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arose, which she did not inform me of, and upon the ad- high temperature in baking, the starch is converted into vice of some old lady friends, applied cold wet bandages dextrine, a soluble substance which is easily digested by to the head for its relief. These soon relieved the very young infants. headache, but the cough returned the night follow- Dalton (Physiol. 6th Ed., p. 120) says: "The interior ing in all its former violence. Warning her against a re- of the loaf in baking does not rise above 212° F.; the petition of any such methods, or meddling in any waywith exterior, which is subjected to a higher temperature, results that might be obtained in the future. I again "becomes covered with a crust formed partially of torprescribed for the cough. But it was much more obsti-refied starch, or dextrine, and caramelized sugar, nate this time, as has been repeatedly stated before as the fact in all cases under suppression, though when I did get control of it, the headache returned just as it was before, and continued for several days, when it, as well as the remnant of the cough, and all other symptoms rapidly disappeared, the patient soon regained all her strength and activity, and is as vigorous to-day as she

ever was.

Such cases, I repeat, it is of the utmost importance for all physicians of our school to understand and explain to their patients; and especially be on their guard against the serious results which patients themselves, their friends or neighbors, will often bring about by interfering with minor troubles, (that often arise solely from the physician's successful efforts in the cure of much more serious symptoms of the more vital organs), the patient driving the disease all back again to become worse, as it nearly always will, than at first. Many relapses are due simply to this very fact, and the physicion is often held responsible, when he may have done full justice to the case in all his curative measures.

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Duncan (Dis. of Inf. and Chil., vol. 1, p. 334) in speaking of artificial food for infants mentions favorably Gerber's milk food, “which is made of condensed 'milk and cooked flour, or bread, the dextrine taking the 'place of the sugar, and, when cooked with from eight to twelve parts of water, corresponds very closely to moth"er's milk." Of farinaceous food the same author further says: The flour must be baked till it acquires a light brown color, the temperature being about 400° or 450° F.; the granules of starch are thus disintegrated and "converted into a soluble substance named dextrine, which by further process of cooking, as in making pap, forms an excellent food for children." Tops and bottoms, so much used in England, owe their value to the same circumstance, namely, that "the farinaceous matter, which is so indigestible in infants, is broken up, by baking, into soluble dextrine.' This principle is taken advantage of in the preparation of most of the farinaceous artificial foods on sale. It is evident, therefore, from the foregoing facts, that though starch, as such, is indigestible and pernicious in its effects on the Had the patient in question been of a delicate, or infant, stomach, yet if properly prepared, it not only naturally feeble consti ution, or inclined to consump-loses these pernicious, properties, but becomes an easily tion, it would have beetn a serious question if the cough digested and highly nutritious article of infant diet. If could ever have been relieved, that is, cured,-a sec- at all doubtful of securing a proper degree of heat in ond time. baking, it may be advised to use only the crust of bread, in which we may always be sure that all the starch has been converted into dextrine and other soluble forms. These crusts cooked with milk and variously diluted with water according to the age of the infant, form an article of food which embraces the essential features of the best prepared foods. The materials for its preparation are The results in such cases, are, furthermore, all in always at hand, it may be freshly prepared for immedistrict accordance with the law of metastasis, for the dis-ate use; while the possibility of varying its nutritive ease, or the cause of it, upon being driven out of the lungs, by curative treatment, that is, from the mucous membrane thereof, and going to the head as described, seats itself upon the mucous lining of the frontal sinuses, which is much less vital than the lungs, producing congestion of that membrane, as it had in the lungs before, and thereby causing the headache, the brain itself not being involved), but the suffering generally subsides, in a few days at most, under continued curative treatment, without going on into inflammatory action. Or if it does, suppuration will take place upon that membrane (just as it would have done, and so often does, in the lungs, if not cured), and the purulent discharges resulting, find their outlet through the proper openings into the nostrils.

