300 DR. GRIFFIN on Treatment as a Test

A R t . XIII.--On+7~eatment as a Test of certc~n P a t h o l b ~ ConditiOns. ByDAN:t~r~ +GRIFFIn, M.D. , M. R. I.A., Llckfi~ + tlate of the King and Queen's Cotlege of Physlelan~'~ Ireland,. an'~ !one OF the Physicians_ to the Count'y o~ Limerick Infifma'ry, &c,

L

~r~$E~vl~ the.practice- of testing the. e~iste~me and ,hair,re "of p~dog ica l coalitions by the. e~eot of,tree,teen* upon.r ~. of~ extensive r in the professiQn, though,no~onnr s~-fa~;as Iarn.~aware, leas. made it the subject of.a pro'fouler ess~y~,~ ventured to give -to it that. developrnent, whi~h-,I thii~k: ira ,irn~ portanee so well deser~ves. I am satisfied. ~ereis,-no mmi,os expe~'ienee.,who has. no~ been obliged, on many Qecasions~::t~ resort to its guidance, and some of the most skilful~and jadi., eious .haye referred to it as nffording the only solut~m.of ~heit~ difficulties in eirenmstances ofmn of a serious and;a-ldrmi~ character, Medical writers do indeed very genemllyat~emp~r ~. draw a distinction between the symptoms presented b T di~;, f~r~n~ pathological states...which resemble, each,.- otherT.~ bdb wherever this attempt is made,: it will be. obserT~d.'bkat, sue~ ~listinction$ are .entirely too fine-drawaa,!br,$raefi~,~ the, diffea'd e .n~ are. :~o ,dight, ~nd. :anes~tiMr that,~ns,a~,ba~is~fo~ ~reat;; ~ent,~ n~;Confid0ot r~li~ne~,ean l~,pla~.~d: upo~.Jd~em,~, ~da~ t~.~t~ke ~aq~ii-~l~,tatlce,,~,~e L a ~ g s ~ P~a~&er~',ia~,h~ ,er, eeltent t~. ~ e . ~..,~ T b e . f 3 ~ c h : m.ns M o r b ~ d ~ e ~ af~e~ ~tatm~" t~e~. da$cr gives a a eable~ fro~lolIy~hibi t ingo the. d'~refi~e~ i~ the. sym,~toms presented by. nn~voas, an&in,~ flammatozy affections of the stomach,,of, whmh i~:may be said.,: dent, ~hite the distirteti~ns are nee by. ~ y memas-,s~rongly.: marked, nor,perhaps alwayswell-founded in-n~uxe,-they are: m many instances entirely,overthrown by,se~reral exceptional, notes .which Mr, Parker,, has~ pla~ed, as tim .rest~tt of his .own e~penence, at the foot of each page, showin~ that so far from being we)l.n~arkod, or generallj, admi$tedr they,formed ma~ter fo.r disagroe~r ~ e n bexw.e~rt tw~o p~thologists, os w,,~o:had~ ~ade ~h~m, ,th~ slabjeet~ef thei~ p~tleulnr study., ,/_~.~. dge~ 1~. ~arker./ad4rdtl~.ihi~s tJtdes ther..:o~ fnv',ih~: ~.y~b, y, T.h~ ~r~gto~slpf v~soular ~a~l nerr oF iha s~ma.ch ar~, sqoaethr~r a0! 0imilat that~he~-mgst~er~erieaeed~ praet~tmner ~. dis~asos 6f, thi~ kin~S~ocvasiona~ty~,~t a loss ,to. decide upon sheir pFer162 p$thol~g~e~l, eharaot~r,,~., 5. a~ende&. ~patient for two years ~w~th ~,ll~:bb, c~$~r~pto~of ,cbxonle gas,

* Page 73. b Page 76.

of..Pq$1~ological Comti~ions., 301

tritis, which were accompanied by progressive emaciation. T ~ Pe~.uli~ri,ty .Qf, the ~ r ,pains whie.h~r~rfl p~a~qn- ~ly'f~lt" ~ th~ eF, i~t~i~ ~a~c~ t~e ~l~an' state qf,~t~.l~' t4)ngue,

~)~,~r of hii mghts led to the admin~tr~ion Of. opi~ates ~n ih~e even~m,~,= after thee0 . . . . . . disease had eonfia~.~ed for eighteen months, when he was l~eeome much emaemted. From this time the,signs_ of gastric disease .began tO ffeeline~; and' at ,the earl:of so~ne months, after having eontiriued the epigtes tot the whole time, the patient had gained m~ch st~engthi and was actually ,become fat.-,This,,then~'was ~evi '~ dnnt~y: ~.:disease of sensibility presentiagal| t he ~yn~p~alas of kooh,ronio inflan~atorysmte,, J . ~ ,.,~ .; L. IThese "netwoila $tf feot~ nm3r:eonsisr~ -scmaedm~ ~in ~d:~ar.ige~dn'~(0tO~lfiS~ )'~ air

t ~ kiflAmimmo,a~kffeeti~/tth'la ~ ~ o ~ , tt~a~a~dht'-,a~e~," '

r ~tse~bl,~hylsegmi~:orqn~a~hm~a~ t~on? w ~h~h:tur~,'~61) hehd~d~ibu~ratl~e~,toud~M.~oi~,by a t~iitment~ framed : ~o:,st~ subh'~f~rm~ ~t~ydtseas~; ~ ~r/ee~it -is that. :we..very commonly, see: ~ioeab depletion i ~ -,the ep~gas- tr~urd, " and,aperient med,ioines injurious' to inafiy affections of the stomach, .which we shou,ld hard supposed, ~f?om the syrup-' ~ms ~ ,which they exhibit~l,, would ,have :been ~ benefited by such remedies. *I,t is beeause these symptoms depefad upon s~me oth~,eatme, ,.and.aot~uppn' ,hyl~eremia' ,, or inflammation[ that-theso:xenmdios,arecn~t,sutw.~esst:~l ~ maff yet~a~ ~s daffietdt;,

irtitatioiaa "J~f,'a% atdmi~k$~aiidvottCa~'~fl'ee~i~i~,0f~r tho.,re~lt~ogmm~ckni beingioeeasi~/udt.y~trr ~,ly/~uides." ' ~.~ ~-Qemtation~, r hik~ k-indJmi~ t ~ mtfl~tp)l ed qa~ b ~ m d the

ayae~ L~ear~ affard~aird~tdee#,~ad~b~sd~f~ll/u~hSSdetm: w~ant i~ith,ee~idaL t i , ~ t ~ e ,tliat~l~:ngbb#~ndik, ~elaeral ~ajh~oa to, ~tmn~ ~aylmtmqs~t~ddhrea~:d ~l~*tPa~Zher~foi%~dff

onL~ one ,mor~t~ie~ t~od~ 'Ea~", ~, j~ e~e~legf 'tirid" practical Report on the Epidefi~ik~ Dysbx~ery oF*h6 ~Nor~h' '6f ]~kland, which wa~ published ,in i~k4~ 'J-0urnat by'Dr.'Malcolm:, in the Number for August, 1853'~ tn:ihat Report it will be seen, that, w~hilo the necessity for tMs therapeutic' test is rationally'and strongly insisted on, ~,yet;,in =the.-attempt to tliscriminat-e the irritative 'and catarrhal-dysentery from that which is-purely

Page 299.

