M. Bricheteau is inclined to adopt the first of these opinions; and M. Bouillaud seems to favour the last.

But in whatever manner we choose to explain the action of purgatives in typhus fever, there cannot be a doubt, says the former of these gentlemen, that they are very often highly useful in cases, the symptoms of which might seem to contra-indicate their use-for example, when the tongue is hot and dry, the epigastrium and abdomen tender and painful, the skin parched, and the thirst and fever intense.* In very severe cases, however, where we have reason to suppose that the intestinal ulcerations are far advanced, and in which, therfore, we have to fear the occurrence of perforation of the bowels and the subsequent discharge of their contents into the abdomen, the use of purgatives ought probably to be abstained from; or, at least, to be adopted with extreme caution.† M. Bricheteau is quite opposed to the system of repeated bloodlettings so perseveringly insisted upon by M. Bouillaud.

As an appropriate pendant to these remarks on typhus fever, we shall now relate two very remarkable cases of a hæmorrhagic diathesis, arising probably from a dissolved state of the blood, such as occurs in certain forms of putrid fever.

Case 1.-A mason, 21 years of age, had but imperfectly recovered from an attack of typhus fever, when he was admitted into the Hôpital Necker. He was extremely weak, had a troublesome cough, and flying pains in different parts of the body; the abdomen was tense and uneasy; the bowels were confined; and the system was feverish.

His face became puffy and livid; the eyelids were infiltrated, and the conjunctivæ exsuded blood. From the mouth also there was a sanguineous exsudation; and several coagula were evacuated from the bowels. He rapidly sunk, and died.

Dissection.-About three glassfuls of bloody serum were found in the abdominal cavity. The internal surface of the bowels was healthy as low down as the neighbourhood of the ileo-cæcal valve, where there were observed several elliptic spots (plaques), the effects of previous ulcerative inflammation.

The pleuræ, and also the pericardium, contained a quantity of sanguineous fluid. The heart was sound; but there was no blood in any of its cavities. The tissue of the lungs was very soft and lacerable.

The serous membrane of the brain contained in its meshes a quantity of gelatinous, partially coagulated, bloody fluid; and blood was found within the cerebral ventricles. The substance of the brain was exceedingly soft. Blood was found within the knee-joints, and also within the tunica vaginalis. The other serous cavities were not opened.

M. Bricheteau seems, in this passage, anxious to expose the errors of the Broussaian school; one of the tenets of which has been to eschew the use of purgatives in typhus fever.

M. Bricheteau closes his remarks on the treatment of typhus, without even adverting to the use of any other remedies except purgatives. Such is the besetting sin of all doctrinaires in our profession: they form theories, and on these they build their practice. Are saline diaphoretics and refrigerants of no utility? are emetics never serviceable? is cold or tepid spunging of the surface of no avail? and is it not necessary in many cases to have recourse, even from the first, to stimulants, as wine, brandy, and ammonia? If the typhus fever of Paris is at all like that which we see in London, we have little hesitation in saying that neither the purgative, nor any other, plan of medication is suited to all cases of the disease; the treatment must be varied, according to the peculiarity of each patient's constitution, as well as of the prevailing type of the epidemic. -(Rev.)

Case 2.-A labouring man died, after being a few days ill, with all the symptoms of hæmorrhagic Purpura.

Dissection. The peritoneum and also the pleura were spotted over with numerous petechiæ; and in many places, where there is much cellular substance, there were immense ecchymoses.

About six ounces of blood, mixed with a small quantity of serum, were found in the left pleura. Both lungs were partially infiltrated with blood. The pericardium, and also the surface of the heart, was spotted with ecchymoses: the tissue of the latter was remarkably soft, and very easily torn. The inner surface of the stomach was here and there ecchymosed; and was so little consistent, that it might be scraped off with the back of the scalpel. Almost the whole extent of the intestinal mucous surface was in a similar condition. The substance of the spleen, and also of many of the muscles of the body, was soft and gorged with blood.

The head was not opened.

M. Bricheteau says, that he is inclined to attribute such cases, as the preceding, rather to a primary affection of the solids, which diminishes their normal adhesion and resistance, than to any degeneration of the blood.-La Lançette Française.

CANTHARIDES PROVED TO BE A CONTRA-STIMULANT, OR ANTIPHLOGISTIQ REMEDY: ITS DEPRESSING ACTION ON THE HEART, &c.: ITS GREAT UTILITY IN INFLAMMATORY DISEASES.

The following really practical observations are exceedingly interesting, and well deserve the notice of medical men. Most readers will probably be surprized at first with some of the positions: but as they profess to be drawn from, and based on, actual experiments, both in health and in disease, we must not allow our British prejudices to blind our judgments.

Without any further premise, we shall now give the substance of the paper by Dr. Giocomini-one of the physicians of the hospital at Padua—and leave our readers to judge of its value for themselves.—(Rev.)

First Series of Experiments.

