diately ordered, and sulphate of quinine, in quantities proportioned to the severity of the symptoms, alone exhibited. From eight to ten grammes of this drug, on an average, were made use of for an ordinary intermittent fever, and from fifteen to twenty for one of a malignant nature. In those wards where sulphate of quinine was thus lavished, several patients were observed affected with anasarca. But this did not prevent recourse being had to cinchona, in greater or less doses, under the impression that this complication was merely the result of the continuance of the febrile symptoms, and which required to be subdued by the specific. In short, sulphate of quinine was at that time an actual panacea. In cases of less importance than those I have just mentioned, sulphate of quinine was administered in doses of one gramme at least, to prevent a paroxysm of regular fever, and its use continued for a variable period. By prescribing it in this manner the practitioners were certain they contributed to place the patients beyond the possibility of a relapse. Finding themselves submitted to a strict regimen, and more especially exposed to an accident so much to be dreaded as general infiltration, patients refused to take the sulphate of quinine, being convinced it occasioned anasarca. This complication occurred more particularly in military men, who had made use of this drug in large doses for a long time, and in whom relapses had been more or less frequent. Although I by no means deny that the existence of the fever may have, itself, in some of these patients, occasioned the accidents above mentioned, still I cannot help thinking that the immoderate use of sulphate of quinine, for the purpose of stopping symptoms which might be removed by its succedanea without causing so great a degree of weakness, contributed in a great measure, by its debilitating action, to throw the nervous system into a state of torpor, to considerably slacken the circulation in the vascular system, to cause a great deal of various organic functional disturbance, and lastly, from this cause to occasion serious disorders of nutrition, which ended almost always in death. In order to give greater weight to the truth of my assertions I will merely rest them on the authority of M. Trousseau, who states, in the article "Quinquina" of his "Traité de Thérapeutique," that it is incomprehensible how M. Bally can assert that he has never experienced the slightest inconvenience from giving as much as four grammes a day of sulphate of quinine. Either M. Bally's patients must have deceived him, or else he himself has not given all the attention to it that was required. "Daily observation," says M. Bretonneau, "proves that cinchona, when given in large doses, produces in a great number of persons a wellmarked febrile action. The characters of this fever, and the period at which it makes its appearance, vary according to the individual. It is generally preceded by a singing in the ears, deafness, and a sort of intoxication; slight shivering soon takes place; a dry heat, accompanied by headache, succeeds, and is gradually replaced by perspiration. While the fever, caused by the active principle of the cinchona, instead of yielding to fresh and large doses of the drug, was sure to be aggravated." In the hospitals where the quinine was not lavished in the manner above mentioned, the cases were less frequently complicated with anasarca, which was met with, on the contrary, pretty often in patients who had had recourse to a treatment similar to the one I am condemning. Those of my colleagues who have lived and who still live in Algeria are able to convince themselves of the justice of my remarks. [An apparently still more effectual method of exhibiting sulphate of quinine than any hitherto employed has lately (March, 1846) been proposed by M. Dacros, in a memoir presented to the Académie des Sciences, and containing the following remarks:"1. Sulphate of quinine, dissolved in sulphuric ether, and rubbed on the tongue, on the velum palati, on the inside of the cheek, or on the roof of the throat, excites an abundant salivation accompanied with a remarkably bitter taste, in doses of five centigrammes (equal to about one grain Enlisgh), and this dose produces a more powerful reaction on the spinal cord than if it were carried "3. This instantaneous therapeutic action is more "5. The instantaneous action of the sulphate of ON THE ABORTIVE TREATMENT OF SUB By M. JULES GUERIN. The intention of the operation is, in the first place, The instrument suitable for this operation is not indifferent. The ordinary bistoury, and, in fact, every instrument having a broad blade and a continuous edge, is improper. It must be either the dart-pointed director (sonde carmelée à dard), or the double-edged spear-pointed bistoury (bistouri en fer de lance à double tranchant), which is nothing more than the director fixed in a handle. It is necessary to allow the director or the bistoury to remain in the wound while the blood is flowing, which may be facilitated by turning the groove over. If a single puncture is not followed by a sufficient discharge of blood to cause the subsidence of the tumour, a second or even a third may be made, but always in different spots. And if, on the following day, the parts are found to be again swollen and painful, the operation must undoubtedly be repeated, taking care to avoid the incisions already made. The indications in the employment of this method need scarcely be alluded to. Whenever pain is felt in any part of the subcutaneous cellular tissue, accompanied by swelling, tension, heat, and deep or superficial obstruction, recourse may be had to it wthout the slightest danger. It is generally from the second to the fourth day of the affection that success is certain. On the fifth or sixth it is probable that suppuration has commenced; nevertheless it may still be employed, for if it has no other result than the relief produced by the depletion of the subcutaneous capillary system, it will not have been practised in vain. A commencing suppuration has been known to be entirely cut short by this method; but it is no longer useful when the suppuration is completely established. M. Jules Guerin, also, refers in his article to several other cases to which subcutaneous section is applicable. These are the subcutaneous incision of inflamed glands; of the tunica albuginea in blennorrhagic orchitis; of the eyeball in some case of hydrophthalmia; of the capsular ligaments in recent arthritis; of the periosteum in periostitis, &c. L'ABIELLE MEDICALE. [As a further illustration of the subcutaneous method, may mention