OBSERVATIONS ON THE USE OF CERTAIN REMEDIES IN TYPHOUS FEVER, AND ITS COMPLICATIONS.

By ALFRED HUDSON, M.B. T.C.D. Physician to the Navan Fever Hospital. The pathology and the treatment of typhus stand the best chance of being enriched, at present, from the "seven millions." The "finest peasantry on the earth" are the victims that typhus rejoices in, and their physicians enjoy ample opportunities of observation.

We refer to the paper of Dr. Hudson, principally for the sake of ascertaining the results of his experiments with remedies exhibited in particular forms of typhus, or for particular symptoms of it. The extracts therefore must not be expected to display any necessary connexion.

A. Treatment of Fever. "I have been disposed to look for its indications to the condition of the viscera, and those symptoms which may daily arise, and not to the adoption of any routine system. I believe it is better to do too little than too much, and I therefore abstain from all hazardous modes of evacuation, once the disease has become established; such I conceive to be bleeding, purging, and sweating. If the type of the case be pure continued fever, I usually content myself with ordering the diaphoretic mixture of the hospital, consisting of equal parts of camphor mixture and aqua ammoniæ acetatis, with an occasional small dose of calomel, reserving all more active measures for such complications as may arise. Of these, the most frequent is the gastric. In more than half the cases of synochus, the prominent symptoms were those of gastrite, and the relief afforded by leeching or cupping the epigastrium was constant and remarkable. In many cases, crisis followed immediately; in all, the patients expressed themselves relieved from prostration, weight, tightness, and similar feelings. As regards prostration in particular, my experience leads me to consider leeches, indicated by its existence in the early periods of fever, as certainly as is the necessity for wine by the same symptom in its advanced stage."

B. Headache and Watchfulness. "In those cases in which headache and watchfulness are complained of, I am in the habit of adding opium to the diaphoretic mixture, in the proportion of twenty-four-drops of the acetous tincture to eight ounces; and I have contantly found all the good effect described by Fordyce to follow this medicne, (3d Dissertation, p. 236.)"

c. Catarrh in Fever. "Another very frequent and most serious complication of the continued fever of this country, is catarrh. As I have already stated, all our fatal cases of synochus suffered from it, and in many others it was with difficulty subdued. Antiphlogistic treatment seemed to have little power over it; when once it was established, it ran into the secreting stage, and then the patient's only chance was derived from a liberal supply of wine and nourishment, and the exhibition of the stimulating expectorant medicines; of these, the decoction of polygala, with carbonate of ammonia, was commonly given; and in very severe cases, a bolus of carbonate of ammonia, camphor, and musk, was found to be a most efficient remedy. In some instances, especially in old persons, I found warm punch of eminent service, when wine seemed to have lost power. I do not substitute it for wine in any instance; and these are the only cases in which I have seen any benefit from conjoining it; but here it produces sudden and powerful effects when wine has failed, giving force to the cough, and causing copious expectoration, restoring the warmth and natural colour of the surface, &c."

D. Stimulation in Fever. In the "general management of a case of severe continued fever, it is usually found necessary to change gradually from the expectant to a stimulating mode of treatment. I am in the habit of commencing the change (as soon as there is any appearance of the prostration of the advanced stage) by adding carbonate, or aromatic spirits of ammonia, to the diaphoretic

of iron as an antidote to 'arsenic, in which they claimed for this remedy all the properties of a true specific. With the view of testing the accuracy of their results, Dr. Von Specz prepared a large quantity of the hydrated peroxyde of iron, and instituted a series of experiments with it, on animals.

Experiment 1. On the 5th of October, 1834, at ten o'clock in the forenoon, twelve grains of white arsenic, mixed with a portion of boiled meat, was adminis tered to a cat six months old. At twelve, retching and vomiting commenced. An attempt was made to administer the antidote mixed with water, by means of a tin funnel, but the animal was so extremely restive, that no more than a drachm of the hydrated peroxyde could be given. Death occurred about one o'clock.

Experiment 2. On the 15th of June, 1835, at ten o'clock in the forenoon, a scruple of the white oxyde of arsenic was given in some sausage to a dog six months old. Half an hour afterwards, Dr. Von Specz attempted to introduce the antidote, by means of a syringe furnished with an elastic tube. The dog, however, bit the tube, and was otherwise so unmanageable, that scarcely any could be adininistered. He died at half-past twelve.

