repast, avoiding generally, pastry, and what are called made-dishes; batter or bread-pudding may be added to the two articles selected for the day. Spirits in all their various forms, and delusive names, I hold utterly objectionable, and malt liquor should be avoided, considering it much better to drink water, or toast and water during dinner, even to the admission of a glass more wine than might otherwise be allowable. If soup be taken, it should beof the simplest kind; for instance, gravy with vermicelli. Brown bread made of flour, from which only the coarsest bran has been taken (but none of the farinaceous parts), may, with great advantage, be substituted for the bakers' bread of London; if this cannot be obtained, biscuit may be taken. Wine is a very important consideration connected with the diet of that class of persons subject to Gout. The quantity should depend much on previous habits; but, I am of opinion, as a medium rule, a pint of sound wine may be taken with impunity during and after dinner, when free from an attack; and the first rule as to choice, I think, is, that which has been found to agree best, avoiding the delusion, though, of considering that the best, which has been found most apt to fix a wandering, or direct a misplaced Gout, to some part more agreeable to the fancy -and I am of opinion that Madeira wine, from some latent acid or other quality, has obtained so much favour, because it is most productive of Gout: if the digestive powers of the stomach be good, I know of no wine better than sound old Port, that has deposited its tartar; should this not agree or not please, the next to be preferred is sound old. Sherry. I have drank some Hermitage, to which I think no objection could be made. Claret may be taken, but should be carefully chosen, none but the very best being admissible. Two or three glasses of Sauterne wine may be drank (drunk): Hock and Cyder should be avoided.

With these few and simple remedies I have named, may every case of Gout be combated and subdued, as certainly and safely as any other severe disease,

and all the deformity and decrepitude we too often witness prevented.

Dr. Leese has amused himself (probably during some comfortable immunity from gout) with a laugh at the absurd speculations which have been hazarded by eminent physicians, ancient and modern, respecting the nature and treatment of this painful malady. We have been too poor and too industrious to be honoured with visits from this aristocratic guest-therefore we cannot lay claim to so much personal experience as Dr. Leese is possessed of. We have seen a little of the complaint, however; and we cannot by any means agree with our author, that gout differs in nothing from common inflammation, except from the nature of the parts which it attacks. Why does gout so generally affect certain parts? Why did Dr. Leese so regularly have attacks of inflammation in his great toe, after indulging in East India Madeira? This looks something like a specific inflammation. How did it happen that the worthy Doctor's nose did not sometimes turn red, instead of his great toe?

HEMIPLEGIA IN PREGNANCY.

There are very few cases on record, where a female has suffered apoplexy and hemiplegia in the last stage of pregnancy, and come through delivery with ease and safety. A case of this kind is recorded by Dr. O. Roberts, in the Liverpool Medical Journal for June last. The female, aged 40, was seized with apoplexy in the middle of the ninth month of pregnancy. She was copiously bled, and when she came to her senses, one side was completely paralysed. Nevertheless, labour took place, and both child and placenta were expelled before the accoucheur could arrive. The uterus contracted well, and no flooding occurred. A case nearly similar is related by Dr. Kellie, of Leith, in Cheyne's work on apoplexy. The woman was in the last month of pregnancy, and had a regular apoplectic attack, followed by complete paralysis of the right side.

She was

safely and easily delivered of a living child. She died of the apoplectic attack, however, a day or two afterwards. These two cases are deserving of record, as marks to guide the prognosis in similar emergencies.

CARDITIS-CEPHALITIS?