the plan proposed some time since in the Gazette Medicale, by M. Diday, for preventing the formation, or, at least, the suppuration of syphilitic buboes. It consists in subcutaneously dividing the lymphatic vessels by which the virus becomes conveyed to the inguinal glands. The operation is performed by passing a straight, sharp pointed tenotomy knife on the inside of the glandular swelling, and from above downwards, beneath a transverse fold of the skin, made in the direction of the Poupart's ligament, with its edge directed towards the deep structures. An incision, about an inch in length, is then made in the subcutaneous tissues, care being taken not to go to too great a depth, it being merely necessary to divide the superficial lymphatics, and the knife then turned round, and the structures immediately in contact with the internal surface of the skin divided as the instrument is being withdrawn, with its edge towards the integument. The external wound is to be afterwards covered with a couple of pieces of diachylon plaister, and maintained for two or three days so as to prevent the formation of matter. As regards the period at which the operation should be had recourse to, M. Diday remarks, that, when the chancre is in its progressive stage, is situated near the frænum preputii, and is attended by an abundant purulent discharge, the operation is then called for, and, moreover, that it would be rational to perform it, considering it is so perfectly harmless-a character which it shares in common with the various procedures arising from the subcutaneous method. But if the chancre be in progress of cicatrization, or merely of reparation, when the glandular swelling commences, then the operation appears to be scarcely required.]—TR. 19, Langham-place. DROPSY-THE NATURE AND ACTION OF She from passing urine, which in quantity is exceedingly limited, and in colour very deep. She is very restless. Bowels tardy; colour of the dejections not known. B. Tincturæ scillæ, potassæ acetatis, aa. 3ss.; tinct. digitalis, 3j.; aquæ puræ, q. s. ad ss. Sumat 3j. 4tis horis. Sumat pil. hydr. c. hyosc. gr. v. omni nocte. In order to relieve the great distention of the labia, I punctured both sides liberally with the point of a lancet; much serum oozed out, with great relief to her pain. Shortly afterwards she passed urine with ease. 3. The headache to-day is almost intolerable. Hirudines vj., temporibus; postea empl. lyttæ pone aures. Utat lot. plumb. acet. lab. 5. Bowels still slow; in other respects better. Ol. ricini, 3ss. statim sumend. 8. Improving in respect to her head symptoms considerably; and in regard to her dropsical ailment, gradually, but decidedly; bowels still obstinate. Addet. mist., 3viij.; extr. elater., gr. j. Cont. alia remed. 11. Has been improving daily, and has continued in the use of the same remedies. The urine is more plentiful; still some headache remains. Appl. vesicator. ad nucham. 15. Is feverish this morning; has some cough with hurried respiration, and a hot surface; is unusually restless; to-day the pain in the region of the liver is scarcely perceptible. R. Tinct. hyosciam., 3ss. ; mist. salin. ordin. ad. ss. Cap. 3j. ter die. B. Pulv. ipecac., gr. j.; ext. conii, gr. iv. ; m. ft. pil. o. n. s. 21. Has taken the above medicine with much advantage; she expresses herself as being greatly relieved, and exceedingly satisfied with her progress towards convalescence. The urine is now plentiful; the motions have assumed a natural appearance; she feels, however, extremely weak. R Acidi sulphur. dil., 3j.; decoct. cinchon. ad. ss., 3j. ter die sum. Rep. pilul. 24. Improves in every respect; she feels only a sensation of heaviness in the hepatic region; bowels obstinate. Ol. ricin., 3ss. st. July 4. Improves, but requires some active agent to keep up the intestinal secretions. Pulv. jalapæ., 3j., p. r. n. s. Rep. alia remed. REMARKS. This person continued to improve decidedly; her appearance altogether has been changing perceptibly up to the present time (July 12th). The face is now pale, but has lost its bloated appearance; her appetite, too, begins to be keener, yet it is not so good as is desirable. Both the head affection and the dropsical symptoms have disappeared. It may be mentioned here that premature labour took place more than a fortnight ago, since which occurrence she has gained ground rapidly. | one or other, save that the stools became rather darker than natural under the influence of medicine, and that the skin, universally, was in some degree paler; nor again; from any external examination could either enlargement or hardening of the liver, or both be detected. This very desirable object was, for the most part, frustrated in consequence of the great amount of oedematous swelling existing and generalized throughout the whole body. Yet, from the negative proof of the absence of all heart-affections, and from our knowledge that cerebral disorder is not (so far as I am aware) a cause or origin of universal dropsy, we are led to infer that the liver, by exerting a certain degree of pressure upon the abdominal venous system, had given rise to, and was keeping up, the anasarcous swelling. It may be argued that compression of the portal system of veins, whether from induration of the hepatic gland, or from other causes, cannot produce general dropsy. It must be borne in mind that the portal vein is not the only vein liable to pressure, and consequently to retardation, and, in some cases, to complete obstruction of its current, from that abnormal state of the liver just named. There is a large vein (the vena cava ininferior), the reservoir of all the ordinary veins of the whole of the lower half of the body, which is also subject to the same compression, and to similar, or perhaps greater, retardation or obstruction as regards its blood. Now, in the one case an ascitic effusion will be the consequence; in the other, dropsy, chiefly of the lower extremities. In the case under consideration the one cause (hardening and enlargement of the liver) was aided by other causes-by great debility, and by her advanced pregnancy. Reason leaves us this inference, viz., that there had been at a period not long gone by, and perhaps even there was at this time going on in the liver, some slow inflammatory process, whence the disordered state of the organ and the evils arising therefrom. Now, for this morbid condition of the liver, alterative doses of mercury, in conjunction with hyosciamus, were given with great advantage, as appears from her case; at the same time she was placed under a diuretic treatment, which in a great measure aided her recovery. The brain