suggested to him by a friend who had invented it as a remedy for his own sufferings. The plan simply consists in returning the bowel, and placing against it a piece of sponge four or five inches long, an inch wide and half an inch thick, rolled upon itself so as to form a pad. The buttocks are then brought as nearly as possible into apposition, and retained in that situation by straps of plaster passed lengthways from one to the other. By this means a very effectual support is afforded to the relaxed bowel. If there is much irritation about the anus the part should be washed with vinegar and water.-Medical | Gazette, February, 1847. [We regard this simple contrivance, the effects of which are stated by Dr. Hake to have been equally satisfactory in other cases witnessed by himself, as one of great value, and likely to supersede many more expensive inventions. The benefit derived from it might probably be increased by dipping the sponge previous to application in some astringent solution, as a decoction of rhatany root, or a weak solution of nitrate of silver.] ON FISSURES AND EXCORIATIONS OF THE NIPPLE. chemists to be those which contain the metal in the state of protoxide; but it has always been found difficult to preserve the metal in that form from its great affinity for oxygen. Even in the saccharine carbonate of the Edinburgh Pharmacopoeia this change takes place, and thus prevents the full advantage which had been anticipated by the proposers of that formula. Dr. Clarke observes that the specimens examined by him rarely contained more than from fifty to sixty per cent. of real carbonate of the protoxide, and he therefore has endeavoured to improve upon the process, by uniting the precipitate as soon as it is formed, with as much sugar as it is capable of combining with. The details are as follows: He first makes a solution of five ounces of carbonate of soda in twenty-four ounces of water, and adds to it four ounces of simple syrup; and having previously obtained a pure sulphate of iron, by sulphuric acid and water with iron wire, he then dissolves four ounces of it in two pints of cold water, and instantly adds the solution of soda and sugar. The process being conducted, as in the Edinburgh formula, the whole is thrown on a filter, and the precipitate rapidly mixed with two ounces of sugar, and dried by exposure to air. Dr. Clarke thus gets a preparation containing from ninety to ninety-five per cent. pure carbonate of iron. TOXICOLOGY. ON THE TREATMENT OF POISONING BY ACIDS. In poisoning by acids, the antidotal treatment alone suffices, if applied early. All toxicological writers advise the employment of magnesia, the alcaline carbonates, and soap, but these are not, according to M. Bouchardat, sufficient, and he thinks therefore, that he is entitled to some credit as having laid down a more definite treatment. M. Donné (Conseils aux Meres sur l'Allaitement) observes that fissures of the nipple, so frequently observed in nurses, are not to be deemed solely as an inconvenience unconnected with the secretion and qualities of the milk; they have other inconveniences beyond the mere pain which they produce. He does not doubt that they are always related to a defective condition of the lacteal secretions, not less injurious to the infant than to the nurse, and in this point of view he considers them worthy of every attention. He states that he has constantly found that women who are subject to these fissures have a poor quality of milk, and that it is commonly mixed with mucosities. So constant is this connection, that he considers the fissures the indication, if not the consequences, of It is well to commence, he observes, with calcined poverty of the milk, of its being deficient in quantity, magnesia in excess, but as a portion of the acid and of its difficulty in flowing,-which difficulty causes is absorbed, and tends to destroy life by producing the infant to make violent and injurious efforts on coagulation of the blood, it is not enough to have suction. It happens too, that the infant becomes ill-neutralized the acid in the stomach, but some soluble nourished, and this, according to Donné, causes the secretion of an acid saliva, which adds to the mischief. [In opposition to this theory of mechanical violence as a cause of sore nipples, it may be observed, that Dr. Rossi has noticed that the painful excoriation never appears, even in retracted nipple, where the greatest efforts on the part of the child are required, unless the infant's mouth presents aphthous ulcerations. He states that he has proved this to be the real cause, by applying children so affected to the bosom of healthy women, when fissures of the nipple have been the result.