with a large swelling on the left labium. One evening, immediately after going to bed, she was suddenly seized with a profuse hæmorrhage from the vulva. The midwife was accordingly summoned to her assistance; but she, finding the alarming state of the woman, sent off at once for Dr. Hesse. On his arrival, the patient was already in the agonies of death: the bed and floor were covered with dark coagulated blood. On examination, the orifice of the vagina was found closed, and its canal quite dry. The Cæsarian operation was immediately peformed; but the child was dead. The uterus was quite empty of blood; and the placenta adhered over its entire extent. No distinct tumor was now visible on the vulva, although the labium was still flabby and voluminous. When it was pressed, a jet of dark blood flowed out from a wound that was not more than half an inch in extent. This wound led backwards, in the direction of the perineum, to a cluster of varicose veins, one of which had burst.

TREATMENT OF CHRONIC CATARRHAL OPHTHALMIA.

M. Reveillé-Parise strongly recommends the decoction, or a strong infusion, of Rhatany root, as a lotion with which the affected eyes are to be bathed. Besides acting as an astringent, this remedy seems to have some other mode of operation; for we do not find that similar preparations of oak-bark or of gall-nuts— although both of these contain a large proportion of tannin-are equally efficacious, as Collyria in the Ophthalmia alluded to. The application should be used lukewarm, and a few drops of Goulard's Extract may be added to it, if deemed proper.

LARGE DOSES OF NITRE IN INFLAMMATORY DISEASE.

M. Desportes (Bull. de Therapeutique) has written a long paper with the view of pointing out the powerful antiphlogistic or contra-stimulant properties of Nitre, when administered in full and frequent doses, in a variety of the Phlegmasiæ. In Bronchitis and other thoracic diseases, although often inducing nausea and consequently a depression of the circulation, it is not so decidedly useful as in Acute Rheumatism and Gout: in many cases, however, of Hæmoptysis it is a truly admirable remedy.

(There is nothing new in the free exhibition of nitre or salt-petre as a remedy in the treatment of the phlegmasiæ; although some of the French writers, in the present day, seem to suppose that they are the discoverers of its virtues. The readers of Sydenham, and other writers of his age, know well how largely it was used by them. Like every other good remedy, it is liable to be abused; and certainly M. Desportes and M. Martin Solon are guilty of egregious blundering, when they fancy that Rheumatism, for example, may be most quickly and effectually cured by monstre doses of nitre. This is one of the many, not only silly but hurtful, results of the ignorant experimenting spirit of Modern Medicine.)

Clinical Review.

REPORT OF CASES ILLUSTRATING DISEASES OF THE BRAIN AND NERVOUS SYSTEM. [Guy's Hospital Reports, April 1844.]

BAGLIVI seemed to think that diseases of the lungs offered the greatest difficulties in the way of diagnosis. Thanks to auscultation and percussion, affections of the respiratory apparatus are now more easily distinguished than those of any other internal organ-excepting, perhaps, the heart. Undoubtedly the maladies, functional as well as organic, of the encephalon, are the most puzzling of the complaints which present themselves to the medical practitioner.

The paper on Cerebral Affections, in Guy's Hospital Reports, is without the name of any author or reporter. But it is one of some importance, and demands notice in a practical journal.

Case 1. Arachnitis.-A female aged 19, a servant, was admitted, after an illness of a fortnight, labouring under pain in the head and loins, fever, and occasional delirium. The usual remedies had been used. There was strabismusinjected tongue, coated yellow-dry skin-pupils rather contracted, and unaffected by light, pulse small and frequent-abdomen rather tender on pressure -answered questions somewhat incoherently.

"She was ordered to have beef-tea and arrow-root; and after taking three grains of calomel, followed by half an ounce of castor-oil, the following treatment was prescribed:

Hyd. Cretâ gr. iij. ter die sumend.

Ung. Hydrarg. i. singulis axillis bis die infricand.
Empl. Cantharidis pone singulas aures applic.

Sinapismata singulis pedibus.

The bowels were twice acted on. She passed a very restless night, with much incoherence'; the gums were tender on the day following; the pulse 112, very small and weak; the subsultus tendinum and delirium continued; and a collection of puriform mucus in the trachea and bronchi interrupted respiration, and was with difficulty expectorated, and that without cough. The mercurials were omitted; and she was ordered,

Ammon. Sesquicarb. gr. iv. ex Infusi Serpentaria ži. 4tis horis sumend. "March 25.-She had passed an equally restless night, with grinding of the teeth, catching at imaginary objects, subsultus, and muttering delirium: the urine was passed involuntarily. Respiration was less obstructed; but she appeared to refer to the larynx as the seat of pain: the pulse were exceedingly feeble and rapid, and the gums were decidedly under mercurial action.

"Brandy, beef-tea, &c. were administered without rallying her; and she died in the evening, but without having had any convulsions.

