flammation, often altogether unaffected; and the bronchitis and pneumonia, which in this country so often, and so seriously complicate the disease, are of less common occurrence." But it appears to me, that it is this very difference in type which ought to lead us to effect an exchange of treatment. In England, the symptoms brought on by croup are not unfrequently more dangerous than the original disease, to wit, bronchitis and lung affections will follow, but not often precede cynanche trachealis. Both these formidable affections are in a greater measure, if not altogether dependent on an obstruction to the passage of air; so that, in overcoming this as quickly as possible, we prevent congestion, and thus have to grapple with one, instead of three separate dis

eases.

My views are so much in harmony with those expressed by Mr. Smith, in his valuable paper in the Medical Times and Gazette, of the 26th January, 1856, that I feel more confidence in stating my conviction that-notwithstanding the difference both in the nature and the type of croup in this country, and the more formidable character it puts on than is generally met with in Franceour earlier introduction of air would not only give us a larger percentage of recoveries, but would place this operation in the same favorable light in which it is now regarded in Paris and other parts of France. Success would enable us to speak with more confidence as to a favorable result in those cases to which we are called early, so that the prejudices of the ignorant would be more easily overcome, and the surgeon be found at the bedside of the opulent, not as at present, when all other remedies have failed, and when death is at hand, but at a time when there is still strength enough and hope enough left, to lead to as reasonable prospect of recovery from tracheotomy, as was before held out by each of the remedies which had already preceded its performance.-[N. Orleans Med. News and Hosp. Gaz.

Cathartics in Dysentery. By O. C. GIBBS, M. D., Frewsbury, N. Y.

At the meeting of the Buffalo Medical Association, Sept. 2d, 1856, as per report of proceedings in the October number of the Buffalo Medical Journal, a discussion took place in regard to the propriety of using catharties in dysentery; also the kind of cathartics best calculated to fulfill the indications in that disease.

* Dr. West on the Diseases of Infancy and Childhood.

As

I cannot too strongly recommend the perusal of this valuable paper to those who are interested in the treatment of this dangerous disease. Mr. Smith, with that characteristic candor which speaks volumes in his favor, is not backward in acknowledging his own failures, while he points out the success of another in proof of the desirableness of his operation.

"In certain European countries, and in England particuiarly, tracheotomy in cases of croup is still so isolated an operation, that in all Great Britain it is not so much practised as in Paris alone."-Lectures on Tracheotomy in Croup, by Professor Trousseau.

this question is fairly before the readers of the Journal above mentioned, we suppose it is open for the expression of opinion or experience, by any of its many readers. Hence, we give expres. sion to a few thoughts, based partially upon our individual experience, and partially upon the generally received opinions in regard to the nature of the affection under consideration. A knowledge of the nature or pathology of any disease, is, perhaps, the surest guide to the appropriate indications of treatment. The public generally, are apt to look upon all diseases accompanied with frequent evacuations from the bowels, as similar at least, if not identical in character. Physicians themselves are not always free from this vagueness of nomenclature. In muco enteritis, as well as milder forms of mucous irritation, each case is accompanied with a diarrhoea or frequent alvine evacuations, and the public gener ally do not discriminate between such cases and dysentery, and we have seen physicians not unfrequently, if not guilty of the same error in diagnosis, at least of the same vagueness of nomenclature. Dysentery consists in an inflammation of the mucous membrane of the colon and rectum, and, though the evacuations may be over in ten minutes, yet, except it may be in the incipiency of the disease, they are not foecal, but consist almost wholly of mucus and blood. Hence, though the griping pains in the abdomen and the tenesmus may be never so great, though the characteristic muco-sanguineous evacuations may be never so frequent, or the straining at stool never so persistent, the case may be accompanied with obstinate constipation. The public generally look upon the frequent bloody evacuations as constituting the whole of the disease, and, conse quently, urge the importance of powerful astringents, which, if unadvised by the attending physician, they sometimes clandestinely and injuriously bring to bear upon the disease. But the physician who resorts to them, to the exclusion of evacuants, will certainly have no reason to boast of success.