symptoms undoubtedly arose from the presence of the more active principles of the bile and of the urine in the blood, as proven by their disappearance as the urine became more plentiful, and as the hepatic pain decreased. The irritation in the bronchial membranes was due in a measure to taking repeated colds, the consequence of a delicate mucous surface; it subsided quickly, however, under treatment. Her abortion confirms the assertion that the malady was partly owing to the existence of a fœtus in utero, because after its expulsion the anasarca of the lower extremeties rapidly subsided. On the 21st of July no dropsical swelling whatever remained, except what was due to mere debility, for which she was treated with agents of a tonic nature. Her ultimate and complete recovery points out the diagnosis to have been correct; the plan of treatment to have been in the highest degree useful; and, "last but not least," the absolute necessity of forming a steady yet confident opinion of the nature of the ailment in the first instance. As to the origin of the disease and the subsequent and successful plan of treatment, there can be no doubt from her general appearance and condition that she was of a phlegmatic temperament of body, with a loose, flabby general texture; therefore, in accordance with a general Attention may be called to the exhibition of law, she would be, was, and still is far more liable squill in this case. A supposition to the effect to infiltrations of serum into these loose tissues, that this agent seems to exert a particular inthan to any other ills "which flesh is heir to." fluence over the liver, under certain conditions, may Touching, however, the primary cause of her not be out of place. We are all conversant with malady, we must look not to the head, or to the power which it exercises over those two great the chest, which in fact became affected, though blood-cleansers-the lungs and kidneys, at least only in a secondary way; or on reverting over the secretory apparatus of each; and in to her case, we find that pain in the region respect to the vital fluid, these organs perform of the liver had annoyed her long before offices the most opposite. Why, then, may it not she experienced any inconvenience either in the influence another and a third great viscus, whose head or in the chest. This uneasiness in this functions are single and different also? "The liver particular region of the body was unnoticed by the it the lazaret of bile," you know. Presuming this patient herself, except in regard to its mere pre- to be an assertion, it cannot be opposed on the sence, but it led me to suppose that the original ground that these several glandular bodies are not and more prominent excitor of all the existing purposed for a common act, since the agent emevils was to be found in the liver though this cause ployed (squill) does not exert an influence in was not very evident from any examination of the common over the individual organs to be acted stools, or from the condition of the skin or con-upon-the lungs, the kidneys, and the liver. In junctiva, since no remarkable alteration had, as the lungs we know it to be of service by inducing far as I could learn, taken place in regard to the a natural action on the mucous lining; in short, by stimulating a surface already too much relaxed. I feel inclined (although out of order) to reprobate that very common and thoughtless practice of giving squill in the first stage of bronchial affections, in which the mucous membrane must be very harsh, dry, and swollen. Most people admit squill to be a stimulating agent, and when combined with ginger, ammoniacum, &c., as it is, in the form of the ordinary pill mass, who will deny its excitant properties? Yet there are persons who still persist in its untimely and indiscriminate employment, forsooth, because their grandmothers did the same thing before them. In a second (the kidney) it is said to act more particularly on its nervous apparatus, increasing, as it undoubtedly does, the flow of urine, whilst in the former case it directly diminishes the exudation from the secreting membrane. What, then, is its action upon the liver? If it have any at all, and I am strongly inclined to think it has, it must be in the first instance, and specifically, upon the mucous secretion; and in the next place, and indirectly, upon the biliary flow. It is not unreasonable to suppose that it causes an augmentation in the flow of mucus, and of course, in this way, a dilution of the bile must follow, hence an explanation of its greater flow. It does this, "methinks," chiefly by exciting the mucous secretory apparatus of the duodenum, which excitement is communicated to, or carried along, the continuation of the lining into the liver. Doubtless, much depends upon the form in which medicine is administered--whether certain things undergo digestion when taken into the stomach in one form, or are taken up by the veins of the stomach, or in any other way, when given in a different shape, is a matter of the greatest interest; it is a question, however, which cannot be entered upon in this paper; suffice it to say that much remains to be explained on this head. Lastly, a few words in regard to the action of the acetate of potassa. In this case, as well as in every other of this kind, it may not be uninteresting to suggest a new mode of action. It has reference not to its supposed stimulating effect upon the renal nerves, but to its more immediate and primary effect upon the blood. It appears to me to be introduced into the circulation through the veins of the stomach-of course in a very fluid state. Once here, it is not merely and singly for the purpose of being carried along with the current of blood to the kidneys, but for a far greater object. In all probability it becomes intimately incorporated with the blood itself: it seems to render it more fluid, in short, more homogeneous and far less vital. It does this, in my opinion, through the operation of an ordinary endosmosis going on between the two active agents, viz., the inorganic salt (or partially inorganic), and the organic textural corpuscles-30 that these corpuscles having in their interior a fluid denser in itself than this saline solution, it becomes drawn, as it were, within the corpuscular disc, and in this way an enlargement takes place, and subsequently a rupture or bursting of the vesicle, by which the blood, as a whole, is rendered thinner and necessarily less textural. This is owing to the breaking up of the chief constituents of the blood. Now, as fibrin is made up, or rather formed, from these very corpuscles-that is to