and mother how to use it, and she has since been more or less constantly, and nearly continuously, under its influence. Thursday, 18th, the pulse was 96, and she swallowed with comparative ease. To-day, Friday, 20th, she is not quite so well; the pulse is 108, the abdominal muscles rather tense, and the reetum will not retain the enemata. In this last occurrence I was of course prepared; and since the 15th, she has been carefully rubbed with oil, butter, and cream. She still swallows tolerably well. My prognosis in this case was from the first serious, for although the pulse was natural, and the spasms had not extended beyond the neck, deglutition was nearly impossible, and suffocation was often imminent. One symptom I have forgotten, which is often one of the most distressing-a constant cough from accumulated mucus, which cannot be raised or got rid of. In two days it has disappeared. I now anticipate recovery. The treatment has been negative, with the exception of the chloroform, which has been most useful. I attribute the improvement on the 17th and 18th entirely to it; and if Mrs. B. recovers, she will owe her life to your invaluable discovery."

Even when not curative of tetanus, the use of chloroform has proved of no small service in relieving the sufferings and agonies of the patient. Thus, in a fatal case of puerperal tetanus, the medical gentleman who drew up the case observes, "We had the just comfort of finding the paroxysms materially alleviated by chloroform, which was used during the last sixteen hours of the patient's life. 'Chloroform Chloroform!' was the poor sufferer's anxious exclamation whenever she felt the spasms impending, and comparative tranquillity speedily followed its application each time." Our practical power over the most rapid and fatal forms of tetanus perhaps amounts yet to little more than a "meditatio mortis." But even to alleviate the sufferings attendant upon such a dreadful disease (should we effect no more), and to produce a state of euthanasia, is surely an object worthy of the best directed efforts of the medical art.—Monthly Journal of Medical Science, Feb. 1854, p. 97.

30.-LOSS OF SENSATION, AND OCCASIONALLY OF MOTION IN THE LOWER EXTREMITIES.-HYSTERIA. Under DR. ROWLAND, at Charing Cross Hospital.

[Sarah Poulton, aged 25, thin and delicate; married, and has had one child. Is exposed to much cold while engaged in her household work, and attributes this as the cause why the menses have not appeared during the last two months.]

For the last two or three months she has had severe pain of back and loins, and occasionally of the legs. She has also been troubled with pricking sensations in the calves and soles of the feet. Yesterday,

when employed in sweeping her room, her legs seemed to give way under her; she fell to the ground, and has not since been able to stand alone. She has lately had several hysterical attacks.

The lower extremities are rather colder that natural, and there is an entire absence of ordinary sensation in them, but when the limbs are forcibly flexed severe pain is excited. She has also lost the power of moving them; there is pain, increased on slight pressure, in the lower dorsal region of the spine and over the sacrum; the appetite is bad; the bowels constipated; the sleep disturbed; the urine is loaded with lithates.

A blister was applied to the spine, and, at first, a mixture containing the iodide of potassium and small doses of the bichloride of mercury was ordered, and afterwards the iodide of iron, with, however, scarcely any benefit. Subsequently she had two or three violent hysterical seizures in the ward, and there was then ordered a draught containing tincture of sesquichloride of iron, M xv.; tincture of cantharides, miv. and mxx. of the tincture of aloes, to be taken three times a-day.

She continued to take this medicine until November 16, and, at the same time, galvanism was applied to the palsied limbs. The improvement was manifest even from day to day. On the 26th of October sensation was nearly complete, and she was able to walk across the wards, but not without considerable assistance.

Nov. 16. She can now walk with very little support; the sensation of limbs is but very slightly impaired; she has not menstruated; the legs, when flexed, are no longer painful.

To take miij. of Fowler's arsenical solution in water, with half a drachm of the compound tincture of cardamoms three times daily. 23rd. Walks now without support; sensation perfect. For the last few days she has complained of pain in the lower part of the back and abdomen; the catamenia have not re-appeared. Rep.