302 DR. GRIFFIN on Treatment as a Test

inflammatory, it is in some degree open to the remark I have made, in considering these cases generally, that the distinctions are, for the most part, too fine, for while any one or two of the distinctive symptoms may exist alone in any particular case, it is only the assemblage of a number of them that can form a basis on which we can rely with confidence in our treatment. Indeed, this admission is made in the observations with which it concludes, for a caution is very wisdly enforced against adopting measures of too decided a character, even when the probable existence of a certain pathological state is pretty clearly made out during the progress of the disease. I do not, however, by these or any other remarks, wish to deprecate any rational attempt at these distinctions; they are not only essential to the scientific treatment of disease, but they must precede every plan of treatment. Disease can only be treated properly by a reference to the conditions that are present, and these again can only be made out in the first instance from the symptoms. A dash into treatment, therefore, without the fullest consideration of them, would be the merest empiricism. I only mean to draw attention to the fact, that, from a singular law in the system, very opposite states will exhibit themselves in certain organs merely by an interruption or derangement of function, and, therefore, present the same symptom. This fact explains, why. the symptoms become, in many eases, such un- certain grades, and why the final appeal in such circumstances must be to the effect of treatment. -The passage in the Report is as fbllows :--

" I t appears that while a considerable variety of forms ob- tained in this epidemic, the prevailing one was decidedly the inflammatory. This is, we think, deducible, not merely from the opinions of the reporters, but also from the comparatively superior efficacy of the antiphlogistic plan of treatment ; hence the value of early discrimination of this form. It is quite true that the opium system, or a few doses of opium with mercm:y, or even a completely expectant mode of management, had ats quota of recoveries. Such facts show that dysentery may be merely catarrhal, or the result of purely accidental irritation ; but in a given case, should this plan fail, there cannot be a doubt that we should be prepared for meeting with prompti- tude a serious, and extensive inflammatory lesion--always,, of course, excepting those rare adynamic forms dependent, chaefly, upon the agency of an animal poison. Now, the nice point is, how are we to discriminate the presence of this inflammatory form sufficiently early ? In many cases, no doubt, there will be little difficulty--the pyrexia being marked, and the local

of Pathological Conditions. 303

symptoms prominent. But it is not always so: treacherous cases are not unfrequent which deceive even the most experi- enceck It is important, then, to have some resource to which we may have recourse in such a perplexity; and, fortunately~ we may rely in a great measure upon the effects of remedies. I f these be inefficient in cases seemingly of the mild forms, or give not satisfactory results within a very short period, let us at once look upon the case as one tending to present the higher grades of ~he inflammatory process, and act accordingly. Of course, while suggesting this counsel, we do not for a moment wish it to be understood that the antiphlogistie treatment is to be at once adopted in its entirety and purlty,--sueh would be irrational,--but merely that it is to form the guiding idea in our management, permitting &such modifications as the par- ticular circumstances of individual cases will always indicate. Besides this therapeutic test, we have every reason to believe that a closer examination of the patient than what is usually adopted may furnish sufficient data for early diagnosis of the existence of inflammation, more especially the examination of the abdomen by palpation, the changing of the tongue just at the lip and edges, the creeping up and alteration of force in the pulse, the temperature, the state, of the urine, and the ap-

p earance and persistence of tenacious and coloured discharge like pneumonic sputa)."

Perhaps one of" the reasons why this appeal to treatment is less insisted on as a principle in medical writings is, that such a mode of practice has on the face of it rather an empirical appearance. The trial of one mode of treatment~ because another has failed, must often appear but the merest experi- ment, and few people are willing to confess that their practice is often experimental; this, however, is not a correct idea of the practice. We try one mode of treatment, not, simply, be- cause another has failed, but because in 1Calling it revealed the existence of conditions, which, if we had been aware of their presence at the outset, would have rendered our treatment from the first what we are now making it. Another reason is this: some physicians are gifted naturally with a siiagular tact in discriminating the real conditions of disease ; -- i t is a faculty, indeed, of the highest value in practice,--one which all who possess it in any considerable degree feel a very excusable pride in exercising and exhibiting :--therefore, a mode of prac- tice which seems to ignore this fine faculty, and would be represented as appealing to experiment, as it were, in prefer- ence to it, can never be po]?ular. Nevertheless, it must be remembered, that the exercise of this talent is itself far from

,3,04 DR. G R : t ~ + a n ~ ' r e a h n a n t + a s a T e s t

be ing s s ~+r~ P~ ~ ' O u s ~ j ~e i v ~.~ e qr ,

cgn4iti?~g> ng#lu :i~ e+d.qw]ep, of'~l~]'.dh +*e+:~i~d befoi+e ~.6 p~+'.dy.~ ~y.~+~+pn.c.+ ,~ ',,a~++'.~,.,,.h.t'#i' F~r6 only re, r b.y t+h~ +r o f ' l , ~ . . } j r G v + ~ trr t.n ' . t l~[,, "+~)vcr St, ~ a[ue �9 . . - - , . , . . . . . ' . . . . , , , , , , . - + . . . ~ , } ~ , . , t , l . . . , . . . ~ . , . },+ ~r)ng,tpp#t+ p~.eF'"l ' ? ~ 9+~.tlig.s+ " ~.stc + s m + |uch -II our . . . . . ~ ? . ~ . . . . . ~ . ~ . . . ~ : , :'3' . , , . , ,

r~, - e " un IJ n , i o~ ' } t~,' kind im+e b - a .t+.?,~++,-p+ .p~. +,,.-~. <RF~: ,+..P .,.-. ~ , , ~ . . ~ ~ . . , + ~ . ~ U ~ f + ~ q ' + n. .++i . fd+q~+++;. , . r . ; . . . . .--: r f j , I~ <)t., ++++ . . . . . . . . . . . . . . . . :, . . . . . . . +.+ r+ iv.

a,p+gnmd+rab/e y;+nety - e taro+cter , [~ ~ ~[ sl}a c,-nhn ~te r+r +,~nt+paper ra ther to aa ~llt, g~4t,+~.u or the ~,ul... ,_.ct by ~i+Pe+,h ,+ +x- . . . . ~ , , , . , . . , , , �9 y f f ~ , ~AT+++ m + l e s selected ~i:~m dtlJv~emt t'la++es,.than Lv a +~.+re~amt)ke a+qT'perhaps t, edJ.o~,~ dpre~ .t. +, It,+ w+!Lb++, se~n t h a h p n c e ~ a m etr- cums tav$~s~+ .M b y ' t !q+e ~9, e~n b~faln r ~ j a b | e evt~enee ~he~ho r an e x ~ s U n + g } @ a ~ J ~ g r ~ ]+ acute or e.hron,r whet lmr ~i+t/ol a ~;~ m~ 6~&;s ++m ,~+P++~+;~++I,/,6 ,~+ +a~c t & b',J~tV' 0 < +,'6o.