say, as fibrin is a mass of corpuscles more highly organized, or further advanced towards independent vitality, it will be at once evident that the introduction of acetate of potash into the system is a means of preventing or impeding this particular process. Granting this, how readily may it be imagined that a greater amount of urine may pass off by the kidneys, seeing that more fluid must pass through these glandular bodies than can occur under ordinary conditions. The authorities of the School of Pharmacy of Paris, having called the attention of the autho rities to the scarcity of leeches, the Minister of Commerce, before deciding on the means that should be taken to remedy the evil, is seeking correct information on the state of the leech fishery. To obtain this, he has addressed circulars to the authorities of the different departments, a well as to the different local medical societies. OCCURRENCES IN PORTO RICO AFFECTINTERESTS OF A MEMBER OF THE MEDICAL PROFESSION, ING THE LIBERTY AND PERSONAL By Dr. D. M'CONNELL REED. In pursuance of a plan which I had formed at an early period of my medical career (viz., to visit successively and practise my profession during a certain time at the principal cities in the West Indies), I arrived at Porto Rico about the close of the year 1840. When in St. Thomas, however, which place I visited previous to proceeding to Porto Rico, I was informed by my friend, the Baron Von Britton, the principal resident Danish physician, that I should have great difficulty in obtaining a license from the Government, in consequence of the extreme jealousy that prevailed, on the part of the authorities, in reference to the establishment on the island of liberally-educated foreigners. The effect, however, of this information, far from discouraging, only made me more anxious to effect my purpose, as I supposed that under such a Government there was something to be learned. With this view I procured, in St. Thomas, such letters of introduction as I thought would be of service to me. Among others I was provided with an introductory letter to Mr. Jacobs, the governor of the Branch Colonial Bank, whom (from his position) I understood to be the most influential foreigner in the island, and who (being a married man) was desirous of the establishment of a British practitioner at Porto Rico. Besides, I was the bearer of a letter to the Spanish mercantile house of Manuel Gonzales and Co., of whom one of the partners, being intimate with the island secretary, was the means of procuring for me a friendly interview with that functionary; during which I informed him that it was my desire to reside and practise my profession in the island for some time; and, exhibiting my British medical testimonials, I asked him if he thought the Government would make any objection to my desire. He informed me in reply, that no one, however well qualified by his scientific acquirements, or well provided with foreign testimonials, could be permitted to practise the profession of medicine under the sanction of the Government, without the license of the Junta Superior Governativa y Medicina y Cirugia of Madrid, or of that branch of it established at the Havannah. Iexpressed my readiness to comply with the requirements of the Government in this respect; but as the hurricane season was then prevailing, I asked leave to defer my trip to the Havannah until it was over, and to be allowed in the meantime to practise my profession privately among my friends, without being considered as a transgressor of the laws. He replied, that, if I would name any particular part of the island where I had the greatest number of friends, he would mention my request to the Governor, and let me know his decision. I thanked him, and we parted. But as I was retiring from the Government-house, in company with my Spanish friend, to whom I was indebted for the friendly interview above referred to, he informed me that I had made a very favourable impression on the secretary, and that he was sure he would do what he could to serve me. Now, the governor of Porto Rico at that time was General Lopez Banos, who had been for some time an exile from his own country and a refugee in England, where, I learned, he had experienced great kindness from a widow lady, which made him partial to the English people; and (to his praise be it spoken) he did not forget his friend in distreas; for while he was receiving pay as the governor of Porto Rico, he allowed the widow £100 a year in gratitude for her past kindness. From General Banos then, under these circumstances, Secretary Olhoa had no difficulty in procuring for me leave of residence at the town of Guayama with my friend George Gifford, a prospering American merchant, at whose beautiful residence I passed the time very agreeably, and composed the greater part of the work on fever which I have lately published. But, in order to render my stay at Guayama more agreeable, the good secretary furnished me with two letters of introduction, one to the district commandant, Colonel Villodas; and the other, to one of the governor's aide-de-camps-a high-bred Spaniard, who was on a visit at the commandant's. Through these gentlemen I became acquainted with the officers of the military detachment stationed at Guayama; from all of whom I received the greatest kindness, especially from Don José Soto, the surgeon of the detachment. It will at once be perceived from this account that I did not want for acquaintances, and, I may add, for patients, such is the estimation in which a British practitioner is held by the inhabitants. This gleam of sunshine in my checquered history, however, was not permitted to last long my friend General Banos was recalled, and with his retirement all my good for tune ceased. General Mendez de Vigo succeeded him; this man was a tyrant-almost every act of his government proved it; and especially the troubled state of the island after his arrival. The inhabitants in the city of Porto Rico began to murmur, but, as is the case in Spanish countries, they did not dare to reveal the cause of their discontent; stories of the precipitate retirement from the island of certain native inhabitants of political importance began to float about, and eventually rumours of insurrections among the slaves. I was in the habit of occasionally visiting the estate of a British subject, some distance from Guayama, for the purpose of noticing the effect of a course of strichnine, under which I had placed the manager, Mr. Pearson, an Englishman, who had been for some time suffering from partial paralysis of the lower extremities. On every such occasion I called on my friend