Favorite methods for the relief of headache under these, as well as other circumstances, are, in addition to the cold wet bandage, bathing the head with bay rum, cologne, camphor, etc., which never afford relief, except through suppression; but many will resort to them against the strongest advice that can be given.

(To be continued.)

FARINACEOUS FOOD FOR INFANTS.
BY GEO. ALLEN, A. M., M.D., WATERVILLE, NEW

YORK.

strength according to the age and digestive capacities of the infant makes it an article to be commended for children demanding artificial food.

Clinique.

TRANSFUSION OF MILK-SURGICAL CLINIC
AT WARD'S ISLAND HOM. HOSPITAL.

BY PROF. WM. TOD HELMUTH, M. D.

(Reported by Malcolm Leal, M. D.)

The patient that we shall now bring before you, gentlemen, is in a moribund condition, so I shall request that you make no demonstrations of applause.

sion.

The

I intend in this case to try transfusion of milk. operation of transfusion of blood from one organism to another is one of the oldest and is shrouded in mythologi cal conjecture. According to classical writers Medea withdrew the blood from the veins of Eson, and by filling them with the juices of herbs restored to him the vigor and sprightliness of youth. Pope Innocent the VIIIth At the last annual meeting of the Homœopathic Medis said to have been killed by the operation of transfuical Society of the State of New York, held at Albany, Feb. 11th and 12th, 1879, the Bureau of Pædology reported a paper in which, among other articles of infant diet, "well baked bread," with milk, was recommended. In the discussion of the paper by the society exceptions were taken to this recommendation on the ground that starchy food, like bread, was indigestible by young infants. Now, as the writer was particular to specify "well baked bread," it is to be presumed that he had an object in doing so. If bread be subjected to a sufficiently

In experiments of transmitting the blood of animals through the veins of one another it was supposed that if blood was taken from an animal of different species, the operation was fatal to the recipient, but if one of the same species supplied the blood to another of its kind, the operation was harmless. As has been since demonstrated in case of human beings, this rule does not invariably apply. The blood of sheep can be transfused in cases of severe hemorrhage with beneficial results.

It is said that the circumstance that led finally to the transfusion of blood, was the statement made by Sir Christopher Wren, that he could construct an apparatus by which he could convey fluids into the blood during life. To Denys and Emmerett, of Paris, belongs undoubtedly the credit of having first performed the operation on the human being with success.

In 1666 or thereabouts, Denys operated on a maniac and relieved him; a repetition, however, in another case, resulted fatally. The operation seems to have been perfected by Lower about the year 1667, who used the method of conveying the blood directly from the artery of a healthy person to the vein of a patient, allowing the force of the circulation to be the propelling power.

ent. We shall also be enabled to see what, if any, influence the age of the milk within limits has on the success of the operation, which will be a very important consideration.

Now in this case, I shall use a very simple contrivance.

I have had the vein at the elbow exposed before bringing the patient before you. We will have her brought in now.

The discovery at the time was regarded by some as a new era in the art of healing. The first experiments however, unluckily, resulted fatally, and excited so much alarm that in France transfusion was prohibited by an act of the Legislature, and soon fell into disuse. In 1826 Dr. Blundell revived the operation and practiced both the mediate and immediate methods as they are called. The second was that employed most successfully by letting the blood pass by its own gravity from the vein of one person to that of another, but find-and turn the stop-cock in the milk tube, and as the two ing this method unsatisfactory, he used "a propella," but still used venous blood--in this differing from Dr. Lower.

So, from time to time it has been revived and is now coming more into use. So far, the results have been unsatisfactory, mainly for two reasons- First, none but moribund persons have been selected for testing it, and the patients are unable to overcome the symptoms of shock which are more or less constant accompaniments of the operation, and secondly, there is danger of clots being introduced into the circulation causing embolism, and also of the introduction of air into the veins, thus causing death probably by obstruction of the capillary circulation of the lungs, with the symptoms of collapse. Many of the patients (like the one we have to operate on to-day) are wasted by disease-and it is not in these that the operation is as favorable, but in those who are suffering from the effects of severe hæmorrhage, the re sults are more satisfactory.

