consider, first, whether there are really apertures in the vascular parietes; and, secondly, whether the result is due to any peculiar properties of the blood corpuscles themselves. Dr. Cohnheim inclines to the belief that interspaces exist between the cells of the lining membrane of the smallest vessels; and, in this view, he is supported by the fact that openings have been proved to exist in the smaller branches of the lymphatic system, apparently in connection with the stomata-like orifices in the epithelium of the serous membranes." The so-called trophic nerves have allotted to them the office of regulating nutrition, but the vaso-motor nerves fulfil the same function, control the flow of blood and the vital actions of the different parts. Hyperæmia and effusion are common to certain skin diseases, and which are owing to nerve irritation-the transudation to pressure. This latter may be limited or diffused according to the nature of the disease and the tract of nerves injured. In large nerves the vasal filaments may be bound up with the sensory when there will be more pain accompanying the disease, as in herpes. Belladonna has the power of acting on the vaso-motor nerves, causing them to constrict the vessels, and is valuable medicine in herpes, engorgement of the mammary gland, &c. Owing to injury of nerve trunks, a change of structure is observed in the skin, which covers the distribution of the affected nerves, and from the observations of Dr. Woakes and American army surgeons during the late civil war in the United States, on cases of injury to nerves by gunshot wounds, &c., it appears that the skin affected usually takes on either an erythematous, papular (lichen), or herpetic character. It also loses its hair (when on the head alopecia), is smooth and glossy. I have met with a disease of the hair which might be called "fragilatas crinium," or extreme brittleness of the hairs, an affection in which no parasitic fungus could be detected, which is essentially a disease of defective or deficient nutrition and of nervous origin. The following are the brief notes of the case :-J. M., aged 45, consulted me on March 4th, 1868, for a "breaking-short" and brittleness in the hairs of his left whisker, which has existed for about one year. He cannot offer any explanation of how the affection commenced, and never had syphilis. His health latterly has not been good, is very nervous, easily agitated, sleeps badly at night, and troubled with dyspepsia. No parasite could be detected on the hairs, for at first sight it presented some of the appearances of the declining stage of tinea tonsurans, except the brany desquamation of the cuticle, the skin of the affected part being healthy. The hairs were uneven in length, fissured longitudinally, and extremely dry, but of the natural colour, which was black, thus differing from the hairs in tinea tonsurans, which are usually bent, of a lighter colour than natural, nodulated, and easily broken; this latter state being due to the sporules of the "tricophyton tonsurans," which are embedded in their structure. The hair bulbs in "ringworm" are also diseased and considerably enlarged, but in this case were quite healthy. I considered the affection to depend on atrophy of the hair, arising from defective nutrition, which was due to impaired nervous power, and consequently prescribed tonics internally, and locally the application of a stimulating lotion, the hair being kept cut short. Should another case of the above affection present itself I would be inclined to try phosphoric acid, considering, as I do, that the disease was of nervous origin. The presence of dyspepsia in this case is also of interest, and in Bostock's Physiology, page 92, I found the following passage:Vanquelin found that the colouring matter of the hair is destroyed by acids, and suggested that when the hair has suddenly changed its colour, and becomes white in consequence of any mental agitation, it is owing to the production of an acid in the system." But this idea seems to be very hypothetical. No doubt, in the case recorded, dyspepsia, accompanied by acid eructations, was present, and a form of dyspepsia has been called " nervous," usually arising from mental anxiety, but to establish a case between 1 Journal of Cutaneous Medicine, No. III. them would be difficult; nor is it at all easy to account for In the disease known as prurigo, we have, on the authority of Dr. Parkes, a highly exalted, sensitive, and irritable condition of the nervous system, a condition not unfrequently depending on a morbid state of the spinal cord; and from the researches of M. Bréschet on the structure of the skin, we are made aware of the fact, that the various nerve filaments proceeding from different trunks are dispersed in many directions, and ramify and subdivide minutely on approaching the cutis, ultimately entering the papillæ. Again in gutta rosacea, a disease due to debility, a close sympathy and nervous connection is evident between the part affected-viz., the sebaceous follicles and the reproductive organs and uterine functions. We have in this disease a determination of blood to the capillary vessels of the diseased part, in fact, a hyperæmia, and which