Villodas, for his passport. On one occasion, however, he informed me that the new governor was very particular, and that he thought I would do well to be cautious; this appeared to me to be a very unnecessary warning, as I was not conscious of having been the reverse. By this time my permit to reside at Guayama (which was originally for four months) had expired; but, as I did not wish to leave some patients whom I had under my care, I applied, through my friends in the capital, for an extension of it, which was with difficulty granted by the new governor. I took my departure from Porto Rico for the Havannah in the early part of 1841; and having obtained my licenses from the medical and surgical junto, endorsed by the government functionaries of the Havannah, empowering me to practise the profession of medicine throughout the whole of the Spanish dominions, I returned, about September the same year, fully persuaded that there would be no longer any impediment to my professional and personal liberty. And, certainly, considering what was the motive of my underaking so expensive a journey to the Havannab, it was reasonable to suppose that on my return I should have been received as a friend, and not treated as an enemy, a vagabond, and a spy. But a guilty conscience is a very common cause of personal accusation and exposure. Had General Mendez Vigo not been aware that there was something in his government which could not bear the inspection of an enlightened foreigner, he would not have been so anxious to interfere with my personal liberty. This, however, he could not reconcile himself to leave unrestrained. On my return to Porto Rico the government could no longer interfere with my freedom of practice, on the score of my being an unqualified person; but every restraint, arising from unnecessary delay, was imposed upon me. I was first told that my diplomas must be registered before I could commence practice; to this I acceded, by leaving the papers at the secretary's office. But day after day passed away, until several weeks were consumed, in fruitless attempts, on my part, to effect that, which, with good faith on the part of the government, might have been done in five minutes. They then told me that I must become domiciled, which is another term for swearing that one is a Roman Catholic; but I objected to this, on the score that I had already taken the oath administered by the supreme medical junto at my inauguration as a member of that body. (This is an oath which, in my opinion, any orderly, right-minded Christian might conscientiously take when imposed by those in authority, inasmuch as it implies no more than a medical man's duty.) I was, however, told by a British resident, whose character I respected, that the domicile had now become a mere formality, and that, therefore, it could not be considered a matter of conscience. This might be very good reasoning for him; but I am sorry that I allowed it to prevail on me to comply with the requisition on the part of the Government, although the lies that were necessary to be told in order to make me out a Roman Catholic did not devolve so much on myself as they did on the paid witnesses employed by my Spanish agent. Still, as those lies were told in order to serve me, I must acknowledge that the weight of turpitude in the matter, next to those who established the unjust requisition, fell upon me, for being so weak as to comply with it; although I positively told the chaplain to the Governor's Council that I was no Roman Catholic, but a stanch Protestant, and that my complying with the formality of the domicile was no proof of my being a Roman Catholic. As soon, however, as I had obtained my domicile, I expressed a wish to visit a part of the island where I understood my medical services were required; but, as my diplomas were not yet registered, I said I would leave them in the keeping of the secretary until he thought fit to register then; and I obtained a passport for my journey. I had not been absent, however, many days from the capital when an order from the governor was communicated to me through the medium of the commandant of the district where I was residing, to the effect that I must immediately return to the capital. I replied to the commandant that I had come to that part of the country (the town of Mayaquez) on my own business; I was attending several of the inabitants who were suffering from chronic intermittent fevers, neuralgia, strictures, and ulcerated extremities, whom I could not well leave; and that it would be inconvenient at that time to leave the place; but as I was not employed in any way under Government, I expressed my surprise at the order, and told the commandant that, with his permission, I would delay my departure until I could receive an answer to a letter which I proposed writing to the governor, to which the commandant civilly assented. I wrote the letter, but the only answer which I received to it was the reiteration of the governor's order, through the commandant, for my speedy return. When I arrived at the capital, I repaired to the Government-house, in order to ascertain the governor's motive for ordering my return. He did not, however, condescend to gratify my reasonable inquiry: but he told me, that if he could not prove what he suspected me of, he would immediately give me my passport. I told him that I thought it would be quite proper that either I or any other man should suffer for transgressing the laws, on sufficient proof of his culpability; but that, as I had been particularly careful to observe them, I felt the course that he was pursuing towards me was not only uncalled for, but, in my circumstances, peculiarly oppressive and unjust, particularly as it was at the suggestion of the Government, and depending on its good faith, that I had incurred the heavy expense of £200, to say nothing of the trouble and loss of time I had sustained in acquiring testimonials for the purpose of securing the protection of the Spanish laws, in the exercise of my profession; but, as he acknowledged that he was acting on suspicion alone, I asked him to tell me plainly what he suspected me of. This, however, he declined doing; but told me that the Government (contrary to the express permission of my diplomas, endorsed by the Government authorities of the Havannah) could not permit me to practise just where I pleased; but that I must confine my practice to the city of Porto Rico. Of course it was out of my power to successfully oppose the garrison of Porto Rico, which might, if requisite, have been arrayed against me in order to compel obedience to the governor's orders, just or unjust. The