which has been carried out as yet, but in a limited number of cases. In our correspondence for the American Journal of Medical Sciences, April, 1847, may be found our account of what we heard upon this subject in the lecture to which we have already referred.

A SINGULAR CASE OF POISONING.

BY DR. W. HOBBS, CARTHAGE, IND.

of this place,

During the first week of May, 1868, Mrs. L visited her friends at Dayton, Ohio, taking with her her infant son, a babe about twelve months old, who was still nursing On the eighth of the month, her child was taken with convulsions, which continued at intervals for two or three days. The case was under the care of a "little pill" doctor in Dayton, and I have not learned his opinion of the pathology of the case, or the treatment which he used. I suppose, however, there was very little of either. The child was so seriously sick, however, that the father was sent for, but in a few days he was so much better that the family came home, of course bringing the babe.

A short time afterward, I was consulted by the father, to know whether it might not be feared that this attack of his child was the beginning of habitual epilepsy. My reply was, that children often have such attacks from intestinal irritation, and, such as this one, with large head and predominant nervous temperament, were peculiarly liable to them during the summer months. He said his wife was settled in the opinion that her child had epilepsy, and she would expect a return of the spasms in a few weeks.

The child was hearty and grew well, until the morning of the 8th of June, when it was suddenly taken with sick stomach, a foul, fœtid diarrhoea, and after a few discharges, was again seized with convulsions. Dr. Pwas first called to the case, but in the evening of the same day I was called in counsel, and afterward retained the management of it. The convulsions occurred at intervals of three or four hours for two days. Few of them continued more than twenty or thirty seconds, and after half an hour's stupor, consciousness was fully restored. During the whole attack, a high state of intestinal irritation

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was maintained, and I could not otherwise conclude than that the convulsions were reflex actions from this cause.

After a few days, he was apparently well again, and so continued until the 10th of July, when the convulsions again returned, preceded and accompanied by the same symptoms as before. This regular periodicity perplexed me very greatly and thoroughly confirmed the parents of their child in the fears of established epilepsy. There being, however, no reason why I should change my views of the pathology of the case, I could but insist upon my opinion, against theirs, and await further developments.

In a few days, the patient was better again, and continued well for some weeks. The mother told me that about the 10th or 12th of August, he would have "fits" again; and, sure enough, on the 12th of that month, the worst attack of all made its appearance, preceded and accompanied by the same symptoms as before. This greatly added to my perplexity-it was the fourth attack, and the three intervals were just one month and two days each. How could this be explained? The convulsions could be easily accounted for, by the intestinal irritation, but what irritant could act thus punctually at exact periods? That was the great question. The child was nursing and taking about the usual amount of other food for one of his age. I had before ordered special care given to his diet, about the occurrence of these periods, when only milk, starch, and animal broths were allowed him, besides the breast. The mother was in good health—the state of his dentition was no cause of disease.

In my perplexity, I inquired of the mother by what rule she had predicted the occurrence of the paroxysms. She replied that she did it by the phases of the moon-that the interval was one lunar month and half way to a change. This suggested to my mind, an inquiry into her own catamenial periodicity. I found that she had been menstruating regularly since her babe was a few months old-that she became “unwell," at Dayton, while her babe was sick, and that since then, in June, July and August, the sickness of her babe at each attack, preceded her flux but a day or two.

My perplexities were now at an end, and I saw clearly, that the periodic functional changes in the reproductive organs of the mother, so altered the chemical constitution of her milk, that it, at a certain period, became poisonous to her child, and by its irritating qualities, so affected the intestinal canal of my patient, as to produce the train of symptoms observed in these attacks.

This was about the middle of August, and a very serious epidemic of "bowel complaint" was prevailing among the children in this part of the country, but notwithstanding this fact, I ordered the child weaned at once. This order the mother carried into execution, but still she could not quite shake off her fears of epilepsy. During the remainder of August and the whole of September, we courageously fought death at the door, through the whole range of drugs and diet, and in October, we gained the victory.

My little patient is now fat and hearty, and has had no spasms since the 12th of August attack above mentioned. The bowel troubles which followed the weaning, made little or no impression on the nervous

centres.

This case has been one of peculiar interest to me, and as I do not remember to have seen a similar one reported, I thought it worth the notice of the profession.