On the 28th, sensation being natural, and motion nearly regained, she was discharged from the hospital, and Dr. Rowland took occasion to make the following remarks:

·

Looking at this case from one point of view, the suspicion of structural disease within the vertebral column might be entertained. Thus, there were prickings and pains of the lower extremities, which suddenly terminated in loss of sensation and motion. But a closer acquaintance with the symptoms tended to remove such apprehension, for, besides the hysterical paroxysms that occurred both previous and subsequent to admission, a more minute analysis of the local symptoms gave results not easily reconcilable with the existence of organic lesion. The limbs were numb rather than decidedly anæsthetic. When force was used for the purpose of flexing the joints, the patient cried out with the pain, and the legs were sometimes painful, even when at rest. The pain of back varied from day to day, sometimes being very severe, at others almost null, while slightly pinching the integument covering the spine was at least equally productive of suffering as firmu pressure.

Moreover, the countenance was often flushed and excited, and there was a good deal of nervous agitation in her manner. These, and similar symptoms, interspersed with those more decidedly hysterical, soon removed all doubt as to the nature of the malady, an opinion which the subsequent history of the case has confirmed.

In this patient, a type of hysteria is presented which bears a near resemblance to structural disease. Instead of the instability or proteiform character usually belonging to the complaint, they were here symptoms pertinaciously continuing for a long period, and at length slowly and gradually subsiding under treatment. In the zeal for pathological discovery, affections merely functional, or which at least exist independently of any discoverable change in the texture of organs, have scarcely been allowed their due importance. In practice, however, it is highly essential to recognise them. Several examples of this kind have lately presented themselves at the hospital exhibiting various forms, but each case preserving its individuality for a lengthened period.

It is true that some cases of hysterical palsy are little more than mere fantasy, and are kept up in a great measure by the patient lending herself to the task, and refusing to exercise her command over the refractory muscles. A rough shock or a strong moral impression may at once remove the disorder; but it is very doubtful whether any such means would be productive of benefit in cases like the present. In some respects this form of palsy resembles that of the portio dura, caused by exposure of the face to a stream of cold air, which, although unassociated with cerebral disease, is often tedious in its cure. In like manner the hysterical paraplegia may commence with irritation of the uterine nerves. It is always accompanied by some kind of derangement in the functions of the womb, and is totally unallied with organic change, or any action conducting to such change in the brain or spinal

marrow.

The pain of back of which this woman complained was of that kind commonly known as spinal irritation. It was by no means a constant symptom; but neither its accession nor its subsidence was marked by a corresponding change of the principal affection.

This spinal irritation appears to me to have had too great influence assigned to it in the causation of disease. It is one of those pathological conditions that dwindle into insignificance under steady observation. That it is commonly found in conjunction with hysterical affections is indeed undeniable, and so far it is valuable in diagnosis. Occasionally, too, applications to the tender points of the spine may seem to mitigate the other symptoms, but far more frequently this practice is followed by no good result. The spinal pain may be observed to come and go repeatedly in some cases, or to change its seat without occasioning the slightest mitigation of the hysterical troubles.

In the early part of the treatment of this patient, iodine and

mercury were given, but no benefit followed. The aloes and iron produced immediately an evident improvement. Sensation was restored to the affected limbs long before their power of movement was regained. She has latterly taken the arsenical solution, which is often found an excellent remedy in these complaints, and even in chronic palsy of cerebral origin when a tonic is required. Galvanism was employed in this case perseveringly by Mr. Muirhead, and it has no doubt materially aided in the recovery.-Med. Times and Gazette, Dec. 10, 1853, p. 106.

31.-CASES OF EXHAUSTION OF NERVOUS POWER IN THE SOLAR PLEXUS.

BY PROF. OSBORNE, Dublin.

