For eight years previous to May, 1878, she complained of a sensation of fulness and great soreness in the bowels, and was tormented with flatulence, though the stomach was implicated only during an occasional attack of indigestion, which usually passed off in two or three days. There was, on pressure, a hardness or induration within the abdomen, on the right side, though its extent was not well defined, and did not always present the same appearance, frequently being aggravated at the menstrual period.

For several years past the diarrhoetic discharges have varied in number, during the twenty-four hours, from five to twenty or more, containing fecal matter, blood and pus commingled, mucus, shreds, etc. No microscopical examination of the dejections was made. During this period she had but a limited control over the sphincter ani, the desire for an evacuation being followed almost immediately by an involuntary discharge, accompanied by most distressing tenesmus, and not infrequently syncope. Usually, the stools were most frequent during the night, but were increased whenever she assumed a recumbent posture.

During the six months preceding May, 1878, her general health had seemed to be gradually failing, the flesh wasted, and the general appearance indicated that the system was being undermined by some profound dyscrasia.

May 19, 1878, I was called to visit her, and found her in bed, suffering severe, cutting, darting, stabbing pains, located deep within the abdomen, more upon the right side, but extending, at times, all through the abdominal region, excepting the extreme upper portion.

A little to the right and below the umbilicus was an indurated mass, which could be distinctly felt through the abdominal walls, and appeared in area nearly as large as an ordinary saucer, and very sensitive on palpation. This induration continued to extend until the whole anterior portion of the cavity, except the extreme upper part, was occupied, and was extremely sensitive on motion, pressure, or even to the touch.

For several weeks previous to death, there was little or no appetite, but excessive thirst and almost constant nausea, while vomiting was a very frequent accompaniment of stool.

June 24, after more than five weeks of the most intense suffer

ing, during which time it seemed as if the disease had been excited to tenfold its former activity and violence, death came to her relief.

June 26, assisted by Dr. D. Humphrey, and in presence of Dr. A. J. French and Dr. Mooers, I made a post-mortem examination. On making an incision through the abdominal walls, I was puzzled in not being able to detect the peritoneum. Continuing, I found myself engaged in cutting through a dense, granular, whitish mass, the exact appearance of which I cannot accurately describe.

Upon further examination, this adventitious growth was found to have almost completely destroyed all trace of the omentum and mesentery, also the abdominal and intestinal peritoneum. Over nearly every square inch of the walls of the cavity, save the portion occupied by the stomach, liver, and spleen, the mass was adherent; while buried within and cemented thereto lay the bladder, uterus and its appendages, all of the large intestine, the ileum, jejunum, and a portion (inferior) of the duodenum.

Of course, muscular contraction of the intestines was impossible.

A little below and to the right of the umbilicus, where the trouble first manifested itself locally, and where the growth was most prominent, a vomica was discovered, capable of holding from one to two fluid ounces, leading from which were three circular openings, half an inch each in diameter, leading into the ileum. The vomica contained two or three drachms of pus, and its walls were breaking down and sphacelated.

Thus it will be seen that nearly the whole intestinal tract may be likened to a tortuous sewer, which only served as a passageway through which drained whatever contents might be present. Why there should be such distressing tenesmus, with no presence of hæmorrhoids, is to me a mystery.

A specimen of the diseased mass, containing in addition a portion of intestine and walls of the vomica intact, was sent to the Massachusetts General Hospital for microscopical examination. Following is the statement of Dr. R. H. Fitz:

"A portion of the small intestine showed numerous small presumably catarrhal ulcers. The mass binding the intestines together was evidently composed of some malignant new forma

tion, probably cancer or sarcoma. As cancerous or sarcomatous peritonitis is usually secondary, it is to be inferred that there was similar disease elsewhere."

The liver, spleen, and kidneys were not critically examined, as they had shown no indications of disease during life.

With regard to the treatment of the case, I will say nothing, as the case was under my care but a part of the time during the past six years, and I know nothing of the medicines she received from others whom she employed from time to time.

My object has been to give as brief and comprehensive a history as possible, regarding the symptoms, both objective and subjective, during life, together with the very interesting condition revealed by the post-mortem examination.

Of course a thousand questions could be asked, and many of them answered, regarding a case of so long duration, but the already great length of my paper forbids.

(For the Gazette.)

THE DISTINCTIVE MERCURIALS.

Part of a lecture delivered in the London School of Homœopathy, Dec. 9, 1878.

BY RICHARD HUGHES, M. D., LONDON, ENG.

(Concluded.)

