former; still, however, without the wished-for success. Being then apprehensive that I had not taken a sufficient dose, I re solved, after a similar interval, to take the remaining whole bottle at once, which had much the same effect in every particular as the first half-bottle; with this difference only, that the sickness was of much longer continuance, but not sufficiently violent to enable me to vomit without great difficulty. The nausea on the stomach remained for several days; and the gout there, as well as in the extremities, evidently gaining upon me, presented no other appearance or feeling, than that I must shortly sink under it. Much about this time there appeared all over my body an eruption resembling very much the measles; but as I had had that disorder many years before, I concluded it must have been occasioned by the medicine. A few days after this, I was seized in bed very suddenly with a copious spitting of blood, attended with a wheezing from the throat, and coughing, which for a while threatened suffocation: this, it is supposed, must have arisen from the rupture of some vessel about the lungs, by efforts made, during the sickness, to vomit.

"The hæmorrhage continued to return in an alarming degree, at intervals, for a week or ten days, till, weakened by its frequent recurrence, and apprehensive, if longer neglected, it would inevitably lead to the most dangerous consequences, I called in two medical gentlemen to my assistance, by whose skill and attention I was soon restored to a state of rapid recovery. "-Here is a very clear and able description of a violent fit of gout, in which the eau medicinale had a very fair trial, and wherein it not only completely failed, but was soon followed by a considerable aggravation of the complaint, and with symptoms threatening the most imminent danger,-delirium, violent vomiting, intense pain, the body covered with eruptions, and accompanied with feelings and appearances as if he had been poisoned; to these succeeded an alarming bleeding from the lungs, placing his life for many days in a state of imminent danger. The patient had often had attacks of gout that were fully as violent as this in the commencement, but were never followed by such distressing and alarming symptoms as appeared on this occasion: it is therefore but reasonable to suppose, that the very unusual disturbance in his system was occasioned by the remedy. How far to refer the hæmorrhage from the lungs to it, may perhaps appear difficult; unless we suppose there may have been some translation of gout, to that part, as well as to the stomach and head, or perhaps. some vessel may have been ruptured in the lungs from the vio-. lent straining in vomiting. Whatever was the cause, the effect

was productive of great danger and alarm. I shall not attempt any reasoning on the operation of the medicine, but leave that for more able hands to do; but I cannot help remarking the similarity of its effects with some vegetable poisons, in its violent operation on the stomach, succeeded by a sort of nettle-rash eruption over the whole body, which frequently happens also after what is vulgarly called a surfeit; that is, when that organ is violently disturbed by any thing that powerfully disagrees with it. I have now given the whole of my experience of the powers of the eau medicinale; and hope that others who have had more opportunities of seeing it tried, will be tempted to favour us with any information which they may be able to communicate, in order that such a stock of knowledge with regard to this medicine may be accumulated, that the faculty at large may be able to decide upon its merits, and thereby be enabled, if generally beneficial, to employ it, or if otherwise, to restrain the destruction it may occasion. The impression on my mind at present, from these trials, is by no means favourable to its general adoption.

While I am on the subject of gout and its remedies, I cannot help expressing here the pleasure I received from reading, in the Philosophical Transactions for last year, Part I., the experiments of Mr Home and Mr Brande on magnesia, for the relief of calculous complaints. Its modus operandi appears to be, by preventing the formation of uric acid; and from the result of their experiments, it appears in several instances to possess a greater power in diminishing this acid than any of the other alkalies, though these were employed very largely. I think that this is a discovery of great importance, both to those troubled with calculous complaints, and to those concerned in their treatment. But the interest I felt in their experiments arose from this circumstance, that in their treatment of one nephritic patient with magnesia, who was also a very gouty subject, (a very common occurrence), they remarked, he had not the slightest symptoms of gout from the time of the last attack, which was more than a year back; a longer interval of ease than the patient had experienced for the last six years. I believe, but for the latter observation of the remarkable exemption from gout, which the patient experienced during, and after, the use of magnesia, that Mr Brande's paper would have passed through my hands without making any great impression on my mind; but his remarks here are so analogous with my own experience of the utility of magnesia in the prevention of gout, that my attention was completely arrested. Since it has been lately suspected that gout. has arisen from a redundancy of a peculiar acid termed uric acid, VOL. VII. NO. 27.