[Believing the depressing feelings belonging to hypochondriasis to depend on a depraved sensibility of the stomach or colon, or both, Dr. Osborne determined to try the effects of chloroform taken internally.]

The first patient who presented the conditions requisite for this experiment was a married woman, and a mother, aged 33, of a querulous disposition, as was well marked in her countenance, and who had been on a former occasion under his care and that of another practitioner, complaining of a variety of pains in the abdominal region; and she, although relieved, yet persevered in the belief that she still had some internal disease. She now appeared to labour under spinal neuralgia. After this had yielded to the application of nitrate of silver to the spine, and some other remedies, she still continued to feel an indescribable sensation of depression, and of internal annoyance, no longer to be referred to the spinal nerves; no cause for it could be detected. The appetite was good, and the action of the bowels regular. In two days, after taking ten drops of chloroform thrice daily, she began, for the first time, to acknowledge that she was better, and in a few days afterwards was free from complaint. The second case was that of a caretaker in the linen-hall, aged 29. He complained of the deepest dejection of spirits, and of an uncontrollable aversion to make any exertion. His countenance expressed sadness and moroseness. All the functions were in a healthy state, except that the heart's action became tumultuous when excited either by emotion or exercise; but no organic disease could be detected. He stated that he had not been addicted to excesses of any kind, and that there was no cause for his lowness of spirits. He got valerianate of zinc, and also pills to regulate his bowels; but although the heart's action became steadier, yet the depression and inward sensation continued the same. After taking twenty drops of chloroform thrice daily for two days, he began to confess, what he never did before, that he was better. His sleep being still unsatisfactory and disturbed by disagreeable dreams, he was ordered to

take forty drops at bed-time. He now stated that he slept with a pleasing dream of seeing his brother, who had gone to America. During the two following nights he took the same dose; and, although his sleep was interrupted by the disturbance attendant on a man in a dying state in the same ward, yet when he did sleep his dreams were pleasant, being usually that he was enjoying the company of the most agreeable of his friends. He was dismissed with a marked improvement in his countenance, and acknowledging that he was better.

The third case was that of a farmer from the county Wicklow, twenty-eight years of age. In him the poet's exclamation Beati agricolæ appeared to be completely reversed. The angles of his mouth were drawn down, his brow generally contracted, and he appeared sometimes as if contemplating suicide; yet he stated that he was in comfortable circumstances, married, and with a family. He complained of an inward sinking and sense of depression, so constant and overpowering, that for some months he could not command himself to make any exertion, and had become unable any longer to attend to his business. His bowels were usually torpid, but although he had repeatedly taken purgative medicines with effect, yet he had obtained no further benefit. A careful examination having been made without detecting any disease, he was ordered to take ten drops of chloroform thrice daily, and two assafoetida pills every alternate night. At the end of about four days of gradual improvement his countenance had become placid. He confessed that he felt much better; and in a few days afterwards, feeling a strong desire, and also a capability, of resuming his ordinary vocations, he went home.

These cases are selected as being nearly free from complication. It must, however, be recollected, that there are several other uses to which chloroform may be applied in affections of the stomach and intestinal tube, but this appears to be one of the greatest value, inasmuch as no other medicine can be named which in this respect seems to come into competition with it. How far the effect is permanent and capable of completely removing the sensation of hypochondriasis, or in what degree it may require to be resumed or repeated, Dr. Osborne as yet has not been able to determine.

The menstruum which Dr. Osborne used in the above and other cases was the decoction of Irish moss (carrageen). With this chloroform forms a uniform mixture, and in the proportion of ten drops to the ounce they remain for an indefinite time without separation taking place. The taste of the mixture is sweet like that of a heavy syrup, to relieve which it may be well to add a few drops of some aromatic or bitter tincture.

Another mode of avoiding the pugnency of chloroform is by giving it in combination with tinctures, as it is soluble in alcohol, and remains dissolved even in proof spirit. The following is a specimen of this kind of formula, and is peculiarly grateful to the taste,