Now, although the operation in itself is simple, it requires nice adaptation, and when you recollect the danger of the formation of clots, and the entrance of air, and the condition of the patient, you will not be surprised if it should be unsuccessful.

To-day I do not propose to transfuse blood, though I shall hope soon to show you that operation-but I intend as I told you to use milk. This substance is now to supersede blood, and as it is more nearly allied to chyle than any other animal fluid, it is apparently eminently suited to the purpose.

Chyle is fat suspended in its finely divided condition, and milk is also fat in an emulsified form, and as chyle enters into the circulation at the subclavian vein without bad effects, it is fair to presume that milk may be used to supply nutrition in certain conditions. It certainly is very highly recommended. Dr. Hodder, of Toronto, in 1850. I think it was, treated several cases of cholera, and in 1873 Dr. Howe, of this city, performed the ope ration, using goat's milk-the patient died three days after the second injection, and Dr. Thomas repeated the operation with success some years after.

A history of the case is unnecessary beyond saying that the patient is in the last stages of pelveo-peritonitis. I have here an ordinary fountain syringe of small calibre; it has been most thoroughly carbolized. To the end of the india rubber tubing I have attached the efferent tube of an Aveling's instrument, to which I had a stop-cock fastened. The milk is heated in a carbolized vessel to such a temperature that as it passes out of the tube it is about blood heat. I now make a longitudinal incision into the median cephalic vein, which has been already exposed and insert into it a silver canula. You see the blood from the vein passes through the canula, upon which I now place my thumb. I now bring the efferent tube of the syringe close to the arm of the patient; I remove my thumb from the tube in the vein, streams meet, I gently pass the efferent into the efferent tube. You see there is not even a bubble of air allowed by this simple and gentle manipulation. Now watching her pulse carefully I inject about an ounce of the milk. This causes some dimness of sight and difficulty of breathing; the pulse becomes weak and rapid; waiting for her to recover a little from the effects, I inject half ounce more. Her temperature rapidly rises-96°, 97, 98; again I inject half ounce more; temperature goes to 101; the rise is too rapid. I think this will do for to-day.

(The patient in a chilly, exhausted and miserable condition, was taken to her bed.)

I had hoped to be able to show the transfusion of blood to-day, but our time has been so occupied we shall not have time.

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CESSFULLY TREATED WITH BROMINE. BY PROF. C. H. VON TAGEN, M. D., OF CHICAGO, ILL. Was called in consultation by Dr. Emily Pardee, of South Norwalk, Conn., Aug. 30th, 1878, to see Miss who had been taken ill about one week before. Patient presented the following symptoms: Fever, with burning pungent heat of skin, thirst, with desire for frequent drink. Tongue red, pasty, and disposed to dryness; brownish, furred appearance down the centre. Lips dry, and parched, countenance much suffused, eyes glistening. Pulse rapid and full; pulsation 120, temperature 104. Patient nervous and restless, especially at night; general downward tendency. The bowels regular; urine high-colored.

Examination of the right lower limb revealed a diffused, deep redness, and swelling of knee-joint. embracing the upper third of the leg and lower third of the thigh. Slight pressure over the part involved caused pain, and gave forth the usual white appearance, quickly succeeded by its former color, indicative of erysipelas. A sense of fluctuation could be readily detected at any point within the region mentioned. There was evidently The results of some experiments on dogs were report- extensive and diffused suppuration which had set in, ed by Dr. Howe in the Medical Record some months dissecting up the tegumental structure entire, over the ago, in which nine animals were bled to a condition of surface of which were several deep purple spots, about syncope. Seven of them were then injected with milk the size of five cent silver pieces, showing that extensive and died, while two were left to themselves and recov-destruction of the cellular and connective structures ered entirely. The Doctor thinks the cause of death in these cases was due to the quantity of milk that was injected; while Dr. Thomas thinks the fault was in the impurity of the substance injected. I have here some milk that is a day old, and intend to use this not from preference, but because it is the best I can get at pres

was proceeding within. To use a homely term it felt very "boggy" all about the joint.