-Ranking's Abstract, vol. ii., p. 294.] MATERIA MEDICA. ON THE PREPARATIONS OF IRON. Dr. Clarke (Dublin Medical Press, Jan. 27th,) has published a communication, in which he gives a formula for producing a better preparation of carbonate of iron than has hitherto been adopted. The most active preparations of iron have been determined by antacid must be given, which may be absorbed, and so neutralize the acid which has reached the blood. The best substance to effect that purpose is the bicarbonate of soda. The author remarks, that it is of importance not to exhibit the soda in the first instance, as the disengagement of the carbonic acid may cause rupture of the coats of the stomach. TREATMENT OF ARSENICAL POISONING. M. Bussy has demonstrated that magnesia forms an insoluble compound with arsenious acid and may therefore be employed as an antidote to that poison. The treatment recommended by Bouchardat is the following: ANECDOTES OF THE MEDICAL PROFESSION. TREATMENT OF POISOING BY LEAD. There are three circumstances to be considered in lead poisoning : 195 ship. Hopeful, in gratitude for his efficient help in a case of great distress to the monarch. It seems that in the year 1636, (?)* (a very early period of our direct 1. The treatment of poisoning by the salts of lead intercourse with India, after the Portuguese had disin large doses. covered the passage thither by the Cape of Good 2. The treatment of slow poisoning by the salts of Hope,) one of the princesses of the Great Mogul's lead. 3. The prophylactic treatment. The antidote most relied upon by Bouchardat for the fulfilment of the first indication is the hydrated persulphuret of iron given in excess, mixed with syrup. Vomiting and purging may be solicited by large doses of croton oil. [The second and third indications are not touched upon.] TREATMENT OF POISONING BY OPIUM AND ITS 1. Empty the stomach by emetics or the stomach pump. 2. Give a solution of the iodide of potassium. 3. Give strong coffee, without sugar. The proportions recommended by Bouchardat are, an ounce and a half of coffee to half a pint of water, to which is added brandy, half an ounce.-Annuaire de Therapeutique 1847. POISONING BY ARSENIC, DATING BACK TEN YEARS: DETECTION OF ARSENIC IN THE BONES OF THE SKELETON. A case of poisoning occurred in the village of Scamagne, without the fact having reached the ears of justice. Ten years after, certain circumstances arose which led to the apprehension of four suspected persons. A medical enquiry was instituted, and a skeleton was discovered, which was recognized as belonging to the murdered individual, and who, upon the confession of one of the parties implicated, had died at the end of twenty-four hours, after having taken a large quantity of arsenic. The skeleton and the remains of the funereal appurtenances were submitted to chemical analysis, and arsenic was discovered to exist in repeated instances. The source of the poison was rendered more certain by the fact, that none was discovered in a skeleton which lay so close to the above, that it was at first mistaken for it.-Cours d'Assize de la Haute-Vienne.-Gazette Méd.,Janv.,1847. ANECDOTES OF THE MEDICAL PROFESSION. [The following anecdotes of the Medical Profession are the "gleanings" of an esteemed member of the Provincial Association. They afford a tribute to the skill, humanity, and disinterestedness which charac. terize the genuine medical practitioner, and are here recorded as an example and encouragement to others to go and do likewise.] 1.-The anecdote most flattering to the medical profession, which I would recall to your remembrance is, the occasion of the first establishment of the East India Company's power on the coast of Coromandel, which was procured by the favour of the Great Mogul to one of our profession, Gabriel Boughton, of the family had been burnt dreadfully by accident, and that a messenger was sent to Surat, where foreign traders resorted, to desire the assistance of one of the English surgeons there, for they had acquired a great reputation amongst the natives for their skill in the cure of diseases. Gabriel Boughton proceeded forth. with to Delhi, and was successful in performing a cure on which the Great Mogul's minister asked him what, his master could do for him to manifest his gratitude for so important a service? Gabriel answered with a disinterestedness,—a generosity,—a patriotism beyond any praise," Let my nation trade with yours." "Be it so." A portion of the coast was marked out for the future resort of English ships, and all duties were compromised for a small sum of money. A better station, it is true, was selected at the mouth of the Hooghly river some twenty years afterwards, and Calcutta was built; but here was the first establishment of our power. Here did the civilization of that vast continent begin; from hence the blessed light of the Gospel may have been first promulgated amongst a hundred millions of native idolaters, since subjected to the control of British power, and made partakers of our enlightened comforts."