weapon through the brain. The stomach was found inflamed, and some ulcerations in the mucous membrane of the intestines. It is curious to think how a man could live sixteen days after the infliction of such an injury, and preserve his intellects till the last. This circumstance, our author thinks, is a proof of the truth of the Gall and Spurzheim doctrines, that the brain is a congeries of organs, each destined to govern a separate order of functions or faculties. Now we can see no other proof in the case before us, than that the brain, like some other organs in the body, is double; and that one side, like that of the lungs, or like one of the testicles for instance, is capable of performing the functions of both, in cases of necessity. The phlogosed state of the stomach, and the ulcerated condition of the lining membrane of the intestines, shew the strict sympathy which exists between the brain and these parts, and the reaction which one is capable of exercising on the other. Baron Larrey, in his Recueil des Memoires de Chirurgie, observes, that he had long remarked that the lesions or alterations of parts about the base of the brain were followed by a diminution or loss of sensitive and locomotive powers, together with great distur bance in the function of respiration, while the intellectual faculties maintained their integrity. The Baron relates several cases in illustration of this point, for which we refer to the volume itself, page 198, et seq. 28. Counter-Irritation.* Mr. Ogden has related, in the last number of the Medical and Physical Journal, a curious case illustrating the effects of extensive counter-irritation. The patient was a child, six years of age, who had been affected with cough and copious expec toration from the earliest period of life." During the last two years he had also been subject to epileptic fits recurring at intervals of nine or ten weeks. But these were always brought on, or preceded by, a deranged state of the alimentary canal. On the 22d October, 1821, the child's clothes caught fire, and he was burnt in a dreadful manner, the skin being removed from the whole of the thorax in front, and a considerable portion of the abdomen. Un→ fortunately too, the terebinthinate dressings produced "a universal erythema of the skin." As a compensation for all these evils, the child was completely cured of his pectoral and epileptic complaints. Although we cannot recommend the same remedy, we think the case affords a strong proof of the great power of extensive cutaneous irritation and exulceration over internal disease. Hydrophobia. Thirteen persons were bitten by a rabid wolf on the 1st of November, of whom nine died, and four survived. * London Medical and Physical Journal for August 1st, 1822. These four were submitted to medical treatment. The first patient was wounded in the neck, in two places. The wounds were healed by the tenth day; but on the nineteenth the cicatrices became red and painful. A warm bath-a drachm of mercurial liniment daily to be rubbed in-one of the following pills every three hours:oxy. hyd. gr. ss. pulv. rad. belladonnæ gr. x. ft. pil. iv. These pills were taken till the 25th, the oxymuriate being increased to two grains, and the belladonna to thirty in each mass of pills. Salivation and faucial inflammation ensuing, the mercury was discontinued, and the bath and belladonna persevered in, the latter being now taken in the dose of four scruples per diem, and gradually increased (in the course of nineteen days) to three drachms. On the 1st December the mercurial treatment was resumed, and continued till the 4th January. In the space of 47 days seven ounces and a half of belladonna, five grains and a half of oxymuriate of mercury, and four ounces of mercurial liniment had been used. The mercury excited febrile irritation, and the belladonna occasioned vertigo, vomiting, tremors of the limbs, obscurity of vision, &c. The sight of the bath occasioned great anxiety, and sense of constriction about the fauces. In the second patient there were two wounds in the neck, and several others in the arm. The former were healed on the 4th of November, the latter on the 9th. He felt an obtuse pain and want of power in the arm. On the 19th the warm bath and mercurial liniment were ordered, with belladonna and calomel, internally. By the 30th of the same month, the dose of the belladonna had been increased from about 16 grains to 36 in the day. The calomel and liniment had produced salivation by the 26th of November. The mercurials and the belladonna were continued more or less till the 4th of January. The warm bath could not long be used, the