rying on the business of life, manifested by a sudden and overpowering invasion, as in the Asiatic cholera, we call in the aid of the lancet, the adjuncts being ammonia internally, and warmth externally. If any thing can countenance the doctrine of debility from an overpowering contagious miasm, these insulated cases must have this effect. Respect to a debilitating cause, and its immediate effects on the nervous system, doubtless warrants in these instances a modification of the usual plan of treatment, and especially caution in the use of the lancet. Ammonia, the warm or spirit-air-bath, with frictions, together with one moderate venesection, regulated by the state of the circulation, and followed by calomel, constitute in these appalling circumstances the principal resources of art. Dr Armstrong has offered some ingenious suggestions to supply the hiatus which every one must feel in our remedies; and Dr Lange of Cronstadt has adopted with great success, in the analogous oppressive stage of spasmodic cholera, the use of salt emetics, and the actual cautery applied to the spine. The inhalation of vivifying gases, galvanism, and other resources of chemistry, are among remedies still under probation. The observation, in short, of the asphyxial form of this pestilence on the arena of British experiment, holds out a reasonable expectation of improvement in the treatment of that oppression of the nervous system which follows the reception of the worst contagious miasms. The intimate union of the nervous and vascular systems, leads us to look for the developement of the injury inflicted on the former in the errors of the latter; and an oppressed circulation is the morbid effect to which our remedies, though not exclusively, are imperatively directed. The most frightful debility is here no obstacle to a cautious employment of the lancet, which, in combination with stimulants, at once lessens present engorgement and future inflammation of the vital organs. The debility of more ordinary fevers will henceforward be viewed through the medium of an analogy, which will strip it of its Brunonian attributes. The preceding remarks require accommodation when applied to those low typhoid or comatose cases, in which the prostration of the vital powers is less complete, and a partial reaction takes place. In the milder examples of this irregular type the lancet may be wholly laid aside and leeches substituted. "In the irregular form of the congestive scarlet fever, or that in which the excitement is partially developed, purgatives and the warm bath," says Dr Armstrong, 66 are the best remedies;" and they must be persevered in, he observes," so long as the general oppression and irregular state of the excitement remain." It was by purgatives chiefly that Dr Hamilton succeeded in an epidemic resembling very much this irregular congestive variety. Delicate management also is required in the fourth variety, especially in its advanced stages. In adults, indeed, in whom the disease proceeds with a less fatal rapidity, and at the very onset of reaction, also, in young children, the lancet may be used more freely in the former, but sparingly in the latter; but if the inflamed surface bear a large proportion to the whole bronchial membrane, the due decarbonization of the blood is so much prevented, that the patient rapidly becomes apoplectic, or dies exhausted with a livid complexion, lips blue, and a rattling in the air-passages. It is in such circumstances, especially when called in after the disease has made some progress, that general bleeding becomes a doubtful remedy, by further weakening the already too much weakened action of the heart. Here ammonia in small doses, combined with topical depletion, mild purgatives, and immersion in the warm bath, shed a doubtful ray of hope, but too often fail to relieve. Dr Armstrong recommends in these cases about a drachm of the solution of chlorine, mixed with six ounces of distilled water, to be given in the course of twenty-four hours.* The vegetable acids, also, added to bland mucilaginous fluids in this, as well as in every form of the discase, are grateful and salutary. The citrate of potass or soda, in a state of effervescence, is perhaps one of the best febrifuges, though recommended at first in this disease by Dr Watson, as an antiseptic and tonic. † In the decline of fever it is advantageously exchanged for the effervescing citrate of ammonia. The only remaining qualifying considerations of the general rule of practice respect the rapid course of the disease, and the greater irritability of the nervous system of children. The former suggests an early and decisive employment of the lancet in the acute forms of the disease, while both preclude its frequent repetition, the necessity for which is obviated by the powerful auxiliaries which we possess in calomel and leeches. Having made a decided impression on the disease we must desist from over-active efforts, lest nature herself be incapacitated for retracing her devious course. It is a golden observation of Dr Farre's, that, " by those who will take the pains to consider inflammation as a process, it will be understood that it may be checked, but cannot be suddenly extinguished, by the most active means. Time must be allowed for the process to decline, even after the fairest efforts have been made to arrest its progress."‡ See Dr Armstrong's Lecture on Scarlatina in the Lancet, Vol. vii. p. 324. Med. Chir. Trans. Vol. iii. p. 327. ART. II.