inserted, and soon the above symptoms of poisoning disappeared, and the rabbit tried to escape. During the 25 succeeding minutes, the manual pressure being continued, no sign of convulsions appeared. At 2 minutes after 12, the pressure was suspended, and, in six minutes afterwards, tetanic convulsions took place, which again ceased when the pressure was renewed, either by the hand or a cupping-glass strongly pressed on the part, without any exhaustion of the air. A slight diminution of the pressure of the glass was sufficient to renew the convulsions, and vice versa. At 22 minutes after 12, the compression was definitively suspended; and, in order to spare the animal any farther sufferings, some Prussic acid was dropped into one of its eyes, and it quickly expired.

Exp. 2. At 22 minutes past 11, Dr. B. introduced three grains of strichnine into the thigh of an adult rabbit. In eight minutes, cries and convulsions, with rigidity of the members, manifested themselves. The part was then strongly grasped with the hand, and almost immediately the cries and convulsions ceased. The compression was suspended, and again the convulsions returned. A cupping-glass was then strongly pressed on the part, without exhaustion, and the symptoms of poisoning were quickly arrested. The cupping-glass was removed, the convulsions returned, and so on. Pressure with the hand had the same effect. The rabbit was set free, having first washed the wound, but it soon died. Nine experiments are detailed, but all with the same results. These results are, we confess, very curious, if they are faithfully related, which we have no reason to doubt. From them it would appear, that the best plan in cases of poisoning, say, for instance, the bite of a mad animal, would be, to apply a ligature as soon as possible above the wound, and also the exhausted cupping-glass to the wound. Leeches might also be applied in all directions below the ligature, by which means the poison would be extracted, and any blood which might happen to be contaminated by that poison.

Reflecting on the above experiments, we are at a loss to account for the manner in which simple pressure relieves the symptoms of poisoning when they have once occurred, and that, too, in so sudden a manner as is here represented. If the experiments be correct and faithful, it would really appear to us, that the explanation of this sudden relief is more easily furnished by the nervous, than by the vascular or absorbent systems. Strong pressure on the wound might deaden the sensibility of the nerves there, and thus take off, for a time, the local irritation of the strichnine, the cause of the convulsions. This, of course, is reasoning on the possibility of poisons acting through the medium of the nerves and when we consider the rapidity with which some animal poisons act-as that of the cobra de capello, &c. we are almost irresistibly led to believe in the instrumentality of the nerves, on some occasions at least. We leave it to physiologists to determine whether the above experiments of M. Bouillaud be in favour of the nervous or vascular agency of poison introduced into a wound.