Cheraw he felt full confidence of a speedy recovery. He was advised to continue the same course of treatment until his health should be restored."

The month of August was spent at a mineral spring in South Carolina, with considerable benefit to the patient's health.

On the 7th March, 1837, he reported that his health was progressively improving that he had no cough, no pain, and was able to ride on horseback without fatigue more than 20 miles in a day. The quantity discharged now was about a gill in the 24 hours, being thin and inodorous. The left side of the chest had fallen in considerably. He had, for some time, left off the injection, and, indeed, all medicine. In March, 1844, Dr. Queen, his medical attendant, wrote to Dr. Wells to say that the fistulous opening still continued, and the discharge was nearly the same as in May 1837. The left side of the chest was very much contracted, and the right side bulged out. The heart, however, had nearly regained its natural position; but there is no respiratory murmur in the left side of the thorax. His general health was very good, and he was able to take considerable exercise without much fatigue. Dr. Wells has added to this case several judicious reflections on Paracentesis Thoracis and Empyema.-American Journal of the Medical Sciences.

PHLEGMASIA DOLENS IN MALES.

Mr. Greenhow relates (in the Prov. Journal) the case of a young man in the Infirmary of Newcastle-on-Tyne, who was operated on for a mulberry calculus, and went on tolerably well till the eleventh day, when he complained of pain in the left iliac region, greatly increased by pressure. In a day or two it extended to the groin-then the thigh-and ultimately the leg; bearing an exact resemblance to phlegmasia dolens of women. The swelling, pain, and stiffness continued for several weeks. The usual means were employed, viz. leeches, fomentations, liniments, &c.

A case of this kind has lately fallen under our notice, and was seen by Sir B. Brodie, Dr. Chambers, Dr. Johnson, and others. The patient was a medical gentleman, who fell into a bilious and ultimately a typhoid fever, which lasted a month, when an extensive slough formed on the sacrum, nearly laying that bone bare. When the slough had entirely separated, and when the extensive wound was filling up with healthy granulations, pain occurred in the left groin, and inflammation spread down the thigh, in the course of the great vessels, with as great tumefaction as ever occurs in puerperal phlegmasia. The swelling was pale-partly elastic-partly edematous, and the pain very distressing. Leeches, fomentations, mercury, liniments, and all the usual means were employed; but the disease ran a long course, and its sequelae have not yet disappeared. This poor gentleman had three narrow escapes from death:-first, the fever-secondly, the slough-and lastly, the phlegmasia dolens.

MR. R. PHILLIPS, JUN. ON A NEW METHOD OF FORMING IODIDE OF POTASSIUM.

Mr. Phillips having occasion to employ the Iodide of Potassium, procured six samples of it from different chemists, and found such impurities as evince the necessity for a good method of forming it. After pointing out the objections to the processes usually resorted to, Mr. Phillips goes on to say:

"Another method is by boiling lime with iodine, thus forming an iodate of lime and an iodide of calcium, fusing the mixture to decompose the iodate, and

then precipitating the lime by means of carbonate of potash, a carbonate of lime and an iodide of potassium being formed. In trying this process, it occurred to me that if I could add a body which would decompose the iodate of lime, the trouble and loss of fusion would be avoided, and this body I found in the protoxide of iron. It is easily prepared by precipitation with the alkalies from the protosulphate of iron. The precipitate must be washed by decantation, on account of its being rapidly converted into the peroxide, if exposed to the air until the solution gives no precipitate with chloride of barium. By this process the iodate was decomposed, its oxygen uniting with the protoxide of iron to form peroxide; it was, however, so mixed with carbonate of lime, as to be valueless. I found that on mixing the iodine directly with the carbonate of potash, the latter was converted into iodide of potassium and iodate of potash. The following is a diagram of the decomposition that ensues, except that potash is substituted for carbonate of potash, as the carbonic acid is expelled.

"The protoxide of iron was then added, when the iodate of potash, in the same manner as the iodate of lime, was decomposed, with the following changes:

"Peroxide of iron being a sesquioxide, that is to say, containing one atom and a half of oxygen combined with one of the metal, it is necessary, in order that the whole of the iodate be decomposed, that for every atom of carbonate of potash used, there should be two present of protoxide of iron. The quantities, therefore, to be taken, are two atoms or 280 parts of protosulphate of iron, which are to be decomposed into two atoms of protoxide, one atom or 125 parts of iodine, and one atom or 83.5 parts of carbonate of potash, P. L. On account, however, of the liability of the protoxide of iron to become peroxide, it is better to take rather more of the protosulphate.

"The protoxide, when washed, is to be mixed with the iodine and carbonate of potash, the proportion of water employed being half a pint to one ounce of iodine. The mixture is at first to be gradually heated, and then boiled for half an hour. The solution afterwards ought to be exactly neutral to slightly reddened litmus paper; if iodine be found in excess, which may be proved by the addition of a solution of starch to a little of it, more of the carbonate of potash must be added; if, on the contrary, it be alkaline, more of protoxide of iron and iodine.

