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a cardiac, or a pleuritic complication in rheumatic fever. It is much rarer that we find two of these complications in the same case, but to have all three rapidly developed during the course of this fever is, according to my reading and experience, very rare indeed.

2. Another point to note is the rapid subsidence of the articular inflammation on the development of the internal lesions, apparently a true metastasis.

3. It has been held that salicine not only shortens the duration of the disease, but prevents its complications, in so far at least as the heart and pleura are concerned. In this case, although given in full doses from the first, it did not appear to exercise the slightest influence on the course of the fever, and it certainly did not prevent complications.

4. The only remission of symptoms which could be observed during the course of the case was for about 8 hours after the leeches and blister had been applied to the head, and the administration of large doses of iodide of potassium and digitalis had been commenced.

5. It is only fair, however, that I should state in regard to salicine, that I had four other cases of rheumatic fever under my care at the same time as the above, that to all from the very first I gave full doses of salicine, and that it really did appear to shorten the duration of the fever, to rapidly relieve the joints, and in none of the four have any complications

arisen.

SALICYLATE OF IRON.

By J. WALLS WHITE, M.D., GLASGOW.

SALICINE, salicylic acid, and the salicylates have now been before the profession for some time, and the verdict on their merits has, on the whole, been favourable; the peculiarities of their chemistry, and the rationale of their physiological actions are, however, but imperfectly understood. Without entering on these, I would, in the meantime, confine myself to one combination that, in my opinion, deserves a trial-salicylate of iron.

Salicylate of iron, in the dry state, is a reddish-brown powder, very insoluble, and with difficulty manipulated; but, if prepared by the accompanying formula, an elegant solution is easily obtained

Sulphate of Iron, 24 grains.
Soda Salicylate, 30 grains.
Soda Acetate, 20 grains.

Water, 1 ounce. Dissolve.

In this case the salicylate of iron seems to be in the state of a protosalt. The solution has at first a pale, port wine appearance; on lengthened exposure to the air, as by the frequent uncorking of the bottle containing it, the colour gradually deepens, and a precipitate of what seems to be a persalt of iron is apt to deposit. The presence of the sulphate of soda set free in the reaction along with the acetate of soda added, retards, and, in dilute solutions, entirely prevents this, so that a tolerably stable solution is obtained, whereby iron in large quantities can be exhibited in a safe and satisfactory

manner.

The solution formed by this formula is by no means unpleasant to the taste, and each ounce contains 30 grains salicylate of iron, or about 4 grains to the teaspoonful. To this mixture, such drugs as potash acetate, spirits of nitre, tincture of digitalis, &c., can be added without precipitating the salt, or altering its appearance much; but ammonia and its preparations are incompatible. Its primary action seems to be to promote secretion, stimulating the skin, and not constipating the bowels, rather correcting the alvine secretions.

As a prophylactic against septicemia after surgical operations it is of value. In zymotic affections, diphtheria, typhoid and scarlet fevers it is worthy of a trial. For diphtheria and the aphthous tongue in children, in solutions containing 4 to 10 grains to the ounce, combined with glycerine, or with chlorate of potash, or both, it can be used with freedom as a mouth wash and as a medicine.

In erysipelas, where one would give large doses of the tincture of perchloride of iron, this, given in tablespoonful doses frequently, alone or combined with diaphoretics, has an effect often marvellous. It promotes perspiration, cleans the tongue, lowers the temperature, and reduces the pulse.

In cases of anæmia, where iron is demanded, this can be given with freedom and in large quantities, without interfering with digestion, rather improving it. In skin diseases also, and in desquamative nephritis, where the digestive organs have become weakened, and a salt of iron is indicated, its powers are very marked.

Salicine and salicylate of soda are secreted by the kidneys as salicylic acid, and this combination being chemically a weak

one, the iron it contains is in a state of easy assimilation, and readily made available. If its use be long continued, some of it passes unchanged with the urine.

It seems to combine the astringent powers of the iron, but in a minor degree to the sulphate or perchloride, with the antiseptic, antipyretic powers of the salicylic acid; and, in many cases where such a course of treatment is indicated, this addition to our materia medica is worthy of more extended trial.

ON A CASE OF MELANOTIC SARCOMA OF THE CONJUNCTIVA AND CORNEA.

By T. S. MEIGHAN, M.D.,

Surgeon to the Glasgow Eye Infirmary.