In the fifth Number of the Quarterly Medical Review, Dr. Stroud has narrated, with great minuteness, a case of the above nature. The patient was a married woman, aged 31 years, the mother of four children, and then suckling, though with difficulty. She had been labouring for a fortnight previously under febrile symptoms, with pain in the back of the head, at the pit of the stomach, and in the loins and limbs. She now has cough, sleeps little, and is sometimes delirious. The pulse is 130, and weak. The tongue white, with red edges-thirst-anorexia-urine natural-bowels confined. The cause of these phenomena is attributed to fatigue, anxiety of mind, and exposure to cold air. Leeches to the temples-salines-sudorifics. This was on the 15th Nov. 1831. 20th. Not much change. The head to be shaved, and the infant weaned. The pulse is nearly 140, and weak-troublesome cough, and hurried respiration. Soothing medicine. 22d. Pain in the back of the head severe, with some intolerance of light-face flushed-pupils contracted-sleep interrupted-delirium occasional. Cupping-mercurial frictions-salines. 23d. Pulse 120 to 140, and very weak-tinnitus aurium -cough troublesome, with "hurried breathing, frothy expectoration, and pain in the middle of the chest." Venesection to eight ounces-blister to the chest-salines-mercurial frictions. 25th. Bore the bleeding well-blood nearly natural-gums slightly affected -pulse 130, and feeble. 27th. Cough dry-breathing hurried delirium pulse very frequent and feeble-" respiratory murmur, now for the first time examined, is sufficiently audible." Venesec. ad zviij., salines, aperients, di

"The ac

gitalis. 29th. Relieved by the bleeding-blood nearly natural. tion of the heart, examined this day for the first time, was found to be very strong, although the pulse at the wrist was extremely small and weak." Venesection to 12 or 16 ounces-leeches to the præcordial region, &c. Dec. 3d. The bleeding and leeches gave relief. "The patient is considerably better." Pulse 112, hard dry cough. 5th. Patient rather worse-pulse 120. V.S. ad zviij. vel zxij. 7th. A miliary eruption has appeared on the head and neck, accompanied by profuse perspiration. The heart sometimes palpitates; but the breathing is tranquil-pulse 120, and weak.

18th. Pulse 140, and excessively weak. On the 28th, we find that a previous bleeding had given great relief, and that the pulse had fallen to 98, the action of the heart being tranquil, and the breathing easy.

We need not pursue the narrative any longer. She menstruated on the 8th of January; and we find that, in the middle of February, the pulse was still 120 and weak, in the sitting posture and after walking. She afterwards slowly recovered, retaining for some time a disposition to irregularity of the heart's action. She became pregnant -was safely delivered, but unable to suckle well her child. In February, 1833, she had a slight return of the cardiac affection, from which she recovered by antiphlogistic treatment.

Remarks. We were a little surprised, on perusing the above case, to see that auscultation was not employed till 12 days after Dr. Stroud had commenced his attendance-and, even then, the action of the heart was not examined. Two days afterwards, when that organ was examined, we venture to say that Dr. Stroud was surprised to find it in a state exactly the reverse of that indicated by the pulse. The depletive measures were then employed with a bolder hand, and we find a corresponding relief obtained. The case is very valuable, as exemplifying the exceeding fallacy of the pulse. Very few would have ventured on venesection at all, if guided by the state of the pulse in the fore

going case; yet we have not the smallest doubt that carditis was going on from the beginning. We are inclined to think that the affection of the head was secondary, or owing to the rapid circulation rather than to actual inflammation. Nothing is more common than these sensorial disturbances, when the central organ of the circulation is in a state of inflammation, or even excitement. We have no fault to find with Dr. Stroud's pathology or therapeutics; but we are much deceived if the above case does not put him more on his guard, in similar cases, for the future, and induce him to compare the action of the heart itself with that of the arteries, whenever there is any doubt as to the state and condition of the circulation. We advise all practitioners to examine the state of the heart and lungs in all cases—were it only for the sake of becoming intimately acquainted with the normal, as well as abnormal functions of the thoracic organs.

ENDEMIC DYSENTERY.

The Edinburgh Charity Workhouse was visited with a severe dysentery, in the years 1832 and 3, of which Dr. J. Smith has given an account in a recent Number of our Edinburgh contemporary. The house stands in the healthiest part of the town, but the inmates are generally infirm, especially on entering the asylum, though they gain flesh and retain good health while there. The diet is chiefly vegetable and farinaceous, with a small proportion of animal food. During Summer and Autumn, they are usually affected with bowel-complaints, as diarrhoea, dysentery and English cholera." In the Winter and Spring of 1832, when the epidemic cholera was at its height in the Lunatic Asylum, 150 yards distant from the workhouse, the inhabitants of the latter escaped-partly, Dr. Smith thinks, from the rigid quarantine_established there! Nevertheless, in July of the same year, dysentery broke through the rigid barrier, and scourged the paupers. That this dysentery was

66

a grade of the epidemic cholera which prevailed in the less healthy parts of the town, is as clear as the sun at noon day. The following description will satisfy the most sceptical.

The attack generally commenced with vomiting and purging, pain of the abdomen, and a considerable degree of fever, the pulse in many cases being frequent and sharp, and the skin dry and hot. In others, however, a degree of collapse followed the vomiting and purging, the pulse was small and feeble, the surface cold or covered with clammy perspiration, and the features sunk. In some cases diarrhoea went on for several days, when tormina and tenesmus succeeded. The matter vomited was generally the ingesta or mucus. It was seldom or never bilious. The pain of abdomen varied very much both in degree and in situation, although it was very generally referred to the umbilical and hypogastric regions.

The epigastric region was often the seat of it, and then there was great irritability of stomach, and vomiting, and a constant burning sensation. In some, the abdominal tenderness was very trifling; but this by no means indicated a mild form of the disease, for the patients to whom this happened, feeling no pain often allowed the disease to go on till it was in its worst stage. The state of the tongue was various; at the commencement, when fever was present, it was dry and furred. It was often coated in the centre, but moist and red at the edges. This might be considered the most frequent condition of the tongue. In the most aggravated cases it was dry, parched, and red; and in some, when the other symptoms denoted a severe form of the disease, it was almost natural. Thirst was generally an urgent symptom, but more particularly in the advanced stage of the disease, when there was great gastric pain and irritation. In such cases there was a constant desire for cold water to relieve the burning sensation in the stomach.

The sound of the voice was in many cases peculiar; it was low and whispering, particularly when there were

symptoms of collapse. The respiration was not affected in such a way as to be remarked as a characteristic symptom. Tenesmus was present in every case, and in the advanced stages the distress attending it was truly harassing. The desire to go to stool was constant, from the feeling that there was always something in the rectum to be evacuated, and the patient, if allowed, would never have ceased straining.

The appearance of the dejections was very various, but always without bile."

To us it appears clear, that the above disease was owing to the general epidemic influence then prevailing, but modified by the insulated locality, diet, and other circumstances of the institu

tion.

On dissection, the large intestines were found thickened, ulcerated, and otherwise organically affected. The submucous tissue was highly injected. These changes were far from being the cause of the dysentery-they were most undoubtedly the effects. They aggravated the disease, and were the chief cause of the fatal termination; but they were not the cause of the dysentery. In many fatal cases of typhus, we find ulceration of the bowels; but it is an erroneous opinion, that these ulcers constitute the essential pathology of typhus.

Treatment. Our author having witnessed the good effects of large doses of calomel in Asiatic Cholera, and having failed in his treatment of the dysentery by the more common means, had recourse to scruple doses of the submuriate.

"It occurred to me, that between the symptoms of cholera and the endemic I had to contend with, there was considerable resemblance. Both diseases came on in the same way, by vomiting and purging. What was ejected, although not the same in both, yet agreed in this particular circumstance, that it was without bile. There was a burning sensation at the pit of the stomach, along with a desire for cold water in both. The post-mortem appearances exhibited this similarity, that the gall

bladder in both diseases was found invariably distended with bile."

The result proved that he was right in his conjectures respecting the affinity of the two diseases. He exhibited calomel in scruple doses, and "the immediate results of the experiment went far beyond my most sanguine expectations." "In no case where the system was brought under the influence of calomel, and ptyalism induced, did a fatal termination ensue."

"The greater proportion of cases not requiring bleeding, the calomel was in general at once had recourse to, in the dose of a scruple, sometimes with the addition of a grain of opium, to be repeated every four or six hours, according to the urgency of the symptoms, and continued till ptyalism was produced. This effect, if it was to take place, was commonly produced in twenty-four or thirty hours, when the calomel was intermitted, and a dose of castor oil was ordered.

The immediate effect of the calomel seemed to be to produce a flow of bile into the intestines, and the stools, which before consisted of blood, mucus, pus, and shreds, now presented the appearance of bile, and were spinach-looking.

As soon as the bile was observed in the stools, an immediate abatement of the symptoms took place-the vomiting and tenesmus were relieved-the pain of abdomen and heat at the pit of the stomach were diminished-and the patient was considered out of danger."

Notwithstanding the large quantities of calomel that were often given, severe salivation did not occur in more than two or three instances.

PLEURO-PNEUMONIA ?

An interesting case is related by Dr. Hamilton, of Falkirk, in the last number of our Northern contemporary, which we deem worthy of notice. Thos. Hansie, aged 50, a strong-looking, hale man, who reported that he had enjoyed good health for 20 years past, complained of an acute pain in the lumbar and hypogastric regions of the left side,

with tightness of the chest, strong quick pulse, some cough, tough sputa. Subcrepitating râle was heard in the lower part of the chest on that side-the respiration tolerably good in the rest of the chest. This was in the middle of July. By the 5th of August, the symptoms were so far subdued by the usual antiphlogistic means, that medical attendance was not deemed any longer necessary. A small blister was recommended to be kept on the side for a few days. Exactly a month after this (6th Sept.) Dr. H. was summoned to the patient, and found him in a very altered condition. He had become emaciated, with anxious countenance, and prominency of the left side. On examination, the ribs were less distinctly visible on this side, and he complained of pain here, and a distinct feeling of airy crepitation could be felt with the hand in the subcutaneous cellular tissue, between the second and third ribs, near the sternum. Here was a tumor, about the size of half an egg, cut in the long diameter. When this was gently pressed, it conveyed the feeling of air, contained immediately beneath the skin; and, when a greater degree of pressure was employed, there was a feeling, as if the air passed through a fluid into the chest. The tumor did not immediately reappear when the pressure was removed. When the patient coughed, a strong impulse was sometimes conveyed to the hand through the tumor, similar to that felt, under similar circumstances, in hernia. A strong gurgling sound was heard through the stethoscope at this place, together with the metallic tinkling, during respiration. Over a large portion of the anterior part of this side, and except in the region of the heart, the same sounds were heard, but less strongly. The respiratory murmur was wanting in the whole of the left side, except faintly at the back part, near the spine. The sound, on percussion, was much duller in this side than natural. Catarrhal râles were heard slightly in the right side. The sputa were muco purulent, and sometimes considerable in quantity. He was ordered to be cupped, and to take

calomel and opium. Sept. 15th. Has been recruiting much during the last week-appetite good-perspiration less -can lie on the right side-expectoration diminished-tumor has disappeared. Has some diarrhoea still-the calomel and opium to be continued. 17th Sept. The sound on percussion is much clearer than it was. Gargouillement can be heard with the stethoscope about the middle of the anterior of the left

side. The respiration is cavernous on a level with the fourth rib anteriorly. Beneath the clavicle, and close to the sternum, there is gargouillement. From this time he continued to improve, and about the middle of November he was able to work. On the 27th November, Dr. H. had an opportunity of examining the patient. In the situation formerly occupied by the tumor, the skin felt more dense than natural, so that the rib could not be distinctly traced. The respiratory murmur was distinctly heard on the posterior part of the left side; but the sound, on percussion, was still duller than on the right side. The man was then strong, and worked as a porter. On the 25th April, 1834, the man continued in good health.

Different opinions were entertained as to the precise nature of the lesion in this case. For our own parts, we have no hesitation in coinciding with Dr Hamilton, that pleuro-pneumony was the first link in the chain-that sero-purulent effusion followed-that a communication took place with some of the bronchi-and that the matter very nearly made its way externally be tween the ribs. This, we believe, was the actual state of the case. The patient was fortunate to escape with his life.-Eds.

CHOLERA.-DR. HAWTHORNE.*

The author of this pamphlet avers that "his mode of treatment differs from every other that has yet appeared be

* A Dissertation, &c. Octavo, sewed, pp. 53. Oct. 1834.