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 typhoid 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 fitrine 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 alkalies 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 (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.-British and Foreign Medico-Chirurg. Review, Jan. 1854, P. 248.

11.-On the Action of Iodide of Potassium. By DR. R. W. 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 seen. He says:] From time to time cases have come under observation, presenting the usual symp toms 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.

I was once inclined to think that these varying results depended on peculiarity of constitution, and that the treatment of such cases by one or other of these remedies must remain, to a certain extent, empirical, and destitute of any settled principle. But a careful examination of all the precedent conditions in the histories of such cases exhibited the following facts:-That in all the cases in which the iodide had been productive of benefit, the patient at some antecedent period had been salivated, in some for syphilis, in others for an inflammatory or other disease; while in those cases in which no benefit was obtained by the iodide, the patient had either never taken mercury to salivation, or had suffered from syphilis or gonorrhoea, which had either been neglected or treated only locally. It appeared then that there were two predisposing causes to the same form of chronic periosteal rheumatism-the impregnation of the system by mercury, and the lurking and subtle influence of the syphilitic virus.

In my clinical lectures for some years past, I have directed the attention of students to these facts, and impressed on them that the treatment of these cases of chronic periosteal rheumatism should be based on these principles: the first form of the disease requiring the iodide of potassium, the second form, the agency of alterative doses of some mild preparation of mercury.—Lancet, Nov. 19, 1853, p. 478.

12.-Local Treatment of Acute Gout.-The extreme pain attending acute gouty inflammation may, it appears, be very quickly relieved by the application of pure spirits of wine. We witnessed a trial of this remedy by Dr. Goolden on a patient in St. Thomas's Hospital, who was suffering at the time agonising pain in the foot, and the result was an almost immediate relief. Dr. Goolden informed us, that he was in the habit of using it very frequently in private practice, and always with the most pleasing effect. He believed it to act by being absorbed, and not by mere evaporation. The mode of application is by a piece of lint saturated in the spirit, laid over the part, and then covered with oil silk.-Med. Times and Gazette, Nov. 12, 1854, p. 501.

13.-Local Applications in Chronic Gout and Rheumatism.—The ancient remedy of soda poultices for chronic gout appears to have fallen into very unmerited disWe have seen lately numerous cases in which very great apparent benefit

use.

was produced by them. The quantity of soda used was one drachm mixed with a common bread poultice, and applied hot over the affected joint every night. Many cases affording illustrations of the good effects resulting from iodine-painting of joints affected with chronic rheumatisın, have recently been under the care of Dr. Bennett, in St. Thomas's Hospital. This remedy also, though long known, does not appear to be so generally used as it deserves. It was, we believe, a great favourite with the late Dr. Pereira.-Med. Times and Gazette, Nov. 12, 1853, p. 502.

14.-On the Medicinal Constituents of the Lemon. By DR. COGSWELL.-[Lemonjuice is not always equally successful in the same number of cases of rheumatism. Dr. Cogswell thinks there may be something due to the difference he finds to exist in the constituents of the fruit. He says:]

The essential oil belonged to a class corresponding to the formula C, H, and including the other oils of the fruits of the Aurantiaceæ, the oils of turpentine, juniper, savine, elemi, copaiba, cubebs, and pepper. Some of them were approved remedies in rheumatism. From trials made with the oil of lemons in this disease, in flatulent dyspepsia, and leucorrhoea, the author entertained a high opinion of its therapeutical value, and thought that the chemical fact stated suggested the possibility of bringing together the various scattered evidences on the remedial efficacy of the oils of the same class, and referring them to a general law. The fresh juice, when evaporated in a water bath, yielded 8.5 per cent. of solid extract, and the ash obtained by incineration amounted to 0.27 per cent. The latter contained sulphuric and phosphoric acids, potash, lime, magnesia and iron. A controversy existed as to whether the citric acid or the potash in lemon-juice is the true medicinal ingredient. In reviewing the evidence, the author considered it an error to suppose that either would answer so well separately as united. The efficiency of the juice probably depends not on one or other of the ingredients, but on the whole combined. In using the essential oil, he gave it in doses of about fifteen minims, with two drachms of vinegar, in barley-water, always being careful to keep the bowels freely open by purgatives. If the efficacy of the juice in rheumatism depended on anything more than the refrigerant action of the citric acid, he thought the true antiarthritic agent was probably the essential oil when present, and he repeated his views as to the necessity of establishing a definite standard for the composition of the juice.-Lancet, March 18, 1854, p. 307.

