14th. No tenderness on either side. Urine was alkaline, and contained some ropy mucus, and a little albumen.

urine still albuminous. From this time he gradually improved, and he went out on the 9th of August, when the urine contained

17th. Urine just passed neutral, with dis- no albumen. tinct pus globules. No pain.

If, then, you find albumen in the urine, He went out at the end of the month, watch anxiously to detect and treat any inwithout any pain, but passing still some pus.flammation which may arise; but the inOn the 1st of May, I still found a little pusflammation may come on before any albu. in the urine. men appears in the urine. A boy, about 14 The contrast between rheumatic fever years of age, was admitted on the second and scarlet fever, in the effect on the kid-week of scarlet fever; no albumen was deneys, is too striking to be overlooked. In tected in the urine. After a few days, he scarlet fever, the affection of the kidneys complained of most severe dyspnoea and has been considered, by the late Dr. Mil-pain in the region of the heart. Still, no ler. to be a necessary part of the disease; and Dr. Begbie has stated that no cases of scarlet fever occur without some albumen being present at some time in the course of the complaint. I cannot agree fully to the fact, or to the theory. Albumen I have not found in every case, although it ocasionally may be found, for a very short time, in the urine, without being followed by any bad consequences, and without the slightest appearance of any desquamation of the epithelium of the mucous membrane of the pelvis or tubes.

albumen could be found in the urine, and there was no friction of the pericardium. The following day the friction was most distinct, but no albumen was present in the urine. The next day a minute trace of albumen was found; this afterwards increased, but was never considerable. The pericarditis, which rapidly went on to extreme effusion of fluid, yielded to treatment, and, when he left the hospital, no albumen was present in the urine.

The quantity of albumen in the urine, after scarlet fever, is no test of the dangerous symptoms which may occur. Thus, I have found very little albumen in the urine, and yet the most intense symptoms have en

Whenever albumen is found in the urine after scarlet fever, the greatest attention of the medical man is requisite to detect and to treat the commencement of any inflam-sued. mation of the serous membranes.

On the 3d Dec., 1848, I saw a school-boy, A young man, aged 20, was admitted, { aged 19, who had been sick the night preJune 20, 1843, on the fourth day of slight scarlet fever; on the 18th day he was apparently convalescent, but I detected some albumen in the urine. On the 23d day, I found still more albumen in the urine, with desquamation of the epithelium. He was perfectly free from all cedema of the face or legs, and made no complaint.

vious. I found soreness of the throat, and a scarlet eruption on the chest. The scarlet fever did well; he had no bad symptoms. On the 20th day he had some enlargement of the glands of the neck externally; they were tender to the touch. I did not exam. ine the urine. On the 24th day he was convalescent. During the following week he had not much appetite, and he had a little dul-pain sometimes in his head. I was not

25th. Some pain in the left side. The following day it was increased, with ness, and œgophony, and gophonic breathing, at the base of the left lung.

asked to see him until the 31st day; he went to bed early; the bowels had acted freely with medicine. About half past 11 P. M., an unusual noise was heard in his

On the 32d day, the effusion into the pleura was much diminished by treatment, but, at the apex of the heart, a distinct rub-room; it was found that he had vomited, bing to and fro sound with each pulsation was heard. This was loudest when he held his breath.

37th day. Still pleurisy, and pericarditis; also some rusty adhesive expectoration;

"The Pathology of the Kidney in Scarlatina." By James Miller, M. D. 1850.

Dr. J. W. Begbie, Monthly Journal of Medical Science Oct. 1852, "On Temporary Albuminuria."

and was not himself. I saw him soon after 1 A. M., the 32d day; he was then vomiting. He did not complain of any pain in his head; I could get no urine, but nothing unusual had been observed in it. In a few minutes he had a most violent epileptic fit; he was cupped to six ounces; he complained much of the pain of the cupping, and while the glasses were on, he had another fit.

Every hour, for five successive hours, a fit and, to the second, that Dr. Miller told me, recurred. The pulse becoming hard pre- that, on the post-mortem examination of the vious to the convulsions, but soft and large kidneys of those who died after scarlet fever, afterwards, when perspiration came on. At he has seen both the enlarged and the conseven o'clock in the morning he had had tracted cortical structure characteristic of seven fits; he was bled to ten ounces. He different stages of Bright's disease. If you was quieter for a time. At ten, the fits still have the opportunity of seeing much of recurred every hour, and were very strong, scarlet fever, you may advance our know. He was again bled to ten ounces, and was ledge by carefully watching the progress of decidedly better for a time. From twelve these cases of dropsy, when the disease is to two, the fits became much more frequent, in its most chronic form. The careful exscarcely even remitting. There was mark-amination of the microscopical appearances ed opisthotonos, and the convulsions were in the urine during life, and of the state of chiefly on the right side. The pulse re-the kidney after death, can scarcely fail to mained of good strength. He had much give new and important results. perspiration, and he passed some water in the bed. At three he became quieter, and at five in the evening the fits ceased. At half-past nine he was quiet, but unconsci

ous

At nine A. M., 33d day, he was sensible. He passed some water for me; it contained a few blood-globules; some coarse and some fine cylinders; much free uric acid; albumen very distinct, but not in large quantity. Specific gravity of urine, 1010.8; 1000 grs. of urine contained 1 gr. of uric acid.