- Sir Henry Halford "On some results of successful practice of Physic." 2. It has been before remarked how the English were indebted in 1655, to the skill of an English Doctor for permission to settle at Pipley; in 1713 our country was again indebted to its medical skill for further privileges. Mr. Hamilton, a surgeon in the East India Company's service, having accompanied an embassy to Delhi, soliciting certain privileges, a powerful opposition was met in the Mogul's court, and the embassy were on the point of returning unsuccessful, when it so happened that the Emperor Ferokshere was seized with a dangerous illness, which baffled the skill of the native physicians. Mr. Hamilton's advice was solicited, given, and successful. On being desired to name his reward, he nobly cast aside private advantages, and implored a grant of the objects of the mission, which were gratefully conceded. Hamilton's remains rest without a stone to mark the spot in the burialground at Calcutta, his patriotism and his services alike unremembered; and although the natives of India have been more linked to England in ties of personal affection, by means of the skill of our surgeons and physicians, than by any other class of the East India Company's servants, they are the worst paid and In 1656 (?) owing to the skill of an English doctor, (Boughton,) the East India Company received the Mogul's sanction to establish a factory on the right bank of the river Hooghly.-Montgomery Martin's History of the British Colonies, vol. i., p. 4. "On the payment of three thousand rupees, a government license for an unlimited trade, without payment of customs, in the richest province of India, was recorded,”Mill's British India, vol. i., p. 7'. most ill-requited officers in the East; their lives are spent in doing good, and old age brings with it little to solace but the remembrance of the past. It is to be hoped that a profession, combining in its exercise, science, extensive knowledge, and christian charity, will soon meet its deserts.-Montgomery Martin's History of the British Colonies, vol. 1, p. 87. [There appears considerable discrepancy in the dates. Sir H. Halford says that Gabriel Boughton btained his permission in 1636-i. e., four years after the Great Mogul granted permission to establish a factory at Pipley; and Mr. Martin says, that in 1656, owing to Boughton's skill, permission was given to establish one on the right bank of the Hooghly, and in alluding to this he also says it was in 1655. The discrepancy, however, does not alter the merit of facts so creditable to our profession.] 3. "I was very anxious to procure, if possible, some medical advice for Mysseri, whose illness prevented my departure. Every one of the European practising doctors, of whom there had been many, had either died or fled; it was said, however, that there was an Englishman in the medical service of the Pasha, who quietly remained at his post, but that he never engaged in private practice. I determined to try if I could obtain assistance in this quarter. I did not venture at first, and at such a time as this, to ask him to visit a servant who was prostrate on the bed of sickness, but thinking I might thus gain an opportunity of persuading him to attend Mysseri, I wrote a note mentioning my own affair of the sore throat, and asking for the benefit of his medical advice. He instantly followed back my messenger, and was at once shown up into my room. I entreated him to stand off, telling him fairly how deeply I was "compromised," and especially by my contact with a person actually ill, and since dead of plague. The generous fellow with a good humoured laugh at the terrors of the contagionists, marched straight up to me and forcibly seized my hand, and shook it with manly violence. I felt grateful indeed, and swelled with fresh pride of race, because that my He soon countryman could carry himself so nobly. cured Mysseri as well as me, and all this he did from no other motives than the pleasure of doing a kindness, and the delight of braving a danger.”