commonly the danger is to be warded off only by attending at the same time to the syphilis and to the complications. So far as it is possible, the whole of the treatment advisable from scrofula or tuberculosis must be combined with the treatment for syphilis. What this whole treatment should be, I need not now try to tell. Cod-liver oil, and bark and other tonics, fresh air and sea bathing, which are comparatively little direct use against the syphilis itself, may greatly help its cure by curing its complications. Iron, too, is often useful; and there is a rule, I believe, of some value to be observed in giving it. The iodide of iron (at least that which is to be had in the syrups ferri iodidi) is not a remedy for syphilis as the iodide of potassium is; it seems coparatively useless. When you wish to give iron, give it in the citrate or potassio-tartrate, together with the iodide of potassium. In this manner I believe that you may get the good effects of both the medicines.

I think that if you will observe these rules about the modes of giving it, you will very rarely be disappointed in giving the iodide of potassium, in doses of two or three grains, for the cure of the symptoms of tertiary syphilis. If they should fail, you should try larger doses; and if they too fail, as in very rare instances they will, you must make the best choice you can between giving mercury or simply maintaining the best possible state of general health, so that the patient may bear the disease till he can live it down.

HYPODERMIC INJECTION OF REMEDIES.- Dr. Anstie (The Practitioner, July, 1868) claims the following advantages for the hypodermic over the gastric administration of drugs: 1. Economy of the drug. 2. Entire abolition of the depressing or irritant effects which are locally produced in the alimentary canal during the digestion of various remedies. 3. Far greater permanence of effect, in many cases, than can be produced by medicine swallowed. 4. Much greater rapidity of action. One most important conclusion from these facts is this: that ano. dynes and hypnotics ought never to be administered by the mouth in acute disease attended with anorexia. Regular and systematic nutrition is the great necessity and the great difficulty in those diseases, and the avoidance of any treatment tending to interfere with digestion of simple food is a cardinal duty.

As to the question of danger of this method, he says, that there is absolutely none if the injector will remember two cautions-first, that the physiological activity of nearly every sub

stance which can be thus used is three if not four times greater when it is given by the skin than when it is swallowed; and secondly, that the liquid injected must not be either markedly acid nor markedly alkaline, nor in any way obviously irritant to tissue.

Morphia, Dr. Anstie says, should be used in the form of the acetate dissolved with a minimum of acetic acid in hot distilled water, five grains to the drachm. One minim of this will represent one twelfth of a grain, a very useful minimum dose in cases of slight neuralgic pain. Two minims (grain) is the best commencing dose for the relief of severe pain, and as a hypnotic in states of nervous irritability. Three minims (or grain) is an unsafe dose to commence with; dangerous and even fatal results have been known to follow its use.

The salt used in this manner is at least three times as powerful for every therapeutic purpose as when swallowed, and the majority of the unpleasant symptoms which opiates, when given by the mouth can produce, are entirely absent when administered hypodermically. The fact seem to be, that in the gastric digestion of morphia much of the salt becomes decomposed, and its specific effect on the blood is lost; but during the digestive process it acts depressingly upon the gastric nerves, and pro tanto disorders the functions of the stomach.

Atropia is an extremely valuable hypodermic agent for the relief of local pain and spasm. It should be employed in the form of solution of the sulphate; four minims containing grain; two minims will be the proper commencing dose in adults, unless the pain to be relieved is very severe. It should be cautiously increased to or grain; more can seldom be needed, and poisonous effects may be produced if pushed to higher doses. Atropia is incomparably the best of all medicinal remedies for every kind of pain in the pelvic viscera. Nothing can approach it in this respect.

Strychnia, Dr. Anstie has found to be a most valuable remedy in gastralgia. It should be administered in solution, two grains to the ounce of distilled water, and the proper commencing dose is two minims (20 grain).-Amer. Jour. Med. Sciences.

A CURE FOR HEADACHE.-Dr. Geo. Kennion extols (British Medical Journal, June 13, 1868,) the efficacy of the bisulphide of carbon in solution as a prompt cure for certain forms of

headache.

The application is made as follows: "A small quantity of the solution (about two drachms) is poured upon wool-cotton, with which a small, wide-mouthed, glass-stoppered bottle is half filled. This, of course, absorbs the fluid; and when the remedy has to be used, the mouth of the bottle is to be applied closely (so that none of the volatile vapour may escape) to the temple, or behind the ear, or as near as possible to the seat of pain; and so held from three to five or six minutes. After it has been applied for a minute or two, a sensation is felt as if several leeches were biting the part; and, after a lapse of two, three, or four minutes more, the smarting pain become rather severe, but subside almost immediately after the removal of the bottle. It is very seldom that any redness of the skin is produced. The effect of the application is generally immediate. It may be reapplied, if necessary, three or four times in the day.

The class of headaches in which this remedy is chiefly useful is that which may be grouped under the wide term of nervous.' Thus neuralgic headache, periodic headache, hysterical headache, and even many kinds of dyspeptic headache, are almost invariably relieved by it; and, although the relief of a symptom is a very different affair, of course, from the removal of its cause, yet no one who has witnessed (and who of us has not seen?) the agony and distress occasioned by severe and repeated headache, but must rejoice in having the power of affording relief in so prompt and simple a manner.”—Ibid.

