152 Periscope.-Syphilitic Inflammation of the Eye. dication, in the discoloration of the albuginea, and the ary and untractable while the mouth is still sore from mercury given for its cure. In such case the treatment state of the dejections, I have never seen so obstinate a to be adopted becomes a question of importance and case of jaundice associated with erysipelas, upon which often of difficulty. To bloodletting, local or general, and a long perseverance in the use of mercurials and pur- resort, because they have either already been employed, other means of depletion, we are frequently unable to gatives did not seem to produce any very decided or they are inadmissible in consequence of the debilitated effect. The association of erysipelas, and other exan- state of the patient. We are therefore called upon to themata, with rheumatism, has been noticed by Dr. adopt some other plan or remedy, and to select from those usually employed in other complicated forms of inTodd, and some other modern writers, and of which flammation that best suited to the particular circumstances of I have met a few of these complications. Two other the patient. Mr. Hugh Carmichael points out such cases as examples of disease likely to be benefited by the spirit cases of erysipelas and rheumatism occurred in the of turpentine, and it is obvious, that as it affords a fair hospital, about the time the above case was under treat-prospect of advantage, it should have a fair trial; guardment. The other eruptive diseases which I have seening, as far as possible, against nausea or strangury. Should associated with rheumatism were scarlatina, roseola, and erythema nodosum. Dr. Todd is of opinion that rheumatism, as well as these exanthemata, depend on some morbid alteration of the blood. His views appear to be favoured by some more recent investigations, and may probably eventually be generally adopted. This association (although, in some cases, it materially complicates and aggravates the case) does not interfere with the appropriate treatment of each. When, however, the three affections become combined, the case then becomes of a very serious nature; and when abortion and puerperal fever become superadded, the prognosis is extremely unfavourable. this fail, or should it be ineligible, the iodide of potassium may be resorted to either alone or in combination with bark or sarsaparilla. Mr. Carmichael, in his lectures on Venelowing testimony to the value of iodine in the treatment of real Diseases, published in the Medical Press, bears the folthe secondary forms of syphilis:-"For the cure of the different constitutional symptoms of this form of venereal, with sarsaparilla, as iodine; which latter medicine, and its there is no remedy so much to be relied on, in conjunction combinations, I consider as a remedy of the utmost value in the treatment of this as well as of the phagedenic form hitherto most unmanageable cases met with in practice. I of venereal disease, which includes the most formidable and began to use it very soon, in cases of venereal nodes, after Dr. Coindet of Geneva, had made known its utility for ing the dispersion of a tumour so obstinate, might be equally goitre; on the principle, that a medicine, capable of inducefficacious in removing affections, however different, of a There was a further peculiarity in this case, namely, from the accompanying symptoms, to dread the injurious similar obstinacy in the bones, in cases where I had reason, the rare formation of matter, as a consequence of rheu-effects of mercury; I therefore exhibited iodine or hydriomatism; its absorption, I think, may fairly be attributed date of potash in this hospital many years since for seconto the effects of the iodine. dary symptoms of these forms of venereal disease, with the A question suggests most flattering success, long before there were any publishitself, did the abortion arise from the rheumatism seized accounts of its utility in veneral complaints. At present ing on the uterus? I think we may fairly admit this believe it is used extensively, but without much discrimi to be the case, as no other satisfactory cause offers in iodine to the extent of a grain, with six or eight grains of nation or selection of symptoms. I began with giving explanation. She had not been taking any drastic the hydriodate, dissolved in a pint of distilled water, directmedicine, nor was there any particular aggravation of ing the patient to take a third of this quantity morning, noon, and night. At present the hydriodate of potash is her complaints at the time. usually preferred, and given to the extent of fronr fifteen to thirty grains, with a pint of decoction of sarsaparilla, duradvantage over the other; but in both ways as a remedy, ing the day. I am not certain that the one mode has any iodine has exceeded, in the two forms of disease alluded to, my most sanguine expectations." It is to be regretted that a post mortem inspection was not made, as much pathological information might be expected to result therefrom. Montreal, Sept. 16, 1846. PRACTICE OF MEDICINE AND PATHOLOGY. ON SYPHILITIC INFLAMMATION OF THE EYE. (Continued.) I This evidence in favour of iodine in the treatment of secondary symptoms of venereal in general would justify our employing it in syphilitic inflammation of the eye even if experience had not proved its