—Cairo and the Plague. Eōthen, p. 314. (To be continued.) Medical Entelligence. HEALTH OF TOWNS. Lord Morpeth obtained leave on Tuesday, March 30th, pursuant to notice, to bring into the House of Commons a Bill for improving the Health of Towns. SOCIETY OF APOTHECARIES. Gentlemen admitted Licentiates, Thursday, March 11th-John Shepherd Fletcher, Manchester; Thomas Oldacres, Market Bosworth; Thomas Binford Eyre, Yeovil; Nathaniel Best Gill, E. I. Comp. Service; George Booker, Dronfield, Derbyshire; Edward Mawthill Tearne, Stockton, Worcestershire; Horatio Lillifant, Exeter; Charles Henry Holman, Crediton; Edward Hancock, Stoke, near Plymouth. Gentlemen admitted Licentiates, Thursday, March 18th :-Robert Finch, Greenwich; Robert Kemp Buckell, Southampton; George Anstice Knott, Bristol; John Edmund Currey, Essex. OBITUARY. Died, February 27th, at Tripoli, John Dickson, Esq., M.D., Surgeon, on the half-pay of the British Navy. Dr. Dickson had been resident at Tripoli upwards of thirty years, and such had been the extent of his gratuitous attendance on the indigent, that his decease was looked upon as a great public calamity. His funeral was escorted by a military guard of honour, sent by the Pacha, and attended by the Foreign Consuls, by all the European residents of every class, and by several thousands of Jews and Mahomedans. March 16th, at Southampton, aged 28, Julius Veronge, Esq., M.D., Surgeon of one of the Royal West India Mail Packets. March 20th, aged 71, Charles Rochement Aikin, Esq., of Bloomsbury Square, a Member of the Royal College of Surgeons, and well known for his scientific and practical knowledge of chemistry. March 26th, in Bedford Square, T. Wilkinson King, Esq., Surgeon, Lecturer on Pathological Anatomy, &c., at Guy's Hospital. BOOKS RECEIVED. The Microscopic Anatomy of the Human Body in Health and Disease. By Arthur Hill Hassall, F.L.S. &c. Part VIII. London: Highley. 1847. Lecture, introductory to a Course of Clinical Medicine, delivered in the Theatre of Queen's College, Birmingham. By Samuel Wright, M.D., Edin., F.R.S.S.A., Physician to the Queen's Hospital, and Professor of Clinical Medicine in Queen's College, 1847. Birmingham, &c. &c. London: Churchill. 8vo., pp. 23. An Essay on the Nature and Properties of the Tenbury Mineral Waters. By A. W. Davis, M.D., London: Whitaker. 1847. pp. 40. CONICAL CORNEA. Mr. W. White Cooper would feel greatly obliged to any gentleman who would, from observation, favour him with the particulars of cases of conical cornea, together with an abstract of the treatment employed, and the result. 2, Tenterden Street, Hanover Street. TO CORRESPONDENTS. Communications have been received from Mr. F. Buckill; the Sheffield Medical Society;. Dr. J. Campbell; the Birmingham Pathological Society ;. Mr. Bartrum; Mr. J. E. Wood, PROVINCIAL MEDICAL & SURGICAL JOURNAL. A COURSE OF LECTURES ON CLINICAL MEDICINE. the touch, and the course of which is marked by a dusky red line. It is evidently the saphena major By W. R. BASHAM, M.D., Physician to the Westminster vein in a state of inflammation. The cord-like hard Hospital. LECTURE IX. Clinical remarks on idiopathic Phlebitis : Record of the : Gentlemen,-Cases of idiopathic phlebitis-inflammation of the veins occurring spontaneously-are of sufficiently rare occurrence to be of some interest to you in a course of clinical instruction. On this occasion I propose to point out to you the pathological conditions of this disease, the most frequent predisposing causes, the general principles of treatment, together with the ulterior consequences or effects of this affection, when existing independently of local injury. The case of inflammation of the saphena veins of both legs in a man in Burdett ward will afford me this opportunity. The case during its progress, may have appeared trifling to you, the symptoms being for the most part unaccompanied by pain, or much constitutional disturbance, yet, is this condition of the veins, fraught with much possible danger, the chances of purulent termination being by no means remote, and which once established excites conditions of fearful jeopardy, and rarely exempted fatality. ness extends the whole length of the vein, and is lost only as the vessel disappears under the fascia to join the crural. The same condition exists in the saphena veins of both legs. There is no swelling of the glands of the groin; no wound or any abrasion of surface on the foot, or any part of the lower extremities. Has not felt any rigors. The