great accumulations taking place, notwithstanding daily evacuations from the intestines producing such proteian and anomalous disorders, in distant parts of the system, as were well calculated to draw off attention from the real root of the evil.

We do not deem it necessary to follow Dr. Brooke in his commentaries on this case, and on liver-coughs in general; because we consider the basis itself unsound, and consequently the superstructure unsafe. We were also grieved to find him repeatedly quote, and prop up his opinions by, the worthless puff of a London Quack, with whose book or person no regular physician in this metropolis would be

seen.

ART. X. A Case of Erethismal State of the Brain. By WHITLOCK NICHOLL, M.Ď.

Our readers know that we gave an analysis of Dr. Nicholl's publication on this subject, in our last number. The present paper contains a detached case illustrative of many points therein discussed. As the case is short, and as we cannot well abridge it, we shall give it in the author's own words.

"Mr. Acton, a very intelligent surgeon of this town, has an infant daughter, who is between eight and nine weeks old; she was, from her birth, lively, very wakeful, scarcely ever sleeping during the day; highly sensible to impressions; when she was scarcely six weeks old she awoke as with a hesitation of breathing, and the muscles of the face were convulsed. She became still more restless, and was very fretful. Nothing amiss had ever been noticed in the character of her stools. She was suckled by her mother, a very healthy Her father young woman. her a dose of calomel, and put her gave into a warm bath; the stool which succeeded to the exhibition of the mercurial purgative was perfectly healthy. After this I saw the child; it started when the door was opened, or when a chair was hastily moved, or when any one coughed, or if any part of its body was touched. It cried very much, and very loudly, and was only appeased, and that momentarily, by being placed in a sitting posture, by being carried about, or by being put to the breast. The pupils were of a natural size; there was no vomiting; no heat of skin; no heat of the head; no flushings of the cheeks; no increased throbbings of the arteries of the neck and head. When this highly sensitive and wakeful state had continued for several hours, the child became gradually more heedless of noises, until, at length, it ceased to notice them; the crying then subsided, and the child bore a horizontal position. In this state, the eye appeared as if insensible

to the light of a candle; the pupil, which was rather enlarged, vibrating, as it were, between contraction and dilatation when strong light was thrown on the eye; the fore-arm bent on the arm; the fingers clenched; the thumb laid flat across the palm; the upper extremities, in this state, raised, in constant motion; the head sometimes moved about, but not much so; the lower extremities sometimes suddenly drawn up; the lips moving; no moaning; occasional rolling of the eyes; the eyes fully open; not a moment in which some muscles were not in quick action; the body bent backwards. When this state had continued for four or five hours, sleep came on, out of which the child awoke, and appearing in its usual state; its arms pliant; its hands open; then came on the fretful, crying, restless state; then the torpid restless state, during which the muscles were in constant action; the fore-arm bent; the fingers clenched as before; then sleep; after which, apparent recovery. And thus did the sensitive erethismal state, followed by torpid erethism, by sleep, by recovery again, repeatedly run its course. The brain, after the highly sensitive state had been long kept up, gradually assuming a state approaching more and more to torpor, until its actions were at rest, and then was sleep present; but after a short rest, the brain AWOKE to its original state. It was remarked, that when the sensitive state of the brain recurred, the bowels were relaxed, notwithstanding the use of opium; the eyes were suffused; the child sneezed, and had an increased quantity of moisture in the nostrils, and of saliva from the mouth: when the sensitive state declined, the bowels were no longer relaxed; the coriza disappeared, secretion having been increased by the erethismal state. At one period, during the torpid erethismal state, there was complete opisthotonos, to a great extent, so that the spinal brain was affected also with the erethismal condition.

"The head first of all was blistered; during the state of opisthotonos, the whole of the spine was blistered. The application of the blister to the spine appeared to give much relief, especially by its first operation; afterward it was thought to irritate too much. A grain and a half of Dover's powder was the remedy always resorted to: if given during the highly sensitive state, it allayed the irritation, and when given during the more torpid state, sleep gradually came on. In one instance, the fretful and the sensitive state and the more torpid state occupied two nights and the intervening day, during the whole of which time there was scarcely any sleep-none for a longer period than a few minutes, then sleep came on, which lasted several hours. The Dover's powder generally quieted the child in three or four hours; a tea-spoon full of syrup of poppies had no effect at any time. Musk had no effect. The muscular actions generally came on at night. I gave decoction of bark in one of the in tervals, a tea-spoon full every hour; I thought that this combined with the p. ipecac. c. had a slight good effect; but it was not followed up, as Mr. A. thought that the child was in pain after taking it. James's powder made it sick. After the child had continued about a fortnight in this state, the train of symptoms being repeated

every day, or every two days, it has continued for the last fortnight without any marked symptom of disease, being better than it has been since its birth; yet there is still an absence of sleep during the day; so that I suspect that there exists some congenital formation of the cerebral structure, which is incompatible with the long duration of health, and perhaps, with that of life. The case as yet has been a well marked one of pure erethism, unmixed with the slightest perceptible alteration in the state of the blood-vessels, and alternating with a more torpid state, which is the consequence of the previous highly sensitive state." 273.

On the above case we do not feel inclined to remark farther than that we do not feel quite satisfied with the explanation of the phenomena, as referred to an erethismal state of the brain. We strongly suspect that the source of the complaint was in some part of the prima vie, and that the brain and nervous system suffered sympathetically. It is but a conjecture, however, on both sides; and therefore we shall not press the matter farther.

