also: accordingly, 4 oz. (all that could be obtained) of blood were taken from the arm, a blister applied to the throat. Tinct. digitalis gft. x. were given every four hours, and a powder containing calomel gr. ij. sacch, alb. gr. i. was directed to be given with the greatest exactness every hour. January 17th, 8 A. M. 24 grs. calomel and 70 drops tinct. digitalis have been taken. The symptoms are as nearly as possible the same, the pulse also of the same frequency, no evacuation by the bowels; continue the remedies. 18th, 8 A.M. has taken 28 grs. more calomel, and 90 gtt. tinct. digitalis: the breathing considerably relieved; the cough, though frequent, much less harsh; pulse 124, tongue white, skin cooler; has had two stools of consistence, and of a dark green colour; continue calomel, discontinue tinct. digitalis. 18th, 9 P. M. has taken 20 more grs. calomel: one stool of same appearance, crouping ceased, cough frequent but loose, pulse 120; no medicine. 19th, 11 A. M. breathing easy; cough frequent, but more mild; he expectorates a sort of thin purulent matter, intermixed with pieces of firmer texture and darker colour; his countenance has lost the turgid appearance, and he seems quite at ease; pulse 108, appetite good, B-bound, capt. haust. purg. 22d, has continued to expectorate the same sort of matter, but the mass is now more uniform, resembling well-digested pus. The result of this case was very satisfactory: it shewed that croup was not, necessarily, a mortal disease; and I attributed the more to the calomel, because less blood was taken by two-thirds than in most of the cases which had proved fatal, and because the disease was to the full as violent as any which I had ever witnessed."

Several other cases follow; and the result of the whole is, that calomel, in very large doses, given early enough in the disease, is the remedy most to be depended on. Some valuable observations follow from the American and French writers.

Art. III.-Observations on Croup; by WM. GAITSKELL, Esq. Surgeon.

The inquiries principally attended to in this article are,1. Whether croup is contagious? 2. Whether it is more frequent in northern or southern countries? The first is answered in the negative, without any reserve, though frequent instances occur of the disease attacking more than one person in the same family. It appears most frequent in northern countries, and in maritime districts. That it is more frequent than formerly, appears ascertained by the bills of mortality, as far as they can be depended upon; and, if we may add our own opinion, we should not scruple to confirm such a report, and strengthen it by a remark we have made, that inflammatory diseases of all kinds have increased in number and violence.

The

The 3d inquiry is, What are the common accidental causes of croup; and what the circumstances which propagate it in one country more than another? The 4th, The relative mortality of the disease? 5th, The general treatment? And 6th, Is there any special treatment for croup?

All these questions are answered with very great attention, from the author's own observations, and the facts he has collected by conversation, epistolary inquiry, and printed authorities. The whole affords a truly valuable and comprehensive dissertation on this formidable disease, conducted by a gentleman, who, from his well-known talents, aided by extensive practice in a crowded neighbourhood, is probably the fittest practitioner that could be selected for the purpose. Art. IV.-Account of Three Cases of Extraordinary Periodical Sickness, two of which were cured by Arsenic; by JOSEPH ADAMS, M.D. &c.

These cases are highly interesting, and show in a very pointed view the effects of this powerful remedy.

Art. V.-Case in which nearly an Ounce of Sulphuric Acid had been swallowed; by the same.

The vitriol appears by the account to have been vomited in the presence of Mr. Aldridge, the surgeon in attendance, ten days after it was swallowed. We shall offer only the reflections with which the paper concludes.

