would take no food, at other times he had excessive appetite. He had never passed ascarides.

His mother's family have all musical genius, and she particularly; his father also is very musical.

The diarrhoea was soon relieved. His parents were then advised to have him magnetised by the nurse, a very suitable person, young and benevolent, and fond of children, with a soft hand. She was instructed how to do it. The mother was also told to play soft airs only, for an hour at a time, for the child, avoiding all music with crashing sounds—to play the soft Scotch, Welch, and Irish airs-and not any difficult music. The medicines chosen for him were Hyoscyamus, Calcarea, and Cuprum aceticum. The child in a week shewed signs of intelligence; in three or four weeks he began to speak again; he has never looked back. At this time he is as intelligent as any boy of his age. He has had no outbreak of temper; there has been no recurrence of lethargy; his countenance, instead of being vacant, is animated. He has not, for long, passed his evacuations unconsciously. The boy has been awakened up to full consciousness, full life. The music and the manual magnetism are still continued. This is one of the most gratifying cases that has fallen under the writer's observation.

OBSERVATIONS ON MELENA.

BY DR. HITCHMAN.

MELENA (péλaiva vócos, morbus niger), the black disease, hence the name of the black jaundice-a term adopted by Sauvages, from the writings of Hippocrates, to denote the occurrence of dark-coloured, grumous, and pitchy evacuations, generally accompanied by sanguineous vomiting. The adjective is here used. singly, the substantive being understood. By Hoffmann, the disease is called secessus niger. According to most authors, this malady is seldom idiopathic, or primary; but is generally the consequence of some pre-existing changes, sometimes chiefly seated in the stomach, at other times in the adjoining viscera, as the

spleen, liver, or pancreas. The blood may proceed from the mucous surface of the stomach, which is most commonly the case, or from the surface of the duodenum, or the oesophagus. It is generally poured out from the congested, dilated, and weakened capillaries, and exhaling pores of this surface; but it may be poured from a limited part, or from a few small vessels chiefly, as when it depends on a congested or other morbid state of the spleen, or on ulceration, or from one or more diseased or ulcerated vessels, which latter is thought by some to be but rarely the case; it may also proceed from an aneurismal tumour which has poured its blood, either directly or mediately, into the stomach. With regard to its etiology, whatever irritates the mucous surface of the stomach or interrupts the return of blood from that organ, will occasionally produce this hæmorrhage. Blows and injuries on the abdomen, particularly on the hypochondria and epigastrium; violent concussions of the trunk; external or internal pressure on the stomach; the ingestion of irritating or hurtful matters into this viscus; intemperate indulgence in alcoholic compounds; the presence of parasitic animals in the stomach or upper portion of the small intestines; powerful and irritating emetics and drastic purgatives, especially when given in the advanced stages of fevers, or in cachetic or visceral obstructions; the suppression of accustomed discharges, natural or acquired, particularly the menstrual or hæmorrhoidal; the application of cold, or of cold combined with moisture, to the lower extremities, or surface of the body during perspiration, or the catamenial period; neglect of the bowels, and consequent accumulation of fæcal matters; diseases of the vessels of the stomach and adjacent viscera; the gravid uterus; indeed other tumours developed in any part of the abdomen. The pathognomonic symptoms of the disease may be said to be an indefinable sense of epigastric uneasiness, with periodical paroxysms of gastralgia, with more or less gastric derangement, such as pyrosis, with flatulent, acrid eructations and nausea, followed by vomiting of blood, either fluid or coagulated, pure or mixed with the contents of the stomach, alvine dejections quite black, and of the consistence and appearance of tar, more or less fetid.

The μέμαινα νόσος was far from being unknown to Hippocrates. He describes two kinds. In the one the patient vomits a black bile, like the lees of wine, sometimes bloody, sometimes a thin, pituitous saliva, acid like vinegar, or a pale-green bile. When the matter vomited is black and bloody, it smells putrid -Povov okεr. When the matter is acid, the fauces are inflamed, the teeth set on edge, and so concentrated is this acid that it effervesces with the earth on which it falls-Tyv yyy aigei. When the patient vomits he feels much relieved, and is equally unable to bear emptiness or fulness; for when empty the stomach is flatulent and sour, and after eating, a disagreeable weight is perceived in the bowels, the breast and back feel as if pricked with pins, a slow fever with headache, dim sight, weariness of the limbs, and blackness of the skin come on. He counsels bleeding, if the patient be strong, with frequent purging, thin drinks, whey and milk; that he should use a cooling, light regimen, and avoid much exercise, exposure to the sun, and venery. Under this management the disease will yield to time, and getting better as the patient becomes old, tends not to shorten life. The other kind attacks those who are weak and thin, who have a yellow skin and light eyes. The longer the disease exists the worse it becomes; at times a few drops only are vomited, and again a small cupful or two, the food is also occasionally rejected, and with it bile and phlegm; a fever, with chilliness, precedes the vomiting, and general pains are experienced after it; grumous bile is vomited as the disease advances, and the same rejected by stool, together with the food little changed, and the patient frequently becomes paralytic without any relief of the other symptoms. In this you must purge freely, "naι naтw naι avw," give asses' milk, use a light, soft, cool, and nourishing diet; a little generous white wine, diluted, must be allowed; strong exercise, by walking, should be daily used, but the heat of the sun avoided. With every possible care, however, this species ends unfavourably, but does not prove very tedious. It will be seen from the above translation that Hippocrates observed and has described two distinct species of the morbus niger. In the first the discharges by vomiting are mixed, partly blood, partly bilious, with a thin