Nine medical students took, each, a pill, containing one grain of powdered cantharides, at eight o'clock in the morning.

In the course of two hours, the pulse in every one of them had fallen in frequency-from two to fourteen beats in the minute. In five the urinary secretion was increased.

A second pill was now taken; and again another at noon. All of them now complained of heat in passing their urine, which continued to be very abundant, and of general weakness and tendency to profuse perspiration, although the weather was not hot. Some suffered from colic pains, tenesmus, and a trouble. some itching about the anus. In all, the pulse continued to be considerably under the natural standard. None of them slept soundly during the following night, in consequence of the heat in the urethra, and the prostration of the system; but, by the next morning, they had all recovered from the effects of the medicine. One, who had for some time been annoyed with chronic ophthalmia, found himself entirely relieved from it.

Second Series of Experiments.

To each of seven youths a pill, containing a grain and a half of the cantharides, was given. Two hours afterwards, the pulse, in five of them, had fallen from five to fifteen beats in the minute; in the remaining two, the pulse was quickened by two beats, but was considerably softer than it had been. Another

pill was now given; and a third at noon. At three o'clock, the pulse in all had become slower than before; all complained of extreme exhaustion and of copious perspiration two only suffered from urinary distress, the rest having drunk very freely of mucilaginous drinks during the day. Next day, all the symptoms induced had passed away, with the exception of the general languor. One of the youths, who had been habitually troubled with palpitations of the heart, was quite relieved from them.

Third Series of Experiments.

Six students tried the effects of cantharidine. Each of them took a fourth of a grain, and repeated the dose, at intervals of two hours, for three times. Demulcent drinks were used freely at the same time. In all of them, there was a progressive retardation of the pulse; the maximum of this retardation was 22 beats in the minute. All of them suffered from general languor and powerlessness; from vertigo, and tremblings of the limbs; from loss of appetite; and from excessive perspirations. The sense of burning along the urethra was present in all; but considerable in one only. In some there was a troublesome diarrhoea. The general exhaustion continued, in a greater or less degree during the whole of the following day. The symptoms were found to be most effectually relieved by drinking freely of wine and of other spirituous beverages; which, although taken by some in large quantities, did not induce any tendency to intoxication.

Before quitting the details of these experiments, we should mention that the symptoms of poisoning were so alarming in one of the youths, that his case deserves to be noticed by itself.

Canton Bartolomeo, 23 years of age, had submitted himself to the three successive series of experiments. Shortly after having taken the last dose of the cantharidine, his pulse became slow, his limbs tottering; and vertigo and confusion of mind came on. The urine, which at first was very abundant, became suddenly altogether suppressed, and the patient complained of intense pain in the region of the kidneys.

The prostration increased; the limbs became quite powerless and cold; and the pulse was thready and exceedingly slow, not exceeding 30 beats in the

minute.

Dr. Giocomini finding that the wine, which he gave him pretty freely, was vomited, began to ply him with rum, in such quickly repeated doses, that in the course of little more than one hour, he took upwards of half a pint of it. The symptoms of poisoning gradually passed away, and the patient did not feel himself at all inconvenienced by the quantity of spirit, which had been given him. From the series of experiments which we have now recorded, two very important conclusions may be derived with respect to the action of cantharides on the system.

1. That it is contra-stimulant, hypo-sthenic or depressing; its operation being exerted chiefly on the circulating system.*

2. That its most effectual antidotes are stimulating substances, such as alcoholic liquors, ammonia, laudanum, æther, &c. It is quite a mistake to suppose that camphor is an antidote to cantharides-both are contra-stimulants.

The therapeutic action of cantharides in disease is quite accordant with these propositions. Signors Borda and Rasori have treated many cases of acute

* Dr. Giocomini is inclined to believe that cantharides, even when used locally as a blister, has a contra-stimulant or antiphlogistic operation; and therefore that other vesicants, such as boiling water, strong ammonia, &c., cannot be so serviceable in the treatment of many complaints, as the blisters made with the Spanish fly.

pneumonia with large doses of cantharides alone; and they have derived the same results from them as from the use either of copious bloodletting, or of large doses of antimony or of digitalis. The tolerance of large doses of cantharides, in acute or hypersthenic diseases, is quite as remarkable as, it is well known, is the case with these last-named remedies under similar circumstances. What would inevitably produce symptoms of poisoning in a state of health, proves to be only a salutary medicine when the system is hypersthenic.

The degree or extent of tolerance, by the system, of cantharides or any other contra-stimulant furnishes a most useful guide to the practitioner in the treatment of acute or inflammatory diseases; as it has been found that the tolerance is almost always proportionate to the violence of the disorder, and becomes less and less, as it abates.

S. Larber de Bassano has employed cantharides in the treatment of all inflammatory diseases without exception; and he reports most favorably of the practice. The action of the heart and sanguiferous system is rapidly abated, and a crisis by urine or by perspiration soon follows. Its irritating effect on the bladder may be counteracted by the copious use of demulcent drinks.