pulse is 84, soft; the tongue is white and moist; there is no deficiency of appetite; no thirst; no febrile heat of skin; but the urine is dark coloured, and deposits a copious precipitate of the pink urates. He has been at work in the cofferdam at the Houses of Parliament, working often for hours up to his ankles and knees in water. He was admitted on the 20th January, and ordered Hydrarg. cum Creta et Pulv. Ipecac. Co., utrq., gr. v., quartis horis. Beef tea diet, and the lower limbs to be enveloped in hot moist flannels, to be repeatedly renewed. On the next day the cord-like tension of the veins had materially diminished, and much less pain was felt on pressure. The dusky-red colour now marks the course of the veins, from the inner ankle to the groin, indicating that some smaller branches, emptying into the main trunk, are here and there likewise affected. On the 23rd slight ptyalism was noticed, and in the course of the afternoon a brisk diarrhoea commenced, which was directed not to be checked unless it became urgent. The remedies were to be repeated. On the 24th the report states, that after many watery dejections the looseness spontaneously ceased, and this day no pain was experienced in any part of the indurated vein, and the dusky-red colour was now confined to the inferior part of the vein. On the 25th the cord-like tension was gradually disappearing, his general appearance had much improved, the appetite, which had not been deficient from the first, had now become craving, and he was placed on an improved diet. On February 1st he was reported convalescent, and discharged on the 2nd. The ward-book reports the case of J. H., a labouring man, aged 27, admitted suffering from idiopathic phlebitis. The appearance of the patient on admission was that of a man throughly out of health, of some what anxious aspect, but not suffering any amount of pain. He states that he has felt a tense cord-like It may be mentioned as remarkable, that a man, sufswelling in both his legs for the last seven days. There|fering from chronic rheumatism, and in Dr. Kingston's is no want of mobility in the lower extremities. He ward, is suffering from a similar condition of the walks and moves about without pain; but commencing saphena in both limbs. I have no hesitation in referat the internal malleola of both legs, and extend-ring the origin of this state of the veins to the effect of ing up on the inner edge of the tibia, and between cold. We did not see this patient during the first the edge of the belly of the gastrocnemius, a cord- | period of the attack; we cannot, therefore, determine like swelling is felt, which is slightly painful to the amount or nature of the constitutional disturbance No. 8, April 21, 1847. Н existing at the commencement; at any rate, we are assured of certain circumstances capable of predisposing the system to such disturbance. The exposure of the lower extremities for hours at this season of the year, to the influence of cold and wet, is not an unlikely disturbing cause. Had symptoms of rheumatism coexisted with the inflammation of the saphena veins, as is the case in the patient in Bouverie ward, there could have been no difficulty in associating this state of the veins with the phlebitis accompanying the rheumatic diathesis, and which has been noticed by more than one author. Yet, notwithstanding the absence of all erratic pains, I am still inclined to refer this condition of the veins to a rheumatic origin, the state of the urine presenting all the features of rheumatism, and the exciting causes being in every respect capable of developing most of the conditions and elements of that disease. Phlebitis from rheumatic causes may be considered as the lightest form of this most serious malady; it differs only from the phlebitis produced by wounds, or by the absorption of animal septic poisons, in that there is less tendency to terminate in purulent formation, a condition that renders these two latter affections of such momentous importance. The plastic contents of the vein in this rheumatic form of phlebitis, either dissolve or liquefy; and being thus removed, are carried away into the general circulating mass, or at most remain as a plug in the vein, becoming semi-organized, and either completely or partially obstructing the circulation through the affected vessel, the numerous venous anastomoses subsequently carrying on the current through their enlarged and dilated canals. When a disease presents distinct external manifestations, it is convenient to consider it-first, in reference to the local