By such observations, you may also determine whether desquamation of the renal tubes necessarily accompanies the albumen in the urine after scarlet fever; or whether, as I have myself seen, the albumen may frequently appear without any appearance of desquamation in the urine.

The question of the passage of the scarlet fever poison out of the system, through the kidney, has still to be proved. In a future lecture I may return to this point. The time obliges me now to point out the gene

On the 41st day, the urine gave theral principles which must guide you in the slightest precipitate with nitric acid and treatment of this state of kidney after scarheat. The albumen was scarcely percepti- let fever; the general treatment differs, howble. There were still some very fine fibrin-ever, in no respect from that of Bright's ous casts to be found. The specific gravity of the urine was 1023.5; it was alkaline, from fixed alkali. He had no bad symptoms, but slowly and gradually regained his strength of mind and body, and vered completely.

disease. Except that recovery is more frequent, and that the symptoms yield more easily to treatment, I know of no difference between this disease and Bright's disease. reco-Mercurials are as dangerous in the dropsy

I have seen the same symptoms and the same result, when the urine, on the addition of nitric acid, has become perfectly solid, from the quantity of albumen which it contained; and hence you must not consider that the quantity of albumen in the urine, after scarlet fever, is any certain index to the severity or duration of the symptoms which may occur.

A very important question connected with this subject, is, how long the albumen may remain in the urine after scarlet fever. Another is, on post-mortem examination of such cases, in what state is the kidney found? I have, as yet, only this answer to give to the first question-that I have seen the albumen continue in the urine for many months without any general symptoms, and that, when these do arise, they may, like Bright's disease, be acute or very chronic;

after scarlet fever as in Bright's disease. Diuretics are as much to be avoided; sudorifics and aperients are as beneficial. In extreme cases of both diseases, the benefit of elaterium might be illustrated by many examples, if my time admitted me to read them. In both diseases the blood becomes impure, from the accumulation of the products of the organic changes in the body. I might sum up the objects to be attained, if possible, in these few words, namely, relieve congestion, and purify the blood.

In conclusion, this appearance of albumen in the urine in cholera is caused by passive congestion of the kidney, while the albumen in rheumatic fever is the result of active congestion. The albumen after scarlet fever may also, at least as regards its treatment, be considered as produced by a state of more or less active congestion of the kidney. The relation of this to Bright's

disease will be the subject of a future lecture.-Med. Times and Gaz. Sept. 10, 1853.

likely to result upon the discovery of such affections. Mr. Lawrence, in one of his lectures on Surgery, published in the Medical Gazette for August, 1830, also described the disease. Dr. Beatty, in the article

year, has entered minutely into the legal questions likely to arise in cases of this nature; so that one is rather astonished at finding that any mistake should now arise as to the nature and causes of such affections.

History of the recent Epidemic of Infantile Leucorrhoea. With an Account of Five"Rape," in the Cyclopedia of Practical Cases of alleged Felonious Assaults re- Medicine; Dr. Churchill, in his work on cently tried in Dublin. By WILLIAM R. Diseases of Women; Dr. Beck, in his WILDE, F. R. C. S., Surgeon of St. Mark's Elements of Medical Jurisprudence; and, Hospital, etc.-Considerable excitement has to come down to the latest authority, Dr. prevailed among all classes in Dublin dur- {A. S. Taylor, in the edition of his work ing the last month, owing to the circum-on the same subject, which was issued last stance of no less than three cases of felo. nious assaults upon children under ten years of age having been brought forward by the Crown at the late Commission before the Chief Justices. Since these trials, leading articles have appeared in some newspapers on the subject; and a correspondence has been published in the Freeman's Journal, { between Dr. Ireland, the Physician to the Police, upon whose informations the cases were sent for trial, and myself, as I had one of the accused persons defended. I think it also right to mention, that so impressed were those members of the profession in Dublin who were acquainted with the cir-errors in future, but as an exposure of the cumstances of the cases, that Professors Cusack, Beatty, and Geoghegan, and Drs. Churchill, Hughes, Hatchell, and Speedy, all came forward in court gratuitously, to tender their evidence in what they considered the cause of truth, science, and humanity.

