cavity, so that nature may have time and opportunity to surround what has already been extravasated, by boundaries of coagulable lymph. Opium, in large doses, is the remedy on which our anthor depends. Two cases are condensed from the fifth volume of the Dublin Hospital Reports, in one of which great relief was obtained, but the advantage was lost by exhibiting an aperient too soon, when all the bad symptoms recurred, and the patient died. The next case was more successful, and our readers will find it quoted in No. XXVIII. of this Journal, page 541. There can be little doubt that, in the case alluded to, there was perforation of the intestine, with consequent extravasation of its contents. The power of bearing opium (which in this case was given to a great extent) without injury to the nervous system, is very remarkable, and is only explicable by the pain, on which the anodyne effects of the opium appear to be expended.

Since the occurrence of these cases, our author has used the same remedy in examples of ordinary peritonitis, where bleeding was inadmisible; and he assures us that he has had no reason to change his high opinion of its powers. In one case where death took place, the opium was borne without the slightest inconvenience. In two cases lately occurring in the hospital, the same treatment has been pursued with the most striking benefit. A case is quoted from the Dublin Hospital Reports, of hepatic abscess, in which the practice here recommended was first tried.

"I have now detailed cases illustrative of

the utility of opium in large doses in peritoaitis, arising from the introduction of fæcal and of purulent matter into the serous cavity. I would further propose it as a remedy in cases of rupture of the bladder and uterus, and in peritonitis after the operation for strangulated hernia. I am at present trying its powers in a case of recent pneumothorax from pulmonary fistula. In two cases of peritonitis after tapping, where the patients were in a low state previous to the operation, the exhibition of these large doses of opium, without drawing any blood generally VOL. XVIII. No. 35.

or locally, has succeeded in my hands in removing the disease and saving the life of the patient. This appears to be a peculiarly appropriate case for the opium treatment. The patients are generally cachectic, either from original constitution or the disease. They almost all labour under visceral disease and obstruction, and a state of collapse commonly follows the operation. All these circumstances go strongly against our use of the usual antiphlogistic treatment; it was in a case of this kind which occurred in the old Meath Hospital, in the year 1822, that Dr. Graves first ascertained the great importance of opium in this disease. A woman had laboured under ascites, for which she was tapped; the operation was followed by the symptoms of peritonitis. When Dr. Graves saw her, she appeared in the last stage of the disease, she had constant vomiting, hippocratic countenance, cold extremities, the belly exquisitely tender, and the pulse 160 in the minute, and nearly imperceptible. The case appearing hopeless, Dr. Graves determined on merely endeavouring to allay the distressing symptom of vomiting, and administered a drachm of laudanum. The

patient soon afterfell asleep, and awoke refreshed, with a more warm surface and fuller pulse; the vomiting had ceased. The same remedy was used in smaller doses every fourth hour, and in the course of two days all the unpleasant symptoms had disappeared.

I now proceed to submit some cases of diseases of mucous membranes, where the use of opium has proved efficacious. From having witnessed its utility in cases of inflammatory states of serous membranes, where the inflammation might be termed,

for want of a better name, asthenic; it appeared probable, that the same condition of mucons membranes might be benefitted by it.

It is now some months since I was called to see a gentleman labouring under all the symptoms of gastro-enteritis, in a severe form. He had considerable fever; thirst urgent; constant smaking of the lips; respiration hurried, without disease of the respi15

ratory system; a red tongue and a great tenderness of the belly. The usual treatment was pursued, but the disease showed great obstinacy, and after six weeks' continuance the situation of the patient appeared hopeless. At this time a violent bronchitis supervened, and so great were the sufferings of the patient from the accumulation of mucus in the trachea, that on three occasions I left him, never expecting to see him again. It was remarkable, that during this attack, the symptoms of abdominal disease greatly subsided. Under a stimulating treatment he recovered from the bronchitis, only to relapse into his former state. The abdominal symptoms now became still more urgent; the belly swelled from tympanitis; the verge of the anus became surrounded by large and irritable hæmorrhoids; there was extraordinary prostration and constant low delirium. Under these circumstances, a diarrhoea supervened, at first slight, but afterwards so severe as to threaten every day death from exhaustion. A great variety of means were tried, but without avail. At this time, when the patient seemed in articulo mortis, I ordered him a grain of opium every hour; this he took regularly for the first 12 hours, without any inconvenience, and he experienced some refreshing sleep. Next day the remedy was continued in the same dose every second hour, and from this time his improvement was rapid; and I rejoice to say, that he is now in the enjoyment of good health."

