regular course, or order of appearance, the remedies most suitable and proper are, stimulants, tonics, acids, and narcotics, epispactics and rubefacients, and the least possible purging, or emesis, that will answer. To be a little more particular:-In the cases of torpor, accompanied with exhaustion, emetics of sulphate of zinc and ipecac, sulphate of copper and ipccac, or sanguinaria instead of the ipecac. Mustard is an excellent emetic in such cases: it operates speedily, excites but little nausea, and arouses the stomach-it is truly and properly an acid emetic.

Stimulants and acids should be given at the same time, in combin, ation with the emetics. If there is much exhaustion, rubefacients and epispastics should be freely used. Very little, if any, of the preparations of papaver, is indicated in these cases. Stimulants, acids and tonics, in regular and uniform doses, at short intervals, accompanied with epispastics and rubefacients, to equalize the heat of the surface, and relieve any local symptoms, and arouse the system. In case of irritability, and exhaustion, stimulants, tonics, and narcotics, are the principal remedies. Stimulants are not required in such quantities as in cases of torpor ;-neither acids nor blisters are indi, cated in these cases of irritability: they may be necessary to meet some local affection but if papaver is not given freely during their application; and deeming the irritation they excite, will far overbalance any good derived from their effects on the local affection, The various preparations of papaver are highly useful, and cannot be dis, pensed with in these irritable cases. When the patients are severely sick, tonics frequently disagree, and stimulants, and narcotics, and often narcotics alone, are indicated. This is the general treatment for cases of torpor, with exhaustion, and irritability, with exhaustion. There is a set of cases, not so urgent nor severe, which will require such emetics as I have alluded to, and moderate purging with calomel, before entering on the administration of acids, tonics and stimulants-epispastics and rubefacients. These are cases of torpor, with moderate exhaustion. The irritable cases with moderate exhaustion, will require moderate purging with calomel, in combination with papaver, before entering on the stimulant, and tonic, and narcotic course. I believe the above general plan, will meet all the general principles of treatment. The incidental circumstances must be met according to the nature and urgency of the incident, be it of what nature it may.

In regard to the insidiously malignant cases, I much doubt whether

any course or system of treatment is followed with success; for I am unprepared to say, what effect any article of the materia medica will have on the great sympathetic system. It appears to be an organ neither of sensation nor motion, in the common acceptation; yet it appears to influence the actions of the heart, and the organs of nutrition and digestion-or in other words, it appears to be the great instinctive agent of the system: perhaps the organ, or instrument, through which the vis-medicatrix naturæ operates, or in which it is seated, as the brain is the organ or seat of intellect. But whether its actions can be changed-whether it can be increased or diminished, by the usual agents, which excite motion and sensation, and overcome diseased action and pathological states and conditions of the system, by producing a different pathological condition, or exciting a new set of actions, I feel no warrant in saying. I am rather in. clined to the belief, that we cannot correct, with any of the agents known, any pathological conditions of that system. Nevertheless, it may be through this very system that all the remedial agents oper ate, and bring about a state of the system, incompatible with any pathological condition excited by the agents producing disease. As this system is connected throughout with the nervous system, parti. cularly in all the organs essential to the preservation and reproduction of the human species, it may be that we should attribute all the suc⚫ cess in the treatment of disease, to remedial agents operating on this system primarily, and changing the actions of the other organs secondarily. As far as I know, at present, I shall leave this subject forever; but not without a hope, that I may have excited some one competent to the task, to take it up, and make all clear and intelligi. ble, that is now dark and not understood.

ARTICLE XLVIII.

Injury of the Medulla Spinalis-Death: Autopsy. By J. A. MAYES, M. D., of Sumter District, South Carolina.

Lafayette, a negro man, aged about 25, of good constitution, and in the enjoyment of excellent health, sustained a severe injury by falling from a tree on the night of the 10th of September. He had been hunting around his master's cornfields for racoons, and had discovered one in the top of a tree some 25 or 30 feet high. The usual mode of taking these animals, practised by the negroes on

Black River, is to climb the tree and shake them out, having full confidence that their trusty dogs below will not allow them to escape. This, Lafayette essayed to do, but when about 15 feet above the ground, he made some false step, which resulted in his being precipitated headlong to the ground. His companions state that he was speechless for nearly half an hour, and as soon as the power of expression returned, he complained of pain in his neck and between his shoulders. He was, however, incapable of voluntary motion, as respects the lower extremities, but could move his head a little— more freely to either side, than either backwards or forwards. He could also raise his elbows, but his hands and fingers were motionless.

I visited Lafayette about an hour and a half after the accident, and found him in the following condition :-His mental faculties in no respect disordered, memory of what had passed perfectly distinct, and gave me the foregoing account himself, differing from that received from his companions only in minuteness of detail; stating that he did not fall directly upon his head, but that the back of his neck and head struck the ground first: complains of pain in the neck, and that only when he was moved; feels no pain when suffered to be still; incapable of any voluntary motion, except the slight movements of his head and elbows before mentioned; surface of the entire body rather cool; pulse full, but slow, 54 to the minuteneither dislocations nor fractures could be detected, but some serious injury of the cervical vertebræ and spinal marrow was considered as absolutely certain, though the nature of the injury could not be correctly ascertained.