beneficial operation. Mr. Lawrence also bears testimony to its value. "In some cases (he observes) where mercury has disagreed, or where after a fair trial the affection of the eye has either not By A. JACOB, M. D., F.R.C.S.I., Professor of Anatomy lent, effect the iodide of potassium, giving three or four improved or got worse, I have lately employed with exceland Physiology in the Royal College of Surgeons, and grains in two or three ounces of the compound decoction one of the Surgeons of the City of Dublin Hospital. of sarsaparilla three times a day. The beneficial operation In addition to, or in combination with mercury, the re- of the change seems analogous to what we observe from medies and treatment already alluded to as resources in the same succession of remedies in certain cases of venecases of simple uncomplicated inflammation of the eye must real disease." I have myself used iodine freely and exbe employed in syphilitic iritis, or in certain cases must be tensively in inflammations of the eye, and have frequently substituted for mercury. Iritis will, it is well known, employed it in cases of syphilitic iritis in which mercury sometimes make its appearance while the system is under was not eligible. Although it cannot be relied on as a means the influence of mercury administered for the cure of of arresting inflammation or as an antidote to venereal dissecondary symptoms of venereal, or it will become station- lease, equal in power to mercury, it may I believe be looked Periscope.-Syphilitic Inflammation of the Eye. upon as possessed of these powers in a less degree; at least I can say that lingering inflammation appears to give way under its use more certainly and rapidly then when it is not employed, and I can positively state that I have treated formidable relapsing inflammations of the eye of scrofulous character, but originally syphilitic, with it successfully. It must not, however, be forgotten that inflammations of the eye, like all other inflammations, sooner or later subside, be the treatment what it may, or even without any treatment; and that syphilitic inflammation runs its course, and finally disappears also; too much importance should not, therefore, be attached to this or any other remedy, lest by relying on it exclusively, we neglect others. We have always to bear in mind that in treating inflammation of the eye we should, after failing to subdue the vascular action at the commencement, direct our attention to the prevention of those disorganizing processes of this condition of parts; and keeping this in view, I think that both from theory and experience iodine is entitled to confidence. I have generally given the iodide of potassium in the cases alluded to either alone or in decoction of sarsaparilla or bark, as the syphilitic symptoms or debility of the system may require the one in reference to the other; and I have given it to the extent of ten grains three times a day. I have also given the combination of iodine and iodide of potassium, as suggested by Mr. Carmichael, and I do not think that I can with safety state that the latter was less effectual than the former. 153 room, and every arrangement made to restore him to the comforts of which as an invalid he was deprived. This being done, the remedies above enumerated may be again resorted to, and the most appropriate either resumed or administered for the first time. To those who rely on the abstraction of the blood from the system and suspension of the process of nutrition by denial of food in the treatment of inflammation during its entire progress, refraining from the use of the lancet and application of leeches, will obtain little favour; nevertheless it is an undoubted fact that inflammation is often rendered less destructive by preserving the natural powers of growth and respiration unimpaired. I may not go the length of Mr. Hewson, when he says, "the patient may be saved the inconveniences of bloodletting or blistering, as they do not afford the smallest benefit, nor will they allay a single distressing symptom; and the same may be said of purgatives; in which respects the venereal ophthalmia is singular, and differs from all other analogous affections," but I feel much inclined to give a qualified assent to this opinion of a trustworthy and practical man. Over and over again I have treated relapsing cases of inflammation of the eye successfully without abstracting a drop of blood, which in former attacks had been treated by profuse bleeding; and I am often obliged to administer mercury while I allow the patient his usual supply of animal food, and have even to accompany it by bark or quinine. Amongst the species or modifications of inflammations of the eye, an iritis from the use of mercury has been enumerated. There does not, however, appear to be any substantial grounds for the distinction. That such inflammation cannot be denied, but that it is a consequence of it remains to be proved. There is nothing whatever in the appearance, progress, or result of inflammation of the eye following the use of mercury to justify us in assuming that it is of peculiar character; neither does the treatment require particular adaptation to any peculiar condition of the parts. If turpentine or iodine be found ineffectual or inapplicable in the treatment of syphilitic inflammation of the eye not admitting of