"Sectio Cadaveris, fifty-four and a half hours after death. Head.-The vessels of the pia-mater were much congested; numerous glandulæ Pacchioni were seen on each side of the longitudinal fissure. Beneath the arachnoid on the convexity of the hemispheres, there was some opaque albuminous effusion, with thickening of the membranes. At the base of the brain there was considerable serous effusion, as far backwards as the pons Variolii; and about the optic commissures there was much opaque albuminous deposit. The convolutions were flattened, and closely packed: the puncta vasculosa were numerous and large: the lateral ventricles contained more fluid than is usually found. Q

LXXXI.

"Thorax.-There was congestion of both lungs posteriorly, with a circumscribed spot or two of hepatization of the size of a shilling in the right lung. There was vascular turgescence of the bronchial membrane, and a frothy mucus in the tubes.

"Abdomen.—The aggregate and solitary glands were prominent and vascular, but no ulceration was observed. There was considerable hepatic venous congestion.

"The remaining organs were found healthy in appearance."

Another case of arachnitis follows; but not presenting any material difference, either in symptoms or post-mortem appearances.

CASE 2. Hydrocephalus.-This was a delicate child, four years of age, with expanded head, and former good health and quick intellect. During the last two months complained of drowsiness-strabismus of right eye-pain in the abdomen, followed by febrile symptoms of the infantile remittent character.

"On admission, his aspect was pallid and subdued; the face looked puffy; the pupils were dilated and sluggish; he lay in a kind of quiet stupor; and complained, when asked, of pain in the forehead and occiput. The sutures were closed and ossified: the surface of the head was hot, and that of the body harsh and dry respirations were 30 in the minute; the pulse 132, small and regular; the abdomen flat, and painful on pressure in the epigastric region; the tongue pale and white, with prominent papillæ: he had anorexia and slight thirst. The alvine evacuations were dark, scybalous, and offensive. The urine was loaded with lithates, and was slightly albuminous as tested by exposure to heat."

Head shaved-leeches to temples-calomel and castor oil, &c. He continued much the same for five days, when he became worse in all respects. Blistersmercurial frictions. After some variations, he sunk on the eleventh day after reception in hospital.

Dissection." The convolutions of the brain were flattened and pale: the arachnoid dry; the lateral ventricles distended with serum; the foramen of Monro was enlarged and irregular; the posterior portion of the fornix softened. The cerebral substance in the other parts appeared healthy: the sub-arachnoid tissue at the base of the brain was much infiltrated, pale, and opaque.

"Tubercles were distributed through both lungs, and their edges were emphysematous.

"The right side of the heart was turgid: the mesenteric glands were hypertrophied and indurated: the other viscera were healthy."

CASE 3. Local Paralysis—Neuralgia.-This case was more fortunate than the preceding ones. Anne Tilson, aged 47, admitted August 7, 1843. Two days previously was attacked suddenly with pain behind the right ear, and tumefaction of the part, and numbness of the whole side of the face. The mouth was drawn to one side, and she was unable to shut the right eye. The right half of the tongue was insensible-articulation confused. Thus it appeared that the three divisions of the fifth, and the portio dura, were paralysed. Low diet-cupping on the nucha-five grains of pil. hydrarg. with fifteen grains of soda thrice a day. In two days the gums were tender. After this she improved, but, on leaving the hospital, the features were still distorted.

These affections of the facial nerves, both neuralgic and paralytic, are daily becoming more numerous.

CASE 4.-A young man had been a victim to hemicrania, after long exposure to miasmata. Every remedy was tried, including mercury, colchicum, quinine, arsenic, iodide of potassium, and large doses of stramonium, without the slightest benefit. At length, a discharge of blood and matter took place from the right

ear, when the hemicrania disappeared. We observe that stramonium and arsenic were continued for some time after the abscess broke; but we confess that it appeared a useless precaution; for it was nature, and nature only, that cured the complaint.

We pass over two cases-one of scrofulous tumor in the brain, with softening, convulsions, and paralysis :-the other, a case of tubercles in the brain, as offering nothing new or interesting.

Several cases of chorea follow, but do not demand much notice in this place. Purgatives, arsenic, and sulphate of zinc appear to be the chief remedies employed at Guy's Hospital, for this troublesome complaint.

CASE 5. Hemiplegia.—A man, aged 72, strong-built, and of florid complexion, was admitted March 20, 1843. Five years previous to admission had had scarlatina, without dropsical effusions. Two months after this, was suddenly seized with hemiplegia of the left side, not affecting the intellect, and passing off in a few days. Two days before admission, had vertigo, dimness of vision, tinnitus aurium, head-ache, &c. On the morning of admission, was seized with paralysis of left arm and leg. The mouth was drawn to the left side. The urine was coagulable, specific gravity 1008. The abstraction of a few ounces of blood caused tremor and sinking of the pulse, which rose again to 80. The motions were passed in bed. On the third day, gout appeared in the left hand. After this he gradually got lower and lower, and sloughing took place on the nates, which terminated his existence, the urine being albuminous till the last. There was no examination post mortem.