sight of the water producing great oppression about the præcordia, and sense of suffocation at the moment of immersion. The patient experienced also a degree of repugnance to the ingurgitation of watery fluid for several days. In the case of the third patient, the wounds inflicted by the rabid animal healed on the 7th November. On the 19th, the belladonna, mercury, and warm bathing, were commenced, and continued till the 31st December, when all medicines were discontinued. There was no dread of water in this case. The fourth of the fortunate patients was bitten in the right arm, in the hand, and in the left hip. The wounds were healed by the 18th of November. His wife and child fell victims to the dreadful disease. He began with two grains of belladonna every four hours, and a drachm of mercurial liniment for daily friction. The belladonna was increased gradually to three drachms in the 24 hours. Slight salivation came on about the 26th November, and the daily use of the warm bath was now added to the other remedies. The whole of the means were continued till the 5th January. In the course of the treatment the patient experienced, besides the usual effects of the belladonna, violent palpitations at night, with cold chills, succeeded by icteritious symptoms, especially in the eyes. On the 21st December he had some hydrophobic symptoms, and complained of pain in the cicatrices of the wounds in the thigh. He peremptorily refused to go into the warm bath; but being forced in, he was attacked by such a degree of anxiety, and also convulsions, that it was necessary to withdraw him immediately. The subjects of the foregoing narrative continued in health-down to the time of writing the memoir, which must have been six or seven years. The other cases all proved fatal, and need not occupy space here. As a prophylactic, we believe mercury to ptyalism is more efficacious than any other remedy exhibited internally; but as we consider the removal of the bitten part as the only thing to be depended on, so when that is done nothing else is necessary. There are circumstances, of course, where the parts cannot be removed, and there are too many instances where excision is neglected ;-here the prophylactic is rationally indicated. The readers of our first series, vol. i. p. 494, et seq. will remember a very interesting paper on this subject, by Mr. Daniel Johnson of Torrington, in Devonshire. That gentleman had served a great many years in India, where canine madness is unfortunately very prevalent, and he asserts that-" in every instance where he had time or permission to impregnate the system with mercury, after the infliction of the bite, and before the symptoms of hydrophobia shewed themselves, the latter were entirely prevented."* For many interesting details respecting the mercurial prophylactic, we must refer to Mr. Johnson's paper. 30. Obliteration of the External Iliac.+ Mr. Bryant was called to a woman on the 21st of January of the present year, who complained of acute pain in the right hypogastric and iliac regions, increased on pressure, and accompanied by quick, full pulse, costive bowels, and pyrexia in general. These symptoms were judiciously treated by venesection and other antiphlogistic measures, and by the 26th the pain in the iliac region had ceased; but she had great pain in the course of the left ureter, with much suffering in making water. These symptoms were also mitigated by appropriate means; but on the 28th, while in the warm bath, she complained of a sudden numbness and coldness of the left extremity, succeeded by severe pain in the calf of the leg. These symptoms continued till the 1st February, when petechial spots appeared on the foot, with coldness, and complete loss of sensation. The calf of the leg, however, was swollen and tender. No pulse to be felt in the femoral artery. On the 3d Mr. Brodie saw the patient, and ordered a flan * No. 4, for April 1819. ↑ Mr. Bryant. Med. Repos. Aug. 1822. nel roller from the foot to the groin. She has diarrhoea. On the 5th Messrs. Brodie, Cline, and Clarke saw the patient. On the 6th, the pulse was 140 and irregular the foot extensively livid"the line of separation between the muscular and tendinous portions of the gastrocnemii muscles is faintly discernible." The right leg is also very painful. On the 8th the livid appearance had spread farther up the left leg, and vesicles were observable two inches above the ankle. We cannot pursue the diurnal reports of this afflicting case; but we find that on the 20th "the toes of the left foot are shrunk, dry, and withered." On the 9th March, "the foot is fast separating. She is looked upon as hopeless." On the 16th “sphacelation has increased rapidly;" but the pain is more moderate; the bowels regular-pulse 110-appetite improved-sleeps better. 