der, also, on percussion, and there were several tracts of indefinite dulness. Dr. Allbutt said that careful watching of the temperature for several days would generally decide the diagnosis, as in tubercle a higher evening temperature was to be expected. In spurious peritonitis the temperature might also occasionally reach 380 (C.), but not commonly or regularly. In the present case, the thermometer pronounced against tubercle and in favour of spurious peritonitis, which Dr. Allbutt attributes to disordered secretions, with the irregular bowels and tumid abdomen as a consequence, while the wasting is due to deficient assimilation. The indications for treatment are to put the bowels in thorough order, to improve the secretions by alkalies, mild bitters, and podophyllin, and to put the patient upon bland and nourishing diet. When this treatment has set matters straight, a short course of codliver oil and mineral acid with gentian is generally sufficient to restore the health. At the same time he would remark that these cases, if neglected, might end in mischief of a more serious kind. The present patient was discharged in a month, quite cured, and looking fresh and well. Spurious peritonitis is more common among the ill-fed and neglected children of the poor, but it is seen also in the families of the richer classes.-Med. Times and Gaz., Jan. 14, 1871. Treatment of Acute Tonsillitis with Belladonna.-Although many of the standard works on Medicine and Therapeutics omit to make any mention of the value of full doses of belladonna as a remedy in severe simple tonsillitis, its employment in this affection is not by any means novel. The following is a case in which its use was followed by a speedy recovery :— A. C, aged eighteen, had been ill for three or four days with severe left tonsillitis. On admission into St. Mary's Hospital, under the care of Dr. HANDFIELD JONES, the left tonsil and the adjacent arch were found to be much swollen, and very red. The inflamed parts had been scarified with some relief, but the formation of abscess seemed to be immiThe pulse was 100, rather weak; nent. the temperature 100.4°. Five grains of calomel and an aperient draught were administered shortly after admission. When Dr. Jones saw the patient, he ordered twenty drops of the officinal tincture of belladonna to be taken in half an ounce of water every two hours. On the second day after admission the voice was much improved, and the patient had less difficulty in swallowing. On the fourth day the patient had slept soundly during the whole of the previous night; the pulse was natural, the swelling had much subsided, and she was free from all distress. On the eleventh day, the tonsil appeared to the eye to be quite natural, but when felt from the neck it still seemed to be somewhat enlarged. With the exception of four and twenty hours, during which the doses were given every four hours, the belladonna was taken every two hours until the fourth day; the frequency of the dose was then reduced to every four hours until the sixth day, when the treatment was discontinued. It will be seen that while the dose was repeated every two hours, belladonna. was being taken at a rate of about ten grains of the extract in every twenty-four hours, though some deduction must be made for doses omitted at night, especially towards the close of the treatment. Nevertheless, neither in this case, nor in numerous others in which large doses of the drug have been prescribed by Dr. Jones for the same affection, has any toxic effect been observed to follow. Dr. Jones considers that this medication is more appropriate where the tonsils are acutely inflamed than in those cases where there is general inflammation of the fauces, without special affection of the tonsils. In the latter case he thinks that either iodide of potassium or the solution of sesquichloride of iron, according to the quality and stage of the inflammation, is preferable; and though he often combines with the belladonna a little quinia, or sulphate of magnesia, or an emetic, according to the indications of the case, and sometimes the use of steam, or a blister applied externally to the neck, he feels justified in maintaining that the success which he has attained in the treatment of these cases is not to be attributed so much | brain reserved for microscopical examinato these auxiliary measures as to the bel- tion.—Medical Times and Gazette, Feb. 4, ladonna. He always gives directions that 1871. the administration of the remedy shall be slackened as soon as the throat symptoms are materially relieved, or on the production of any toxic effect. Dr. Jones does not pretend to decide whether the remedy operates by producing constriction of the arteries, or by a direct sedative effect on the elements of the affected tissues; but he proposes that, if further observation should confirm its value in acute tonsillitis, the patient should be saved the regularly recurring pain of swallowing doses of medicine, by reducing the preparation of the drug to the smallest possible bulk, or by injecting it subcutaneously in the form of atropia.