I have never seen a case of true gangrene.

My friend Dr. Lalor,

the Medical Superintendent of the Richmond Asylum, who has been engaged for twenty years in the treatment of the insane, informs me that he has never seen a case, in nearly 3,000, which have passed under his observation.

Of the specimens of gangrene of the lung brought before the Pathological Society (about twelve in thirty years) only one was taken from the body of a lunatic, who had been under the care of Professor Law in the Dundrum Asylum. It seems, at first sight, difficult to reconcile these conflicting statements, but it is after all an easy matter.

The truthfulness of the reports of the Continental physicians I have referred to is beyond all question; we must therefore admit the fact, and seek for an explanation, and I have no doubt that the absence of gangrene in our asylums depends on the inproved mode of managing the insane of late years. Formerly all the conditions most likely to favour the development of gangrene and other cognate diseases were in full operation in hospitals for the insane. The improvement is not confined to English hospitals, but has also taken place in Continental hospitals; and doubtless the great relative number of cases of gangrene of the lungs no longer exists. Wunderlich tells us that he learned from an eminent alienist physician that in his establishment, in which the practice prevailed of keeping the patients the whole day in the open air, gangrene of the lung was unknown. Cruveilhier has particularly noticed that gangrene of the lung is frequent among epileptics; and again I must observe that this is not in accordance with my own experience.

The prolonged and excessive use of spirituous liquors, combined with the usual consequences, misery and want, have been supposed to play an important part in the etiology of gangrene of the lung.

In this case lately under my observation, as well as in those reported by Drs. Stokes and Gerhard, the subjects of the disease were confirmed drunkards, but how little does the frequency of gangrene of the lung accord with the presumed causes.

So far from some of the persons who have laboured under the disease being broken down in constitution by intemperance and want, it is stated, particularly by Mosing, that in the epidemic which occurred in the house of correction at Lemberg, those who were attacked were chiefly young and robust individuals.

It is probable that the man whose case has suggested these VOL. XLIII., No. 85, N. s.

H

observations was long the subject of tuberculosis of the lung; that the lining membrane of the tubercular cavities became the seat of sphacelus, which subsequently extended to the tissue of the lung, and finally, in the last few weeks of his existence, involved both lungs.

The case is in one respect noteworthy, inasmuch as I know of no recorded example of the disease in which the lungs throughout their whole extent were found in a state of putrefaction.

Cerebro-spinal Arachnitis.-Some remarkable and unusual forms of disease have been observed within the last twelve months in this city. Cases of cerebro-spinal disease, or at least presenting phenomena closely resembling the disease with which we were at one time familiar in an epidemic form, have occurred. In the greater number there has been no examination of the body after death; but, however, from a careful consideration of the phenomena observed in them, and a comparison with those cases in which an autopsy has verified the diagnosis, I believe we may assume that the disease, although as regards the discolouration of the skin, so to speak, a new disease, was nevertheless cerebro-spinal arachnitis

In The Dublin Medical Press, May 30, 1866, I published a case of this terrible disease, and I then called attention to the state of the skin, which was of a deep cyanotic hue, and which to the same extent I had never before seen in cerebro-spinal arachnitis.

The subject of the disease was a boy aged fourteen; the duration of his illness was three days. The post mortem examination exhibited the ordinary appearances of cerebro-spinal arachnitis. On the 30th of December last I was requested by my friend Dr. Newland to see a patient with him, who had been suddenly taken ill the night before. The history of the case is shortly as follows:A boy, aged fifteen, a grocer's apprentice, had been, up to the night of the 29th December, apparently in perfect health. He had been hree months residing in Dublin, having previously lived in the country. He had exhibited no sign of delicacy-he was extremely well fed and cared for in every respect, and there was nothing in his manner of life, so far as could be ascertained, calculated to act injuriously on his constitution. Late in the hevening e was observed to look ill, and he was recommended to go to bed.

On being visited soon after he retired, he complained much of his head and of sickness of his stomach; he had got out of bed, and was so faint as to be unable to get back. At midnight he was

visited by Dr. Newland, who found him complaining of headache, intense thirst, general uneasiness, and sickness of stomach. The next morning a remarkable change in the symptoms had taken place. The legs and arms were thickly covered with spots. The pulse, which the night before was very rapid, was now almost imperceptible; the expression of the face was much altered, he had incessant vomiting, and the restlessness was extreme. About noon

I saw him, in consultation with Dr. Newland, who detailed to me the history of the case as I have given it. We found him in a state of great depression. Frequent vomiting, particularly on taking any fluid. The pupils neither dilated nor contracted, but little influenced by light, and there was strabismus of one eye. The legs and arms presented an extraordinary appearance, being covered with spots of a purple colour, of different sizes, some regular and round, and about the size of a florin, others irregular in shape. On passing the finger over the surface, the spots were found to be slightly elevated. The body had some spots, but not many. There was no retraction of the neck, but the boy had complained of pain along the spine, and in the legs, and the sensibility of the surface was exalted. He was pulseless, and the temperature of the extremities was very low.

