1. When the urine is albuminous certain changes are discovered in the genito-urinary apparatus, and in the blood.

2. In dropsy with albuminous urine, the solid <matters of that fluid are diminished in quantity and are found to exist in the blood and serous effusions.

3. In albuminuria, not only does the urine contain albumen, but its specific gravity is below par, and it is deficient in salts. It sometimes also contains mucus and blood corpuscles.

4. The urine may be albuminous for several days together in several acute diseases. When this is the case, it indicates congestion of the kidneys or bladder [When urine is albuminous under these circumstances, its specific gravity is not diminished, but on the contrary is sometimes increased.]

5. During health, the urine may exhibit an albuminous re-action, in consequence of irritation of the urinary passages. The same thing occurs when semen is passed with urine in any considerable quantity. In females the admixture of the menstrual secretion with the urine may cause it to contain albumen.

6. In hæmaturia, the urine may contain albumen either in conjunction with the colouring matter of the blood alone, or with the fibrinous portion also.

7. When the urine is slightly albuminous, and at the same time contains mucus, and pain along the course of the ureter exists at the same time, it is probable that the pelvis of the kidney or the ureter is inflamed but not the substance of the kidney.

8. Urine which exhibits a distinct deposit, or flocculi, of spontaneous coagulated albumen, is indicative of chronic inflammation of the ureters and renal calyces.

9. Prostatic abscess opening into the urinary passages, renders the urine albuminous as in chronic pyelitis ; in this case the appearance of pus-globules under the miscroscope explains the phenomenon.

nephritis. According to him the urine in Bright's disease exhibits the character of anæmic urine,namely, a deficiency in its chemical elements. In twenty-two cases the specific gravity fluctuated between 1006,3 and 1014.7. The uric acid and its compounds were greatly diminished in proportion to the other saline constituents. The urine was in general acid, but without sediment. If any complication should exist, as an intercurrent fever or inflammation, disease of the heart or liver, then the urea will re-appear. In other cases the urine may become alkaline, and deposit the phosphates. Finally, in some cases of the disease the urine retains its normal characteristics.-Atlas für Path. Anat., Lief 10, p. 17.

FORMATION OF TUBERCLE.

[The opinions of pathologists are even to the present time divided as to the proximate cause of the deposition of tubercle, some maintaining that inflammation is the active agent, others denying that the product ever originates in that process. Dr. Wilshire appears to entertain opinions which may be made to amalgamate with both, maintaining that tubercle may be deposited in three modes,-by an error of nutrition, by inflammation, and as a consequence of morbid exhalation. The conclusions on this subject, which may be. found at the close of one of his excellent lectures, aïe as follows]:

1. The simple act of nutrition,—at least an abnormal kind of one,-may be sufficient for the deposition of tubercle.

2. If the blood be morbid, and the constitutional tendency strong, organic assimilation in any of the more important organs can scarcely be attempted without being accompanied by tuberculous formation. S. In a great many cases, not only is it unnecessary that inflammation should happen, but it is not even essential that any local congestion should ensue, in

10. Albuminous and purulent urine becomes ropy order that tubercle be deposited. and mucoid when the urine is alkaline.

11. Urine containing seminal fluid may exhibit an appearance of albumen: the microscope reveals the true nature of the case.

12. Albuminous urine containing fibrinous flocculi is a common symptom of "calculous pyelitis," cancer, and fungus hæmatodes of the kidney, as well as of idiopathic hæmaturia. In such cases fibrinous casts of the ureter or other renal passages are frequently passed and have been mistaken for worms.

13. If urine which does not exhibit any spontaneous deposits coagulates by heat and nitric acid, and at the same time is deficient in the urea and in the uric and phosphatic salts, especially if dropsy be confirmed, we may predict the existence of Bright's disease.

14. If urine after having been copious and glucosyric coagulates by heat and nitric acid, it is (according to Thenard,) indicative of amendment. I have frequently confirmed this observation.