relief by mercury, the practitioner has to con-occurs after, or even during, the administration of mercury, sider what other remedial resources are within his reach. He has indeed in some cases of inflammation of the eye, modified perhaps by the constitutional influence of syphilis, scrofula, rheumatism, and mercury, to encounter often the greatest difficulties which practice presents. Bleeding, local or even general, may, in certain cases, be still available, and may be followed by antimonial medicines and other antipholgistic treatment; but this does not often hap- Syphilitic inflammation of the eye is sometimes, although pen, the state of the constitution more frequently requiring rarely, met with in infants, and it may be assumed that its nutritious food and preparations of bark or other tonics. rare occurrence is to be attributed to the comparative inSarsaparilla, colchicum, and guaicum, afford the best pros- frequency of syphilitic disease at this time of life. The pect of advantage where rheumatic constitutional disease practitioner should therefore bear in mind the possibility exists, and the hydriodate of potash in decoction of bark, of the existence of such disease when called upon to attend with some tincture of the same, promises best in scrofulous to infants suffering from diseases of the eye, or of its future habits. In these cases where we may say mercury has appearance in those labouring under symptoms of syphilis, gone astray, the disease remaining stationary, and the ge- without any present appearance of iritis. This it is neral health impaired, I generally discontinue all medical necessary to inculcate, because syphilitic inflammation of treatment for a time, and make such change as to diet, ven- the eye sometimes takes place in infants, as in adults, untilation, and temperature, as can with safety be adop- accompanied by any other form of the disease; and is someted. Practitioners are sometimes too anxious to push times accompanied by such slight increase of vascularity or powerful remedies to the utmost without delay, apprehensive other appearance of disease that it may escape notice. In that the inflammation is causing rapid disorganization, but the early stages, redness of the sclerotic, discoloration of there is often no necessity for this hurry. The inflammation, the iris, and irregularity of the pupil, are the appearances we may say, at this period has spent its force and assumed to be observed; and at a more advanced period, alteration a chronic form, requiring more a steady and continued plan in shape of the sclerotic and cornea, contraction of the puof well considered treatment than any sudden change of a pil, and adhesion of its margin to an opaque lens. Somevery decided nature. Festina lente is frequently the max-times a dilated and irregular pupil with a transparent lens im to be inculcated, and in accordance with it, I generally is the consequence; but in either case, when the disease find myself acting. In private practice, when I am per- has escaped observation, or has been neglected or mismanmitted to have my own way, I am in the habit of commenc-aged, insensibilitity of the retina or amaurosis and conseing by getting rid of all those incumbrances which accumu-quent blindness remains. At this time of life little informalate in a sick room, and making such arrangements as will tion as to the extent of the disease can be obtained from trial secure the admission of light and fresh air; an object often of the visual power of the organ. The baby will grasp at difficult of accomplishment; such places being generally a watch or other bright object presented to it as long as more like the crowded storerooms of furniture dealers than any degree of sight remains, but slighter defects of vision apartments provided for human beings. All medicine is then discontinued for a time, and nutritious digestible food substituted for slops and compositions offensive to the stomach and pernicious to the system. The patient, if in bed, is quietly dressed and placed in his chair, and if circumstances admit of it, in a day or two is removed to a sitting can scarcely be detected. It is therefore necessary to make a very careful examination of the eye, and close inquiry as to the presence of other syphilitic disease, or of its previous existence. I see these cases oftener after the mischief has been done and the organ destroyed than during the commencement of the attack when it might be had considerable fever; restless; thirst urgent; nausea with a disposition to vomit; about twelve o'clock the fever passed off, and she said she felt much better; could turn in bed without producing any unpleasant feeling about her head; mind clearer; better. In the afternoon she fell asleep, and slept till near night; talked more rational; expression better; thought she could hear at this time I left her; I saw her again about 9 o,clock, P. M.; at that time she was decidedly better than she had been; expres sion natural; talked rationally; says she is entirely free from pain. saved; yet even at this period, the emaciation or defect March 30th, 6 o'clock, A. M.