upwards, will be generally found necessary; and it is seldom that we can have patients, especially in public institutions of charity, submitted to treatment for such a length of time. The following four cases will illustrate the principles recommended.

Case 1. M. L. aged 9, was presented at the hospital on the 1st April, 1831. In addition to scrophulous disease of the eyes and lids, there were numerous fistulous openings in the skin over the sternum, which was found bare and rough by the probe. Two other fistulæ existed on the outer side of the mamma, just below the anterior fold of the axilla; and the rib at this part was also carious; a fluid injected through these last-named openings escaped by those situated over the sternum. The child laboured under the effects of mercurialism; profuse diarrhoea and hacking cough. The constitutional irritation having been first subdued, recourse was had to iodine. In the beginning of June the iodated water was given in the dose at first of two ounces, and gradually encreased to 10 ounces in the course of of the day-three iodated baths were ordered every week. This treatment was continued for five weeks, and then suspended for a fortnight or more. In addition to the former treatment, the fistula were now injected with a concentrated solution of iodine. By this time the ophthalmic disease was quite cured; and the discharge from the abscesses much diminished and improved. In a few months, the caries of the sternum and ribs was conquered, the fistulæ healed, and the patient discharged well.

Case 2. S. D. aged seven years, was very similarly affected to the last patient; obstinate disease of the eyes and lids, and caries of the two first phalanges of the left fore-finger, and of the fifth metatarsal bone of the same side. The iodine was administered in the form of drink, baths, and injections, and the cure was ultimately complete.

Case 3. T. S. aged 12. The left

over it of a violet-red colour, and disfigured by numerous scars, and fistulous apertures, from which there flowed a profuse discharge. The bones found bare on the introduction of a probe. The fore-arm bent on the arm at a right angle, and could not be either bent, or extended-no motion between the radius and ulna. The general health was well attended to, and iodine administered both externally and internally. In four months all the fistulæ were cicatrised, and the motions of the joint much more considerable.

Case 4. M. L. aged 8. Almost complete anchylosis of the right elbowjoint, which is much swollen and puffed; there are five scrofulous ulcers, two of which penetrate to the humerus and ulna, which are found bare and rough. General health good, with the exception of an obstinate diarrhoea. At first sulphureous baths were employed; also local alkaline baths to the joint, and alcalis were given inwardly; but no success ensuing, cinchona was ordered, and an iodated bath thrice a week:-the ulcers to be dressed with an ointment containing ioduret of lead. In the course of a month, the mineral iodated water was given internally in the dose of from 4 to 6 ounces. With an occasional intermission this plan of treatment was continued for about three months, by which time the ulcers had healed; the swelling disappeared, and the anchylosis much diminished. We cannot fail to attribute the rapidity of the cure to the means employed; no spontaneous cure is ever effected so speedily; the patient had been in the hospital nearly 12 months, before the iodine was employed; and in that period very little progress had been made; whereas in three months afterwards the disease was subdued.-Revue Médicale.

X.

PUERPERAL PERITONITIS, FOLLOWED BY ASCITES AND SPONTANEOUS PERFORATION OF THE ABDOMINAL PA

RIETES.

of her 7th child. On the second day after her confinement, she was much agitated; and the consequence was, that severe pains in the abdomen came on, the lochia were suppressed, and the mammæ became flaccid. The symptoms were alternately relieved and aggravated for eight days; and at this period Dr. Puntons was called in. He found the patient much dispirited and alarmed; belly distended, sonorous, and painful on pressure; distinct fluctuation; suppressed lochia; urine much diminished in quantity, obstinate constipation, severe headach, tongue clean, much thirst, pulse irregular, somewhat hard and very frequent; œdema of the feet and ankles.