, . ~ , . ,~ - -+ , : ~ . ' ,~ t ~ C + ( i , , , + r , + 1 ,

+ a W , ' + ~ ~f-~]nflamw,~+t+o~+ +~ an +intense+ eh r a e t e r - - w e �9 6+r . . . . . . . . . . . . "' .~. +'+~ , ' . . -~, ,,-',+,++ +~+. +,P_,+~+,.,+>,-++:+++,h ~ , + i+y,mptom~, qf ' ehconw mfl0,m, mat~nn <~epert+ up,:,n the aclffal~ li~.t,mt'e O i ' ~ a t +rate or: rqere rt ~ct ,:;n,~L,l,en:mKr,'m-'nt .~'+ w,. Is

, . , _ _ + ', . , . ..-+" . ~ ,~ f '~ , ; , aoveral ,,lh~.~r trnpL, r+;tOt t>z,+~q|tlSl,)np. 113 I:.e:ls,.,Dir~ t,,n (h , +ub- . - ' . ' ' , ' , - - ' . - . . l ' h . + - i t , [ : i _ ' ' ' I P '1 , l~ t , hot'~r 1t, c,.,t++td~ial.,le c,tt~ ~ ,+ }ec -.+-, r~,. 7~11 the - nts . + , . , . . . , _ . . . . . , , , . . . . . . . , ~ ' , t . , , L , Y , ~ ; . . . . . , ~ . - , 14+I. t i l e I L t & L o r v r ( ~ & C l l t ' t l $ ~ _ l l l U S [ t h e , W ~ l ~ h ~ l J O X . I C I I } ' + a ( l a I t l O

'~j+3,,+ 'dj++~+,~$(~-'~ ,' ~, ta:+~+d'i o g,'+i,iT~h'd P,o m~,,.+:"~ " : z r + I ~ t~l I , ' p . I ~ ' l l J | ' i ~ ' ' , . l l ~i i i t ' ' ' i ~ l ' , ," ' l i t ' i f . , l . + i i ' I ' + ..}+ ~r+,,1 tp, l$,pS (0,~, prooe r ptac~p to re~m'P~', ll+~t bV tire DnSt.

~'eatt}+eu .~ tn.egp ~u+b' t reatment ~hat may hht, e ex st,.+], )~" I+o mf+~i k .d i,'e'4uue"a't,';~ t, h ll --[ 'or it is an ;' ~6 ~rtat:,t Ih6t th at in ~,>me ~1 ' . ' , . t,,,, + ' 'I ... ', ~' t ", �9 ,'~ ", +d-m cure,_ : tances y. metetx', expect, ant,t, r e a L t , ~ e u t . Ill~.y' tse c{, ,.'t kerr" ' p~].~ia c'o~'har,x~:te,:a, r,:,~,~r,|L-,'t [,o exi ' : t ing di ,ca :e : '3.~, for i~l:txnci.'~, j~ casqs oftoh-:eure i ' ,diamm.ui.m a+,.~,:,L.;Jled"w;th'sx, v~ptoms or" ~dr~bili.tv, or wl~k'h ;m ,.'.\ample x~i I l.,e Ri~en; and some others

~ + ~ f ~ ; S ~ + L - G ~ m ~ + ~ + ~ / + + + c c o m , ~ , @ m + 4 " ~ o + o ~ ; ~ , , ~ - ~ , ~ : ' : ~ ? O : , ++ + , 4 ~ t t , + t s " ~ '+) + ' ' t ; : + ~ ' + " ~ '-' ~" ~+ f , + ,+ ~

. . . . . . . . + +~-~ 7~- '++ . ~ . J ( Gt++~+-+u:+ +~ �9 + % ' + . - ,,,~'~. +- *,,+ <+:+q - s - r , ' + �9 , ~.-+ , t~rlllTl rein P]~h%~V"pl~,-+'r~_,lJ,+/a~lt +] ' r O b d ' ~ t .

' ' , A ' . 1 ' ' �9 - i - ~ ~ , ~ : / - - �9 . . , - .

a ~ . ? ~ , ~ o t ~ l )g-e~.+..v,h ul+r d,-,e~ at ,t. ,.,,it@t, +,, a +ex'+fe. O:.,ild e.man+.tbe ~ e , ~ a,+d a,r-,,au.,:a,"r*, tit thia '~tatd c~t+~

' ~ K t 'J{& + 1 1 " I t " % ' I l l ' l | I , t L , I ,~'~- " " , i . " / - + �9

~ e m g ~ery mod-erate, Ire ffas t+.akeAo{Jr {8'~]iSvb. T~ .~G~j~N- m+r+l~+~+++~, ~+? , +~+++ia +` p~,# +h+ a+r wouta +: +t~#+~+r �9 �9 I . . , ~++ Z - ~ c - , ,

(~f P6'YWt~yt~dl Cor{~ibibh~:

~uls~130, and small ; mu '~. dy~pncea.; b,'eadfi n_r ir re,..,nl~/r~ ~bSU't �9 _r tn a t rhnule ; ~hum ,1 ",~les '.all , ~ the,. ,' 7.17esf, bt,t ~,r dt, I- ne.-.is ; expect,: ,ration almu~Mfl', lm't"di.~c61L artd '6f f r m h v rrltt,

_ , i 1

dus~ the di~cul~v" o1" b rda t~ i ' h~ '~ /h '~ ' a~ . r , i~ l t bd wlw,..n"th6 , ' t , , . l ' t , , l : ' ~ t t ' , t t l J , " : t l " , " " t ~ ' - �9 . '

,,_,r sv6.rll m~l~ed~. A c.onsdh'.s tJ,h'l'fi'~ ~d6'l',~ i~ ~ a laut4.r �9 , I ' J ' , , . ] ~ ~ 1' .~ i l l "J t " ' I , t " ' " ' I , t , t ,on m"hethe,' t~ie alttll.'t/ wa~ sfl~ a~'~ffk'+Ph~,d +~.-#meit :t elff+ffm a' ,~ ,t t.| lll'J '' "'1,1%1; -| It'l I 11" ~' ~ :" ' , " ' Io,'m, an'r ~,hat .de,#~,e of dr ',li~,~,~tl-i'e #a~l/}'9,,~01.

. ' . ' ' . , . ~ . I . ~ J ' t l l r - ~ t l J "s , , ".3 " , ' " ~ ' t l " I ~ , ' '

, ' ' . - - - - , .' ~,.,,.~ . , ' , l , l f I . [ q . 6 " , , 1, , I~ ' ' ". ~" . a ~d,~r ilaf'o6us I+od~ ot w~ucli it~+dgb.'l;l I'1~ l ~J&~'btlt h'r06 Ivo~'~. . : . t.,, i l , ,, . 1 ~ I, I ~ l l t , ' I ",, ~ ' �9 - dm c,,mmen~:erndnt, an,j, a~. a~,'uo.-[ d ~ I:,rflV dh'm~' f,,'htr_'h 'had

b,:,n ,-,t,~ttiet]' ~a~ t,l'eod,n,-,, ,t was-l#t@rh~,n$tt t,~,q~b v tt ~ all . . . . ~" I ' i .r

h:.eclms ~,:.,'.~ appl led, ~hi,Ai "[,~,..,1 ~ err" ~?,~.dl~v: ' TT,6te '~ 'n : ' i ~ -

V O L . X V I I . 1 ~ O . 3 4 , N . S .

306 Da. Gar~'~i,~mh ' ~ r ~#,a Test

of ttg~,~ dtm~g~ar~tCalc~dtq~eii~t~ d#aplmlcLCype,J was',~/)de~y

tl',rt,:,t th.a~, am~-eO~lh~l~aTlfisV, ilise~e: l I',.,I heen in l,ifrd,cn n ~Ir.:,rt. tilne l ~ b v i ~ v . ,'t~6 ~_m@| ,)o Im:goinr ou ~,,:ll,.tmt

~i~n: arid, t,h~ a?~tva~ibn 'oF a, ll the~ymptom~, ~,'hich"follo~d 'th6"~eecl~irrg on',a former ocoaslon. The effuskiw~di~app~a~6fi .by ~egree~ under ~ ~itd supporting regimeni'bur it i , probxble ~n-e'me6r or a!b|isVe~.'alone without/the le~ehing,woutd in-'~h@ ins~nc~i,hUve ~ e n a' n~ore ~ppr0priate )emedy.

