being often completely masked by the sympathetic participation. The common acceptance of such a case is "a bilious attack," or if symptoms of irritation attended by heat of surface, pain in the back and limbs and partial aberration, be present, "a bilious fever." The reality differs widely; as the brain or spine is seriously affected, and the source of enteric engagement by nervous extension is clearly pointed out. Such cases as above observed are to be found in those who have in various ways and from different necessities over-exerted themselves. both bodily and mentally, or in children or youths of strumous habits and excitable temperaments, but whose brains have been unduly exercised. The reverse of this also happens, and the constitutional degeneracy need not be great, as the liver, stomach and intestines may be seriously diseased, the brain averting notice of the latent disorder, by delirium, carpal or pedal spasm, or by alternate rigid extension and flexion of the extremities. Frequent gagging, or vomiting of bile in great quantities, or of mucus mingled with it, generally announce the cerebral disorder. When the stomach and liver are the seat, there is little or no vomiting, but there is greater pain on local pressure, unless the cerebral symptoms run high, when the gastritis and intestinal ulceration may have proceeded to fatal extent, yet be unac companied by pain. And what renders the foregoing symptoms more obscure is, that there may be constipation, or very slight diarrhea, and this for the most part is attributed to the remedies. Ulcerations of the colon and other visceral portions to fatal extent, and unannounced by any symptom, have been reported in such cases, the affection of the brain averting all suspicion.

In these latter cases we have lesion of the scientific branches of the sympathetic, the presence of irritative contents in the intestine not being noticed, by which the propulsive efforts should be aroused, suppuration ensuing. We see this exemplified where suppuration of the cornea takes place from lesion or destruction of the ophthalmic branches of the fifth pair, the protective mucus not being secreted. The ulceration of an intestine may thus progress to fatal issue, unattended by pain, and in consequence of the loss of sensory endowment in the sympathetic. The absence of pain on pressure, therefore, must not always be set down as evidence of freedom from gastro-enteric disease, as the parts may be in a state of anesthesia. The treatment of these cases is of vast importance. When the brain is the seat, but the liver and stomach by bilious vomiting disguise the latent disorder, and large and frequently repeated doses of calomel and drastic cholities have been administered, it is easy to understand, that the innervation of these organs being in a state of high irritability, they must necessarily be more acted upon by such remedies having a specific stimulant effect on them, and thereby from irritation pass rapidly into destructive inflammation, and thus react on the brain. Hence it is that paralysis so frequently follows the injudicious employment of calomel and other mercurial preparations, but which are mostly dated from a bilious attack. The treatment should consist in leeching the spinal column and base of cranium; Dover's powder in repeated doses, to subdue the nervous irritability, conjoined with small portions of nitrate of potash, if the skin be dry or husky-and two narrow straps of blister-plaster on each side of the gastro-spinal region, after the topical detraction of blood.

Where the disorder is primarily enteric, the calomel forms the

sheet anchor of the treatment, the cerebral disturbances quickly yielding, after copious dejections, thereby freeing the blood of biliary impurities, by stimulating the liver, and at the same time subduing the portal congestion.

A few cursory remarks on constipation and diarrhoea, from nervous causes, will not be inapplicable here. I have already referred to the suppuration of the cornea from division of the fifth pair. The mucous membrane of the intestinal canal receives sensific and motor endówment from the sympathetic. The secretions vary according to the state of the sensific and organic branches, the mucous sheathing, the villi becoming increased, diminished or checked according to their condition. The muscular tunic is warned to contraction by the impressions on the sensific expansion-or at times by direct irritation of the cœliacsemilunar ganglia, &c.—and the contents of the canal are then evacu ated. The discharge of mucus, as regards quantity and quality, depends on the state of the nervous power. In low conditions the mucus secreted is thick, or becomes inspissated by collection, and the impression on the sensific branches is mechanically lessened, the bowels remaining quiescent; but if the secretion of mucus be natural, and the ingesta be acrid and irritant, diarrhoea results. If this continue long, true hypertrophy results from the continued exercise of the function, exhibited in constant expulsive efforts. On the other hand, if the secretion be exhausted and the mucous membrane unprotected, as in inflammation, the tube contracts spasmodically on itself, as is often witnessed on autopsy, the intestinal coat appearing raw and chapped.

The same takes place in the bladder, when the mucous membrane becomes diseased: the muscular coat being hypertrophied, is constantly contracting and expelling small quantities of irritative urine, although at first from disease or injury of the spinal marrow, the catheter was necessary for its withdrawal.