But as such errors have arisen, and might, but for the pains taken to expose them, have led to the most serious consequences, we think it our duty as public journalists to bring the matter under the notice of our readers, not merely as a warning to such members of the profession as might, from inexperience, be led into similar

deficient system of medical police in the United Kingdom, and as a warning to lawyers and public prosecutors with respect to medical jurisprudence-a subject, by the way, on which, except when barristers "cram" for the defence of a prisoner, they are especially deficient. Even judges may occasionally require to have the wellestablished laws of medical jurisprudence very forcibly pressed upon them, before they will take them in evidence against the

Most practical physicians and surgeons, particularly those attached to public institutions, or who are well acquainted with the diseases of the lower classes, know perfectly well that vaginal discharges, attended { assertion of an ignorant witness. with inflammation of the external parts, The causes of the inflammation and and an exematous excoriation of the labiæ, muco-purulent discharge from the genitals and the adjacent portions of the thighs, are of young children may be an impaired state not uncommon affections in girls aged from of the general health, arising from ill-feedfour or five to ten years. This affectioning and a residence in an unhealthy locality has been lately denominated infantile leu--scrofula, intestinal worms, and the negcorrhoea, but vaginitis is a more character-lect and inattention of their parents and istic term. It is of a more decidedly in- guardians. Generally speaking, the disflammatory character than leucorrhoea, and ease arises, in the first instance, from some the accompanying discharge is puriform. of the foregoing causes, and is then aggraOccasionally, it assumes a very virulent vated by uncleanliness. Being at first, and appearance, resembling cancrum oris, and when perhaps confined to the vagina, painsloughing of the genitals, and even deathless, no complaint is made by the child, has followed. It is at times epidemic. Sir until the urine passing over the excoriated Astley Cooper published, in his Lectures surfaces of the labia and inside of the thighs; on Surgery, nearly forty years ago, an ac-or, in aggravated cases, the difficulty which curate description of the disease, and also the little patient experiences in walking atin graphic terms described the consequences tracts attention. Frequently, however, ac

1

cident, or the state of the child's linen, first to influence her, has had connection with a calls attention to her state.

Iman, it is not likely that she will conceal it from her mother or near relatives when hard pressed; but in all cases where the crime has not been committed, considerable time elapses before the story is made out. In one of the cases tried in Dublin, the mother stated in her informations that she had to threaten her daughter severely for more than a day and night before she would acknowledge to the fact; and she also swore, at the Commission, that she threatened her little girl "to cut her tongue out of her." And in another case, the mo. ther—a step-mother, by the way-com. menced by giving the unhappy child a sound flogging, and a threatening of more

It is here proper to premise that a delusion prevails very extensively among the lower orders in Ireland, to the effect that a man can get rid of an obstinate gonorrhoea, which has "failed the doctors," by having connection with a virgin; and, as the easiest mode of effecting that object, a child of tender years is selected; and hence the felonious assaults occasionally attempted, and for which men have been most justly convicted, and most righteously punished. But in all such cases it has been proved that the men laboured under gonorrhea or venereal, although the popular impression among the lower orders is, that the disease is not only completely but instantaneously if she would not confess to the fact. transmitted from the male to the female. Then comes the next part of this extraBut it is not alone in this country that this ordinary drama, also graphically described popular delusion prevails. From the work by Cooper. The names of a number of of Duchesne, on the prostitution of Algiers, persons are suggested, not in the first injust published, we learn that "the Arabs stance as having perpetrated the crime, but believe that syphilis may be transmitted to merely as having been kind to the child, a negro female, the individual thus trans- paid it attention, or given it presents. The mitting it becoming free from the disease." child acknowledges to some such act of Well aware of this wide-spread supersti kindness. In one of the Dublin instances, tion, and also naturally suspicious of any a bit of sugar given some months before by disease in the genitals of a female child or the prisoner to the child, was the alleged young girl, the mother at once jumps to the reward, and also the reason why that parconclusion that some impure connection ticular person was selected; and in one of has taken place, and possibly she may be the other instances, a penny to buy strawconfirmed in this idea by some medical man, berries," was said to be the reward. The not conversant with such affections, stating name having been at length selected, the that it may be either gonorrhoea or the re- threatenings are recommenced, and a series sult of violence. But even without this of questionings, as to whether such and medical authority, the mother commences such circumstances did not take place are a course of questioning and threatening, so instituted; and thus, as Sir Astley said, with precisely identical with that so graphically great truth, "The child is driven to confess described by Cooper, that one would think what never happened in order to save hershe had been instructed out of his lectures; self from being chastised " All this time in fact, the evidence given upon the cases the infatuated mother, firmly believing in lately tried in Dublin was, in truth, but a the commissiom of a foul act, little suspects paraphrase of the very words of our great that in the promptings and suggestions to surgeon. First commences the questioning her frightened innocent child, she is leading as to the fact of connection. This the poor it from the path of truth and demoralizing child denies, and generally holds thereto its mind by entering into details which, as for a greater or less period, varying accord- may easily be seen from the language aftering to her own knowledge of or her appre-wards adopted by the child at her examinaciation of truth, or the amount of reward tions, are those of a grown person well acoffered, or of punishment threatened. Now, upon this subject I may remark that where a child, who has neither love nor passion

