always tense, whenever the hand was placed on the belly. He had passed in the preceding 24 hours about two pints of blood, without any coagula, mixed with watery fluids, but without any fæcal matters or smell. No real fæculence was seen by Mr. Bampfield in the stools for the preceding week; and the patient lost at least 20 or 24 ounces of blood daily during that period. Superacetate of lead and opium were given for three or four times, and then a gentle aperient. This made little alteration in the discharge. Two half-drachm doses of oil of turpentine were then given. The first dose came up, the second was retained. For two days, the blood disappeared from the stools, and some traces of fæculence were observed in the liquid motions. The hæmorrhage then returned. After exhibiting various remedies, the hæmorrhage again stopped, or nearly so, for three days, and decided proofs of fæculence were in the motions. It was now fondly hoped that the danger was over; but in the midst of these promising appearances, the patient was suddenly seized with a great prostration of strength, and died in the course of a few hours-about 16 days from the commencement of the intestinal hemorrhage.

The suddenness of the death induced the writer to suppose that ulceration had existed in some part of the intestinal canal, and that perforation of the bowel had taken place, with extravasation of fæcal matters into the general cavity. Part of this prognostication was true, and part was false. On examination, in presence of Mr. Brookes, surgeon, and Mr. Owen, his assistant, a series of ulcerations were found in the ileum, varying in extent from the size of a split pea to that of a half-crown piece, and from a slight abrasion of the mucous membrane, to complete destruction of all the coats, except merely a pellicle of peritoneum, through which boundary the ulceration had not passed. The ulcers gradually increased in size and depth as the ileo-cæcal valve was approached, where they occupied nearly the whole circle of gut. There was no ulceration above or below the intestinum ileum.

Now we need hardly say that these ulcerations were formed during the fever, and that from these the hæmorrhage proceeded, when the fever was, in fact, over, and convalescence was apparently commencing. Yet here had been no diarrhoea-no pain complained of in the abdomen, and scarcely any tenderness on pressure, up to the very day of this patient's death. Had the hæmorrhage not taken place, and the patient died, who would have suspected intestinal ulceration?-very few we believe. The case offers an instructive lesson-namely, that gastro-enteritic inflammation, and even ulceration, may be going on in fever, without any obvious or well-marked symptom to indicate its existence. A superficial examination of the abdomen, after death, without opening the intestinal canal itself, would not have revealed the true state of things-for in many places where there was serous ulceration of the mucous membrane, there was little alteration in the appearance of the external surface. We hope this example will induce practitioners to suspect the existence of gastro-enteritis in fevers, where the symptoms are equivocal-and to carefully examine the internal

surface of the alimentary canal where an opportunity of dissection is given.+

The case was attended, during the latter days of the patient's life, by Mr. Brookes (Mr. Bampfield's successor) in company with the

reporter.

17. EXTRACT OF BALS. COPAIBÆ IN GONORRHŒA.

Surgeons are well aware that the balsam of copaiba would be often successful in gonorrhoea, if they could prevail on their patients to continue its use for a certain time. But this they rarely can do, from the nauseous taste of the medicine, and its effects on the stomach and bowels. It would be extremely desirable that the article could be deprived of its disagreeable qualities, without injury to its medicinal; and this Mr. Thorn thinks he has done by the preparation of a resinous extract, from which the essential oil, possessing the obnoxious part of the balsam, is separated. The remaining extract is supposed to contain all the virtues of the copaiba."

Mr. Thorn divides gonorrhoea into three stages-1st. that which occurs within twenty-four hours of the first appearance of the symptoms-the 2d, is when the inflammatory symptoms are fully established-and the 3d is, when the inflammation has ceased, the membrane of the urethra being in a state of atony, and the only symptom being a thin mucous discharge.

Medical men have generally been afraid to exhibit the bals. copaib. in the second, or inflammatory stage, and the first stage has often elapsed before they are consulted. It is in the first two stages, that the extract of copaiba has been found most advantageous. Mr. Thorn has related one case where the disease was cured in a couple of days, when the medicine was given in doses of fifteen grains to a scruple thrice daily. In the inflammatory stage, unless there were symptoms indicative of approaching swelled testicle, he has not hesitated to give the extract in doses of ten or fifteen grains thrice a day. In no case has he found it produce any other effect than that of relieving the scalding, and frequently doing away with this symptom, in a short time. The medicine should, of course, be continued for a few days after all the symptoms are gone. Mr. Thorn very properly combines the dapletory treatment and cooling regimen with the exhibition of the medicine.

