a stimulating injection, but it was postponed till the child should be older. The dropsical accumulation was becoming very large, and Dr Hastings was permitted to prescribe. He gave Rhododendron twelfth dilution, three globules night and morning for three days; then pause three days and repeat. A lotion was applied of:

B. Tr. Rhodod. chrys. 3ij.
Aqua font. vi.

Apply twice a day after fomenting the scrotum. The hydrocele was cured, and the boy, now seven years of age, has continued well.

SCROFULOUS INFLAMMATION OF THE SYNOVIAL MEMBRANE OF JOINTS.-HYDRARTHUS.

In joints we meet only with different examples of the connective tissues,-bone, cartilage, synovial, areolar, and fibrous tissues. A connective tissue may be said to consist of " a number of cells still retaining their nuclei, round each, or each group of which a quantity of tissue material is collected; the quantity of the tissue is derived from the consistence and constitution of the inter-cellular substance. Thus the cells of cartilage, bone, fibrous, and areolar tissue, have probably the same proteine contents, but are surrounded-the one by chondrine in a solid form, the other by lamellated bone material, the third by gelatine in a fibrillated arrangement, and so on. The function of these tissues is not vital, but mechanical; the inter-cellular substance, therefore, whereon the function depends, has no vital constitution, but each district or band is dependent upon its own cell for its support. The nutrition of these tissues is kept up by the selecting and organizing quality; their repair by more abundant multiplication, their absorption by excessive generation of the cells. Thus it is that the connecting tissues are capable of repair by like material through fresh formation of cells, which, by the law of organic descent, develop similar tissues. The means of this repair are the simplest form of the inflammatory process, as we see in the union of a wound by the second intention." (Barwell.)

A scrofulous synovitis is, in its first characteristics, not essentially distinct from another slow inflammation of that tissue, but the difference lies in the indisposition to further development. If there have been a breach of tissue from a wound, the gap must be filled up by cell-generation, which in such a case is called granulation. As long as the patient remains in a good state of health, the older cells-that is, those of the deeper layers of this formation-assume the fusiform shape, and form gradually into the fibrous material, which forms the scar; but, when the health begins to flag, the granulations do not change in that manner, but cells remain, generally, round, increased

unduly, and form those large, flabby exuberant growths which require repression, caustic, or other means to stimulate them to healthy action, and to keep down their generative tendency.

On this principle we distinguish between the healthy and strumous synovitis. In the former the membrane and sub-synovial areolar tissue generate cells, which, if the constitution be good, form new fibrous tissue, causing some thickening, and only to a slight degree interfering with the action of the joint. In the latter cells also are generated; but, instead of making fibrous tissue, they remain in the form of spongy granulation tissue, and produce that form of disease which Sir B. Brodie has named "Morbid change of structure of the Synovial Membrane." The best remedies are Kali-hydrio., Mer.-iod., and Sul.-iod.

8. SPINA BIFIDA.

PATHOLOGY-In some cases the opening does not extend far into the canal; and the spinal marrow is not compressed or deranged in function. Of these many may be cured. The external tumor in these cases is generally covered with integuments and appears very firm, not easily compressed, very elastic to the touch, and yet fluctuation is perceptible; the dura mater is the only lining membrane of the cavity in the tumor, and the fluid contained does not extend far into the canal after passing the aperture in the spinal apophysis.

in

some of the muscles, Here the fluid is con

In the other cases which are much the most frequent there is a thin almost transparent membranous covering in many parts of the tumor, and sometimes on the greater portion of it. The tumor is easily compressed and there is less of voluntary action sometimes with derangement of the secretions. tained in the arachnoid membrane, and may extend the whole length of the canal. M. Bichat and other anatomists say it may extend even to the lateral ventricles of the brain. There have been some cases in which the head was enlarged like that of a child with chronic hydrocephalus. Such cases have perhaps been uniformly fatal.

The Ligature. This mode of operation is preferred when the base of the tumor admits its application. Apply it first tight enough to produce moderate inflammation. Afterwards draw it closer as it does not then produce so much pain or so extensive sympathetic effects. All cases cannot be cured in this way.

In some this treatment would destroy the child. Dr. Trowbridge (Louisville Med. Jour., 1840,) says he has seen about thirty cases, some of which were in every portion of the spine, and were of various sizes and appearances. He had tried their treatment by puncture, incision ligature, &c., and in many of them he failed. But some were curable.

Case by Dr. Trowbridge.-Miss B., of Jefferson County, New-York, aged 25, phlegmatic temperament, mind retiring, delicate, was born with a considerable tumor over two of the lower lumbar vertebræ. The tumor was protuberant, and was pronounced spina bifida; and it was expected to prove fatal in a few weeks from birth. For twelve years she suffered but little from constitutional derangement, except feebleness; the tumor enlarging with the growth of the body. From this time to the age of twenty-five she had much extreme pain in the cerebrum, disturbance of mind, with vertigo, confusion of intellect, and some neuralgic symptoms. The secretions were natural; and the natural developments of childhood and womanhood were without unusual delay. She was of middle stature, and with perfect use of all the muscles of the body. She was during these paroxysms of pain and nervous excitement injudiciously treated by bleeding, cathartics, and Opium; but the tumor continued to enlarge. Dr. Trowbridge found it fifteen inches in circumference, covering the upper part of the sacrum and four lumbar vertebra, of conical form, rising about seven inches, covered with the integuments and distended with fluid. She had managed her dress to prevent the deformity from being noticed. Riding in a carriage had pressed and injured the tumor, adding something to the pain and nervous excitement; all exercise increased her sufferings; and thus enlargement and concussion of the tumor continually added to her distress as well as her danger.

