left home to go to work, and sent immediately for the parish surgeon, who arrived about seven o'clock, and administered an emetic, which not operating as he wished, he gave it another; this dose had the effect of evacuating the stomach, but, as I afterwards learnt upon inquiry, with scarcely any trace, by smell of the existence of opium. After leaving directions to keep the child moving, he left the house with the following observation:-" No man can save that child; and as you have got into it, so you must get out of it as well as you can."

I take particular notice of these words, without wishing to make an unkind observation concerning any practitioner, but only to show how readily patients are by some considered to be beyond relief; and, be it observed, in this case it was even after the operation of an emetic.

The friends, (for the mother was in too distracted a state of mind to render any assistance) moved the child about and shook it for two or three hours; but finding the stupor continue, they abandoned all hope, and laid it down upon its bed, as they thought, to die. The mother, whom I had formerly attended, insisted that I should be sent for, notwithstanding the resistance on the part of the friends, after the surgeon's remark; they accordingly sent for me, and I arrived not until after eleven o'clock, A. M. When I entered, I found the child, lying upon its bed, breathing stertorously, and the colour of the face changing to the livid. They told me it had been lying thus about half an hour. I caused it to be placed immediately in a warm bath, and to take alternately weak vinegar and water and strong coffee, at the same time bathing the head with cold water. All these means at first roused the child, and made it cry, but I found that their effect soon went off; the back and chest were then sprinkled with cold water which acted at first powerfully, but again the little patient relapsed into its former state of stupor; it was now taken out of the water and placed upon the knee of one of the attendants, and the sudden impression of the cold air upon the whole surface of the body at once was quite sufficient to rouse it; this effect, however, not continuing long, upon reimmersion in the warm bath it cried out, and showed clearly the efficacy of the alternate impressions. Having now satisfied my- ́ self of our power to rouse the child, I left the house with directions to continue this sort of treatment at intervals of an hour or two, e. g. using friction, dressing it, and giving it exercise, together with the warm bath two or three times in the day, if necessary, and continually to administer internally some of the fluids above mentioned. I saw this patient again in the afternoon; it was still drowsy, but better. I desired the friends to continue the treatment, and bring the child to me in the evening, which they did, perfectly

recovered.

Observe, this practice should be continued, according to circumstances, from three to twelve hours. (See "Christison's Medical Jurisprudence.") The patient should be also occasionally roused, even when he may be allowed to sleep, in order to be sure of his recovery.

CASE 2.-The other case is that of a female-she might be about 50 years of age, who having suffered domestic trouble took laudanum, with the intent to commit suicide, in the following manner:-Between seven and eight o'clock in the evening she went out and bought two-pennyworth (as she said) of laudanum, which, as soon as she was out of the shop, she swallowed; she then went to another shop and bought three-penny worth, which she made use of in the same way; she afterwards went to a third shop in the neighbourhood, and bought two-pennyworth more, but paused a few minutes before taking it, and conversed with some acquaintance whom she accidentally met, but as soon as that person left her she took the remaining dose, and returned home, keeping what she had done a secret from her family. At length, however, her son perceiving something irregular in her manner, began to converse with her about herself, and finding him importunate, confessed that she had taken opium. He then went for medical assistance, but could not procure any until ten o'clock, when two medical attendants ar

rived, one soon after the other, and tried the stomach-pump, but did not bring any thing away that at all satisfied them as to the presence of opium.

Finding ber now in a state of great stupor, two persons were employed to shake her whilst sitting in her chair, but with little effect. One of these gentlemen came to me requesting my assistance. Although I attended immediately, I did not arrive until past 11, P. M., when I suggested that her feet should be put as soon as possible into hot water, and the head, neck, and chest bathed alternately with hot and cold water, while acidulous fluids, ammonia, &c. should be given internally. When I found that these means were losing their influence, I directed that the feet should be placed in cold water: this, as might be expected, produced a sudden and powerful effect; but it should be particularly observed that the feet should not be allowed to remain above a few seconds at a time in the cold, for the reasons mentioned above, in speaking of the warm bath; they were consequently soon replaced in the bucket containing the warm water. After persevering in this plan for rather more than two hours, the patient recovered so far as to converse a little; I then directed that she should be wiped dry and rubbed, still continuing the fluids internally, and that if she was found to relapse at all, to bathe her again; but in a short time she was so far cognisant, as to insist upon being placed by the fire, and soon after went to bed. I may add, that, perhaps a little is due to the fact that some of the fluids given internally with a large spoon, having accidentally gone the wrong way, made her cough.

I trust these two cases are sufficiently illustrative of the power which we gain by such a plan of treatment; and of the utility of making it public, since in the first the practitioner had no hope, and in the second one of the medical attendants thought proper to call in further assistance. I may also mention (to show how even well-informed persons may lose sight of the principle here inculcated) that the other medical man attending this last case, exclaimed, when he saw what I was doing, "That is Christison's plan, is it not?" Besides, I would observe, that although occasional rousing by physical force or shaking may be useful, it requires great exertion on the part of the attendants, who may be difficult to procure; and it is also very fatiguing and painful to the patient, and if not continued most unremittingly, it is, I am inclined to think, apt to confirm the stupor rather than relieve it.

