then vid, black, greenish, golden-yellow, or straw-coloured., The sputa, during pneumonorrhagia and peripneumony, is often yellow also, not from bile, but from the guttula of blood; and the fæces often vary from yellow to æruginous, when the ductus choledochus is obliterated. He gives the CASE of a girl, who had broad scorbutic maculæ over the skin, alternating with epistaxis, or with intense yellowness of the whole skin, even to the palms of the hands, and soles of the feet; but the albuginea of the eyes remained of a clear white, and no other symptom of icterus was present. In jaundice, the very bones are tinged with yellow, and the teeth, except the enamel. Morgagni says, the substance of the brain is not tinged, though Frank says it may; and he has found the milk of nurses yellow, greenish, and even bitter. The skin is chiefly tinged on the neck, breast, abdomen, and arms; and the bile oozes out with the perspiration, and colours the clothes. Celsus gives a CASE, in which yellow water instead of blood was drawn off by cupping. It is very singular that the tongue and mouth, often remain of a bright red, and without any bitter taste. Frank gives a CASE of icterus calculosus, in which the colour of the face and eyes remained white and beautiful. In old persons, the tongue sometimes appears as if covered with ink at its root. Frequently the itching of the skin, particularly towards night, becomes intolerable. It is observed, to be sometimes relieved, and sometimes increased by micturition. He gives his decided testimony against the vulgar error, that objects appear yellow to the jaundiced eye; an error, which must have originated in the yellow colour of the albuginea. The abdominal affections are inflation, tension, pain, spasm, colic, gripes, flatus, borborigmi, difficulty of breathing, oppression of the stomach, loathing of food, nausea, drowsiness, acid and acrid eructations, and singultus. Fever is often absent, but there is langour, sadness, anxiety, prostration of strength, and it is not rare to observe fever supervene to these with shiverings, and alternate flushes.

It is known that GALL-STONES, may be found in the substance of the liver, as well as in the gall-bladder or the ducts. Frank, however, is not disposed to consider all calculous concretions found here, to originate in bile; as he has seen instances in which this could not have been the case. The proper gallstones, are from the size of a barley-corn, to that of an egg; and round, oval, or triangular in form. They are usually single in the bile ducts; but often numerous in the gall-bladder.

In ICTERUS CALCULOSUS, the symptoms arising from the actual irritation of the gall-stone, may be slight; but are often ushered in by sudd en pains in the right hypochondrium, which are acute,

cutting, and lancinating; and nausea, cardialgia, vomiting, hard small pulse, cold extremities, convulsions, anxiety, and fainting succeed; and are followed by the characteristic symptoms of jaundice, above noted. This continues till the gall-stone is removed, either by the stomach or the bowels; or goes on with aggravated symptoms till death ensues. The diagnosis of jaundice arising from gall-stones is, however, exceedingly obscure, and difficult; and it is to be remarked, that they do not always produce icterus, as dissection has proved, that a thousand gall-stones may be found, and they may even distend and obstruct the gall-bladder and the ducts, without producing jaundice, and sometimes without apparent disease.

The CAUSES of biliary calculi are unknown; for neither the sort of food and drink, nor the atony of the primæ viæ will explain it; but their greater prevalence among females, than males, in the proportion to about five to one, would lead to the inference, that, from sedentary and relaxed babits, the stagnation of the bile disposes it to crystallize, or to become inspissated by the absorption of its more fluid parts.

When it is ascertained, as far as in so difficult a diagnosis it can be, that icterus is caused by obstructing gall-stones; their passage through the ducts, is to be promoted by emollient fomentations and clysters, the warm bath, and unguents; such as laudanum with the emulsion of gum arabic. From the observation, that cattle fed in stalls, upon dry hay, generate gallstones, which are voided, when the cattle are sent to good summer pasture; there have been prescribed, extracts of grass, taraxacum, and endive. Gum ammoniac, various salts, and even mercury, have also been exhibited. From their chemical quali ties, much was expected from alcohol, turpentine, and ether; and Frank prescribed a mixture of three parts sulphuric ether, with two parts spirits of turpentine; two scruples to be taken in whey. But the patient could not, on account of the nauseous taste, be induced to take it twice; and besides he has little faith in it, as it can only act on the stomach and intestines, and cannot reach the ducts, to dissolve the calculi. Bleeding he found useful, but sees no advantage in mercury or nitric acid. Emetics are dangerous.

SPASMODIC JAUNDICE may arise from terror, from anger, from cold bathing, from concussion, wounds, or fractures of the cranium; from viper bite, from emetics or drastic purgatives, from incarcerated hernia, metastasis of rheumatism, or colic, or from pregnancy. That this affection does not arise from compression of the ducts by tumours, or otherwise, is manifest from the unusually relaxed state in which they are found after death. It

occurs chiefly among the nervous and debilitated, and among infants, and hysteric women. In TREATING it, all depletion and evacuations must be carefully avoided, as these are not only useless but hurtful. Unless there is complication, therefore, we are not to be deceived by bitterness of the mouth, with nausea and vomiting. Anodynes are best in small doses, frequently repeated; and ammonia or ether, in infusion of chamomile; or an emollient, not a purgative, clyster, with the hip-bath.

The other species of jaundice he treats upon similar judicious principles, adapting the cure to the cause of the disease, and the temperament and habits of the patient.

The observations of our author on URINARY CALCULI, are equally excellent and just; but as the cure of these affections by medicines, hypothetically called lithontriptics, is extremely doubtful, if not altogether fallacious; and as he does not enter into the surgical part of the subject, we think, that our readers will excuse us for omitting what is of little practical utility, except to prevent them from trusting to delusive remedies. Lithontriptics may, however, be of use, as preventives after the operaration of lithotomy.