finally ends in suppuration. Like erythema, herpes and pemphigus are diffuse erup- 2 Thompson on Diseases of the Skin, edited by E. A. Parkes, M.D. 5 Journal of Cutaneous Medicine. No. V., page 37. paresis, and I may mention that I have found no medicines more useful to check it than large doses of tannin, combined with quinine. The following remarks of Dr. Handfield Jones are extremely interesting:-"The fact is of much significance, that in tolerably vigorous persons, the application of a linseed poultice produces only a macerated state of the epidermis, whilst in the weakly it gives rise to well-marked eczematoid eruption. The influence of the vaso-motor paresis in promoting perspiration is shown by many facts, as the occurrence of profuse sweating during sleep in phthisical, rachitic, and other persons. The same results from strong exercise, where the nerve-force is used up by the muscles, and to a much greater degree in those who are in training. By a statement made in a report from the Vienna Hospital, that when the sympathetic nerve is divided on one side of a horse's neck, that side of the face and head appear bathed in sweat. The occurrence of sweating and vesicular eruption as co-results of nerveparesis is illustrated by a report given by Schrann respecting genuine intermittent fever, in the Upper Palatine, in 1856. The cold stage was short, while an abundant sweat came on early, attended with an eruption of herpes of varying intensity, which occupied the abdomen and forearm, and appeared to be rather the cause than the consequence of the sweat. In the above-mentioned instance, the vasomotor nerves alone, or with the sensory, seem to have been directly affected; but the same phenomena, or very similar, may be produced by inhibitory (reflex) irritation." authority of Dr. Duclos, that nearly all asthmatic subjects present a herpethic diathesis. Dr. Woakes, in a paper on the "Correlation of Cutaneous Exanthema with Neuralgia,”! records cases of herpes arising from the exposure to a cold wind. One case is especially interesting-a little girl, aged 3, took a long journey in a waggonet during the prevalence of a cold north-easterly wind. Though well covered in front, it escaped observation that the seat against which the child leaned was open at the back, and the short skirts of the child, resting on the seat allowed an almost uninterrupted admission of cold air to her waist. The following day, although previously in good health, a dense streak of herpes began to make its appearance round the left half of the body, about the line of junction of the child's skirts, and the more closely fitting portion of its attire. Allusion has been made to the fact that herpes zoster is frequently preceded by neuralgic pain in the part about to become affected, and it is interesting to note that Heberden was aware of this, as in the following case—“ In a woman, more than 50 years old, the herpes appeared upon the right clavicle, together with fever and pain throughout the whole right arm; the eruption and fever continued some weeks, but the skin remained scaly for several months, and the whole arm gradually became weaker, till it lost all power of motion, and in this state continued at least three years, and probably her whole life. The fingers were constantly in an involuntary tremor." Brodie and Watson have noticed more or less inflammation accompanying neuralgia; and, according to Dr. Handfield Jones, Dr. Anstie has seen a well marked erysipelatoid condition developed under the same circumstances. A short time since, I admitted a boy, aged 12, at the dispensary for skin diseases, who first suffered from urticaria, which gradually disappeared. Labial herpes and pemphigus of the lower extremities then ensued; for, according to Dr. Burgess, the same exciting cause will produce different Vesicles are defined by Hebra3 to be elevations of the kinds of cutaneous diseases in different individuals. Thus, horny layer of the epidermis by transparent or milky certain substances which suddenly derange the organs of fluid. "An essential character of the vesicle is its size, digestion, sometimes produce urticaria, sometimes erythema for only those elevations of the epidermis, which are in or roseola. The form presented by an eruption is no crite-size between a lentil or a millet seed, receive this appellarion as to its cause. In many instances urticaria is noso tion, all those larger are reckoned as bullæ." This latter logically identical with erythema, as is proved by their elementary lesion is considered by the same author to have occasional occurrence in the same person, from the same its seat in the epidermis between its mucous and horny cause. In other instances, urticaria is a reflex irritation layers, and are found "both at the aperture of hair sacs proceeding from some important organ, usually the stomach and in the inter-follicular spaces, bullæ, or blebs, are disor uterus, and under the control of a plexus of the sympa- tinct from vesicles simply by their magnitude." In another thetic system. Dr. Russell has published a case of a female, part of his work the same author states that the first formed aged 23, affected with pemphigus. Every attack was cluster