-Lancet, Jan. 7, 1871. Diabetes Mellitus.-Dr. OGLE showed us four cases of this disease in one ward of St. George's Hospital, two being under his own care, and two under that of his colleagues. Of his own cases, one was dying with very severe lung symptoms. In the other case, the gums have all the appearance as if salivation had been induced by mercury. Dr. Ogle has understood from Mr. Haward, of Halesworth, under whom the patient had been, that this symptom of salivation had come on with the disease, and remained throughout, no mercury having been given. In one of his diabetic patients, Dr. Ogle showed us the uvula diverted to one side, and decided inequality in the anterior arches of the palate. In another diabetic case, he found the same appearances, only the deflection was to the opposite side. He noticed the fact of this deflection of the uvula being observed in two out of the four diabetic patients, alluding to the observations by Dr. Saunders, of Edinburgh, upon vertical hemiplegia of the palate in facial paralysis and in diabetes. He looked upon the fact of two out of four cases of diabetes, casually associated, presenting divergence of the uvula and inequality in the two palatal arches, as something more than accidental. In the fatal case of diabetes, Dr. Ogle has had the medulla oblongata and other parts of the Notes of Cases in Addenbrooke's Hospital, Cambridge.—The following cases have been under the charge of Dr. Bradbury, at his hospital: Eruption of Purpura under the Use of Iodide of Potassium.-During a recent visit to this hospital, we noticed, under the care of Dr. Bradbury, the case of a brewer's labourer (fifty-eight years of age, who had lived well for the last two years) in whom iodide of potassium, administered for rheumatic pains, twice produced an eruption of purpura on the thighs, legs, and arms. Dr. Bradbury said he felt convinced that the purpuric spots were due to the iodide of potassium, for when he ceased to administer the drug for a fortnight, the purpura disappeared. On the iodide of potassium being readministered, the spots reappeared, again to disappear on the drug being suspended. Dr. Bradbury informed us that the same effect of the drug had been noticed by Ricord and Virchow. The former had a syphilitic patient, who, whenever he was treated with the salt, suffered from purpura hemorrhagica. Virchow's case was one of cancer, the subject of which had purpura hemorrhagica whenever the drug was administered. Dr. Bradbury's patient had also had several slight attacks of epistaxis. Incontinence of Urine treated by Hydrate of Chloral.-Amongst Dr. Bradbury's outpatients is a girl who had been troubled with incontinence of urine for nine years, wetting her bed, according to her own and her mother's account, every night. She was ordered fifteen grains of chloral hydrate every night, and since she took the first dose of medicine there has been no return of the complaint. Santonine in Helminthiasis.--We also saw a girl suffering from helminthiasis (ascaris lumbricoides) who, her mother said, had passed fourteen worms since her last visit. Dr. Bradbury had, from the patient's symptoms, suspected worms, and had prescribed santonine, with the above result. He looks upon this drug as a spe cific for these worms, having never known | extent when she was sitting or lying the remedy to fail when properly admin- down. On leaving the wards she became istered. Brit. Med. Journal, Feb. 4, 1871. an out-patient. Mary P.. Eight months after her discharge from the wards the patient left off the apparatus and began to walk with a stick, bending the knee moderately well. A few days ago she was brought to the hospital by Mr. Walton, in order to show her present state. She has complete use of her joint, and can flex and extend the leg perfectly. She goes up and down stairs with ease and without halting. The muscles of the leg and thigh have nearly recovered their volume. The patella is still in its abnormal position; and when the leg is semi-flexed, the condyles of the femur, the trochlear surface between them, and the attenuated tendon of the conjoined muscles, can be distinctly felt.—Lancet, Jan 28, 1871. aged twenty-three, was admitted into St. Mary's Hospital three years and eight months ago. All trace of acute disease had by that time passed away. The leg was straight and rigid. The ligamentum patella was so much contracted that the lower edge of the patella was drawn nearly to the tubercle of the tibia. That this was the chief source of the stiffness of the joint there was little doubt, but it was also certain that there were other changes about and without the joint which contributed to its rigidity. The muscles of the leg and of the thigh were much wasted from disuse. The patient walked with crutches, but very imperfectly. As there was no bony anchylosis, Mr. Hayes Walton thought the case to be a proper one for forcible flexion, by which adventitious adhesions about the joint might be broken through, and the extensor muscles stretched or more or less torn, and the