ON THE SYMPTOMS AND TREATMENT OF HYDROPHOBIA, WITH SEVERAL SUCCESSFUL CASES, BY M. M. Brera,

WEST, AXTER, &c.*

By making attempts to cure diseases, which have hitherto baffled all medical skill, success may be, sometimes, unexpectedly attained, or palliatives of considerable efficacy may be discovered. When we are called, therefore, to a patient labour. ing under hydrophobia, or any other malady, held to be incurable, we ought to examine the circumstances of the case with the greatest care, and use the most powerful means, to palliate

Commentario Clinico per la cura dell' Idrofobia. Del Cavaliere, V. L. Brera, in Mem. Soc. Ital. Scienz. Modena. Tom xvii., Parte Fisica.

Example sur un enfant de cinq ans et sept mois, de rage communiquée par la morsare d'un chien. Par M. West, in Magendie's Journ, de Physielogie, ii. 91. M. Michel Axter, in Nouvelle Bibliotheque Germanique, Medico Chirurgicale. Paris, 1821.

or arrest the progress of the disease, and not abandon the sufferer to his fate, so long as the vital energy remains. In recording the annals of our profession, we deem it of great importance to attend to all the efforts which are made with these views, and we have accordingly selected the books before us, as furnishing a sequel to our copious analysis of the excellent work of Trolliet in our preceding volume. The successful recovery of some of the following cases, gives very considerable interest; and the name of Brera, adds to these an authority which we cannot dispute. The history of his cases, it will be observed, is very similar to that of M. Trolliet..

On the 1st. of November, 1804, a wolf, of uncommon size, having descended from the Bergamasca Alps, along the valley of Serio, attacked and bit successively, in the neighbourhood of the City of Crema, thirteen persons of different age and sex, in various parts of the body, and under various circumstances. Of these, nine were attacked with fatal hydrophobia, and four were fortunate enough to escape. All these persons, but one, were treated by Professor Brera, in the hospital of Crema. As the season was temperate, and the ground free from snow, it cannot be supposed that the animal was impelled by hunger. Before attacking the individual treated of in this commentary, it had crossed the river Serio, whence we may conclude, that in brutes, rabics is not always, if it ever is, attended by hydrophobia.

It has been calculated, that a fourth part bitten by rabid animals escape the disease; and in the present instance, nearly the same portion, (four in thirteen) was remarked. But as particular circumstances accompanied the infliction of the wounds, and distinguished the disease under different modes of treatment; so the relative comparison of the cases leads us to observe, that those who escaped with life, were not all exempt from slight attacks of rabies; and, therefore, to conclude, that the preservation of life in these four cases, was not owing to that law of nature, by which the fourth part of the wounded escape. And if we attend to the fact, that the four individuals who avoided the catastrophe of the others, were the only ones who employed a uniform mode of cure, are we not entitled to think, if not positively, at least, probably, that their preservation depended on the adoption of that plan?

Fourth Case. The wolf being chased, met Girolamo Peverari, aged twenty-eight, attacked and bit him on the left side of the neck; upon which he made a blow at the beast, and to secure himself, leaped into a ditch filled with water. The animal followed him to the edge, but stopped there, and turning round, went off quietly. Peverari, as soon as the wolf was gone, re

paired to the hospital of Crema, where it was found that the wounds were two holes in the neck, made by the teeth of the animal, pretty deep, but not dangerous. They had healed by the 10th of November, and Peverari was kept as a convalescent. The diseased state of the animal being, afterwards, fully proved; on the 19th, a plan was commenced with the patient, for the prevention of rabies, which was the more necessary, as the cicatrices had become tumid, red, and painful. A warm-bath was ordered, with friction of mercurial liniment, to the extent of a drachm daily, and the internal use, every three hours, of the following pills:

R. Hyd. oxymur, gr. ss.

Rad. Belladonnæ. gr. x.
In pil. iv. dividend.

This prescription was continued until the 25th, the quantity of the sublimate being increased to two grains, and of belladonna to thirty for each mass of pills. Salivation having then taken place, the internal and external use of mercury was suspended, and the treatment was confined to the warm-bath, and the use of belladonna, the dose of which amounted, on the 1st of December, to four scruples a day; and at the maximum, on the 19th, to three drachms. The mercurial frictions, were resumed on the 1st of December, the salivation having then ceased, and were continued along with the warm-bath, until January 4th, 1805, when the medicines were wholly relinquished. Peverari remained in the hospital until the 29th of the same month, and then returned in good health to his family. In the space of fortyseven days, Peverari took 73. of belladonna in powder, and 54 grains of corrosive sublimate; he used the bath fourteen times, and rubbed in 43. of mercurial liniment. On the second day of this treatment, Peverari began to sweat, and pass much urine by night. His pulse remained natural, until the first salivation; he then became febrile from the inflammation in the throat and gums. During the remainder of the cure, the ocea sional heat of the mouth, and flow of saliva, evinced that the mercurial action was kept up in the system. The belladonna, besides the dryness of the fauces, occasioned vertigo, vomiting, tremours of the extremities, obscure vision, and pains in the orbits, which rendered it necessary to diminish, or suspend the. dose occasionally. It should seem, that during this treatment, Peverari was not altogether exempt from the disposition to rabies, for besides the pain of the cicatrices, he several times entered the bath unwillingly and sighing; the sight of the water, causing anxiety and constriction of the fauces.