and very acid phlegm. It is relieved by venesection, or phlebotomy (Eẞos Tou), purging, and the antiphlogistic regimen, and is not fatal. In the second, the vomiting is entirely bilious, no mention whatever of blood being made; it occurs in debilitated and bilious people; is incurable, and is only mitigated by such means as prevent an accumulation of bile in the primæ viæ, or carry it off if already accumulated. Hoffmann (in his Med. Rat. Syst.) describes melæna pretty much after the style of Hippocrates; he adds that the disease is seated in the stomach and spleen, and proves, by dissection, the blood to be derived from these viscera.

In many cases, after death, the spleen was found tumid, and the vasa brevia greatly enlarged; the vessels also of the stomach were distended with black blood, similar to that which had been vomited and purged before death. He quotes numerous authors who had observed similar morbid appearances on opening the bodies of those who had died of this disease. He endeavours to show that it is a symptomatic disease, arising in general from suppressed menses and hæmorrhoids, and not unfrequently attacks after the cessation of their catamenia those delicate women who had been subject to much mental anxiety. He appears to have been more fully aware of the frequency of the black discharge by stool than Hippocrates had been, and justly asserts, that in such cases the matter does not come from the stomach, but from the small intestines, and says that in some dissections he found all the mesaraic vessels distended with black blood, and a quantity of a similar fluid extravasated in the cavity of the intestines. When the melana proceeds from a diseased spleen or liver, when the discharge, particularly that from the bowels, is bloody, pitchy, and highly offensive, and is accompanied with much debility and faintishness, the disease is not to be cured. Sauvages defines the complaint with singular perspicacity: Fluidi atri per superiora, vel inferiora frequens rejectio. A blackness of the stools, occurring without griping pains, constitutes, as he says, the character of this disease; and these evacuations, diluted with water, either verge towards a yellow or a black colour, as the liver or spleen may be primarily implicated. He particularly notices the ab

sence of smell (vix fœtidas) in the alvine discharge; a circumstance which I have often observed, and which I think only occurs when the discharge is purely bile changed so as to appear like tar, and quite unmixed with either blood or ordinary excretion. Cullen says: "I am aware blood is known to assume that appearance where it has stagnated for any length of time in the alimentary canal." But he also allows that it is possible that the bile may put on a black viscid appearance, and give a real foundation for the appellation of an Atra Bilis. The term black disease we know has been applied to a variety of serious maladies, in consequence of their peculiar sombre aspect: thus we have the black death, a name given in Germany and the North of Europe to an Oriental "plague" which occurred in the fourteenth century, characterized by inflammatory boils and black spots, or maculæ, upon the skin of the patient, indicating putrid decomposition. In Italy it was called la mortalega grande (the great mortality). In many of its characters this pestilence resembled the particular bubo plague, complicated also with pneumonia and hemorrhages. In the instance we are considering (black disease), this, and black jaundice, are English terms for the morbus niger of the Latin writers, and the péhava vocos, of the Greeks. Black water is an English term for pyrosis; the black vomit, or melæna cruenta, as it is sometimes called, has reference to substances of a black appearance rejected in certain forms of disease, as in typhus icterodes, or yellow fever, &c. Melana Cullen supposes to be a venous hæmorrhage from some part of the internal surface of the alimentary canal, and that it is a symptomatic disease. If from any interruption of its proper course the blood be accumulated in the veins of the vena portæ, from tumefied spleen, or obstructed liver, that accumulation must resist the free passage of the blood from the arteries into the veins; this again must produce some congestion in the extremities of the red arteries, and therefore some increased action in them, which must be determined with more than usual force, both upon the extremities of the arteries and upon the exhalents proceeding from them, and this force may occasion an effusion of blood. This doctrine, though brought forward to explain the hæmorrhoidal flux, applies equally well, he says, to the morbus niger.