The root, stem, and leaves of this plant abound in bitterness, and hold a high place among the indigenous tonics of the East. It also acts mildly as a diuretic, and is deemed febrifuge by the natives. Another twining shrub of the order of Menispermaceæ, deserving attention as a bitter tonic, is the Coscinum fenestratum, indigenous in Ceylon and the southern portions of the Indian Peninsula. It has been recently ascertained that this plant contains a considerable portion of berberine. Two other plants of this order, possessing bitter and tonic properties, are the Clypea hernandifolia and the C. burmanii. Closely allied to the Menispermaceæ, both in a botanical and therapeutic sense, is the natural order of Berberacea, the Indian species of which have latterly attracted considerable attention for their tonic and antiperiodic properties. Of these the Berberis asiatica, B. lycium, and B. aristata, are considered the most active. The parts employed are the wood, the bark of the root, and an extract prepared from these. The natural order of Simarubaceæ contains but few species indigenous to India, the most important being the Nima quassioides. Among other plants belonging to other natural orders, are the Guilandina bonducella, which is a prickly shrub, yielding a bitter fruit; the Andrographis paniculata, which is an excellent substitute for quassia, gentian, and other imported bitters, and is a pure tonic; the Coptis tecta, the roots of which are employed as a bitter and tonic remedy; the Thalictrum foliosum, the root of which is tonic and febrifuge; the Aconitum heterophyllum, the root of which is used as a general tonic; the Aristolochia indica, the root of which is bitter and tonic; and the Azadarichta indica, the margosa or neem tree, which is inferior to none of the preceding plants as a bitter tonic and antiperiodic.

Astringent Tonics.-Without even attempting to describe the indigenous astringents of India, Mr. Waring directs attention to a few indigenous plants, which, while they possess more or less astringency, are classed among the general or constitutional tonics. The natural order of Cedrelaceae contains two trees belonging to this class-namely, the Soymida febrifuga and the Cedrela toona, the barks of both of which are astringent and tonic. The natural order of Apocynaceae contains some trees, the barks of which rank high among the astringent tonics of India. Among these is the Wrightia antidysenterica, the bark and seeds of which possess the same properties; the Alstonea scholaris, the bark of which has for a long period been esteemed for its astringent and tonic properties by the natives of some parts of India, and has also been reported to act as an anthelmintic; and lastly, the Hymenodictyon excelsum, a tree belonging to the natural order of cinchonaceae, which, from the physical properties of its bark, may be confidently expected to prove a valuable astringent, tonic, and antiperiodic.

XII. On the Employment of Instillations of a Tepid and rather Concentrated Solution of Chlorate of Soda into the Trachea of Children affected with Croup. By M. BARTHEZ, Physician to the Hôpital Ste. Eugénie. (Bulletin Général de Thérapeutique, May 30, 1858.)

In a letter written to the above journal, M. Barthez calls attention to some cases in which he has employed local applications to the false membranes produced in croup. For about two months, an epidemic of croup had prevailed near the Hôpital Ste. Eugénie, and had assumed some peculiar characters, being attended with the production of a false membrane in the bronchi, trachea, and larynx, seldom in the pharynx, and hardly ever in the nasal fossa. The general symptoms of blood-poisoning were generally absent, and after tracheotomy, the children died with the symptoms of slow asphyxia; they all died, and in the greater part of them, the trachea and the bronchi were filled with false membranes.

M. Barthez had previously made some experiments on the comparative effects of chlorate of soda and chlorate of potash, when these salts are applied to the false membranes. Two portions of false membrane, of nearly equal dimensions, were placed in contact respectively with a concentrated solution of chlorate of potash, and a concentrated solution of chlorate of soda. The false membranes were gradually altered in character: they softened and lost their opacity; their tissue became less compact, more transparent, and afterwards diffluent, and their membranous form disappeared without losing all its cohesiveness. The only difference observable in the two solutions was that the changes began later in the chlorate of potash than in the chlorate of soda, and required a much longer time for their completion. The same membrane immersed in water only, preserved its natural appearance for many days.

