developed to decide whether an acute inflammation of some deep-seated part has set in or not, this instrument will often decide the doubt. No acute inflammation can exist without preternatural heat of the body. Hence, if in a doubtful case the temperature, after a careful investigation, be found natural, the case is not one for aconite; while, on the other hand, if the symptoms, although doubtful, indicate an inflammation, the presence of an increased heat of the body will very considerably add to the probability of its existence, and will so indicate the advisability of employing aconite.

Another instance may be mentioned. After scarlet fever, as is well known, acute inflammation of the kidneys is very liable to occur. This would at once be indicated by a rise in the temperature of the body. It is therefore desirable to direct the friends of such patients to observe, night and morning, the temperature; and if this should rise beyond limits of health, they should at once commence the administration of aconite, and not allow some hours to elapse before the patient can be seen by the medical attendant. It is true the fever may depend on some other complaint than inflammation of the kidney; but it will even then probably be inflammatory in character, as from gastric catarrh, over-feeding, and the like, in all which cases the aconite will be equally efficacious.

Whether aconite is of use in the fever of acute specific disease, as scarlet fever, measles, &c., is not so certain as its power over inflammation. But although there may be some doubt whether this remedy can lessen the severity of the fever of the acute specific diseases, there is no doubt it can control and subdue the inflammatory affections which often accompany them, and which may by their severity endanger life. Thus aconite will moderate the inflammation of the throat in scarlet fever, and the catarrh and bronchitis in measles, and in this indirect manner lessen the height of the fever. It appears to be unable to shorten the course of these acute specific diseases. In the treatment both of simple inflammations and acute specific diseases, aconite may be appropriately administered in conjunction with some other remedy which may be indicated.

The treatment which has just been described will be found of value in erysipelas, in which disease belladonna may also with advantage be given. In the treatment of acute rheumatism aconite has been much praised, and from the eminence of the authorities by which it has been recommended there can be no doubt of its usefulness. Still in this complaint its good services are not so apparent as in acute inflammation. This disease has no regular course or duration, but may, untreated, last only a few days, or many months. It is difficult, therefore, to decide whether the speedy decline of the fever in some cases is a

natural decline, or has been accomplished by the aconite. It is certainly ineffectual in many cases, which appear to run their course uncontrolled by this remedy. So that it is still required to determine in what class of cases it is useful, and in what cases it is without effect. In one respect it often appears to be of service-namely, in removing the pain from inflamed and swollen joints.

Gouty pains are said by some to yield to this remedy, and it has in many instances, apparently with good results, been given to persons suffering from neuralgia.

The effect of this remedy on the heart has been mentioned. There it was shown to lessen the rapidity of the circulation. Aconite may thus be used in all cases where there is vascular excitement which it is desired to suppress, and also when it is desirable to diminish the force of the circulation. In fact, it may be given in precisely those cases which were formerly treated by bleeding.

This remedy may be employed with advantage when the menses are suddenly checked, as by cold, on account of its power to restore the flux, and so remove the distressing and peculiar symptoms which not unfrequently occur when such a disease is produced.

The "fluttering at the heart" of nervous persons, and also nervous palpitations generally yield to this remedy. Usually when such disturbances occur, more general treatment is required, but when the conditions causing the palpitation cannot be discovered or cannot be removed, then aconite may be usefully employed.

The acute stage of gonorrhoea may be well treated by a drop of the tincture of aconite each hour, and the same treatment will often remove chordee.-Lancet, Jan. 9, 1869, p. 42.

111.-ON POISONING BY STRYCHNIA.

By Dr. CHAUNCEY PUZEY, House-Surgeon to the Liverpool Royal Infirmary.

[A man, 24 years of age, was admitted into the Liverpool Royal Infirmary, on Tuesday, Feb. 18th, 1868, at 2 a. m., suffering from acute tetanic symptoms said to be the result of poisoning by strychnia. He had taken sixpennyworth of Hunter's vermin powder by mistake.]

On admission, at 2 a. m., he was cold, with feeble rapid pulse, face congested, and skin clammy; breathing short and hurried. At intervals of every three or four minutes, a spasm came on, in the form of well marked opisthotonos. During the spasms the respiration became hissing, jaws fixed, eyes very prominent,

face congested and livid, and the man appeared as if he would die of asphyxia.

Each spasm lasted not quite two minutes, then there was about two minutes interval, during which intervals the man was quite conscious, and described his sensations after taking the poison. Thirty minutes after admission he vomited again. (In the vomited matter, a trace of strychnia was found.) The act of vomiting was accompanied by great pain, and was of a peculiar spasmodic, jerking character. He could swallow nothing, so it was determined to try subcutaneous injection. At 2.30 a.m., one third of a grain of morphia was injected into the calf of one leg. The introduction of the needle brought on violent spasm, but in five minutes the man expressed himself as being easier than he had been for the last two hours, and the attacks became less frequent and less severe. About 3.15 they began to increase again, and a third of a grain of morphia was injected into the other leg, with renewed benefit. Shortly before this, the patient seemed so exhausted, and the pulse so feeble,-in fact, hardly perceptible during the spasm,-that small quantities of brandy and water were frequently given, at first with considerable difficulty.

