tion of the nervous system, and that the division of the nerve in the part whence the pain seems to originate, may prove rather injurious, than beneficial. This unfavourable issue of an unsuccessful operation, is not an assumption founded on mere reasoning or analogy: cases have occurred, where the patient. has not only been disappointed of relief, but the irritation has been transferred, subsequently, to the spinal marrow and the brain. On the Effects of the Nitro-Muriatic Acid Bath in several Surgical Diseases. By G. J. GUTHRIE, Deputy Inspector of Military Hospitals, Lecturer on Surgery, &c. &c. [From the London Medical Repository, for December, 1817.] DURING the last two years, at the recommendation of Dr. Scott, we have tried the nitro-muriatic acid bath, in the York Hospital, Chelsea, in a variety of cases, both medical and surgical; especially in those where the use of mercury was supposed to be indicated, and where it had failed of producing a good effect, or had been obviously detrimental. The manner of using the bath, as well as the proportions of acid, were varied; it was tried as a pediluvium, as a bath to the lower extremities, or to the whole body; of a strength to turn the skin and nails yellow, to produce the pricking sensation that has been attributed to it, as well as an eruption of pimples that were equally disagreeable; and it has been used so diluted, that many patients have immersed the body to the head every other day, and occasionally every day, from fifty to eighty times, without perceiving any sensations upon the surface whatever, except those which are equally produced by water of the same temperature; that is, from 90° to 95° Fahr. In our first trials the acid was used in the proportion of three parts of nitric to one of muriatic; and the acid so mixed was not measured, but poured into the warm water until it became very sour: this changed the colour of the nails, and was only used as a pediluvium. By the advice of Dr. Scott, it was used in the proportion of eight ounces to forty gallons, and sub sequently to twenty gallons, when it was employed as a bath; and with these proportions the greater part of our experiments were made. In particular cases, and especially at a later period, it has been used considerably stronger, with equal portions of the two acids, and with three parts muriatic to two of nitric, the quantity of acid being increased to twenty ounces in twenty gallons of water, and even to two ounces to the gallon. Having thus noticed the composition and manner of using the bath, it is desirable that the general effects should be next specified, according to the different proportions of the acids to each other, to the water, and to the surface of the body exposed to its influence: but this becomes exceedingly difficult, if not impossible, from the circumstance of its not producing any per ceptible effect on many persons on whom it has been tried, in whatever proportions it has been used, except what might be equally attributed to the warm water alone. I beg, however, not to be misunderstood. I do not mean to imply that the remedy has no powers; on the contrary, it does occasionally produce particular effects which are not usually attributed to water alone; yet I wish to give it as my opinion, that no dependance can be placed on any particular proportion, and that it is very uncertain in its operation: although I am disposed to believe, what I think many will as willingly concede, that the larger the surface to which it is applied, provided it be not of a strength to affect the skin, the more certain will be its effect. It naturally follows, as a conclusion, that I can have little or no reliance upon simple immersion of the feet and hands. At present I recommend the bath, where there are no abraded surfaces, to the whole body, except the head, in the proportions of half an ounce to an ounce of the equally-mixed acids to a gallon of water, at the temperature of 90° to 95o, according to the strength of the patient. If he have not strength to bear a warm bath of that heat for fifteen or twenty minutes, or the use of it is inconvenient, I desire the person to sit down in it; and if it be used with the view of relieving pains in the legs and thighs, I sometimes confine myself to the immersion of the parts affected. I have said the remedy sometimes produces no effect, or a permanent effect which can be discovered the day after its use; yet the complaint for which it has been recommended shall slowly subside or disappear, whilst in other instances it shall remain stationary, or gradually get worse. In all these cases I am aware it may be said that no effect has in reality been produced, but that nature has caused the amendment or deterioration by her own efforts, either properly or improperly directed: but I dissent from this proposition, because I have seen in many of these cases the good or bad result too evidently depend on the use of the remedy, not to believe that it had a principal share in producing it. In general, the acid bath increases the quickness of the pulse, causes, like the warm bath alone, a general relaxation of the body, and, if continued, may produce syncope. On coming out of the bath, a variety of sensations, in the same manner, may or may not supervene. When it agrees with the patient, there is no perceptible effect, save a greater redness of the skin than what the warm bath occasions. In others, there is swiming of the head, nausea and even absolute sickness, general uneasiness; and, in several cases where there has been a predisposition to it, the testicle has suddenly swelled, become painful, and even inflamed; and this has again occurred on a repetition of the bath after a certain interval of time. The