No, I must resist,

As if fighting with fist,

And sometimes must twist,

Or soon I shall die with the Hypo."

It is consolatory to know that this poor victim to HYPPO was greatly relieved by a seton in the back of the neck-warm-baths and other remedies, so that he returned to his family, where he will probably favour us with another ode to HYPO-we sincerely hope a FAREWELL ODE.

We now take leave of our amusing contemporary, and, although his Locus PENITENTIE is "pent up in Utica," we trust that the products of his brain will have a wide range trans and cis-Atlantic.

FURTHER OBSERVATIONS ON THE USE OF NITRIC ACID AS AN ESCHAROTIC IN VASCULAR TUMOURS OF THE RECTUM. By John Houston, M.D. Surgeon to the City of Dublin Hospital.

Since Dr. Houston's first Essay on this subject in our Dublin contemporary, he has had many additional opportunities of testing the efficacy of the application in question, and the results he considers to authorize a supplemental communication. The cases here published are selected wholly from hospital practice, as being more authentic documents than those furnished from the note-book of the private surgeon. Dr. H. reiterates his caution that the nitric acid is only applicable to the internal bleeding pile-" that soft, red, strawberry-like elevation of the mucous membrane,-for which I have used the term vascular tumour— and which the acid removes by the production of a slough of its surface.”

"The surface to be thus acted upon must be soft, and free from any coating of cuticle, such as is apt to form on it by persistent prolapse; for, if the acid be used in a case so circumstanced, nothing more than a removal of the cuticle may be expected from the application; and further, to ensure to the caustic its full effect, the part to be touched by it should, beforehand, be dried and cleared of all mucous or other adherent fluids. There is no danger, that I know of, to be apprehended from the application of the acid; I have never seen any consequence from it beyond what I have stated in my reports. But, to be successful, the remedy must, of course, be used with decision. The acid must be laid on in quantity, and rubbed in with force, enough, to be pressed into the pores of the surface. At the best, it produces only a very superficial slough; and, on this account, it will be necessary in some cases, as where the tumours are old and firm in texture, to make a second, and even a third, application. Of this, the patient should, of course, be informed beforehand, that he may not be taken by surprise, in case any such necessity should arise."

The great value of this remedy lies in its applicability to general practice, and in the readiness with which invalids can be prevailed upon to submit to it. Dr. H. has detailed six or seven cases in his present paper, of which we shall here insert one as a specimen.

"Case VI.-William Gray, æt. 32, a tall man, a tide-waiter, temperate, and much exposed to wet and cold, admitted Feb. 12, 1844. He has laboured under his present indisposition for about five years, but during the first year he did not regard it much, as his only inconveniences were those of constipation; out of this arose a habit of taking aperients, which by producing tenesmus, long sittings at stool, pruritus ani, prolapse, and hæmorrhage, only made matters worse. About six months ago, he suffered a more than usually severe attack of this kind, with considerable prolapse, pain, and loss of blood, and from this period

these symptoms did not, as formerly, go off; on the contrary, they became aggravated and accompanied in addition with muco-purulent discharges, which, in spite of his best efforts at cleanliness, kept his linen soiled. The part was touched with solutions of sulphate of copper, caustics, astringent tinctures, &c., and purgatives were administered, by different medical gentlemen, but such treatment only irritated, without diminishing the protrusion or lessening the discharges.

"State on Admission.-The muco-purulent discharges are now constant; the blood, occasional; he has almost continually pruritus; he finds difficulty in controlling his inclinations to sit long, and strain at the night-chair, after the evacuation is completed, notwithstanding his long experience of the fallacy of the sensation of there being still something to come away, and his conviction that he has the power of at once relieving it by returning the prolapsed part to its place. He has rarely a stool, unless as the result of medicine; the tongue is white, and he complains of thirst, bad appetite, and flatulence. He suffers from an uneasy sense of fullness, with a glow of heat, and pulsatory throbbing inside

the anus.