On the treatment of croup by large doses of tartar emetic.-By Charles Wilson, M. D. Kelso.'-I have now treated in all twelve cases of croup in children with high doses of tartrate of antimony on the contra-stimulant plan, and of these, two only have died. In one of the fatal cases there had been distinct and severe croupy symptoms two days before I had any opportunity of exhibiting the medicine, yet its use was followed by a striking relief of these symptoms. Within the first seven days of treatment, the patient, a boy of four and a half years of age, took thirty-six grains of the tartrate, in doses which averaged half a grain, given at first every hour, and afterwards every two hours. The cough and respiration improved from the beginning, and at the close of the fifth day of treatment resembled what is heard in ordinary catarrh. The voice improved on the sixth day, and at the close of the eighth day of treatment it was heard distinctly, though previously little more than a feeble whisper. The medicine frequently caused vomiting, but no catharsis; the bowels, on the contrary, requiring to be regulated by enemata. On the eleventh day there was a relapse, and on the twelfth day the cough was again croupy, and the inspirations sonorous. hesitated, and I believe improperly, in again employing the antimony; and the patient died on the fifteenth day after I had first seen him, and the seventeenth from the commencement of the disease. In the other case the patient died on the fourth day of the treatment, the antimony, however, having

1 Border Med. Society, 1839, and British and For. Med. Rev. April, 1840.

I

never been properly administered, nor my directions in other respects implicitly followed. With respect to the successful cases, I may observe, that I certainly met, for the most part, with little tolerance of the remedy in as far as the stomach was concerned, vomiting having been freely produced in nearly all; but there was no troublesome catharsis, and, even in one instance where there was a tendency to diarrhea previously to the exhibition of the antimony, this ceased on the second day of the treatment, and it became necessary to have recourse to mild laxatives. Indeed, not a single case occurred, during some part of the treatment of which it was not requisite to exhibit castor oil, infus. sennæ, or some other remedy to act upon the bowels. The treatment was generally commenced with the application of leeches to the larynx, which were followed by warm poultices, frequently renewed; and, simultaneously with the leeches, the tartar-emetic was begun in doses of one fourth or one third of a grain, generally at first every hour till a decided impression was made, and afterwards every two hours till the patient was considered in safety; care being taken that its use was not intermitted at too early a period for the certainty of the cure. The remedy was usually exhibited in a mixture with a little mucilage, prepared with warm water to ensure its solution; and occasionally, with the older children, half a minim or a minim of T. Opii was joined to each dose, which seemed to have a marked effect in ensuring tolerance of the medicine, without diminishing its sanatory effects. The largest quantity given in any of the successful cases was sixteen grains, and in this case the tolerance was complete after the first two doses. In one of the cases the antimony, at a certain period, was combined with calomel, of which upwards of a drachm was exhibited. A blister was generally applied to the top of the sternum towards the close of the treatment, in order to obviate the risk of a relapse.

I am well aware that the tart. of antimony has been employed by numberless practitioners in croup, and that Cheyne among the rest has prescribed it in considerable and frequently repeated doses; but I am not aware that any one has exhibited it in precisely the same way or with the same aims as myself,or that they have sought from it any thing beyond its ordinary well-ascertained action as an emetic. I have thus had no guide to direct me in the use of the remedy, an advantage which I probably might have possessed had my acquaintance with medical literature been more extensive; and, of course, I do not pretend that the limited experience which I have had of it has established its value beyond dispute. Having formed my diagnosis, however, with what care I could, and having treated my cases at periods when I heard of others attended with fatal consequences occurring in the vicinity, and my success in the treatment having been far greater than any I had hitherto attained with other methods, I considered myself justified in laying these details before you, and in recommending the remedy to your attention.

On the relative frequency of Hernia at different ages.-M. Malgaigne has communicated to the Royal Academy the following details of his inquiries upon this subject. They are drawn from three series of observations, collected at the central bureau of hospitals at Paris during the close of 1835, and during the two succeeding years.

The first series embraces 410 cases which were noticed in persons who applied at the central bureau for trusses. Of this number 335 were males, and 75 were females.

The second series exhibits a total of 2,767 cases ;-of which 2,203 occurred in males, and 564 in females.

The third series comprises 2,373 cases ;-1,884 of which occurred in males, and 489 in females.

London Medico-Chirurgical Review, April, 1840, p. 529.

From these data we may reasonably conclude that ruptures are four times as frequent in the one sex as in the other.

Now with respect to the influence of age as a predisposing cause of hernia. Among infants under twelve months of age herniæ are more frequent than during the second year of life. During the following three years the tendency becomes strikingly less and less.

In considering the period of life between five and twelve years of age, it would seem that hernia is of more frequent occurrence during the latter than during the former half of this time. Hence we may infer that there is a recrudescence, at about the ninth year or so. This recrudescence or increase of predisposition, is still more marked during the next eight years-between thirteen and twenty. It is however to be particularly noticed that the increase bears exclusively on the male sex.

