dogs, first saturated them with the sulphurous acid, by giving them large quantities of the sulphites of the alkalies or alkaline earths before injecting pus and putrid substances into their veins to induce septic diseases. Consequently, before I commenced using these agents, my highest aim was to prevent the blood from becoming further deteriorated by the poison; hoping by their use to hold the action of the poison in check, as it were, long enough for its elimination from the system, not expecting to relieve the patient of the effects already produced. Though, after watching the operation of these remedies in numerous cases, I believe I am warranted in saying that, in some cases, they not only prevent the morbid change of the blood and tissues, but restore them to their normal condition, and, in cases where there is no local inflammation established, the patient is relieved by their use from the morbid influence of the poison and restored to health.

In epidemic erysipelas of a malignant character, especially where it is complicated with phlebitis or pyæmia, these remedies are invaluable, by preventing the morbid influence of the poison until the erysipelatous inflammation subsides or is relieved by appropriate remedies. But in local erysipelas of a mild character, the effect is not perceptible, and, indeed, I am not sure that they have any special effect, for such cases usually recover under ordinary

treatment.

I have prescribed the sulphites in quite a number of cases of variola, two of which I have related; in one, as already stated, it appeared to arrest the disease and prevent pustulation, but as that effect did not follow its administration in other cases, it might not have proceeded to pustulation had the remedy been omitted.

However, in every instance where I have prescribed these remedies, in bad cases of this disease, the morbid condition of the system was relieved, and the pustules matured and dried up earlier than usual, rendering the case mild and manageable. Others who have prescribed these remedies in this disease have noticed the same effect.

In diphtheria I have prescribed these remedies in two cases. They were bad ones, and both recovered. Further experience will test their value in this disease.

In uterine metritis or uterine phlebitis, these remedies are undoubtedly valuable. Professor N. S. Davis relates four cases successfully treated with them, and I have used them in two cases, one of which I have just related, where no other remedies were used that could possibly have effected the cure.

I will not further particularize the diseases in which these remedies have been used to advantage, but say at once that they will be found useful in all septic or blood-poison diseases without regard to the stage of the disease, though the earlier we commence with them, the better will be our hope of success. They are without doubt valuable also as prophylactics, and where we can anticipate a malignant case of blood-poison they should be given.

From Dr. Polli's experiments, and from my observations with regard to the use of these remedies, I have arrived at the following conclusions:—

1st. That the sulphites of soda and lime can be given to patients suffering from zymotic diseases, in large quantities, and continued for a long time, without producing deleterious effects on the system.

2d. That (in accordance with Dr. Polli's experiments) the sulphurous acid is disengaged from the alkaline base in the system, permeating it in every part, thereby preventing fermentation or decomposition of the blood.

3d. That they do not destroy or decompose the poison in the system, but prevent its deleterious action on the blood, and consequently the tissues, until it is eliminated from the system.

4th. That the quantity prescribed should be in proportion to the malignancy of the disease, that is, the more hopeless and malignant the case, the greater should be the quantity administered in a certain time.

5th. That these remedies should not be too suddenly withheld in bad cases, but continued until the poison is carried out of the system by the emunctories.

6th. That the effect of these remedies, in well-marked cases of blood-poison for the first few hours, is imperceptible; but by continuing them a day or two, the secretions become improved, and the patient is relieved of the morbid symptoms.

7th. That these remedies will not cure inflammation of an organ already established, though in cases where they are indicated, they prevent the deleterious effect of the poison until the inflammation subsides or is relieved by appropriate remedies.

8th. That the use of these agents will not prevent the use of other remedies indicated in the particular case, unless chemically incompatible.

9th. That these remedies are generally well retained on the stomach, though the dose is large and the sulphurous taste is disagreeable to some patients.

10th. That the more malignant and hopeless the case, the more perceptible and satisfactory will be the effects of these agents, unless the case is beyond the reach of remedies.

The question has often been asked, which of these two remedies is the most reliable? In my opinion there is very little difference, unless there is diarrhoea or looseness of the bowels; under such circumstances, the sulphite of lime is altogether preferable; but in the opposite state of the system we generally use the sulphite of soda.

It has been difficult to obtain a pure article of sulphite of lime in Chicago for the past year, consequently I have used most frequently the sulphite of soda.

The preparation of sulphite of lime, which I first prescribed, was prepared by Dr. Squibb, of New York, specially for internal use. It was an impalpable powder, insoluble, with a very slight sulphurous taste, and in appearance like magnesia. But the article generally kept in the shops is very different; it is coarse, has a strong sulphurous taste, and is unfit for internal use, and for fear of impurities I do not prescribe it.

The dose or quantity of these remedies necessary to be given to relieve the system from the morbid effects of the poison, is not yet fully determined. Calculating from the experiments of Dr. Polli, I first commenced with a drachm of either of these remedies every four hours, and being so well satisfied with the results, I have continued to prescribe them in the same dose, though repeating it. every hour or two in urgent cases, until the morbid symptoms began to yield, then every three or four hours according to the necessity of the case. Professor Davis and others, I find, have adopted a similar course. But what quantity will eventually be found most beneficial, further experience will demonstrate.

In conclusion, I have only to say that I have endeavored to investigate the effects of these remedies with care, and have reported the facts with impartiality and truthfulness. Not expecting, however, that we have fully established these agents as specifics in zymotic diseases, but hoping that the cases related in connection with the interesting communication from Professor Davis will induce the profession to test these remedies in catalytic diseases more fully, and demonstrate their true value.

Should this report have that effect, my object in bringing the subject before the Association will be accomplished.

THE

CAUSATION, COURSE, AND TREATMENT OF INSANITY IN WOMEN: A GYNÆCIST'S IDEA THEREOF;

BEING THE

REPORT

OF THE

STANDING COMMITTEE ON INSANITY FOR 1864-5.

BY

HORATIO ROBINSON STORER, M. D.,

OF BOSTON,

SURGEON TO THE NEW ENGLAND HOSPITAL FOR WOMEN,

ASSISTANT IN OBSTETRICS AND MEDICAL JURISPRUDENCE IN HARVARD UNIVERSITY, AND PROFESSOR OF OBSTETRICS AND THE DISEASES OF WOMEN IN BERKSHIRE MEDICAL COLLEGE.

VOL. XVI.-9