of vesicles are always nearest the nervous centres, preceded from a few minutes to an hour by itching, accom- and that those which subsequently develop themselves lie panied with pain; the part about to be affected appeared more towards the peripheral distribution of the corresperfectly healthy until the eruption was becoming de- ponding nerves. veloped, when a raised red spot became visible, at the apex of which effusion quickly took place, a bulla forming, the pain then began to moderate. The exciting cause of herpes, or pemphigus, may be from exposure to cold and wet, pemphigus being often observed in barge and lightermen, who are, from their occupation, frequently wet for hours, especially their lower extremities. In these individuals the cutaneous eruption is often of a mixed character, if I may so express myself-viz., bullæ and vesicles, when the latter, a considerable area of the skin may be covered by the eruption. The origin of pemphigus in these men is considered to be due to cutaneous imbibition; but I think that exposure to cold and wet, which paralyses the nerves of the part, and the capillary vessels thus losing their tone, allow of the escape of the more fluid parts of the blood, is most probably the chief cause; in other words, a paresis of the vaso-motor nerves takes place, for, according to Dr. Brown-Séquard,3 if the nervous supply of a part be injured, the blood-vessels become dilated, and the temperature of the affected part is increased. That herpes may arise from exposure to draughts of cold air, &c., is well-known, the eruption being preceded by neuralgia. In common catarrh, herpes of the lips is a common symptom, and this eruption has also been observed alternating with asthma; indeed Trousseau1 states, on the The following are Dr. Handfield Jones' views of the pathology of herpes zoster:-"Some morbid matteror influence strikes the cutaneous branch of an intercostal, or other nerve, and affects both the sensory and vasal nerves, paralysing them. The alteration produced in the former conditionates pain, which is a mode of sensory paralysis. The alteration of the vaso-motor nerves gives rise to hyperæmia and vesicular eruption. Nothing is of course more common than the neuralgic affection of the sensory nerves, the vaso-motor remaining exempt, yet we have not unfrequent examples of the latter becoming involved in the paresis of the former." Herpes zoster resembles urticaria in its connection with the nervous system, being now understood from the observations of Dr. Von Bärensprung to be occasioned by irritation of the spinal ganglia, the posterior roots being implicated, and, according to Trousseau, in neuralgia, a disease 1 Journal of Cutaneous Medicine, No. III. 2 Journal of Cutaneous Medicine. No. VI. 3 Hebra on Diseases of the Skin. New Sydenham Society. 5 Herpes zoster has, according to Dr. Eulenburgh, always a peripheric origin, and consists of a characteristic change in the skin, with an accompanying affection of the vaso-motor system ef nerves, and not as Von Bärensprung insists, in a primary affection of the spinal ganglia. In spinal nerve, frequently only a single twig, and certain branches of the plexus are affected, which sometimes is observed in the neighbourhood of individual branches of a plexus (for instance, the brachial) with interruption of motor power in the corresponding nervous branches, complicated with paralysis of individual muscles. He records a case of a shoemaker, in which the symptoms were as follows:-Neuralgia, then no case is it the rule that zoster follows the whole course of a certain intimately connected with herpes, there is always tenderness on pressure over the spinous processes of the vertebræ accompanied by cutaneous hyperesthesia at the point of exit of the nerve trunks. That the wheals in urticaria contain fluid has been proved by the simple experiment of G. Simon, who passed a needle into one, and subsequently observed fluid to ooze from the puncture, and the vesicles of herpes zoster are nothing more than small bullæ, the only difference between this disease, herpes, and urticaria is that in the former the oedema ends in serous exudation, which elevates the cuticle in the form of vesicles or small bullæ, whilst in the latter, the effused fluid is in less quantity, not so superficial, and gives rise to the appearance known as wheals. For instance, we have in erythema, redness of the skin, and fluid effused into the subcutaneous tissue, especially in chronic cases; this effusion may elevate the cuticle in the form of wheals, and which, pressing on the cutaneous nerve filaments, gives rise to tingling; the disease may now be called urticaria. The effused fluid may increase in quantity and elevate the epidermis either in the form of vesicles (herpes) or bullæ (pemphigus). After the disappearance of these symptoms, the infiltration may still remain accompanied by itching, and leads to the establishment of an eczema ; all these symptoms may be called the rebound of nature against irritation either internally or locally, which signifies in other words reaction, and which may become permanent, as in chronic urticaria, for all chronic diseases are liable to exacerbations. Dr. Haughton! has