I mention the above, not as the only cases of cure with this medi. cine, but as prominent cases in three different forms of disease. I am persuaded that the Alnus Serrulata is one of our most valuable vegetable alteratives, and deserves the careful and attentive investigation of the physician, pharmacien, and medical botanist.

More recently I have witnessed the valuable properties of the extract, prepared by the evaporation of the decoction to the consistency of thick tar; it makes a very convenient form for pills or solution. I prescribed a strong decoction of the extract, two months ago, in a case of impetigo of long standing, and which had proved very obstinate, refusing to yield to all the various plans of treatment both general and local, persisted in for more than three years. The lady was of full habit, somewhat corpulent, but general health good; the disease affected both ankles over the instep. She was directed to drink a decoction of the black alder and 3 j. of the extract dissolved in 3 viij. of water for a local application twice a day. In two weeks her husband reported to me "that the 3 j. of extract had done more for her than all other remedies put together." At the present date, two months since the first application, she is entirely cured.

Impetigo is in my experience a very intractable form of disease; yet, in this case it yielded readily to the extract of Black Alder. It is the first and only case I have ever prescribed it in as a local remedy; I intend however to give it a more extended trial in some other diseases, where its tonic and astringent properties will be more fully tested.

I am informed by the individual who prepares the extract, that it is an invaluable remedy for dyspepsia, taken in doses of 3 ss. three times daily.

I have intentionally condensed these remarks to bring them within the compass of an ordinary letter; and if you think my experience with this medicine, and these remarks are of any value to the profession, they are at your disposal.

ART. VIII.-On the Use of Quinine, &c.-By W. S. KING, M. D., U. S. A. (In a letter to the Editor.)

Fort Leavenworth, Feb. 20, 1847. DR. C. A. LEE,-Sir,-In the New York Jour. Med. for November, 1846, favorable allusion is made to the practice of administering quinine, in combination with a diaphoretic. Without being aware that this mode of giving quinine had been recommended or used by others, I have been in the habit of resorting to this combination for some time past, particularly during the past summer.

The novelty and excitement incident to the Santa Fe expedition, caused much anxiety among the sick here, lest their recovery should not be rapid enough to enable them to leave with their companies. The interests of the service also rendered it peculiarly desirable that the cures should be as prompt as possible. As a means of effecting the desirable object, quinine and sp. nitr. dul. (generally, however, with the addition of tinc. opii or tinc. opii comp.) was my usual and favorite prescription. This formula was used, in several hundred cases, of intermittent and remittent fevers, and, in almost every case, with happy effect. With opium, as an adjunct to the quinine and sp.

nitr. dul., it will readily be conceived that the value of the prescription is increased, and is rendered capable of fulfilling a much greater number and variety of indications. It may then be employed in those cases of fever, where there is much restlessness and nervous excite. ment, and, by allaying pain, checking various symptoms, soothing and tranquillizing the patient's feelings, greatly contributes to his comfort and convalescence. The diaphoretic properties of the prescription are much increased by the addition of the opium. The power which this medicine possesses of restoring the equilibrium of the circulation and excitement, by determining to the surface, makes it particularly useful in the hot stages of fever, and enables you to use the quinine earlier than otherwise would be safe.

There are several advantages in this mode of giving quinine. 1st. There is a gain as to time, often of twenty-four hours in intermittents, and in remittents, of perhaps several days, which would otherwise be lost in waiting (as recommended by good authority) for the apyrexial intervals, before exhibiting the quinine. 2. By tending to lessen and thereby shorten, and speedily terminate the paroxysm of fever, you place the patient in a short time, in a fair way to recover, and thus diminish the liability to complications which often occur, and in a great measure secure him from the consequences of accidental affections of a distressing and dangerous character. 3. To shorten the paroxysm of fever, and thus destroy the chain of morbid influences that surround the patient, before the strength and restorative powers of the system are weakened, are objects of the highest degree of importance, particularly so in broken down constitutions, or, in such as are feeble and exhausted by previous injurious influences. It needs no argument to show that any means calculated to promote these results must exert an influence highly curative.

I have been much pleased with the success attending this union of remedies, and believing it to be capable of fulfilling the indications I have pointed out, can cordially commend it to those who have not yet tried this method.

