frequency of the respirations, the dyspnoea being relieved and the respirations rendered easy, full, regular, and decidedly less frequent.

I respectfully ask physicians everywhere to give this remedy a fair trial, and report results through the medical journals, for if I have placed two high an estimate on its remedial value, in pneumonitis, the sooner I am convinced of my error the better. I do not claim to be the first to employ this agent in pneumonitis; many others allude to the remedy in the highest praise, but they all advise it as an auxiliary to other measures, and recommend it mainly as a stimulant. True, Dr. Flint advises its employment to prevent heart-clot, and gives it throughout the disease. Dr. Styles employs it in large doses, but at what stage of the disease I am not informed. Many physicians in the West use hydrochlorate of ammonia to promote absorption of the exudation, but for no other object, as I understand. Some writers contend that the carbonate of ammonia is decomposed in the stomach, and assumes the form of hydrochlorate, by the action. of hydrochloric acid. This may be true, but it should not cause us to substitute the hydrochlorate for the carbonate, as I have found the effects of the two preparations very different in pneumonitis, as well as in other diseases.-American Journal Medical Science.

ART. VI. SOME REMARKS UPON CASES OF OBSTRUCTION OF THE BOWELS, IN WHICH SURGICAL MEANS WERE USED. By A. REEVES JACKSON, M. D., Chicago, Ill.

Strangulation of Ileum by a Band of Adhesion-Puneture of Intestine-Gastrotomy-Recovery.—The patient was a woman aged twenty-eight years. She had been married four years, but had never borne children. Menstruation commenced at thirteen, and had always been painfully performed. During the preceding fifteen months she had suffered from occa

sional attacks of apparently causeless constipation, accompanied by colicky pains, and followed by diarrhoea. Sometimes during these painful seizures she had experienced a degree of relief by getting upon her elbows and knees. At first these attacks were separated by an interval of six to eight weeks, but latterly, that is to say, within the past four or five months they had become more frequent, the interval between some of them not exceeding two weeks. Besides, during the past ten months she had been suffering from a cough, which had become more and more troublesome, and in that period had had two slight attacks of hæmoptysis. Still she kept up, and was able to do ordinary household work.

The present illness had commenced on the morning of October 2, 1859, with sharp pain in the left iliac region, which was attributed to the ingestion of some improper article of diet. The pain was more constant than it had been on any previous occasion, and was increased by pressure. Without advice she had taken a full dose of some purgative pills, and finding them ineffectual, at the end of five hours the dose was repeated. As these also failed to produce the desired effect, an ounce of castor oil was taken, and immediately vomited. From this time forward almost everything was returned that was taken into the stomach. The pain increased in severity, and was no longer confined to the spot in which it originated, but extended upward, and into the right side. The abdomen became swollen and its walls tense. A physician being called at this stage of the case, prescribed a turpentine enema, which brought away a small quantity of dark-brown fæces, without relief to the symptoms. A second enema of warm water was then administered, but it came away in a few minutes unchanged. There being no facilities for giving a warm bath, the patient was then wrapped in blankets wrung out of warm water, and a teaspoonful of laudanum administered. This was retained nearly half an hour, and was then vomited, together with a draught of water, which she had imprudently taken. The dose of laudanum was repeated, and this time retained.

The patient now

became easier, and was drowsy. A purgative enema, consisting of an infusion of senna with sulphate of magnesia, was then given, and firm pressure made against the anus to prevent its return. Its pressure produced so much pain, however, that it was permitted to escape. All active treatment was now suspended. The patient was kept under the influence of opium, while small quantities of beef-tea and brandy were given from time to time.

I saw her October 4th, the third day of her illness. At this time she was in a state of semi-consciousness, and almost unable to speak. Her extremities were cold; pulse small, feeble, and rapid. Nausea and ineffectual retching were constant. The stomach had not retained anything during the past twelve hours. Her face, bathed in cold sweat, was pale and haggard, and its expression denoted that life was fast ebbing. The abdomen was enormously distended, and the writhing of the enlarged coils of intestine could be distinctly seen through the walls which enclosed them. The rectum was empty and contracted. I was informed that the urine had been scanty, highcolored, and voided without difficulty.

