density of the urine, whether with or without an increase in its quantity, the diminution and disappearance of albumen are favourable signs. But this will, on the contrary, rather indicate a gradual advancement of the disease, if the density of the urine should at the same time slowly decrease, especially where its quantity remains stationary. Diminution of the albumen, with increased quantity and diminished density, cannot be relied on as a prognostic on either side." On the whole, the patient's danger would appear to be in proportion to the lowness of the density of the urine, unless the quantity of daily discharge is considerably above the standard.

Respecting the treatment of the disease in the acute stage, authors are highly unanimous. Antiphlogistic remedies of active character are recommended by all,-and, of course, the most important of these, blood-letting, "When there is no contra-indicating circumstance from age or constitutional infirmity, whether original or acquired, the extent to which bleeding is carried should," according to Dr. Christison, "be regulated, as to extent and repetition, by the same rules which govern its employment in ordinary inflammations." This writer gives a hint of no mean utility, in enjoining careful examination of the blood drawn, more especially in respect of its colouring matter; by the proportion of the latter, he conceives, the degree of advancement of the structural changes in the kidneys may generally be ascertained; and if it should appear from the low proportion of colouring matter that the disease is not in its early, but in some one of its more advanced stages, and hence the acute symptoms are not strictly primary, depletory measures should be pursued with much greater caution than under the contrary circumstances. The invariable accuracy of this mode of ascertaining the amount of progress of the disease may be doubted. Local abstraction of blood by cupping or leeching the renal regions, and the application of large linseed-meal poultices, are recommended by Drs. Bright, Barlow, and Rayer. The warm bath-if used beside the patient's bed-is advised by the same practitioners.

The restoration and maintenance of the cutaneous perspiration is one of the most important points to be attended to in the treatment of this affection, according to the testimony of the majority of those who have written upon it. Hence the value of keeping the patient in an equable and tolerably elevated temperature: so important is this, that we find Dr. Bright, who confines his patients closely to bed during the entire duration even of a protracted treatment, ascribing increase of anasarca to the passage of the cool air allowed to circulate through the wards over the bed clothes of the patients. The use of flannel clothing is indispensable. Diaphoretics are advised in this stage by the majority of writers, and after the employment of more active remedies are probably useful; but the best diaphoretic treatment is here, as in inflammatory affections generally, the antiphlogistic. Dr. Osborne's views respecting the administration of medicines of the class just referred to, have been too long before the profession to require discussion at our hands.

The notions of Dr. Barlow on this point, though briefly alluded to in one of Dr. Bright's early papers, having for the first time been fully explained in the last number of the Hospital Reports, may be here more fully alluded to. This physician, he informs us, struck with the slowness of recovery of patients treated by the ordinary plan of bleeding, &c., was induced to seek for some more effectual method of removing the disorder. Persuaded of the inflammatory nature of the complaint, he determined upon a trial of tartarised antimony; and the results have, he assures us, as usually happens with the devisers of novelties in therapeutics, fully answered his expectations;-and several cases, which at least prove that recovery will take place under the use of this medicine, are related. Some of these are valuable in a pathological point of view, as further contributing to prove the identity of the renal disease occurring after scarlatina with the affection described by Dr. Bright, and as exhibiting the tractableness of the complaint when really

occurring with the character of an acute disorder in adults. But the reader must not imagine that Dr. Barlow confines himself to the exhibition of tartarised antimony in diaphoretic doses,-this appears a mere adjunct in the treatment, and the precise share of the sum of benefit obtained which is to be attributed to it cannot very easily be established. Dr. Barlow "would not merely recommend tartar emetic in the acute form of this disease on account of its diaphoretic properties, but on account of its power of lowering the heart's action, as well as its local effects upon the capillaries when it reaches them through the circulation." If the pulse be hard and full, the medicine may be given in nauseating doses,-if not, smaller doses are sufficient. Whatever share of converts Dr. Barlow shall eventually make to the propriety of his modification of the diaphoretic mode of treatment, it is certain that the latter is far from being held in general estimation. Rayer, whose expectations of benefit from its employment have been "rarely realised," has found that the effects of even the most powerful agent for producing perspiration-the simple or medicated vapour bath-have rarely been maintained beyond a few hours after each bath. Dr. Christison observes: "I have often resorted to the diaphoretic plan, sometimes with evident advantage, much more generally without success; and I must likewise add, that I have several times seen general perspiration, both spontaneous and from the use of diaphoretics, fail to produce any material relief." Yet, singularly enough, we are told in the next sentence "that no one can question the general propriety of the diaphoretic method of cure."