-On awaking in the morning she of nutrition, arrested growth, and pallid dingy skin, proclaims the nature of the disease; and sometimes other forms of it, even now, may be detected. I was lately called on to see one of these cases, considered to be simple cataract, in a child of three years old. The pupil was contracted, and adherent to an opaque lens and capsule, and vision was irreparably destroyed. This occurred when the child was only a few months old, yet on examination I found the tongue studded with small irritable ulcers and clefts, and a soft condylomatous elevation at the anus, which speedily disappeared after the administration of some hydrargyrum cum creta. The treatment of syphilitic inflammation of the eye in infants does not differ from that prescribed for adults, except in degee. Mercury and the local application of extract of atropa belladonna during the existence of the inflammation, and tonics, alteratives, and generous diet, should the disease linger, constitute the principal resources. Of the preparations of mercury the hydrar- general improvement in her situation; slight roaring in the in April 1st, 6 o'clock, A. M.-Slept well; fever very slight; a gyrum cum creta appears the most appropriate and conveni-jured ear; blue mass has not operated; took half an ounce of ent, and in acute cases it may, with advantage, be combined, calcined magnesia; this produced a gentle action on the bowels. at first, with James' Powder, or other manageable antimo- From this time, she gradually convalesced without a return of nial. Sarsaparilla, iodine, and bark, can be resorted to as any of her unpleasant symptoins, and is now perfectly restored.auxilliaries if necessary. Medical Framiner. 'GENERAL ERETHISM PRODUCED BY INJURY OF THE MEMBRANA TYMPANI. March 31st, 6 o'clock, A. M.-Did not sleep well last night; return of fever, restlessness; thirst very urgent; craves ice; complains of a roaring in the injured ear like distant thunder; says that she sometimes loses her senses; cephalalgia very great, con she fell asleep; slept about an hour with decided benefit; saya fined to the forehead; fever passed off about 10 o'clock, when she always feels better after sleeping. In the afternoon I gave her eight grains of blue mass. TREATMENT OF LEAD COLIC. During the three years that I was with M. Gendrin, I saw a By JOSEPH B. COTTMAN, M. D., of Whitehaven, Md. (in a vast number of cases of lead colic; we had, indeed, nearly always letter to Prof. Dunglison.) two or three men thus affected in our wards, sent from the carbo nate of lead manufactory at Clichy. All of these cases were March 28th, 1846.-Mrs. J., on the night of the 28th, while treated with sulphuric acid, and I do not recollect having seen one picking her ear with a knitting needle, accidentally passed it in in which the disease proved refractory to the treatment adopted,too far, so as to injure the membrana tympani; the effect of the a case or two of confirmed chronic paralysis excepted. The dura. injury was instantaneous; she seized hold of the nearest object tion of the treatment, as far as I can collect from my notes, was to prevent her from falling from the chair, and called for assist-about three days in slight cases, and six or seven in severe ones. ance. With some difficulty she was carried to an adjoining room The sulphuric acid was given, largely diluted with water (forts. in a state of insensibility; being placed on a bed, she recovered four drops to a pint of water); two or three pints being administer. her reason sufficiently in a little while to tell what had happened ed in the twenty-four hours. The amount of pure strong acid to her. State at this time.-Expression wild, pupils very much taken in that time was, therefore, from one drachm and a half to dilated, face flushed, the least motion of the head seemed to give two drachins. Sometimes the sulphuric lemonade, as it was the most excruciating pain; she would scream aloud; tetanic familiarly called, was vomited as soon as ingested. Still when twitching of the muscles of the arm;-pulse strong, full and this was the case, the patient was made to persevere in its use, bounding; violent throbbing of the carotids. In the course of and the stomach soon became accustomed to the acid, and retained fifteen or twenty minutes, this state of things was succeeded by it. When it was retained, the abdominal pains generally began to general syncope; her face would become blanched, her extremi- diminish after the first, second or third day, the constipation soon ties cold, long and laboured respiration, with occasional sighing; giving way naturally, after they had become less intense. In al this would continue for half an hour or more, before she could be these instances, not a grain of any kind of medicine was given aroused; when aroused, her conversation was incoherent, her besides the sulphuric acid, nor was an enema used, the sulphure face flushed, pupils preternaturally dilated, violent sick stomach, acid being the only medicinal agent resorted to, if we except baths. with occasional vomiting; rigors; extremities cold. This state of things continued alternately from 10 o'clock at night until 3 o'clock in the morning, when she fell asleep. Slept about three hours. March 29th, 6 o'clock, A. M.