In the third stage, that of gleet, too often dependent on some alteration of structure in the mucous membrane of the urethra, the extract of copaiba has not proved so useful. Our author speaks favourably of an injection composed of one drachm of extractum tormentillæ to six ounces of water. It has been used with advantage by Mr. Tyrrell, of

+ We beg the reader to refer to the first article in this Number, page 327, proposition 136, for an explanation of some remarkable phenomena in the above case, especially the want of pain on pressure of the abdomen.-Ed. * Mr. Thorn's Observations on the Treatment of Gonorrhea, 8vo. pp. 57,

St. Thomas's Hospital, and also by Mr. Alcock. Several cases have been communicated to our author, and are here published, from Mr. Tyrrel, corroborating the efficacy of the extract of copaiba in gonorrhoea. The medicine is prepared by Philp and Co. 62. Quadrant, Regent-street. We think the surgical profession are indebted to Mr. Thorn for thus early and candidly communicating the results of his experience with the extract of copaiba.

18. CARBONATE OF IRON IN NEURALGIC AFFECTIONS.

This preparation is daily increasing in fame, and we are convinced that it will prove one of the most valuable medicines in the pharmacopoeia, for very many of those anomalous and painful affections of nerves, where no vascular excitement obtains. Two cases are reported in No. 174 of the LANCET, from the hospital practice of Dr. Elliotson, of which we shall take a very concise notice.

1. The first was that of a female, 33 years of age, who had suffered for three months, with a violent pain in one of her legs, commencing in the great toe, running along the inside of the tibia to the ham, the groin, and across the lower part of the abdomen round to the loins. It came on rapidly, especially by pressure or friction, and was of a shooting or stabbing kind. She was ordered the carbonate of iron, two drachms every six hours. In five days the pain was relieved, and the medicine was continued for a fortnight longer, when the improvement not being progressive, she was ordered half an ounce thrice a day. In three weeks more she was reported, "quite well."

2. The second case was rather more puzzling, and presented some of the phenomena of angina pectoris. The patient was also a female, 36 years of age, who had suffered for seven months with violent pain in the left side of the chest, occurring at intervals, and shooting from the region of the heart over the left breast, and sometimes down the arm, and backwards towards the spine, During the paroxysm she experienced dyspnoea, amounting to a sense of suffocation. Pressure or friction brought on the attacks, or even a deep inspiration; but the pain was never brought on by quick walking. The pulse was regular, and the stethoscope detected no organic disease of the heart. For two months she was bled, blistered, cupped, and took digitalis, colchicum, and prussic acid, without benefit. She was then ordered to take half an ounce of the carbonate of iron thrice a day, and in little more than a fortnight she was cured.

The symptoms of real angina pectoris generally depend either on ossification of the coronary arteries, imperfection of the valves of the heart, or on a peculiar softening of the muscular structure of the organ. In none of these cases have we ever seen much good, but frequently mischief, result from depletion or the use of sedative medicines, as digitalis, colchicum, &c. with the exception of opium. In the pseudoangina pectoris, like the instance above detailed, we cannot expect benefit from depletion; and we much wonder that so talented a phy

sician as Dr. Elliotson should have persevered two months in such unfeasible measures, especially when he ascertained by the stethoscope that there was no organic disease of the heart. In these imitative cases, there is usually some nervous irritation, and a morbid susceptibility in some portion of the alimentary canal, and we conceive that the carbonate of iron removes this susceptibility by its tonic effects on the sentient extremities of the gastro-intestinal nerves. This susceptibility often returns, if the digestive function is not regulated, and the secretions kept in a good state.

19. GENERAL VASCULAR INFLAMMATION,

Considerable doubts have been lately thrown on the nature of those appearances in certain structures of the body (especially the internal surfaces of vessels and hollow viscera) which have currently passed as proofs of inflammation having existed during life. These doubts may be carried too far, and it is necessary for us to be on our guard against errors on either side of the question. The following cases communicated by Dr. Dommanget to the Societé de Medecine, are not without considerable interest.