joint made available. He thought, too, that if the joint were used the wasted muscles would regain much of their bulk and the limb its power. The patient was placed under chloroform, and with the exercise of a great deal of force, the leg was flexed on the thigh to the full extent. The operation was followed by constitutional irritation and local inflammation. The limb was kept in a straight splint for two months; an iron apparatus was then applied, and the patient began to move about the ward on crutches; at the same time, slight flexion was made daily, and gradually increased. She left the hospi-ing of fungus. In the centre of the cheek tal at the end of five months. She was then unable to stand without the iron apparatus, but could walk without crutches. She could flex the leg to nearly the full Wound of an Artery in Opening an Abscess; supposed to be Malignant Disease.Dr. THOMAS GREEN, Consulting Surgeon to the Bristol Royal Infirmary, records (Brit. Med. Journal, Dec. 17, 1870) the following interesting case of this. A lad was brought into the Bristol Infirmary. On admission, one side of his face was much swollen and covered with layers of lint, strapping, and bandage, apparently to stop bleeding. They were all saturated with blood, and a weeping of blood was going on under these coverings. The history was, that the swelling was thought to be an abscess, and was punctured by a surgeon; no pus, but blood followed the puncture. The case was then thought to be one of malignant disease, and was sent to the infirmary as a case of fungoid disease of the face. The lad became my patient. Bleeding was still going on, and he looked pale; it therefore became necessary to know at once what the disease really was. The coverings were all taken off, and the part well sponged. The swelling felt "doughy;" it wanted the hardness of scirrhus and the soft elastic feel was an ulcerated opening, through which dark blood was oozing at the time. On passing a finger through the opening, it appeared to enter a large cavity filled with coagula. On withdrawing the finger, it | face of the wound. A case precisely simwas covered with blood and small coagula. I determined at once to lay open this cavity freely, to clear away its contents, and know what it really was. This I did immediately; and, the exposed parts having been well cleaned, an artery was found bleeding, which I tied. It seemed to be either the facial or one of its primary branches. ilar to the one described occurred in the infirmary, where more than a pint of blood was lost in a gush. The tourniquet was at once applied, and I was sent for. By the advice of a very experienced colleague (the late Mr. Lowe), the artery was not tied, but the stump was opened in the way described. Not a drop of blood could be seen, merely the sodden surface just described. The large bleed was kept in by the dressings, had accumulated until the wound was mechanically distended by the large amount of fluid and could contain no more, when it suddenly burst through the coverings; and this led to the supposition that the main artery had given way. In both these cases the wound healed rapidly under the usual applications, and without the use of carbolic acid or an invasion from those "septic germs" supposed by some to be such potent agents for mischief. The conclusion to be arrived at is, that the instrument used in opening the sup-ing must have been from the surface; it posed abscess, wounded the artery. Blood issuing from the puncture, the wound was immediately closed, and constant pressure kept up to stop the bleeding, the coagula being kept in by this pressure. The swelling, no doubt, was from that form of inflammation, in which there is more fluid than solid exudation, giving a deceptive feeling of suppuration. We have often seen these swellings opened when there was no pus formed. I think this case gives us a caution not to be too hasty in making a diagnosis of malignant disease; and it also confirms a most useful rule of practice, which is, where pressure fails to arrest bleeding from a deep surface or cavity, at once to lay the parts open freely, and thus ascertain whence the bleeding comes, whether from one vessel which can be tied, or from a number of minute ones, where styptics can be applied. Cases occur where bleeding goes on a few days from a stump, say after amputation of the thigh. A large gush of blood comes on suddenly, and is supposed to come from the main artery, so as to lead the surgeon to think of tying the vessel above the wound. Let the wound be freely laid open, if necessary, adhesions separated, and the entire surface exposed to view. There may be some oozing of blood going on, or, more often, the mere exposure to air at once arrests any further hemorrhage; and in some cases the exposed surface of the stump looks like sodden skin, showing a want of vital power and consequent failure to throw out granulations-the only process by which the wound can be filled up, aided of course to some extent by vital contraction in the surrounding parts. Any stimulating dressing in such a case as this now brings on a healthy condition on the A Case of Peri-cæcal Abscess.