The limb below the seat of invasion was œdematous, with more or less pain and soreness along the surface. The slightest movement of the joint was also painful. The previous treatment, both internal and external, had

been conducted with all due care and skill, and aided materially in limiting the invading disease.

The time had now arrived for a free use of the knife, which together with the internal and external use of Bromine, was recommended by the writer, and acquiesced in by both the attending physician and the family. Some ten or a dozen free openings were made along the anterior aspect of the invaded region, also in the popliteal space where the burrowing was equally profuse. A large quantity of foetid pus, mixed with necrosed cellular tissue, escaped. The suppurating cavity, or pouch, was then washed out freely with Bromine, one part Bromine, Aqua, 60 parts, and afterwards dressed by enveloping the part in stimulating poultices composed of pulv. flax-seed first boiled in water to a somewhat thick consistency, afterwards thinned out with heated porter to the proper state. Commencing from the toes, the entire limb was bandaged up to the hip. The limb was now placed in a semi flexed position and supported on soft pillows.

The patient was put upon Bromine, sixth dilution, a dose every three hours, except at night, when asleep. A nourishing and moderately stimulating diet was ordered, consisting chiefly of strong beef essence, milk punch with raw egg, pure grape wine, wine jelly, tap ioca, &c. Daily dressing was made for a period of three weeks, afterwards every second and third day, when the patient passed on to a good recovery, regaining the use of her limb, and was able to ride out on several oc

severe cases, with a reduction of loss, from sixty-eight to 20 per. cent. speaks volumes in favor of the superiority of the Bromine treatment, and warrants him in making so bold an assertion.

An elaborate essay, with tabulated statements, and the various complications, was sent into the Bureau of Surgery, of Homoeopathic Centennial World's convention, that met at Philadelphia, during the summer of 1876. This production has not yet seen the light of day, notwithstanding repeated inquiries made by its contributor. No information could be obtained of its whereabouts until quite recently, when it was unearthed, after considerable exertion and no small expense to the writer. No satisfactory explanation of this conduct has yet been vouchsafed, and the paper, like some others before it, had no doubt been consigned to oblivian. There is an old and true saying, that kissing goes by favor," and it applies to that once noble organization entitled the "American Institutute of Homœopathy," now a mere political ring controlled, as Tammany was and is still, by a chosen (?) band who manage matters to suit their own particular adherents-voting themselves fat salaries from a treasury impoverished for years. and keeping those out in the cold who decline to participate in their nefarious plans-violating the order of exercises as prescribed and printed, and, by preconcerted action, gathering to themselves all the loaves and fishes, leaving scarce an unpicked bone for their honest associates. Rumors have been rife of party favoritism of "dead-head ing" by some of the clique," at the various points of There was, however, one point over the knee joint, meeting. A hilarious band are these same fellows, and and below the patella, that seemed to persist in refusing well known for their proclivities, especially as regards to heal, but nevertheless dwindled down to what appeared the wine-cup. Put-in-Bay is a favorite resort with them, to be an open sinus. This particular portion, for some and for obvious reasons. The chairmanships and bureaus reason not easily explained-possibly, à lingering of the are allotted to juniors of limited experience; and favored old leaven of impurity in the part; possibly, also, a too striplings thus take precedence of men who, for long free use of the joint-became invaded again. Pus years, have faithfully served their generation. These formed, as before, with more or less burrowing and in- are facts which cannot be successfully controvertedfiltration into the subjacent layer of integument, and the although they may be denied. Truly may we exclaim erysipelas re-appeared. The knife was again called in- Alas, how has the once noble American Institute fallen to requisition, and the same course of treatment relied into the hands of the scribes and pharisees!" Is it not upon. The case was now left to the attending physi-high time for an open expression of indignation—for cians. The effect was prompt, and the invader again succumbed-this time, finally-the patient being now cautioned against using the limb too freely.

casions.