"On straining in the sitting posture, a protrusion takes place, at least an inch and a half in length, spreading broad over the sides of the anus, and exhibiting three large, blood-red tumours on its mucous surface. The whole texture of the protruded part is tumid from congestion, but the vascular tumours stand out beyond the general surface of the prolapse, although they do not, to the feel, exhibit any greater density or hardness than the other parts. Blood oozes from them if they be allowed to remain protruded for any time; the prolapse is not at present at its worst, nor is it accompanied with pain; there is little appearance of varices in the neighbourhood, either inside or outside the anus.

"On the evening of the 13th I administered a purgative draught. On the 14th, while the prolapse was at its greatest projection, I applied the nitric acid effectively to all the tumours. The application caused them to bleed freely; but this was more from the friction on their turgid surface, than from the escharotic effects of the acid; oil was then applied, and the protrusion carefully reduced. The man was placed on his back in bed, with directions not to allow the prolapse to recur; an opiate was administered. The pain of the application was not much complained of.

"15th. He says that he suffered some pain, heat, and throbbing yesterday, after the touching, but that it was of a distressing kind; he was lulled from the opium, but did not sleep; he had, unexpectedly, a free motion during the night, unattended with any unusual pain, and occurring without prolapse. There is, this morning, a projecting, pale, cedematous ridge of the mucous membrane at the margin of the anus, an evidence of inflammatory action, inside, induced by the irritation of the caustic.

"16th. Found him walking about, at the hour of visit; he feels no pain or discomfort whatsoever, except when he coughs or makes some bodily exertion, and then he is only reminded of his ailment by the part being hurt a little in the effort.

"18th. The bowels have been moved without medicine; the evacuation consisting of fæces stained with pus and sanies (the discharge from the cauterized surface), but not with unmixed blood; there was no prolapse with the movement, and the tumours did not come into sight; nothing is now to be seen wrong, and there is only a slight soreness on pressure.

"20th. He left the hospital sufficiently well to go about his ordinary busi

ness."

We need hardly say that this is one of those short, practical, and valuable papers which contain more information than some of the lean or dropsical octavos which we are too often destined to wade through.

TRANSACTIONS OF THE NEW YORK STATE MEDICAL SOCIETY. Vol. VI. Part I. Albany, 1844.

FROM a talented address to the New York State Medical Society, on the subject of insanity, we extract the following practical remarks:

"In the therapeutical treatment of insanity, every case must be considered and treated as an insulated one. Remedies must be applied to the constitution and peculiar features of each case. While the first indication is to remove or lessen, as far as possible, irritation as the immediate cause, pervading the cerebral and nervous system, and through sympathy the vascular, yet are we to bear in mind the condition of other remote organs morbidly excited, and participating in the general disturbance. For instance, the associative powers of the stomach as a central organ are immensely important, as it regards the phenomena of disease. So also, through arterial agency, defective secretion of the gastric juice, and loss of power in the secerning system, we account for local congestion, impaired appetite, and waste in fevers.

"Remedial means when rightly applied need be but few. And what is the popular aim in the cure of diseases, at the present day? but to sustain the conservative principle, the strongest in nature, by the revulsion of excitement to parts less essential to life, and equalising circulation. Hence the importance that our first move in the treatment of incipient insanity, should be based upon a correct diagnosis; critically regarding the necessary distinction ever to be maintained between phrenitis, and active mania. The one concentrated inflammation, affecting the substance and meninges of the brain, the other, irritation specifically embracing the nerves of sensation and volition, sympathetically disturbing every function and fibre of the human system. The first demanding bold depletion as the anchor of safety, the latter to be approached cautiously, by milder and more comprehensive means, as we shall proceed to enumerate. "Here then, permit me to remark that no one is competent to endure this searching ordeal who is not well versed, analytically and pathologically in every branch of medical science.