~3a~ ~tI'.,:.~-Pntnvmo,nia.wi#~ ,typhOid @miStom~:-~W:.O. ~ ~. e~l �9 [ . , , , ~ - , ~ , . , , , ,~ , ~ . , - . ( ~ - . .

'st~a f l . f ~ t t o t 4 ~ iW,l~i~,~eelJ, l bu t , ,~J~ t~ gthetly;q~sfidff~d !a~w~ei~ .~a(t[oilally.e,,Md~i~,thir~Wsomg~u~h ~n&~'~'l~a~R- ~@~ w iiieh ;Mst,f~l~o~cd, dt~is hal@l?' mbt-o' chart, prbportior~,~o t~6 rapi~i.tyofl,h~ eDzu)ati on:." S~u ta ~ ~i~oJpa~ule~-'arid ~ust- eoloured, -.bu(~q~ttedy,,les~ d~ark;, left. side,'d~fll., deer 'its' Whale extent, wi~h' some: moist s~uudi,,:bu~: ~ y a<Cc~eul4a:;'i~urm ur. R~g~h~ s~d~ dutl ar its tow~-r ~m, th shgh, t mm~ eret~tat~, a~d'absen64 of ttm.~ves~eulav marttlur.-.,No'-~eatm6nt~had ltee-n ~dopted,,i b:rrt';h,d l~dd ple~4ty,d: gruel" and, Wt, Oy. :-"4qe~'e . . . . . . ' "#a~ a ~t~se of, a vOty alm'mm~ charaet~F. ~ .It, wg~,6b- vxous ~ ,~ i ten~ ' ~flamma~mr~ was lotesents: bu~. what, w ~ ~vm r ~athol~gir eor~di~ion:.~ --Wt~:thr ~14bili'~y di-

: r~-8~ i~l~ireeV.~'n W ~ ~l~>a, ie.a~e ! 60~ty~l'~,hsa~ t'e~tJe~.. 4pl~Rekt~l a*i~h pnedmdni~ '-Or twt~ lit ocir its' r witllou# :}at ~T hi~'drance?:6n4 by-', ig~'4 " ~ * r ~ & p a - raly~ing the~ eire/tlal~O w,~ ~d e~t~Oyir~g~Oh ~ ~9~a doi~a~,g~he, 'hm~s, and, through them, those of the brain arrd~d~t'fr~orgg~is.? ~t"~1~ question wa~,ono ofgve~Itcpra~tida~-imp&~ar~!, beek[~e~,/though depletion.seemed esse" n.tia~" ifi tim eh~mimst~noes, i t Was certain that any considerable amount of it would be borne badly if' the

of Patl~.~al Condi6ens.~ 30,7

na~e.l! f o r ~ ua~tmth~ m~nga~.~n, thee. -;Tke~o~r~u ,m#~t~a~a~I .f~ ~dee~sa9~ ;on ~he~qu~tzm% az~d, .ma~k~,tt~ose,of at~ehr~n~ eh~9o~.~h'4his:&eeisioa ,must he, ,p~omp&r,alad r ",t~, tla(h~i~,~s t)r gho ~fimr .w~ll ,pa~r wheaa-iVc~n 'l~of~ay. service. An,o%pea S t~a~t ~oatm~t ~ A~ea, ta'ied~,an&, resuh~,i~ the :sympmm~,:I lmve, derailed,. Mareover,,wh~n~r de~i~n Jam~de~,thr ~ae~- sur0s: mtts%,in-oae-eas~, he ~6mowhas :~s ,hei'oio,ki~fo~.a~y

not, in this rew ~ be ao~id~ro~a~a~|~s~r~t~)~ ~ a ~ $ i ~ h ~ a . I, h~erefo~e~ determined to,asaumd,~]~at~ t, lm ~a~iog-i~ll g t ~ w as on~ of s t~ugl%,in soa~p~in~,e~l~e~e~L.~l~ter~s of ~ typhoid qharac,~er~ and. 1o act a e~diag~y. "~.,~a.~h 4hr ~!~ feoti"and "press. the treatment :or desi$~ aecOr~ing, ~.o. ~i.ror stances. ~Eight good leeches xrere first, ai~plied to, th~,l~ft side, and ablister,over vhe ches~. :He, was put: U,~n c~L~m,~]; and hFdrargyrmn :.gum cr~t~, m. i~ smaLt ~doses, ~ ~'-D,o,ver. a . ;a~

falkawhag ia4ha!hiatg~ ra~ .~r~gook~ao$~,~r~mg;~" " . ~:, ,~ ~'-:. The le0~h~. ~,eo~ia~l~d, ~ h a g ~ al~ ~aig~ a~,,arg~ ~r

sio~ ! .abated :;~. p~tse. ~ubsh~t~fialr~.an~, ~i~ul~r,at, L ~ ;,~ongae cleaner, and h i s , g ~ , aS~pOq~iit~,fiCrtt~, l~i~ h a ~ hl~r ~heen i~e• ~ir162 7rt~or,;~turak ,h~ fe~i~, ,, Ki~lneys

','~ Sunday, 23rd,~--!~C~,w~r~h3hi~morai~g~:~ul~e436, .and .very feeble;, cot~g~ raad dyap~a(zi~ .~or :l~u~ there is :oonstau~ delirium. On" inq,u~ry, ~ dad he ha~ .had no. gruel, an4nottfiag btt~ whey sifieo my:,visi trof yesterday..COntinue the medioine, and ,give ~w~ 9,ounoes! of gruel everyl t~o hottrs, ax~t whey addibitum. '-~.~." Moaday, Jan, 24th.~--Mueh improv~td; aough ,ea~ and dyspa~a loss; paise ~teady at, 1,18~ ,aacl.goneral.~appe~rartee

Da. Ga~r~s,o~t . T ~ t ~s 'a Test

gocMi{ igkicr~soft tmd~,~pl~-~bew~ls~.welL movod,~ di~ehaTges ~stiil

�9 w : T 4 c e ~6t t~) tak~ ' :~ lhre Sgrd ~and,-;24'th ~how,ho/v~.near,~ ~his ca~ ,~a~r t b ' ~ ! ~ 0 h ~ t ~ f direct debifi~y @l~en 'de~aleticm could 1~ ~ ltm~c~',~0x~r~tm;~l~y~ ~lso show ~b,e, nee~sslt~r, of mateh- h ~ a f i g a ~ r 1 6 2 d o w r / 6 r

lg/mi~lsC~mv~iJ ia6~(i~inie~l~I/e0tt~ies, g~ke~some importanr

air ~t~r I olca t ~ k l r .bo ~ ~ l ' ~ b ~ a / a d ~ a &t~i~ cases also;. l[~:,St~ke~,-m~ik~r ~,,eoy ihto~st[ ng alhlsieqr td tlgis~tralt, bf tMg latd'eh4i~ent physieign' ~n his diseeut~e on his.lith~ and writ, ingt~ r~ t~q~e/br~r of 0/e K4ng.,'a.nd~(~eea~tColi~gr of!Pt~sicla~S, ~:Irietarid on;a~ late' ooeasion.~ :,~, ~.I:~ :the th~,tb'et~t0gress e/f, thi~oa~e,~ the sym-pmms deel4-n~:

t ~ ~_~ges.; ~the tekpirar i~prove&in;boohqung~;but morn ~ deeidedly,~ii~.L;r ;w considerable y6tfion~ofi theqeft~, h-ow~ ~#r;)we~v ~hrough ~ e supp~ra6ve~ *flanger , 'He-haq, c~stan~, e~3pim~sexpee~tutiOn ~ of 'p6r~alent m ~ t ~ ' for,maray- weekt~,- h~e~ie..~fivet }i ~r6fuse.nighv peospiea6ons-,~ ~ g ~ . ~ g 6 o n : ~ r

a,~e~e:'ttva~pc6vod 4 ' t s , ~ m ~ m ~ e ~ : d e e i ' d e 0 | y ~ h ~ h ~ : , I t had e-re ~y,i~pp~r ~ue.,b[f~eo ftfi r fneO r e.;symy- t~4s'.'~l#i,~,b-apa~0~rfi'~m,i4~,-/'ph[ysidl 6xa~n~,a6r not ih~.an'y-w~.u dit~ifigtfivl~d, fr~on4 it ;i,evi~# tu relomnoe ~ , i t s h~sto~y and'bt'~"n.eon|d a~t hnve,.bee~ s~fli~ient;' btrt the ~ �9 ~r oi~;disti~otty;,wh6re 6~e~misoMcf~,hv,~.~nd s h ~ d ~he ~es~ oi%he:lnn gs~ .as the ~case'~tclv:a~eod+~ ~ ~ree' ~ o m dise~er chat :it,-coutd, no~. be:~doubted. ~he~e; s~Cere ~ symptoms w~r~:th~.~rosut~ ':of~he lbird~ s|a~m~,of: ~r~flammat$o~a*.,, z,The'y~ung man"niade~peffeeg ~ecc~dr~f,and, is' now ~at' ,hi~ uaual oecupa, ~ ti6,n,, ~i~ t b e ' e ~ y m e n r of excellen~ he~hh. '-'-~ Cxs~-lI |~-~t~t~ona/:Deran~m~nb'~imula~.[ ~ ' Gh~on@ ~a~s*

tr/t/a.z.-A' |ady~-'about thirty*~venyea, rs' of %~e r unmkrried~'*vas a6yaclded xvit~h ,tim' .saa|-sy~nl~tOmS vf oBrdnio

~ln6~,in ' , a~ rail& ' f~m; .bay ,at~mtc~db'wivh",ghe.~l(~tz~yer- w~l~tn~'~ens~-6f d~spoad~ney~:, ~hin~g~on!d~[pe~utale~her the,attaoti:~wottt4 ~ ed~ in';4~solttti~nv L~l~e:.h~d t c ~ e s s on p0gssur~0fclt'eepi~m~tdi,m~iw6fl~ o6c~ona i , p~ , ; t h e t o n g ~ w~s clean,and ~,ma|l~,~t 0f,~ar.hgt".t~, ~ :col0ur ~ ~h0 I~owels opert, the di~l~avg o-es~boi.n~y" ~ dlo~r ~ ~ tuth~v~;hin ~ , . .. Them':_ was, a total loss, of appe.tate;,and bttV |itt%~(~sir6' for, driri't~. -Sh~ wa~ ~ leezhed tmd~bhst~r0d~ m o r o ' ~ h a ~ m ~ a r i d under themse of

C o ~ d ~ h ~ m . ~r~ t ~(it9 o f l ' a d ~ o g i c a l ~ ' '

luydrargy, r~tm. mum,.~reto: ,nad;J)o~or s~ .po.-~d~ _~an~ sm_gH d ~ i with a mixture of infusion of easearilla with hydrodylah~ aside, ~tttph~ewand ,,.r magneaia~ ,~eem~ .44~l?im- larov~ f~r ia ,~e . , : She was, short afterwards-,s~e~ wtth .~,- miring, ~l~ieh-. nothir~'could allay,, the fluid ,throwr~ ~p l ~ r ~ aci4,, She:got,some mixture of chalk with-hy&~oeyani~ a4d~, with some, relief again. ,This was succeeded by ~ diarrh~ea~.~th. discharges -be ing . ,thin~ of,the sarrte ~olou~. as before, smnlt,in., qaan~ity, bat hot, sharp, ~nd -irritating~ neat- prodnoing ~mu~h~ tenesmus., The ehal'k mixtarawaalaer~'~odjn,aa~d the,~stcanaeta again btlsmr~d;~b, ut~mi~h.wery, l~ttta,r shu~a~vared

th.e, mi'xtaro~:.WonL~a,.qaa~ ~q ~r~iagvb~An~. iJL~-~iaccfs~a~o# tha t no t e v e n a teasp~.dco~m!y~hioff .~ld~ba~ic~i~tbla bo~n~qor ,armorer.s ~I~d.e~a~a'dg~y~sti.|~v~a~eO d~ ~as - " he e

from{ t~a'e ,fi,adne~ita.l~.. oI~a~|r q ~ N ~ ,eo~4aedt t~ I g~g$~

apprethenzi-~'~--mysetL~: has~ tttat her~w~st~.fea~:~9~..~,bl~r,: i~ed. I men~ion these particulars to shaw. to -whataer~o~i~ea~t~s,~ even4n.-a ,very ordinary ~ease,. a want of. sut~ei~t-dtt~!~.iar~ to a, .single..symFtom.. an~ that .probably .a- mere effee&, o L t ~ diseaseA a~tion, wilt lead ,~ The' ar idly of the matmr~,ejeeted i~,om the.!stom a~h &;ad ~co~i~ued ~om~he,firs t~, a~_ d, becam~o, now.

e~reoting_ i~,, ~ i~r ~ t ~ , pre ser ib~d~We~J~~61~:, t~_ ~laU 1"1/~r o., iJ'to~tO,~eaxt, tOW.~

that aim, the case wQtl}~..bir ~l~le,o~ttodl~g.~t;c~h~r!~f ~,q~'e..r :

a .graimof a~faCq :~fea~o~pbi,,~ttSt~_ ~ f ~ hyflmey.aai~

completdy-this ai~r distressing symptomS,.,,,(~b~ diat)fltd0a,.qo_~tfing.,~a~d~,ge~t irritab~ity, aqLee~sCd ~ithjn_a~.d*y~i 8he w.a~ SOon **b~.t,o~tak~ sago .food; ~ad ,ree~ve~.ed~,.complmoly,;r perfae~ly~.:withot~. may..e~ang.e in,,t-he, t~tmen~.,~, eep~ te~thr bot~Oen the ;doso~ .of the, alkali,.~ ,the ,impro~meo~ w. ,~n~;-o~: F, rOm the :tal~id~ty,.os ~mendmen,, i~..W~. (tvidellv th~ affer tion,ma~a m~rely,~funet~nal;.one,, aad~.~ kag#Ivl~ry, l:itt~ d~ttbt that if the same had been prescribed at a sufficiently early pe-

310 De, G a ~ t ~ " on 7t~'oat'men~ as a Tes t

riod, there would have been no'necessity for either bleeding or blistering. . ' ~'-' ' / ' ; ~ �9 '