At the present time, (December, 1878), the patient is again able to be about; everything seems to promise a complete and successful result, and with as good use of the limb as ever. It is hardly necessary to add that the invasion of so important a joint as that of the knee is always to be seriously regarded, and it behooves us to watch closely so insidious and devastating an enemy as erysipelas at all times, but especially when so valuable a member is attacked.

One rule in the after treatment it is important to note, viz. that a joint thus affected should not be kept in a fixed position. A frequent change in its angle should be regarded. This precaution wisely used will prevent the occurrence of anchylosis, a very inexcusable result. The writer, in both his military and civil service has been frequently required to operate upon stiffened and anchylosed joints, the result of erysipelas, unskilfully treated, obliging the patient to undergo a very painful operation, as well as an after treatment, not only painful but tedious.

In different instances, the anchylosis affected the joints of the knee, shoulder, elbow and wrist, and had lasted during periods of from three to seventeen years.

In conclusion, the writer will here take occasion to repeat what he has already frequently remarked, that in Bromine we have the most powerful agent known for the treatment of hospital gangrene, gangrenous and phlegmonous erysipelas, with pyæmic, or rather chorrhamic complications. The observations made by the writer, during the war of the Southern rebellion, as well as in private and hospital practice, in the course of which time he has personally treated over one thousand

some attempt to rescue our organization from the grasp
of these cormorants who, in the pursuit of their selfish
and unprincipled ends, will inevitably bring about its
downfall? Like the money changers of old, they should
be driven in disgrace from the Temple they have so
shamefully profaned.

CACTUS GRANDIFLORUS IN CARDIAC
DROPSY.

BY EDWARD JAY MORGAN, M.D., ITHACA, N. Y.

Mrs. B- a lady aged sixty years, was attacked on the first day of July, 1878, with violent palpitation of the heart, accompanied with very distressing dyspnoea.

Upon examination I found evidence of structural change of the mitral valves, with regurgitation, and congestion of the lungs. These symptoms continued two weeks, when general dropsy supervened. At this juncture I gave an unfavorable prognosis, and commenced a course of treatment, looking more for palliation than a cure. The breathing became more and more labored. And it was impossible for the patient to assume the recumbent position. Two weeks later the extremities became edematous.

I succeeded in relieving the effusion temporarily with large doses of Indian Hemp and Digitalis. But very soon the dropsical symptoms increased with an aggrava tion of all the distressing symptoms. I then gave the most powerful drastic Cathartics and Diuretics until the bowels and kidneys utterly failed to respond to any of them. Whereupon I advised my patient to house in order," expecting at every subsequent visit to see what physicians are so often compelled to meet, viz., Crape on the door. At this time, while visiting another patient, I was asked to see a Cactus in bloom. The

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flower was given me, and from it I prepared a tincture and gave my patient four drops every three hours, which decidedly aggravated her symptoms. I then gave the 3rd decimal dilution, with slight amelioration only. Following that I gave the 20th dilution. And (thanks to the immortal Hahnemann!) it was "like throwing water on fire." It is now the first of October, and my patient is well. During three months' treatment the Cactus was the first drug that restored the bowels and kidneys to a healthy action. Every vestige of the dropsy has disappeared. The regurgitation has ceased and there are no abnormal symptoms remaining, except slight valvular murmer.

fered from " ‘bladder trouble" for nearly a year, being most of the time under the care of Canadian physicians. He had never been sounded, although the symptoms of stone were marked. Four months previous to our examination, he had an abscess point and break just below Poupart's ligament, and at a point where psoas abscesses usually discharge. This continued to emit pus for over three months, but when we saw him there was a wellformed cicatrix, and but slight remaining induration. On sounding, we detected a hard substance in the bladder which we supposed to be a calculus. A few days after I operated on the boy by the left lateral method. The bladder was quickly entered without difficulty, but instead of finding the wished-for stone, I extracted two pieces of necrosed bone, one nearly circu lar and about the size of a silve three cent piece, the

