take place, unless in connection with something within the cavity rendering it necessary. 17. When balls lodge in the bones of the pelvis, they should be carefully sought for and removed, if it can be done with propriety and safety. 18. In a wound of the bladder, an elastic gum catheter should be kept in it, until the wound is presumed to be healed; unless its presence should prove injurious from excess of irritation, not removed by allowing the urine to pass through it by drops, as it is brought into the bladder. 19. In all cases in which a catheter cannot be introduced, in consequence of the back part of the urethra or the neck of the bladder being injured, an opening for the discharge of the urine should be made in the perineum. 20. The treatment of all these injuries must be eminently antiphlogistic, principally depending on general and local blood-letting, absolute rest, the greatest possible abstinence from food, and in some cases from drink, the frequent ministration of enemata, and the early exhibition of mercury and opium, in the different ways usually recommended, with reference to the part injured. (Ranking's Abstract.) Treatment of Chronic Cystitis by injections of a solution of Nitrate of Sil· ver. Dr. Robert L. MacDonnel, in an interesting paper in the British American Journal of Medical and Physical Science, (Sept., 1847,) extols, in strong terms, the efficacy of injections of nitrate of silver, in chronic inflammation of the bladder,- -a disease which has proved very refractory to other remedies, and which entails on those who labor under it, the most exquisite suffering. In proof of the value of the remedy, he relates four cases, one of which is the following "A gentleman consulted me last February, under the following circumstances. He had suffered for some months from inflammation of the bladder, marked by frequent desire to pass water, accompanied by heat and scalding, violent straining, pain in the region of the bladder, above the pubis and in the perineum, and a constant feeling of heat and weight in the lower portion of the abdomen. These symptoms gradually increased in severity. The urine became at first bloody, and afterwards purulent, and the desire to void it became so urgent, that it had to be yielded to at last every fifteen minutes; the discharge of the fluid being followed by pain and scalding at the neck of the bladder, and along the course of the urethra. His general health became impaired; and his sleep being so frequently disturbed, a haggard and anxious expression of countenance, and extreme irritability of the system, were soon established. "When he first consulted me, fully one-half of the fluid passed from the bladder was pure pus; and after repose, a deposit of blood-globules was found to intervene between this and the supernatant urine-the latter being highly alkaline, fetid, and albuminous. Examined microscopically, it exhibited some scales of nucleated epithelium, a large deposit of triple phosphate in prismatic crystals, pus, and blood-globules. There was no pain in the loins or along the ureters. He had a stricture of long standing, about one inch from the orifice of the urethra. In addition to the above characters, the urine was frequently mixed with tenacious masses of lymph, varying in length from half an inch to an inch,* and entangling a quantity of earthy matter; they frequently obstructed the passage of the urine through the stricture, and required to be broken up and squeezed through by the pressure of the patient's fingers. "Having dilated the stricture, so as to allow a large-sized catheter (No. 11, Weiss) to pass, I determined to treat the disease by injections of nitrate * C'est encore dans les cas de suppuration, qu'on trouve des productions pseudomembraneuses dont parlent les auteurs. C'est l'expulsion de ces fausses membranes par l'uréthre qui a fait répèter à tant de medicins que la tunique muqueuse de la vessie pouvait être entièrement detachée et expulsée par portions avec les urines.Ferrus, Dic. de Méd., Art. Cystite. of silver; and accordingly, on the 17th of February, I injected into the bladder a lotion composed of eight grains of lunar caustic, two drachms of tincture of hyoscyamus, and four ounces of distilled water. "The injection caused hardly any inconvenience, except that of inducing a strong desire to empty the bladder, which was prevented by compressing the penis, until the fluid had been in the bladder for about one minute, when it was allowed to escape. The next day, the patient stated that he was somewhat better, but the quantity of pus and blood was not, however, much diminished, and the flakes of lymph were more numerous and larger than before. Although he continued improving, yet, as the amendment was not as rapid as I anticipated, injection of the viscus was again resorted to on the 5th of March. On this occasion, the quantity of caustic was increased to sixteen grains in the four ounces of distilled water, and the hyoscyamus was omitted. A decided improvement immediately followed; the frequency of making water was greatly diminished; instead of requiring to be voided every fifteen