66

Copious abstractions of blood should ever be avoided in insanity as endangering dementia. Very few are the cases of insanity, even in its incipient stage, that admit of venesection. In such only as are plethoric and in the vigor of life, is it admissible at all, and then only in a cautious degree. The pulse is deceptive, for though there may be increased impetus of blood in the carotids, yet they will be found compressible, and the radial artery feeble in its action, showing an unequal distribution rather than congestion. In such cases where symptoms seem urgent, topical bloodletting by leeching, or cupping, may safely be resorted to without danger of collapse. In the treatment of six hundred cases, venesection has not been resorted to in more than one in a hundred, after they entered the institution, and then only moderate in quantity. Many, however, have been brought to the Asylum, after two or three copious bleedings, undoubtedly with the best intentions; yet the results have proved a prostration of the vital energies, more difficult to overcome than the original disease.

Puerperal insanity, which generally comes on within a week after delivery, arises from a metastasis of morbid lacteal and lochial secretions, is attended with rapid pulse and great prostration of strength. Hence bleeding is inadmissible. If prudently managed it seldom terminates in permanent insanity. The head and uterus principally suffer, tension and pain of the abdomen being less than in puerperal fever. Generally ushered in by sudden impressions of cold from a higher to lower temperature. Hence the retrocession, and the necessity of restoring the

secretions.

"Active emetics are seldom admissible as tending to a determination to the brain. Where there is great derangement of the digestive organs, ipecac and

calomel combined, in such quantities as to produce a slight emetico-cathartic effect, may prove salutary in their operation. So also the blue mass with one fourth part of ipecac, adds to its efficiency in restoring the functions of the liver.

"Drastic purges are seldom advisable. Laxatives to keep up a steady action of the intestinal tube are far preferable, and may be aided by injections, due exercise, and a well regulated diet. No particular formula can here be laid down. The judgment of the physician must decide on the quantity and appropriateness of the article, according to the constitution and peculiarities of the patient.

"Narcotics and sedatives are next in order. Opium, camphor, morphia, stramonium, conium, belladonna, and aconite are most to be relied upon, but require great prudence as to the time and manner of their administration. These are often improved by combination with other remedies. For instance, opium, ipecac, and soap, equal parts, forms a pill much easier given than Dover Powders. Camphor mixture, with half a grain of tart. antimony, and five drops of laudanum to the ounce, given in half-ounce doses, is a powerful sedative and adjuvant in allaying nervous excitement. Morphia with colchicum when there is a gouty or rheumatic diathesis, endangering metastasis, is a valuable auxiliary in treatment. Stramonium acts specifically on the sensorium, stimulating the absorbents. A saturated tincture of the seeds in camphor mixture, is the best mode of administering it. Conium is best combined with the different preparations of iron. Belladonna and aconite are often improved by combination. Extracts of these vegetables can only be relied upon when evaporated by solar heat. "Counter-irritants, revulsive in their effects are valuable auxiliaries, more especially in metastasis and suppressed erruptions; and are more cheerfully submitted to when allayed with some of the vegetable narcotics endermically applied.

Bathing. One of the most powerful remedial agents in equalizing circulation, is the warm bath. The patient should be immersed from twenty to thirty minutes, the heat at 96° Fahrenheit, refrigerating the head while in the bath, when the heat of the part should indicate its necessity. Warm bathing will be found particularly beneficial and appropriate in melancholia and delirium tremens. Fixed alkaline salts added to the water, are useful in removing the sebaceous oil from the surface of the body. The nitro-muriatic bath is a valuable and effective agent in a congestive state of the liver, and should be repeated in connection with the usual remedies, until we have evidence of a healthy secretion of bile. The value of the shower bath is known to all, yet it is too indiscriminately used. Great prudence and watchfulness is necessary in its application. Should atony prevent a suitable re-action and warmth over the surface, it may do serious and lasting injury, A pitcher of cold water poured over the back part of the head is often grateful as well as useful to the patient.

