night afterwards she was brought to us again, having had a relapse of the complaint, and now a loud systolic murmur was immediately detected. In another the heart was hopelessly injured previous to his admission. These cases cannot be therefore set down as evidence against the utility of the nitrate of potash in rheumatism. At the same time the number of examples is far too few to establish the probability of immunity from heart complication nnder this treatment. It can only be said that nothing of the kind occurred in these patients. With regard to the form of the disease in which the salt is most likely to prove beneficial, the testimony derived from the cases now cited decidedly shows that its efficacy is most remarkable in acute rheumatism; and it might almost be said that the beneficial result was the more striking in proportion to the activity of the attack. When subacute rheumatism supervened upon the chronic, although the nitrate was commonly efficient in removing the former, it seemed to exercise no influence over the latter. So invariably was this observed, that I have ceased to prescribe this medicine in purely chronic cases. Pains of a gouty tendency, and the capsular variety of rheumatism, appear to be equally irremediable by this means. No preliminary treatment was adopted, but the salt was almost invariably commenced at whatever period of the complaint the patient happened to be on his admission. There is no reason to suppose that its influence is greater at one stage than at another. It should be stated, however, that an aperient was prescribed when it was required, and sometimes an anodyne at night, when the sufferings were so great as to prevent sleep.

It is not easy to determine the mode of action of the salt in this affection. The theory that it removes from the system a supposed redundance of the lithates and lithic acid can hardly be sustained. Not only was there no marked acidity of the urine in several of the patients, but in two of them it was strongly alkaline, and in one loaded with phosphates. Even during the continuance of the nitrate the urine regained its property of slightly reddening litmus-paper. Nor was there any sustained sensible action either on the bowels, skin, or kidneys. Purging never once occurred. In a few cases the perspiration was occasionally increased, but by no means continuously; and bearing in mind the tendency to copious sweating in rheumatism, it might be questioned whether the salt does not exert an influence in moderating, rather than augmenting the cutaneous discharges. The urinary secretion was increased more frequently, and rather more permanently, but the diuresis was never very remarkable. Whether the salt possesses any action on the fibrine of the blood these observations do not enable me to determine, but the symptoms and aspect of some of the patients scarcely warranted the idea that there was an excess of that ingredient in the circulating mass.

The dose of the nitrate never exceeded half an ounce, and it was sometimes limited to three drachms daily; it was dissolved in a pint

of water, the patient being directed to take the whole in twenty-four hours. This is a much smaller quantity of the salt than it has been recommended to employ for the cure of rheumatism; but there is a manifest advantage in prescribing it in as small a dose as will answer the purpose, for there will be less danger of its producing gastric or renal irritation; and when two or three ounces are given daily, a large quantity of fluid is required for the necessary dilution, and this circumstance alone would render the remedy too disgusting to admit of its general adoption. No injurious consequences arose in any instance from the exhibition of the medicine, nor was there any complaint made by the patients of the disagreeableness of the remedy, or of any inconvenience arising from its use. There may be an apparent exception to this fact in one patient, who complained of dysuria when undergoing treatment with the nitrate. But as this symptom continued, although the medicine was withdrawn, and subsided after it had been again prescribed, it is hardly probable that the irritation had been occasioned by it in the first instance.-Lancet, Feb. 11, 1854, p. 149.

9.—Treatment of Acute Rheumatism by Acetate of Potash. By Dr. Golding BIRD, F.R.S.—[Dr. Bird seems to depend on this remedy more than any other in the treatment of acute rheumatism. But, after all, it appears that the efficacy of lemon-juice itself depends not so much on the acid as upon the supercitrate of soda which it contains. It seems that all these kinds of salts are useful when they act powerfully on the kidney, and thus eliminate poisonous matter from the system. Thus citrate of potash, citrate of ammonia, acetate of ammonia, nitrate of potash, as well as the acetate of potash, all act very beneficially in rheumatism. On the subject of acetate of potass, Dr. Bird affirms]

That he has never seen the disease in question yield with so much facility to any other remedy. In the several cases in hospital practice under his own care, Dr. Bird has seen the cure to be more rapid, and the immediate relief to the patient more marked, by the use of acetate of potash in quantities of half-an-ounce administered, largely diluted, in divided doses in twenty-four hours, than by any other treatment. In three days he has frequently found the exquisite pain of the joints nearly absent, the patient comparatively comfortable, and able to bear with greater ease the helpless state in which the still swollen joints placed him. In no cases have any bad consequences succeeded the employment of the remedy, while complete recovery has been more expeditious, and the ill effects of colchicum and mercury have been avoided. The most interesting and no less important fact has been noted by Dr. Bird in his experiments with this salt, namely, that the pain of the disease remarkably declines so soon as the urine becomes alkaline and rises in specific gravity; and he further records his

impression, that the tendency to affections of the heart is very much, lessened after the alkalinity of the urine has been established.

Dr. Bird's experience of the efficacy of the acetate of potash in the treatment of acute rheumatism has been derived from a large number of cases. The only adjuvants he has employed have been a mercurial laxative, if constipation existed, and a full dose of Dover's powder on the first day or two of treatment, if the pains be severe; the joints being wrapped in sheets of wadding, a plan the author has followed since he experienced in his own person the comfort it affords.(Urinary Deposits, 4th edit.)-Edinburgh Med. and Surg. Journal, April 1854, p. 427.

10.-ON THE INFLUENCE OF LIQUOR POTASSE ON THE URINE IN RHEUMATIC FEVER.