This was a fair case, Dr. S. observes, for the employment of this heroic remedy, since all other means had failed. The next case is one to which he confesses he cannot but look back on with pleasure, was that of a patient who was admitted in February, into the Meath Hospital, complaining of sore throat and shooting pain through both ears. His countenance was haggard-voice raucous-body emaciated.

"An extensive and unhealthy-looking ulcer, covered with a whitish matter, was found to occupy the left tonsil, the back of the pharynx, and left side of the uvula. The patient denied having had venereal, but cir

cumstances led us to suspect this; he had, however, been frequently salivated in India, for abdominal disease and fevers. He first felt the soreness of his throat six weeks before admission, which was the time when his vessel made the British Channel. We ordered the patient the sarsaparilla decoction with nitro-muriatic acid, and touched the sore with a strong solution of nitrate of silver, which caustic was changed in some days for the butter of antimony. No good effect was produced by these means; the sore extended quite round the uvula, which it rapidly destroyed. The breath became fætid; the cough laryngeal; the patient's appearance was still worse than on admission; his nights were sleepless, and he complained much of pain in the head.

I now changed the plan of treatment, omitted the sarsaparilla and the lotion, and ordered a gargle of chloride of lime with the internal use of six grains of opium daily, and an increase of his wine. At once the sore began to assume a more healthy appearance; the fætor of breath diminished greatly, and in a few days wholly disappeared. After a short time, in consequence of want of sleep, we increased the dose to eight grains, on which he has been kept since the 20th of February. The sore is now healed, and the whole state of the patient singularly improved."

At the time of writing, there was in the Meath Hospital, a woman who, for an enteritis, had taken 18 grains of opium in 48 hours. Previous to the exhibition of opium there had been retention of urine, which gave way under the administration of the remedy.

"Hitherto I have alluded to the employment either of simple opium, or its tinctures. In Dr. Bardsley's interesting collection of Medical Observations, several cases are detailed, where in affections of the stomach, the acetate of morphia was employed with benefit. I am persuaded, that it is a remedy of great power, particularly in chronic cases of dyspepsia, where there is much acidity. I was consulted some months back by a gentleman who has led a very dissipated life, and who for the

last ten years has been a martyr to the worst symptoms of dyspepsia. About two years ago, he had a violent attack of hæmatemesis, and latterly the stomach had become so irritable, that it was scarcely possible to find any article of diet to agree with him. His sufferings were dreadful. After trying other means ineffectually, I ordered the of a grain of the acetate twice a day. He took the • remedy three times in the day, with the most perfect relief. The secretion of acid which had been enormous, was suddenly checked, and the patient in two days declared that he had felt better than he had done at any time for the last ten years. His appetite was good, and he foolishly indulged in articles of diet from which he had long abstained. On the fourth day, while in the highest spirits, he became pale; fell, and threw up several pounds of blood. The remedy was of course omitted. In about a fortnight, all the former unpleasant symptoms returned, and his indigestion was as complete as ever. I now ventured on exhibiting the morphia again, but in the doses of the 1-16th of a grain, twice in the day. This diminished dose again produced the same improvement, but in a few days was followed by a return of the hæmatemesis.

The next case is one of a gentleman who has been for a length of time in the East Indies, and who has become a victim to hepatic disease. He is subject to attacks of pain in the epigastrium, followed by jaundice and fever. These have been treated by leeching, purgatives, and the use of mercury; but during the last attack, his debility was so great, that I did not wish to venture on this treatment. The acetate of morphia was given twice a day. It was commenced on the 26th of December, and continued till the 18th of February. The greatest improvement has been made in this gentleman's state. The pain has disappeared; there is now no tenderness; the jaundice has subsided, and what is most remarkable, his bowels now act regularly without the assistance of medicine. He has gained flesh, and his whole appearance is singularly improved."