The following case of pleuritis treated with cantharides by Dr. Giocomini will serve as an example of the practice. A robust, middle-aged man, was seized with the usual symptoms of pleurisy on the 15th of May, 1834. He had suffered several times before from similar attacks, which had been successfully treated with bleedings and other antiphlogistic remedies.

On the 17th he was admitted into the hospital, with sharp pain in the side, cough, hurried respiration, and burning fever. Four grains of cantharides, divided into twelve pills, were ordered to be taken in the course of the day.

18th. Copious perspiration during the night; pulse considerably reduced in frequency and strength; urine scanty, but voided without heat. The same dose ordered.

19th. Copious perspirations again; pulse 64 and soft; frequent desire to pass urine, and also some degree of tenesmus present; all the thoracic symptoms mitigated. The same dose repeated.

20th. Symptoms as yesterday. The urine has now become very abundant and the fever has almost entirely passed away. A scruple of camphor ordered to be added to the pills. In the course of a day or two the patient was quite convalescent.-La Lançette Française.

PROFESSORS OPPENHEIM AND FRICKE ON THE USE OF IODINE INJECTIONS IN HYDROCELE.

The advantages of injecting an iodine-tincture solution into the tunica vaginalis of the testicle, after the evacuation of water, are stated, by the advocates of the practice to be manifold;-the cure is much quicker, being usually effected in from three to six, instead of twelve to fourteen days as after the port-wine injection; the pain is very much less continued, the patient being often able to move about in a few hours after the operation; and the risk is very much less in the event of any of the injected fluid making its escape into the cellular tissue of the scrotum, one of the most valuable properties of iodine being its ready absorbability. Indeed we are told that even although several drachms or an ounce of the iodine solution be left within the tunica vaginalis, it will gradually be absorbed without any bad consequences.

The very numerous cases, amounting to upwards of 200, in which Mr. Martin (vide Transactions of the Medical and Physical Society of Calcutta) has employed the iodine solution as an injection in cases of hydrocele, afford strong testimony in favour of the practice.

No. LX.

S s

Professor Oppenheim mentions that he has been induced by these successful results to give a trial to the iodine, and that he has used it with great advantage in fifteen cases.

The first case occurred in a countryman, sixty years of age, who had long been troubled with a hydrocele, which had been tapped several times. After drawing off about six ounces of citron-coloured fluid, Professor Oppenheim injected a mixture of one drachm of tincture of iodine and three drachms of water, and left it in the sac. As the pain was very inconsiderable, he rubbed the scrotum with his hand, so as to bring the inclosed fluid in contact with every part.

Next day, the pain was still trifling; but rather greater on the third. A few days after this, the Professor met his patient in the street apparently quite well; and on examining the scrotum a week afterwards, he found that there was no trace of any recurrence of the effusion.

The second case occurred in a gentleman, 40 years of age. He had been punctured three times, at intervals of from six to ten months, before he applied to Professor Oppenheim. After withdrawing the fluid, a mixture of two drachms of the iodine-tincture and six of lukewarm water was injected, and left in until considerable pain was induced. The pain continued till evening, and then subsided.

For the following two or three days, there was considerable tumefaction and uneasiness in the scrotum; but these passed away, and on the sixth day after the operation, the patient found himself so little inconvenienced that he got up, and walked a considerable distance from his house. At the end of the third week, every trace of the disease had disappeared; and up to the date of the report, fourteen months later, there had been no return of it.

The third case is very instructive. The patient had submitted not only to puncture of the swelling ten times, but also to the injection of port-wine into the sac, by the late Professor Delpech of Montpelier. Still the disease returned. Oppenheim now used the iodine injection-two drachms to six drachms of tepid water. The pain lasted for three or four hours and then subsided; although the testicle was a good deal swollen the next day, the patient rose from bed; and on the fifth day, he went to business without inconvenience. The cure was permanent.

The fifth case deserves notice on several accounts. The patient was upwards of seventy years of age; he had been troubled with the complaint on both sides for nineteen years; the operation of puncturing the sacs had been repeatedly performed; he had submitted to the introduction of a seton through the left sac, and had been confined to bed for two months in consequence of the severe pain and suffering he had endured from it;* and he had resolved never to undergo any other operation, until he accidentally heard of one of the cures effected by Professor Oppenheim. The Professor seems to have entertained some reluctance to make any attempt to effect a permanent cure in the present case, in consequence of the age of the patient, &c. But the patient being now very desirous himself, his wish was acceded to. Three drachms of iodine-tincture with an ounce and a half of tepid water were injected. After remaining for about ten minutes in the sac, no pain along the cord was induced; the Professor withdrew the canula, and left the greater part of the injection within the sac. The patient walked home after the operation. No re-action followed either on this or on any

The use of the seton had effected a cure of the disease on this side, after very protracted suffering.