Being called upon to direct the treatment of this interesting case, I directed counter-irritants to the spine, believing that the only hope of a successful termination consisted in relieving the spinal marrow of the dangers of high inflammatory action, although it was very questionable whether its integrity was preserved. As this latter condition could not be ascertained, I could do no better than to take it for granted, that the spinal marrow had received no lesion, which would, of itself, cause death, but that loss of life might be the result if high inflammatory action should supervene. Counter-irritation, by means of blisters from the occiput to the sacrum, seemed to be preferable to any other treatment; blisters also were applied to the extremities, and not till then did I discover that he was entirely insensible to pain in the lower limbs-although the blisters drew well,

he never felt them.

After reaction was somewhat established,-the pulse being 75 to the minute, full but soft,-I bled him from the arm about 10 ounces, and administered zi. of castor oil. This was on the day after the accident occurred. The oil did not operate, how. ever, until a second dose of like quantity was administered. The muscles concerned in the expulsion of urine seemed to have been completely paralyzed; the catheter was therefore used twice daily. The secretion of urine was very abundant, and had the appearance and smell of healthy urine until the 8th day after the injury; at which time it became tinged with blood and very fœtid, the quantity also was considerably increased; this state of the urine continued till the 10th day, when it became rather thick with mucus to be drawn off by the catheter: he died a few hours after I first observed this state of the urine. His bowels were rather torpid the whole time, but could be moved by large doses of castor oil, that being the only purgative medicine administered. His breathing was very full and easy the whole time. The pulse remained at 75 until the 8th day when it rose to 90, soft, but with less volume-the 9th day it was 110, very feeble and for many hours before death it was exceedingly quick, but too indistinct to be accurately counted. He had no appetite, but seldom refused nourishment when brought to him. From the 8th day he belched a great deal of fluid from his stomach, and this belching had increased so much on the 10th day, that it was almost an incessant flow. He had hiccup occasionally on the day of his death. His intellect remained unclouded and frequently spoke of approaching death with calmness. On the night of the 20th Sept., just 10 days after the injury was received, he was relieved of his sufferings, by death; no doubt a welcome relief.

In reference to the treatment of this case, I should have but little to say, but as some may in such cases, prefer cupping to blistering the spine, it is proper that I should give my reason for preferring the latter. Cupping relieves by local abstraction of blood, and does not exert any influence upon the system generally, whereas, a blister relieves by local depletion and at the same time exercises an important stimulating influence over the whole animal economy; a matter of great moment in a case like the present. If my views on this point are incorrect, I hope some one will take the trouble to correct them; as my object in reporting this case, is not to attempt to enlighten the Profession, but simply to announce the fact that I am in want of information, good practical information,-on the treatment of injuries of the Spinal Marrow.

Autopsy-7 hours after death. The autopsy in this case did not embrace a particular examination of all the organs, as the lungs, kidneys and brain exhibited no evidences of injury during life. Want of time compelled me to make the examination as short as possible. The cervical vertebræ were exposed and found to be injured in two placed-The atlas and dentata were entirely separated; the atlas remaining firmly fixed in its position. The spinal marrow did not appear injured at all at this point. This fracture (as it may well be called a fracture) was complete, the separation being entire. The fifth and sixth vertebræ were also partially separated, and at this point there was manifest injury of the medulla. As soon as the muscular coverings of the bones were cut through, the marrow gushed out, similar to the escape of purulent matter from an abscess, when opened with a lancet. The medulla spinalis, at this point was evidently in a state of decomposition. How more injury had happened to the medulla at this point, where the bones were still adhering in front, than at the other, where the separation was entire, appears to me inexplicable.

The internal organs were very cursorily examined. Evidences of peritoneal inflammation were plainly to be seen, though its existence was not suspected during life. The bladder was nearly black and had formed strong adhesions to the surrounding viscera on all sides; distended with urine-The stomach was also distended with fluid.

The result of this examination was a conviction that in consequence of the injury of the medulla spinalis, no treatment would have done any good; death would have been the ultimate result. The peri toneal inflammation, no doubt, hastened its approach.

ARTICLE XLIX.

Case of Adherent Placenta with Hour-glass Contraction. Reported by Drs. MARTIN & SMITH, of Atlanta, Ga.

Obstetricians are divided in opinion relative to the adherence of the placental mass in hour-glass contractions of the uterus. Very respectable authorities* contend that it is extremely rare, others of equal standing, that it generally exists. We are not prepared to decide the point, but from our limited experience, are inclined to the latter opinion.

* Ramsbotham, Dewees.

+ Douglass.