15. On the other hand, I have known a diabetic patient become dropsical without a co-existing albuminous state of the urine.

Becquerel regards morbus Brightii as hypertrophy of the Malpighian bodies, and not as a form of

4. But in other cases it may be affirmed that although the blood be bad, and the scrofulous diathesis exists, the simple act of nutrition is not alone sufficient to give rise to a non-fibrinous granular albumen, in the form of tubercle. But here local inflammation being added, the exudations are not in character with those of other inflammations and tubercle is formed.-Medical Times, May S.

TUBERCULAR TUMOUR OF THE VERTEBRÆ OPENING

INTO THE ESOPHAGUS.

A female, aged 29, entered the hospital of Bassano for an obscure affection, accompanied by extreme marasmus, which had supervened upon her last confinement. She had very great difficulty of swallowing, repeated vomiting, difficulty of breathing, and great general debility. She died completely exhausted by heetic fever. On examination after death both pleurs were found adherent, and behind them, directly over the vertebral column, a tumour was discovered, about the size of a walnut, and springing from the fifth dorsal vertebræ. A second tumour, of larger size, was also seen to include the bodies of the fourth, fifth, and sixth vertebra, the osseous structure of which was converted into a soft caseons matter. On opening the œsophagus

HOMOEOPATHY.

that canal was found to be narrowed, and firmly adhe
rent to the most prominent part of the last-mentioned
tumour, a portion of the contents of which had escaped
through an irregular ulceration of bad aspect.
Giornale dei Progressi, Jan., 1846.

MORBID ANATOMY OF CHRONIC AND ACUTE
RHEUMATISM.

In a case of muscular rheumatism, Hasse found the muscles, and cellular tissue subjacent, dotted over with ecchymoses, and delicate vascular ramifications, the latter tissue being likewise more or less infiltrated with yellowish transparent fluid. He gives the following account of the morbid anatomy of the joints in chronic rheumatism:-On closely examining the cartilages of the affected joints they were found of a reddish hue; the articular surfaces of the bones presented scattered red points of different sizes. The foramina of the bony substance were also filled with a dirty red pulp, con. sisting of aggregated cells of a globular form, which treated with acetic acid displayed a large nucleus.

There were also numerons-blood corpuscles. The fat. cells were few in number and of a particular shape The whole cell-wall was separated from the usually homogeneous contents, and the interval thus formed was more or less filled with oily granules. Occasionally a little spot of yellow was seen among the dirty red colour, which indicated the presence of normal fat-cells. The reddened portions were dotted with tubercular spots which were sharply circumscribed. The cartilage was in many places irregularly thinned,

especially at the margin of the joint. On examining

the bones of non-rheumatic persons, Hasse could not distinguish any of the above-mentioned changes.

The author concludes by the following remarks:-It is certain that in rheumatism the cellular tissue, as well as the bony substance, may become the seat of inflammatory exudation. It is even probable, that in the great majority of cases, especially the slighter ones, the morbid anatomy consists of the appearances described. The changes in the bony tissue may be easily recognized after many years have passed. Those in the cellular tissue are determined with more diffi

475

He then took the ox gall and calomel, and a second
time became greatly relieved. Dr. Clay lost sight of
him from this time, but it appears that while in
Dublin he suffered a severe relapse, with pain in the
old spot, which had become more tense and perma-
neut. At this spot Dr. Clay passed a grooved needle,
and as it gave issue to a drop of pus, he tapped it
freely with a trocar, and drew off four pounds of
fœtid pus. At each dressing for several days a pound
of pus escaped, but after that time the discharge
gradually diminished, and at the end of three months
the man was completely recovered. Dr. Clay calculated
that in all, at least sixteen pints of matter must have
been discharged. The treatment after the evacua-
tion of the abscess was tonic and alterative, the functions
of the liver being restored by the ox gall and calomel.