Dr. Montgomery informs me that he knew a case in which a servant-woman affected with gonorrhoea induced a child to have connection with her, in the hope of thus curing herself.

quainted with such matters, and of the mother who, as the great authority so often quoted said, being "perhaps not quite clear herself. she is more ready to suspect others." If the child is taken into an hospital or a public institution (as occurred in three of the nine cases which lately appeared in

wards, the mother having discovered a vaginal discharge and excoriation, etc., in her child, put her through the usual course of examination, and then brought her to the police-office, where she charged the servant of the gentleman alluded to with having violated her upon the day when she was seen at the door by the master, and swore that the crime took place in the gentleman's office, the next room to the dining parlour

Dublin), the mother may be disabused of her unjust suspicions, and the nature of her child's disease explained to her; and she may return to her home happy and contented, while at the same time her child is prescribed for and soon gets well. But if, on the other hand, she applies to the police, the accused person is immediately arrested without summons or warrant, as the crime is a felony punishable by transportation for life. And a system of examination and in-in which his family were than sitting either quiry is pursued which may lead to a public trial, in which the accused man, unless ably defended or assisted by medical evidence in his behalf, stands a good chance of being sent to Spike Island or a penal colony. Such was nearly being the catastrophe lately, the particulars of which are as follows:

at or after dinner! The case came, in due course, before the magistrates; the medical officer of the police made the usual examination of both parties; found the man perfectly free from disease, but stated that the child laboured under a vaginal discharge; with other marks, which, together with the child's evidence, induced the magistrate to send the case for trial, and to refuse a large amount of bail offered for the prisoner. The

I have already stated that the disease is occasionally epidemic, and such would appear to have been recently the case in Dub-informations of the child were very concise, lin, as I bave received the particulars of no merely stating how, when, and where the less than nine cases, viz. one recorded by act occurred. Neither the mother nor the Mr. Hamilton in the Dublin Medical Press, medical officer of the police swore any infor the 4th of May last, and tried before the formations, and as the gentleman's family Recorder; the three which formed the sub-were naturally exceedingly distressed at the jects of the late trials at the Commission; circumstance, the case was kept as private two which presented at the Pitt-street Dis- as possible, and no account of it appeared pensary, under the care of Drs. Croker and in the public newspapers. The child, says Hardy; two treated by Dr. M'Clintock; Mr. Hamilton, in his report, was sent to the and one at present under the care of Mr. Richmond Hospital, "by the police, as havDwyer. In none of the cases where the ing been violated; the man suspected of the children were first brought to public Insti- offence was in custody. The face was pale, tutions, or where private practitioners were but not delicate-looking; the crime was said consulted, were trials instituted, although, to have been committed a fortnight before. in three of them, the mothers were at first Her story, which she detailed very glibly," possessed with the same suspicions regard-being that already related. The disease in ing violence and infection to which I have already alluded. In the case related by Mr. Hamilton, the first of the epidemic which presented, the facts are these: A beggarriations, extending over so much of the child, residing in a dirty, unhealthy lane, thighs as were washed by the discharge, or leading from one of the principal markets, came in contact with each other. A few of was in the habit of receiving bread and the neighbouring lymphatics were enlarged. other charities from P. Tracey, the butler To assist in forming a diagnosis of the case, of a solicitor residing on the north side of Mr. Hamilton performed inoculation, with the city. Upon a certain day, the master the matter of the sores, on the thighs of the of the house, when going out to dine, ob- patient; but it failed. The child, he says, served her at his hall door, waiting to re- was in a "filthy state," at the time of her ceive the usual charity given to her at such admission. The accused person did not extimes. He desired her to go away from the hibit "the smallest trace" of any affection place. Trivial as this circumstance is, it is of the genitals. I expressed an opinion, worthy of note, inasmuch as it would be therefore, says Mr. Hamilton, "that, as far one of those facts laid hold of by the Crown as the medical evidence went, there was as corroborative of the child's statement re-nothing to show that any violence had been garding time and place. Some time after-used with the child, or that contact had

the genitals was characterized by the usual symptoms of swelling, redness, superficial sores, vaginal discharge, eczematous exco