RECURRENT TUMOR OF UVULA.—REMOVAL. other about half an inch long and from two to three

BY H. C. FROST, M.D., BUFFALO,

In February, 1878, Dr. Broardt of this city, brought a patient for operation of whose case the following is a description. Boy, æt. 4 yrs. 6 months, of German parentage, ill-nourished. Both father and mother were suffering from constitutional syphilis; the father having syphilitic ulcers on leg, and psoriasis in flexures of knee and elbow-joints, and on palms of hands and soles of feet. The mother had a large well developed condyloma at anus. In December, 1877, the boy complained of a lump in his throat, and difficulty in swallowing The mother on looking into his mouth, discovered a large lump over root of tongue, she consulted a physician in her neighborhood, who prescribed a gargle. The growth continued to increase in size, and the symp toms it occasioned became more troublesome. When I saw the boy, the tumour filled the back part of the mouth and the fauces. When supine it gravitated into pharynx, causing great difficulty in breathing. On several occasions it had bled quite freely, I removed it with the wire ecraseur. The only trouble experienced was in getting the wire around the pedicle: The hæmorrhage following its removal was considerable for a few minutes, so I applied the actual cautery, introducing it through a glass speculum. The tumor appeared precisely similar to those gelatinous polypi found in the nasal passages.

Nine months after the removal of the growth, the boy was again brought to me, with another growth tak ing its origin from the same surface. It was about the size of a hickory nut; the base or pedicle was much larger than that of the first, and its external characters were entirely different. It resembled a fungoid growth of the brain, was of a dirty greyish color, its surface warty and dotted over with several small ulcers, which bled on the slightest provocation. I put around its base a rubber ring small enough to make considerable constriction Two days after, when I next saw the patient, the tumor had shrivelled to about half its former size. The fifth day the mother brought the boy to me and said that that morning, when he arose, the tumor was gone, so I supposed it had become detached during the night and that he had swallowed it in lieu of a better bolus.

I should not attempt to use the ring on another case, it being very difficult to place, but would use a rubber ligature. Have put the boy on the Protiodide of Meroury, third trituration, with a daily dose of the iodide of potassa.

LATERAL LITHOTOMY.-SEQUESTRA OF BONE FOUND INSTEAD OF CALCULI.

H. C. FROST, M.D., BUFFALO.

In January, 1878, I was asked by Dr. Hoxsie, of Buffalo, to sound a boy for suspected calculi. The boy was of German parentage, æet. five years, with large and singularly formed head, the vault being exceedingly broad. He was pale, and much emaciated. Had suf

lines in width. The boy made a rapid recovery, and to-day is in good health.

Query-from what source did these bones come, and how did they find their way into the bladder? My opinion is, that the abscess that pointed in the groin was one of those called psoas; that the exfoliated plates of bone were the result of a diseased vertebral body; that they found their way into the theca of the psoas muscle, and from there worked their way to and through the lateral wall of the bladder. Can any one suggest a more reasonable solution? The case seems to be unique,- -so far as my reading will allow me to judge.

TRANSLATIONS FROM GERMAN JOURNALS. BY G. OEHME, M.D., TOMPKINSVILLE, STATEN

ISLAND.

1. Clinical Cases.-A man had toothache for three days. It was worse after eating, also nights, so that he had to sit up in bed part of the night, in order to get. some relief. He could give only an interrupted description of his suffering, as he had to walk to and fro and to rinse frequently his mouth with cold water, to give temporary relief. Appetite good, would like to eat, if it did not increase the pain. The stinging, jerking, burning, pain was on the left side, at first only in the lower jaw, afterwards alternately in the lower and upper one, extending to the ear. He had only a few sound teeth, but many decayed ones. The gum was not swollen, inflamed or sensitive on the painful part; no sensitive place on either jaw. Whenever sick, he likes to retire from his family. Bryon. 2x, two drops every hour cured completely within four or five hours. Slept the whole night.-Hirsch. Ztschrft, 27, 182. E. Lewi.

