mixture. The following day there was an aggravation of the symptoms; the patient had spent a restless night, and the relatives became anxious. Upon this I prescribed an eight-ounce mixture, containing two drachms of the muriate of ammonia, with five-drop doses of tincture of aconite. The combination seemed to act magically; before the bottle was finished the pain was gone. Sulphate of iron and quinine was afterwards given, and four months have now elapsed without any return of the complaint.

Case 2.-A. L., aged 19 years, single, of a full habit, and hitherto healthy, became affected with a violent pain in the left groin, for which immediate advice was required, as the woman in attendance dreaded the existence of a hernia. On being visited I found the pulse high, and the usual symptoms of inflammatory fever. She had suffered severely four months previously to being visited, and had passed no water from the commencement of the attack; vomiting was a constant and distressing symptom. On examination I found slight swelling on the left side, with intense pain on manipulation; the tenderness extended below Poupart's ligament. Having satisfied myself that there was no rupture, I ordered turpentine stupes to be applied, and directed her to have a warm hip-bath, and a mercurial aperient. The following day, as there was no progress towards amendment, I applied six leeches over the site of pain. This gave temporary relief, but towards evening the pain became if anything more severe. I found her, on being visited, on her hands and feet out of bed, apparently suffering most acutely. I prescribed her a draught containing twenty drops of cannabis, and immediately placed her on the muriate of ammonia and aconite mixture. The ensuing morning she expressed herself considerably relieved, but the tenderness remained, at times the pain recurred, producing vomiting when it did so. The patient got on remarkably well until the menstrual period arrived, when the same state of things occurred over again; but under the muriate of ammonia and aconite much was done to arrest the disease. She has had a menstrual period since without any recurrence of the pain.

Case 3.-A. R. F., aged 22 years, married for the last fourteen months, has long suffered from chronic ovarian pain, increased during the menstrual period. Has taken, to use her own words, "no end of medicine," and has been under the treatment of various physicians, "who all told her the same thing." I prescribed at once the muriate of ammonia and aconite; two bottles in the course of six days entirely removed the pain. Six weeks have elapsed, a menstruation passed with little pain, and at the present time (July 14) I learn from the woman, who came with another patient, that she has entirely recovered, and has had no return of the pain since she finished the last mixture.

Case 4.-J. L., married, aged 40 years, has suffered from ovarian neuralgia for a number of years. At times the pain is unendurable; during its existence there is fulness and tenderness over its site. Having been under treatment for an hepatic lesion, and obtained the above information in the history of her case, I told her, when the ovarian neuralgia returned, to apply, and I should prescribe for its relief. She accordingly did so in the course of time, and from the muriate of ammonia and aconite she obtains almost immediate ease.

Case 5.-G., about 25 years of age, single, has suffered from the time of her first menstruation with ovarian pain, causing frequent and painful micturition, with vomiting. Gave her the muriate, and had the satisfaction of hearing her express that she obtained instantaneous relief after its administration. Has suffered from subsequent attacks, which invariably yield to the medicines advocated.

Case 6 is furnished to me by a professional relative. It is that of a woman, aged 30 years, who has borne three children, and has laboured under ovarian suffering for a term of years. She has been a constant patient of my informant. He had "exhausted the Pharmacopoeia," as stated, but with no benefit. Upon the exhibition of the muriate and aconite, the symptoms directly yielded to treatment, and the woman was relieved from much periodic suffering, and the physician re-established the confidence hitherto placed in him.

Although I am at a loss to account for the inexplicable property possessed

by the muriate of ammonia in curing ovarian neuralgia, I can unquestionably vouch for its efficacy in the same way as the French and German authors first bore out its high character and undeniable specific action as a stimulant in mucous fevers, when the inflammatory symptoms have subsided.— Medical Press and Circular, Aug. 19, 1868, p. 162.

107.-TWO CASES OF INCONTINENCE OF URINE FROM EARLIEST CHILDHOOD, CURED BY MECHANICAL DILATATION.

Under the care of Dr. BRAXTON HICKS, at Guy's Hospital.

A cause of incontinence of urine is indicated in the following cases which is not generally recognised. The treatment which Dr. Hicks applied was very successful, and we have no doubt that the record of it will be of great service to practitioners who have patients suffering from this very troublesome condition.