well described this condition as a series of continuous vibrations against a cause which was formerly operative, but which has long ceased to have a real and tangible existence. A familiar example of the principle in question is the sensation as of sand in the M. Dumontpalier1 has reported a case of intermittent urticaria, in which the attack appeared each night for six weeks; and it is interesting to note that different members of the same family had each some nervous affection-the parents were asthmatic, the grandfather rheumatic, the grandmother had angina pectoris, the brothers were rheumatic, and four children suffered from intermittent diar-eye, after the offending particle has been removed, as is rhoea. The observations of Trousseau2 on the connection of asthma with cutaneous eruptions is of much interest-viz., that asthmatic subjects usually exhibit in their youth eruptions of an eczematous or herpetic character, "indeed, nothing is more common than to find herpetic, rheumatic, gouty, and hæmorrhoidal affections transform themselves into asthma. also the common feeling as of pain in the foot, felt by men whose legs have been amputated. And now, in concluding my rambling paper, I hope that the preceding remarks, in which the observations of others are freely made use of, may direct our attention to the morbid process going on in the lungs, and occasioning many cutaneous affections, and also furnish us with a hint Thus, eczematous eruptions, rheu-to their successful treatment. matism, and gout are complaints which may be replaced by asthma, and may replace it in turn." Asthma, as is well known, is a neurosis. Mr. E. Wilson3 has recorded a case of traumatic eczema, which occurred in the person of a volunteer at a review from a "kick" of his rifle on the shoulder, and upon which he rubbed tincture of arnica. In the course of a few days the disease (eczema) appeared on his groin, as well as on his shoulder. The tincture of arnica, probably, acted as an irritant; and the irritation, Mr. Wilson states, excited in the injured part is propagated by the injured nerves to the cutaneous branches at a distance, the mechanism of nervous reflex function is set in motion, and papular and vesicular eruption with pruritus are developed on parts of the body at a considerable distance from the focus of irri tation. Mr. Hooker has published a case of a neuralgic affection of the leg, complicated by superficial ulcers, and which was cured by division of the popliteal nerve, derangement of the digestive organs, suppressed menstruation, &c., have caused the appearance of herpes and pemphigus-in fact, the same set of causes as in urticaria, only that this latter disease is more intimately connected with the function of digestion and assimilation. Pemphigus usually occurs in debilitated subjects, frequently from intemperance, is secondary to some constitutional derangement, occasionally arises from local causes, and has been observed to co-exist with urticaria; indeed, Hebra has described a case of urticaria, in which several of the wheals passed into bullæ. From the preceding remarks, it will be evident that .there exists an intimate connection between certain cuta ON SOME POINTS CONNECTED WITH Br RD. J. KINKEAD, A.B., L.M.T.C.D., L.R.C.S.I., &c. But its importance has, like most surgical operations, & two-fold bearing. The first, and most important, that relating to the patient, and just now treated of; the second, that relating to the surgeon. I know of no operation that will gain the surgeon, and the young surgeon especially, more credit if skilfully, or more discredit if unskilfully, per formed than that for hare-lip or for cancer of the lip. The child is exhibited by its mother, the grown patient will point out his own lip: and each will tell how beautifully the operation was performed-how carefully the wound was dressed afterwards. No unevenness, no gap, in the free edge of the neous diseases, especially as regards their origin. This lip, little or no "mark" in the skin, no one, if not told, group might be arranged, as follows: 1. Erythema. 2. Herpes. 3. Pemphigus. 4. Urticaria. anæsthia and cramp in those parts to which the ulnar nerve is distributed, diminution of sensibility; and, lastly, herpes zoster, with distinct localization to the course and distribution of a cutaneous branch. rheumatic or perineuritic; from this arose diminution in the conducting Primarily, here we have the affection of the ulnar nerve, apparently vaso-motor and sensory fibres which supply the skin, and hence the zoster.-Edinburgh Medical Journal, No. CLXI., June, 1868. power of the scissory and motor portions, and loss of function of the 1 Bullen de l'Acad. Imper. de Med., November 30th, 1866. 4 Lancet, 1859. 