have some slight degree of muscular power in the fingers. This improvément gradually increased, and, by the 17th September, there was no paralysis left.

Reflexions. On a former occasion, Dr. Bland had published some observations on the influence of great muscular exertions in the production of apoplexy; and considers the above as a case in illustration. It requires but the effort to strain while the breath is held in, to convince any one that blood is thereby accumulated about the head. If predisposition to apoplexy obtains at the time, such as weakness, or disease of any of the cerebral vessels, there can be no doubt that this straining may be the immediate cause of extravasation on the brain. That the extravasation was to a very small amount in the foregoing case, we think is evident, from the rapidity and completeness of the cure. But that there was extravasation, we have not the smallest doubt.

Case 2. Pharyngitis, with acute fever. A female, 35 years of age, after exposure to wet and cold, on the banks of the Rhone, was seized with general malaise, chills, and heats. Two days afterwards, anorexia, pains in the limbs, fever, acute pain in the pharynx, with great difficulty of swallowing. In the same evening the fever was intense, with head-ache, &c. Barley water. Third day. The symptoms still more evident-pulse strong and full -difficulty of swallowing increased. Barley water and warm pediluvia. The patient fainted away while the feet were in the water, and this syncope continued for the space of 15 minutes. At length the patient revived; but the fever and pharyngitis were gone, to return no more.

Dr. Bland occupies many pages with reflections on this case, and in attempts to prove that syncope has a tendency to check inflammation. In this country the principle has long been known, and syncope is often aimed at in the treatment of severe local inflammation. But in France, where blood-letting is hardly ever carried to such an extent, the effects of syncope are but little understood. The practice pursued by Dr. Bland, in the above case of severe pharyngitis, is a specimen of the Hippocratic practice still prevailing in that country.

20. REMARKABLE CASE, BY C. MULLER.

Case. A corporal in the Sleidgwick Cuirassiers, while assisting a man in putting up hay into a loft, fell back on the ground, and on being raised, it was discovered that he had lost the power of his upper and lower extremities. Surgeon Muller was called to his assistance in half an hour after the accident, and found the soldier pale, but sensible and powerless. The circalation and respiration were unaffected; but the lower half of the body was dead. Feeling was extinct in all parts of the body. There was no external wound; but the man had evidently fallen with his back across a cylindrical block of wood. M. Muller could not ascertain whether or not the spine was luxated. Blood-letting was practised, and a purgative exhibited. In the night, the patient was agitated and delirious. Next morning, he talked rationally, and he was more animated in his countenance; but the pulse was feeble, and he felt convinced that he was dying. He died a few hours afterwards.

On examining the spine, blood was found extravasated between the muscles and the vertebræ, as also into the theca vertebralis, from the sixth cervical to the ninth dorsal vertebra. The brain was perfectly sound, as were all the other viscera of the body.

* Biblioth. for Læger, 1824.

21. CASES of softening and PERFORATION OF THE STOMACH IN CHILDREN. BY DR. KRUGER.

Case 1. This was an infant consigned to an ill-tempered nurse, who had moreover some suspicious copper-coloured spots on her body. When Dr. K. saw the child, it was then six months old. It was peevish, and evidently laboured under disorder of the primæ viæ, as evinced by acid eructations, vomitings, and green stools. The doctor prescribed alkaline absorbents, tonics, and nourishing diet, with warm baths, and good air. There was a slight amelioration of the symptoms. But they returned from time to time, and were greatly exasperated by the application of a sinapism to the epigastrium, soon after which, the infant expired in great torture.

On dissection, the stomach and duodenum were found much distended with gas; and a very gentle movement of this last intestine, for the purpose of separating it from the stomach, caused it to burst. Its coats were softened along the whole exent of the great curvature, into a kind of bouillie, and the mucous membrane was of a brown or greenish colour. In the small intestines there were seven or eight invaginations.

Case 2. This was a little girl, three years of age, who had been confided, like the other, to a nurse suspected of being syphilitic, and who had exhibited copper-coloured spots on the skin. Her food having been of an indigestible nature, and bad in quality, she began to shew symptoms of gastric irritation, and diminution of strength. M. Kruger exhibited mercurial medicines, alternated with conics, and, by these means, the health received a temporary improvement. Suddenly, however, the following symptoms were developed :-general coldness-tumefaction of the limbsslow respiration. Next morning these symptoms were changed to vomiting and diarrhoea. The irritation ultimately spread to the chest and to the head, and convulsions closed the scene. Stimulants had been administered in this case, both internally and externally.

Dissection. Slight redness of the air-passages-effusion in the chest, and also into the abdomen. The stomach was of a brownish colour internally, and its coats so softened for a considerable space, that they went into a kind of mucilage between the fingers. This disorganization was chiefly found in the great cul de sac of the stomach, and gradually disappeared towards the superior part of the organ. The fluid found in the stomach was slightly acid, as in the former case.