-Case of Extirpation of the Eye-Ball. By J. H. WISHART, Esq. F. R. S. E., Surgeon to the King in Scotland. EURETTA DOUGLAS, æt. 13, from Alnwick, February 1832. The right eye projects considerably beyond the orbit; the upper eyelid is very much elongated, so as still to cover the eye when she is asleep. On her looking downwards with the eye, a firm tumour can be distinctly felt near the situation of the lacrymal gland, and extending inwards and backwards towards the bottom of the orbit. About two years ago the eye began to increase in size without any previous pain, and without any evident cause that could be assigned. In twelve months it attained its present size, in which state it has remained for the last year without any visible change. For the first three months nothing was done for it; but after that, there was such a rapid increase of size, that the surgeon who was consulted, pronounced it to be dropsy of the eye. He applied leeches over the eyebrow, and blisters to the temple, without producing any mitigation of the symptoms. She also got various medicines internally, in the form of pills, powders, &c. without deriving any benefit from them. At a consultation with Dr Gillespie and Professor Lizars, it was agreed that nothing could be done to save the eye. The total extirpation of the organ was therefore thought proper; the girl herself being most anxious to submit to whatever was thought advisable. I removed the eye, assisted by these gentlemen and Mr Burt, on the 1st March. The operation was performed in the usual way, and the whole contents of the orbit removed. The hemorrhage was considerable; but the orbit being filled up with slips of fine lint, a common compress, formed of two or three folds of linen, was laid over the eyelids, and a few turns of a roller over all; the patient was put to bed, and soon after got an opiate. On examination of the eye after its removal, the disease was found to be seated in the substance of the optic nerve; the coat of the nerve being very much distended, and evidently forming the outer covering of the tumour. The eye itself was found perfectly sound, and of the natural size; the previous enlarged appearance being caused entirely by the pressure of the tumour from behind. The tumour was of a firm consistence, resembling the cerebral substance, generally considered of a malignant nature. A view of the eye, with the tumour attached, is given in Fig. 1. of the engraving. In about two hours after the operation she did not complain of any severe pain; had a heavy feeling in the right side of the head; pulse 98; took one grain of opium, and slept half an hour. 6 P. M.-Still continues easy. No pain; no thirst; skin cool and soft; has slept a good deal since 4.-8 P. M. No bad symptoms. Pulse 90. Pulse 90. The left side of the face and eyelids are considerably swollen, but give no pain. Great inclination to sleep, and not at all restless. March 2d, 9 A. M.-Continues easy, and slept well. No increase of pain. Pulse continues at 90, as in last report. Feels quite comfortable. She was visited again at 11, at 2, and at 4, and was continuing quite easy, sleeping most of the times when visited. 6 P. M.-Complains of a little more pain; restless; pulse 96, skin rather hot and dry. Has taken nothing but a little lemonade. Has had no passage since the operation.-B. Pulv. Jalap. comp. ii. to be taken immediately. At 9 she was easier, and not so restless. Cold wet cloths to be applied over the dressings. March 3d, 9 A. M.-Slept well. Does not complain of so much pain. Medicine has not yet taken effect. Has had a little senna tea this morning. Pulse 86; skin moist. 4 P. M.-Has had a free passage. Continues easy. No alteration in pulse since last report. 8 P. M.-Complains of some pain round the eye, from the blood having become hard under the dressings. March 4th, 9, A. M.-Rather feverish; skin dry and hot; more pain in the eye, head, and temple; more restless than formerly during the night. Ordered the saline mixture, a spoonful to be taken every two hours. 12 o'clock. Has taken one spoonful of the mixture. Not so feverish; skin moist; pulse 84. Has taken some cool tea, with a little bread soaked in it, since morning. To go on with the mixture. 5th, To-day the compress was removed, and gave considerable relief. There was no discharge followed. A small portion of the slips of lint was removed daily from the orbit. The whole was taken away in three days, very little matter being discharged along with the dressings. From this time she went on without any unfavourable symptom. She was dressed regularly twice every day; the discharge very moderate all along. A small slip of lint was introduced at every dressing between the eyelids; and a pledget of the same, spread with simple ointment, laid over all. No change taking place from this time, no regular report of the case was kept down to the 14th, when she was still going on favourably, had a good appetite, and slept very well every night. The discharge was now very moderate, and quite healthy; a small quantity of thick matter was seen adhering round the bottom of the orbit. A weak solution of the acetate of zinc was thrown in with a syringe, and continued every day regularly, the discharge gradually diminishing. She went out daily to walk, and before the end of the month was perfectly well. The upper eyelid, also, has returned to its natural size; and she returned home about the middle of April quite recovered. This case has had a much more favourable termination than was expected from the opinion formed after the examination of the tumour, which resembled that of many other cases which I had extirpated from similar situations, all of which cases had ended in the death of the patient, except one removed at a very early period of the disease; the patient now enjoying perfect health, and being an active member of the Established Church. I have never met with any cases of the same description as Douglas's in the works of surgery or morbid anatomy which I have examined. The only one resembling it is related by Panizza in his work Sul Fungo Midollare, in a little girl six years of age, in which there was found on dissection, not only a small tumour surrounding each optic nerve, but a still larger cerebral mass in the basis of the brain. In a letter of the date of 23d March 1833, received from Mr Rate of Alnwick, he mentions, "The girl Douglas, in whose case you took so lively, disinterested, and expensive a concern, is growing quite healthy and strong, and you seem to have effected a perfect cure." This has been confirmed by Mr Wilson, son of an eminent surgeon there. Edinburgh, York Place, 1st June 1833. ART. III.-Phenomena of the more advanced Stages of Intoxication, with Cases and Dissections. By F. OGSTON, M. D. Licentiate of the Royal College of Surgeons, Edinburgh. THE present attempt to illustrate, from personal observation, the phenomena usually presented by the more advanced stages of intoxication from spirituous liquors, it is hoped will not be deemed supererogatory. The subject, as far as I am aware, has not been lately treated at any length; the notices occasionally met with in systematic works are not very full nor satisfactory; while writers on cerebral diseases (who might have been expected to pay particular attention to it) have generally overlooked |