Again I saw the boy at ten o'clock at night, with Dr. Newland, who kindly permitted my colleague, Dr. Bennett, to see the patient, as he had observed the case in Sir P. Dun's, which had manifested symptoms so closely resembling those in this case. There had been from the first no effort at rally. Stimulants had no effect, even when retained, but generally the brandy was rejected. The first sound of the heart was inaudible, and no pulsation existed in the carotid or femoral arteries. He seemed utterly unconscious of everything. From four o'clock in the afternoon until his death, which occurred in about thirty hours from the onset of the disease, the boy had three attacks of convulsions. The rapidity of this case was greater than that of the case recorded by me in The Dublin Medical Press, but the resemblance to it was very striking, and was immediately recognized by Dr. Bennett; and we agreed as to the extreme probability of finding, in the event of our obtaining permission to examine the body, similar appearances in the brain and spinal marrow. It was impossible to obtain a post mortem

examination.

The case was a fearfully appalling one in the suddenness of the seizure and rapidity with which collapse set in, a few hours only

intervening between the period when he seemed in perfect health and when death was inevitable.

All remedial agents in such a case are alike powerless, nothing seems to have the slightest influence in staying the fatal progress of the disease. This case and the one referred to which, resembled it, were unlike the sporadic cases of cerebro-spinal arachnitis, but forcibly reminded me of the epidemic form with the epiphenomenon of discolouration of the skin and spots. A remarkable and striking feature which had never, I believe, been seen in the cases in France or in this country when the disease was present in an epidemic form, nor until lately in any of the sporadic cases which have come under my own observation since the year 1846.

ART. X.-Reports in Colonial Practice. By HUGH CROSKERY, L.R.C.S.I.; Member of the Surgical and of the Obstetrical Societies of Ireland; Fellow of the Obstetrical Society of London; Corresponding Member of the Scientific Association of Trinidad; and late Editor of The West India Quarterly Magazine, Chapelton, Jamaica.

1. ON THE VALUE OF TARTAR EMETIC IN COMPRESSION OF THE BRAIN, AND IN CONTROLLING CONVULSIONS AND MANIACAL EXCITEMENTS DEPENDENT THEREON.

2. ON A CASE OF LEUCOCYTHEMIA, COMPLICATED WITH RECURRENT ATTACKS OF HEMATEMESIS AND ASCITES; ALL DEPENDENT ON AN ENORMOUSLY ENLARGED AND INDURATED CONDITION OF THE SPLEEN; WITH REMARKS ON THE SPLEEN AND ITS FUNCTIONS, FOUNDED ON OBSERVATIONS MADE DURING A CLOSE ATTENDANCE ON THIS CASE FOR A PERIOD OF NINE YEARS.

3. CASE OF SPINAL MENINGITIS, TREATED BY OFTEN-REPEATED DOSES OF OPIUM AND QUININE, AIDED BY THE CONTINUOUS APPLICATION OF POWDERED OPIUM, COMBINED WITH MERCURIAL OINTMENT TO A RAW, BLISTERED, SURFACE ALONG THE SPINE; RECOVERY.

4. CASE OF DOUBLE HEPATIC ABSCESS, OCCURRING AS THE RESULT OF A PROLONGED ATTACK OF DYSENTERY; THE FLUID EVACUATED THROUGH PUNCTURES MADE IN THE ABDOMINAL WALL AFTER UNION HAD BEEN ARTIFICIALLY ESTABLISHED BETWEEN THE LATTER AND THE LIVER; RECOVERY.

5. CASE OF EMPYEMA, THE RESULT OF A SUBSCAPULAR ABSCESS HAVING BURST INTO THE CAVITY OF THE CHEST; PUNCTURE THROUGH THE WALLS OF THE ABSCESS; RECOVERY.

6. AN ACCOUNT OF FOUR CASES OF STRANGULATED HERNIA,

EACH OF WHICH PRESENTED SOME POINT OF INTEREST.

1.-On the Value of Tartar Emetic in Compression of the Brain, and in Controlling Convulsions and Maniacal Excitement Dependent Thereon.

a

G. H., a young white Creole gentleman, had been suffering for some days from languor and pain in the right hypochondrium. On Thursday morning, the 31st of October, 1861, he left his bedroom, about six o'clock, in his usual good health and spirits, and partook of the accustomed Jamaica dish-a cup of good coffeeusually served at that hour of the morning. He went out for a stroll, and was seen to walk with a steady and buoyant gait. An hour afterwards he was found, about five hundred yards from the house, in a fainting state, and with his body lying on the pathway leading through a pasture on the hill-side. Being in the house at the time, I was called to him at once, and found him with contracted pupils, a feeble pulse, a cold, pale, skin, and completely unconscious. He was lying where, a short time before, he had been discovered, with his body up and down the hill, and in such a position as-if coincident circumstances did not point to a different conclusion— to lead to the belief that he had either laid himself down to rest there, or that he had felt faint, and had fallen down at the spot where he had been found: his head rested on a place by no means hard, and his hat was found not far from his person.

When I first saw him, he was in a state of syncope, which might have been the result of a heavy fall, and consequent concussion of the brain, or of sudden faintness from the exertion made use of in ascending or descending the hill. His state of health for some days previous and the fact that no cuts or bruises about the head, or stones about the spot, could be discovered-tended to convince me of the probability of the latter being the cause of the mishap. With this belief he was kept a short time where he was, in the horizontal posture, and a stimulating salt was applied to the nostrils. In a very short time, however, it became quite evident that he had

* "Creole" means, simply, born in the West Indies.