We have now only to append the conclusions to which our author has come relative to the exhibition of opium.

"1st. That in certain cases of inflammation of serous and mucous membranes, where depletion by blood-letting, or other antiphlogistic measures are inadmissible, and the system in a state of collapse, the exhibition of opium has a powerful effect in controlling the disease.

2d. That under these circumstances the remedy may be given in very large doses, with great benefit and safety.

3rd.

That its effect then is to raise the powers of life, and remove the local disease.

4th. That the poisonous effects of opium are rarely observed in these cases; the collapse and debility of the patient appearing to cause a tolerance of the remedy.

5th. The cases in which the utility of this practice has been ascertained, are as follow:

Simple peritonitis, in a stage where bleeding cannot be performed. Low puerperal peritonitis. Peritonitis from perforation of the intestine; from the opening of an abscess into the sac; or lastly, after the operation of paracentesis in debilitated subjects. Violent diarrhoea, supervening in an exhausted subject. Phagedenic ulceration of the throat, in a similar individual. And cases of chronic gastritis, and gastro-duodenitis in patients exhausted by the long continuance of the disease.

6th. The cases in which this mode of treatment would be probably useful are,— peritonitis from rupture of the bladder, or uterus, traumatic rupture of the intestine, or after the operation for strangulated hernia.

The last observation which I shall make here is, that in most of these cases, particularly in those of diseases of serous membranes, wine was given in conjunction with the opium, and in all, the patients were supported by a lightly nutritious diet."

This paper is certainly interesting, and the subject important. On this account we have laid a full account of it before our readers.

VII.

ST. THOMAS'S HOSPITAL.

CASE OF SPURIOUS HYDROCEPHALUS, CONNECTED WITH PSOAS ABSCESS.

THE patient (Mary Tyson,) æt. 8, from Richmond, having a fair skin, and light red hair, and very much of a scrofulous appearance, was admitted under Mr. Green into Queen's Ward, Nov. 11th, 1830.

It is difficult to obtain any satisfactory history of this case, even from the friends of the child, who seem to have some motives for secrecy, arising from their doubts as to the propriety of her being taken into the hospital, and the poor girl herself is so peevish and fretful, that it is not easy to induce her to answer at all, and when she does make a reply, scarcely any information is communicated.

In the right groin there is a hollow ulcer, of a florid colour, smooth and glistening (no granulations projecting from its surface), about two inches in length in the oblique direction of Poupart's ligament, narrow in the centre, and decreasing in width towards each extremity; and from it there issues an extremely profuse discharge of healthy pus, in the collection of which the bottom of the sore is bathed. On the right side of the spine, in the lumbar region, a round and deep ulcer exists, also discharging most copiously. This, as well as the former, is said to have followed an abscess which broke spontaneously in that situation, but it looks exactly like the effects of moxa, or caustic potass. The surface is smooth, and the edges quite defined, the granules being minute and florid. We learn from the friends, that the child ailed not three weeks ago, and that, on the ensuing Sunday, she walked the distance of twelve miles. Disease of the spine is not discernible, and they affirm that no application of a caustic nature has been made to the back. The quantity of pus from both sores must be supplied from a deeper source, and this is believed to be an abscess

in the psoas muscle. The patient lies on

her left side, with the right lower extremity crossed over the other. That on the affected side thus appears shortened, and the trochanter major being much more prominent than ordinary, dislocation of the head of the femur upon the dorsum ilii is simulated. Pulse is quick, at 100-skin hotface a little flushed.

Poultices applied to the ulcers.

Nov. 16th. The little patient is improved in general health, sleeps well, and is free from pain. Pulse 96; skin moist; bowels regular, without medicine. When the poultices are removed from the sore on the back, pus streams from it, evidently having a deep origin, and it seems probable that it communicates with that in the groin, which latter yields an equally copious discharge.

Ordered porter, a pint daily.

26th. Child appears still better. A very abundant flow of pus continues from both ulcers.