—(Under the care of SIR H. THOMPSON and Mr. CHRISTOPHER HEATH.)-In a previous number of this Journal (Dec., 1870, page 171), we alluded to the case of a youth, about twenty years of age, in whom Mr. Heath, in the absence of Sir H. Thompson, had opened an abscess which was pointing between the anterior superior spine of the right ilium and the mesial line of the abdomen; and stated that the incision was followed by a copious and forcible stream of offensive pus, the withdrawal of a large shred of sloughing cellular tissue, and finally by an alarming flow of venous blood, which was only arrested by filling, with lint soaked in perchloride of iron, a large cavity which was found to exist beneath the situation of the incision. The further progress of this case, we learn from The Lancet (Feb. 11, 1871), was as follows: During the night following the operation some feces escaped from the wound. Two days afterward the plugs of lint were removed, and the cavity was washed out with a solution of carbolic acid (1 in 40), and refilled with fresh plugs soaked in the same preparation. | tracted but healthy. The small intestine Notwithstanding the passage of a firm mo- was healthy. tion by the rectum, portions of fecal matter continued to be discharged through the wound. On the fourth day, the patient showed signs of increasing weakness, and complained of frequent faintness. The wound, which still gave passage to feces, was dressed as before. On the fifth day he felt better. On the sixth the wound gaped widely, and some large sloughs were removed. The cavity presented a red granulating surface, and contained more sloughs. Feces were passed daily by the rectum as well as by the wound. The cavity was directed to be washed daily with the carbolic solution. By the ninth day it was clear of sloughs, and when it was not full of feces, its surface could be seen to consist of granulations. On the eleventh day the patient appeared to be getting weak. He died exhausted on the twenty-second day, the fecal discharge from the wound having recurred to the last. At the post-mortem examination there was found, in the right iliac fossa, the sac of an abscess which was bounded on the outer side by the iliacus muscle and the iliac bone-the surface of which was bare within two inches from the crest-on the inner side by the cæcum and some thickened peritoneum, and in front by the abdominal walls. The finger could be passed anteriorly into a sloughy cavity between the bladder and the pubes, and posteriorly between the rectum and the bladder. The pus had penetrated into the subperitoneal tissue, but had been arrested in its course towards the perineum by the rectovesical fascia. The whole sac of the abscess and the surrounding parts were removed en masse, but a careful examination failed to discover the source of the hemorrhage. In the inner wall of the abscess were situated two large openings, which communicated with the cæcum, and through which prolapsed the mucous membrane of the gut, of a dark red colour, each portion presenting very much the appearance of a prolapsus ani. On opening the intestine, no scars or other traces of recent ulceration could be seen. Beyond these openings the gut was con MEDICAL NEWS. DOMESTIC INTELLIGENCE. Meningitis treated by Bromide of Potassium; Recovery. -By ROBERT HORNER, M. D., of Gettysburg, Pa.-On the 19th of last December, I was requested to see a child eighteen months old, of a scrofulous diathesis, with convulsions. The paroxysm was slight, but was followed by a violent attack of pneumonia. After a few days the pneumonia yielded to treatment, and the child seemed to be recovering, when meningeal inflammation set in. There was acute pain in the head, with great restlessness alternating with stupor. The head was hot, the stomach irritable; the stools green. The usual mode of treatment was adopted and continued for some days without making any perceptible impression on the disease. The case was becoming hopeless. The stupor was more intense, verging on coma; the eyes were turned up, the lids half closed, the pupils dilated, pulse less frequent. The child was now put on the bromide of potassium, one half grain every three hours, and continued for two days without any change in the symptoms, the child, however, not getting any worse. was then increased to two grains, when, after continuing it for twenty-four hours more, there was a marked change for the The dose better. The bromide was continued in the two-grain doses until the head symptoms had all subsided. The recovery was complete. Placenta Prævia.-Dr. D. HUMPHREYS STORER reported to the Boston Society for Medical Improvement (Boston Med. and Surg. Journal, Jan. 12, 1871) the following case of this to show how satisfactory, in some alarming cases, is the treatment proposed and practised by the late Prof. Simpson. "You are aware that in cases of placenta prævia, when the os uteri is so undilatable as to render it utterly impracticable to introduce the hand into the uterus for |