Not considering that the use of purgatives or other preparatory treatment was necessary in all cases, I have frequently given the quinine and diaphoretic (with or without the opium according to circumstances) at once on the patient's reporting sick, and have had no reason to regret it. By this plan the patient is exempted from the disagreeable and debilitating effects attending the exhibition of emetics and purgatives, which in many cases may be happily dispensed with. The following formula answers very well in some cases, and where no irritability of the stomach exists, is often preferable to the one already mentioned.

Fiat mist.

Sumatur alternis horis. The antimonial was generally omitted in my usual prescription which was similar to the above, with this exception. I do not pretend that in all cases of intermittent and remittent fever, this alone will answer, but, that in experimenting with remedies, or plans of cure, I have found that I could cure and return

to duty a greater number of cases, and in a shorter time, by this, than by any other medical treatment. I do not offer these considerations because I esteem them new, or worthy of special attention, but for the purpose of bringing the practice of using quinine in combination with various other substances, (which I believe has many advantages over the plan of giving it alone), to the attention of the profession, with the hope that farther experience will lead to improved modes of exhibiting this article, that will be free from the objections now made by some to the use of this invaluable medicine.

[No apology will be needed for appending to the above the following interesting case recently received from Dr. King.]-(Ed.)

Fort Leavenworth, May 3, 1947.

DEAR SIR,-An article in the March number of your Journal, entitled "Deglutition excited by dashing cold water on the Face," reminds me of a case I witnessed in the winter of 1843, among the Winnebago Indians in Iowa. An Indian belonging to this tribe, in a drunken quarrel with his wife, received a severe flesh wound in the thigh. Owing to his intemperate habits, and their improper method of treatment by filling the wound with various irritating substances, violent inflammation followed, attended with severe constitutional symptoms from which he finally died. On the day previous to his death, I was requested to call and see him. When I arrived, he had lost all power of deglutition, and the nourishment his wife was attempting to administer, with the hope of preserving his failing strength, when poured into his mouth, remained unswallowed, and threatened instant death from suffocation. By my direction he was turned over on his side, to allow the fluid to escape from his mouth and enable him to breathe. His wife, who was unceasing in her attentions, then filled her mouth with cold water, and introducing a small quantity of the broth (by means of a wooden spoon) into the mouth of her husband; she immediately spurted the water from her mouth on his throat and chin, and, at the same time using gentle frictions with her fingers to the same parts. The muscles of deglutition were excited to action instantly, and the fluid was swallowed. This was repeated again and again with like success. The custom of using the mouth in the manner mentioned to eject the water, is one which prevails among almost all Indians, and is generally employed in washing their young children . and offensive wounds or sores. It may not be uninstructing to notice another part of the treatment adopted by this squaw in this case. Observing the respiration to become exceedingly laborious, in consequence of a quantity of matter clogging the air passages, she procured a long feather, and passing it down the throat and larynx, it was immediately drawn out loaded with a tenacious phlegm, which she removed by drawing it between her fingers, and again introduced it. In this way, in a short time, a large quantity of matter was removed with decided and speedy relief to the patient, manifested by the breath. ing becoming freer and more prolonged. Occasionally she dashed the water on the chest in the manner mentioned, evidently with a view to excite the respiratory effort. In these attempts to relieve her husband she persevered until an hour before he died. He was perfectly

conscious until near his end, and encouraged her in these efforts by intelligent signs expressive of his wishes to that effect. The life of this Indian appeared to have been prolonged by the untiring efforts of this poor squaw, as I believe he would have ceased to breathe sooner, had not the timely removal of the obstruction saved him from suffocation. In the case of his death her own life was forfeited by the sanguinary code of the Indian, and she was accordingly killed by her husband's relations at the grave of the deceased, the day after he died.

ART. IX. Puerperal Anæmia; or a peculiar anæmic Condition, occurring in gestating and lactating Females.-By H. N. BENNETT, M. D., of Bethel, Ct.