15.-On the Efficacy of Galium Aparine in Certain Forms of Cutaneous, Scrofulous, and Cancerous Diseases.-[DR. WINN read a paper on this subject before the Medical Society of London. He stated his belief that the galium aparine possessed remedial powers in the above diseases which promised to equal if not surpass those of arsenic.]

When Dr. Winn first drew the attention of his professional friends to the properties of this plant, two years since, he was only aware of its efficacy in treating lepra; since then he has ascertained its benefit in other skin diseases. Dr. Winn then related the circumstances which led to his acquaintance with the galium aparine. A friend of his in Truro, who had suffered for many years from lepra vulgaris, and had taken all the usual remedies in vain, informed him that he possessed at last a remedy for his troublesome complaint in a common wild plant of which he did not know the name. Dr. Winn found this plant to be galium aparine, which grows abundantly in England, and on making further inquiries, learnt that three other persons in that district had been cured by the same remedy, one of whom had been discharged from St. George's Hospital as an incurable patient. After a botanical sketch of the plant, Dr. Winn expressed his belief that the ancients were acquainted with this plant, and that it is identical with the anapun of Dioscorides. On referring to some very old authorities, he ascertained that the galium was much in vogue as a domestic remedy in this country many centuries since; it was then highly extolled as a cure for cancer, scrofula, leprosy, and dropsy. An Italian writer, Giuseppe Terramosia, had published in Schmid's Jahrbucker an account of

several cases of scrofula, in which the galium appeared to produce rapid absorption of enlarged scrofulous glands. Diebach had also recommended it for phthisis, ascites, and scrofula. Richter considered it beneficial in strumous affections. Dr. Winn wished to direct attention to the fact of galium having been efficacious in glandular affections as well as lepra; it tended to confirm the theory that the two diseases were owing to the same cause-a strumous diathesis. It was also a remarkable circumstance, and one not generally known, that arsenic is highly beneficial in glandular swellings. Mr. H. Rees, an experienced and successful practitioner in the diseases of children, informed Dr. Winn that he had tried arsenic in infantile glandular affections, and proved it to be a most efficacious remedy. When first Dr. Winn used the galium, it was in the form of a decoction; but finding this mode inconvenient, he requested Mr. Hooper, of Pall-Mall, to prepare an inspissated juice, and that able operative chemist had succeeded in making a very valuable preparation. A teaspoonful of the juice equals in strength a half pint of the decoction. In ordinary cases a drachm, taken three times daily, will be found sufficient, but in obstinate affections the dose must be doubled. The juice of the galium had been analysed by Terramosia and Robert Schwartz. The former gives as its constituents-acetate of potash, gallic acid, tannin, extractive, water. The analysis of Schwartz is somewhat different. He gives its component parts thus-galitannic acid, citric acid, rubichloric acid, chlorophylle, starch. With regard to the modus operandi of the galium, Dr. Winn said he had little to offer but what was merely conjectural. Many of his patients were conscious of an increased flow of urine during its use, possibly from its acting on the kidneys as a depurating agent. The class of cutaneous diseases which had been benefited under his own observation was chiefly that dependent on a case of dyscrasia, such as lepra and psoriasis. He also considered these diseases as often arising from a strumous diathesis. The gentleman suffering from lepra, whose case had been referred to at the commencement of the paper, was one of a very consumptive family. In him the family disease had manifested itself under another form. It is highly important that the fluid extract be perseveringly used. Many patients have failed, no doubt, from not having given the remedy a sufficient trial. The same may be said of arsenic. Dr. Winn had tried the galium in nineteen cases of skin disease. Of these, five were cases of lepra, six of psoriasis, four of eczema, two of lichen, one of inflamed acne, and one of ordinary-coloured syphilitic eruption. In nine of these cases the benefit derived from this medicine was very striking. In one an instance of lichen circumscriptus, the effect produced by substituting the galium for other remedies was almost marvellous. With regard to the efficacy of this plant in the treatment of cancer, Dr. Winn was solely indebted to the experience of Mr. Bulley, of the Bucks Hospital, who had forwarded to him an account of three cases of cancer, in which the galium appeared to exercise a remarkable influence in arresting the disease. Dr. Winn was recently told that large quantities of galium are sold at Coventgarden annually, and that it is chiefly used by the purchasers as an external application in cases of cancer. This fact strongly corroborates Mr. Bulley's observations. -Lancet, Feb. 11, 1854, p. 155.