From these hints the treatment can be readily discerned. In those diseases and especially happening in those termed of "nervous temperament "where the retained secretions became highly irritant to the mucous surface, and constipation ensues, the evacuation cannot be forced by drastic or stimulant cathartics, as their exhibition would only tend, by their retention, to cause greater and more extended contraction of the intestine, and an increased non-elimination of the protec-. tive mucus. Demulcents, sedatives, and at times the local detraction of blood, or even from the arm, form the proper remedies, thereby subduing the over-excited nervous irritability, and allowing the mucous membrane to recover its secretion.

In other cases a double state exists, viz., purging from the lower and large intestines, with spasmodic contraction of the small intestines. The discharges are generally attended with dysenteric mucus, highly offensive, and without relief to the symptoms. This condition may be idiopathic, or result from the administration of remedies containing aloes, colocynth, and others, which have, by their absorption, a specific tendency to the lower bowels. The patient complains of the insufficiency of these stools, and places the hands over the middle abdominal region, saying he feels as if a cord were bound around him. Opiate injections, in some mucilaginous vehicle, form the treatment, the irritated condition of the colon being soothed by them, whilst the constriction of the small intestines is resolved. Where large and re

peated doses have been given, it sometimes becomes necessary to give opium by the mouth, for the double purpose of calming the spasm, and preventing hypercatharsis from the small intestines.

Another condition presents itself-and I have seen it most frequently in children-where overdosing has been habitual, or where the nervous impressibility has become sluggish from general disease or spinal injury. In these cases, the whole intestinal tract is in a lax condition, the mucous membrane, for the most part, being thickly sheathed with inspissated mucus, consequent on the severe nervous depression, thereby further preventing the action of remedies. Nervo-stimulants, conjoined with astringents, are here indicated; and the practitioner, by referring to such cases, must remember to have seen where brandy, wine and bark have been administered with a view of supporting the patient's strength, that the evacuation of the bowels frequently resulted. Some years ago I was induced to employ small doses of strychnia, or nux vomica, in these cases, and with the happiest result. The physi ological action of this alkaloid over the spinal and ganglionic system is now well established, and need not be cited, its astringency being also called for.

From these instances this law can be established, viz., that where the nervous exhaustion or interruption is great, the mucous membranes throw out a thick, tenacious secretion, and that when the nervous power is unduly excited, or stimulated, that the secretions become more freely poured out, which, if long continued, or the part be specifically acted upon by remedies causing increased local action, may, from simple irritation, pass rapidly into inflammation, the total suppression of the protective mucus ensuing. It will not now be difficult to understand, how it is that, where the liver becomes irritated, it may be goaded into inflammation, by the exhibition of mercury, or other stimulant specifics. Whether these conditions exist in the lungs, or the abdominal viscera, the effect is the same, and the inflammation must be relatively treated. And hence it is we find that, in some inflammatory affections, the antiphlogistic and sedative treatment is only successful, whilst in others, happening in those of depressed nervous power and exhausted circulation, the stimulo-tonic plan is indicated; and these latter classes form the most difficult to subdue, as real debility is conjoined to the local inflammatory disorganization. By reflecting upon this, more professional charity would be bestowed daily, when a case not fully reported, but too frequently meets the sweeping condemnation of the practice pursued, the sthenic or asthenic condition of the patient not being known or inquired into.

Before closing this paper, I will drop a few hints respecting sympathetic engagements of the bladder and uterus, resulting from latent rectal irritation, or injury of the lumbo-sacral spine. These form most troublesome affections, and are often sources of injury to one practitioner, for the benefit of another, whose diagnosis may perhaps result from greater knowledge, or from previously learning the plan employed by his unsuc cessful predecessor, thereby directing his mind to other and more efficient views.

Vesical and uterine affections may owe their date from causes irritating the lower lumbar or first sacral nerves ;-these causes may be congestion, inflammation, direct engagement, or injury, &c.-the channel of nervous connection being sufficient to arouse morbid exhibitions in the organs, thus aiding in the masquerade of disordered action from

distal origin. Hence the treatment in such cases is a matter of moment. The local application or direction of remedial measures, whilst they may serve to soothe the engaged organs, yet fail to cure. As an example of this can be taken the incontinentia urinæ of children, resulting from ascarides or worms, and but too frequently unnoticed, their expulsion being requisite for cure. I will here call attention to a certain troublesome "sore nose" in children, resisting all local treatment, but which can be easily subdued by cold mucilaginous injections, in small quantities, and repeated several times a day. Here is illustrated the irritation of a mucous membrane from distal causation.