Case 1.-M. A., about 22 years old, had suffered ever since she can remember from nocturnal incontinence of urine, and almost incessant desire to micturate during the day. Had been under a great amount of treatment. She was admitted into Guy's Hospital under one of the surgeons, who examined for stone, but found none, nor any disease of the bladder, but a contracted one. Dr. Hicks offered to take charge of her. He began first by injecting solution of morphia, which lessened the irritability to a great extent, so much so that she was free for two or three nights from her distress. However, no further progress was made, but rather retrocession. Dr. Hicks then ordered the bladder to be distended as much as possible by plain warm water. This was done by his clerk, Dr. Chas. Smith, very carefully, daily. Almost directly she derived benefit, and in the course of a week she was quite well. The treatment was kept up for a week or more, and she went out. After three months the nocturnal incontinence returned, and she was readmitted; but the bladder became rather more irritable. Morphia was again used, but not acting so well as before, an injection of nitrate of silver, twenty grains to the ounce of water, was employed. This caused some pain after, but in a week she improved, with occasional trouble at night. She could hold half a pint of urine at a time in the day, but not so much at night. However, by an occasional injection of morphia she gradually regained the power of retention, and went out again free from her complaint. It was curious that for two or three days during the latter part of her treatment she was troubled with complete retention of urine; this, possibly, was of a nervous character.

Dr. Hicks remarked that the constant evacuation of urine permitted by some mothers to their children allowed the bladder to become so constantly empty, that after a time the muscular power of the sphincter was not sufficient to counteract the contractility of the organ. In recent cases, no doubt this could be voluntarily overcome by adults; but in old-standing cases, although we might do much by lessening the sensibility of the bladder, yet we might proceed at once to overcome its resistance by mechanical force, so that further treatment would not be required. This was strongly shown in the following case, which recently was under his care in Guy's Hospital.

Case 2.-The history was precisely similar to that of the last. The bladder was at once injected with water; it shortly held half a pint. The incontinence was rapidly cured; and the patient went out to service.

Both these girls had been unfit for service from their complaint. Dr. Hicks suggested the applicability of this treatment to both sexes, in cases with similar history; at any rate, it would be harmless unless violence were used. He thought it was possible that in some of the cases there were congenitally small bladders, and these possibly might be more difficult to manage.

There is much more difficulty in treating the contracted state of the bladder in chronic cystitis. A great deal can, however, be effected by injections of various kinds, as was shown in the following instance :

C. C., aged 26, had cystitis after delivery, which caused her great pain, and intense desire to void urine every half hour. Various remedies were tried styptics and sedatives to the interior of the bladder. Nitrate of silver injection (thirty grains to the ounce) was the most beneficial. The distress it caused was considerable; but she preferred it, as giving most subsequent relief. Morphia solution was always left in afterwards; and also at other times, to lessen the sensitiveness occasionally; mechanical distension was employed, but it was found nearly impossible to inject beyond three ounces at any time. After two months she could retain urine for nearly three hours, when Dr. Hicks thought it might be possible to distend the bladder to a greater extent under chloroform. This was tried; but three ounces was the greatest quantity admitted. There was a good deal of irritation after, and she was not so well as before. After a week she could hold her water only for an hour and a quarter. Afterwards she improved, and could manage to retain urine for an hour and a half, when she left the hospital.

Whether the resistance of the bladder was simply from thickened walls, or from this and inflammatory adhesions also, did not appear clear in the case. The resistance was very firm. She had, however, gained something altogether by the treatment; but not so much as she would have done had no attempt been made to distend the bladder.-Lancet, July 4, 1868, p. 7.

108.-NEVI IN CHILDREN TREATED BY ACTUAL CAUTERY. Mr. T. HOLMES has recently had two cases illustrating the advantage of this mode of operation. The cautery employed was that known as Wordsworth's, which consists of a steel needle springing from a bulb; the latter being brought to a white heat in a blow-pipe flame, it keeps the needle heated for a considerable time. The cutaneous part had been previously treated by nitric acid, and the subcutaneous had been partly removed by the ligature. The cautery was, therefore, employed to destroy a few remaining portions of the nævus tissue. The nævus was pierced in ten or twelve places, the needle remaining hot the while. The result was most satisfactory; there was no irritation nor suppuration. -Practitioner, Sept. 1868, p. 183.

ADDENDA.

109.-ON THE USE OF CROTON OIL AS A COUNTER-IRRITANT IN HEAD AFFECTIONS.

By Dr. ROBERT S. TURNER, M. A.

[Dr. Turner, whilst resident medical officer at the Sick Children's Hospital at Edinburgh, had opportunities of observing an unusually large number of cases of tubercular meningitis.]

Case 1.-Elizabeth Wilson, aged six years, was admitted into the Children's Hospital on the 21st of August, 1867. She was in hospital about five weeks before, suffering from measles, and although convalescent when dismissed had never regained her usual strength. About ten days before readmission, her mother said she had had a fit and afterwards attacks of "the nerves." She had complained for some time of pain in the head and bowels. The bowels were confined. Several children of the same family had died of phthisis in the hospital.