These cases are analogous to some that have been recently published in this country-especially by Dr. Gairdner, and are not devoid of interest. We shall here state a case of perforation in an adult, which happened in this country.

Case. 3. This is related by Mr. Syme, in the October number of the Old Edinburgh Journal, of which the following are the particulars.

J. T. aged 23, had been dyspeptic from childhood, and when he applied to Mr. S. he complained of pain in his stomach, very severe after mealshabitual costiveness-dark-coloured stools-tenderness in the right side of the epigastrium on pressure, without tension there. He was put upon a system of diet, and ordered pills composed of equal parts of the mercurial and compound rhubarb masses. About a month after this Mr. S. saw the patient, who had experienced no relief, and was emaciating. On the 1st. of July, 1825, he dined more fully than usual, and in the evening, was observed by his workmen to put his hand frequently on his stomach. He remarked that he thought he could not live long. In the night he was seized with severe pain in the epigastrium, which he considered to be cramp,

and employed hot fomentations, &c. These proved unavailing, and Mr. S. was called in. He had now severe pain in the stomach and unquenchable thirst, with retching and vomiting. The pain was relieved by pressurepulse neither sharp nor much accelerated-tongue clean and moist. Bled to 16 ounces-a full dose of opium-sinapism to the pit of the stomach. In the morning, no relief, except of vomiting. A warm bath, and a dose of castor oil, followed by an enema. The oil did not operate, and the enema returned without fæculence. Pulse was now 124 and sharp-pain more extended-abdomen tense and tender. Bled to 30 ounces-salts and senna. July 3d. All the symptoms aggravated. At 4 o'clock he died.

Dissection. Abdomen tympanitic-some air and muddy fluid in the peritoneal cavity. The peritoneum itself was of a brownish red colour, from great vascularity-stomach externally of its natural colour, but much distended with air. On pressure being applied to this organ, air escaped through its parietes. On opening the stomach there was found an aperture, the size of a sixpence, in its lesser curvature, near the pylorus. The margins of this hole were regular, white, and firm, resembling ligament, being somewhat thickened. There were neither ulcers, cicatrices, nor inflammation in any other part of the mucous membrane. Some of the contents of the stomach had escaped through this opening into the abdomen.

Remarks. There can be no doubt that this aperture was an ulcer of long standing, in the stomach. The case is very nearly similar to that which we related some time ago, as happening to Mr. Barber of Covent Garden. In both cases, the rupture of the bottom of the ulcer took place after imprudent repletion. It is highly probable that ulcerations of this kind would occasionally heal, if the patient could be persuaded to adopt a most rigid system of diet on farinaceous food. But there are few who will forego the luxuries of the table, even when warned of the dangerous predicament in which they stand!

Case 4. In a late sitting of the Academy of Medicine, M. Leveillé read a report of two cases of spontaneous perforation of the stomach, of which we shall only notice one. A man, 55 years of age, had experienced four attacks of syncope in one year, and afterwards symptoms of derangement of the stomach, but without vomiting, tumour, or constipation. At length, there came on suddenly in the night, acute pain in the hypochondrium, distention of the abdomen, &c. and death took place before the morning. On dissection, there was found an oval hole on the anterior surface of the stomach, of small diameter, near the lesser curvature, three or four inches from the pylorus. Around the perforation were several minute yellowish tubercles. The mucous membrane was eroded for some space around the perforation. The left auricle of the heart was double its natural size, and to the mitral valve was attached an encephaloid tumour, forty-five lines in circumference -the probable cause of the attacks of syncope.

22. EPILEPSY CURED BY NITRATE OF SILVER.

Dr. Balardini has added one to the many instances on record of the efficacy of this remedy in epileptic fits. The patient was a young woman, aged 21 years, who, from her infancy, was subject to this complaint. It had now become very severe, very frequent, and the paroxysms often followed by temporary alienation of mind. Various remedies had been used in vain, when Dr. B. gave the argentum nitratum a fair trial. He commenced with two grains a day, and gradually increased the dose. The VOL VI. No. 11.

R

medicine was continued three months, and never produced any bad effects. Occasionally it acted slightly on the bowels. The patient was cured.

We are inclined to think that this medicine will be more used than heretofore. If epilepsy be dependent on organic disease of the brain, we do not see that the nitrate of silver can do any harm, but probably good, if due attention be paid to local evacuations from the head, and counterirritation. If, as is very often the case, the disease be connected with irritation in the primæ viæ, there is no other medicine more likely to remove this irritation, or at least to remove the morbid sensibility of the gastric and intestinal nerves, than the nitrate of silver.