SULPHATE OF QUININE IN ANEURISM OF THE AORTA
AND IN OTHER INTERNAL ANEURISMS.

It appears that sulphate of quinine has been em

ployed with much success in some Italian hospitals for aneurisms. It belongs, in this use of it, to what are termed hyposthenics (subduing action,) and is to be carried as far as the system will bear it.. It has, say its Italian supporters, the immense advantage of bringing down the pulse without disturbing its rhythm, of making the buffy coat of the blood disappear, that is, of

the relief of aneurism of the aorta and other internal

dissipating the organic condition,-namely, arteritis, on which it depends, and thus of retarding the progress of the aneurismal tumour. The other hyposthenics

adapted to the same end according to the same

authorities, as by alternation with the sulphate of quinine, are the vegetable and mineral acids, the sulphate of iron, the ergot of rye, the cold ferruginous waters, the arsenious acid, the acetate of lead, and the iodide of potassium-Monthly Journal, July, 1847.

HOMEOPATHY.

The following case of administering powerful drugs

culty.-Monthly Journal, from Zeitschr. für Ration in large doses under the guise of homœopathy, is

Med. Band 5.

PRACTICAL MEDICINE.

ABSCESS OF THE LIVER TREATED BY PUNCTURE.

The following cases reported in the Medical Times by Dr. Clay, is sufficiently rare in this country to deserve further publicity:

noticed in the Medical Gazette as having recently occurred in London:

"A lady who had been attended by a highly respectable general practitioner, recently consulted a homeopathic physician, who has acquired some celebrity in the fashionable quarter of the metropolis, for his skill in treating and curing diseases by infinite small doses. She received from him four small white powders, with explicit directions, (now lying before us,) one to be taken every other night,-each powder being numbered and the night on which it was to be taken, as well as the mode of taking it, being particularly specified,— "all dry on the tongue." No. I was swallowed according to order, and the patient was soon afterwards seized with great sleepiness, stupor, and other alarming symptoms indicative of the action of a powerful narcotic. These effects were followed by diarrhea. The patient was alarmed, and instead of looking upon

The patient complained of fixed pain in the right superior portion of the umbilical region, for which he was treated antiphlogistically without relief. His bowels were constipated; countenance yellow; spirits depressed; anorexia; pulse 90; evident enlargement of the liver, with paucity of bile. He took ox gall, dr. ij.; calomel, gr. x., divided into twenty-two pills, of which, one three times a day was the dose. Under this plan he quickly improved, and remained well until after bathing, when the fixed pain returned. Being at this time in a different locality, he was again the result as an indication of the beneficial working treated by bleeding, &c., and as before without benefit. I of homœopathic powders, or as a means of curing her

PROVINCIAL

MEDICAL & SURGICAL JOURNAL.

ON ULCERATION OF THE CERVIX AND OS
UTERI, AND ITS OCCASIONAL CAUSE OF
DYSMENORRHOEA.

By SAMUEL EDWARDS, M.D.,
Physician to the Eastern Dispensary of Bath, and
Physician to the Bath Ear and Eye Infirmary.
(Read before the Annual Meeting of the Bath and Bristol
Branch of the Provincial Medical and Surgical Associa-
tion, held at Bristol, July 22, 1847.)

The subject, Mr. President, which I intend to bring under the notice of the Association, is that of simple or inflammatory ulceration of the cervix and os uteri, confessedly the most common of all the diseases of the uterus, and for that reason the more important that its nature and most successful method of treatment should

instrument, and topical applications, warrant, I conceive, the above remarks.