On admission the child was dull and sleepy, kept constantly grinding her teeth, and frequently started in her sleep. The pulse was slow and irregular. From the history and symptoms, the case was readily diagnosed as one of tubercular meningitis. The bowels were moved by an enema, and the stool was carefully examined for worms, but none were found; the hair was cut short, and cold applied to the head; she was ordered also to have two grains of iodide of potassium thrice a day. The symptoms increased in severity, and, three days after admission, she had a convulsion and became comatose, with stertorous breathing and strabismus. Dr. Weir, the physician on duty at the time (to whom I am indebted for liberty to report this and the two following cases), now ordered the head to be shaved and croton oil (one part of croton to three of olive oil) to be rubbed into the scalp. As soon as the croton eruption appeared the coma gradually passed off, and the child began to regain consciousness. She rapidly improved, and about a fortnight after admission was able to get up and run about. On the 15th of September, however, she was suddenly seized with a violent convulsion, and the head symptoms returned. Next day she had another severe convulsion, and died. A post-mortem examination was not allowed.

Case 2.-Helen Allen, aged five years, was admitted 21st August, 1867. Patient had been complaining of dizziness and headache, and had been losing flesh and appetite for about a month before admission. A sister died of tubercular meningitis in the hospital about a year before.

On admission her symptoms were much the same as those of Elizabeth Wilson, just described, and, in addition, she had vomiting and great intolerance of light. There were no worms in the motions, which were at first confined but afterwards loose. She was ordered cold to the head, and iodide of potassium. The symptoms increased, but not so rapidly as in the preceding case. About a week after admission she was decidedly worse. She lay on her back with her eyes turned up, and could not be roused without great difficulty. Her head having been shaved, the croton liniment was now applied, but, before the eruption had time to come out, her breathing had become stertorous, she had slight convulsions, and her urine and fæces were passed unconsciously. As soon as the eruption appeared, however, the symptoms

began to abate, and in a few days they had altogether passed off. In addition to the iodide of potassium she was ordered cod-liver oil. For about three weeks she continued well, but as the irritation of the eruption was passing off, she began to complain of headache and giddiness. The liniment was again applied, with the effect of relieving the symptoms, and the eruption was kept up for some weeks, during which time the patient appeared perfectly well. By the middle of October the irritation was again allowed to subside, and although the patient complained of a little headache, the croton oil was not applied till the 20th October. On that day she fell down in a fit, and her head was severely cut by coming in contact with the corner of a stool. Before the eruption appeared she had another less severe convulsion, but on its coming out fully she again got better, and continued so till she was dismissed on the 26th of November.

Case 3.-Andrew Armstrong, aged two years and nine months, admitted 2nd September, 1867. The history was the usual one of tubercular meningitis-irritability, loss of flesh, starting, and grinding the teeth during sleep. On admission he was in a semi-comatose state, and the pulse and respiration were irregular. His head was at once shaved, and the croton liniment rubbed into the scalp, and he was ordered two grains of iodide of potassium thrice a day. Next day the coma had become deeper, and squinting had come on; so ill was he, in fact, that it was considered hopeless to apply the croton oil again with the view of hastening eruption. On the following day, however, the eruption began to appear, and, as in the other cases, the patient was well in a few days. The irritation was kept up for some time by a weaker liniment. He recovered without a bad symptom, and was dismissed on the 5th of October quite well.

Case 4 was that of a child about three years old, whom I saw in the outdoor department of the hospital. I have no notes of the case, and therefore I am not able to detail the symptoms; but they were of such a nature that, taking the history also into account, Dr. Caton, then assistant to the extra physicians, and myself had no hesitation in ascribing them to tubercular meningitis. Directions were given to have the head shaved and a croton-oil liniment rubbed into the scalp, and iodide of potassium was ordered internally. The child soon got so much better that attendance at the hospital was stopped, and he continued well till the eruption on the head disappeared. About a fortnight after his last visit to the hospital he became much worse, and his mother wrote requesting that he might be attended at his own home. By some accident the letter was not delivered till three days after, and, when I got to the house where he lived, I found another medical man in attendance, who said he was treating the child for acute hydrocephalus.

Case 5 was seen more recently, and is at present in the Infirmary under the care of Dr. Grainger Stewart, who has kindly allowed me to refer to it.

William Macintosh, aged 36, an engraver, was admitted into Ward 6, 22nd January, 1868. Two years before admission, he sustained an injury on the head by falling down stairs, from the effects of which he was laid up for some days. Afterwards, although able to work, he occasionally had fits of headache, with shivering and loss of appetite. In the end of August last he was exposed to cold and wet, and for about six weeks after had a severe headache, with occasional loss of consciousness and convulsions, which occurred two or three times a day, and lasted for about five minutes each time. By the end of November he had got better, but on the 24th of December he had a violent convulsion, and from that time became gradually worse.

On admission he was in a dull, drowsy condition, and could be roused only when spoken to sharply and loudly. When answering questions, he spoke very slowly and indistinctly. He complained of pain in the head. The pulse was slow and irregular. The bowels not having been moved for some days, he was ordered a large dose of castor oil. Next day he was much in the same state, or rather worse. The castor oil had not acted, and an enema was ordered. The head was shaved and croton oil rubbed into the scalp. On the 25th he was much worse, the urine and fæces being passed in bed. The eruption had not appeared on the scalp, and the liniment was again rubbed