only successful opposition, therefore, which I could hope to make was to protest; which I did, both verbally and by writing. The following is a copy of the letter which I addressed to the governor on that occasion: "Porto Rico, October, 1841. "To his Excellency the Captain-General and Governor. "Excellent Sir, I have the honour to submit, that conformity with your excellency's order to reside in the capital will be very prejudicial to my private interests as an individual; and as a subject of a Government, as far as I know, upon terms of the strictest amity with the Government of Spain, I had hoped that no objection would have been made by your excellency to the choice of my residence. "I am domiciled and provided with Spanish diplomas, and, according to the treaties which I believe to exist between the Governments of Spain and Great Britain, I am entitled, under these circumstances, even in the Spanish colonies, to the same rights and immunities as a Spanish subject. And, if such is the state of the case, I am not aware of having done anything to forfeit the rights and immunities which I am entitled to enjoy in common with other domiciled persons. I have money ble, but had a hoarse sound. Inhalatio et mist. I had an opportunity of seeing the patient a few Having named the quinine mixture, I may observe, that I frequently prescribe the disulphate of quinine, in combination with iodic acid, as an ele gant tonic in diseases of debility, in phthisis, and as a finish in the treatment of chronic inflammations and syphilis. Poor-law Schools, Norwood, Sept. 23. ON ABSORPTION OF THE ALIMENTARY to be the absorbing power of the fluid sustenance from the stomach and bowels, aided by the opera tion of another power of equal magnitude, which I shall now point out. Majendie proved that absorption from all the surfaces was carried on in the inverse ratio with the distention of the blood-vessels. Now, as the blood circulating through the liver (by the excitement imparted to it by the agency of the oxygen absorbed into it from the stomach), on the bilious secretion being derived from it, is much reduced in quantity, it, necessarily, draws upon the current of the portal vein, and this is con tinued as an absorbing power (the vessels becoming thus partially emptied) in the gastric and mesenteric veins, and thus is the aliment imbibed. These views are confirmed, I am of opinion, by the fact that ruminating animals-which are all veBOWELS, AND ON THE BLOOD'S CIRCU-getable feeders, requiring therefore a larger amount LATION THROUGH THE LIVER. By C. SEARLE, M.D. Bath, Sept. 20. of food than others, and an increased supply of oxygen for the maintenance of a more active conI believe I may venture to say, without fear of chewing the cud, thus obtain the oxygen required; dition of the liver and lacteal absorption-in due to me in the country which I wish to collect, contradiction, that the generally acknowledged animalizing the product most probably, at the same and my prospect in Mayaquez alone, from medical powers of the blood's circulation through the sys- time, by the nitrogen acquired in the same process. practice, is certainly equal to six thousand dollars annually. The outlay incurred by my journey to, and expenses at, the Havannah, in order to procure Spanish diplomas, was very considerable, which is an expense incurred in vain (not to mention the loss of time), if I am not permitted to exercise my profession to the best advantage; in other words, in the place which offers the greatest prospect of success. In consequence of these circumstances, I beg leave, once more, to entreat your Excellency to allow me to change my domicile to Mayaquez, and to afford me the facility of attending to my interests. This justice I expect and entreat from the goodness of your excellency. "But, should your excellency still find it necessary to refuse my request, then I entreat your excellency to order my diplomas to be returned to me, even though unregistered, and to grant me my passport to go by the first steamer to Jamaica. "I have the honour to be, with the greatest respect, your excellency's most obedient and most (Signed) humble servant, "D. M. REID, APHONIA OF FIVE MONTHS' DURATION By EDWARD MONKS, Esq., Norwood. Isabella Thorn, aged twelve years, of phlegmatic temperament, united with a plethoric habit, was received under medical care in January, 1842, suffering from catarrh. The usual treatment was adopted, and in about three weeks the febrile symptoms, cough, &c., passed off, but the voice remained low and hoarse, and in a week or two gradually sunk into a whisper, and was inaudible, unless the ear was placed near the patient (as far as could be seen, there was no apparent organic lesion of the organs of speech). This atomy or paralytic state of the vocal powers continued, and the friends of the patient growing anxious on finding that the voice did not return with the approach of summer, I was a second time consulted early in May, 1842. The patient had considerable embonpoint; she was treated by emetics and aperients, and subsequently by mercurials, iodide of potassium, with cinchona and astringent acidulated gargles. This course of treatment was steadily persevered in till the following month, June 25th, without the least amendment, when, on the eve of making arrangements for her removal to the seaside for change of air, it occurred to me that inhalations might probably be useful. Accordingly, therefore, I prescribed the inhalation of the vapour of iodine in the ordinary way, from one of Woulf's bottles, for fifteen minutes twice a day, and at the same time ordered the following mixture : B. Quinæ disulph., gr. j.; acid, iodic., gr. iij.; tinct. aurant., 3.as.; aquce e. syrup., ad 3j-m. t.d. July 2, 1846. The voice had become more audi HOSPITAL REPORTS. MEDICAL TIMES PRIZE REPORTS THIRD SERIES, George's Hospital. MEDICAL CASES. SUBJECT-DROPSY. (Continued from page 415, vol. 14. When the body is in a state of natural health, the functions of nutrition, secretion, and excretion are performed in a regular and proper manner; but in the performance of these all-important functions various vital organs are employed, and these organs are often liable to undergo changes, which not only derange the function over which they preside, but the whole system suffers secondarily. In the case which I am about to mention, I imagine that the circulating system is the immediate cause of the appearance of the dropsy, for that is the effect of the changes concerning which I shall speak. I do not say that the circulating system is the first to be affected, for we often meet with serious, and often fatal, derangement of it without any dropsy; but when certain vital organs become diseased they undergo an organic change of structure, and, as I will hereafter explain, they produce a certain change in the circulation which causes the effect concerning which I am now speaking. tem in general are the heart's power, in its two- There are certain causes, too, which produce venous system. It is necessary that something should relieve this, or life could not exist; and to effect this the capillaries throw out fluid to relieve the loaded circulation. Here we see that the CASE 1.