With others, I have often seen instances in which the mother's milk became unhealthy after the establishment of the menstrual flow, so that the child had to be weaned; but this case differs from such, in the fact that the milk was healthy and nutritious up to a certain period, which was within twenty-four or thirty-six hours of the commencement of the "flow," when it quickly changed its qualities, and became powerfully irritating and poisonous. These qualities it certainly retained but a very short time, perhaps not longer than until the "flow" began, if even so long, as the convulsions of the child and the intestinal irritation which caused them, continued but a short time, if at all, after the "flow" was established. Indeed, I can not see that the irritation in either attack which came under my notice, continued longer than might have been expected as the effect of a single portion of irritant poison taken into the stomach. That the milk was suddenly changed from a nutrient to a poison, is shown by the fact that the child was well nourished to a certain period, when it became as suddenly sick as though it had taken arsenic, or almost any of the mineral poisons. That this quality of the milk did not long continue, is further proved by the fact that the child nursed often during his sickness, a portion of which was retained in the stomach. Repeated doses of so virulent a poison, would certainly have destroyed the patient, or maintained the irritation for a longer period. Will some kind chemist tell us what this poison was, and by what process it was formed in the vital laboratory?

CASE OF PERFORATION OF THE INTESTINE IN TYPHOID ·

FEVER-DEATH.

BY A. G. CRAIG, M. D., GHENT, KY.

Cases of perforation of the small, and occasionally of the large intestine, in typhoid fever, are not very rare, and yet not of as frequent occurrence as some writers would lead us to believe. I have known but few physicians who have met with this accident in their practice, and during my term of service as an interne of the Commercial, now the Cincinnati Hospital, I do not remember to have seen a single case. Of two hundred and five fatal cases of typhoid fever collected and analyzed by Bristowe, Murchison, Louis, Pfeufer of Munich, together with the records of the London Fever Hospital, perforation occurred in forty-three, the proportion being a fraction under onefifth. The following brief report of a case, occurring in my practice, may not prove uninteresting to the readers of the Journal:

On the morning of the 25th of August, 1868, I was called in consultation to see a little girl whom I found with congestion of the brain. The case terminated fatally on the following day. Her little brother, aged about ten years, had typhoid fever, but was at that time, convalescent, though there were marked tympanites and great tenderness on pressure over the whole abdomen. I was requested to attend the patient until he had entirely recovered. Hygienic and supporting measures, such as fresh air, rice-water, wine-whey, beef-essence, etc., together with small doses of turpentine emulsion, formed the most important part of the treatment. About nine o'clock, on the evening of the 30th of August, I called to see my patient; I found him cheerful, disposed to talk, and seemed to be doing as well as I could expect, except there was enormous distension of the abdomen, and the tenderness on pressure, had considerably increased since the day previous. His skin was moist; pulse 103, and moderately full; breathing tranquil; tongue moist, and gradually cleaning; some appetite; very little thirst; bowels inclined to be loose; urine scanty and high colored; decubitus dorsal. After congratulating the parents at the prospect of a speedy recovery, I took my departure. At two o'clock on the following morning, I was summoned to the bedside of my patient. I found him in a state of collapse. His pulse had ceased to beat; his countenance had assumed a ghastly, hippocratic aspect; his extremities were cool, and the whole surface was bathed in clammy sweat; he was mori

bund. His father informed me that at about ten o'clock he heard a gurgling in the bowels, which probably was caused by the escape of the liquid contents, and that in a few minutes afterwards, he was suddenly seized with severe pain in the abdomen, and vomited freely and frequently. His pulse soon became quick, and fluttering, and scarcely perceptible, and he rapidly sank into a state of unconsciousness. Death took place at daylight.

The practitioner can not be too guarded in giving an opinion as to the probable termination of a case of typhoid fever. Perforation occurs oftener in the mild than in the aggravated cases of the disease, and the severity of the fever does not correspond with the amount of the intestinal lesions. After perforation has taken place, the case is hopeless, though life is sometimes prolonged for several days.

REPORT OF A CASE OF STRANGULATED HERNIA-OPERATION, &C.

BY J. R. WEIST, M. D., RICHMOND, IND.

On the evening of September 22, 1868, I was requested to see Mr. R. Lyon, at Millville, Henry county, Indiana, who was said to have strangulated hernia.

On my arrival, about midnight, I found the patient to be a thin, spare man, weighing about one-hundred and twenty-five pounds, thirty-two years of age, who gave me the following history of his case: "Have had a small inguinal hernia on the right side for about thirty years, which has always been reducible until within the last year. The hernia has never given me trouble, and I have never worn a truss. On the eighth of September, I fell from a fence, and was immediately afterward seized with severe pain in the region of my hernia. On examination I found the protrusion greater than ever before. I made an effort to reduce it, but failed to accomplish reduction. The pain grew rapidly worse, and extended over the entire abdomen. I sent for Dr. Guisinger, who gave me chloroform and tried to reduce the hernia, without success. He then gave me a large quantity of morphine, from which I received some relief. The next day Dr. Guisinger sent for Dr. Jones, of Anderson. On his arrival, they gave me chloroform again, and tried to return the bowel, but failed as before. Dr. Guisinger con