Yet his treatment fluctuated, was weakened by experience, and again corroborated by experience still more extensive. For example, the treatment by means of mercury was not generally found very successful. Calomel and ipecacuan; the blue pill and ipecacuan; doses of five grains of calomel and half a grain of opium, at stated intervals of four or six hours; larger doses of the same medicines, a scruple of calomel and two grains of opium-all often failed when the disease was established, yet Dr. Cheyne has no doubt that the mercurial treatment is entitled to confidence in dysentery of other forms, and even in this one, in the less advanced stages.

The pathology of dysentery which supposes, that the symptoms (such as tenesmus, and the sensation of the intestines being loaded and oppressed) depend upon an accumulation of indurated fæces, requires to be reconsidered, as it appears, that in this as in other cases, one of the effects of the disease has been mistaken for its cause. In many cases accordingly, purgative medicines seemed greatly to increase all the sufferings of the patient; and castor oil, the cathartic to which the preference is usually given, frequently roused the dormant griping pain, so that it appeared not altogether to maintain the character of excellent, to which it has acquired a kind of prescriptive right. Venesection, against which we are so often cautioned by the best writers, was certainly the remedy the least equivocal in its effects, and the most uniformly useful of any which was employed in the Whitworth hospital.

In the first stage, when there was little pain or fever, a purgative was given early in the morning, and about ten grains of the compound powder of ipecacuan early in the afternoon, and again at bed-time; at the same time enjoining low diet. This practice restored him to health, though it is but proper to add, that the disease, as well as the concurrent fever, often ended spontaneously in free perspiration. When the symptoms ran higher, with fever and much tenderness of the abdomen with tormina and tenesmus,-mercurials, venesection, and saline purgatives, with a small proportion of tartarized antimony were useful, along with the tepid bath in the evening, and an opiate rendered diaphoretic at bed-time.

When the stools chiefly consisted of bloody mucus, with tender abdomen,-venesection was never omitted. The blooddrawn was in many such cases cupped and buffed. The bloodletting, sometimes immediately altered the character of the stools, though purgatives had produced no change. Those who object to venesection in this form of dysentery, have surely never witnessed the great relief which profuse spontaneous hemorrhage from the bowels sometimes has on the disease.

When extensive ulceration was apprehended to have supervened, indicated by agonising pain, unceasing tenesmus, intolerance of the slightest pressure, and great pyrexia, in the course of a single hour, considerable quantities of blood have been abstracted, two grains of opium, and a scruple of calomel given, with the warm bath, and a swathing of warm flannel. Dr. Cheyne recommends opium to the extent of four or five grains, as it was this which seemed to him to arrest the progress of the inflammation, and whatever procured respite from the agony of the tormina often proved of permanent benefit. After the large dose of calomel and opium, calomel in doses of five grains, with half a grain of opium every third or fourth hour, till ptyalism was induced, proved highly useful. When the ptyalism supervened, the mercury was intermitted, and a mixture of balsam of capivi was given every fourth or sixth hour,—often producing the greatest relief, (see PEMBERTON on the Viscera). When the capivi draught lost its effect, the chalk julep, or catechu mixture with laudanum were substituted, with farinaceous diet. It is to be remarked, that when the mercury brought the skin to a natural state, that the disease, for the most part, took a favourable turn. It seems not unreasonable to suppose, in the cases in which the action of mercury was unfavourable, that it affected the biliary organs in the same way as it affected the salivary glands,-stimulating beyond the point of secretion, and thus adding to the patient's distress. In the very advanced stage of the disease, leeches were preferred to the lancet, but the subsequent bleeding from leeches when the debility is great, must be carefully watched or the patient may sink.

Even in the earlier stage of the disease, MERCURY often failed in relieving even those patients whose mouths were affected by it. The gums also sometinies became tumid, florid, and inflamed without salivation. In some instances, the mouth could not be affected at all; and in others the saliva flowed excessively, the tongue became inflamed and swelled, and the worst description of mercurial mouth was produced. In short, it appeared, that the atmosphere of the hospital was a means of not merely maintaining the disease, but of counteracting the salutary effect of our most powerful remedy. Elsewhere, Dr. Cheyne thinks, the mercury might have been advantageous. In the ulcerative and the emaciated stage, mercury appeared to be hurtful.

On the authority of Salle (De Curandis Morbis, p. 157.) who recommends in bilious dysenteries "vesicatorium abdomini imponendum, pulpaque tamarindorum, et cremore tartari, ad aliquot uncias per diem, alvus solvenda,"--the crystals of TARTAR, very

finely levigated in the dose of half an ounce every fourth or sixth hour, were extensively tried with some benefit, alternating with Dover's powder, capivi, the chalk mixture, and warm and tepid bathing. The gentleman who suggested the remedy, ascribed its action to its antiseptic properties; but Dr. Cheyne thinks it more probable, that it acts by bringing down the bile, in which he thinks it excels most other purgative medicines. Home considers, that, on the same principle, cream of tartar has proved efficacious in dropsy depending on obstructions of the liver. (HOME's Clinical Experiments, p. 283.)

Encyclopedia Medica.

CASE OF TRAUMATIC TETANUS*.