My design in the present paper is to describe a certain morbid state, which I conceive to be peculiar to females who are either pregnant, or in conditions consequent to pregnancy; in short, a morbid state resulting only from the processes of reproduction. Within a few years past, I have met with numerous cases of the character which I am about to describe, and my description will be drawn chiefly from observation, as as I have never seen in the Journals or elsewhere, any accurate and complete account of this disease. Several articles have appeared at different times in the American Journal under the head of " Nursing Sore Mouth," which give a very correct description of one of the most common and decisive symptoms of the affection, namely, a peculiar inflammatory state of the buccal and lingual mucous membranes. One of these articles is by Dr. Backus, of Rochester, N. Y., another by Dr. Taylor, of Monticello, Florida. An extract from a paper by Dr. E. Hale, jr., was also published in the same Journal for April, 1842. I may refer to these articles in the sequel of this paper, only saying for the present, that the true pathology of the disease is not in my opinion, recognised in either of the papers mentioned.

According to my experience, this affection frequently commences from the seventh to the eighth month of gestation, a period at which the development and growth of the foetus are most rapid, and draw most forcibly upon the vital powers of the mother. The female begins to assume a pallid appearance, not unlike the anæmic pallor common to cachectic conditions; but this appearance is not at first accompanied by emaciation. The appetite is often impaired, and digestion rather difficult, accompanied with gastralgia, especially after taking certain articles of diet. There is a decided tendency toward diarrhoea where the gastric symptoms are marked. The function of digestion, and the appetite may, however, at this period, remain unimpaired, and the female only complain of lassitude, neuralgic pains in different parts of the body, and some slight cerebral symptoms common to all anæmic conditions. After a continuance of this state for a longer or shorter period, it is not uncommon to witness the occurrence of oedema. This may supervene either before or after delivery, and is confined to no particular part of the body; it is very generally perceptible in the face. It may be either slight or excessive. I have known one instance in which the cedematous effusion was accompanied by alarming symp

toms. In this case the oedema was excessive, and was attended by accidents on the part of the respiratory organs; namely, difficulty of breathing, respiration accompanied with humid râles, and inability to lie in the recumbent posture. The lady was delivered of twins, and notwithstanding the temporary increase of all the symptoms, after this event, she finally recovered. This œdema has no special characters, and is to all appearance, similar to that which occurs in other anæmic

states.

Accompanying the symptoms just described, or immediately succeeding it, I have frequently seen the "Sore Mouth," previous to delivery. It is this symptom which I look upon as pathognomonic of the affection in question. The inflammation of the buccal and lingual mucous membranes, has characters which I believe to be peculiar, and which I have never seen in any other disease. Upon inspection, the parts affected appear dry and polished, of a pink color of different shades, sometimes very nearly approaching a red, while the other portions of the mucous membrane appear paler than natural. The inflamed parts are usually the edges and inferior surface of the tongue, the surface of the lower lip in contact with the teeth, and that of the cheeks. The parts thus affected, are painful and excessively tender. The first indication of the development of this inflammation is very correctly described by Dr. Taylor. There is "a sensation of soreness and heat of the tongue and lining membrane of the mouth, accompanied by a discharge of a thin watery fluid." "The patient compares the pain and heat of the mouth to the sensation produced by scalding." The female is compelled to avoid those articles of diet which contain much salt, or spice of any kind, particularly pepper. Sometimes even all solid food.

At a later period of the disease, you will frequently see, within the limits of the pink patches, especially upon the edges and inferior surface of the tongue, and upon the labial membrane, a number of pustules or rather vesicles of some size, containing a milky fluid, which appears as if lifting up a thickened and indurated epithelium. These pustules sometimes degenerate into small ulcers with raised edges, which are exquisitely tender, At other times, the fluid would seem to have been reabsorbed, or discharged without leaving an open ulcerated surface. In any case the ulcerations occurring in this disease, are very distinct from those of aphthous affections. I may remark, in passing, that this inflammation, particularly in its first stages, has appeared to me very superficial, and that it materially changes the character of the epithelium, which becomes thickened and of a smooth polished appearance. This inflammation is not peculiar to the mouth, it sometimes occurs upon the external organs of generation, and occasions a very troublesome soreness and pruritus. I have known but two instances of this kind. In these the mouth, and labia were affected conjointly.

While the mucous membranes of the mouth, &c., are in this condition, there are also increased symptoms of gastric disturbance. The appetite is very much impaired. All stimulating and acrid ingesta produce a lively burning sensation at the epigastrium. The bowels are sometimes constipated, but usually immoderately loose, the discharges being thin and watery. In short, the whole gastro-intestinal