23. ERGOT OF RYE.

In some recent Italian Journals we find several cases related where this medicine exhibited its specific effects on the uterus in a very unequivocal manner. In an animated discussion in one of our metropolitan medical societies, this season, an eminent accoucheur contended that the ergot of rye could hardly ever be required for the expulsion of the foetus, since the efforts of Nature would always, if time were granted her, bring the child within reach of the forceps, when it could be extracted without danger or difficulty. He also contended that if the os uteri were not dilated, or, at all events, not easily dilatable, the violent contraction of the uterus, occasioned by the ergot, might be productive of dangerous effects, and probably rupture the organ. It was contended, on the other hand, by some able obstetric practitioners, that, where the os uteri was dilated or dilatable, there could be no just reason for waiting days together for the slow operation of Nature, and that, in such cases, the administration of the medicine was proper and justifiable. Several cases were related by some of the members present, where the medicine was administered with advantage, and without any bad consequences. Upon the whole, we are inclined to agree with the last class of practitioners, and we think that, under the restrictions above-mentioned, respecting the state of the os uteri, the ergot of rye may occasionally prove a useful auxiliary to the languid powers of the uterus.

24. AN OVER-DOSE OF HYOSCIAMUS.⚫

The widow Rankin and her daughter had breakfasted on what they supposed to be hyssop tea, but which, in reality, contained an almost entire young plant of hyosciamus niger. The mother, who had taken a larger dose than the daughter, was soon seized with giddiness, vertigo, &c. and when Mr. D. arrived, he found the old woman in a very merry mood, being completely delirious, singing, and imitating with her hands the occupation of spinning. Her pupils were dilated-hands and feet cold-face pale, and covered with perspiration-pulse small and irregular-and she was incapable of comprehending what was said to her. The daughter was not nearly so much affected. Six grains of tartar-emetic, and a repetition of the dose, dislodged the enemy from the daughter's stomach; but it required eighteen grains of tartar-emetic, two scruples of sulphate of zinc, one scruple of sulphate of copper, and three drachms of ipecacuan powder, before the contents of the old woman's stomach could be cleared away. She soon got well, and felt no inconvenience from the strong doses of emetics. Mr. D. regrets not having a stomach-pump, or any thing that would form a substitute. We

* Case of poisoning by Hyssop tea. Mr. Donaldson, of Stonehaven. Ed. Journ. Med. Science, No, 4:

would strongly advise the surgeons of a town to have at least one stomachpump pro bono publico, which should be kept in a place where any one of them could have ready access to it in cases of emergency. The expense would be trifling in this way-and some lives, as well as reputations, would probably be saved by this small JOINT-STOCK-COMPANY.

25. SULPHATE OF QUININE IN FRICTION.

A memoir was lately read in the Parisian Academy of Medicine, by M. Pointe, a physician at Lyons, on the use of sulphate of quinine, employed in the way of friction on the gums and inside of the mouth, in fevers of the intermittent and remittent type. M. Pointe, being apparently a disciple of Broussais, had the fear of "gastro-enterite" in his mind, and found, or fancied he found, the stomach irritated by the internal use of the quinine. He, therefore, used it in the above manner, and the fevers were cured. A lively discussion ensued among the different partisans, and some of them stoutly denied that there was any gastritis or enteritis in these cases; but only an "etat bilieux," for the relief of which emetics ought to have been prescribed, and then the quinine would have succeeded better. The exhibition of emetics, however, was against the Broussaian doctrine, and was much condemned. But if "gastro-enterite" be the proximate cause of these intermittent and remittent fevers, we much wonder how the quinine should have cured the disease, in whatever way it was administered. We believe, with M. Miguel, the reporter on this memoir, that this same quinine does not act merely as a revulsive, the sophism of Broussais, but “by a specific, though unknown operation on the stomach."

26. BRONCHOCELE.

M. Angelot, of Grenoble, has transmitted a memoir to the Royal Academy of Medicine, of Paris, on goitre. This curious disease, endemic among the Alps, affects a great number of the soldiers sent there from other countries. They generally begin to shew symptoms of bronchocele in three or four months' sojourn among the mountains; but all these goitres are readily cured by the external use of iodine ointment. M. Leveillé observed that, in many instances, it was only necessary to remove from the goitrous country, to be cured of the disease, and cited the case of two persons affected with goitre, by some residence in Switzerland, and who got rid of their complaints by a removal to Paris. M. Desgenettes wondered that the author did not notice one of the principal causes of goitre, the snow-water used by the soldiers. He had been able to preserve whole regiments from bronchocele, by prohibiting this water, and causing the men to bring pure water from a spring for their daily use. But here we think Desgenettes has made a great mistake. That snow-water has little or nothing to do with the production of goitre is proved both in Switzerland and other countries, by attention to localities. How is it that bronchocele is so prevalent in Sussex, and so rare in Scotland? The reverse should obtain if snow-water were the cause of the disease. Again, how is it that bronchocele is scarcely seen in the valley of Chamouni, where the water is nothing else than drippings from Mont Blanc-while on the other side of the Col de Balme, in the Valley of the Rhone, we see hardly any thing else than bronchocele and cretinism? That the cause is in the water, we have no doubt; but the snow does not appear to be connected with the etiology of the disease. M. Desgenettes may have preserved his soldiers from