THOMAS MINTO, a fine healthy boy, æt. 15, on the morning of Wednesday, March 6th, 1822, got entangled in a threshing machine at the time it was in full action. The machine was almost instantly stopped, but not before he was severely wounded. The four smaller toes of the left foot, part of the metatarsal bone of the second smaller toe, and the metatarsal bones of the third and fourth toe of the same foot were shattered, and the left thigh was broken. The right thigh was also broken; the skin and cellular substance torn in pieces from the knee to the pubis; the sartorius muscle was torn in two, and many of the other muscles lacerated. Messrs. M. and C. surgeons, who were first with the patient, removed the shattered bones of the left foot, and dressed the wound, there being nearly as much skin as covered the bones: By this time Dr. H. arrived, when a consultation was held upon the state of the right thigh, and it was determined to amputate it immediately. This was accordingly done by Messrs. M. and C. about two inches below the great trochanter. The bone was completely covered by the muscles, but in some places there was a deficiency of skin and cellular substance. Before proceeding in the operation the femoral artery was tied, and the fractured left thigh bone had been previously set and fastened with pasteboard splints. The

* This case was transmitted to us by the gentleman who had the kindness to furnish our two last Retrospective articles.

boy stood the operation with the most heroic courage: previous to the operation, he had one glass of wine, and after it another. He was put to bed about 12 noon; pulse 120, small but regular. Eight p. m. pulse 126; the pain has been very trifling, but he has been a little delirious.

Thursday, March 7. Six a. m. pulse 120; had no sleep but was quite easy. Eleven a. m. pulse 125; felt pain in the foot and left fractured thigh.

B. Nitr. Potass. 3ij.

Tart. Antim. gr. j.

Syr. Sacch. 3i.

Aquæ. Lib. ii. M.

A wine glassful to be taken every two hours.

Ten p. m. skin warm; rather restless; sponged the breast, head, and hands with vinegar.

Friday, March 8. Seven a. m. pulse 110. Has had two stools, aided by injection; skin cool; says he feels perfectly well. B. Sulph. Magnes. zi.

Eleven, p. m. pulse 123; in high spirits; Cont. Mixt.

Saturday, March 9. Ten a. m. pulse 90. In great spirits ; a poultice applied to the foot. Twelve, midnight, pulse 100, hard and irregular; skin dry and hot. Added a grain of tinct. antimon. to the former mixture; gave an injection; bowels to be kept open by occasional doses of sulph. magnesiæ.

Sunday, 10. Nine a. m. pulse 100; skin cool; dressed for the first time; femoral artery beating furiously; little discharge from the stump, but it is evident, that some of the saved skin and cellular substance will slough; a considerable foetor from the foot, which is rather painful. It was dressed with lint and simple ointment, and a large poultice was put over all; he complained little or none of the left thigh, but said it had started a little. Eleven p. m. feels comfortable; has had two stools.

Monday, March 11. Ten a. m. pulse 126; foot painful; dressed as yesterday; all doing well. Ten p. m. pulse 120; skin hot, sponged with vinegar and spirits; room fumigated with tar vapour; foot dressed,

Tuesday, March 12. Eight a. m. pulse 100; rather restless in the night, but slept two hours; his mixture has been continued regularly. Eleven a, m. pulse 120; dressed; copious discharge from both stump and foot; skin soft; every thing favourable, Eleven p. m. pulse 100, feeble; one stool; dressed the foot; cont. mix.

Wednesday, March 13. Ten a. m. pulse 95, soft. Wounds

dressed; discharge lessened; granulation luxuriant on the foot. Ten pum; pulse 110. skin dry.

B Sulph. magnes. 3 gr.

Thursday, March 14. Ten a. m. pulse 96; skin soft; two stools; dressed; pulsation of femoral artery less; feels wonderfully well; tongue dry. Ten p.m. pulse 104; skin hot; sponged; dose of his mixture increased; foot dressed.

Friday, March 15. Eleven a. m. pulse 120; irregular; had a tolerable good night; dressed; stump looks remarkably well, though part of the skin and cellular substance is sloughing; little matter from the foot; fractured thigh painful. Ten p. m. pulse 125; feels rather uneasy; thinks he has got cold; oppression at his breast; an injection given without effect.

Saturday, March 16. Ten a. m. pulse 124; rather hard; complains of having caught cold in the night in his neck and throat, as he was restless, and often threw off the bed clothes; dressed; matter seanty; thigh painful. Ten p. m. pulse 130; restless; an opiate administered.

Sunday, March 17. Nine a. m. pulse 125; seems to have got a slight sore throat, as he has some difficulty in swallowing, and cannot open his mouth with the same case as formerly; dressed; wounds look well, only the remaining piece of metacarpal bone is carious, Eleven p. m. pulse 135; foot dressed; very uneasy; bowels have been kept open with salts; opiate and sloughing of the stump ceased.

Monday, March 18. Ten a. m. pulse 125; wounds dressed; the night was passed pretty tranquilly; but now his eyes sparkle with unusual lustre; his tongue is rather foul; appetite fails; there is stiffness of the muscles about the neck and breast; and the foot begins to start; had just now a sudden spasm which rendered his breathing laborious for a minute; began to rub on his breast the following liniment:

B Camphora,
Opii āā zij

Ol. oliv. 3j M.

To have one grain of opium every two hours till sleep be induced the nitro-antimonial mixture to be omitted. Ten p.m. feels easier; liniment to be continued during the night. Tuesday, March 19. Nine a. m. pulse 120; little difference, though he has slept little or none; the opiate seems to have raised his spirits, for he repeatedly said during the dressing of his limbs, I have no pain; opium increased to two grains; dressed the foot with lint dipped in a solution of opium, and a poultice ; at the suggestion of Mr. C. a drop of prussic acid was