minutes, the bladder could retain its contents for more than two hours at a time, and the quantity of pus had greatly decreased. An injection, of the same strength, was again employed on the 28th of March, and with happy results. The urine could now be retained for three or four hours; was passed without pain or scalding; was clear and transparent, and, to the naked eye, free from pus; but, when examined microscopically, a deposit of pusglobules and some epithelial scales were perceptible. On the 18th of A¡ ril, I repeated the injection, and since then he has been completely free from any symptoms of his troublesome disease; he has resumed his former mode of life and pursuits, and has been subject to various changes of temperature whilst travelling, without experiencing the least return of his former symptoms." The method of injecting the bladder which Dr. MacDonnell has found most efficient is the following: "The patient being placed either in the erect position or on a sofa, a gum elastic catheter, about the size of No. 9 or 10 (Weiss,) is introduced, and water at the temperature of 98° Fahr., is injected through this into the bladder, by means of a caoutchouc bag, or, what I prefer, a syringe, with a "three-way valve," by which the fluid can be drawn back from the cavity if necessary. After the bladder has been completely cleansed of any fetid urine and mucus which may be contained in it, the solution of the caustic being heated to the same degree, is to be introduced in a similar manner, and allowed to remain there for about one minute, care being taken, by compressing the urethra, to prevent its being forcibly ejected by the violent straining that is certain to be induced. The quantity of water or solution should never exceed four ounces, for though the bladder in its healthy state is capable of containing nearly a pint and a half of urine, without being over-distended, yet as the quantity it is capable of retaining in severe chronic inflammation, seldom exceeds a few table-spoonfuls, the bladder accommodates itself to its diminished contents, and gradually becomes smaller, and consequently, a large injection would act injuriously in two ways-by over-distending the organ, or by passing up into the ureters. In fact, we find it unnecessary to use a larger quantity of the solution than I have mentioned, for it requires some address to introduce even that amount without resorting to force. The patient is then ordered a warm bath, and should the urine become bloody or mixed with shreddy concretions, he should use frequent fomentations and anodynes. But these symptoms seldom last for more than a few hours, and our patient should always be informed that such consequences are likely to be the immediate effects of the operation. "My patients have not suffered from retention of urine, which it appears frequently follows the use of the solid nitrate in the practice of Lallemand, nor have they had any inconvenience which was not readily allayed by an opiate. "The advantages which I consider the solution of nitrate of silver possesses over that substance in a solid form are, first, that we can employ it of various strengths, from one to four grains, or even stronger if necessary. Secondly, we are certain that the application comes in contact with the entire diseased surface. Thirdly, we are also satisfied that it does not act more violently on one part than on another. Fourthly, it is more readily employed by an inexperienced operator; and, above all, it cannot possibly be attended with any risk, from the apprehension of which it is not easy to divest the mind, when using the porte-caustique of Lallemand; and together with the above advantages, it has this also to recommend it, that it will be found at least equally successful.”—Amer. Jour. Med. Sci. Treatment of Dissection-wounds.-D. Hargraves recommends the following as a simple, and in his experience, efficacious plan of treating dissectionwounds. It is applicable to the fingers and the thumb, the parts most frequently liable to be wounded:-Wash them well for a few minutes in cold water, then suck them; immediately after apply a ligature a little above the cardiac side of the wound with such tightness as will induce decided congestion, which will be indicated by the color of the parts; some blood will also flow from the injured surface, and a certain degree of numbness will follow its application. The ligature is then to be firmly tied and knotted, and allowed to remain on for at least twelve hours; I have kept it on for double that period, and still pursued my professional engagements. The physiology of such treatment is explained by the ligature causing a permanent stasis in the fluids of the part injured on its distal side, and producing a well-marked plethora there; the greater the amount of it, the greater will be the impediment to absorption. The constriction caused by the ligature, will also oppose a barrier to the return of the venous and lymphatic fluids into the system, consequently to their being circulated through it, so that the poison is prevented entering into the constitution and destroying it, and will then be eliminated locally from the part where it was first applied; thus suffering and pain will be obviated, and life, valuable to all, will be preserved.