Guided by these experiments, M. Barthez instilled through the canula a tepid solution of chlorate of soda in some cases of tracheotomy, in the hope that he might thus effect the softening of the false membranes, and consequently the more easy destruction of their adhesions, and their more rapid and complete expulsion. The results of these experiments were very encouraging, for all the patients previously treated had died, but when the new system had been introduced, three out of seven patients recovered. Judging from this result, M. Barthez is convinced that the instillation is innocuous, and that it is even useful. In order to ascertain

the different effects produced by solution of chlorate of soda and by pure water, a patient was treated by instillations of water only, but although the instillation was very frequently repeated and cough was excited, yet no other liquid but water was thrown out. At last, solution of chlorate of potash was substituted for the water, and it was instilled every quarter of an hour; and at the end of about an hour a remnant of false membrane was evacuated, and then other portions in succession until the next day. The suffocation diminished in proportion, and the patient recovered completely.

M. Barthez relates five cases in which the chlorate of soda was employed in instillations in the trachea; and although he admits that the cases are not sufficient to establish incontestably the efficacy of this treatment, yet he thinks that the beneficial action of the soda-salt is very probable. Tracheotomy ought not to be performed unless there is reason to suppose that a false membrane exists in the trachea; even when the false membrane exists, it is useless to employ instillations when there are symptoms of diphtheric poisoning, or when the expectoration of false membranes is abundant; but when tracheotomy has been performed, and it is determined to use instillations, then the chlorate of soda appears to assist the child in discharging the false membranes which oppose the entrance of air into the lungs.

XIII. On the Employment of Oil of Turpentine and Opium in Large Doses in the Treatment of Severe Puerperal Diseases. By Dr. E. BONFILS. (Bulletin Général de Thérapeutique, May 30, 1858.)

M. Trousseau has lately employed, with considerable success, a method of treatment, proposed originally by Dr. Graves, in puerperal diseases. This treatment consists in giving opium and oil of turpentine in large doses to women in child-bed who are attacked with metroovaritis, peritonitis, uterine phlebitis, &c. Among other cases, M. Trousseau has treated in this manner, and with success, a woman attacked with peritonitis and double pleuro-pneumonia. He also employed this plan in another case of a woman attacked with general and very severe peritonitis, which was very rapidly checked and afterwards cured; but although the cure appeared to be permanent, the patient was unfortunately seized with hectic symptoms of an insidious character, and sunk under what appeared to be a putrid infection. In the first case the opium was prescribed in pills and the turpentine in injections. At first five centigrammes (about one grain) of opium were given in five pills, to be taken daily; then the dose was gradually augmented till it reached about two grains a-day. The opium was continued for thirteeen days. The turpentine was administered at first in the dose of ten grammes (about two drachms and a half) in two glysters, one in the morning and the other in the evening; then the quantity was progressively augmented to thirty grammes (about seven drachms and a half). In the second case the opium was also given in pills, in the dose of five centigrammes (about one grain) for three days. The oil of turpentine was administered by the mouth in capsules, each containing one gramme (about the fourth of a drachm) of turpentine; six of these capsules were taken every day, and they were continued for six days.

XIV. On the Treatment of Inflammation by Digital Compression. By M. VANZETTI, Professor of Clinical Surgery in the University of Padua. (Giornale Veneto di Scienze Mediche, April, 1858.)

From the success which has attended the treatment of aneurisms by manual compression of the arterial trunk, M. Vanzetti was induced to apply the same method to the treatment of inflammations, in those cases where the artery leading to an inflamed limb is accessible to the finger. He has several times had recourse to digital compression of the femoral, brachial, or subclavian artery in cases of phlegmon, arthritis, and inflammation of the fingers, and he has obtained such decided effects by this treatment, that he has adopted it in all cases where it could be practised. Although this method is of course only applicable in certain cases, yet it is found that compression will not only quickly cure incipient inflammations, but even when the inflammatory process has made some progress, it may be arrested by a patient and persevering use of the same means. This plan of digital compression had been already proposed theoretically by some authors, but it was never employed by any of them, and it had fallen into oblivion. They have also proposed the use of instruments for the purpose of compressing the artery, without at the same time interrupting the venous circulation, but M. Vanzetti recommends that manual compression should alone be used, as being preferable to all others. Although this method of compression presents some difficulties in its performance, it is only

because one or two persons are sometimes required to apply it exactly; the surgeon ought, in urgent cases, to make compression himself for two or three hours; this period will sometimes be sufficient to diminish sensibly the acuteness of the inflammation, and thus to save a seriously diseased limb. Most frequently the patient can himself perform the compression of the femoral, or the humeral, or even of the subclavian artery in cases of very considerable swelling of the arm; he will be able very easily to continue the compression for eight or ten minutes, and then to leave off and re-commence after he has rested. These short intervals present no obstacle to the desired effect.