Dec. 2d. It was yesterday observed that all discharge had ceased from the groin and dorsal region, and that the ulcers had a dry surface and rather prominent granulations. About two o'clock this morning the patient was attacked with violent convulsions, which lasted till five, and have left her perfectly insensible. There is now evidence of serious mischief within the head-the eyes are rolling and displaying a vacant stare, the pupils being dilated to their utmost-pulse 120— skin hot and dry. She does not moan, nor refer to her head as the seat of pain. Has had an enema, which brought away a natural stool. Was seen by Dr. Elliotson about 12 o'clock, noon; he ordered the scalp to be shaved, and a large blister to be applied upon it: also

Hydr. c Creta, gr. v. 3tiâ q. h.

3d. After the third dose of the medicine, and about 11 o'clock last night, the little patient's senses returned in some measure, and she has been since that time sensible. Has some pain of head-the eyes retain their vacant stare, and the pupils continue dilated, but less than yesterday-pulse 120, more feeble, regular-skin cool. The blister

was placed over nearly the whole of the vertex, and rose well-stools fetid, and of a greenish colour.

Vespere. Is more rational and the countenance is restored to a more natural expression.

4th. About nine last night, the convulsions returned with great violence, and lasted two hours. She, at the end of that time, awoke from them, perfectly sensible, having injured her tongue with her teeth; the convulsive fit is now present, but her motions are not violent. She is moving her head about on the pillow, and tosses her arms in every direction, occasionally, moaning-the eyes are turned upwards, and staring-pu pils dilated-pulse 100, and small-no heat upon the head, or rest of the body. Her tongue is severely injured by gnashing of the teeth, and would be more so, if it were not protected by the interposition of the handle of a spoon between the jaws. Sore in the groin has contracted, and is quite devoid of secretion; that situated upon the back has also diminished most rapidly, and affords no pus, both being quite dry.

Blister upon the head to be repeated. Pergat c. medic.

5th. Is now quiet, but has been convulsed in the night. Her countenance is not distorted, and the eyes are fixed in a natural manner. The surface of the body is cool, and the extremities are still lower in temperature. Pulse quick, and more feeble. Bowels are open, and the motions not unhealthy. Mercury is intermitted, by Dr. Elliotson's direction, no effect being produced on the mouth by this remedy.

6th. Has been restless during the night and greater part of yesterday; and early this morning her powers began to fail, and the skin became colder. She now lies in a state bordering on coma, but is conscious of pain, as she has been endeavouring to tear off the blister from her head, which was reapplied yesterday. Her hands are, therefore, muffled. She has just been removed out of bed, and by this slight passive exertion, her breathing has been hurried, and is performed with much heaving of the chest-skin cold -eyes not turned in an unnatural direction

pupils still dilated, but less than heretofore. Pulse not to be felt at the wristbowels open. Dr. Elliotson visited her, and prescribed

Quinæ sulph. gr. iij. Inf. rose co. 3j. 4tis. horis. Nourishment, in the form of arrow-root and milk, beef-tea, &c.

Dec. 7th. At intervals she is sensible; there is very little, if any, alterarion in her general condition. Bleeding has taken place from the mouth, but not to any amount of importance, and apparently from the fauces, or upper part of the pharynx. Continues quinine, and takes some little nutriment, by dint almost of force.

8th. Has not been convulsed since yesterday. She is sensible, but lying in a dormant state, crying out at times from pain in her head. Pulse 130, very feeble and irregular-tongue blackened, from the hæmorrhage of yesterday. Sordes is collecting about the lips and teeth, it having been once washed off this morning. She has become surprisingly emaciated. Continue.

9th. No change has transpired, and she appears in less pain. Constant watchfulness countenance placid. Very little nourishment is taken.

10th. There is to-day a plentiful discharge of pus, both from the sore in the groin and that on the back, and the patient is astonishingly better. She is perfectly sensible, has very little uneasiness in her head, and her countenance and eyes exhibit quite a different aspect. Pulse stronger, about 110—skin warmer, not dry, bowels open, and the stools have a proper colour.

11th. Patient still better, the discharge continuing freely from each situation.

12th. Has taken food for the first time since the attack. She is quiet, and devoid of pain.

14th. Nearly the same as on the 12th. Has an appetite for meat, of which she has partaken.

21st. Very little change is to be observed. She is on meat diet, and sleeps a great deal.

26th. Takes her nourishing remedies, and her strength is increasing.

28th. A small and projecting superficial