At 5.30 a. m. he had been dozing a little, and the spasms had been much less violent, but they appeared to be returning a little more frequently. Their character was, however, much altered, as they came on with sudden jerks that nearly threw the patient out of bed, causing him sudden acute pain, but unattended by trismus. A quarter of a grain of morphia was injected, and the brandy stopped, as his skin was much warmer, and pulse better.

At 7 a.m. he was again seen, and was so much better that nothing further in the way of treatment was thought necessary; but every now and then a sudden jerking spasm would seize him. These gradually became less violent, and by the afternoon had altogether ceased, He suffered from considerable pain and tenderness for several days afterwards, and slight ecchymoses appeared about the legs and arms, where the spasms had been most severe.

He went out quite well in less than a week.

It appears to me that there are two or three points in this case worthy of notice.

There seems to be no doubt that the man swallowed the whole powder. Mr. J. C. Brown, B. Sc., the lecturer on Chemistry and Toxicology at the Infirmary School of Medicine, analysed a similar powder for me, and found that it contained exactly three grains of strychnia. (This according to Taylor is usually a rapidly fatal dose.) He vomited a little about an hour after taking the poison, but it must have been nearly two hours

before the contents of his stomach were evacuated, for the emetic given him by the surgeon who was called to see him did not take effect until he was being brought in a cab to the Infirmary, at 2 a.m.

But after this a considerable quantity of strychnia remained in his stomach, for at 2.30 he vomited again, and in a small quantity of the vomited matter, collected and analysed by Mr. Brown, there was found of a grain.

It appears probable that the absorption of the poison had been retarded to a certain extent by the state of the man's stomach, he having been drinking spirits freely that night, and that to this fact he owed his escape from speedy death within an hour.

As regards the treatment adopted, it consisted of three things

1st, An emetic to remove the poison remaining in the stomach;

2nd, The injection of morphia, to put a stop to the convulsions, the result of the poison already absorbed; and

3rd, Stimulants to overcome the exhaustion due to the spasms.

Neither the first nor the second part of the treatment would per se have been sufficient. Of course, it would have been unreasonable to trust to the morphia whilst any poison might still be in the stomach; and it was evident to bystanders that the emetic alone would not have saved the man's life, as he must almost have certainly have died from exhaustion if the tetanic symptoms could not have been relieved, and his strength at the same time supported; and in no way could this so soon be effected as by the hypodermic method.

Probably many would suggest that the administration of chloroform would have succeeded as well. But, in the first place, it appeared to me that it would be difficult to combine this with the administration of stimulants and support to the patient; and again, I thought it a less safe method of treatment. For it seemed so likely that the man would die, during, or immediately after one of the convulsions, that I was fearful, lest, supposing such a thing occurred whilst he was inhaling chloroform, death might be attributed to it. In the Medical Times and Gazette of May 9th, of this year, and in that of the 27th of June, 1867, cases of recovery after strychnine poisoning are related where chloroform was found to act in the most satisfactory manner. But even supposing each mode of treatment to be equally safe, there can be no doubt, I think, which is the more convenient, where there is not a staff of assistants to relieve each other in the administration of the remedy.

The effect of the hypodermic injection was manifest almost immediately. In five minutes the patient expressed himself as being easier than he had been for two hours before, and in half an hour he was able to swallow frequently small quantities of brandy, without which it appeared likely that he would sink from exhaustion. To the necessity for the administration of stimulants in such cases, Mr. Phelps draws attention in his observations on one which he treated at the Northern Hospital in this town, five years ago, and which is the second of those I alluded to above. In his case, beef tea and brandy were injected into the stomach whilst the patient was under the influence of chloroform.

The effect of the morphia was only temporary, for the injection had to be repeated in three-quarters of an hour, and again in two hours more.

The change in the character of the symptoms, as the effects of the poison were passing off, was peculiar, the violent tetanic spasms gradually becoming weaker and weaker, and then being replaced by sudden short jerks or starts of apparently every muscle, occurring at uncertain intervals, and calling to the mind of the observer the slight and interrupted shocks given off by an electro-galvanic machine after it has been worked for a considerable time.-Liverpool Medical and Surgical Reports, Oct. 1868, p. 89.

112.-ON A NEW AND SIMPLE METHOD OF INDUCING ARTIFICIAL RESPIRATION IN CASES OF ASPHYXIA FROM DROWNING, STRANGULATION, CHLOROFORM, &c.

By Dr. W. P. BAIN, Surgeon to the Poplar Hospital. The author introduces a plan hitherto not known in this country, the invention of the celebrated Pacini, of Florence, which consists in placing the patient on his back on a table or bed, the operator having his abdomen against the head of the patient, placing his hands in the axilla on the dorsal aspect, and then pulling the shoulders towards him with an upward movement at the same time. The shoulders are then relaxed, then the former movement, and so on alternately. In many cases operated on by this method the air makes a loud noise when it passes the larynx, as in snoring.

The author was so impressed with the excellence of this plan that he determined on his return from Italy to make experiments on it, as suggested to him by its illustrious inventor. He had not long, however, proceeded with these before he discovered two modes considerably superior, and throwing also somewhat in the shade the labours of Marshall Hall and Sil