M. Vanzetti records two cases treated by digital compression in the hospital at Padua. The first was a severe case of phlegmonous erysipelas of the left arm, and the second was one of acute arthritis of the right wrist. In the first case the limb was enormously swollen, and a thread was placed around it to measure any change in its dimensions; digital compression was exercised on the subclavian artery for fifteen continuous hours, after which, there was decided relief of the disease and diminution of the swelling, and although there was subsequently extensive suppuration, yet the patient recovered completely. M. Vanzetti thinks that suppuration might have been prevented if the patient had come earlier under treatment, as he was advised to do. The second case was one of arthritis, and was treated by compression of the brachial artery, which was performed sometimes by the pupils of the hospital, and sometimes by convalescent patients, properly instructed. The pain and swelling of the joint were distinctly relieved, and the patient entirely recovered without the adoption of any other treatment whatever. In this case, the patient was able to distinguish whether the compression was properly or improperly practised by the amount of relief which he experienced.

XV. Veratrum Viride as an Arterial Sedative: a Mutual Paper made up of Contributions from the Members of the Middlesex East District Medical Society, Massachusetts. (American Journal of the Medical Sciences, October, 1858.)

This plant was introduced to notice as a medicine in the year 1835, and in 1856 the Middlesex East District Medical Society in Massachusetts had its attention invited to its properties. Since that time it has been constantly in use, with results which are believed to be very important, its chief employment being as an arterial sedative in most inflammatory affections. This species of veratrum grows rather abundantly in swamps, moist meadows, open woods, and along the banks of mountain streamlets from Canada to Georgia, putting forth its leaves in April and beginning to flower at the end of May. The officinal part is the root, which has a sweetish bitter taste, and produces a burning sensation in the mouth, on the tongue, and in the fauces and throat, together with a sensation of dryness and heat. When dried and powdered it acts as a powerful sternutatory, and applied locally it causes irritation, rubefaction, and even vesication of the skin. In relation to its chemical composition, it is found to contain gum, starch, sugar, bitter extractive, fixed oily matter, colouring matter, gallic acid, an alkaloid substance identical with veratria, lignin, and the salts of lime and potassa. The alkaloid principle is nearly insoluble in water, more soluble in ether, and entirely soluble in absolute alcohol. The tincture is the preparation employed in practice. It is made by slicing the root, and drying the pieces over a furnace, and then triturating them, after which the powder is macerated with strong spirit of wine. The proportions employed are about four ounces of the powdered root to a pint of spirit. This tincture has been employed successfully as an arterial sedative; the dose is one-half to two drops for infants, two to five drops for children, and three to ten drops for adults. The first indication of a sufficient quantity having been given is the occurrence of nausea and diaphoresis, and then the dose must be diminished, or the use of the medicine suspended for a time. Although the veratrum album is a drastic cathartic, experience has shown that the veratrum viride very seldom, if ever, purges. The evidence brought before the Massachusetts Medical Society shows that the tincture of veratrum viride possesses great efficacy in the treatment of diseases attended with excitement of the circulatory system, as, for instance, in inflammatory affections and palpitation of the heart. It has been used in pneumonia, pleurisy, erysipelas, and scarlatina, and its use is always attended with a diminution in the frequency of the pulse. In acute rheumatism it is reported as being a medicine of great efficacy. Thirty-four cases are recorded as having been treated by this medicine, including cases of palpitation of the heart, organic disease of the heart, puerperal fever, pneumonia, pleurisy, bronchitis, acute rheumatism, intermittent fever, and scarlatina, and in all the cases its employment appears to have been attended w th beneficial results.