From the 20th to the 28th year, the number of herniary patients very sensibly increases, whether we take them in the mass, or distinguish them according to their sex.

Among men there is an increase of at least one fourth ; and among women the increase is nearly one half. The rapid increase among males from the 13th to the 20th year of life may be attributed in part at least, to the laborious Occupations in which they are engaged. The same cause operates no doubt during the next eight years on both sexes; to which is now to be added the influence of marriage, and also of pregnancy.

From the 28th to the 29th year of life there is a notable augmentation in the disposition to herniæ-stronger indeed among women than among men; and indicative of some secret influence acting on the constitution, which becomes more decided in after life.

The decennial epoch from 30 to 40 years of age may be divided into two halves, during the first of which the tendency to ruptures seems to remain nearly stationary, and during the second becomes considerably and suddenly greater-the average number for the series of the year 1836, being 29 in the first five years and 58 in the next five; and for the series of the year 1837, 26 for the first five years and 46 for the next five; thus showing an increase of nearly a double.

During the next decenniad, from the 40th to the 50th year, the average decreases ;-viz. from 58 to 54 for the series of cases for 1836, and from 46 to 42 for that of the following year. But here there is a marked difference in the relative frequency of herniæ according to the sexes. In the earlier years of life, the proportion of females affected with rupture was, as we have stated above, not more than a fourth of the number of males; but about the age of forty, this proportion rises considerably, some new cause of predisposition seeming to be operative about this period of life.

If, for example, we take the two preceding periods-from 30 to 35 years, and from 35 to 40 years-the proportion was found to be thus:

54 females and 231 males,

100 females and 418 males,

-the proportion being in either case short of a fourth. But during the next ten years, from 40 to 50 years, the number of women affected with herniæ was 242, while that of men was 722-giving a proportion of one third.

From 50 to 60 years of age, the general number of herniary patients increases, and the annual average becomes again equal to, or even above, what it was from the 35th to the 40th year. Moreover, the relation between the two sexes re-appears very nearly as during this latter period of life. From this we may infer that there is an increase of herniæ among men, and a decrease among women, during the period between the 40th and 50th year.'

There is surely a mistake here; as we have been told in the preceding paragraph that there is a very marked increase of the complaint among women during the fifth decenniad of life. The decrease takes place in the next decenniad-viz. from the 50th to the 60th year, and not from the 40th to the 50th year.—(Rev.)

During the seventh decenniad-from the 60th to the 70th year-the general number decreases, and as that of women seems to remain about the same, the proportion re-becomes nearly one third.

During the next decenniad, the number of hernia in men was found to have decreased by not quite a half, while in women it had fallen by at least two thirds. This difference seems to indicate, that at this epoch of life the mortality, which is evidently higher in herniary than in other persons, would be still greater from this cause in women than in men. If we follow the decrease of the herniary population, year after year, we no longer observe at this period-the eighth decenniad-as we had observed in the preceding ones, new cases of the disease to fill up the blanks caused by death. Thus, in the total of 3,140 cases comprised in the two series, we find 48 in individuals of seventy years of age, only 22 of seventy-five years, six of eighty, five of eighty-one, three of eighty-two, and one of eighty-three years.

M. Malgaigne has lastly endeavoured to ascertain the proportional number of herniary persons to the entire population of France. According to his inquiries, there are about two in every 41 of the inhabitants. He has also tried to determine the relative frequency of the complaint in the different provinces; but his data on this topic are still very imperfect.

Observations on diffuse inflammation.-By Henry Kennedy, M. B.This is an elaborate essay on a very important subject. We regret that we have only room for the conclusions which Dr. Kennedy considers as warranted by the investigation entered upon by him. They are as follow:

1. That diffuse inflammation will not attack a person in perfect health. 2. That the bad state of health preceding diffuse inflammation is powerfully caused by anxiety of mind, by great bodily fatigue, by shocks of the nervous system, by improper diet, or by any thing which has a tendency to lower the general healthy tone of the system.

3. That this deranged state of the health is shown principally in a vitiated state of the bowels.

4. That when once this unhealthy condition is established, the slightest cause is capable of inducing diffuse inflammation.

5. That venous inflammation does not necessarily cause diffuse inflammation.

6. That venesection may cause diffuse inflammation, the vein, however, remaining healthy.

7. That when venous inflammation does exist, the fever which accompanies it is more likely to be of the typhoid type than when diffuse inflammation exists alone.

8. That diffuse inflammation may attack several parts of the body in rapid succession, or it may be confined to one part, as the hip, or one organ, as the lung.

9. That pus may be poured out into the joints, serous cavities, or cellular structure without any appearance of surrounding inflammation.

10. That, at the very onset of the attack, the free application of the actual cautery holds out a fair probability of checking the disease; but, when once formed, free and deep incisions are the only treatment on which any reliance can be placed.

'Dublin Journal, Jan. 1840, and British and For. Med. Rev. April, 1840.