Dr. Von Specz finding that the hydrated peroxyde of iron could not be given in a sufficient dose in this way, made the following change in the mode of exhibition.

Experiment 3. On the 28th of October, 1835, at ten o'clock in the forenoon, a drachm of finely powdered arsenic was administered to a mastiff six months old, which had been sparingly fed the day before. About five minutes afterwards, an ounce of the dry hydrated peroxyde of iron, finely powdered, and mixed with a sufficient quantity of fried liver pudding, was laid before him. He ate the whole, and afterwards drank about three ounces of milk. About eleven o'clock, he had some fluid evacuations from the bowels, but still appeared lively. About three o'clock P. M. he looked dejected, went to his bed, and lay there quietly; during the night he had five fluid evacuations. On the 29th, he looked dejected, did not stir from his bed, and neither ate nor drank. On the 30th he ate a little meat, drank about six ounces of milk, and returned to his bed. On the morning of the 1st of November, he was quite lively, and ate every thing that was offered to him.

Experiment 4. On the 10th of December, 1835, at ten o'clock in the forenoon, a drachm of finely powdered arsenic was given in some pudding to a bitch, twelve months old. Five minutes afterwards, an ounce of the antidote was given, mixed with liver pudding, the whole of which was devoured by the animal. At eleven o'clock she went to her bed, appeared shy and timid, and refused to eat. She remained quietly in her bed the whole night, without vomiting or purging. On the morning of the 11th she had three fluid evacuations from the bowels, and did not appear to be ill; on the 12th she was running about as usual.

The foregoing mode of exhibiting the antidote to animals may be employed until vomiting commences; after this occurrence, it must be administered by means of a syringe.

As one sixth of the quantity of arsenic administered in Experiments 3 and 4, is more than sufficient to kill a dog, Dr. Von Specz looks upon the hydrated peroxyde of iron as a true specific, and thinks that its failure in any given case is to be attributed to its being employed too late, or given in too small a quantity. In order to ensure the giving of a sufficient dose, ten times the quantity of hydrated peroxyde of iron must be administered; but a much larger quantity may be safely given, as this remedy does not exercise any deleterious effect on the animal economy. In order to obtain the remedy in a state of purity, and free from any admixture of copper, he recommends the precipitation of the iron by ammonia, and states that this preparation when properly made, and preserved in bottles with good glass stoppers, will retain its virtues for a very considerable time. The following is the mode of exhibition which he recommends in cases of poisoning by arsenic.-R. Olei Amygdal. dulcis, Pulv. Gummi Arabici, Pulv. Sacchari Albi aa 3ij. tere simul et affunde, sensim terendo, Aquæ destillatæ 3xv.; Hydratis Ferrici 3iij; of this mixture, previously well shaken, a dessert-spoonful is to be given every three minutes.

Dr. Von Specz resumed his investigations the following year, but instead of the pure hydrated peroxyde, he employed substances in which it is known to exist in considerable quantity, and which require no previous preparation, namely, rust of iron, and hæmatite (red iron ore.)

Experiment 1. On the 16th of January, 1836, at ten o'clock in the forenoon, a drachm of finely pulverized arsenic, mixed with about an ounce of fried liver pudding, was given to a dog twelve months old. Immediately afterwards, a mixture of two ounces of hæmatite with seven ounces of liver pudding was offered to him, the whole of which he devoured, and then drank a small quantity of milk. Forty minutes afterwards, he was attacked with violent retching; the anterior extremities were extended spasmodically forwards, and the posterior drawn backwards, as is usual in cases of poisoning from arsenic; he also had severe vomiting, and convulsive spasms of the abdominal muscles. At eleven o'clock he went to his bed and was peevish; the retching continued during the afternoon, and he had five dark-coloured evacuations from the bowels. On the 17th of January, he remained the whole day in his bed, refused to eat or drink, and had six dark-coloured evacuations. On the 18th he appeared quite lively, sprang to meet the servant, and ate and drank with much desire.