M. cyanatus, the bicyanide of the metal, "mercuric cyanide," we know at present almost entirely from its effects in a few cases of poisoning by it which have occurred and from symptoms furnished us by Allen. It does not corrode chemically as that does, so that its effects on the mouth and throat are of dynamic origin. Among these we find in one case, "buccal mucous membrane red and injected (third day), a round ulcer, with grayish base and upright edges, and encircled with bright red, on the inside of the right cheek (fourth day), the ulcer in the mouth has spread, and is covered by a large, gray, feathery coating (fifth and sixth days)"; and again, "a grayish, diphtheritic-looking deposit around the anus, quite similar to those on the inside of the cheeks"; and again, “a white, opalescent coating on the pillars of the velum palati and on the tonsils." In another case we have "the lips, tongue, and inside of the cheeks

covered with a grayish-white pulp (fourth day)." In both instances these local symptoms were accompanied with great prostration.

It is not surprising that such phenomena should have suggested M. cyanatus as a remedy for diphtheria. Dr. Beck, of France, was the first to make the application; and Dr. Villers, of St. Petersburg, learning it from him, reports that he has had astonishing success with it. Some of his cases are given by Dr. Oehme, in his excellent "Therapeutics of Diphtheritis." Dr. Villers has lately reported that in ten years' time he has treated over a hundred cases of the disease, of all degrees of severity, without a single death, never giving anything but M. cyanatus. He began with the sixth dilution, but now prefers the thirtieth. Its effects are very rapid, the exudation generally clearing away within twenty-four hours, and the general symptoms improving pari passu.

Dr. Villers is not without supporters in this experience of his. One of them is an old-school physician of the same city, Erichsen by name, who claims to have been more successful with it than with any other remedy, giving from one forty-eighth to one ninety-sixth of a grain for a dose. Even when the false membranes extended into the larynx, he found them clear away under the action of the drug. Of twenty-five cases thus treated, he lost three only, one from cardiac paralysis, one from suppurating parotitis, and one from meningitis; but even in these cases the local disease was gone. * He, of course, omits to credit the remedy to his homœopathic colleague. Dr. Jousset esteems it the best medicine in the putrid form of the disease; and Dr. Burt, of Chicago, has lately stated that for the last three years he has been administering it in diphtheria with such wonderful curative results that now, as soon as he is certain that he has a case of diphtheria to treat, he at once puts the patient upon the cyanuret of mercury, with a feeling of almost absolute certainty of curing him. In two at least of his cases the membrane had invaded the air-passages.† The two last-named practitioners employed the lower triturations.

Dr. Burt experimented with the poison on a dog, injecting it

*St. Petersburg Med. Wochenschrift, 1877. † American Homœopathist, II. 22.

under the skin. Great prostration, with feebleness of circulation and respiration, were produced; and on post-mortem examination the larynx was found inflamed, with its mucous membrane and that of the posterior nares loaded with mucus, and the right ventricle contained a white,, fibrinous clot. In the "Homœopathic Times" for October, 1877, Dr. W. A. Allen writes, "A partial proving of the cyanide gave great prostration and weakness, a low febrile condition, a whitish-gray deposit upon the tonsils and mouth, extending along the right side of the tongue, with slightly swollen tonsils and difficult deglutition."

These symptoms are given as communicated to me by the prover. The prostration and other symptoms were so severe that he ceased taking the drug, the second potency had been used, and rapidly recovered by the use of Baptisia. I think that such facts should encourage us to a free and trusting use of this remedy when we encounter the disease in question.

Mercurius iodatus,

Mercurius biniodatus. By these names we designate the two compounds which Iodine forms with Mercury,—the green and red iodides (fulvum and rubrum) of common language, the mercurous and mercuric iodides of our present chemical nomenclature. They are prepared by trituration. I group them together, as they have much in common, but shall not fail to indicate their distinctive places.

The mercurial iodides are prepared by trituration. Both have been proved in the school of Hahnemann, the protiodide by Drs. Lord and Blakely, on six persons, the biniodide by the Philadelphia Provers' Union. The pathogenesis obtained by the latter experimenters is given by Hering in his Materia Medica; both may be read in Allen.

They add little to our knowledge of the physiological action of the compounds, which had been ascertained to behave mainly like Mercury, though the double, equivalent of the nitrogen in the biniodide made it exceedingly irritant. Their use in the old school has been mainly in the treatment of syphilis, and Ingol's experience with Iodine in scrofula made it supposed that they would be especially suitable to patients having this diathesis. I do not know that the idea has been confirmed, and it has not prevailed in the homoeopathic school. Here the compounds (and