6 Allg. Wien. Med. Zeitung, 1858, No. II. would have known that a piece of the lip had been taken away, or that there a hideous gap had before existed. It is easy, on the other hand, to imagine how detrimental must be the censures passed where the edges of the wound cicatrix disfigures the patient for life. are irregularly joined, where the lip is notched, and a broad Many deem that the most important part of the treatin hare-lip, or the excision of the diseased portion in epi ment consists in the revivifying of the edges of the fissurethelial cancer, and that the after-treatment of the case is trivial in comparison, but such is not the case. No doubt, the cutting part, the actual operation, is most important, but the after care of the case is no less so. The success of 1 Medical Mirror. October, 1867. the most skilfully performed operation may be defeated by carelessness or ignorance with regard to the treatment of the wound after the operation. The two following cases show this so fully, and besides contain many interesting points, such as the seat of disease in one case, the extent of lip removed, &c., that I need no apology in bringing them under the notice of the profession. S. M'G., aged about 80, a farmer, called on me towards the end of August, 1867, to consult me about a sore lip. He gave me the following history -About three years before a small sore came on his upper lip, he thought from sun-burn, but he did not mind it at first thinking it would get well in winter, and in the first winter after its appearance it almost passed away, reappearing next summer, in a more aggravated form, again getting better in winter; the next summer it was again worse, gradually extending from near the centre of the lip towards both angles of the mouth; this winter it did not get better, but continued gradually to get worse till the date at which I saw it. For about six months the growth had been rapid, and the discharge annoyed him greatly. The lip presented the following appearance :-Its free border was ulcerated for about three-fourths of its length, the commencement of the ulceration being about equidistant on both sides from the angles of the mouth. The surface of the ulcer had a warty appearance; its edges were white and indurated. The induration and thickening of the lip spread for something more than onefourth of an inch from the free edge of the lip towards the nose. I operated on the 1st of September, 1867, in the following way : An assistant compressing the arteries at the angle of the mouth, I transfixed the lip from within outwards with a straight bistoury, at a point opposite the centre of the left nostril, about two or three lines below its orifice, and carried an incision in a right line (so as to include the cancer) towards the centre of the portion of healthy lip, between the angle of the mouth and the diseased part. When the knife had arrived within a line of the junction of the mucous membrane and skin, I here turned the blade inwards, and finished the incision as Druit recommends; the raw surfaces of the cut forming at the termination an angle of about 100° with each other I made an exactly similar incision on the right side. The diseased part of the lip was now supported by a portion equal in thickness to a half of each nostril and the columna nasi. Taking the diseased part in my left hand, I cut down on each side from the angles of the incisions at each nostril to the middle of the sustaining part, the cuts terminating at a point opposite the centre of columna nasi, and three lines from termination of the induration of the lip (about one-half inch from free edge). The disease had now been removed by what I may call a W-shaped incision. I brought the edges into exact apposition by means of three needles with sealing-wax heads, and a "twisted suture," laid a bit of wet lint over them, and as there was considerable strain on the suture, owing to the great loss of substance, I supported the parts by a long strap of adhesive plaster, extending from ear to ear. The third needle transfixed the v-shaped centre portion. Very little blood was lost. On the 2nd, twenty-four hours after the operation, the wound seemed to have united throughout. No pain, no pus. He complained of nothing but that he said his mouth was too small, and asked me if I would not take out the needles and make it larger, as he feared the neighbours would laugh if his mouth was so small. The strain on the suture appeared to have disappeared. On the 3rd, forty-eight hours after the operation, I withdrew two needles, but as the third was very firmly adherent I did not remove it till the next day. On the 5th, I found the whole anterior portion of the lip in a sloughy condition. After being poulticed for a couple of days the slough separated, and showed that the mucous surface and about the posterior third of the lip were firmly united, and the anterior two-thirds, or that compressed between the ligature and needles, was that which sloughed; the V-shaped portion escaped. The wound healed rapidly, contracting as it healed, and leaving very little more scar than would have been the case if it had united by the first intention. The situation of the disease in this case was very rare, epithelioma as a rule attacking the lower lip. Its situation, also, taken in connection with its size, made the operation more difficult than it would otherwise have been. If the same extent of the lower lip had been implicated I would have removed it by a semi-circular incision extending from one angle of the mouth to the other, tied the arteries, and brought the mucous membrane and skin into apposition by a few points of suture; but this method was