With scarcely a hope of doing more than giving temporary relief, I introduced a small exploring trocar and canula through the walls of the abdomen, at a prominent point, into the distended bowel. This gave immediate exit to a large quantity of flatus, and the abdominal fullness rapidly subsided. Flannels, saturated with a hot infusion of hops, were applied so as to envelop the entire abdomen; sinapisms to the calves of the legs and epigastrium; and a teaspoonful of brandy, with a fourth of a grain of morph. sulph. were administered. The patient had become somewhat aroused, and expressed a sense of relief. A stomach-tube was now passed into the colon and a large quantity of beef-tea very gradually injected, but, despite every effort to prevent its return, it was expelled almost immediately. At the same time the patient vomited the brandy, and this was followed by eructations having a decidedly stercoraceous odor, although there was no fæcal matter thrown up. The tympan

ites returned also, and in an hour the abdomen appeared as large and resonant as it had been prior to the puncture.

I now proposed opening the abdomen, in the forlorn hope that something might yet be done to overcome the obstruction which evidently existed, and the operation was decided upon.

Commencing a little below the umbilicus, an incision was made in the linea alba, and continued directly downwards three inches. On opening the abdominal cavity the omentum was brought into view, its lower edge being forced through the incision by the pressure of the distended bowel. The cut was now lengthened about an inch, when a large coil of intestine, very greatly congested, protruded through the wound. Taking hold of this, I commenced the work of tracing up the point of obstruction. This was soon accomplished. Making gentle traction upon the bowel, I found that it could not be drawn from behind the omentum, and upon raising the latter upward and passing a finger beneath it, the cause was apparent. It consisted of a band of lymph, about two inches in length and nearly half an inch in width, extending from the posterior free surface of the omentum to the lower side of the tranverse colon, forming a triangular space between these parts. A fold or loop of the ileum had insinuated itself through the opening thus formed, and becoming enlarged and congested, was unable to return. The band, which was tolerably firm in texture, was ruptured by the fingers, and the strangulated bowel freed. The portion which had thus been strictured was of a dark purplish color, while marks of incipient inflammation of the peritoneal investment of the small intestine above this point were everywhere present. I had the satisfaction of observing a very great change take place in the appearance of the liberated bowel before closing the wound. It became immediately filled with flatus, now able to pass onward, and its color changed from purple to dark red. I searched for and found the spot which had been punctured by the trocar. It was about fifteen inches above the point of strangulation. It formed the centre of a

deep red space nearly an inch in diameter. The opening was no longer perceptible, and I was unable to discover the escape through it of either gas or fluid. I removed the whole of the adventitious band which caused the obstruction, and then, after carefully replacing the parts, closed the wound with four points of twisted suture. A flannel compress dipped in warm water was applied over the wound, and confined by means of a flannel binder loosely pinned. During the time this was being done, large quantities of gas escaped per anum, and they were soon followed by a copious discharge of fluid fæces. Strict rest was enjoined, and a full dose of opium given.

The wound healed well, but the operation was followed by an attack of peritonitis, which was treated by opium, quinine, and a concentrated nourishing diet, and from which she slowly recovered. Nearly five weeks elapsed before she could be considered fairly convalescent.

This patient died of phthisis pulmonalis, in September, 1860, eleven months after the operation.-Chicago Medical Journal.

ART. VII. SULPHATE OF QUININE IN THE TREATMENT OF SPONTANEOUS ERYSIPELAS. BY DR. PERROUD, Physician to the Hotel Dieu de Lyon. Translated from Annales de Dermatol. et de Syphilig., Deuxieme Annee, No. 4, by JAMES C. WHITE, M. D., Boston.

It is not the tonic, neurosthenic action of sulphate of quinine, nor its anti-periodic action that we have desired to take advantage of in the following experiments, but certain properties it possesses with regard to the globules of the blood, which have been the subject of interesting investigations. These investigations, as well as the researches lately made in connection with the erysipelatous process, have served us as a guide; and inasmuch as they have determined our therapeutics, it is necessary that we should recall them in a few words.

Two years ago M. Vulpian, after Koster, Volkmann and