X

the alkalies have been employed pretty freely for gout, particularly soda; and I believe it has been used in many cases with considerable advantage. But I have repeatedly found the daily and continued use of magnesia still more beneficial; and patients, during its use, have enjoyed so wonderful an exemption from gout, that they could scarcely attribute their relief to a remedy apparently so unimportant; and many more would have shared its advantages, by a freedom from the disease, had their faith in the means been sufficient to have kept them to its regular use; but, from a want of this, they were not so fortunate. The ingenious Mr Home, to whom the public and profession are already so much indebted, considers the superiority of magnesia over the other alkalies, in the prevention of uric acid, to consist in its insolubility in water, as it thereby remains longer in the stomach, and gives it a greater opportunity of combining with an acid; while the other alkalies, from their solubility in water, are carried very rapidly into the circulation. But leaving the theory of its operation out of the question, Mr Home and Mr Brande have given us great reason to believe, that it does generally exert a greater power in preventing the formation of uric acid, than any other medicine we are at present acquainted with; and if gout does at all depend on the presence of this acid, it is surely of great importance to know the best means of correcting it, as we are thereby enabled to keep off, if not cure, a complaint that makes so many people dupes to almost every empiric pretending to cure gout. I have generally ordered my gouty patients to take regularly twice every day, more particularly in the intervals of the disease, as much magnesia, sometimes joined with a small quantity of rhubarb, not exceeding five grains, and a grain or two of ginger, as their bowels will admit. If this plan is regularly and constantly adhered to, I feel very confident that arthritic patients will receive much benefit, and not only greater freedoin from gout, but also from calculous diseases, in which this medicine was so beneficial, by the experiments of the gentlemen before-mentioned; these complaints generally arising from the same causes, and frequently occurring also with gout in the same subject. It will also have another recommendation to the gouty, from this consideration, that they will be under less necessity of submitting to restraints in eating or drinking, than they can possibly be under by any other system; for this medicine is better calculated for counteracting dyspeptic complaints than almost any other, and when combined with a small quantity of rhubarb and ginger, forms one of the very best remedies for strengthening the digestive organs, that we are at present acquainted with; an object of no small importance in gout. I claim the merit of no great originality

323 in the recommendation of this medicine, as the same has been recommended in gout in the writings of Cullen, and I believe also by Heberden. They, however, have only mentioned it casually as a useful purgative when wanted; but I recommend it as medicine not for this purpose only, but as one likely, when taken constantly, to be productive of permanent advantage, by preventing the recurrence and occurrence of two powerful dis

eases.

Mase, Clifton, May 11, 1811.

XII.

History of Three Cases of considerable Effusion of Blood, from local Injury, to show the utility of making a free Incision to al low of its removal. By GEORGE LANGSTAFF, Member of the Royal College of Surgeons, London.

IN

N extensive effusions of blood, either beneath the integuments or fascia, arising from external violence, it is, I believe, the general practice to apply cooling lotions to the tumor (or ecchymoma, as it is termed) in order to prevent the surrounding integuments from suffering from the consequences of inflammation, as well as to assist the absorption of the effused blood. This plan of treatment, even when conducted in the most scientific manner, and under the direction of many eminent surgeons in London, I have seen attended with the following consequences: The patient suffered excessive pain from the inflammation, and tension of the skin, which caused symptomatic fever; the inte guments at last sphacelated, and produced an ill-conditioned sore, discharging an. offensive sanies with ichor, which was with difficulty healed.

Being fully aware that a plan far more effectual than the former might be adopted, I was induced to have recourse to the following expedient, which, I am happy to say, even exceeded my expectations; as will, I trust, be fully proved by the success which attended the following cases.

A boy about 13 years of age, fell from the mizen-top of a ship, and struck the ulnar part of his right arm; a swelling and discoloration immediately ensued. The next day the bruised part was extremely painful, and the whole arm swoln. On the following morning I found a tumor about the size of an orange,

in the under part of the arm, about three inches from the extremity of the ulna, or olecranon; the integuments were hot, and so tense, that the tumor felt like a solid substance.

A free incision was made through the integuments, which proved the contents of the tumor to lie beneath the fascia of the fore arm this was also divided to the same extent as the former, when a small tea cupful of coagulated blood was removed, resembling black currant jelly in appearance, as well as in consistence. The part was well sponged with warm water; the wound brought together with adhesive plaster, and healed by the first intention, except a small aperture, from which there was a sanious discharge. Both the pain and swelling soon subsided by the use of cooling applications, and the wound healed.

Mr Dear, a carpenter, aged 70 years, remarkably stout, and of an excellent constitution, received a blow on the left hypochondrium, by the fall of a large piece of timber. Having been taken to his apartment, a surgeon was sent for, who ordered aq. lith acet. comp. as an external application to the part, which, in the course of a few hours, was swoln to an immense size. This plan of treatment, with such internal remedies as were thought proper by his attendant, was pursued six days; but the extreme violence of the pain, heat and inflammation of the part affected, together with the symptomatic fever, had so much alarmed the patient and his friends, that they imagined the injury to be of more serious consequence than it really was. At this time I saw him. He was delirious, and had been so two days; his pulse was full and hard; skin hot and dry; tongue parched; urine high coloured. I found a tumor extending from the middle of the crista ilii to the margin of the fourth false-rib, and posteriorly as far as the spinous processes of the lumbar vertebræ. The skin had begun to slough, to the extent of an inch, at the most prominent part of the tumor. It was very hot, and extremely tense to the touch, which caused the patient much pain. The discoloration of the whole injured side of the body proved most evidently the violence of the blow.

Having no doubt that blood formed the tumor, and that the integuments would slough, to allow its escape, which might be attended with serious consequences, I determined, even under all the unfavourable circumstances, to lay the part fairly open, in hopes of relieving his sufferings, and expediting the curative process.

An incision of about three inches, including the sphacelated part, was made, and a small bason full of firm coagulated blood, like currant-jelly, taken out. The part was well sponged with warm water, and the sides of the cut afterwards brought toge