-Still complained of pain in her head: the least motion aggravated it; said that her mind was very much confused, that she could not think; face flushed: pupils dilated; tetanic twitching of the muscles of the extremities; occasional flushes of heat and cold as she described it; pulse full, strong and corded; conversation at times incoherent, I tied up her arm, and took about a quart of blood with decided benefit; her pulse became natural; her mind clearer; taiked more ration. ally; said that her head felt better, that she could hear a little in the injured ear. Up to this time she had not heard at all in that ear from the time of the accident. She felt so much better that she desired her female attendants to take her dress off; in attempt. ing to do so she was placed in an upright position, this produced syncope which continued for nearly an hour; during this time her breathing was stertorous and laboured; her extremities cold; oc. casional twitching of the muscles of the arm; pulse very slow and feeble; it was with the utmost difficulty that she could be aroused, and when aroused complained of being very chilly; violent sick stomach and a constant disposition to vomit. In the afternoon, two small blisters were applied behind the ears; these drew well, and produced a general amelioration of all her bad symptoms; she fell into a quiet sleep at night, and slept well until morning. At the commencement of the treatment, a sulphur bath was given to the patient, the result of which was, that the sulphur, combining with the particles of lead that were on the skin, formed a black sulphuret. The amount of lead, which is thus discovered to encrust, as it were, the skin of those who have worked at pre. parations of lead, is nearly incredible. I have often seen men go into the sulphur bath quite white, and come out nearly as black as negroes. The lead lying on the skin having been thus made visiand half a pound of soft soap, and made to scrub themselves daily ble to the naked eye, the patients were supplied with a harsh brush in a warm bath, until all the black sulphuret had been brushed off. The sulphur bath was then repeated, the sulphuret of lead brought out, brushed off and the process renewed, until it no longer rendered visible any trace of lead. This precaution is indispensable with all who labor under satur. nine disease, if we wish to ensure patients against relapse. Whilst at the hospitals of La Pitié and Saint Louis, I have repeatedly had patients under my care with lead colic, who had been discharged as cured from other hospitals a few weeks previously. The sulphur bath, which exhibited a thick coating of lead on the skin, explained at once the cause of the relapse. Indeed, the presence of this coating of lead on the surface of the body is, no doubt, the principle cause of the relapses which are mentioned by authors as occurring so often in these diseases. The lead which thus lies on the surface is gradually absorbed, and, at last, poisoning having Periscope.-Typhoid Fever Arising from Local Miasma. again taken place, all the symptoms to which it gives rise are manifested. No patient who has suffered, and been treated for lead colic, can be considered safe unless he has gone through the ordeal of a sulphur bath, with a perfectly white skin. One of the great advantages of repeating the sulphur bath during the treat. ment is, that the patients, whom it is easy to convince of the im. portance of getting rid of the metallic poison, when they see it plainly on their bodies, rub with real good will. The mode in which the acid acts in neutralizing the poisonous effects of the lead is easy to explain. It combines, no doubt, with the lead in the tissues, and forms with it an insoluable sulphate or sulphuret, which is consequently inert, and is gradually eliminated from the economy. This is the interpretation adopted by M. Gendrin, and it appears rational enough.-[Mr. Bennett in London Lancet.] A CASE IN WHICH THERE WAS CONGENITAL Seaman's Hospital. 155 ter in a state of decay. The witnesses may have assigned too wide and too exclusive an influence to such emanations in en. gendering and propagating fever. But they appear to have established, more clearly than was ever done before, the tendency of putrid effluvia to favour its spread and aggravate its malignity. And they have also gone far to prove, that in particular circum. stances, not yet, however, ascertained with any accuracy, the same cause is capable singly of actually generating fever, even in the most malignant form. Admitting the possibility that continued fever may originate simply in exposure to the effluvia of organic decay-and it appears difficult now to deny this doctrine-a number of deductions will result, which present important bearings on medical practice. One of the most obvious of these is, that continued fever may show itself with the characters of an endemic or epidemic in localities extremely circumscribed. It is well known, that circumscribed epideinics do occasionally make their appearance;-that continued fever, in the typhoid form, and at times most malignant in type, has been observed to occur in very limited localities. On such occasions the impossibility of tracing the introduction of the disease to infection, the extreme narrowness of its range, and its virulence within the circle of its influence, have been peculiarities which distinguished it, in the eyes of all observers, from continued fever in the usual epidemic forms,-exciting at the same time much speculation as to its The subject of the case was a gentleman who died on the 6th nature, giving rise to plausible, though unfounded, suspicions of of May, 1846, in his