S'6me cases 0~' (h~o~/fiq ~inflatnrr;a'fion 0f the eye 'resemb|e those of the, acut~ f6trh so ~eompletety ~liat:at ls~ wholly amvos- sible tc~ disti~ghi~s~[:ifl~th: ~;kce~t'.b~: ~hzei~e~.t bf t,~atment. Irt this, as iiv other c ~ 6 f - ~ i ~ d ~ e f i f i ~ , I :have/seeia practi- tioners 6f~lhe~d~:t/~.~6~d~ci:d~det/#edn the '~bs ta t e s by the

of. hea~ .and thr3B~]h~, ~he tears- bean~ "h0t o r toM;" and othel; pamculaIs ; bu t t ~tii Sa~h~ffe~l;' frowz numerouh'ea?e~ that have /'alldni:~indei/my ob~vafi'ofi:, ~hat; Whatever:~ay ~oe[the resflt~ generally, there ai"e:~dveral instan~Ss ifi'~wb3611 'tMs ~anno~ l~y a-n3/such' meansb~fibnd.o ~ Many of these, indeed m~st oY'their] i are dcute' ~t first, bh'ar dep~etJon:+eiry'weH, 'and are much bene, flied ~by It, but, tis'~'ime wea'rs on, We find 'that a persevera~iee an the ~ame means~does ~iot effect a cure, ~aay, ~]aat they are rer~- d'ered stationary,(o~ even' mad~ w6rse By 'it, an~l~it is only 6s the repeaied application'ot~s/ch means, 'and their being pressed to an extreme wfien' they do not succeed at first, that we see they i a~e ineffecttia~/'6r the end proposed.' Cases 'are met Witlr from' ti-f/m.Ao time: that :b~eaf'out the~e observatim~s in revivals de~rees'. ~The folIbwin~ is One of~h~,:mdSt ' pcfin~ed:ti~a~ has

woman,k~out twe~tyr-fi ~ e a r ~ orange, nn:d n'-~oc~)iea-l~ , vcaa

mia: ot'~ b:o~h ?eyd~; :tlae:qeh being ~ tfi~e' wo~s~: "~ 'Stie ~" hgd" been ailing 'abofi'~ ~s VCeeks,:but ' e~ployca ha~iy ~y veme6ies e• some aperients and fbmentktioffs. ' She was bled ~nd leeched.freely, pufg.ed 'and blistered, and witti: cbnsiderable benefit, for n time'; sl/e then had ~ ~lapw supposed to Fe i?om cold ; the same means we're repeated and renewed, and again with benefit, when'anothei~ aggravati6n occurred. '~Aftbr this had taken place three Or" rotor tithes, the siaCe 0f'thd eygs-be- came wo~rse than ever, and I began to suspeet~these ' repeated relapses were not wholly due to the6ause"assigned. A!l,]Seal applleations were merely' palliative ~, the inflammation g6emed

. ' �9 . ' , ~ , , , . . , x , now extremely intense; there was ~great~'he~t-m the r headach; tfiro~3bing, and much intotei'an~Ce ~ oFl'i~ht,,:the ~6n '- jnncti'va was deeply htoodshbt, and ~he t~ar~:h6t and burning~ there was,' hbwev~r, rid chdmosis, arid ho-ddstru6iive process was going on; nor wh's tl~ere eith~r in ' t hd girl's congti~tifion, nor the aspect of the case gener/dly, arr3r " sign 6 f a sta'umous diathesis. On going Over the history of th-e case with some pupils of the hospital who were present, I directed their

oj" Pathological Conditions. 3s l

tinetio~ between thein canbe made by the :effeqt 'Of ti'~a~m'eht alone. /In all this tliere isn0thing new; iaqthing ~ha~ has not been discovered ,by,everyone who ~as been~]bng m pl:actice;

3L2 I)R. Ggn?FI~, o n ~"~:eat'ment as a Tes t

tl~e~r~re~ ~ ~h a t I> ~w:ish ..to .:insist on is ,not. so ,muot~ .the,:t~acts th.em~!.ves, ~hough .they. axe va!uable~ as. the very general .ap- pliqa)jOx~ o f ~he~c~n~c~u~sioa~. ~h~h~nay be drawn from them. I f g~, be :tru~ that city,gin, inflamma~ry aff~otions of th~_conjunc- ~Ya os ~r~ os :..th~r i0rpulmo~a ~ mucous mem- :~aa% are,ca.p~bl~: i ni ~e: : r of being greatly ~en~e~itedflhy ap :i .~prgvad diet~. :the: sa~aQ .wi,l:l.:. be.true~ a,lso,

c~!v~ i~.is~-ga-necess~ry', it ~r~ei~ves a ~tmag oonfin~aa~ori:ff~m the experience of m a n y able physicians, amon~ whom t~m~, ..men~io~ the tgtet Dr.-Graves, -who ~sav~., "tha~'~n Chron~'d 7- ~ntery:, anea~'~iS:fa~r too J n ~ h ~frain~ed. ~ from; an&,.fl~#t manor cases ,wblch,-d~Sti~lately:~resist ~he most :varie4rremedies; ass~- duo~aly grnpl~.~ed~.~et.~we!!. ~pid!j~ Mtttr ~ liberal, ~al|o s~an eo .of meatfis .-gi,v~n>.to)the~i'. : ~o :.-the :.truth .of~this ~ assertiomDr. ,Mayn, e .also:. bears gmple ~stimoa~ i~aan,]~teresting mrts

'"Sueceed~d,.in. ~is. W~y.,a~ter .t-he, faj.la~re, ofial}~o~ta~m~m~zeaiY

~ o ~ , : ~4~nt~ti:~n~t' tube/is itae!s pr@e~ o~s~mj~t~On, care should:~ ~takimmca ~.m admhaisI~r ~o~ras ~mf~t i a ~ unsUi~ab!e, form it~,miist~,~be.asJea~Tof ~ i ~ i .atioiar "t~ud.ei'i tmd,i dig~stiblr as, A~a, ni~qref ~iiJ,~ aflm~ 6f,,, o.~her~isoi i~t ,' will ~Only ,a&l, ,to, th6 ~ embaer~smcr~t ~ai~idy e, Xisting.

t:L~Ving s F~ke n ~ f the ~-udqu~, ~urfaeesi~Iam anx,lous, ,e,von ,.the risk :o~ heiiag t~ough~.,tediO~e, :tin i i l a s t ~ e eertai~ affze;

tlons, of tee s~rou~ qa~iti~s,...~mt~y~ ,rigi,nat~g,~Ln inflamrdafi~m~ ,.by a.~e.fe,~eel i;O, s~rne i~ ~rozti~ff, .~vase~ ~,txeac~-al~udeddto!;... l

......... :...., : : , _ ....

genarM,are ~Q.~r,#~.~2,~.,~-~hjakJ~mz~erj~Jhatarntilfi~ qabiim~for

interna'l ]~art~,of'~he ~.y# l~e~l~oabl~s :Jtex~ anttch'i~vhatshas: bean

a Clinj~ 1 Leetaro,,~ edited b~ ~Neligtm, "*oh i i , ;p, 138.