OBSTETRICS.

Atelectasis

CASES IN MEDICAL JURISPRUDENCE.-CASE 1. Pulmonum in a child five weeks old. This case is probably unique in the anals of medical jurisprudence, and will afford a lesson in medical ethics which may deserve attention.

On January 4th, 1859, a child aged five weeks, died in Ledbury-road. A medical gentleman visiting another party in the house, was told of the circumstance, and shown a mixture which had been obtained the night before from a surgeon who had not seen the child, and of which a teaspoonful had been given. This gentleman very incautiously examined the bottle, and still more injudiciously expressed an opinion that there was laudanum enough in it to have killed the child.

After this of course an inquest was indispensible, and Dr. Chas. Clarke, now of Adelaide, was requested by Mr. Wakley to make a post-mortem examination. He wished my assistance

and I now give a short description of the appearances presented, as well as a microscopical examination kindly made by Mr. Quekett, accompanied by two drawings on wood by Mr. Searson under Mr. Quekett's supervision. The result will show how annoyingly the matter might have turned in ordinary cases against the surgeon prescribing, while the facts adduced can only make it a matter of the utmost surprise how the child could have lived to the time it did. I regret that the space I could expect in the Lancet prevents my entering fully into the literature of the subject.

The following is the composition of the mixture, of which scarcely a teaspoonful was given eight hours before death: Syrup of squills, two drachms; compound tincture of camphor, sixteen minims; water, one ounce. It will be seen that two drops of the compound tincture of camphor could hardly be said, even under such circumstances, to have a deleterious influence. Besides the child had no appearance of having during life suffered from an opiate.

Emily P, aged five weeks, labored under cough on the evening of January 3d, 1859, and died on the morning of the 4th. The mother, after attending to the child, fell into a short sleep, and when she awoke the child was dead. The post-mortem examination took place on the 11th. The child seemed in good condition of body, rather plump, with a rosy hue on the parts exposed to atmospheric action. The brain was evidently much conjested, black dots appearing on slicing it transversely. The blood was dark and clotted in the sinuses and veins. No appreciable effusion into the ventricles. The thymus gland was large, and gorged with a white fluid of a chylous character, about half a drach of it occupying the central cavities. On opening the throax the lungs presented a solid appearance, firmly contracted towards the base, part of chest inelastic, and leaving much of the pericardium exposed; no crepitation in any part, and in cutting into them they showed all the appearance of lung in a foetal state-the usual sanguineous serum being absentthey weighed eighteen drachms, or one thousand and eighty grs. The pericardeum contained two or three drachms of serum, and the heart itself was plump, hard and enlarged, as if bursting with its contents. The right chambers were filled with perfectly black, clotted blood, which was equally black, but small in quantit y, in the left.

Each pleural cavity contained about an ounce of serum. The foramen ovale and ductus arteriosis were pervious. The stomach was nearly empty, containing about two drachms of dark grumous fluid. The liver was large and fully congested, as

were also the kidneys. On cutting into the abdomial walls a deposit of fat was observed, and the intestines appeared healthy.

With the heart attached the lungs sank rapidly in water; the heart being detached they also sank rapidly in their entirety. They were divided into several pieces and all sank quickly, so as to cause Mr. Wakely to say to the jury that he had never seen anything approaching it before, and to express his surprise how the child could have lived; adding that it could only have required the slighest impediment to respiration in order to cause death. Not the smallest piece floated. On inflating part of the lung it partially floated, but most of the air soon escaped again. Indeed, inflation was quite imperfect, the air entering with great difficulty, as if owing to an inexpansible condition of lung.

I left several pieces of the lung with Mr. Quekett, together with a note saying, "I now send you the pared-off edges of the uninflated lung. You will find two of the pieces, weighing only one-half and three-fourth of a grain respectively which sank as rapidly as the rest An examination of these is perhaps all that is necessary in order to render the subject perfect." Some inflated portions were also sent. Mr. Quekett replied

ROYAL COLLEGE OF SURGEON'S, May 7th, 1859. "DEAR SIR-I have made many observations upon the lung of the young child which you put into my hands for that purpose. I find that by far the greater part of the specimens are so much solified that they not only sink in water, but, on examination with a pocket lens, exhibit little if any trace of cellular structure. A few pieces (and these I have since learnt had been attempted to be inflated) sink much less readily in water; in these a slight trace of air cells may be seen with a pocket lens, but on making thin slices and examining them with a power of two hundred and fifty diameters, all the more solid parts appear to be made up of the small cells or granules, which, for want of a better name, may be called exudation-cells These cells adhere very firmly together, so that a section, however thin, when placed between glasses for microscopic examination, was so co-herent that the operation of tearing with needles would hardly allow of a proper isolation of the individual cells. In some parts there were slight indications of fibrous tissue, which was not disposed in the form of circles like that employed in the construction of the framework of the air cells. Those parts of the lung which were above stated to exhibit under a low power the character of foetal lungs in general, when treated in the same way as the more solid parts, certainly exhibited the fibrous structure of the air-cells very distinctly in some points; but although the air-cells were marked out, they were in