Permit us to say, that we do not propose to discuss the nature, cause, or symptoms of dysentery, nor to enter into full details of treatment. We propose only to make a brief expression of our opinion, upon the question under discussion, viz., the propriety of cathartics in dysentery.

Some authorities have condemned the use of evacuants in dysentery, on the ground of their supposed irritating influence upon the inflamed mucous membrane. But we feel confident that, when the evacuant is judiciously selected, and repeated with due discrimination, and with proper adjuncts, its irritating influence is more fancied than real. The object of the cathartic seems, at first, to be to free the bowels from irritating secretions, and the object of their repetition is, conjoined with the above, to prevent constipation, which is the inevitable sequence of the inflammation and consequent fever. A second, and not less important object to be secured by the evacuant, is to unload the portal veins, thus dimin

ishing congestion in that important circulatory system, and to stimulate the capillary circulation in the liver, which is often sluggish, resulting in a deficient biliary secretion.

In regard to the choice of a cathartic there has been and is a great discrepancy of opinion. Some have advised calomel at first, to be succeeded by castor oil; others have advised castor oil from the first. Rhubarb. componnd powder of jalap, cream tartar, epsom salts, rochelle salts, &c., have all had their advocates.

We were formerly in the habit of giving, at first, calomel intimately commingled with rhubarb and a little pulverized opium, and afterwards, whenever an evacuant seemed demanded, gave castor oil with a few drops of laudanum. But recently we have made choice of a different evacuant, and, so far, have been much pleased with the change. In the June number of the Western Lancet, for 1855, Dr. D. B. Dorsey communicated the result of twenty years' experience with a cathartic mixture, first proposed to him by Dr. Lemoyne, of Washington, Pa. Summing up his results he said "in a practice, not very limited, in the cities of Wheeling, Va., and Steubenville, O., in the latter of which dysentery prevailed as an epidemic twice or thrice during my residence there, I had the high gratification of seeing all recover who were treated with this remedy from the commencement of the attack." With this high encomium before us, we made trial of the combination in the next case that came under our observation, and with such happy results that, except in young children, we have used it in all dysenteric cases since, with success in all cases.

We quote Dr. Dorsey's formula and directions from the paper above referred to. "Take of saturated solution sulph. magnesia, seven fluid ounces; aromatic sulphuric acid, one fluid ounce-mix. "The saturated solution is prepared by dissolving epsom salts in an equal quantity of water, by weight, at 60 deg. Fahrenheit It will be ready for use in eight or ten hours. During that time it should be shaken occasionatly.

"The medium dose of this medicine for an adult, is one tablespoonful, delivered with two or three ounces of water, every four to six hours, until it gently moves the bowels. It should be given regularly, and perseveringly, until the bowels are manifestly under its influence, which will be evinced by feculant discharges, abatement of tenesmus, and general feeling of relief. The size of the dose and times of repeating it, must be varied by the practitioner's judgment, according to many circumstances of age, violence and stage of disease, &c. Sometimes it will require two tablespoonfuls of the medicine, every three or four hours; at others a teaspoonful every six or eight hours will be sufficient."

Accompanying each dose, when the pain and tenesmus are great, one-sixth of a grain of sulph. morph. may be given. But this remedy, also, must be varied, both in quantity and frequency of repetition, according to circumstances.

We have seldom or never exceeded tablespoonful doses, and of tener fallen below that. But instead of giving once in four or six hours throughout the twenty-four, we have usually commenced with it in the morning, to be repeated every three hours until it operates, always combined with a small quantity of morphine. This course we repeat every day so long as the indications demand. During the remainder of the twenty-four hours, we give ipecacuanha with morphine, or such other remedies as the circumstances of the case seem to require. It may not be amiss to say here that mercurials are incompatible with the mixture.

The acid doubtless stimulates the capillary circulation in the liver, promoting bilious secretion, while the sulphate of magnesia relieves the portal congestion and frees the bowels from irritating secretions. From the relief which speedily follows its action, to the tormina and tenesmus, greater than that following any other evacuant, we cannot help thinking the acid has a direct sanitary influence upon the inflamed mucous membrane.

