days, and spontaneously subsided; that about the same time. or immediately subsequent to it, his feet and legs, and abdomen commenced swelling, and continued to do so until the the time of his admission into the hospital.

Condition when admitted.-Head, normal. Thorax-respiration natural. Resonant throughout, save great dullness upon percussion, over a space covering the præcordial region proper, extending from the second to the seventh intercostal space, and about six inches in width. Heart, was found beating with considerable force, the impulsion being felt at the third intercostal space, above the nipple, instead of, as usual, at the cartilage of the fifth rib; no morbid sound could be detected by auscultation; pulse about ninety and very feeble. Abdomen, greatly distended by serous effusion; fluctuations very plain, appetite not good, digestion feeble, bowels loose, having four or five watery evacuations in twenty-four hours; urine in natural quantity; could not ascertain the condition of the liver and spleen. Lower extremities œdematous.

Diagnosis.-Contraction of the ventriculo-aortic semi-lunar valves, probably by the deposit of lymph at the time of the acute pain complained of, when metastasis took place. Probably hydropericardium.

Ascites and oedema of the lower extremities, dependant upon the obstructed circulation. From the diarrhoea we thought that absorption of the effused fluid had commenced, and was being thrown off by the bowels. Elaterium gr. ss., every two hours-farinaceous diet.

The treatment was continued four or five days, with the effect of producing almost a constant thin, watery discharge from the bowels, with an obvious diminution in the size of the abdomen and lower extremities, and without much loss of strength. In consequence of some irritation of the stomach

and bowels, the use of the medicine was suspended thirtysix hours. It was then re-commenced and continued until the 26th, with the same effects; when the ascites and oedema were almost entirely gone, and the dull præcordial space was not so large. The use of the medicine was again suspended, but the discharges from the bowels continued, and when he was transferred with the other patients on the 1st of September, there was scarcely a relic of the ascites and œdema; strength improving; free from pain, and in a fair way for at least a temporary recovery. From the active pulsation of the heart and the feeble pulse still continuing, there probably exists the structural lesion of the aortic valves spoken of, which will render him liable to dropsy again.

CASE 5TH. NEURALGIA RELIEVED BY THE EXTRACTION OF a TOOTH.-In the American Journal of Medical Sciences, for August, 1840, p. 509, Mr. G. B. Fundenberg, Dentist at Pittsburg, makes some observations on facial neuralgia, in which he asserts with most apparent confidence, that at least two thirds of the cases of this affection "are caused by pressure or other local irritation of the nerve." In support of his positon he gives three cases. In the first-a case of fourteen years standing, the anterior maxillary foramen, the point at which the patient had complained of most pain, was nearly closed; most probably by an osseous deposit, consequent upon the formation of an alveolar abscess contiguous to it. The foramen was exposed by an incision and drilled out, by which the nerve was freed from pressure, and the patient entirely relieved from his painful malady. In the second, a well marked case, the suspicion arose that it proceeded from some affection of the teeth; and upon tapping a superior bicuspis the patient screamed out with pain. An immediate cure was

effected by extracting the tooth, on the end of the fang of which was found" a large exostosis." In the third-a case of two years standing, in which the patient had complained of "a singular pain in the side of the head, accompanied by a darting pain in the lower jaw," and which gradually extended down the neck and side, a similar effect as in the second case was produced by tapping an inferior cuspidatusthe tooth was extracted-"a large osseous deposit was found on the fang "-and the patient was relieved.

We are by no means prepared to assent to this opinion of Mr. F.-that two thirds of the cases of facial neuralgia proceed from the causes above mentioned; nor are we disposed to controvert his position; for it is very difficult, in a disease the cause of which has been admitted by all writers on the subject to be so obscure, to fix any proportion of the kind. It will certainly require much additional evidence to establish the truth of his position. Doubtless however, he is correct in as far as he supposes some cases to be attributable to such cause; aud we can give a case which we consider in point.

In the early part of July last, before the number of the Journal containing Mr. F.'s article was published, we were called to see Sidney, a negro girl, belonging to a gentleman of this city, who had been suffering a day or two with a severe "pain in her face." She is about 20 years old, stout, and has been always healthy, save that recently she has suffered with some slight catamenial derangement. At the time we were called to see her, there was no derangement of her general health, and she complained only of pain in the left side of her face, which was most severe about the articulation of the jaw, and extended anteriorly to the angle of the mouth, and nearly to the nose-above, a short distance

upon the side of the head, and below, upon the neck as far back as the edge of the trapezius muscle, and nearly down to the point of the shoulder. It was paroxysmal in its character-was much the most severe at night-and unattended by any febrile excitement, tumefaction, heat, &c., showing it to be clearly a case of neuralgia, and not of rheumatism. A purgative had been given before we saw her, and we directed strong counter-irritation by means of a small blister by the concentrated spts. ammon. over the root of the facial nerve; and 10 drops of the acet. tinct. of opium, to be repeated as might be necessary.

This treatment was continued for several days, and the severity of the paroxysms was somewhat mitigated by the repetition of the circumscribed blister, which was generally drawn in two or three minutes; but no material improvement was effected, and she was directed to rub the face frequently and freely with veratria ointment, containing fifteen grains to two drachms of lard. Several days elapsed with no relief, save the temporary mitigation of pain by the blister; and a pill containing the twelfth of a grain of veratria was directed to be taken every four hours, together with a continuation of the ointment, &c. This treatment was kept up until the twelfth or fourteenth day of the attack, without any additional amendment, when upon examining her mouth we found several decayed teeth in both the upper and lower jaw of the affected side. Thinking that possibly the condition of the teeth might have caused some irritation of the second or third branch of the fifth pair of nerves, which could be transmitted to the portio dura by the free and anastamosis existing between them, and thus have produced the neuralgia, we sent her to a dentist, who found that some pain was produced in several of the decayed teeth by tapping on them,

same means.

and severe pain in the first molar of the upper jaw by the He extracted the tooth, and found at the extremity of its root a sac about the size of a pea, which had been filled with pus, but was ruptured by the operation. The root itself was carious; so also were several fangs that were extracted. Some soreness remained for several days, but about six weeks have elapsed, and she has had no return of the neuralgia.

September 10th, 1840.

ART. II.-Stramonium in Dysmenorrhea. By Dr. T. J. CoGLEY, of Mount Vernon, Ohio.

MRS. S., æt. seventeen years, commenced menstruating at fourteen. Had not the slightest difficulty during the first three periods, but during the fourth period she was exposed to cold, and the discharge was checked. From this time she was much afflicted with dysmenorrhea at each period; but married soon after she was fifteen. This event seemed to augment the disease very much, and violent hysteria soon supervened, before each menstrual period. Every few months she had an attack of hysterical convulsions, and when she had no convulsions, experienced extreme difficulty in menstruating. She did not come under my notice until the 12th of May, 1840, when I found her laboring under all the distressing symptoms of dysmenorrhoea. I prescribed camphor in 10 gr. doses every hour, for three hours, without the least mitigation of the pain, which was excruciatingly severe. I next resorted to sulphate of morphia, the warm bath and venesec