"On a review of this case, I am aware that considerable scepti cism will arise concerning the length of time which the vitriol remained in the stomach; and, perhaps, concerning the possibility of a delicate female recovering from the violent effects of such an accident. I have, however, related the events as they occurred, with the authority on which each of them rests. I shall now add, that to me they are all satisfactory. The mode of accounting for them must be left to those gentlemen to whom we are so much obliged for their experiments in animal chemistry. From some of these we learn, that the vitriolic or sulphuric acid does not affect living animal matter, and that it coagulates mucus. If I am right in this, the above history may be explicable in the following manner: the vitriol was swallowed early in the morning, before any kind of food or drink had been taken to wipe off or dilute the mucus of the mouth, throat, or œsophagus. When received into the stomach it would coagulate the mucus with which it came into contact, and stimulate the stomach to secrete more. By these means it might have been contained in a number of cysts of coagulated mucus, or in one or two large cysts which might have been thrown up at the time Mr. Aldridge perceived the stain and consequent hole in his coat. At "the same time, it can hardly be expected that these cysts would be sufficient entirely to preserve all the acid from contact with the stoNO. 222.

S

mach,

1

mach, which, being denuded of its proper mucus, might be inflamed to a certain degree, and thus secrete a substance consisting partly of blood, which, when thrown from the stomach, has frequently this black appearance.

"This suggestion will, I hope, be considered only as hints for the consideration of those gentlemen who have devoted so much time, and with so much success, to this branch of medical science; and, if any better solution of the difficulty should occur, I shall gladly receive it; at the same time, I should be sorry if the relation should excite so unjust a scepticism as to supersede all reasoning on the subject."

Art. VI.-A Case of Lusus Nature of the Female Organs of Generation; by WM. GAITSKELL, Esq. Surgeon.

In this subject the vagina ended in a cul de sac, instances of which have occurred before. The author's reflections, however, are judicious, and his authorities numerous and well selected.

Art. VII.-Case of the Vermis Lumbricus perforating the Intestinal Canal and Abdomen; by J. C. LETTSOM, M.D. &c. An abscess, formed in the integuments of the abdomen, when opened, emitted air and pus. After a few days,

"On removing the poultice, a pointed substance in motion appeared in view. It was taken hold of between the fingers, carefully drawn through the orifice, and proved to be another vermis lumbricus in a living active state, in length about nine inches; small air bubbles occasionally appeared; as well as some fæculent matter; both ceased in a few days. For some weeks afterwards, no fæces were discharged through the wound, but seeds of apples or pears, which she had swallowed with these fruits, occasionally protruded. This ceased before the month of December, the orifice of the abscess had cicatrized, and an accretion of the body was perceptible." Some practical remarks follow particularly on the use of ol. terebinthine in worm cases.

Art. VIII.-Case of Diseased Action of the Heart, effectually relieved by Blood-letting, and Confinement to a Horizontal Posture, by H. CLUTTERBUCK, M.D. F.M.Ş.

The importance of this case, related as it is with all possible brevity, induces us to transcribe the whole in the author's words.

Mrs. Churcher, thirty-five years of age, wife of a person in the employ of Messrs. Calverts, brewers, applied to me Oct. 20, 1814. She had just walked from her own house, a distance of about half a mile.

"Her general appearance at this time was exceedingly distressing. Her countenance expressed great anxiety. The skin in general was perfectly pallid and ex-sanguine, except on the cheeks and hips,

2

which

which were of a leaden hue. The tongue was clean and moist, but as colourless nearly as the skin itself. Her extremities were cold; pulse weak and irregular; breathing much oppressed; the face looked full and bloated; the legs were swollen as high as the knees.

"She complained of constant uneasiness in the region of the heart, which was affected with frequent palpitations, sometimes coming on even when lying down in bed, but always upon walking, or any other bodily exertion; and, at these times, the pulse at the wrist becomes irregular. Upon making any unusual exertion, this uneasiness is aggravated to the degree of acute pain, which extends to the back, collar-bones, and middle of the upper arms, particularly the left. The menses, she observed, were regular in their periods, but trifling in quantity, and nearly colourless. She fancied she had hardly any blood in her veins; for she said, that, when she accidentally pricks her finger, so as to draw blood, the fluid that issues scarcely stains linen. Her appearance altogether was that of the most complete state of chlorosis, with not a few of the symptoms of hydrothorax or hydrops pericardii.