CASE 6. Cerebral Disease with Amaurosis.-W. C. aged 27, married and temperate, had been subject to failure of sight at particular hours of the day, together with giddiness and head-ache. On admission the countenance had a somewhat idiotic appearance-the cardiac sounds over an increased space-pulse 72-trembling of the limbs, and sense of numbness in left arm-daily recurrence of amaurosis. This was 17th Nov. 1841. Ordered low diet and purgatives, with a seton. On the 21st there was considerable febrile re-action, requiring depletion. After this, mercury and iodide of potassium were given, and the mouth made sore. The attacks of amaurosis became less frequent, and at length disappeared. He left the hospital much improved in general health.

CASE 7. Hysterical Epilepsy.—A girl, aged 16 years, had menstruated during the last year, once a fortnight, with leucorrhoea intervening. Three weeks before admission had a fit, apparently epileptic, preceded by sickness after eating. The fit was sudden, and she remained unconscious for more than an hour, in an outhouse, and unseen, this was followed by headache and pains in her limbs. She had a second attack, both at the approach of the catamenia. On admission, the heart's action was very irritable, pulse 100. Thoracic and abdominal viscera sound. Sulphate of zinc was administered, at first in doses of two grains thrice a day, increased to eight grains ter die, without sickness or other inconvenience. She was soon discharged cured.

CASE 8. Spinal Meningitis.—A young man, aged 19 years, temperate in his habits, and healthy till within 18 months ago, when he had been in the hospital for pleurisy. After discharge he became affected with scarlatina, followed by wandering pains in his neck and loins, with general malaise. He had been an out-patient for the supposed rheumatic pains; but was admitted, May 7th, with symptoms of fever-pains in the neck and loins-disinclination to turn in bedtetanic rigidity of the muscles of the back, &c. Three days afterwards he lost the use of his arms for a time, with temporary cessation of pain, but returned with motion. Next day convulsions came on, with foaming at the mouth, dis

torted features, clenched hands, insensibility-tonic rigidity of neck-trismusdeath.

Post-mortem.-Skin slightly jaundiced-veins and sinuses of head large and congested-puriform fluid exuding, apparently from the centre of the spinal cord, just below the medulla oblongata-effusion of lymph and puriform albuminous matter between the arachnoid surfaces, and beneath the arachnoid itself, rendering these membranes slightly adherent and opaque. The lungs were adherent posteriorly, and congested. Liver granular and easily lacerable spleen the same-kidneys coarse-other appearances not very particular.

CASE 9. Tetanus. A young man, aged 27, a tee-totaller, had, while sifting cinders and exposed to cold, abraded the skin of two fingers. A few days afterwards symptoms of trismus, and then tetanus set in, and lasted till death, in despite of every remedy, including the Cannabis Indica. The appearances on dissection, were chiefly traces of inflammation and congestion about the brain and spinal-marrow.

We must take leave of this paper, having noticed nine cases out of 39 recorded. Many of the cases might have been left out, as not sufficiently interesting, and all of them are detailed with much more minuteness than was necessary. We have greatly abridged the more important of them for the benefit of our readers.

CASES OF PELVIC INFLAMMATION, WITH ABSCESS, OCCURRING AFTER DELIVERY; WITH REMARKS. By JOHN C. W. LEVER, M.D. [Guy's Hospital Reports, April 1844.]

This disease is, by no means, of infrequent occurrence, though not often treated of by systematic writers on obstetricy. Dr. Lever's paper, in a late number of the Guy's Hospital Reports, is therefore deserving of full notice. The complaint has been alluded to by HUNTER, under the name of "iliac abscess," not dependent on a determination of milk to the part-by Levret, as a "depôt laiteaux” by Deleurye as the same-and by Kennedy as secondary inflammation." Dr. Doherty, Dr. Churchill, and others, have also noticed the complaint in modern times.

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Abroad, Dr. Martin, of Montpellier, has published an excellent monograph on the subject, and Dr. Lever has read a considerable number of the following cases before the Physical Society of Guy's, in the course of the last Winter. We shall give a condensed view of the principal of these.

Case 1.-Ann D, mother of six children, was attacked with puerperal fever on third day after confinement, and treated by local depletion, aperients, &c.; but chronic inflammation remained among the pelvic viscera, for several weeks, when she came under the observation of Dr. Lever, at the hospital. She had now, bearing-down pains-weight in the pelvis-quick feeble pulse-furred tongue-restless nights-regular bowels. A distinct fulness was perceptible in the uterine region. Vaginal examination shewed heat, and induration in the left side of the vagina. A mixture of salts, senna, and hyoscyamus, with Dover's powder at night. Little alteration occurred during a week, when the abdominal swelling increased, with frequent micturition, irritable bowels, nocturnal perspirations, rigors, quick small pulse, furred tongue, depression of spirits, &c. In about a fortnight, she discharged half a pint of pus into the vagina, streaked with blood, and followed by mitigation of symptoms. The discharge continued for several days. Vagina frequently syringed with warm decoct. pap.-generous diet-pint of porter-quinine. In three weeks she was well.