repeated use of the bath sometimes occasions a degree of general excitement, the pulse quickens, the tongue becomes white, the patient feels uneasy, or, as he expresses it, a little feverish: in such a case it must be discontinued. In others, after a continued use of it, the patient looks pale, loses flesh, and is certainly debilitated. In some cases the immersion at once produces a sensation of the mouth in an increase of saliva, and in others the flow of it is more permanently increased: on examination, the gums look red and swelled, although not affected in the same way as by mercury, neither does the mouth emit the same fœtor. This state of the mouth and the increased flow of saliva, must be considered as symptoms which do not occur after the use of the warm bath; but there is another and principal effect, which much more commonly, indeed I may say generally, follows its use; that is, a greater degree of regularity and increase in the alvine evacuations, and sometimes a greater desire for passing urine, than has been experienced for some time, although there may not be an increase in the secretion of urine. As Dr. Scott has truly remarked, in people who are disposed to a naturally large secretion of bile, the quantity for the time seems increased, and may require the aid of purgatives for its removal. In those where the secretion of bile appears to be deficient, in consequence of derangement in the action of the liver, its effects are in many instances more remarkable than those I have observed to follow the use of other remedies: it gradually increases the secretion of bile, restores in consequence the proper action of the intestinal canal; the evacuations become more regular, more natural in colour and consistence, and the functions of the digestive organs are altogether improved. In some cases it even proves completely purgative. I am not, however, prepared to say that this happy change, when it does occur, will continue; on the contrary, I am disposed to believe it is only a temporary amendment; and that, when there is truly organic disease or derangement of structure, these good effects will soon cease, although they may, after an interval of time, be again induced by a repetition of the remedy. In one case this was shown in a remarkable degree. The patient had had the Walcheren fever during the expedition to that island, and had suffered ever since from visceral disease, with great and solid enlargement of the abdomen; his bowels were very irregular, an evacuation taking place only once in two or three days. Shortly after he had commenced the use of the bath, the bowels became regular every day, and continued so for some time; but they gradually returned to their former state, although the bath was continued, and the man, finding that no permanent benefit was obtained, preferred going home to his friends in the country. In another case the patient had been ten years at the Cape of Good Hope, had suffered considerably from inflammation of the liver, and for the last five years had been constantly unwell. He laboured under severe pain in the epigastric and both hypochondriac regions, which was much increased at intervals; he was unable to lie on the left side, and had occasional spasms of the abdominal muscles, with so great a soreness of the surface as hardly to allow the slightest pressure. There was a sense of great weight in the right hypochondrium, a sallowness of countenance, loss of appetite, and general appearance of ill health. This man took a variety of medicines, principally mercury and laxatives, as his bowels were always irregular and confined, and the warm bath was used to try the comparative effect of it and the acid bath; but, although persisted in for six weeks with much benefit, still it had no effect on the bowels. At the end of this period the acid bath was used instead of the warm bath, and the effects on the bowels were observable the next day, and have continued, with evident advantage to the patient. This effect, which is certainly the most constant of any which has been yet observed, is still, however, not general. In many persons it does not take place, and in these it does not appear to be useful; so that we may, I suspect, attribute any efficacy it possesses, especially in the cure of bilious complaints, to its power of increasing the secretion from the liver and intestinal canal. The soreness of the mouth occurred in a few instances, not more than six, on whom it was tried, under my immediate observation, and then not to any extent; which renders it doubtful whether that state of the gums arose from any specific effect of the acid, or whether it simply took place in consequence of the increased general excitement which ensued from its use after mercury had been previously and frequently employed; which was the case in four of the six instances alluded to. In the fifth and sixth, the gentlemen who used it for derangement of the functions of the liver, as was supposed by their medical attendants, had not taken mercury previous to using it, except as an occasional purgative; and they complained of its rendering their gums sore: but it was not carried to any satisfactory extent. I have since seen the mouth affected in several cases; but, in all, the patients had taken considerable quantities of mercury for the cure of their complaints, although in some a year had elapsed since they had omitted it. But whether it be dependent on this cause, or whether it be the specific effect of the acid, is not sufficiently ascertained to induce us to consider it as a regular effect of the remedy, which may be naturally expected when its use is persisted in to a certain extent. Sir James M'Grigor, when surgeon of the 88th regiment in X |