Having during several years availed myself of many opportunities of examining diseased conditions of the cervix and os uteri, and having preserved accurate notes of many of the most important cases that have fallen under my notice, I prefer exemplifying by two or three of them some of the causes, and the symptoms and treatment of simple or inflammatory ulceration of the os and cervix uteri, thus showing how readily these evils are under the control of medical art wher attacked by judicious topical applications. The

first case which I shall now relate, I have taken care to be more minute in, as it well illustrates the symptoms, general and local, which the mischief sooner or

later, is sure to produce; the others I shall give less in detail, as this will be sufficient for the object I have partially in view-viz., to confirm the statements as to the ready curability of these evils by such means, as referred to by Lisfranc, Jobert, De Loury and Peraire, and since made more particularly, perhaps, known to you, by Dr. Henry Bennet.

be studied and appreciated. In connection, I would wish to draw particular attention to the occasional occurrence of dysmenorrhoea as an effect of the disease. The drawbacks for investigating the condition of the internal female organs of generation, in this country, are numerous, and those who have made this branch of our profession a subject of special study, will agree with me when I assert, that a delicacy of feeling in the patient, which I, at the same time, cannot too I. The case just referred to is that of a lady, 24 highly commend, has been hitherto, too frequently years of age, usually of robust health. A few days fostered on the part of the medical practitioner, by his after marriage she was attacked with severe inflammanot duly estimating its importance, and thus caused an tion of the vagina and vulva, whilst in London, and additional impediment to the necessary examination there treated very judiciously by a surgeon. A slight leucorrhoeal discharge, however, continued on her with the speculum, necessary alike, I believe, to the welfare of the patient and the reputation of the practi- thirteen months, at which time she first came under leaving the Metropolis, and existed more or less for tioner; and if, Sir, the welfare of the former be conmy notice. During a portion of this interval she had nected with such an investigation, may not the phy-been attended by a friend in Brighton, from whom she sician's delicacy be construed into an almost criminal neglect, if he thus allows evils to continue for years disappointing hopes of relief, and leaving for a last resort, that which is from the beginning the only rational and efficient mode of treatment. I am quite aware that slight sores and abrasions, from various causes, very frequently recover without any or very little treatment whatever, yet the cases that are so frequently met with of severe ulceration continuing for years, without even a proposal for the employment of the speculum, and a consequent neglect of remedies applied to the diseased part, and subsequently the rapid cure which I have seen effected by means of that No. 18, September 8, 1847.

received some little relief. On her applying to me she complained of a constant pain in the loins, a sense of heat and dragging in the pelvis, and sexual intercourse during this period had been at times extremely painful; the leucorrhoeal discharge was abundant, of a dirty yellow colour, and occasionally sanguineous; her health had suffered much, and she had become nervous and dyspeptic; her tongue was pale, and furred in the centre; pulse quick and irritable. Menstruation had always been natural, but since her marriage she had always suffered much pain. The usual treatment having been had recourse to previously, and an examination only by the finger having been proposed and adopted, I recommended the employment of the speculum, which

S

was immediately acquiesced in. The annoyance of the disease to both husband and patient prevented, I may remark, a false delicacy from stepping in the way to a chance of relief. On the introduction of the finger the vagina was found relaxed, the upper part irritable, and hotter than usual; the os uteri was high, and directed backward; the cervix was large, and of an cedematous feeling, the anterior lip being most so; on the finger being carried over it, an inequality was observed, a part appearing rough, which was more sensitive than the remaining portion. This was more apparent towards the os uteri.

The speculum revealed an inflamed appearance of the cervix, as evidenced by its red and shining hue. The anterior lip which first came under view was seen ulcerated to about the size of a shilling, being depressed a little below the surface, and covered with dark red granulations, which bled on the slightest touch of the speculum. The os uteri to one half its circumference was surrounded by the ulceration, and from the orifice flowed a small quantity of milky-coloured mucus, a proof, as it is asserted, and I believe correctly, that the neck of the uterus partakes of the mischief.