Case 1. Francis Blanc, aged 25 years, a French soldier in the Madrid Garrison, was brought into the Military Hospital on the 20th September, 1823, having been ill for a fortnight in the neighbourhood of the Spanish capital. The pulse was strong and frequent-tongue red -great thirst-face suffused-conjunctive injected-breathing precipitous and impeded-dry cough. On percussion, the chest sounded very dull-there was a burning heat at the epigastrium, and indeed over most parts of the body. Venesection to eight ounces-emulsionscold applications to the abdomen, and warm fomentations to the chest. 21st. The thoracic symptoms were diminished-those of the abdomen continued. Thirty-six leeches to the epigastrium. In the evening something better-tongue less red-frequency of pulse abated. 22d. The patient was better; but during some devotional exertions, he became suddenly worse. The gastro-intestinal phlegmasia increased rapidly, accompanied by sympathetic affection of the head, rising to delirium, requiring some men to confine the patient in bed. The tongue got dry -the thirst inextinguishable-the eyes sparkling-delirium loquax. 23d. Same condition, Thirty leeches to the epigastrium and tract of the jugulars. Ice to the head-warm fomentations to the abdomen. 24th. No alterations in the state of the pulse. In the evening the patient got some wine clandestinely, immediately after which the delirium was greatly exasperated, and a strait-waistcoat was applied. 25th. No material change. Forty leeches were applied to the epigastrium and neck-cold to the head continued. 26th. The patient is more calm; but the force of the pulse is nowise abated. He passed black blood by stool, in some quantity. 27th and 28th. Same state continued. 29th. The delirium is now changed to coma, with a kind of periodical trismus. The pulse is still unabated. Colliquative diar

rhoea added to the other symptoms. In this deplorable condition the unfortunate patient continued two days, and then expired.

Dissection. There was some effusion between the membranesopacity and thickening of the arachnoid-softening of the cortical substance of the brain-water in the ventricles. The same conditions were observable in the spinal canal, which was entirely opened. The Jungs appeared sound exteriorly, but the parenchymatous structure shewed many points of chronic inflammation, and some crude tubercles. The mucous membrane of the lungs was extensively inflamed, and the bronchia filled with viscid mucus. The pericardium adhered in some places to the pleura of the lungs. The heart was pale, and its structure flaccid. "The ventricles and auricles were evidently inflamed, as were the mitral and tricuspid valves." The arteries, at their origin from the heart, were of a cherry-red colour, which extended, in the pulmonary artery, to its divisions and subdivisions-in the aorta, to its iliac bifurcation. The carotids, jugulars, and subclavian vessels were all inflamed—and the appearances of inflammation could not be washed off by repeated lavations. There were several marks of phlogosis in the mucous membrane of the stomach and bowels. Near the cæcum there were ulcerations to a great extent, with tumefaction of the mesenteric glands. Some of these were as large as pigeon's eggs, and degenerated into a melanose structure. In the colon were numerous marks of inflammation-several vestiges of cicatrised ulcers-and many ulcerations still open. There were several other morbid appearances in the body, but none of them apparently connected with the immediate death of the patient. There were, however, marks of inflammatory action in almost every part of the body—even in the joints, absorbent glands, &c.

Remarks. Our author has never seen or read of an instance presenting proofs of such universal inflammation, as this case afforded. Perhaps indeed, if examinations were made more minutely, there would be found more general tokens of a phlogosed state in those who die of diseases with great excitement. The interior surfaces of the vesselsthe spinal marrow-the ganglia-the glandular system, are but rarely examined, on account of the time necessary for such investigations. In the present case, our author thinks he might be justified in concluding that there was a general phlogistic diathesis; but he considers it more correct to conclude that the inflammation began in one organ or class of parts, and involved others in succession. "It appears to me that the inflammatory process commenced in the mucous membrane of the digestive tube and respiratory apparatus, and was thence propagated by sympathetic association, to the heart and the brain-and finally that, from these last centres of vitality, the phlogosis was extended to the various structures dependent on them, or connected with them."

Case 2. A fusileer in the eighth regiment of Swiss Guards, aged 23 years, entered the Military Hospital of Madrid on the 31st of January, and died on the 8th of March. The following were the principal