symptoms; and, secondly, as to the extent of constitutional disturbance, accompanying or produced by the local disease. I wish therefore to detail to you-first, the pathological conditions of the inflamed vessels, the cord-like tension of which first arrests our attention; and, secondly, the constitutional conditions, if any, produced by the state of the veins. canal, and considerably diminished its capacity-not totally closed it. It is now, irrespective of complete, or only partial, obliteration, that the vessel has acquired that cord or quill-like character to the sense of touch, which you felt in this case. The plastic lymph lining the vein is for the most part colourless; it has been derived from the blood, and consequent upon its isolation and deposition there occurs a serous infiltration into the outer tunic of the vein, and not unfrequently extending into the cellular tissue investing the vein. This serous fluid holds in solution the hæmaphæin, or colouring matter of the blood; and it is its presence in the serous infiltrated fluid which causes the dusky-brown red hue that externally marks the course, extent, and ramifications of the inflamed veins. It may happen that the inflammatory action does not continue with sufficient intensity completely to plug up the canal of the vein; and I think the case before us presents us with an example. When this happens, the circulation is still imperfectly carried forward through the centre of the plastic layers; for as these layers are invariably thrown out from the lining membrane of the vein, and are added to the circumference of the plug, it follows, that for a time, at least, the circulation goes on, the calibre of the vein diminishing as each succeeding layer is added to the circumference of the deposit. As a consequence of the complete obliteration of the vein, the circulation is then maintained by the anastomosing veins. One of the most important characteristics of venous inflammation is its tendency to centripetal progress: it less frequently extends from trunks to branches than from branches to trunks; and thence progresses towards the heart, the centre of the circulation. This is one of the conditions that causes phlebitis to be of such vital moment. The subsequent changes that take place in the plastic mass, plugging the channel of the vein, are strictly analogous to those observed in inflammatory products in other parts of the body. One of three conditions must happen: 1. The fibrinous mass disappears slowly, and gradually becoming dissolved, it is carried away by the restored current of the circulation. its capacity diminished, and when cut across, the vein would remain uncollapsed, and as an open cylinder. It would appear from the pathological researches of the most recent observers, that the inner membrane of the veins in the earliest stage of the inflammatory 2. The lymph becomes semi-organized, and forms process becomes discoloured, of a purplish hue, a permanent addition to the inner parietes of the vein: occasionally of a light scarlet, and that this discolour- this more frequently happens when the plastic layers ation is not uniformly spread over the inflamed portion, have not completely obliterated the channel, but but irregularly-in patches, sometimes presenting a merely lessened its calibre. When this occurs, tense, striated appearance. Accompanying this alteration in quill-like hardness persists, and a subsequent examinacolour, and as the result of the hyperæmia of the lining|tion of the vein would present its walls much thickened, membrane of the vein, is the exudation or deposit of plastic lymph, which, forms in layers, each succeeding layer being deposited external to the last, the whole being concentrically arranged, till the tube of the vein becomes completely clogged, and impervious to the current of the circulation. It does not, however, necessarily follow that the vein becomes totally impervious; for the fibrinous deposits do not always continue till the canal of the vessel has become obliterated. The inflammatory process being arrested, the layers of lymph have, perhaps, only lined the 3. The third and most serious change to which the inflammatory exudation is exposed, is the special tendency that it has to pass into suppuration. It is this tendency which makes phlebitis at all times so hazardous in its consequences; the blood becomes contaminated by the purulent degeneration of the plastic layers, abscesses in different organs of the body, the liver, lungs, and other glands, are the formidable effects, and death the inevitable termination. |