Treatment. Emollient fomentations, mercurial frictions on the inside of the thighs, calomel and nitre inwardly. Diet, chicken broth. This plan of treatment was persevered in for a week; the abdominal tenderness had much abated; but the distension had become greater; pulse less hard-a blister or dered to be applied to each thigh. On the 18th day from the commencement of the attack, an opening or slit occurred in the abdominal parietes, about an inch below the umbilicus; the part had been smooth and glistening for a few days before. About a pint of yellowish, inodorous fluid escaped. Two days afterwards a similar vent took place in the upper part of the left hypogastric region, and an ounce or two of a citron coloured serum flowed out. Simple dressings applied to the wounds, and firm compresses to the abdomen, in order to promote the expulsion of the fluid. The woman gradually recovered.

Observations. An analogous case is mentioned by Frank. The effused fluid was visible through the navel. The author of the Nosographie Philosophique narrates an example of puerperal peritonitis, in which a large abscess formed in the left labium; on the 14th day, it broke, and the patient was speedily cured. Van Swieten and Chomel allude to many cases in which the abscesses had found their way into the intestines and caused a purulent diarrhoea.-Revue Médicale.

XI.

ON SOME OBSCURE FORMS OF THE
PHLEGMASIE.

An inflammation, when its symptoms are uncomplicated and unobscured may be always very easily detected, and very certainly cured; cases however frequently occur, in which the characters of the disease are modified, and curtailed of their accustomed distinctness; and in the management of which unusual attention is demanded of the physician, as the attack is generally insidious, and the progress irregular and ill defined. The danger of such cases is ten fold greater than of others, in which the symptoms may be much more violent and formidable; as the activity of the remedies may be easily proportioned to the severity of the malady.

Case 1. A man, aged 55, had long been afflicted with strictures of the urethra. On the 4th February, 1831, he was admitted into the hospital. A constant muco-purulent discharge from the canal-bougies were employed, and the strictures dilated-still the discharge remained. The Venice turpentine was given inwardly, and produced very beneficial effects on this vesical catarrh. On the 24th of April he complained of heat in his throat, slight difficulty of swallowing and other characters of angina. The symptoms became alarming-great dyspnoea; pain in the larynx, and perfect inability to swallow. By very active depletion the inflammation was subdued; but a relapse most unexpectedly took place, in the course of two or three days; and so rapid was the onset, that on the evening of the attack, his life was despaired of, the respiration being performed with extreme difficulty and accompanied with a slight tracheal râle; the sputa viscid and purulent, and expectorated with great distress; no pleuritic pain. Nevertheless auscultation and the ensemble of the symptoms proclaimed the existence of a serious pneumonia. Patient bled from both arms; and 60 leeches to be applied to the side-died an hour after (!!) Several hours before his decease, the patient

had experienced rheumatic pains in the right knee, which was tender on pres

sure.

Dissection. Slight traces of inflammation in the pharynx and larynx. The left pleuræ adhere by cellular bands. The lung is congested as in asphyxia. The right pleuræ present some recent albuminous patches, and, in their cavity, a purulent effusion to the amount of seven or eight ounces. The lung, towards its base, crepitates; but, in other parts, is gorged, and in a state of congestion.

Reflections. It is interesting to trace the events of the above case in their sequency. First a vesical catarrh-this is stopped; then symptoms of general fever supervene―angina and laryngitis ensue, and these give way to a fatal inflammation of the chest. What occasioned this succession of phlegmasiæ, in a constitution by no means plethoric? We can only answer, some inexplicable disorder of the constitution; but in what consisting, or on what depending, we cannot tell. This obscure and indistinct form of pulmonic inflammation is not very uncommon after severe wounds or injuries, when complicated with extensive suppuration. The attack is so insidious, that it has often made alarming progress before the existence of the disease is suspected. It is generally fatal in its issue; and the morbid appearances found on dissection differ considerably from the pathology of ordinary pneumonia and pleuritis. We do not recognize the different structural changes successively developed in, and denoting the progress of, the different stages of the disease; but, instead of this regularity, we find all these changes occupying confusedly, here and there, a lobe of the lungs, which thus acquire a sort of mosaic appearance, from the apposition of party-cocoloured spots or patches.