— Dublin Med. Press. Removal of a Portion of the Substance of the Brain for Cancer. Temporary Recovery. By M. SANSON. In the year 1834, Mr. B. came to Paris for the purpose of undergoing an operation for a cancerous tumour of the orbit; the growth had acquired the size of the head of a fœtus. Pains in the limbs and some degree of previous paralysis, showing that the brain was in all probability implicated, induced Professor Sanson at first to set aside all idea of an operation. But, the patient having expressed his settled determination to destroy himself if the operation was not proceeded with without delay, M. Sanson consented to operate in presence of several British practitioners, fellow countrymen of the patient. A portion of the frontal, the nasal, and maxillary bones, having been removed, the dura mater was found to be affected, and was likewise excised, but the cerebral substance itself was occupied by the disease; and after a short conference, in which Sanson alone persisted in the opinion that it was his duty to achieve the operation he had begun, one ounce and a half of cerebral substance was removed by a section which penetrated into the lateral ventricle. The cerebral vessels were cauterized with a heated probe, and the patient recovered completely from the effects of this tremendous operation-no paralysis, no disturbance whatever of the cerebral functions having been observed. Sixteen months after, the patient died in consequence of reproduction of the growth in the scar, and on dissection the disease was found to extend as far as the posterior cerebral lobe. (Med. Times.) Burns treated with Ammonia.-M. Guérard, Physician to the "Hotel Dieu," has used, for upwards of twenty years, a concentrated solution of ammonia in burns of the first and second degrees. He has frequently hap * Aqua Ammonia, we presume.—Trans. pened to burn himself with charcoal, phosphorus, gunpowder, etc., and the immediate application of this remedy has always arrested any further development. When the ends of fingers are burnt, he plunges them in the liquid without admixture of water. If the seat of the burn was such as to prevent this immersion, he would cover it with a compress dipped in the ammonia, and would prevent its evaporation by covering it with dry cloth. In such cases it is necessary to repeat the application from time to time, whenever the heat or sensation of burning returns. As soon as the ammonia is applied, the pain ceases; and the relief continues longer, in proportion to the strength of the solution. According to what M. Guérard has himself experienced, he believes that the application should be continued at least an hour, in order to give permanent relief, after which the burn may be left without any further dressing. If the burn be extensive, one hour will not be sufficient, but then the patient will be apprised of it by the return of pain. M. Guérard does not believe this application adapted to cases in which the skin is removed. The pain is immediately relieved, no phlyctæna are developed, and the cuticle dries and finally falls off like parchment. It is well to observe, that if the application has been made to an extensive surface, the compresses should be handled with forceps, for concentrated ammonia very rapidly vesicates the skin in the healthy state. The patient, as well as dresser, should also avoid breathing the vapor, and the vessels used should be made either of tin or of earthenware, inasmuch as copper is readily acted upon by ammonia. The use of ammonia in burns is not new. Physicians have long since observed that it prevents in such cases the development of inflammation. It has been seen, however, that it is especially suitable for burns of small extent, and in which the skin is not excoriated, that M. Guérard advises the use of this caustic. Thus far we see no objection to recommending its trial to practitioners. As to burns involving a large surface, it requires more circumspection. There are efficacious means in more common use, such as the oleocalcareous liniment and carded cotton, prolonged cold baths and fomentations with iced-water. There is at this time a case at the Hopital St. Louis, in which the most happy results have been obtained with cold water.—[Translated from Jour. des Conn. Méd.-Chir.—Bull. Gén. de Therap., April, 1847.} -South. Jour. Med. MEDICAL PATHOLOGY AND PRACTICAL MEDICINE. Quinine in Acute Articular Rheumatism.