21st. The bones are exposed-rests well-strength improves. On the 6th July, we find that the foot had been removed, merely by dividing the bones, and the fibula was still exfoliating one-third below the knee. The patient's health was out of all danger. We fully agree with the gentlemen who had the charge of this case, that it was far better to follow the steps of Nature, and remove the bones as they became denuded, than to attempt amputation above, when the soft parts were swollen and painful, and there was every reason to believe that the artery was obliterated, and consequently the parts precariously supplied with blood. Cruritis, or Phlegmasia Dolens. Dr. Hosack, of New York, has published some cases and observations on this painful disease, in a letter to Dr. Francis of the same city. The cases we shall pass over, as containing nothing very remarkable; but we shall give the Professor's deductions respecting the pathology and treatment of the disease, in his own words. He infers "1. That cruritis is an inflammatory disease, not only affecting the limb, but the whole system. 2. That it most usually proceeds from a suppression of the natural excretions, the effect of cold, stimulating drinks, and other means of excitement. 3. That it is not necessarily connected with the lochial discharge, as inculcated by Trye, Denman, and, indeed, by Rodrigus Decastro, of Hamburgh, in 1603, by Wiseman, in 1676, and by Mauriceau, in 1712, who were the authors of this doctrine. "4. That the first irritations frequently appear about the calf of the leg, and not in the groins and pelvis, as asserted by Dr. Denman. "5. That it follows easy as well as difficult labours; and, therefore, cannot proceed from the pressure of the child's head upon the edge of the pelvis, rupturing the lymphatics, as supposed by Mr. White. "6. That it is not a disease confined to the lymphatics, but, as in the cases recorded by Dr. Hull, it appears in every part of the affected limb. "7. That it is not confined to females, but, as in the cases recorded by Dr. Hull, Dr. Ferriar, Dr. Thomas, Dr. Denmark, and others, it occasionally appears in males. "8. That, as in gout and rheumatism, when depletion is not actively employed, the inflammation, after appearing in one limb, is in some cases transferred to another. 9. That it sometimes appears in both limbs at the same time. "10. That the general means of subduing inflammatory action are the most effectual in removing the active stage of this complaint. "11. That in the second stage of cruritis, in addition to the use of general stimuli and tonics, stimulating spirituous liniments, friction, and the roller, are most useful in restoring the circulation, and in exciting the absorbents in the removal of the swelling which remains in the passive stage of this disease. "12. That occasionally, as in the cases related by Hull, Denman, and by Zinn, it ends in abscess, and proves fatal, especially where the antiphlogistic treatment has not been vigorously pursued in the first stage of the disease, or when it occurs under great exhaustion and debility of constitution." 32. Poisoning by Opium. In the last number of the Repository, Mr. Sprague, an intelligent practitioner of Kingston on Thames, has laid down some plain, practical, and, we think, judicious rules for the guidance of the medical attendant in cases which do not afford much time for reflection. The first object, of course, is to evacuate the poison. For this purpose Mr. Sprague affirms that the following form of emetic is preferable to all others. B. Subcarb. ammoniæ j. pulv. rad. ipecac. 3ss. aquæ mentha pip. 3iij. tinct. capsici 3ij. m. ft. haust. emet. This, if deglutition be impracticable, must be conveyed by a tube into the stomach. A little of the liquor ammonia on a feather is to be applied to the nostrils, and a more dilute stimulant of the same kind, is to be applied to the external canthus of the eye. The patient's head should be kept raised, and wetted with cold water; but our author does not mention the cold affusion, as recommended by Mr. Wray and Dr. Copland. When the poison is well evacuated, then the vegetable acids are to be employed; and subsequently the exhaustion is to be counteracted by suitable means. 33. Double Hare-Lip, with separated Palate Bones.t The pa tient was about twelve years of age-palate bones much separated, and free communications between the mouth and nostrils-con • Mr. Sprague. Med. Repos. Vol. III. No. 10. |