The mucus having been wiped away from the part, I applied the nitrate of silver thoroughly, and introduced it a line or two into the os uteri. Little or no pain was occasioned. An injection of decoction of poppy, to be used twice a day, and a mixture of infusion of gentian, with solution of potash and tincture of henbane, were ordered. Six days after, improvement had taken place, the secretion was less, and the ulcer certainly contracting; the eschar had come away on the fourth day. The decoction of poppy was changed for an injection of the diluted compound alum solution of the London Pharmacopoeia; the mixture to be continued, and a pill, containing a grain and a half of mercurial pill and extract of henbane requested to be taken every alternate night. Rest in the horizontal posture, and freedom from all sexual excitement, were enjoined. From this period I used the nitrate generally, with two exceptions, twice a week, for seven weeks, when the ulceration had entirely disappeared, as also the leucorrhoea; the softness of the cervix had returned fully, and its size was considerably diminished; the dyspeptic symptoms had all abated, and she had progressed equally in strength. This patient left Bath in February last. Two months after she became pregnant, and she still remains free from the old complaint.

examination, the cervix was found" low in the vagina, greatly enlarged, and considerably indurated. The speculum discovered an ulceration of at least an inch in its widest diameter on the right side of the cervix, covered with florid granulations, and raised above the margin of the surrounding texture. The mucous membrane was much injected; the os uteri open. In this case also the nitrate of silver was freely applied, and rest enjoined. A sulphate of zinc injection, and the usual remedies for restoring the lost tone of constitution, were prescribed. After nine weeks' treatment (the nitrate having been applied over the whole of the cervix once, occasionally twice, a week,) the ulceration was healed, the leucorrhoea with its accompanying symptoms had left her, and her health was vastly improved. I examined this patient about three weeks after she had ceased attendance at the dispensary, and found the cervix in a normal condition and position.

III-Case third is that of a lady, aged 40 years, mother of six children, who applied to me in April, 1845, under the following circumstances:-In January of the year previous she became pregnant, and soon after, leucorrhoea set in, accompanied with pain in the hypogastric region, a sense of weight on standing, and great irritability of the meatus urinarius, causing frequent desire to micturate. These symptoms continued, without medical advice, and on May 7th she aborted; a large quantity of blood was lost, and for three weeks she was confined to her bed or couch. After this most of her former symptoms disappeared, excepting a slight dragging sensation of a sickening character, as she described it, whilst standing long, In the especially if she had previously walked. November following she again became enceinte, and about two months after the old symptoms re-appeared; and not valuing them as she should, she allowed them to continue, without seeking advice, until the commencement of March, 1845. At the fifth month she again miscarried. The uterine symptoms continuing, I was consulted in April. I found the digestive organs disordered, and her general health was unsatisfactory, She complained of deep seated hypogastric and lumbar pains, and a distressing sensation on standing; the leucorrhoea was trifling. On examining, the cervix was found lower than usual, and its density as well as volume increased; it had much resistance, and was tender. The speculum disclosed the os uteri patulons, and entirely engaged with ulceration, extending from II. The second case is that of a patient I attended which were two small patches of ulceration, about the at the Eastern Dispensary of Bath, unmarried, aged 31. size of a fourpenny-piece, the one anterior, the other She had been confined, after a long and lingering labour, on the right side of the posterior lip; both had dark in Bristol, six months previously; she soon recovered, in│| red granulations, much depressed below the surface a week being up and about her usual avocations. of the surrounding part, and bled on the speculum After the lochia had 'disappeared a leucorrhoeal dis-pressing. The whole of the cervix and upper third charge set in, accompanied with pain in the back, and of the vagina were much congested; the former I a bearing down. She was attended professionally, freely incised in several places, which bled freely. A but received little benefit. About two months prior warm bath was ordered, and a warm opiate injection to her applying to me, blood appeared with the to be used night and morning; a mild laxative was discharge at times, and to the extent of several ounces. prescribed, and rest enjoined. This continued up to the time of my first seeing her, when she was weak and much emaciated; complained of headache and loss of spirits and appetite.

On

Three days after this I again examined; the congestion was much relieved; the nitrate of silver was now first applied to the ulcerations, as well as slightly