er, or only reappear months afterward-all make it a question whether there be not a scrofulous disease of the lung independent of a tubercular one, and one moreover which presents a much more favorable prognosis. Among the scrofulous children which throng our public institutions, cases like those alluded to are not uncommon, and any one who has had charge of a large dispensary will recognize the existence of a disorder with the characters indicated. It is certainly unlike the ordinary forms of pulmonary tuberculosis, and it is not bronchial phthisis. It does not present the paroxysmal cough, the signs of pressure on the trachea or large bronchi, and the dull sound on percussion between the scapula, which are the common accompaniments of enlarged and tubercularized bronchial glands.

"Some years since I had an opportunity of inspecting the lungs in one of these instances of supposed pulmonary scrofula. I was treating a little girl for this affection when she received a severe injury which resulted in her death She had, when first seen, an eruption on the scalp, sore eyes, and enlarged cervical glands. She was also very much troubled by a cough. A marked dullness was detected at the upper portion of the left lung. Here, as in fact throughout the whole of the left lung, and the upper part of the right, the respiration was rude. But for two weeks before her death the symptoms and signs had markedly improved under cod liver oil and iodide of iron. She was rapidly losing her cough and gaining strength, the dullness on percussion was diminishing, the respiration becoming less and less rude. At the autopsy the greater part of the left lung and a portion of the right were found to contain yellowish, cheesy deposits, which exhibited under the microscope a large quantity of granules and some shriveled cells, without distinct nuclei."

We therefore conclude that scrofulosis and tuberculosis are distinct conditions of the system. With Niemeyer* we would say that scrofulosis is more a condition of the system than an

*The term Scrofula signifies a morbid condition of the system.-Niemeyer.

entity. That scrofula might result in phthisis simplex, but not in phthisis tuberculosa. We are not willing to go so far as Hueter, (Med. Rec., N. Y., March, 1835,) who says "that scrofula is the soil in which tuberculosis is produced." We agree with Dr. Cochran that tuberculosis is a specific disease, transmissible from sire to child. That it is incurable by any means yet known to the profession.

That it is our duty to treat all cases of phthisis as if they were scrofulous or curable. That the means best adapted to this end are: Climate, diet, cod liver oil, iodine, alcohol.

Dr. Pepper says in the paper above referred to:

"Cod liver oil appears to exercise a remarkable influence in controlling scrofulous inflammation, and it has appeared to the writer not improbable, that this remedy will be found to be more especially serviceable in those forms of phthisis where the parenchyma of the lung is indurated rather by scrofulous inflammation than by tubercular deposit, and hence it is that the oil is particularly efficacious in bronchial phthisis, and in those forms of consumption which are associated with the external evidences of scrofula, such as enlargement of the cervical glands and other unmistakable indications of this diathesis. Under these last mentioned circumstances it is no unusual thing to find a subsidence of the local signs corresponding with the general improved condition of the patient; whereas, in tuberculous phthisis, in the strict sense of the term, the auscultatory phenomena generally persist, notwithstanding the improved state of health; owing to the fact that they depend upon tubercular deposit and not upon scrofulous induration, as is generally the case in the first named class of cases. Judging from the numerous instances in which tubercular induration and vomica are supposed to have disappeared since the introduction of cod liver oil into general use, it would be natural to conclude that such instances would, at least occasionally, fall under the observation of those connected with a large general hospital, where numerous cases of tubercular phthisis are constantly admitted and under treatment; and yet I am free to declare that it still remains for

me to witness the first case in which an unequivocal tubercular vomica has become cicatrized, whether revealed by an examination post mortem, or during life by the gradual disappearance of the characteristic physical signs. I have already expressed my belief in the occasional occurrence of such cases, but experience has convinced me that they are exceedingly rare; in many instances, the auscultatory signs would be greatly diminished, or even temporarily disappear, owing to some obstruction of the communicating bronchial tube; but, in a few days or weeks, the same unwelcome sounds generally returned; in others, the physical signs depended upon pulmonary induration conducting the sounds from the large bronchial tubes, and gradually disappeared as the conducting medium was restored to its natural condition. At the same time, I most cheerfully bear testimony to the very excellent effects in many cases resulting from the use of the cod liver oil. Inducing, as it frequently did, an abatement of the hectic symptoms and expectoration, together with an increase of strength and flesh, it appeared, at least for a while, to cause the lamp of life to burn brighter and longer, and thus afford precious time for the use of other important measures both hygienic and therapeutic. In incipient phthisis, it occasionally seemed even to correct or so modify the existing diathesis as to prevent the further deposit of tubercular matter; but, as before stated, in no instance that has fallen under my observation did it appear materially to promote cicatrization of tubercular cavities."

Dr. Wilks, speaking of this remedy, uses the following language:

It

"Cod liver oil certainly seems to be more efficacious in consumption than in any other disease, and I have every reason to believe that alcohol is antagonistic to the tuberculous state. may be true that drunken and debauched individuals die of what is usually styled phthisis, but their form of disease is rather one of chronic pneumonia or fibroid phthisis than tubercular. Alcohol, I believe to be good as a medicine, and in young children I have administered it with the best success." [Guy's Hospital Reports, vol. xiv., pages 48 and 49.

Dr. Flint is very emphatic in his recommendation of alcoholic stimulants in phthisis. He says:

"Basing my opinion on clinical experience, I do not hesitate to express the belief that in a certain proportion of cases, alcohol exerts a curative influence. Of the sixty-two cases of arrested tuberculosis which I have analyzed, in fourteen the treatment, irrespective of hygienic measures, consisted exclusively of alcoholic stimulants. In nine of these cases the recovery was comparatively complete; the patients remaining well after periods dating from the time of the arrest, ranging between four months and eleven years. Some cases which I have observed seem to exemplify, in a striking manner, the curative effects of alcoholic stimulants." [Flint's Practice of Medicine, page 294,

PUERPERAL ECLAMPSIA :

CHLOROFORM-FORCEPS-PUERPERAL MANIA.

BY W. A. BRADFIELD, M. D., OF EAST PASCAGOULA, MISS.

At 6 o'clock A. M., April 3d, 1875, I was called to see Emma M., (Creole) primipara, aged twenty-five years. I found that for several days she had complained of great fullness in the head, and some headache; and that the day before and last night had vomited a great deal. At four o'clock this morning she was taken with convulsions, and has had two, in one of which she fell full length from the bed on the floor. On examination I found the os partially dilated, with waters discharged and a vertex presentation. Every thing seemed to be perfectly natural, and nothing wanting but a few good pains. I had scarcely finished my examination when she was seized with another violent convulsion, which seemed to cause every muscle in her body to become perfectly rigid. I then chloroformed her, and instructed the midwife how to keep her in that condition until I could go to my office and get my instruments and more chloroform. I remained with her for several hours, hoping a natural pain would come up and expel the child, and to promote this end, I administered a teaspoonful F. Ext. Ergot. This seemed to have no effect, and allowing her to become partially from under the influence of chloroform, she had another violent convulsion; after which I was not able to hear the foetal circulation. I then determined to deliver with forceps as early as possible. The os uteri not being sufficiently dilated, I proceeded with my fingers to dilate