"Her appetite was extremely bad: she felt always great uneasiness after eating; and the constricted state of her bowels required a constant employment of purgative medicines. Her general strength was greatly reduced; and this, with the growing severity of the symptoms, seemed to indicate much danger, of which she herself was very apprehensive.

"The symptoms now described had continued for several months, and were gradually increasing. They came on soon after a severe attack of inflammation in the chest, which she suffered about a year ago.

"On visiting her the next morning, Oct. 21, at her own house, in consultation with Mr. Key, surgeon, of Fenchurch-street, we found the violence of the symptoms much abated, from her being in a state of rest, and in bed; and the pulse was tolerably regular.

"The symptoms above described sufficiently indicated an excess of irritability and disordered action in the heart; while their dura tion, severity, and their having succeeded to an attack of inflammation in the chest, gave reason to apprehend, that the disposition to such irregular action in the heart, was the consequence of some dis organization having taken place.

"The constant and, at times, severe pain the patient suffered, and the gradual increase of the disease, rendered it probable that the diseased and inflammatory action was still going on; and all hope of relief appeared to me to turn entirely upon our being able to check its further progress. No means seemed so likely to effect this desirable object as blood-letting. Notwithstanding, therefore, the debilitated and, seemingly, bloodless state of the patient, it was determined to make a cautious trial of it. Upon the pretext of exa mining the state of the blood, about five ounces were drawn from the arm, though not without much reluctance on the part of the patient; she bore it, however, without inconvenience. After the blood

had coagulated, there was observed a full proportion of crassamen tum, which was of the ordinary consistence, and somewhat cupped or contracted in form, but without any buff upon the surface of it. There appeared to be either a deficiency of the red particles, or else they wanted their usual florid colour, the crassamentum presenting almost a leaden hue.

"The patient experienced evident relief from the loss of blood, and the road to further probable advantage seemed by this to be pointed out. The digitalis was administered in small and frequent doses, as a means of lessening the irritability of the heart; as was the ammonia in small quantities, with the view of exciting a little the action of the stomach, and of determining the circulation to the extreme parts. Aperients were exhibited in such quantities as to ensure several evacuations by stool, daily-the use of plain, easily-digested animal food was allowed, as the appetite might require; all strong drinks were prohibited, as they had always been found to aggravate her sufferings; and, above all things, perfect quiet of body and mind, and a horizontal posture, were enjoined; and, for this purpose she was confined to bed almost entirely for the space of ten weeks.

"The blood-letting was repeated at intervals, and the plan altogether persisted in, with great regularity, for nearly three months, with gradual and continued amendment; and, at the end of this period, her health was perfectly restored. She had lost every uneasy feeling about the chest; the pulse became quite regular, and of its natural strength and fulness; the swelling of the extremities disappeared; her appetite returned, and the bowels acted readily with very little aid from medicine. The menses returned at their regular periods, and, the last time, in a perfect manner, both as to quantity and colour. Her complexion, also, was now as good as at any pe riod of her life.

"She was bled, in the whole, four times from the arm, and once by cupping, from the nape of the neck. From ten to twelve ounces of blood were taken away on each occasion after the first. The time preferred for the purpose was immediately after each imperfect attempt at menstruation. Four or five evacuations by the bowels were procured daily, by small doses of aloetic pills, with which a very small quantity of sulphate of iron was combined.

"I have not mentioned a troublesome beating which she felt in the head, at the time that the heart acted most irregularly; as this symptom appeared in a secondary light only, and it yielded with the other symptoms.

I have related this case, as it appears to me to establish some useful practical points. It serves to show, that symptoms of an alarming kind, seeming to indicate an organic affection of the heart, (or which, at least, threatened to terminate in disorganization,) are not altogether hopeless; that a case which seemed of all others, from general appearances, and according to general opinion also, to be the most unfit for blood-letting, not only bore this evacuation with impunity, but evidently was effectually relieved by it. And, if

So,