The advisability of diuretic medication in this complaint is likewise matter of dispute. Dr. Osborne thinks that, so far from being useful, it may actually produce the disease; Dr. Bright has little confidence in it; Dr. Christison, on the other hand, "has very seldom witnessed decided diminution of the dropsy unless where diuretics [diuresis] or purging was either artificially induced at the same time or arose spontaneously." This practitioner has particular confidence in digitalis and cream of tartar.

We should have felt desirous of examining briefly the peculiarities of treatment required in respect of the diseases termed secondary in this affection, but we find we have exhausted our space.

M. Rayer's volume terminates with an historical sketch, occupying one hundred pages, of the rise and progress of knowledge respecting the remarkable disease which has been under consideration,-or, we should rather say, respecting its detached phenomena. In this most erudite dissertation, the laborious author traces the germ of our acquaintance with the subject in the very earliest writers: first, in regard of the connection of dropsy and disease of the kidneys; secondly, of dropsy and coagulability of the urine. Nothing can be rendered more clear from this survey of the contributions of our progenitors than the great merit of Dr. Bright, and that this principally consists in his having detected the connection between these three conditions.

BIBLIOGRAPHICAL NOTICE.

Edwards's Outlines of Anatomy and Physiology.'

The value which we have placed on this preliminary treatise to his work on Natural History by Dr. Edwards, is shown by the circumstance that we have urged upon more than one person to translate it into English; and an English version by one of our learned physicians was actually advertised in the Philadelphia prints. It is a valuable compendium for the tyro and for the general reader, and is elucidated by numerous woodcuts. The translator appears to have executed his office well.

Outlines of Anatomy and Physiology, translated from the French of H. Milne Edwards, Doctor of Medicine, Professor of Natural History at the Royal College of Henry IV. &c. By J. F. Lane, M. D. 8vo, pp. 312. Boston, 1841.

Jefferson Medical College.-Catalogue of Graduates, Session 1840-41.

W. Brook Jones, Wash., D. C. Rheumatism.

The honorary degree of Doctor of Medicine was conferred on Dr. SAMUEL ANDERSON,

ART. I.-ON THE THERAPEUTICAL PROPERTIES OF THE PHYTOLACCA DECANDRA.

BY ALFRED T. KING, M. D.

The study of natural history, particularly botany, having been for some years the occupation of my leisure moments, my attention has therefore been naturally directed towards the investigation of the medicinal properties of some of our indigenous plants. The following observations are the result of some experiments made since the year 1837, in order to determine the therapeutical properties of the phytolacca decandra. This is an indigenous, dicotyledonous plant, found growing in vast quantities in every part of the United States, from Canada to Georgia, and from the Atlantic to the Pacific ocean. It flourishes along road sides, in newly cleared fields, and near the borders of woods. Although the phytolacca is peculiar to our own land, yet it is said to grow luxuriantly in the north of Europe, and in the south of Africa, where, however, it is supposed to have been introduced from this country.