ART. XI. Case of Melena. By Dr. NICHOLL.

A HIGHLY delicate and nervous female, married, and the mother of a family, had laboured under severe cough and pain in the chest, so as to threaten phthisis. She was relieved from these, but was afterward attacked with vomiting and diarrhea, which continued some days, during which she could not sleep. When Dr. Nicholl first saw her, (27th June, 1820) she was extremely languid, pulse from 115 to 120, stools liquid and frequent, fulness of the abdomen, tongue moist and white. She had been taking hydrargyrus cum creta with saline medicines, which were ordered to be continued, with the addition of rhubarb and confectio opii, in small quantities. Two days after this the patient was affected with an unaccountable state of wretched agitation. and terror, attended with profuse perspiration, coldness of the lower extremities, thirst, quick full pulse, and dry tongue. After some hours she became tranquillized, and next day seemed much better, the stools having a more healthy appearance. In the evening of the 30th, however, a recurrence of the same unpleasant symptoms took place, with an insuperable dread of sleep. She passed two large evacuations of liquid bile, with a considerable quantity of blood, the abdomen being very full, but free from pain on pressure.

"On the next morning (July 1st) I visited her at 8 o'clock. I found her in a state of great anxiety, repeating that she must die, but Vol. II. No. 7. 3 Z

that she cannot die; her face pallid; the nose flattened, sharpened, white, and almost transparent: the pulse jerking and throbbing, beating 130 times in the minute. She had passed a very large quantity of liquid stool; that which had been voided in the preceding evening had a more decided tinge of red, and contained black grumous clots; the stools which passed on the morning of this day (the 1st) were perfectly black, thin, and watery: the whole of them were of an inky black, entirely inodorous, and free from even a vestige of fecal matter. She had passed several pints of this fluid, and it continued to come away very frequently." 277.

At nine o'clock a draught, composed of ol. tereb. half a drachm, syrup of poppies a drachm, peppermint water an ounce, followed by a clyster containing an ounce of turpentine oil. This came away in an hour, untinged with red or black. At noon the draught, and at three, p. m. the clyster repeated. These medicines were reiterated several times, but no more melena. The patient gradually, but slowly, recovered.

"Not a particle of discoloured matter passed from the intestines from the moment in which the turpentine was first injected; although up to that moment the fluid nigricantis picei coloris, and tetri atri coloris, as Hoffman terms it, passed away almost continually." 279.

Melena is, undoubtedly, at all times an alarming disease, and, as Hoffman terms it-truculentus et ad sanandum difficilimus; it is therefore interesting to see it checked by remedies, and thus certifying the power of medicine over a formidable malady.

ART. XII. Case of Ruptured Vagina, terminating favourably, &c. By THOMAS M'KEEVER, M.D. Assistant to the Dublin Lying-in Hospital.

ALTHOUGH, as Dr. M'Keever observes, this case is not likely to prove of much practical utility, it affords a striking instance of the extraordinary efforts which Nature, at times, will make for the continuance of life.

A young woman 26 years of age, was taken in labour, of her second child, on the 29th July, 1819, and continued in strong pains until the evening of the 30th, without making any progress. The surgeon now found her weak and exhausted, the stomach irritable, the pains nearly gone, the pulse quick and feeble, and the head of the child still high up in the pelvis. In this alarming state he determined to open the head and deliver with the crotchet. The operation

occupied two hours, and was accomplished with great difficulty, the patient being very unmanageable, and requiring several people to keep her in bed. During the night after the operation she had several hours' sleep, and made no particular complaint. On the following morning one of the attendants perceived a substance, about six inches in length, of a smooth shining appearance, hanging from the external passages; and taking it to be some of the membranes, contented herself with passing a portion of rag through the loop which it had formed in its descent. No passage through the bowels, though opening medicine had been taken. The 1st of August passed also without complaint, except great soreness of the parts, the bowels, however, remaining obstinately confined, in despite of repeated purgatives. On the 2d of August force was injudiciously used by the nurse to pull away the supposed membrane.

"From this moment a train of the most formidable symptoms set in, her abdomen swelled up, and became excessively painful, she had incessant vomiting, with occasional hiccup, and she complained much of pain, which she described of a dragging, lacerating kind, in both iliac regions. In this state she continued, with but little variation of symptoms, until the Friday following, when I saw her for the first time. It would be difficult to conceive a more melancholy or distressing picture of human misery than she at this time presented; her belly was much swoln, and excessively painful, so much so that she could scarce bear the pressure of the bed-clothes; her stomach rejected even the mildest articles of diet; bowels obstinately costive; pulse small, intermitting, and tremulous; countenance pale, and extremely anxious: in short she had every appearance as if a few hours, at farthest, would put an end to her sufferings. On raising the bed-clothes for the purpose of examining the precise state of matters, I found, in place of the alleged portion of membrane, near a yard and a half of her bowels coiled up under her, black, and to all appearance, putrid; exhaling a shockingly offensive odour. The cylinder of the intestine was in many parts so incomplete that the finger could be freely passed up and down through the rents." 285.

In this deplorable state, the prognosis was, of course, most gloomy. Reduction of the intestine was impracticable as well as improper-in short, nothing could be attempted but that of palliating symptoms. The saline mixture with small doses of tinct. opii, also three grains of calomel with half a grain of opium, were ordered every four hours-the abdomen to be fomented-and a little wine for drink.

Next day, although pressure was better borne on the abdomen, yet vomiting, hiccup, constipation, cold extremities, collapsed face, cold perspirations, seemed to announce the