2. A young man of twenty commenced six or eight years since to have frequent attacks of pain in his stomach, probably in consequence of mistakes in diet or from getting wet or chilled in hunting, When he confined himself principally to a light vegetable diet, he was much better, but as this did not satisfy his immense hunger, he ate hearty food and meat. This and immoderate drinking increased his disease. His physician supposed he had å tape-worm and administered a regular tape-worm treatment, but no worm passed off.

Status præsens: continuous, pressing pain in the fundus ventriculi, as if from a stone, at times better, at times worse; better after, worse before, eating; the more he eats at a meal the longer the amelioration continues, and the more hungry he is, the worse the pain. It is better when lying, worse when sitting, still worse when moving. When perspiration is produced by exercise, or when he gets warm in bed, the pain is better and sometimes entirely absent. New bread with butter, or meat causes more pain than any other food. Appetite good; slight constipation. Diagnosis: probably erosion of the mucous membrane. Arg. nitr. 3 dil., three drops four times a day, and a simple nourishing diet, not much meat. At-night a.wet compress over the bowels. The

pain soon subsided. Recovery in a few months.-panying vessels. In this condition the efferents are wholly Hirsch. Ztschr. 27, 137. Mossa.

3.-A strong man of thirty-two, with black hair, took cold in the fall and had a cough. He had frequent at tacks of tiredness, chilliness, pain in the head and limbs. and dizziness; also occasional pain in back and chest. Diminished appetite, sensation of fullness and pressure in the pit of the stomach. These complaints grew much worse in Dec., and he further complained of burning pain in the stomach and chest, drawing and stinging through the chest, pain in the bowels, especially in the evening till midnight, with frequent urging to urinate. The urine scant, yellowish, turbid, causing violent burning. Sleep not until after midnight, on account of shivering and cold feet. Uneasy, dreamful sleep. Colchic, 5., three times a day, improved considerably in two and cured in four days.-Hirsch. Ztschr. 27, 131. Schelling.

4.-A man of sixty-nine, frequently subject to stomach and abdominal complaints, had had for three months pain in the back and small of the back, frequent urging to urinate and burning while urinating. Status præsens; burning in the stomach and chest, little appetite, pressure after little food, bloated stomach, pain in the pit of the stomach, frequent passing of fetid flatus; frequent urging to urinate, burning while urinating, urine scant, dark yellow, turbid, forming white flakes in standing; night and day violent tearing, stinging pain in the back and small of the back, with jerking into the thigh and knee, especially on the right side. At night difficulty of finding an easy position; sleep none or uneasy and short. Constant chilliness, cold limbs; face bluish gray, lips dry, purplish. Colchic. 5, every three hours one dose, improved in one day and cured in a few days.-Ibid.

inadequate to pass along the torrents of blood which are supplied them through the great femoral artery, the profunda, the tibial and other branches, by the now powerful contractions of a fever infuriated heart. As a consequence firm emboli of blood are lodged here and there and thus, all in all, the circulation is interrupted almost as much as it might be under the pressure of a tourniquet. The inguinal region now becomes tumified and shortly thereafter the whole thigh and leg may become enormously swollen, tense, white, shining and hot, though not always hot. This swelling is at first unyielding or elastic. But the impaired circulation is soon followed by much effused serum into the whole cellular tissue of the leg. These pathological conditions are not always first manifest in the groin. Sometimes they are in the calf first. Generally the left leg is first affected, then the right, unless the morbid process is arrested by some remedial agent.