~f P a ~ f a l 6"ocd~ons, al~8

t~bma&y ~de~crhbed-'avoeearring h~'othdr tis~eb. ' ~Tl~y,}~pi0qe it~u~tl~,r~rly'trtages dnad~r bleedirrg~ general anff>l~d~ ai~. ~eir 'duriatization~; a ~dtipt~ o~:tw0:oeeurg and : ~ e y i ~ ~# ,~ ~/~iith!; 4dhe~ro~d~ they~remaiii~:s~Otion~y~r ~,:t~me;. d~ :~allJ~o~,J~tad txlmm~themaot~ ~he~',/omedir preesed~ the w~rse ~t~hey gb~; ~ill~t~h is~eettain ~at~a~pst~eweranr in t h e m ~ u ~ 4 ei~@ni~r ~e.!tthe-~totaLdesta~tefi~nmf,~sio~:.: ~ is~ at' thi~ pOifit 't|i~aCVff th~ f~:mer ~ , tme~ '~ t rve i nbt ~.bee~t= puske& :tff'~a' hd f l o~ ex, ~nt,:, l:fmd,_ th'e mtmli d'ngula~ m~ff de~iesi.~,4~ e~eeV,ft0rd -,he, use of oil ,of ~Irrpentine in,~doses:, of 'tW~mty ~r.:. fiye,ancLtw'enty d r ~ s tl~ee or~ur~tiraes~a'~ay~'.'.'-~*I~cw0~l ~mti~.~pi~::the

~ml~li~ ~odw ~-.r~:oa~ ,e, aaiuiawtq oid~ Xrmm io ~9~t~i'~oqxa .',d~ , . ~ . �9 , ~T* * a ~ , ~ r - [ " ,

�9 ~ ~ " " " d . . . . . .

~,a~ek :he: ~ ~i~hm~.: ~ II~ ~wtr~ ~h:led~tfd ~ l e 6 ~ ~, ,i~:e ~t~'dI~; and: goC>.andor f la~, i .~nei~ ~f mevctrry, !and ~with,~ei~'ebr~i:

~l~ wass s~fe~l~4t ; i~t t

{alla~edalayrne~ra~J~aina~rda~a~6~s~ri.dF l~4a}h-, ~h!dfi at last filled the whole anterior chamber, and blocked d6:e~37 poi~ th~agh mh~el*,~ighv~aokl)~t~[~ ~Ttt0dlgfl.l~il~{6.~l~.vcr,

faeg thine,boy; w~ nea~ly ~li~d~ ~ir dJ~) ~ ~ a ~ g l l ~ a o i ~ l ~ , ~as indeed, to 'every,/body~_d~e~ha~lq~ ~ , ~ a ,i~ii~h=l~e~ 'edfi'4~-

r ( [ r $ t "~ 1 tion whendm.grst.earh~ irdd.,ho@imli h~6"~e~ltke~eda':"tb ib6~hl, lowed, to, go. home; Feeling, l~ow~a,i~redifaMe;st~di-.kn eCent would, be in the~ eireumstunc~: i~ iea~rnes~ly ~press~d q~im :t0; i:e~ m a~ n, e,.tittle.l~nger~partly an der=the ph'ete xt ~ ~ fge t~fl'g ~fi~ '~bt-~ movath ~etl., ~ ;,T.o,*hi~ ke,at :.last rehmta.ntly,c6nsefa~eiJa ;~'.t/'tlie antiphlogistic measures were immediately suspended. He got a lotion for his mouth,, ,and, was ~rdered,twIeh, y'Si~ops of' oil of

3~4 DR. G~r~r~,on ilbeatmeat, as a Test

tarr ,~c~flare~ t/trms~ day~::tt ~as~a ~r~elz ~ f o m .~he eA~r t .of th~C}~t~la ~s ' d:~tita~}~ Cr tihte, but~when.onoe he-became

. g B . , . ~ r P " "' = . . . . '1 " sefls~bla ~b~ ,h~ff lie~.,~a~ce~y wfll!ag~,t~,go on,.,. A t,h~ugh ~ogal~oc,ti~ni~.i~lo~, ti~:w~ steadying. )uni~ker~upted.- Tim etff~e~d,:lff:n~lt~h ~ s b~.<~cg~ea-,teAvn..~p,~,~h~PUtfiLregffmed its r~a act ~ s~ ~ ~deacnet~s~ ~a~l 4hoAr~ ins ,$~o~on. r prooess ~of

of4h~remedy~.beoa~use I observe that~h0ugh~its!e~eie.~..y~i~

tried it, it yet seems to be looked on as a me~c;~pe0i~ie ~n~o~r. tadtr,~t~s~,~nd~t~ ~pow~.ga~geneaaL agcn~lm-~go~tr~ldingl in- flttmmo~.'3bgCt~i,~n4:ro~oving it~ c ~ q t ~ n ~ o a ~ m s ~ t ~

!a4".m m.ad~:i~ a'~:,first;l~ka&oa aa a:spe~ifieArr ~pt, ~olr~pta~t~

is curious, for w~ find easdar~cmrelr162 i~-,~ ~zo~.a ~( .nA: n f l a ~ ~ f f e ~ t i ~ r r a ' 6 c ~ u r ~ i . ~ '~ _~g~%~s.s~uc- td rc~ ,~ i~b~ao~ara t :#a~es ~ff~ohartte~r~,t.he ~ r ~ - , i t m g ~ b~ng ~ ~n~:~hLdr ~thel'*aeaxra~ha~ fail~d~/~.Thos~. J ~ha~o~r r~. y~K,,th~iigh.~oneLofiliera ..~er.e~so ~eraag-kaht~as the p~,g~ h~,O.-qdc~t~],~, havr om.Vainty, sufKei~tl~y,mita~roua.to~,-.. m bli~h 4he~,:~0r~tusion t,have tbeen :aimi~ge ah-~i~hat.4r acts.on .~ generd~yhi~cipld., !It ~s :no~ ~easy~ t~ explai~ ~,h~ th~ t~ondgfiona at0~thgt, ar~, ~nms,~,. favourabte m ~i~s-success.~ ~no~iaflamma~ry, i~,.4h0ir ir~imate,~r ~hey are, ~r -~o.~rt ~heir origin:, They am. prabably~.f~ a phronie.oharaeter ratMr, ~art ar tUe,lyat t~'s h:not, ~hdr-so!e MistiaOt~ve,mark~dor EalthMas~r~ce I. k~vca given there was no change of regimen nor any alteration save the employment of the turpentine in~tead of the means previ-

a~or3ba~t~ .m.yt ~xpo'r i~i~, , r6mo~iyla~: /~0t ,~oc~d'- so well,: or; @~d.eefl~r I.;*bi~k#~t"kl~ ~ i~r i r e ?eii~l~r~sCa~es~li ~ imflgr~ma-

tioga have ~nifireiy ~ailed,.,i~ei:therr i;?it,ea~,~eX,l~da its mode of' aotion,.as s0me. h, ave. attempte&to, do ;~ivis; auffieieart-ow,this. poi~it to say that ~IPthe' e'XiSlgiigtibrls ~ Iih//ve' seen' are quit~e in-

of PathotoyieM',. Cond@io~ 3.1~

consistent~ ~r ,have: come ,ander ~y,'own ~ e r tion. I a ~ so~tttcOngty persuade@ h~w~vor, bdtk~6f its :eflleacy and thd!'~eneeat rmtnre of its a~tibrrethat t thinkit-w~ll.~dith~ of' a m~e,'~t~iensi~ce -triM-than dt has yet ree6i veal:in sovevaJl, emL ba.~-rassi~g :eases.,of. irrflamm~ion of:,serous membva~e~:,~a~d indeed, ~f! other tissues also,---the .fi, mec.mo~ '|avou-rabt~o it~ acti0n being; as I have said, when .tl4ey are'rtm~in~ inWe ettroz ni~,:eanditioi% and when depletion an-d mex~ury ~6 not-,~eem~, after a .faSr trlat, tO have,st~cceede~. ~WlmV:a~a invahmlvl~:.ad:db tion it would be to our list of'therapeutics flit was foundgap~ble

eh a ,ge~ O~hMe~d~.a[t~rati~h of ~ o r i t i c ~ ~t~hgn S~D~h+ *$14~ ea~'&,6 tbe~ s~e)~i~ Vu~$ du~ ~r~ultsr in ehvo~ie ~ a~os*ot],pe fi~gi~llci~

u~e 9f to ~6xpl~ ~th~ oxc~ption, ~Iy rd~n~ng,:~r b~?l~e~Idt u~nderstood,by g~iv.g-t/:ease in point,-