inapplicable to the upper lip, as, owing to the immovability of the parts, a gap, the shape of the incision, would have left the teeth exposed and the patient unable to close his mouth (this would not be the case in the lower lip, the mobility of the skin over the chin being such that in twenty-four hours it would be hard for a casual observer to know, only for the suture, &c., that an operation had been performed). Under these circumstances I was compelled to leave as much as possible of the upper, or, if I may so call it, the nasal portion of the lip, as it was the most immovable, and hoping, also, that it would give support and take off some of the strain from the freed edge of the lip. This I was able to effect by leaving the v-shaped portion, and making the whole incision like an inverted W (vide woodcut). I finished the incision in the angular direction, in order that a prominence might be left opposite the line of union, to guard against a depression being left when the wound was healed, for the wound not only contracts from side to side in healing, but also in its length, so that if this precaution be not taken the line of the lip will not be per. fect, and the patient will be more or less disfigured. The next case is only interesting as exemplifying the lesson taught by the last, with regard to the length of time the pins should be left in. M. O'S., aged 69, farmer. Had an epithelial ulcer, on lower lip, of moderate extent. On the 5th December, 1867, I removed the ulcer by the ordinary V incision, and brought the edges together by three needles similar to those used in last case. six On the 6th, exactly 23 hours after the operation, I withdrew the middle pin (which compressed the vessels); hours after I removed the pin nearest the angle of the wound, and the following day the third pin, which was only used to bring the edges into exact union. The wound united throughout by the first intention, not a single drop of pus appearing. A small ulcer formed at the orifice nearest the point of the last pin withdrawn, a couple of days after its withdrawal. In this case I withdrew the needles so soon, one in 23 hours, one in 30 hours, and the last in 48 hours, because I am convinced that the sloughing in the case of M'G. was occasioned by leaving the needles in too long, and that such was the case is shown by the posterior portion of the lip not exposed to the pressure between the needles, and the suture uniting at once, and not participating in the sloughing condition of the anterior parts between the two lower needles, and yet I left in the two lower needles only 48 hours, and the upper needle 72. Most surgical writers recommend the needles to be left in as long, if not longer, as, for instance, Liston says 48 hours, Erichsen 60 hours, S. Cooper 4 days, and Druit says that in 5 to 7 days is quite time enough to withdraw them. In all cases where a large piece of the lip has to be removed, there must, of necessity, be a very considerable pressure of the lip between the hemp or silk of the suture and the needle, in order to get the edges to meet at all, and therefore there must be (and especially in old people) a great danger of killing the part, and losing, as in S. M'G.'s case, the whole portion by loughing, or, as I once witnessed, the needles ulcerating out, and leaving not only the scar of the incision, but that, also, of each needle, which, to say the least of it, is not an improvement to the human face divine. I would even recommend in many cases the needles to be removed in even a shorter period than 24 hours, as the hemp or silk of the suture is firmly cemented to the lip by the coagulated blood, &c., and will keep with the aid of a strip or two of adhesive plaster, the edges of the wound in firm apposition. OVARIAN NEURALGIA TREATED BY HYDROCHLORATE OF AMMONIA AND TINCTURE OF ACONITE. BY J. WARING-CURRAN, L.K.Q.C.P.I., &c. WHILST acute inflammation of the substance of the unimpregnated ovary is of rare occurrence, having never myself, in either hospital or private practice, met with what one would be led to believe a genuine or an established case, thus believing that the ovarites of writers on the subject is in character chronic, or perhaps in a few rare cases sub-acute, yet neuralgia of the ovary is far from uncommon. By neuralgia of this body, I mean that class of ovarian disturbance which Dr. Churchill has described under the nomenclature of "ovarian irritation,” and to that which Dr. West applies the simpler designation of "ovarian pain," to me ovarian neuralgia appears a preferable and more correct term. Clinical observation has taught that the disease is independent of any local lesion, and more remediable by constitutional than any other method of treatment. My object here is not to enter into those cases of ovarian neuralgia dependent on defective moral training, and where a strictly moral treatment is to be enforced, and undue connubial excitement checked, but those cases where the patients' sufferings are constant and severe, when there is no hysterical temperament, and no obvious symptom of imprudence or immorality. My object, also, as briefly as possible, is to enter upon the treatment of such cases, and to illustrate, by the history of the six following, the great benefit to be derived from the muriate of ammonia and tincture of aconite in the treatment of this affection, when leeching, purgation, antispasmodics, vesicants, sedatives, internally administered and locally applied, had signally failed. Cuse 1.