Dr. John Bell, in a Report on Materia Medica for the year 1857, published in the 'North

American Medico-Chirurgical Review' for September, 1858, thus sums up his opinion upon the effects of the veratrum viride: "After this survey of the different uses to which veratrum viride has been put in the treatment of disease, it is easy to see that much yet remains to be known concerning its therapeutical capabilities. So far, its use would seem to have been confined to febrile and inflammatory diseases; but, if we can attach any importance to the analogy which this substance bears to the class of sedatives belonging to the vegetable kingdom, we must believe that its greater range and variety of application will be found in subacute and chronic affections, in which the nervous system and nutrition are implicated, as in the neuroses, and in scrofula and the secondary stages of syphilis, as well as in chronic rheumatism and gout. May it not deserve, in various cardiac affections, especially in hypertrophy, the epithet applied to digitalis, of its being the opium of the heart? Beyond the sedative action of veratrum viride, we have very little accurate knowledge of its action on the organism. Experiments, both physiological and clinical, are wanting to show to what extent it acts as a diaphoretic or expectorant, although these properties are claimed for it by its eulogists. The natural tendency of a febrile paroxysm to end in sweating, and of pneumonia to relieve itself, after a few days, by copious expectoration, should make us slow to admit the efficacy of an agent as a diaphoretic or an expectorant in these diseases, merely because diaphoresis and expectoration follow its use. The operation of veratrum viride in either of these ways has yet to be tested by its trial in a much wider circle of disease, and with more guards against fallacies than have yet been had recourse to. We have heard nothing of its action on the kidneys; and in this respect it differs greatly from digitalis. As an adjuvant and corrigendum to purgatives, especially to those of the resinous and drastic order, much good might be expected from veratrum viride, which in this, as well as in some other particulars, will be found to resemble hyoscyamine."

QUARTERLY REPORT ON PATHOLOGY AND MEDICINE.

By EDWARD H. SIEVEKING, M.D.

Fellow of the Royal College of Physicians, Physician to, and Lecturer on Materia Medica at, St. Mary's Hospital.

I. Clinical Illustrations of the Pathology and Treatment of Delirium Tremens. By T. LAYCOCK, M.D., &c. (Edinburgh Medical Journal, Oct. 1858.)

THIS paper illustrates by precept and example the error of the system very commonly, though not universally, pursued of treating delirium tremens by the administration of spirits and opium. Dr. Laycock argues that the withdrawal of the accustomed stimulus in habitual drunkards is not the ordinary cause of an attack, but that it is commonly brought on by a prolonged debauch, giving rise to an intensely alcoholized state of the blood. His own cases certainly bear out this view; in only one of twenty-two cases treated by the author in the Edinburgh Infirmary during the past summer was there any shadow of evidence of the delirium having been due to a withdrawal of the alcohol; in all the others the patients, when admitted, were under its immediate influence. If the disease be due to the blood being overcharged with alcohol, Dr. Laycock argues that it would be illogical to increase the force of the disease by multiplying the cause, and in support of this theory brings forward statistics, furnished by his own experience and that of other observers, to prove positively the advantage of the entire absence of alcoholic stimuli in delirium tremens, and, negatively, the pernicious effect that results from their administration. Of 403 cases treated in 8 years in the Royal Infirmary, according to the routine system, with spirits and opium, 101, or 25 per cent., died; of Dr. Laycock's 24 cases, treated in the Infirmary, none died, and he quotes Dr. Peddie's method of treatment without opium as equally successful, 80 patients who were under that gentleman's care having all recovered. With reference to the usual argument in favour of narcotics in delirium tremens, drawn from the patient's sleeplessness, Dr. Laycock states that experience abundantly shows that sleep, and "therewith return to health, will come on naturally in delirium tremens without the use of any narcotics, or even any drugs whatsoever." In addition to his own cases, he refers to the experience of Kühn, Esquirol, Calmeil, and Ware. The latter "treated 29 cases on the expectant method, 1 died; 12 by emetics, 1 died; 8 with opium, 4 died."