The disease having been fully established, the pulse ranges from 100 to 140. The limb is now very painful especially along the tract of the affected veins. This is just what might be expected, the nerves accompanying the veins and ensheathed with them in a common fascicu lus, being hard pressed by the impacted serum and swollen tissues of adjacent parts.

metastasis of uterine inflammation, or more properly Crural phlebitis in the lying in patient is generally & speaking, inflammation extended by contiguity through the uterine veins into the iliacs and on to the crurals, the whole thing, perhaps, chargeable to rough handling, or some dystocia at the time of labor and delivery. But while this disease is usually found between the first and fourth week after confinement, it sometimes shows itself a few weeks before that time. These cases are probably induced by the great pressure of the gravid uterus upon veins communicating with the leg. Severe chronic diseases of any of the abdominal viscera may result in crural phlebitis, as also may a lesion or wound, either incised or contused in any part of the body, in any sex or of those veins occupying the nearest relation to the leage; but not necessarily crural phlebitis; but phlebitis sion. Every time we ligate an artery there is developed a certain amount of phlebitis; but fortunately in such cases 6.-A man of sixty-eight years had dropsy; face, ab- just enough to answer the ends for which we ligate, viz: the union of the disruptured endangium and the formadomen, and limbs swollen; he could not lie down: notion of a plug of lymph, which becomes as it were, a appetite; urine scanty; cough. Many remedies ineffec: sealed cork-an effectual bar to any onward flow of tual. Squilla tinct., ten drops every two hours, cured blood. No doubt phlebitis may be induced by exposure in one week, Ibid. Dr. L. has used squilla with to cold or by any sudden change of temperature; and success also, when albumen was present in the urine. by other causes too, some of which, perhaps, may be quite occult.

5.-A sea-captain of ninety, active, of small stature became dropsical. Water in the limbs, face, chest and abdomen; had to sit up, being unable to lie. Cough with expectoration. All remedies seemed ineffectual and death imminent. Ol. Terebin. in drop doses, but he took the medicine on his own authority by the teaspoonful. The urine passed off in large quantity, he recovered entirely, and lived three or four years longer, when he died of old age.-Hirsch. Ztschr. 27, 102.

Lembke.

CRURAL PHLEBITIS.

BY S. BISHOP, A.M., M.D., (Read before the McLean, Co., Ills., Medical Association.)

This disease has a history going back to the year 1603, and it is a matter of surprise that for a period of more than two centuries, it should have been so imperfectly understood, and, until within our own time, it should have had no better names than, white leg, swelled leg, puerperal tumid leg, anasarca serosa, bucknemia sparginosa, phlegmasia dolens, phlegmasia alba dolens, phlegmasia lactea, ædema lactium and the like.

Diagnosis in this disease, especially the utero-crural form of it, is not difficult. The patient has had previous rigors or chills and now the heart is almost frantic in efforts to keep the circulation good, volens nolens. There is great irritability, depression, thirst and want of appetite. The leg is swollen and painful. The pain, it may be, is in the calf. On flexing the limbs and endeavoring, with the hand to shake the calf of the affected leg, it will be found not loose and flabby like that of the other leg; and if now the calf is pressed hard up against the tibia the patient will cry out from pain. It may be the femoral vein, or rather the ensheathed vessels with it, can now be traced from the groin down the thigh feeling hard and rolling under the fingers like a cord. If so it is himself the question, what of the prognosis? and he may think too, what of the pay? Shall I ever get it, or even thanks for my pains-taking, patience and skill in the treatment of a disease so grave? But should the malady already be very far advanced, he may soon be relieved of any farther responsibility, the patient suddenly dying, perhaps as she raises herself in bed. There may be slow and tedious suppurative fever resulting in pyæmia or even septicemia. However, the great majority

If at last we have come to the true pathology of the disease, it seems to be about this. The endangium-a plain case and the attending physician may next ask inner coating of the vein-first becomes inflamed and consequently thickened, thereby narrowing the calibre of the sanguinary channel. From these tumid walls of the vein there exudes quantities of plastic lymph, which attaches in membranous form, lessening the channel still more, and to complicate and contract still farther, serum is now poured out from the outer or fibrinous coating of the vein into the cellular sheath in which it runs, thus firmly packing it, with the nerve and other accom

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