Operation.-Dividing the upper part of the tumor with a scalpel five inches, I encircled the prominent part of the integuments within two elliptical incisions. Twenty-two ounces of fluid resembling pure alcohol was discharged. On its standing till cold, it did not show serum or lymph, but remained clear like distilled water. These incisions and removal of the tumor exposed its interior and bottom. It was lined with the dura mater, distended and enlarged by the fluid. Two of the lower spinous processes were wanting. A cavity was presented showing the spinal cord in its natural position. The divided parts were brought together by adhesive straps, and compresses were applied, with a bandage over them. She suffered little except from the former symptoms of concussion, which were troublesome for a few months. For the first five days there was constant secretion and discharge of fluid, with neuralgic symptoms, with increased arterial excitement, these were checked by morphine and warm fomentations over the spine. Suppuration was free. On the tenth day there was mitigation of all the symptoms. There was a sound state of the parts with depression of the skin over the part. She had had continued good health when seen eight years afterwards. The proper constitutional treatment, which has often succeeded alone, consists of Sulph., Calcarea, Calc.phos., Kali-hyd., Silic.

Iodine. It was in scrofulous forms of dropsy that Iodine gained its first reputation.

The history of Iodine, says Dr. Forget, "is very remarkable. First introduced as an anti-goitre medicine, it was long before it obtained credit in scrofula. For some years it has had a tremendous run. It began by curing hydrocele, then a bold hand introduced it in hydrarthus, then it passed to ascites; then to hydrothorax; ovarian cysts; hydrocephalus. "Ah, there is the remedy of remedies, the specific of the present age!"

For centuries, says Dr. Manson, writing in 1825, "Burnt sponge was the chief remedy in the cure of bronchocele. (Medical Researches, p. 8.) Chemistry discovered Iodine in sponges." "In not a single instance has the medicinal powers of an important remedy been made by science. They have all been accidental. Tradition, descending from periods when no medical science existed, accident, fanciful hypothesis, and hap-hazard experiments have been their sources." (Henderson.)

URÆMIA.-URÆMIC POISONING.

Consequences of the Retention in the Blood of the Constituents of the Urine.

1. "In a variety of diseases occasionally accompanied by albuminuria, such as cholera, scarlatina, diabetes, &c., the constituents of the blood become changed by the introduction either of a poison or some other substance. If this occur, it is quite manifest that the blood is no longer normal, and because of its altered condition its elaboration in the kidney will also be modified; so that in lieu of the ordinary elements contained in the urine, we shall sometimes recognize albumen, an absence of urea and other pathological phenomena. May this not be satisfactorily explained on the principle that the product of endosmosis will be modified in proportion to the changes in the fluid on which it acts? Again: the blood is changed in pregnancy" by various other wellknown circumstances.

2. Structural or Dynamic Change in the Kidney may result in albuminuria, though the precise conditions on which it depends be unknown; the presence of albumen in Bright's disease and scarlatina "may be due to a desquamation of Bellinis' tubes, yet this cannot be said of many other affections of the kidney in which albuminuria exists, but in which no desquamation takes place. Experiments have been made by Segalis and by Dr. Brown-Sequard (Experimental Researches applied to Physiol. &c., Phila. 1852, p. 13,) which seemed to show "that the urinary secretion is not absolutely dependent upon the nervous system, while on the other hand it has been satisfactorily shown that the nervous system may, under certain circumstances, exer

cise a marked influence over this secretion. Marchand "has produced in a dog not only all the symptoms of uræmia, after placing a ligature on the renal nerves, but also discovered urea in the blood, and in the matter vomited by the dog." Albuminuria has also been produced by different experimental physiologists by operating on the sympathetic nerve of the neck, the cerebellum and the medulla oblongata; and we have sufficient evidence to establish the fact of the direct influence of the nervous centres-when diseased or injured-" over the urinary secretion; and it is quite possible that the irritation of the uterine nerves during pregnancy, and in many of the diseases, both organic and functional, of the uterus itself, may, through reflex action of the medulla spinalis, produce various morbid changes of the urine. The influence of mental emotions, as fear, grief, and anxiety have long been observed. 3. Pressure on the Renal Veins.-Robinson, Meyer, and Frerichs have abundantly proved that a ligature tied more or less completely around the renal veins will cause albumen to pass from the blood into the urinary secretion; and urea, to say the least, is not a very virulent poison; its excess in the blood will not per se produce uræmic intoxication, nor will it explain the numerous phenomena which are so fre⚫quently found to accompany its presence in the circulation. May not these phenomena, then, be produced by some other agent which has generally happened to be associated with urea in the diseased condition called uræmia. Frerichs has attempted to demonstrate that uræmia depended neither upon a diminished quantity of urea in the urine, nor upon an excess of this substance in the blood, nor upon albminuria; but that it is traceable solely to Carbonate of Ammonia in the system, which, he says, is formed through the agency of a ferment from the urea itself: or, in other words," that ureamia is exclusively due to the transformation of urea into the Carbonate of Ammonia." Dr. Bedford says that "there is no proof as to the manner in which this transformation is accomplished; but the major point, viz.: dependence of uramia on the presence of Carbonate of Ammonia seems to rest on strong and cumulative testimony. Some of this testimony may be summed up in few words:

Orfila produced convulsions in an animal by giving it Carbonate of Ammonia. The animal became convulsed and died. Brown-Sequard has shown that Carbonate of Ammonia, injected into the stomach, does not poison; but it is absorbed slowly and passes off through the lungs with Carbonic-acid. But if it be injected in a certain amount into the blood, it has time to act on the nervous system and to cause convulsions before it is expired. Dissection of those who have died of uræmia shows that there is in these cases no organic lesion of the nervous centres, showing that death results only from direct poisoning Carbonate of Ammonia has been detected in the stomach and intes