twenty-seventh year. He had enjoyed good poisoning, and leading in the end to no very satisfactory explanahealth until within three years of his decease, when he became tion of its origin. There can be no doubt, however, from recent ailing, and looked ill and bloated, but was well enough to continue experience, that events of this kind might have frequently admithis pursuits, and to take tolerably active exercise up to last ted of an easy interpretation, had the observers of them been Christmas. In March he was affected with dropsy and album-sufficiently aware of the liability of fever to arise from the insidious inuria, with frequent epistaxis, and general disturbance of all the emanations of concealed organic matter in a state of decay. functions. The under side of the tongue and the inside of the which lately excited a strong sensation in the neighbourhood where These reflections have been suggested by a remarkable incident cheeks and lips became gangrenous before death, the body exhaling a strong fœtid urinous odour. The secretion of urine how.it happened, and which at the time went the round of the news. ever, continued, to the amount of a pint and a half in the twenty; four hours, up to the day of his death. The left kidney and superior renal capsule were entirely wanting; the ureter on that side was very small, and was inserted in the usual place into the the occasion in two capacities, first, as physician simply, and papers as a mysterious occurrence. Having been consulted on afterwards medico-legally by the public authorities, I was led to inquire with some care into the details; which have since appearbladder, and terminated about six inches from that viscus in a ed to me so interesting, that, with the consent of the medical cæcal extremity. The right kidney was corrugated, and veryment of the leading facts before this society. The statement practitioner principally concerned, I have ventured to lay a state. small; the capsule closely adherent; the form otherwise normal; the substance condensed, firm, waxy, and marked on a section which follows is derived partly from my own observation and in. with white puncta and striæ. Microscopic examination showed quiries, when consulted respecting two of the cases, partly from a no oil, but partial obliteration of the tubular and vascular structure, precognition by the officers of the crown, which was subsequently and in other parts a deposit in the tubuli uriniferi of an opaque put before me for my opinion, but chiefly from answers to queries urinately granular matter, soluble in acetic acid, and presumed to since submitted by me, with a view to publication, to Mr. Macnab, surgeon, at Peebles, who originally attended all the cases, and who has investigated the particulars on the spot with great care and fidelity. be of an albuminous nature. "She The author remarks that the case presented an instance of com. plete deficiency of one kidney, without corresponding increase in size, or alteration of shape, of the existing one, which was ap- will be particularly described hereafter, Mrs. W. the wife of an In a thinly-peopled rural district of Peeblesshire,-the locality parently even below the natural size; and he observes that the extensive farmer there, was attacked on the 22nd of January last diseased condition there present, and the consequent albuminuria, was not owing to the deposition of oily matter in the tubuli urini. with rigors, general prostration of strength, and great disinclinaferi, or substance of the gland, but to the pathological change tion for food; to which occasional vomiting was added five or six analogous to that which produces cirrhosis in the liver, or, as it days afterwards. She was visited for the first time professionally may be supposed, to an adhesive inflammation of the tubuli urini. on Friday, the 30th January, by Mr. Macnab; who found her in feri, and, probably, to the venous capillaries of the gland-a con- the following state, as I shill give it in his own words: dition, in his opinion, more common as the cause of chronic albu. complained of rigors, pains in the back and limbs, headache, a minuria, and the other symptoms produced by what is termed little intolerance of light, slight sore throat and dryness of the granular kidney, than that in which a superabundant quantity of mouth, a painful sense of palpitation along the course of the deoil is found in the tubuli uriniferi. And he stated his belief, that scending aorta, nausea and desire to vomit, with occasional fits of in all cases where there was an undue deposit of oil in the kidney, vomiting, thirst, want of sleep, total loss of appetite, and great exthe liver would be found diseased; and that the secretion of oil by haustion. The pulse was 92 and feeble, the tongue covered with the kidney, as in other cases that of bile, takes place by the very thick brownish-yellow fur, the back of the throat somewhat vicarious action of that gland supplying the defective power of the red, the vomited matter partly mucous, partly bilious, the bowels constipated, the evacuations dark and offensive, and the urine unusually yellow, as if bilious. The countenance had an anxious expression, and the eyes were suffused; but there was no appear. ance of petechial eruption either at this time or subsequently. The temperature of the body, and of the extremities more especially, was lower than natural. There was no pain in the epigastrium liver.