Experiment 2. On the 19th of March, 1836, at eleven o'clock in the forenoon, a drachm of finely powdered arsenic, mixed with three-quarters of an ounce of liver pudding, was given to a dog four months old, and immediately afterwards an ounce and a half of rust of iron mixed with six ounces of liver pudding. The animal ate only three fourths of the antidote, and then drank a small quantity of milk. At half pas eleven he vomited, but still appeared lively; at one o'clock he had a green evacuation from the bowels. During the afternoon he had five alvine evacuations and frequent retching, but no vomiting. In the evening he went to his bed, and remained there quietly during the night; on the morning of the 20th, he had several dark brown fluid evacuations, but was in other respects lively, had a good appetite, ate bread, and did not exhibit the slightest trace of illness.

Experiment 3. On the 19th of March, 1836, at two o'clock in the afternoon, a drachm of finely powdered arsenic, which had been previously dissolved in two ounces of hot water, was poured down the throat of a dog four months old, while the solution was still warm, by means of a tin funnel, and about ten minutes afterwards, an ounce and a half of rust of iron, mixed with a quantity of milk, was administered in the same way. Five minutes afterwards, the dog was attacked with convulsions and retching, and dropt down as if dead. After fifteen minutes he got up, crawled into a corner, and vomited violently. During the night he had several dark-coloured alvine evacuations. On the 20th he was sullen, and refused to eat; on the 21st he was fresh and lively, and greedily ate some bread offered to him.

Experiment 4. On the 24th of March, 1836, at nine o'clock in the forenoon, a drachm of arsenic, mixed with an ounce of liver pudding, was given to a dog four months old, and then an ounce and a half of hæmatite, mixed with five ounces of liver pudding: the animal devoured the whole. Forty minutes afterwards, he was attacked with retching and convulsions followed by severe vomiting; as soon as the retching ceased, he ate up again what had been ejected from the stomach. At twelve o'clock he began to vomit again, became dejected, and went to his bed; he whined, retched continually, and his jaws were covered with a whitish foam. During the afternoon he had several alvine evacuations of a reddish colour, trembled, and was affected with constant retching and convulsive twitches. In the evening he was more tranquil. On the 25th he was quite lively, sprang to meet us, and ate with a good appetite.

Experiment 5. On the 24th of March, 1836, at eleven o'clock in the forenoon, a drachm of finely pulverized arsenic, mixed with an ounce of liver pudding, was given to a dog three months old, and immediately afterwards an ounce and a half of lapis hæmatites mixed with five ounces of liver pudding; the animal consumed only two thirds of the antidote. Twenty minutes afterwards he begar. to vomit, and at the same time had an evacuation from the bowels: he was then attacked with retching, vomiting, and convulsions, which lasted until one o'clock ;

during this time he vomited six times. At two o'clock he became dejected, shivered, and sought his bed; the retching was extremely severe, and his jaws were covered with foam. These symptoms disappeared about eight o'clock in the evening. On the 25th, he remained in his bed; about ten o'clock in the forenoon, he vomited twice a white frothy fluid; at eleven, he had some fluid evacuations from the bowels. On the 26th, he had several greenish brown evacuations, but appeared lively and ate with appetite.

From these experiments Dr. Von Specz is led to conclude, that rust of iron and hæmatite, although they do not prevent all the bad effects of arsenic on the system, may, in defect of the hydrated peroxyde of iron, be employed as antidotes to that poison. To the hydrated peroxyde, which is capable of neutralizing all the deleterious properties of the poison, he assigns the first rank as an antidote to arsenious acid, next to this stands rust of iron, and then, sed longo intervallo, hæmatite, which, in consequence of its slow operation, may be used without any beneficial result where the poison is exercising a very powerful action on the system. Experiments 1, 4, and 5, of the second series, show distinctly the predominant influence of arsenic on the system, although the hæmatite was administered immediately after the poison, and before its specific effects could be produced. The animals, it is true, did not die, but the counteracting powers of the antidote were not manifested until nearly three hours after its exhibition. These objections do not apply with any thing like the same force to rust of iron, which Dr. Von Specz thinks may be advantageously employed as an antidote in defect of the hydrated peroxyde. Its great efficacy as an antidote is shown in Experiments 2 and 3 of the second series. The remarkable effects of the arsenic in Experiment 3 are to be attributed to the mode of administration, for Dr. Von Specz has repeatedly found that the poison operates much more rapidly when introduced into the stomach into a state of solution. A drachm of arsenic in powder does not produce its deadly effects on the system in less than six or eight hours, while the same quantity dissolved in warm water destroys life in a much shorter time. Rust of iron has also the additional advantage, that it can always be procured with facility.