"The sesquioxide of iron remaining after being washed until the liquor gives, when acidulated with nitric acid, no blue colour if solution of starch be added, may be heated red hot for a few minutes, a beautifully pure preparation remains, which, on account of its easy solubility in hydrochloric acid, might be used with much advantage in the preparation of the tincture of the sesqui-chloride of iron. I have several times mentioned a solution of starch: it may be as well to observe, that it requires a temperature of about 170° to dissolve this substance."-Phar maceutical Journal, August 1844.

GONORRHEAL ORCHITIS AND ITS TREATMENT BY NARCOTICS. By J. GAY, Esq. F.R.C.S.E. Surgeon to the Royal Free Hospital, &c.

Cases are recorded in some of the recent numbers of the Lancet shewing the efficacy of narcotics in that, the most common, form of orchitis which is met with after the fourth week of gonorrheal urethritis; and pages 602, 3, and 4, of the same Journal contain an article in which Mr. Gay's views of the nature of this affection, and the reasons which led him to adopt this mode of treatment are set forth, of which the following is a summary.

The prevailing symptoms of this affection are:-" general debility shown by unusual pallor of the face and mucous membranes: the skin covered with large drops of perspiration on slight exertion; quick pulse; furred tongue; highcoloured urine, and constipation. The local symptoms set in with dull aching pain about the testicle and epidydimis, increased on pressure; and the formation of a dense tumor, generally in the most depending portion of the epidydimis, and circumscribed by its investing tunic. Inflammatory action commences in the part, and extends itself to the tissue of the testis; the whole swells, becomes more and more dense, and so acutely painful that the slightest touch can scarcely be borne. The vas deferens, cord, and scrotum, next become involved in one swollen, painful, mass, the veins of the latter tunic becoming exceedingly congested with dark blood. As the inflammatory action proceeds, so does the condensation of the tissues (first observed as a small hard tumor of the globus minor) extend upwards, involving in its progress the lowest portions of the testis and epidydimis, until, eventually, in extreme cases, the testis and epidydimis become one dense compact mass."

These symptoms are introduced by a dull pain in the testicle, only discovered by pressing that organ: and hence it is of the utmost importance during the continuance of that stage of a gonorrhoea favourable to these affections, that the testis should be constantly watched, so that any increased susceptibility of touch may be detected; and by the use of appropriate remedies at this period, the more serious consequences be averted. The spread of the inflammatory action from the testis to the adjacent and tegumentary tissues in all probability depends upon the obstruction which the abdominal ring offers to the free return of venous blood consequent upon a swollen condition of the cord from effusion into its cellular tissue; and it may admit of some doubt whether the parietes of the inguinal canal may not, under these circumstances, spasmodically contract upon the swollen cord; for it is a remarkable fact, that upon the administration of a remedy in such cases, whose tendency is to allay spasm, the inflammatory action of the cord and integuments which is last set up is most frequently the first to subside. The following case will illustrate this pathological view. In December, a man named S, ætat. 48, was brought into the Royal Free Hospital, having fallen from a scaffolding, and was so injured that he died. Two days before his death, and three days subsequent to the accident, a violent attack of orchitis came on, the inflammation involving, in order, the epidydimis, testes, cord, and scrotum. The parts were all very much swollen as high as the external ring. He had discharge from the urethra. The veins over the scrotum, and throughout the inflamed parts, were excessively distended; the testes and epidydimis, on being cut through, showed the first stage of inflammation, the cut surfaces exhibiting a roseate tint, and a vast number of small vascular points throughout. The globus minor of the epidydimis, and most depending portion of the testis, were, by a shade, of a deeper red than the other parts, and slightly more dense; the structure in these parts being rather more distinct, in all probability, from the commencement of effusion of lymph between the tubuli. There was a little fluid, probably not more than in health, in the tunica vaginalis. The sheath and tisues of the cord were excessively distended by serum and venous blood.

No. LXXXII.

Amongst the causes of this affection, the chronic disease of the urethra which maintains the discharge, is obviously the most important: but it does not stand alone, for such diseased action may continue for months and yet no affection of the testis supervene. Combined with it there must be other agents and these are ever of a depressing character, and calculated to bring about those general indications of debility which the symptoms that have been recounted present; such as the long use of purgative medicines, low diet, mental disquietude, the disuse of accustomed invigorating exercises, &c. The immediate cause will generally be found to be either over exercise, especially walking, a blow, constipation, improper stimuli applied to the urethra, sometimes the operation of a drastic purgative, or several of these combined.

The orchitic affection commencing in the testis, and thus showing its purely sympathetic character, differs essentially from that form to which M. Ricord refers, in which it occurs "from succession or continuity of tissue, or by extension of the inflammation from the urethra to the canalis ejaculatorius and thence to the vesicula seminalis, canalis deferens, and lastly to the epidydimis, as demonstrated by pathological anatomy." This form is rarely to be met with, occurs in the acute stage of gonorrhoeal urethritis, and is amenable only to active antiphlogistic treatment.

66

With regard to the influence of the discharge from the urethra upon the orchitis, Mr. Gay does not regard it as a “translation of the inflammation,” as Mr. Hunter supposed. Mr. H. says, a swelling in the testicle coming on shall remove the pain in making water and suspend the discharge, which shall not return till the swelling of the testicle begins to subside; or, the irritation in the urethra first ceasing, shall produce a swelling of the testicle which shall continue till the pain and discharge return, thus rendering it doubtful which is the cause and which the effect. I have, nevertheless, known cases where the testicle has swelled, and yet the discharge has become more violent; nay, I have seen instances where a swelling has come on after the discharge has returned with violence, and remained as long as the swelling of the testicle." The explanation of these admirably described and apparently anomalous facts, Mr. Gay conceives to be as follows. Orchitis setting up during the continuance of a discharge from the urethra, acts upon the primitive seat of disease as a counter-irritant, and may or may not be effective in arresting the discharge; the failure to do so being for the same reasons (whatever they may be) that the application of blisters with the view of removing chronic disease in any organ does not in all instances effect its purpose. But there can be no doubt that, as the chronic disease of the urethra was the cause, without which the subsequent orchitis could not have existed, the speedy removal of the one is essential to the cure of the other. Hence the popular plan of renewing the discharge from the urethra by means of bougies and other irritants is most unsafe and unphilosophical; on the other hand, the employment of a mild injection of sulphate of zinc, or di-acetate of lead, or, should the disease have existed long, of a strong solution of nitrate of silver, will be found as safe and necessary as it is reasonable.

From these data Mr. Gay infers :

:-

"1. That by a protracted gonorrhoeal discharge from the urethra, and the remedies used for its cure, the general health suffers, and a state of diminished tonicity, with irritability of the whole system, is produced.

"2. That from sympathy with the seat of discharge the nerves of the testis and epidydimis become affected with an especial degree of morbid sensibility. This particular sympathy of the secreting apparatus with the urethra is constantly noticeable. An injection, which gives pain to the urethra, will always impart uneasiness to the testicle.

"3. That thus prepared, local exciting causes will produce inflammation of a low order in the cellular tissue, connecting the seminal tubules (for it is obviously that element of the gland that the diseased action, in all its stages, occupies,

from the fact that there is no obstruction to the passage of the seminal fluid during an attack of orchitis).

"4. That the results of this action are effusion and venous congestion, from a want of power in the veins (owing to their participating in the systemic asthenia), to return the increased supply of blood to the testis.

"5. That congestive inflammation of the adjacent and tegumentary textures with its consequences will follow; and probably an extreme of this condition will be produced by the obstruction to the free return of venous blood from the testis, which the external abdominal ring has been found to offer."

Hence Mr. Gay deduces the practical fact, that opium, hyosciamus or other narcotic, so given as to produce indubitable evidence of general narcotism, does and will speedily effect a cure of this special form of orchitis by allaying that general and local irritability which is presumed to exist as the immediate cause. But it is found imperatively important that the bowels should first be thoroughly evacuated by a brisk and cleansing purgative; and the aperient should be repeated in three or four days if the bowels tend to constipation, which is a constant feature in this affection. The anodyne Mr. G. uses is the tincture of hyosciamus, of which from 15 drops to a dram may be given every four or six hours, according to the urgency of the case, and at the same time cold applications should be made to the scrotum, and the patient be required to remain on his back with his hips raised. This treatment is however but another plan of fulfilling the same intention for which Frieke's system of bandaging was devised, but it is more extensively applicable, more easily employed, and equally remedial.

LEPRA GRÆCORUM CONTAGIOSA ?

Nova Pestis Adest!

The inhabitants of New Brunswick are at this moment labouring under a LEPRAPHOBIA, little inferior in violence to the Cholera-Phobia which prevailed in this country, during the eventful years of 1831-2! The Government, like the Parent Government, issued a Commission to investigate the terrible malady; and the following is a critique on the "Report" of the said Commission.

'Brief Remarks on 'The Report' laid before the Government of New-Brunswick by the Medical Commission appointed by the Lieutenant-Governor to investigate the Nature, Causes, &c. of a Disease termed Leprosy, prevailing in certain French Settlements in that Province, bordering on the Gulf of St. Lawrence.— By ALEXANDER BOYLE, M.D.

"A representation having been made to the Lieutenant-Governor of New Brunswick, that a disease of a highly malignant and loathsome nature, receiving the name of Leprosy, had been discovered among the inhabitants of certain French Settlements in the Counties of Gloucester and Northumberland, in that Province; a Commission, composed of four Medical Gentlemen and the French Clergyman residing in that district, was appointed for the purpose of investigating its nature and causes, and suggesting such measures as might be judged necessary for its prevention. The Commission entered on this enquiry in March last, and the result is now before the public; and a sum of £1000. has been granted by the Provincial Legislature, to enable the Government to carry into effect the measures proposed.

"As they have unanimously recommended the erection of a Lazaretto, the removal of the sick, and their strict seclusion in that establishment,' as means