-Thomas Silk was admitted with anasarca of the lower extremities; this was of six weeks' duration. The pulse is full and sharp; there is a foul tongue; he has had a cough with expectoration for two months, but can draw a deep breath without pain; the urine is scanty and highcoloured, but not coagulable by the ordinary tests; and, lastly, a loud valvular murmur can be distinctly heard. higher classes, by continuing the remedies, life may be prolonged for many years. There is another very important organ which, upon becoming the seat of a particular disease, gives rise to anasarea: I allude to the kidney. We have general anasarca, the pulse is not weak, there is no perceptible enlargement of the heart; the urine is copious and high-coloured, but, on examining it, we find that its specific gravity is much diminished, and that it contains a considerable portion of albumen, varying, of course, according to the extent of the disease. The case (case 3) of William Brinkworth is a very interesting case of this kind. Here we have all the symptoms of this disease proceeding to a fatal termination, but, unfortunately, his friends objected to the examination of the body; but, if this had taken place, no doubt the kidneys would have been found in the most perfect state of granulation. circulation of the current gmented; here, though afterwards they become atrophied. Un There then is, as far as we can judge, a pure case of disease of the heart; we have no reason to suppose that any other organ is affected. The urine is not coagulable, and its specific gravity is not lowered. There is no ascites, and the sound of the heart itself marks the disease. The cavity of the heart is enlarged, while the orifice through which the blood has to pass retains its natural size, and, consequently, the rushing sound which we hear is produced. We have the same sound produced by another cause, but then the anasarea, and the other symptoms attendant upon it, are not present. The heart may be of its natural size, but the force of the then, the force is great for the size of the orifice through which it has to pass, and we have the same blowing sound. We often meet with this in hysterical girls, in whom there is no disease of the heart. In such a case as Silk's, of course, the exciting cause of the disease cannot be removed, but much may be done to alleviate the symptoms; in fact, the anasarca in this case was, for the time being, entirely got rid of by the remedies employed. In the first instance he took a combination of digitalis, squills, and blue pill, which acted very efficaciously as a diuretic; his mouth became sore, and he then left off the pill, and took the bitartrate of potash, and was enabled to leave the hospital completely relieved, as far as the anasarca was concerned. CASE 2, Elizabeth Campion, is also a well-marked case of dropsy from disease of the heart. There was palpitation of the heart, dyspnoea rendering it impossible for her to lie down in bed; there is quickness of breathing and pain across the lower part of the chest, especially in the left side. There is some anasarca of the lower extremitics, but this is described as having been much greater; and there has been some swelling of the abdomen. Here we have disease of the heart occurring in an elderly female, and, from the pain expressed during life, we might easily imagine that there was disease of the aorta as well; the pain in such cases being often very acute, and not met with in simple enlargement of the heart, that there was disease of the heart was made manifest by the anasarca, which never happens in cases where the aorta alone is diseased, the heart being unaffected. There is another thing worthy of remark in this case, and that is, the history which the patient gave of the subsiding of the swellings; the unhappy patient looking upon the dropsy as the sole disease, and looking upon its disappearance as a most fortunate circumstance, but in truth it is only the precursor of death, which in many cases occurs suddenly, either from effusion into the chest or pericardium. This patient died shortly after her admission, and on examination, after death, we found some slight effusion into the pericardium; there was effusion into both pleurae; and both lungs, through the greater part of their extent, were loaded with red, frothy serum; and this fully accounts for the termination of her life by suffocation. There was dilatation of the aorta, and a considerable atheromatous deposit on its internal surface. The pulmonary apoplexy may be accounted for in this way; there was disease of the aortic valves, and consequently an impediment to the return of blood from the lungs; therefore some of the smaller vessels ramifying through those organs gave way and poured out blood into their substance. In these cases our grand object is, if possible, to get rid of the anasarca; and, where there is no disease of any other organ, this may be done by diuretics In the other two cases, David Davis (case 2, delirium tremens) and Charlotte Brooks (case 4), we have the same disease, but not having proceeded to the same extent that it had in Brinkworth. The kidneys in both were large and congested, which is always the case in an early stage of the disease, fortunately for these two patients, the disease of the kidneys was combined with disease existing in other viscera, rendering the treatment more complicated. and the alleviation of their symptoms more difficult to be achieved. In the treatment of these cases what remedies are we to employ? If we use diuretics we do but add fuel to the flame; we must, therefore, trust principally to purgatives. If the action of the skin can be augmented, and perspiration can be produced to any amount, it is often of great service,; but there is generally much difficulty in producing this effect. The remedies which seem to be most generally used, and often with marked benefit, are the neutral salts, with vegetable acid bases; potassæ tartras; potassæ acetas, in large doses-for instance, pot. bitartratis, 3ss. omni mane, which in some instances will destroy