16.-Treatment of Dropsy. By JONATHAN TOOGOOD, Esq.-[Dr. Toogood, in his Reminiscences of a Medical Life,' gives us the practice of his old master, Mr. Dawe, of Bridgewater, in the treatment of dropsy. He says:]

During my pupilage I have often seen patients who consulted him, with bloated and livid countenances, oppressed breathing, oedematous extremities, and other symptoms of great obstructions, with greatly diminished secretion from the kidneys, so much relieved that they have continued well for many months together, and by the occasional repetition of the same treatment, have lived for years in comparative health. His plan was to give a dose containing eight grains of calomel, with the same quantity of jalap, and one grain of emetic tartar in the morning. This acted violently on the stomach and bowels, and used, according to his own expression, 'to ruffle his patient a good deal;' during and after its operation he directed a little wine or other cordial; afterwards the patient generally fell asleep, and awoke relieved. He then prescribed three grains of powdered squills, with two of digitalis, every night for six successive nights, and a mixture with bitter infusion, and small

doses of tincture of squills and spirit of nitre, twice a day. The digitalis was then omitted, and the other medicines continued for six nights more; and if the symptoms were not much relieved, the digitalis was resumed again. If the case was unusually obstinate, the drastic dose was repeated, and sometimes the dose of the digitalis was increased from two to three grains. But this was rarely done; very little attention was paid to the origin or cause of the disease; the great object was to unload the patient."-British and Foreign Medico-Chirurgical Review, April, 1854, p. 483.

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17.-REMARKS ON CHRONIC INFLAMMATION.

By DR. C. HANDFIELD JONES, F.R S.

[When we have very little exact knowledge of the real causative condition of a morbid action, we are apt to class it under the term chronic inflammation. Cirrhosis of the liver, Bright's disease, white pericardial thickenings, &c., we are apt to regard as slow inflammatory processes in the respective organs. Dr. Jones observes:]

I would wish to name all the morbid changes in which the character of growthof new formation-decidedly predominates over that of inflammation, according to their principal feature. I would call them simply fibroid thickenings, or fibro-cellular growths, and thus avoid giving them a name, either merely trivial, or of doubtful correctness. The matter is not one of nomenclature merely; it has important bearings on practice. Suppose a case intrusted to our care in which the liver was found considerably enlarged, projecting below the ribs, and that we have satisfied ourselves that the enlargement depends neither on engorgement with blood, nor on fatty change, nor on bacony deposit. The probability, then, is very strong that it is in a condition of cirrhosis, the fibrous tissue between the lobules being prodigiously increased in quantity. Can we hope by the administration of mercury or iodine to remove this deposit? If it were simply inflammatory, the attempt might be successful; but as it is a growth, one may confidently predict that it would be fruitless if not injurious. The same remark will apply more or less completely to any of the other instances before mentioned.

It seems to me that observers have not sufficiently held in view, although generally admitting as a matter of course, the vast predominance of that unknown force, call it what we please, which determined and still determines that here bone and there muscle, and in another spot nerve, and in another tendon, should be formed. There is some such force, and it is certainly liable to be deranged, and its derangements are just those which are most difficult to rectify. This perversion of the nutritive act (to borrow Andral's phrase) is that which determines the origin and growth of a cancerous, or a fibrous, or any other kind, even of a fatty tumour. It is the same, I believe, which causes the textural changes above enumerated, and some others which might be added, and not inflammation, which of itself and in its best marked form, produces no exudation which is capable of growing and enlarging. It is this property of vegetative increase which makes the removal of new formations and all allied productions so difficult: mere inflammatory effusions we can melt down and get absorbed, but these resist our "sorbefacient" remedies with the same persistence almost as the natural tissues.

The degenerative process which constitutes true morbus Brightii does not quite come under the above class of morbid changes. The best observers are agreed that production of new interstitial tissue constitutes no essential part of the morbid action. Most writers incline to view it as a nephritis of more or less chronic character; but the great name of Prout can be cited in support of the view that the substratum of the process is something essentially different from inflammation. My own observation has always inclined me to adhere to this opinion. In the enlarged, often mottled kidney, we see simply a derangement of nutrition, producing hypertrophy of the epithelium concurrently with malperformance of its function. The albuminoid cell-growth does not undergo its normal changes; and instead of forming the secretion, it collects in the tubes, either choking them up and distending them, or getting washed out in the stream from the Malpighian tufts. In further stages, or in more rapid degrees of change, the tubes and epithelium break up into mere detritus. In all this process we see really nothing to justify us in considering