J. B., a tall thin man, æt. 63 years, was admitted to the Glasgow Eye Infirmary in May last. He complained of being very weak, and becoming increasingly weak from the constant pain he suffered in his eye, and all over the right side of his head. A tumour of considerable size was situated on the front of the right eyeball, but more to the temporal side, and protruding from between the lids. Its vertical diameter was over one inch, while horizontally, at its broadest part, it measured fully half an inch, and from before backwards also half an inch. The eyelids were elevated and kept widely open, and in a state of spasmodic contraction which, no doubt, occasioned a good deal of the pain. There was considerable puro-mucous discharge, with lachrymation and excoriation of the margin of the lids. The tumour, which was of a greyishblack colour, was kidney-shaped, lobulated on the surface, firmly fixed to the eyeball, and elastic to the touch. It was found to be attached at the ciliary region on the outer aspect of the eye, overlapping the whole of the cornea except a small corner at the inner side, through which the patient could distinguish light and shade. The eyeball appeared to be normal in size, and moved pretty freely in its socket. Ophthalmoscopic examination showed that the eye could be illuminated, and that, as far as could be seen, there was no penetration of the tumour into the interior.

He stated that the tumour commenced nine months before, and that it was slow in growth at first, but latterly had increased quickly. A similar tumour, smaller in size, was

removed eighteen months previously, and six years ago a still smaller tumour was removed. He attributed the origin of the disease to an injury on the right side of the eye from a rusty nail nearly ten years ago; and he stated that, shortly after, a small warty like growth appeared which he said was movable on the ball, and, as it did not increase in size or cause much disturbance, was not removed for two or three years after. Each time the growths were firmer and became. darker in colour. The glands of the neck were not affected, there was no indication of disease in other organs.

The patient, having been unable to follow his employment for a considerable time, very readily consented to my proposal of extirpation of the eye; accordingly, three days after admission, chloroform was administered, and the eye was removed, with the surrounding loose cellular tissue and all the conjunctiva except that on the lids. He made a good recovery, and was dismissed in a fortnight entirely free from pain.

On making a median horizontal section of the eye and tumour, the mass was observed to be of a grey colour, getting darker towards the inner side and somewhat mottled. It was found to be attached to the ball at the corneo-sclerotic junction, the attachment being firmest on the corneal side, and here that tissue had increased in thickness. All the other parts of the eye were normal. The following woodcut represents the lower half of the section-its natural size-and from it the general relations of the tumour will be gathered.

[graphic]

Structure.-Thin sections from different parts showed it to be composed of round and spindle shaped cells, with a fibrillated intercellular substance. At the base of the tumour, the intercellular substance, with long elastic fibres, was in greater quantity than at the surface of the growth where the cells preponderate and almost hide the intercellular texture.

No. 8.

I

Vol. XII.

There was a distinct arrangement in the structure, for while the spindle cells (which had a bright nucleus, sometimes double) were running in different directions, some placed vertically, others slanting, the most characteristic feature was the presence of large round pigment cells appearing only as a slight infiltration at the base, but increasing towards the exterior, where they occurred in globular masses, occupying alveolar spaces formed by the fibres and spindle cells. These pigment cells contained large nuclei, with bright nucleoli, and were closely packed towards the surface, and darker in colour in some parts of the tumour than others. The cells altogether were exceedingly large, the pigmented ones being especially so. The large cells with oval nuclei had often a fallacious resemblance to epithelial cells, and the tumour might possibly be mistaken for an epithelioma.

Remarks.-There can, I think, be no doubt that the above is a case of melanotic sarcoma. Such tumours affecting the eye claim the most serious attention of the surgeon. This form of disease is fortunately very uncommon, so much so, that out of the many patients treated in the Glasgow Eye Infirmary since 1865, only two have come under observation. They seldom primarily originate in the cornea, and although in this case the tumour was found attached to the surface of the cornea, it is very probable that it had originally begun in the conjunctiva over the corneo-sclerotic junction, and only secondarily became attached to the cornea. I am inclined to this view from the fact that in the history of the case the tumour first appeared as a small warty-like growth, movable on the surface of the ball, and Virchow, in his description of the pathology of tumours, says of secondary corneal sarcomata, that they usually start from conjunctival sarcomata which have gradually spread over the cornea, or that they may originate in fleshy or melanotic warts seated at its margin, which ultimately develop into true sarcomata. They occur in the form of small flat tumours, which have a granular or lobed appearance, and are of a greyish-brown or black colour, often a little mottled. Sometimes they continue to grow as a small fleshy pannus over all the cornea, and under the epithelium. When they become larger their surface becomes more irregular and more lobed. There is a case reported by Dr. Thomas Reid in the journals of the Eye Infirmary in 1865, where the tumour appeared as a small fleshy growth, at first loosely attached, at the corneo-sclerotic junction; it was removed five times successively, each time it was darker in colour, firmer in feeling, and appeared to become more adherent to the

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