"In the second stage of insanity, a more tonic treatment becomes necessary, and it is to be regulated according to the age, constitution, and temperament of the patient. The various preparations of iron, mineral acids and quinine, nitrate of silver, followed with a solution of iodine to prevent a discolouration of the skin, conjoined with suitable moral treatment, will often decide the future prospects and destiny of the patient.

"

In moral treatment, no more restraint should be used than is absolutely necessary for their own and others' safety. Chains are never necessary in an institution. You cannot chain the human mind, nor cure a patient in chains. I have never used one. Pinel is entitled to an enduring monument of fame, for having been the first who dared to break off the chains of the maniac, throw open his prison door, bring him forth to the light of heaven, and to the enjoyment of the essential elements in their purity."

THE AURISCOPE.

Dr. Warden, the inventor of this ingenious and useful instrument, has related the following cases in the September Number of Dr. Cormack's Journal.

"Case 1.-A. H., a maidservant, aged 20. My attendance was required in consequence of acute abscess of the right labium obstructing the evacuation of urine, and attended with symptoms of general fever. This condition was speedily relieved by the ordinary means. It afterwards appeared that leucorrhoeal discharge had existed for an uncertain time, and in consequence of the renewal of the abscess and suffering, a more particular examination was instituted, the result of which was the detection of pathological conditions not ordinarily recognised as marking such an affection, and the knowledge of which has not entered into the indications of treatment in such cases. In explanation it is to be observed, that by the employment of the speculum above described, not only do we throw every requisite supply of light upon the parts at the extremity of the tube, but every point of the entire walls of the cavity is made to display its picture upon the interior prism in all its reality of visible aspect, just in the same manner, and with the same truthfulness, as the pictures of the landscape in the camera lucida. By the use of this instrument in the case under notice, the os uteri was found turgid, rubescent, and giving issue to a profuse purulent discharge; and the examination of the walls of the vagina obtained through the medium of the second prism presented different diseased states, exemplifying a diversity of pathological conditions to which the mucous membrane is liable. In the neighbourhood of the os uteri, the inflammation was vesicular; in different portions of the parietes of the vagina there were patches of ulceration, of more and less vivid inflammation, and of warty vegetations, giving distinct indications for corresponding differences of topical treatment, and for which the speculum employed by me afforded all necessary facility upon the removal of the intervening glass tube. Within a fortnight these varied morbid conditions of the mucous surface have been treated with appropriate dressings, and a case which otherwise must have undergone an uncertain management and duration, will immediately admit of complete cure.

"Case 2.-Mr. G. S., aged 43, of bilious and leucophlegmatic habit, has suffered from impaired hearing, and disease in both ears, since his boyhood. The symptoms at the commencement are not distinctly remembered, but as deafness has been prevalent in his family, it is probable there was a morbid delicacy and predisposition affecting the organs in question. A marked and permanent aggravation of the dulness of hearing took place about 20 years ago, in the course of typhus fever. Constitutional and local treatment have been employed on various occasions, attended with slight and temporary improvement, but without preventing the progress of increasing loss of hearing. All remedies had been discontinued, as hopeless, for nearly two years, and hearing is produced only by bawling as to one on the house-top, the patient erecting the auricle with his hand to catch every vibration of sound. Upon examination with the auriscope the diseased condition of the affected organs gave little or no room to expect benefit from local or other treatment. The auditory passages were cleansed by washing with the hair pencil, when the cuticular lining was found blanched and thickened, as by maceration, and flocculent portions were readily separated from the surface, which was without the natural conditions of sensibility and ceruminous secretion. Upon carrying inspection to the situation of the membrana tympani, which is effected with facility by means of the prismatic auriscope, I found, in the right ear, that the bottom of the passage was occupied by a spongy organized mass protruding from the chamber of the tympanum, while, on the left side, a crescent-formed fragment of the drum only remained, and that having a lardaceous appearance, as if quite disorganized, and in progress of decay. In