Intestinal, uterine or vesical paralysis, frequently ensue from concus. sion or other spinal injury, giving rise to some of the most indomitable forms of functional disorder. The most remarkable and severe case coming under my notice, resulted from a sudden fall across the arm of a rocking chair. The concussion on the spine was so great, that insensibility, with trismus ensued instanter, followed by violent muscular spasms and convulsions resembling those in hydrophobia. The result of this accident was paralysis of the bowels, bladder and lower extremities, with tetanic spasms. She was perfectly restored under the treatment employed, consisting in the free use of internal and external stimulants, and the application of the continued galvanic current. The vesical inertia was overcome, by passing a galvanic stream from the rectum and spine to the supra pubic region, and through the urethra by a silver catheter, the positive pole being placed upon the spine.

I was led to employ galvanism in vesical paralysis, from the result of some of my experiments on animals with the current. By passing a strong stream, (interrupting it at pleasure), through the lower lumbar and sacral nerves of the animals, (dogs), I have caused the bladder so to contract, that on post-mortem examination it seemed more like a hypertrophied uterus. In these instances the urine was jetted with force, or oozed steadily out.

In some of the Journals I had seen it proposed to employ galvanism as an antidotal means to the effects of strychnine. According to my knowledge and experience in the action of both the antidote and poison, I considered the proposition dangerous, not only on account of the apparent similarity of convulsive action produced by each, but chiefly on account of the rapid absorption that might ensue by the galvanic influence. I subjected it to proof, by obtaining a cat, and placing five grains of strychnia within the mouth. Sneezing was the only effect produced for nearly an hour. I then secured the animal, and having placed a metallic tube in the rectum, in connection with the battery, I touched the tongue with the other pole. Instantly the peculiar spasmodic actions of the strychnine resulted, and continued with great violence till death ensued, in about two minutes.

By carefully reflecting upon these results, the rational application and modus operandi of those remedies, having control over certain vesical and uterine affections resulting from some known cause, can be readily made out; and hence it is by the employment of a remedy of known physiological action, as is to be found in a galvanic current of proper intensity and quantity, that the specific influence of many articles in materia medica can be discovered, and I need not say, by so doing, many changes will be forced upon the mind for recog nition. In other words, by selecting those cases cured by the ad

ministration of certain remedy or remedies, and finding the like cases cured by the application of a galvanic current, the curative action of the medicines can be learned, and the remedy, styled sedative, will be found stimulant, and the counter-irritant become a nervo stimulant. I do not propose galvanism to the exclusion, or even as superior to other means, but I hold it preferable not to punish by internal drugging, a man's stomach for his bodily infirmities, if an outward application of a current will answer the same purpose. Galvanism is no panacea, but has been and will be found a most valuable remedy in certain cases.

In conclusion, I will concisely state, that in the employment of galvanism in the various forms of paralysis, the diagnosis between "organic" and "muscular” paralysis must be well established, in order to obtain satisfactory results. In the former, the positive current must be passed from the extremity to the spine; in the latter, from the spine to the extremities. In all cases a mild current is to be preferred at first, and its continuance must be subjected to the capacity of the patient at the time, and the susceptibility of the part affected. I should advise in chronic cases the long continuance of a feeble stream, say from one to six hours; in preference to the more powerful action of an increased current for a shorter period. In passing it through the head, great care must be exercised, and a light power should be used, and only for a short time, constantly withdrawing one of the sponges from the surface. By means of the galvanic current I have been enabled to form a surer diagnosis as regards the loss of power, &c., being owing to organic difficulty, or functional disturbance. I have shown this particularly in those cases where the tongue has been affected, the words being completely or almost inarticulate. In some, after a minute's application, the power to pronounce the word distinctly for a time has returned, and by daily administration has been permanently improved. It will be found particularly serviceable also where deglutition and laryngeal expectoration and the power to free the mouth of the saliva are deficient. 513 Broadway.

ART. IV. Case of Double Hare-lip.-By N. S. DAVIS, M. D., of Binghamton, N. Y.

APRIL 20, 1847. Mr. Y. came to my office with his son, æt. seven years, robust and healthy, but with an aggravated deformity of the face arising from a congenital hare-lip. The fissure was double, extending, not only through the lip on either side, but also through the entire maxillary bone and palate, converting the mouth and nostrils through their whole extent, into one cavity.-That portion of the alveolar process containing the four front teeth projected forward nearly one inch beyond the lateral pieces of the jaw, and contained two large incisor teeth. The lateral or side pieces of the jaw had so far approximated each other as to come in actual contact behind and beneath the projecting middle piece. The projecting portion had been deprived of the piece of lip, that naturally belonged to it, by an injury inflicted some time since. The firmness of the lower, together with the close approx. imation of the lateral pieces of the jaw, precluded the idea of forcing the middle piece back so as to bring the lip together over it, and thereby preserving the full rotundity of the face, as should be