These were only manifested in four out of the whole number. One stated that the "medicine made him feel nervous," but declared there was improvement, both in breathing and in general strength. A second suffered severe headache, and the treatment was omitted. A third, a young female with disease in the third stage in both lungs, stated that "the medicine made her feel stupid and useless for a few minutes," but her general strength improved. A fourth said that the immediate effect was to make her feel powerless, but she became better and more cheerful.

II. Influence on general health.

A. 13 cases manifested great improvement.

In class A three patients stated that "they felt quite different men;" all testified to a great improvement, and these assurances were corroborated by signs of obvious improvement and by decadence of the signs of disease.

In class B the effects attested were-1, increase of strength; 2, decrease of cough; 3, arrest of fœtid expectoration; 4, improved rest; 5, increased appetite; 6, arrested night perspirations.

In class C one was a case of acute phthisis, in which the medicine was frequently vomited; the second coexisted with great hypochondriasis, and vomiting was a prominent symptom; in the third there was marked hysteria, and no improvement was manifested; in the fourth the disease progressed without any change for the better; and in the fifth the drug was omitted on account of headache.

III. Influence of nutrition.—There were in cases of fifteen patients whose weight was recorded

A. Gain of weight in 9 cases.

B. Loss of weight in 6 cases.

A. The increase of weight was 1 lb. in four cases, 24 lb. in one, 3 in two, 4 in one, and 5 in one; an average gain of 2 lbs.

B. The decrease of weight was, in three cases, fromlb.

to 14 lb.; in a fourth case 3 lbs. (very extensive disease of both lungs); in a fifth a decrease of 4 lbs. in weight was manifested coincidently with improvement in signs and symptoms; whilst in the sixth case the loss was 6 lbs., and the drug was omitted on account of sickness.

15. After a review of these cases I think it can be scarcely denied by any of those conversant with pulmonary disease that they bear a favorable contrast with similar cases placed under any other circumstances, however favorable. Without claiming for the salts, however, any undue advantages, we are, at least, justified in concluding-that the sulpho-carbolate of sodium, in doses amounting to sixty grains per diem, may be taken in the great majority of cases by patients in delicate health for a period of two months without the production of any deleterious effect whatever.

16. Concerning the operation of the sulpho-carbolate upon the economy, we can conclude that it is absorbed and then decomposed within the body into sulphate of sodium which is voided by the urine and carbolic acid which is exhaled by the lungs. Whether or no the carbolic acid is also in part excreted by the urine is undetermined; but it is certain that a marked influence is produced by the treatment upon that secretion— a fact proved by the extraordinary preservation of the latter from putrefaction. Although the tissues of the animal body do not disclose to tests the presence of carbolic acid, it is certain that they have undergone some potent change whereby they are preserved from decomposition. It is possible that the germs whose development in the dead body gives rise to the phenomena of putrefaction can obtain no vitality in tissues wherein carbolic acid is present.

17. Taking into consideration (1) that, as established by a multitude of observations, carbolic acid is a powerful agent for the destruction of organized germs, (2) as I think the foregoing observations afford sufficient evidence, the sulphocarbolate of sodium is a practical and efficient vehicle, whereby carbolic acid can be conveyed to the tissues of a living animal. I consider that an à priori case is made out for the treatment of zymotic diseases (i. e. those diseases whose manifesta

tions are considered to be due to the operation of organized germs) by the sulpho-carbolate of sodium.

18. As to the success which has hitherto attended the application of these principles, I desire to speak with great reserve. I have myself employed the sulpho-carbolate of sodium as an internal remedy in a large number of diseases of the zymotic class (including diphtheria and very severe scarlet fever) during twelve months. I have had no case which has terminated in death or in any untoward complication. I consider, however, that any individual experience is of the least possible value in the elucidation of the question of the value of the treatment in cases of zymotic disease. Such a question can only be determined by the accumulation of data, and especially by the employment of the remedies in the organized departments of the State.

A CASE ILLUSTRATING

THE

PHYSIOLOGY AND PATHOLOGY

OF THE

CERVICAL PORTION OF THE SYMPATHETIC NERVE.

BY

WILLIAM OGLE, M.D. OxoN., F.R.C.P., HON. SEC., ASSISTANT-PHYSICIAN TO, AND LECTURER ON PHYSIOLOGY AT, ST. GEORGE'S HOSPITAL.

Received Jan. 29th.-Read March 23rd, 1869.

OUR knowledge of the functions of the cervical sympathetic is derived almost exclusively from experiments on animals, man himself having furnished very few data, pathological or experimental. I cannot, therefore, but hope that the case which I have now to bring forward will be found one of great interest; for the symptoms observed in it will, I think, satisfy physiologists that the sympathetic nerve had either been cut through on one side of the neck, or, if not actually divided, yet so disorganised as to amount practically to the same thing.

It will perhaps be well before I narrate my case, to recall briefly the chief observations which have hitherto been made on this nerve in man.

So far as I have been able to ascertain, there are only two

cases on record in which the symptoms observed during life led to the conclusion that the cervical sympathetic had been severed.

In one case, a surgeon in removing a tumour from the right side of the neck apparently divided the nerve. Next day the face on that side was deeply congested, and marked with well-defined patches of a violet red. The right pupil was contracted; the conjunctiva normal. No observations were made as to the temperature.1

The second case is of more importance. An American soldier in the course of the late war was shot through the neck with a bullet. Two months after he had been thus wounded he came under the notice of Messrs. Mitchell, Morehouse and Keen, who have recorded his case in their work on gunshot wounds (p. 39). The pupil of the right eye was very small, that of the left eye unusually large. There was slight but distinct ptosis of the right eye, and its outer angle seemed to have dropped a little lower than the inner angle. The ball of the right eye seemed smaller than that of the left, and its conjunctiva was somewhat redder. The pupil was not only contracted but slightly deformed, oval rather than round. In a dark place, or in half lights, the difference in the pupils was best seen; but in very bright light the two pupils became nearly of equal size. The left eye watered a good deal, but had the better vision, the right eye having become myopic. He complained of frontal headache, of loss of memory, and of red flashes in his right eye when exposed to the sunlight, and also, after long exposure, in the left eye. With all this there were no abnormal retinal appearances. The patient's face presented a curious appearance after walking in the heat. It became distinctly flushed on the right side and pale on the left. The flush extended to the middle line, but was less definite as to its limits on the chin and lips than above these points. Unfortunately no thermometric examination was made, while the man was thus flushed with exertion; but careful examination made during repose, showed no difference in the heat of the two sides 1 'Gazette des Hôpitaux,' No. 64, 1868.