—Several French journals have lately directed attention to the employment of quinine in acute rheumatism. We are informed that it was M. Briquet, now one of the physicians of La Charité, Paris, who first administered it in this disease. The success which he obtained could scarcely vanquish the repugnance which many had to prescribing so energetic a medicine. Some unfortunate cases, also, in which, from the dose being too large, or the individuals peculiarly predisposed, alarming accidents, and even death had been caused, added to the discredit inwhich it was at first held. At present, however, a re-action has taken place in its favor, and a considerable number of the hospital physicians in Paris are of opinion that, given with prudence, in moderate doses, beginning with 14 grammes to an adult, and 75 gr. to a child, the sulphate of quinine causes effects of a slightly energetic nature only, at most trifling cephalalgia, noises in the ears, and slight indistinctness of vision. Amongst the physiological effects, one of the most interesting, without doubt, is the depressing action which it exerts on the circulatory system, the pulse daily diminishing in force and frequency. In a few days the pulse has been known to fall fifty beats, and that without the individual experienc ing any very well-marked symptoms of intoxication. Another important effect, is the modification it produces in the rheumatismal pains. In general, at the end of 12 or 24 hours the patients are considerably relieved; the swelling and rigidity, however, still remain. Unfortunately this result is not al ways constant and durable, but there are exceptional cases, for in the great majority of instances, the amelioration is rapid and permanent. It has been objected to this treatment that it does not prevent the cardiac complications which are so likely to arise. But do we know any absolute means of doing this? Do we not see rheumatic pericarditis develop itself in individuals treated by the most energetic antiphlogistics? But in some cases it has been observed that the cardiac disease has diminished daily under the use of sulphate of quinine. On the whole, the treatment of acute articular rheumatism by sulphate of quinine, when employed with prudence, is without danger. Doubtless, it will not succeed in every case, but where is the remedy that will? Whenever there is no amelioration on the third or fourth day, notwithstanding that the dose has been gradually increased, the medicine should be discontinued, and some other treatment employed, such as bleedings, nitrate of potass, colchicum, opiates, &c. But whenever the pains are rapidly diminished, and the pulse rendered less frequent, it is very probable that the articular rheumatism will be cured on the eighth day. In one case it only continued four days. Sometimes it is useful in robust and phlethoric subjects to precede the use of sulphate of quinine, by a bleeding from the arm. It may be added that the drug is easily administered, that children take it without hesitation, notwithstanding its bitter taste, and that it will, probably, be of the greatest service in the treatment of acute rheumatism in young persons, a period of life when blood-letting, if not injurious, is seldom advantageous.—Month. Jour. Med. Science, from L'Unio Medicale, 23d Fevrier, 1847. Nitrate of Strychnia externally in Gout.-M. Wendt recommends the nitrate of strychnia, in the form of ointment, in irregular gouty affections; for example, in gouty affections of the vertebral column, which, through the filaments of the great sympathetic, attack the chest, and give rise to symptoms imitating angina pectoris. The formula recommended is as follows:nitrate of strychnia 10 parts; axunge 8 parts: to be made into a perfectly homogeneous ointment, and applied by friction on the sides of the spine two or three times a day.-Am. Jour. Med. Science, from Gazette Medicale de Paris, 13 Mars, 1847. On Bronchitis. By. Dr. THOMAS LAYCOCK, Physician to the York Dispensary, and Lecturer on the Theory and Practice of Medicine, Sometimes there is little or no expectoration during or after an attack of bronchitis; but there is a most teasing cough. In such a case an opiate is indicated, and may be safely given; but you must be very careful how you prescribe opiates in bronchitis. If the cough is excited by the mucus contained in the bronchial tubes, and not by an irritable condition of the nerves or their lining membrane, it is nature expelling an injurious thing. The mucus must be got rid of somehow, and I do not know how it can be got out of the tubes except by coughing. If you give an opiate, it is true that you give the natural effort a quietus, but at the same time, you paralyze the sensory nerves. You paralyze the muscular fibres; and at last, when the mucus has accumulated to such an extent that your patient must cough or die, he cannot cough! Old people are often complaining of their violent morning cough-as soon as they awake they begin ; but it is because mucus has accumulated in the bronchi during the night, and it is only perceived by their mucus membrane when sleep ceases-the sentinels have been dormant. But the mucous must be expelled, and, therefore, the patient must cough. The plan in these cases is to reduce the blenorrhea; first, by taking care that the membrane is not irritated by cold air, and then by suitable remedies. In the meanwhile preach patience to your patient, and tell him his cough is his safeguard so long as the lungs are clogged with phlegm. Sometimes mothers go to a druggist for "something for a cough" that their children had they get oxymel of squills and syrup of poppies, give a good dose to quiet the |