By Dr. E. A. PARKES, Professor of Clinical Medicine in University

College, &c.

The following summary expresses in general terms the action of liquor potassæ on the urine of twenty-four hours:

The urine in rheumatic fever appears to have peculiarities which distinguish it from the urine of other fevers. It resembles the typical febrile urine in its deficiency of water, in its depth of colour, in its great per-centage of solids, and in the rapid deposit of dark urates. But apart from possible differences connected with the urea, and extractives, it differs from the febrile urine of pneumonia and the specific fevers in the greater amount of the absolute excretion of solids (i.e., in 24 hours) and in the enormous excess of sulphur, and its derivatives.

The excretion of sulphuric acid is far greater than in any other febrile disease which I have examined,-viz., than in small-pox, typhus and phoid fever, scarlatina, erysipelas, pyæmia (with purulent arthritis), pleurisy, and pneumonia. In these cases the sulphuric acid has been also in excess of that which would have been formed during healthy tissue metamorphosis, except in some cases of pneumonia in which the sulphuric acid (in common with other urinary ingredients) has been retained in the system during hepatization, and been poured out afterwards during resolution.

The excess of sulphuric acid in the rheumatic urine is not due to an excess of febrile action in this disease, over the other fevers just enumerated. In cases of typhoid fever and scarlatina, the temperature has been higher than in rheumatic fever; and yet the amount of sulphuric acid passed in 24 hours has not reached to half the quantity. The sulphuric acid is not, then, in any close proportion to the temperature. As the temperature is usually considered to be a correct indication of the rapidity of tissue-metamorphosis in febrile diseases, it follows that rheumatic fever is an exception to the rule, and that the sulphuric acid is in excess of what would have been predicated from the amount of fever.

It appears, therefore, a fair inference that in rheumatic fever there is a source of sulphuric acid, independent of the augmented disintegration of tissues, as measured by the heightened temperature, and it may perhaps be conjectured that chemical analysis will hereafter demonstrate the existence in the blood of some compound richer in sulphur than fibrine and albumen, which during the height of the disease is rapidly disintegrating, and forming, probably among other products, sulphuric acid.

The effect of liquor potassæ, of the bicarbonate, and perhaps of the other alkalie is at once to aid this disintegration, and to increase the elimination of sulphuric acid, by augmenting the alkalinity of the blood. If this hypothesis be correct, the administration of alkalies in rheumatic fever would acquire a basis more rational than that usually assigned-viz., that they merely neutralize acid already formed.

With respect to the efficacy of liquor potassæ in rheumatic fever, although the cases are so few in number, yet as it is unlikely that additional cases can be treated so rigidly without other medicines, and as in fact other remedies (mercurial purgatives, colchicum, opium, hot air bath, &c.), ought to be employed, I may mention the general conclusions which may be deduced from these four cases.

No symptom was immediately affected, except the pulse; this was generally, but not always lowered, and sank, although the temperature continued high, to 80, 70, and even lower. The febrile heat (as measured in the mouth), the articular pains, and the perspirations, were not affected, except in so far that the duration of the disease was shortened. The effect on cardiac complication was uncertain; in one case pericarditis came on, but there was a strong suspicion that it had

actually begun before the medicine was commenced; in two cases basic systolic murmurs appeared, in one case before, in the other (a man), decidedly after the potash was commenced. The murmur, however, disappeared during convalescence.

The duration of the disease was in three cases short, although the severity of the early symptoms led to the belief that it would be obstinate and long-continued. The first case lasted scarcely a week; the second eighteen days; and the third (relapse) about seven days. In the fourth case (old and recent heart-complication, pericarditis) the duration was greater, and the patient was not convalescent till the 23rd day. The average of the whole was 13.75 days from the first symptom; but as an average of 3.25 days occurred before treatment, the actual period from commencement of treatment to perfect freedom from joint-pain and fever, was ten and a half days. This result (if it occurred in all cases) would certainly be favourable, but it is well known that other observers have obtained equally fortunate results from very different treatment; so that the superiority of the treatment by liquor potassæ, per se, cannot be held to be sufficiently proved.

A great disadvantage in liquor potassæ is its nauseous taste, and frequently also, after a time, if it be given in large doses (and this is necessary), the stomach does not tolerate it well.-Brit. and For. Medico-Chirurg. Review, Jan. 1854, p. 248.

By DR. R. W.

11.-On the Action of Iodide of Potassium. BASHAM. Any observations upon that so much neglected branch of medical science, Therapeutics, demands every attention. Dr. Basham makes the following important remarks on the action of iodide of potassium. He believes, that though in other forms of disease this drug presents pretty steady characteristics, yet that it is in diseases of a rheumatic character that its beneficial results are most uniformly He says:]

seen.

From time to time cases have come under observation, presenting the usual symptoms of chronic rheumatic pains, gnawing and erratic, with paroxysms aggravated by atmospheric changes; and there has been diffuse tenderness of the periosteal surfaces nearest in contiguity to the skin, as the scalp, clavicles, ulna, tibia, &c.; sometimes distinct tumefaction with exquisite tenderness, and these nodal elevations in some have been evanescent, in others, persistent during the whole course of the malady. It has been frequently noticed, and practitioners of experience cannot have overlooked the fact, that some of these cases materially and rapidly improve under the administration of the iodide of potassium, while in others, with symptoms in all respects identical, no benefit has been derived or improvement become apparent till the patient has been put through a course of the bichloride of mercury and sarsaparilla.