Med. Jahrbücher des k. k. O. St. xix Band. 4 Stück. xx Band. 1 Stück. 1836.

SURGERY.

DISLOCATION, WITH EXPOSURE, OF THE ELBOW JOINT.

BY JOHN H. DAYTON (SAG HARBOR, N. Y.)

(In a Letter addressed to the Editor.)

I send you a brief account of a case which, so far as I recollect, is unique. On the 7th September last, Charles Mott, æt. 12 years, fell from a horse, dislocating the elbow, 2 o'clock, P. M. When first seen, presented the end of the radius, and the olecranon process, which had passed round the condyle of the humerus, protruding through a transverse wound on the inside of the arm, one inch above the bend. The artery, veins, ligaments, and in fact the whole of the soft parts except the nerve, completely torn across; the synovia escaping from the wound, which was nearly two inches in length, and the fore-arm flexed backward upon the arm. Had bled as near as could judge iss. With the assistance of my friend, Dr. Lord, the dislocation was easily reduced, the soft parts retained together by adhesive strips, and the arm kept in a semi-flexed position by a splint and bandage. After placing him in bed, with warm flannels about the limb, the pulse 50 and weak, ordered a weak sling. At 9 o'clock,

P. M., pulse 60. Slight oozing of blood, some pain; slacked the bandage above the elbow.-Tinct. opii m xv.

Sept. 8th. 9 o'clock, A. M., slight swelling, pain, thirst, tongue white, numbness of the arm; pulse 70; sulphat magnesia 3ij. 9 o'clock, P. M., more swelling and pain; two evacuations. Bandage loosened in its whole length, arm extended to the best position in expectation of anchylosis.-Tinc. opii m. xv. Sept. 9th. Swelling increases; pain, numbness, thirst as before; pulse 85. Bandage slacked.-Lemonade.

Sept. 10th. Free evacuation of the bowels. Slept well; pulse 95; otherwise as before.

Sept. 11th. Less pain, oozing of pus, pulse 90. Doing well.

Sept. 12th. Removed the dressing. Two-thirds of the external wound closed by adhesion, dressed with dry lint, free flow of pus; pulse reduced to 70, inflammation much abated.

Sept. 14th. Redness, pain, heat, and swelling, gradually subsiding. Pulse natural, oozing of a thin watery fluid, dressed the wound with salve.-R Acet. Plumb.3ij; Sulph. Soda 3iiij; Cera Flava, Axunge aa Hj.

Sept. 238. General appearance the same.

Sept. 26th. Some increase of heat, redness, and tumor; slight irritative fever; hit it severely yesterday.-Six leeches to the part, sulphat magnesia 3ij. From this to the present he has been constantly, though slowly, gaining. There is flexion and extension to the extent of five or six inches, but very little if any rotation. The arm is somewhat less than the other, and entirely without pulsation at the wrist. What appears singular to me in the case is, that both bones protruded through the wound on the inside of the arm without fracture of the olecranon.

OBSERVATIONS ON EXTRACTION AND DISPLACEMENT OF THE

CATARACT.

By J. A. ROBERTSON, M. D., Surgeon to the Eye Dispensary of Edinburgh. THIS is a very excellent statistical and practical paper, and, as far as it goes, places in a clear light the relative success resulting from the different modes of performing the operation for cataract. Dr. R. passes in review the advantages and disadvantages of-1. Division, or breaking down the lens in situ; 2. Extraction; 3. Displacement; including Depression and Reclination; in the former process, the lens being pushed perpendicularly downwards; in the latter, the lens being imbedded in the vitreous humour, with its anterior surface turned upwards and its upper edge backwards. We can only find room to give some of the numerical results deduced by Dr. R. from the collation of numerous cases, and the conclusions which he has found himself warranted to draw from the whole faets and reasonings.

Out of 1307 operations by Extraction, there were 397 failures, or 30 per cent. (nearly). Out of 5729 operations by Displacement, there were 1004 failures, or 17 per cent. (nearly). This last series includes a great number of operations by Depression as well as Reclination; and Dr. R. remarks, that inasmuch as the latter operation is preferable to the former, so ought the results to be much more favourable if all the cases had been operated on by Reclination. The preceding results are collected from the writings of others. Dr. Robertson subjoins a statement of 179 cases of hard cataract, without any complication, operated on by himself. The results were as follows: