in the right iliac fossa, situated near the line of approach of the fibres of the iliacus and psoas muscles. The gentlest manipulation at this point gave him pain. Being cognizant of the opinions of Dupuytren, as they are recorded in the very interesting memoirs of MM. Husson, Dance, and Meniere,† we were prepared for the serious involvment of some of the important structures comprehended within the region of the right iliac fossa. And there is no doubt that this foreknowledge, so to speak, invested the case with more than an ordinary share of interest. It may be stated in this place, that our patient had been in vigorous health up to the moment of his seizure, and that his bowels had always been regular. It soon became manifest that leeching, and other depletory measures, only weakened him, without at all checking the progress of the intumescence. His easiest position in bed was having the trunk elevated, so as to meet the limb, and the thigh and knee gently flexed, and thus supported by means of a doubled-up pillow placed under the ham. Being aware of the necessity of not wasting his strength, the mildest form of aperient medicine, and of enemata, was employed: the body and bed linen, and the alvine evacuations, were from day to day inspected; but no pus ever escaped by that route. Indeed, throughout the illness, there never was any disturbance nor obstruction in any portion of the intestinal canal, to lead us to expect that the caput coli was in any way implicated, or that it was to become the medium of outlet. By the twelfth day, the boundaries of the abscess (for abscess it was) had so far encroached on the natural hollow in the right flank as to raise the parietes to a level with the crest of the ilium. We were exceedingly anxious at this stage to detect the earliest sign of fluctuation,-because, among other reasons, some degree of constitutional disturbance had set in, as denoted by a brown tongue, rapid pulse, and occasional, but slight delirium. On the sixteenth day, fluctuation having been detected, a small cornea knife was introduced obliquely through the parietes, so as to make a valvular opening into the abscess, at a place about an inch inward and downward from the crest of the ilium, and about two inches upward and backward from the superior anterior spine. Thick pus, of a good colour, but of a fetid odour, escaped in a steady stream. Not the weight of a feather was allowed to touch the parietes while it was flowing. Numerous small specks, evidently the elements of blood, were noticed in the discharge. So long as the tonicity of the structures urged the contents through the opening, so long we waited, and then the simplest and lightest form of dressing was applied, care at the same time being taken to guard the abdomen against pressure. Only in a very slight degree was the power regained, to extend the limb on the trunk, after the opening of the abscess. During several succeeding days, the irritative fever persisted, and to the former symptoms were now added, heavy perspirations, and frequent intermissions in the pulse. However, he passed over this period of peril, and at length rallied, so that at the end of six weeks, he was permitted to go into the open air. We shall not enter into a detailed history of phases through which the diseased structures passed during a period of two years and a half afterwards. It is sufficient to mention, that fistulous sores made their appearance in different places; one was situated on the outside of the iliac bone, below its crest, leading us to believe, that an eroded hole of communication had been formed in the thin part of the bone, with the abscess within the pelvis. There was a fistulous opening also, on the inside below the crest, nearly opposite to the one just mentioned. A regular drain was established also by ulceration, underneath Poupart's ligament, and for several weeks, the matter secreted within the pelvis (but in very small quantity) made its way out at the groin. The glands in this region, and the superficial lymphatic vessels in the upper third of the thigh, became the seat of slight ulcerations during a very long period afterwards. Finding himself still lame, our patient decided on going to London. He was separately and carefully examined by three of the eminent surgeons there, but he returned dissatisfied with the result of his visit. No change took place until the beginning of December 1832,when symptoms indicative of congestive inflammation of the liver, manifested themselves, and, in spite of every means used, the disease advanced to a fatal termination on the 11th March 1833. Tuesday, March 12, 1833-Examination of the Body.-The integuments in the right hypochondriac region were in an empurpled and oedematous state. There were strong adhesions between the convex surface of the liver and the floating ribs on the right side, the separation of which opened a large abscess in the substance of the liver, from which four pints of matter issued. This abscess had destroyed almost the whole right lobe of that organ, leaving walls of a thickness varying from one-eighth of an inch to one inch. The exterior of the convex surface, where thinnest, was gangren ous. The upper convex surface adhered firmly to the diaphragm. The spleen was healthy. Between the under surface and lower edge of the liver and the ascending colon, were strong adhesions, which seemed to be of recent origin. When these were separated, the abscess was again opened at this point. The right kidney was more than double its ordinary size, and was seated two inches lower than the left one. Its posterior superior portion was diseased in structure, and had a pale mottled appearance like that exhibited in some of Dr Bright's figures. Some purulent matter escaped into its pelvis, from the contiguous suppurating structures, on cutting into this portion. The caput coli was attached to the right iliac fossa, by very strong, almost cartilaginous adhesions. The appendix vermiformis was tied down by condensed cellular membrane to the colon, and its middle portion was obliterated for about one inch, while its extremity, instead of being closed, communicated with a small abscess seated between the muscular and peritoneal coats of the caput coli. The fistulous ulceration in the integuments on the inside of the flank was in communication with the small abscess, already mentioned as being seated between the muscular and peritoneal coats of the caput coli. The lower fistulous opening in the groin was in communication with an abscess of limited extent, seated in the substance of the psoas magnus muscle, and, with another abscess situated between the iliacus internus muscle and the bone-what remained of the fascia iliaca was found to be inseparably and undistinguishably united or blended with the peritoneum. The muscular fibres, more especially those of the iliacus internus, were converted into a yellowish-white, almost cartilaginous substance. The iliac bone was bare to a small extent-about the size of a sixpence-just within the internal lip, about one inch below the crest, but there was no opening through the bone to the outside. A communication had been established during life between the inside and the outside of the iliac bone; but this, it appears, had been effected by the matter flowing over the lip of the crest, whenever the accumulation within had arrived at a point of elevation above that level. ART. X.-On the Physiological and Therapeutical Effects of Colchicum autumnale. By ROBERT LEWINS, Junior, M. D. &c. [This communication is an abridgement of the Essay which the Harveian Society honoured by presenting to the Author their Annual Prize.] In order that the physiological and therapeutical properties of any active medicine be rightly understood, it is indispensable to have an accurate knowledge of the effects it produces, when administered in large and small doses. Above all, it is necessary to ascertain the quantity which can be prescribed with safety. That we were lamentably deficient on this essential point, with reference to Colchicum autumnale, is abundantly evinced by the remarks and prescriptions of medical writers. Indeed, it may be asserted that many highly respectable members of our profession are ignorant of the proper manner, and even of the dose in which this active medicine ought to be administered. Dr J. Johnson, editor of the Medico-Chirurgical Review, at a public discussion a few years ago, expressed his disbelief that one drachm of the tincture of the seeds given every three hours would produce a fatal effect.* The late Dr Duncan, in his Dispensatory, has stated that half an ounce of the tincture of the seeds is the proper dose,+ and in Dr Spillan's work lately published, entitled a collection of Medical Formulæ, a draught, containing amongst other ingredients, half an ounce of the tincture of the seeds, is ordered to be given every sixth hour, Dr Elliotson prescribed half a drachm of the wine of the seeds of colchicum, to be taken three times a day for a period of three weeks, and, in another case, he gave the same dose every eighth hour for several days together.§ Dr Armstrong recommends one, and even two drachms of the wine of the colchicum to be taken in the course of twenty-four hours, and continued for some time.|| Dr Barlow of Bath, certainly very high authority on this or any other medical subject, gives the following hazardous directions with regard to its employment. "It may be given either in full doses, so as to purge actively, or in divided doses, frequently repeated. One drachm, one drachm and a half, or two drachms of the tincture of the seeds should be administered at night, and repeated, if necessary, next morning. This quantity will generally purge briskly, but if it fail, another dose the following night will be pretty sure to succeed, at least, as far as my experience goes, I have seldom found it necessary to exceed these doses." Other distinguished members of our profession have given equally dangerous directions as to the mode of administering colchicum. I may here also remark, that death resulted from a dose of two drachms of the wine of the seeds, given to a patient in a public hospital a few years ago. A fatal case is also recorded by Mr Haden in his translation of M. Magendie's Formulaire, where two drachms and a half of a tincture, made by infusing four ounces of the root in eight ounces of proof-spirit for three days, had been administered; and I may also allude to a case which fell under my own observation only a short time ago. On Sabbath, November 22, 1840, I had an opportunity of seeing W. D. aged 23, who had consulted a distinguished practitioner of Edinburgh, in consequence of pains in his extremities, and cough, from whom he received a prescription, of which the following is a copy: B. Vin. Sem. Colchici Vin. Antimon. a zi.; Tinct. Hyoscyami, 3ss. M. S. A tea-spoonful to be taken three times a day, which is equivalent to one drachm of the Vinum Colchici daily. This quantity had been persisted in for a week regularly, with the most prejudicial effects. The patient laboured under violent diarrhoea since the second day after taking the medicine, and had he persevered in its use for twenty-four hours longer, it is probable he would have perished. His pulse was 170 in the minute; his strength most alarmingly reduced; he could only speak in a whisper; he See Lancet, Vol. xv. p. 698. + See last edition of Edinburgh New Dispensatory, p. 953. See Lancet, Vol. xii. p. 540. See Lancet, Vol. vii. viii. p. 97. § See Lancet, Vol. ix. p. 395. Cyclopædia of Pract. Medicine. Article Gout. complained of great pain in the abdomen; and the bowels had been moved upwards of twenty times in the course of the day. Astringents, in various forms, were had recourse to in vain, until a com. bination of opium and acetate of lead was prescribed, which speedily checked the exhausting diarrhoea, and obviated the other mischievous effects which had resulted from the improper administration of the colchicum wine. The effects of colchicum, when administered in larger and poisonous doses, are well exemplified in the following cases related in the twenty-sixth volume of the Medico-Chirurgical Review; which coincide, in most respects, with those which I witnessed in dogs, where a sufficient dose was administered to produce death, as will be related in a subsequent part of this paper. Madame de B. 25 years of age, swallowed a large quantity (a wine glassful) of the tincture of the bulbs of colchicum, with the view of destroying herself. She was immediately seized with most severe pain in the epigastrium. Two pints of milk were administered in about half-an-hour after the act had been committed, and subsequently two grains of tartar emetic were given. Copious vomiting of a brownish fluid ensued. M. Caffe did not see the patient till nearly six hours after the accident. He found her cold and very pale, complaining of tenderness in the epigastric region, a sense of constriction around the chest, and of great dyspnoea. There was no stiffness nor any convulsive movements of the limbs; the lips were of a purple hue; the pupils were not dilated, nor was the vision affected; the tongue was pale and cold to the touch; there was an almost constant vomiting, but no purging; the pulse was very slow and thread-like; and the patient, who was quite sensible, was tortured with a burning thirst; and every now and then she uttered the most distressing groans. M. Caffe administered iced aerated water, and ordered sinapisms to be applied to the feet, and embrocations to the limbs and abdomen. On the following morning there was complete prostration of all the vital powers, the retching continued, and the cramps in the feet, although not so severe, were still present. Sinapisms were applied to the thighs, and a few leeches to the epigastrium. The patient became gradually weaker, and death took place in the afternoon-twenty-two hours after the poison had been swallowed. The body was examined seventy hours after death. Putrefaction had already commenced. Most of the parenchymatous viscera were congested with dark-coloured fluid blood. The stomach and intestines were removed, and set apart for the purpose of analysing their contents. On the following day they were examined, but unfortunately putrefaction had already advanced so far as to have altered considerably the appearance of every part. The mucous membrane of the intestinal canal, in different places, was of a wine-red colour; but no dependence could be placed on the result of such an examination. Equally unsatisfactory was the chemical analysis of the contents of the bowels. Strange to record, the sister of this patient, a girl of about 20 |