--Dublin Medical Press. ACCOUNT OF A TYPHOID FEVER, APPARENTLY a By ROBERT CHRISTISON, M. D., Professor of Materia Medica in or in either hypochondriac region. Under the use of frequent lax the University of Edinburgh. In the reports of the government commission appointed to investigate the causes of the unhealthiness of towns various impor. tant facts have been brought forward to illustrate the connexion of continued fever with emanations proceeding from organic mat atives and diaphoretics she gradually recovered. On the 9th of February she was able to take food with relish, and for some days had been without any tendency to vomiting, so that she was left as convalescent, but with instructions that assistance should im. mediately be procured if any unfavourable change presented it. self." Having heard nothing farther of the case for four days, 156 health. Periscope.-Typhoid Fever arising from Local Miasma. The next case was that of her husband, Mr. W., also a hale old person of seventy. He was taken ill on the 25th January, within three days after his wife. His illness commenced in the same way, On the 30th Mr. Macnab found him labouring under symp. toms precisely similar to those described above, and nearly the same in degree, except that he had not so much prostration of strength, being able to sit up at the fireside. The pulse was 92, and of moderate strength. Like his wife, also, he improved under the administration of laxatives and diaphoretics down to the 9th February, when the vomiting had ceased, the appetite was tolera. ble, and he felt himself able to leave his bed. After this, however, the same symptoms recurred; on the 13th Mr. Macnab found him greatly worse; remedies were no longer of any avail; and he died on the 18th, two days after Mrs. W.; his mental faculties continuing, as in her case, unimpaired till a few hours before dissolu. tion. The body, after death, had a yellowish sallow appearance, and speedily began to decay. The Mr. Macnab went on the 13th to inquire for her; and, to his sur. he was seized with nausea, tendency to vomit, thirst, disinclination prise, found her labouring under all the former symptoms in an for food, considerable prostration of strength, and slight headache. aggravated degree. "The thirst was intense, the nausea and He continued in this state, sometimes confined to bed, sometimes vomiting very troublesome, the pulse 100, small, feeble, and inter-going about a little, until the 28th, when urgent business compelmitting, the tongue covered with a very thick, dry, yellowish-led him to proceed to Edinburgh, a distance of twenty-two miles. brown coating, the bowels very constipated, the evacuations dark, He went thither on horseback, feeling sick and uncomfortable on bilious, and fœtid, and the vessels of the conjunctivæ much in the way, and vomiting a little; but he was able to remain in town jected. But there was still no pain in the abdomen, and no ap- till the 30th, and afterwards to ride back to the farm, where Mr. pearance of petechiae anywhere; neither was there any wandering Macnab saw him next day. He then felt better, but still comof the mind. The remedies which were formerly of service had plained of sickness, tendency to vomit, slight headache, sore now no effect; the more urgent symptoms went on steadily in throat, and little appetite for food. The pulse was 86, and of creasing; on the 16th towards evening articulation became indis. moderate strength, and the tongue was covered on every part but tinct, and her words for the first time incoherent; and at six the mere edge with a very thick yellowish-brown fur. Subseo'clock of the same evening she expired. An inspection of the quently he became worse. The vomiting gradually increased in body was not allowed. It presented after death an emaciated ap. frequency, and the vomited matter acquired a bilious appearance. pearance, and a peculiar yellowish colour, but no tumefaction." The bowels were obstinately costive, and the evacuations dark Mrs. W. was seventy years of age, but had long enjoyed excellent and bilious. The urine seemed as if loaded with bile. lining membrane of the throat was slightly red, and the vessels of the conjunctivæ were full of blood; but there was no appearance of petechial eruption on the skin. He continued much in the same condition till the 9th February, when he became considerably better, so that he could even take a little food with relish. But on the 13th he was much worse again. The vomiting bad become urgent, the thirst extreme, and the desire for food altogether gone. The pulse was about 90, rather feeble, and the tongue loaded with a yellowish fur as before. He now also complained of severe pains in the limbs, especially below the kneejoints, down the front of the tibiæ, and also to a less degree in the arms and hands. He described this sensation as a painful uneasy numbness, causing incessant restlessness and change of posture it was attended with coldness of the integuments to the sense of another person, and he derived no relief from the warm bath or hot fomentations. No change for the better having occurred in five days more, he was removed on the 18th to Edinburgh. He bore the journey well, and under the care of Dr. Begbie, began speedily to improve." On the 20th, I saw him in consultation with Dr. Begbie and Mr. Macnab, who came to town on purpose. The vomiting had ceased: but the pulse continued about 90 and rather weak, the tongue much loaded, though less so, the bowels difficult to move, and the desire for food still altogether wanting. The disease under which Mr. and Mrs. W. died presented the The pains in the limbs were also distressing, and occasioned much characters of ordinary typhoid fever, but with certain peculiarities; restlessness and want of sleep. There was a good deal of lanand it proved fatal, like many cases of ordinary fever, about the guor; but he conversed without difficulty. The countenance and close of the third week. The servant, Isabella M., aged 20, was skin generally were pale, the eyes clear, and not injected, the ex. seized on the 26th January with rigors, vomiting, loss of appetite, of the disease struck me at once as different from that which has pression not oppressed; and altogether the general physiognomy and prostration of strength, exactly as her master and mistress before her. On the 30th Mr. Macnab found her affected, like them, long been familiar to me as characterizing the several forms of the with "pains in the extremities, slight sore throat, nausea, and infectious typhus of this city. Under the use of laxatives, calomel, frequent vomiting, palpitation of the heart, and a troublesome diaphoretics, morphia at night, and tonics, the patient gradually pulsation in the descending aorta, urgent thirst, total loss of appe- of good general health. But the painful uneasiness of the limbs threw off the more urgent symptoms, and was restored to a state tite, complete want of sleep, and great debility. The pulse was continued without material abatement. Even so lately as the 4th 112, and small, the tongue covered with a very thick yellowish-of May, more than three months after he was taken ill, Mr. Mac. brown fur, the temperature below the natural standard, with oc- nab wrote to me, that "the legs are somewhat swelled from the casional rigors, the bowels constipated, and the evacuations dark knees downwards; he complains of a sense of uneasy soreness in and offensive." The symptoms therefore were precisely the same them, together with a numbness and want of the feeling of pain as in the previous cases. But their progress was very different. when the skin is pinched; he walks with very great difficulty: For no abatement was accomplished by treatment; her strength and altogether the affection seems to be of the nature of partial was quickly exhausted; and she died in the afternoon of the 1st and incomplete palsy." [He continued in the same state on the February, within six days and a half after being first taken ill. In her instance death was preceded for twenty-four hours by 8th June.] some delirium and considerable stupor; but in no other case were conclude the narrative of cases. A short example of the slightest form of the disease will now these symptoms so well marked as to attract notice. The body one of Mr. W.'s ploughmen, residing within two hundred yards "Marion H., daughter of after death presented the same yellowish sallow hue of the in- of the farm-house, had been frequently in the house milking the teguments, as in the cases of Mr. and Mrs. W. These were all the fatal cases. cows and taking occasional charge of the two domestic servants In addition twelve other in. while sick. On the 1st Feb. she was seized with nausea and de. dividuals were more or less severely attacked with similar symp-sire to vomit, thirst, and the other early symptoms mentioned toms to those detailed above; and three or four other persons were above. The pulse was 96, the tongue furred, the bowels consti. more slightly affected, whom, however, Mr. Macnab did not at-pated; but the thirst was not urgent, and the sore throat incontend professionally, and concerning whom consequently he derived siderable. his information at second hand, and in a way not quite satisfactory gradually recovered, and in ten days she was able to be out of Under the use of laxatives and diaphoretics she to his mind. It is unnecessary to describe all these cases, as they doors. On the 4th of May she was in excellent health, and enpresented a singular uniformity of characters. Two only may be gaged in her usual occupation as a farm servant." Neither this added, the one as an example of the disease in its severe form patient, nor any other but Mr. G. W., and another girl, a house when not fatal, the other to exemplify the mildest form. servant, suffered from pains of the extremities or incomplete para. The third case in point of order was that of Mr. G. W., the son of Mr. and Mrs. W., who was taken ill on the same day with his father. But it may be as well to take notice in the first instance of the fourth, because it was the only other that proved fatal. This was the case of a servant girl in the family. Mr. G. W., son of Mr. and Mrs. W., aged about 27, "afterlysis. being absent from home for about three weeks, returned with his The foregoing case will serve to illustrate the characters of this sister from the Island of Skye on the 19th January, three days be. little epidemic, so far as the symptoms are concerned. I regret fore his mother took ill, On the 25th, six days after his return, that no opportunity occurred for 'illustrating its pathology by as. |