Case 2. A coachman, by a fall, received a severe contused wound of the leg. After suppuration had been established for some time, the discharge ceased for two days. The patient felt himself indisposed, but had no cough, nor expectoration, nor pain; nothing,

in short, to lead any one to suspect serious pulmonary disease. In a day or so, copious sputa announced the presence of pneumonia in its third stage; but, in spite of the remedies used, the patient died, and dissection displayed one of the lungs in the morbid state described above, throughout its entire extent. There was also an abscess in the liver.

Case 3. A. L. aged 37, pale and emaciated; can lie only upon her back; pulse small, contracted, and frequent; constant cough, with expectoration of sputa, such as are observed during the resolution of an attack of pneumonia ; diarrhoea, and distressing sleeplessness. The symptoms, after a time, became suddenly much aggravated, and threatened immediate dissolution: the respiration was panting and frequent-pulse rapid and full-skin hot-expectora tion more abundant, and streaked with blood

diarrhoea increased; death soon followed. The patient had been ill of an obscure pectoral complaint, for upwards of a month before the history of the case begins.

Dissection. A large effusion of a purulent serum in the left cavity of the pleura. The lung of this side was much wasted, and adhered to the pleura costalis by strong false membranes. The superior lobe of the right lung exhibited numerous tubercles; the middle one was hepatized in different parts, and the remaining portion, although crepitating when compressed, was infiltrated with a frothy reddish serum. A well-formed pus oozed from some of the veins of the lungs, especially in the hepatized patches; and in other parts, the veins were found choked up with coagulable lymph. It is an interesting subject for reflection, whether the inflammation of the veins, which had given rise to the deposition of pus and fibrine in their canals, was caused primarily by the absorption of the purulent effusion in the pleurae; if so, the present case is approximated, in a most important feature, to those already narrated in illustration of the form of pneumonic inflammation supervening during the process of suppuration.

GENTLEMEN,-The Government has more than once consulted you on questions which concern the practice of medicine, and you have always displayed a readiness and zeal in explaining the relations between the laws which regulate the profession of the healing art, and the general spirit of our national legislation, and, consequently, the connexion, in certain points, which subsists between the legislation, and the customs and manners of the people; for surely all government, to be good and permanent, must be in accordance with the ideas, feelings, and interests of those whom it rules. It belongs to you, at present, to declare the painful regret you experience, on the subject of the edict lately issued by one of the magistrates of the Department of the Seine, an edict upon which I shall not comment, as it can be viewed only as the offspring of a strange error, which will no doubt be expunged whenever it is exposed by you. It is not my intention to examine whether this disgraceful mandate is conformable to the principles of the existing legislation, and to the decision pronounced in last ses

or

sion by the Chamber of Deputies, wherein it is enacted, that non-disclosure shall no longer be considered as an offence or crime; or whether, in point of justice, the ordinance of 1666 and that of 1806 can be put in force, when the article 378 of the penal code subsists, and is later in date than these; or, lastly, whether it is well calculated to obtain any great political advantages. What I shall chiefly insist upon, is the flagitious immorality of the action required of professional men, and that, too, under pain of a penalty. As all political discussion is, and ought to be, interdicted within your walls, so our accord with the rules of a pure moraevery action and every word must strictly lity, if we hope to benefit either science or humanity, our fellow-citizens shameful outrage to the medical profession, to call upon us to reveal secrets as sacredly binding as any confessed to the minister of religion. Now a priest, if he ever abuses the confidence reposed in him, is for ever branded with infamy; and where is the difference between the duties of a priest and those of a physician? both have a public, official, and moral character to sustain, and without which the most imposing and useful attributes of their profession are often nullified. Both the one and the other are considered as "exceptional professions," in the article 378 of the penal code. By this article, medical men are received in the same light with the parents, brothers, and sisters of their patients; and thus it not only relieves them from all obligation of disclosing, but denounces punishment if they lose sight of those sacred ties which bind them to all such as are entrusted to their professional care. I, therefore, propose that a commission should be appointed, to examine into all the questions which may spring from, and are connected with, the above very important topic; and to decide whether the respect due to public morality, and the fulfilment of our duties towards our fellow-citizens, are compatible with the edict which has demanded so unworthy a compliance.-Journ. Hebdom.

our individual characters. Oh!