With young children, where smallness of dose and pleasantness of taste are always cousiderations of much importance, the above mixture is decidedly objectionable. The taste is rather disagreeable, and the necessity for diluting the mixture, renders the bulk such as no child will readily take. In such cases we have been in the habit of scorching rhubarb, adding boiling water and extract of hyosciamus, the dose of such proportioned to the age and condition of the patient, sweetening the mixture and flavoring with nitre.

This is to be given in repeated doses in the morning, sufficient to produce a laxative effect, and during the balance of the day we give hydrargyrum cum creta, in small doses, with Dover's powders or such orher medicines as the circumstances of the case may indicate.-[Buffalo Medical Journal.

On the Use of Ice in Uterine Hemorrhage. By E. A. HILDRETH, M. D., Wheeling, Va.

Every physician has experienced the uncertainty, or to say the least, the want of promptness in the effect of the "usual" remedies for this difficulty. The remedy we propose is the introduction of ice into the uterus. It is not proposed as an "experiment, for it is now about ten years since we first used it, and have a sufficient number of recorded cases to prove its utility.

The safety of passing a quantity of ice into the cavity of the uterus after the expulsion of the child or placenta, has been questioned by some, as we believe, on purely theoretical grounds. The effect in every case we have used it, has been to contract the uterus quickly, energetically and permanently; and as a matter of course stop the uterine flow. We have yet to see any unpleasant result,

directly or indirectly arising therefrom, on the contrary, the relief afforded is prompt and permanent.

We do not wish to theorize on the subject at this time; allow me to subjoin a few facts as observed and noticed when they occurred. CASE I. June 16th, 1846, Mrs. McC., æt. 40, in labor with her fourth child. Describes her previous labors as "lingering." On examination "per toucher" found the os uteri thick, firm, opened as large as a half dollar-membranes entire-breech presenting, pains slight. Prescribed Pulv. Ipp. Comp. grs. xii, and left requesting them to call on me when the pains became more active. Called back in 6 hours, found her pains strong and expulsive, and half an hour after, the child was expelled. Upon introducing my hand along the umbilical cord, it was ascertained that hour-glass contraction was present; the placenta remaining at the fundus of the uterus. An attempt was made slowly to pass the hand through the contracted portion, but failed. Gave her Morphia Sulph. grs. ss. and permitted her to rest. Says she has felt no pain since the birth of her child. In about half an hour she had some pain with profuse hemorrhage. Used effusion of cold water over abdomen with pressure and gave her B. Morphia Acet. grs. . Acet. Lead, grs. iii. Flooding is checked. Endeavored to extract pla centa but failed. In about fifteen minutes flooding returned to an alarming degree-placed pounded ice over hypogastrium, and introduced several pieces of ice into the vagina as high as os uteriflooding restrained and hour-glass contraction relaxed so that the hand could be introduced and placenta extracted. Five minutes after the flooding returned. Passed my hand into the uterus in hope of provoking contractions, but without effect-it feels like a wet leather bag. Pulse very small and frequent, face and lips pallid, complains of faintness and dizziness. Fearing now her rapid dissolution unless a more seccessful treatment was pursued, I seized a lump of ice as large as a lemon, and carrying it through the os uteri slipped it from my hand. The effect was immediate and powerful, expelling a quantity of coagula, and contracting the uterus to its usual size and firmness; a graduated compress and bandage were then applied-pulse 120, small, weak, complains of giddiness-M. M. perfect rest in horizontal posture-pulverized opii. grs. iii immediately after rest-Panada with Brandy. Saw her four hours after-has slept some-no return of "wasting"-feels comfortable-pulse 100, soft, full-womb well contracted-no pain on pressure.

17th. Feels well-slept well last night-pulse 90, weak-likes her Panada-no pain or tenderness over abdomen-lochia not more free than usual-M. M. let her rest.

18th. doing well-22d thinks she can sit up-forbid it and dis charged her, well.

CASE II. Nov. 7th, 1847. Called in haste to see Mrs. B.; found a German woman attending her as midwife-the child has been