-R. A., twenty-seven years of age, of sedentary habits and chlorotic appearance, unmarried, sought advice for a severe and constant pain suffered in the left iliac fossa; had been under another medical gentleman for ten days, from whose treatment she stated she had experienced no benefit. The pain was dull and aching in character, occasionally passing along the anterior surface and inner side of the thigh; has not slept for a week; the appetite is impaired, but the secretions are all healthy; the tongue has a characteristic nervous coating, and the pulse is quick; there is no hysteria. Upon examination, I find a fullness in the left iliac region, with tenderness. I ordered the application of liniment, belladonna, with chloroform, over the seat of pain; prescribed a saline aperient mixture, contain ing tincture of belladonna and a sedative draught at bedtime. For three days this treatment was persevered in, but there was no relief to the symptoms; the only ease experienced was when the patient lay flat on the face. I then applied a blister over the seat of mischief, gave opium, cannabis indicis, and camphor, in the form of pill, and tincture of conium in mixture. The following day there was an aggravation of the symptoms; the patient had spent a restless night, and the relatives became anxious. Upon this I prescribed an eight-ounce mixture, containing two drachms of the muriate of ammonia, with five-drop doses of tincture of aconite. The combination seemed to act magically; before the bottle was finished the pain was gone. Sulphate of iron and quinine was afterwards given, and four months have now elapsed without any return of the complaint. Case 2.-A. L., aged 19 years, single, of a full habit, and hitherto healthy, became affected with a violent pain in the left groin, for which immediate advice was required, as the woman in attendance dreaded the existence of a hernia. On being visited I found the pulse high, and the usual symptoms of inflammatory fever. She had suffered severely four months previous to being visited, and had passed no water from the commencement of the attack; vomiting was a constant and distressing symptom. On examination I found slight swelling on the left side, with intense pain on manipulation; the tenderness extended below Ponpart's ligament. Having satisfied myself that there was no rupture, I ordered turpentine stupes to be applied, and directed her to have a warm hip-bath, and a mercurial aperient. The following day, as there was no progress towards amendment, I applied six leeches over the site of pain. This gave temporary relief, but towards evening the pain became if anything more severe. I found her, on being visited, on her hands and feet out of bed, apparently suffering most acutely. I prescribed her a draught containing twenty drops of cannabis, and im mediately placed her on the muriate of ammonia and aconite mixture. The ensuing morning she expressed herself considerably relieved, but the tenderness remained, and at times the pain recurred, producing vomiting when it did so. The patient got on remarkably well until the menstrual period arrived, when the same state of things occurred over again; but under the muriate of ammonia and aconite much was done to arrest the disease. She has had a menstrual period since without any recurrence of the pain. 66 Case 3.-A. R. F., aged 22 years, married for the last 14 months, has long suffered from chronic ovarian pain, increased during the menstrual period. Has taken, to use her own words, no end of medicine," and has been under the treatment of various physicians, "who all told her the same thing." I prescribed at once the muriate of ammonia and aconite; two bottles in the course of six days entirely removed the pain. Six weeks have elapsed, a menstruation passed with little pain, and at the present time (July 14) I learn from the woman, who came with another patient, that she has entirely recovered, and has had no return of the pain since she finished the last mixture. Case 4.-J. L., married, aged 40 years, has suffered from ovarian neuralgia for a number of years. At times the pain is unendurable; during its existence there is fulness and tenderness over its site. Having been under treatment for an hepatic lesion, and obtained the above information in the history of her case, I told her, when the ovarian neuralgia returned, to apply, and I should prescribe for its relief. She accordingly did so in the course of time, and from the muriate of ammonia and aconite she obtains almost immediate ease. Case 5.-G., about 25 years of age, single, has suffered from the time of her first menstruation with ovarian pain, causing frequent and painful micturition, with vomiting. Gave her the muriate, and had the satisfaction of hearing her express that she obtained instantaneous relief after its administration. Has suffered from subsequent attacks, which invariably yield to the medicines advocated. |