the coagulable quality of the urine, where the disease has not proceeded to too great an extent. I have heard from good authority the following account given of the modus operandi of these neutral salts, when they destroy the coagulable quality of the urine: An alkaline property of the blood is necessary to hold the particles of albumen in solution; if this be lost, the albumen is drawn off by the kidneys. A neutral salt with a vegetable acid base supplies a larger quantity of alkaline matter to the blood, and prevents the albumen being drawn off by kidneys, causing it to be held in solution by the blood." The species of dropsy concerning which I have been hitherto speaking has consisted in an effusion of serum into the cellular tissue in various parts of the body, called anasarca; but there yet remains another kind, in which the fluid is poured out into various cavities, constituting hydrothorax, hydrocephalus, and ascites; it is concerning this last form that I wish to make a few remarks. There are two states of liver which may produce ascites; they differ in this all-important fact materially, that the one will yield to treatment, whereas the other is incurable. We meet with one occurring af er an attack of ague; the spleen and liver become affected, and occasionally ascites follows; but this will yield under much the same plan of treatment that is employed during the continuance of the intermittent fever. Bark administered in large doses will remove the affection of the liver and spleen, and having removed the exciting cause the dropsy will disappear, and will not return. Not so where there is an organic change of structure in the liver; there, as in all cases where an organic change has taken place, it is beyond our power to effect a cure; we cannot renovate or restore to their pristine state organs which have already undergone this change; and, therefore, all we eau hope for is to alleviate the symptoms and ward off the impending fate as long as possible. In the case of David Davis (case 2, delirium tremens) we meet with disease of the liver or purgatives. By such means we may often suc-causing a cites, and also in the case of Brooks ceed in removing the anasarca, so that, in the (case 4) we have it from the same cause; and the post-mortem examinations of these two bodies will illustrate the nature of the disease. We here see the sharp margin of the liver destroyed and rounded off, giving to the organ that peculiar rounded form which we meet with in such cases. The dropsy depends upon an obstructed venous circulation, and various reasons have at different times been given to account for this obstruction; but I think one of the most reasonable is, that it is caused by a thickening of the capsule of Glisson, which retards the return of venous blood from the intestines by pressure on the portal veins, and the congested capillaries pour out fluid to relieve the circulation. The nutrient artery is also pressed upon, and hence the atrophied state of the organ. The cellular tissue then becomes condensed, and the liver by this means is puckered up, constituting the hobnail liver, or cirrhosis. In these two cases the disease had not proceeded far enough to produce this appearance. In the examination of Davis there was very little fluid found in the abdomen; this had, in all probability, been carried off by the skin in the profuse perspiration which accompanied the delirium. These two cases did not consist in disease of one single organ: in both, the disease of the liver was complicated with disease of the heart and kidneys; and such complications are by no means uncommon in these unfortunate cases. In Joseph Dean (case 5) we meet with ascites, but the ascites was combined with jaundice, and this not of the common kind. The poor fellow was of a peculiar greenish-yellow hue-such a colour as is always indicative of some serious disease of the liver, generally malignant. In most cases of tubercular deposit in the liver there is seldom jaundice, and with contracted liver we seldom have it to this amount; and we might, therefore, suppose that there was some mechanical obstruction to the passage of the bile existing in addition to the organic change. The obstruction might have been caused by a gall-stone; but the patient had every appearance of labouring under malignant disease, -the peculiar colour, his previous loss of flesh, and the extremely rapid emaciation, really dreadful to behold, almost marked the disease as one of a malignant nature. The examination after death clearly proved this: there was extensive disease of a malignant character, and there was also an obstruction to the passage of the bile, but such an obstruction as no human art could remove. In these cases of ascites from disease of the liver, it is necessary to get rid of the dropsy with as little stimulation of the organ as possible; and when the distention becomes very great we may seek relief for it by the operation of tapping, but not until it is absolutely necessary, for the operation is not unattended with danger from peritoneal inflammation, and it very soon becomes necessary to have recourse to it again. In addition to ascites or an effusion of fluid into the cavity of the peritoneum, we meet with another form of dropsy very much resembling it, as far as outward symptoms are concerned, and this is ovarian dropsy. The fluid here is not effused into the cavity of the peritoneum, but is encysted, being contained within the ovary. This form of dropsy, however, often proceeds to an enormous extent, and we have a good example of it in the case of Hannah George. In such a case as this, how are we to distinguish it from ascites? In ascites, where the intestines are free, they invariably rise to the surface of the fluid, in whatever position the patient may be placed, and they there give out a resonant sound on percussion. This is not the case in ovarian dropsy: the enlarged ovary rises in front of the intestines, which, from being tied down by the mesentery, are pressed back by the tumour, and, if any resonant sound be given on percussion, it is in the flanks, and there alone, whatever be the position of the patient. The same remark holds good with regard to the umbilical region, for, however much the position be varied, we always meet with a dull sound in that situation. These remarks, of course, only refer to the advanced stage of ovarian dropsy, for, in a more early stage, the situation of the tumour, and the fact that the fluid is not equally diffused throughout the whole abdominal cavity, and but circumscribed in extent, will at once mark the nature of the disease. Now, with regard to the |