Agreeably to the Linnæan arrangement, this plant belongs to the class decandria, order decagynia. It has a large perennial root, from five to six inches in diameter, very branched, covered with a brownish cuticle, but whitish, fleshy, and fibrous within. The root ought to be gathered, for medicinal purposes, late in the autumn, or early in the spring ere its vernal shoots begin to expand. Its annual stems often attain an immense height, even twelve or fourteen feet, when growing in a rich and genial soil. The stems are very branched, and the branches assume a reddish hue towards the middle of July. It is at this period that the leaves contain the greatest amount of medicinal activity, and should then be gathered, and carefully dried in the shade. The leaves are oblong, ovate, acute at each end, alternate, and petiolate. Flowers are in simple racemes, small, with ten stamens and ten styles. The corolla consists of five ovate, concave, and inflexed petals, white. This plant belongs to the natural order phytolacca, the medicinal properties of which, according to Lindley, are emetic, cathartic, and anti-rheumatic. Every part of the plant appears to be active, the root, the leaves, and the berries. The root, however, it is generally supposed, possesses the greatest amount of medicinal activity, but I have usually preferred the leaves, if I can obtain them fresh-for they lose much of their virtues by drying-at the period when their stalks are assuming a reddish hue. Speaking of this plant, Professor Lindley makes the following remarks: "A tincture of the ripe berries of phytolacca decandra seems to

have acquired a well-founded reputation as a remedy for chronic and syphilitic rheumatism; and for allaying syphiloid pains. By some it is said to be more valuable than guaiacum. Its pulverised root is an emetic. And a spirit distilled from the berries is stated to have killed a dog in a few minutes by its violent emetic effects." According to Decandolle, this plant is also a violent purgative. The young shoots in this country are frequently eaten as asparagus. In the form of an unguent, prepared from an extract of the root, I have found it more efficacious in obstinate cutaneous affections than any other remedy except the sanguinaria canadensis. But in hemorrhoids its effects have been, according to my experience, the most remarkable and striking. Indeed, over this disease it appears to have a peculiar and specific action.

The term hemorrhoids comprehends various tumours which grow from the verge of the anus, and whose constitution and characters differ so widely that surgeons usually divide them into three distinct varieties or species, viz. internal, external, and venous hemorrhoids. The two former varieties admit of radical cure by excision, but in the treatment of the latter our best surgeons rely upon palliatives only; neither puncture, which has been advised, nor excision, either by the ligature or the knife, is at present deemed expedient. Professor Syme, in reference to the treatment of venous hemorrhoids, says: "The tendency of the venous tissue to resist irritation forbids any operation, and excision, as well as puncture, which have been recommended, should both be carefully avoided, lest they excite inflammation of the enlarged vessels, and give it the unmanageable character which distinguishes it when of traumatic origin." As this variety depends upon a varicose enlargement of the hemorrhoidal veins, they are liable to the same kind of sub-acute inflammation to which the varicose vena saphena is subject; and this inflammation may go on to suppuration, and thus lay the foundation for fistula in ano. To be able to obviate so deplorable a state of things has long been considered a desideratum, and I think that he who will examine unprejudicedly and impartially the virtues of the phytolacca decandra, will be satisfied that we possess in it all that we could desire. But, in order to demonstrate its effects in this painful disease, I will give a brief extract of a few cases from my note-book:

CASE 1.-Saw B. H. in the summer of 1837, while labouring under a severe attack of hemorrhoids. He told me that he had suffered, with occasional intervals of immunity, for near five years. The tumours often bled, which always gave him temporary relief. Had used all the ordinary remedies in vain. The bowels having been opened by an aperient, I determined to try the effects of phytolacca decandra; accordingly, I procured a handful of the green leaves, had a strong infusion made by pouring a pint of boiling water upon them and allowing the whole to stand one hour near a warm fire, and directed him to take one tablespoonful every two hours, to keep himself quiet, and as much as possible in a recumbent posture. He followed my directions strictly, and was rewarded, in less than a week, with a perfect and permanent cure.

CASE 2.-Mrs. N., aged about 37, had suffered much agonising pain for six or seven years. The tumours never appeared externally except by an expulsive effort, when they were protruded and always bled. Took the infusion as above directed, and was perfectly cured. A short time afterwards she moved into Ohio, and I have not heard from her since. Presume, however, I would have heard from her if she had had a return of the disease.

CASE 3.-Sheriff of this county had been afflicted for twenty years with hemorrhoids. Was relieved by the phytolacca, but died a short time afterwards of phthisis pulmonalis.