The state of the patient being one of great excitement, he should be placed in circumstances favouring repose, and the elimination of the alcoholic poison by the natural emunctories be promoted; food is necessary, because in almost all cases the absence of proper food has been one of the causes of the supervention of the seizure, and the complications, which mainly consist in sub-inflammatory states of the stomach, duodenum, liver, or kidneys, should be attacked by mild sedatives and depurants. The chronic inflammation of the chylopoietic viscera, so commonly associated with delirium tremens, is treated by Dr. Laycock with small doses of calomel, nitrate of silver, and morphia, combined in the form of pill; but where no such disorder exists, he finds the hygienic treatment sufficient to restore the balance of the circulating and nervous systems, and sleep ensues without the administration of medicinal

narcotics.

II. Is the Chorea of Abyssinia, or Tigretier, a Distinct Form of Disease? By Dr. LE ROY DE MÉRICOURT. (Archives Générales de Médecine, Août, 1858.)

Those who have read Hecker's 'Epidemics of the Middle Ages' will remember that he classes Tigretier with the dancing mania, and gives the sanction of his authority to the description of an affection under that name by Nathaniel Pearce, an Englishman, but not a medical man, who lived in Abyssinia from 1810 to 1819. Dr. De Méricourt does not appear to have had any opportunities of witnessing the phenomena under discussion, nor to have been in Abyssinia: but, after analysing the details given by Pearce, who was not a medical man, and examining the accounts of more recent travellers in that part of the globe, especially of Lefebvre, Petit, and Dillon (two of whom were medical men) he arrives at the following conclusions:-1. There is not in Abyssinia, nor in the Tigré country, a special endemic disease which deserves a separate place in nosology under the name of Tigretier. 2. The description of Mr. Pearce does not prove that he was witness of a species of mania analogous to the dancing mania of the Middle Ages. 3. His description presents no symptom characteristic of the neurosis known as chorea. 4. It is nothing but a more or less faithful account of the superstitious practices employed in Abyssinia for the cure of diseases generally, and often doubtless used as means of fraud.

III. Memorandum of New Facts relating to Epilepsy consecutive upon Lesions of the Spinal Cord. By Dr. E. BROWN-SÉQUARD. (Journal de la Physiologie, Numero iii., Juillet, 1858.)

Our readers will remember that Dr. Brown-Séquard has demonstrated the occurrence of epileptiform seizures in animals in whom a horizontal section of part or the whole of the spinal cord has been made; section of the portion intervening between the seventh or eighth dorsal and third lumbar vertebra being particularly liable to induce the phenomenon: The author now adds, that having been doubtful whether in these cases there was a complete loss of consciousness, he has since found that in certain cases no signs of pain or reflex action can be elicited during the attacks-viz., when the transverse section of the spinal cord is made on a level with the last dorsal vertebra; he therefore concludes that the convulsive disease thus produced is genuine epilepsy.

Dr. Brown-Séquard next discusses whether there is a form of epilepsy which deserves the name of spinal epilepsy, and he maintains that there is a variety of epilepsy which deserves this name, but which is distinct from that described under the term by some authors. He supports this statement by reference to experiments and to cases observed by himself and others in man. He observes that when the spinal cord has been nearly or entirely divided in the dorsal or upper lumbar region, the reflex movements that occur in the posterior paralysed portion of the body put on an alternately tetanic and epileptiform character. The two posterior extremities will become perfectly stiff, and subsequently be affected with violent, irregular clonic convulsions. These attacks last from two to eight minutes. The tetanic stiffness is sometimes so great that in attempts to overcome it forcibly, Dr. Brown-Séquard has broken the bone. The two posterior extremities are not affected in the same way at the same time; one may be in a state of rigid extension, while the other is violently agitated by clonic convulsions. If the anterior portion of the body is attacked with epileptiform convulsions, the posterior extremities are also involved in the convulsions.

Dr. Brown-Séquard, in the same paper, adverts to a third point of importance connected with the production of epilepsy, the occurrence of a contraction of the vessels of the cerebral hemispheres, and the circulation of black blood after this contraction has ceased. He intends shortly to publish new researches on these and allied points, but makes the preliminary announcement that he has seen the contraction of the cerebral vessels in epileptic animals at