CA~,VI.:--:. ~ ilepHe~'i~sdttringPC'e~',, . oy . ~ . , t , y . ~ A . Ot~r~ ~ d ne~vly.lnarncc], a~d :i~ .her ~first pregnaney~ beeam6~ .'sdb}~: ~to fit~whm~we~e ealle&- wea~,n~sses.-or .~r ~t~ trot wh~eh,.on a~ro,pan~tm!ar mqmcy~I'f6un d~t~bo ~.tm ~pi~ t ie

at;firstUbitt~OC~atd~th~,lattev"~art',.O~ het,.:lJtegn ane~ ,m;~h oftener:, ~h'e~ gomet~me~,oceu~ed wherr m~bei't~, but more ge= ne~/liy ~ ~h~n ~slui ~ s Jn, a stooping posture, ~nd'-wet~ vei~y:sud- deti.~ ~u l~heir aeeo~s :~)when~she e~me ~out~of.r flt~shed~ ~n~.',l~a-,~yi~she .breathed stertbro~l)~.', ~ ~anS e,ven~Whdrt recovered~poke'i~O~herentlyTor ~4ime. I saw her.oh b~ie ve,

a ~inee the above ~:as .wr!tten I have met with the following passag~e in Watson ~, Lectures ~n" the Prinelp]~s and%l~,ractlce of Physic',i4.: ~ 8ff : - - J . . . . . . . " " ' '

�9 '~ Bu~ when infmmmation.lm~ miffene& tale rcaLves of *he heart, or staldd~l: them with littt~e ~vart-lkke masses of fibri~% how f ~ do 4hese m01"bid states , d~ i t of p.erg~c~ recgyery ? It is not so easy to say. I am not aware of any facts which woul d forl~id altogether' the :h~ipe that here, as in: iritis,' the re-abSorl~ffon 'of' rembv~ll of fl/6'l~i~ph may'bo~tat~, a~4 the restorr/tlon of the parts 'com'plete 3 o~ tl~o:eontrm~ ,at~ eb~hL p a r a t i v e ~ ird~.efiuenvy, pf w~rt-like eqccre~cencas in the slowly S a/~al.~g~es .of. rhqlm~ie carditis.leads to the opMon tlmt such deposits may disappear as readily and,entirel~ ~rom the valves of'the heart as ~ fl'om thd'~fis:" . . . . '

Da. ~ , I I ~ o~a Treatmeat,a~ a Te~t, c~o:

~ ~ w ] a l c h ~ 1 ~ c~_~rod,~in~,0ne-, or~wo:,instanaea before.:

everythlng oF the nature of ~edicine. ~ s she had never beea subject to .theso a t t ~ - t - l ~ o k r orr thena as assoeiated

MR. S~tyr.y on ~Dtdooatiort of the ~Meta:tar'Sat )Bones. ~?"

or five,~dayg~prod~eed ~ sO decidedly benefieiat ~n':dffeev~thnt '~di; tendeaby to. a ~-eeurvene6 of~he; fit:entirely ceased.'* StUd ~ f f throngh ]rer ooniinement w~thout-~smgle bad s y m p t o n h ; i i ~ her infan~}!and has enjoyed very~good health ever slnee:

I railst,here bring this paper to a close. If eireumatmaee~ permig l ~ a y perhaps at s0me future time offer some furtl~e~ illu~trations-ot'the important subj~t.bf~vhieh it treats.

AR~. XIY .... O~ Did~eaaon;,Of a~e ,Maa~dcd:Bones ~wa-

Surgco, n ~to..theoMedth Hds~ita[ ~nd C0untv. ~f Dtd~)~n, In.

l~'tq~e last ~ Number of this'JournaPMr:: Tufnetl has-balled thd at~ent~ort, Vf file ~,rofession to "a:form ~ot ~ di'slodation bf t~i~ foot ndt l~e'v~ously described." :/tie'very prbperly says; ~ . ' I ~ h ~ by ri,~6 megns infer :that~it.lS:the ~6 'n~y~ tl~at ~s" ~e~i:ed; f~,zii~pl~ning Under ~he~germv - of-cafises ~vhi6h h~ix~t '~ br ' h~ve, ex~'~ed ~lual "4rs~ pre~, we cannot But ress~2ab~y st~ppose tha~t sur ~acc~de/ats ~ u ~ i i a x e ~ . ~ e n ~ :i~dtwfluals

o~ ~ ~h~i~ ~ ~eve~'al expefidnc~ ;:ha~ '~5ne ]Ji~g~i~t&t i'fla~s: ~eei~t~ di~toct~fibn :from bemg]~nbwfl~." "

Mr. Tu(ncll's Case is' certalnty the-fitst :up6n(rec0rd of luxafion 0f . the metatarsus downwards.: A base of this kind

rl "ri h c~'me u der my care a :t d'Meath Hospi~al~deVen years '~o; wh~qa Lought then :to: hdxe ~made: kn~wrq ~as Upon mvestz~ ga~ng the ~ubject I f0U~c}:the~ Case to l)e ~q~ht~{r~"~the:best authorities being ]gnbrarff~ of t~ie ex]~tgnee' :0f-;'gi~lf ~ldsi0~'nl mad some d~a,~ng!~he ~ p0SSi~illty of its t~eChrzefice: ~It ma3i beof use' to ]Jring t'orwai?d my case even now; a~ a dbntrlbutlort to-0uCstoe~ of knowledge.: "No doubt rhany #~iu;abIe ~acts are los~ fi'om' want of d~hgenee'tn collecting tls~m~ :as well as from ignorant' bt" their value./Mr. Turn'ell h~s sh0~n a~go0a! ex- ample--:worthy of imitation:

William P., a young mani WaS ~adm~tt~d:irit61 th~ ~ t~Ie~th Hospital on the ~3rd of March, t843,:foi': aii 'injury of the tbot, which "h~: ~r tltt)~ before: "H6'-w;a~ driving a c~t,;sitting in front/when i in,m'akih~ w~y fdr anothdr Vehicle

sidd~:~dnd~thd can ~on whi~ti ~ he sat Was~i~et :. : 'He 'fell sb ths Mg'i~h~0o~ got betb~een the: Shaft add the bhgk:6~tRe~:aiteh. T~i~ ~hiiff'-~rtished ' the heel against the toes, wli-i~h were fixed by th6' ]~15~: "'Th~ iia~ient sutTered severely at tl/e tittle, and