Pharmacopoeia Londinensis" dismisses the whole matter in these laconic words: "Use-in some cases of paralysis."

Pereira does not allude to it, though he speaks of the efficacy of the drug in "dyspepsia, pyrosis, and some forms of dysentery.

Dr. Copland, whose mind seems to have embraced almost every thing in medical science, says, "In cases apparently depending on deficient tone of the muscular coat of the large bowels, and imperfect propelling power of the upper part of the rectum, I have seen benefit from combining the extract of nux vomica with the pilula aloes c. myrrhà or compound extract of colocynth."

Dr. Neligan, in his excellent treatise 'On the Uses and Modes of Administration of Medicines,' observes: "I have used the extract of nux vomica with much advantage, as an addition to purgatives in constipation depending on want of tone in the muscular coat of the large intestines, one of the most frequent causes of this state in females, and one which is distinctly characterised by great secretion of flatus, and colicky pains which accompany it.'

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So far as I have been able to learn, we are indebted to Magendie for the first suggestions on the powers of nux vomica. In 1845, Dr. Tessier, of Lyons, published a paper which was quoted in The Lancet,' and in which he says that "he considers it particularly indicated in cases where there is reason to suspect general want of tone in the bowels, as in paralytic and old persons, or where we suspect want of tone of the muscular coat, in consequence of great and long-continued distension; or, in short, where the constipation can be referred to an undue secretion of gas, which in itself, by causing distension of the bowels, diminishes their contractile power."

In the Journal of this association for May, 1848, is an article by Mr. Boult, of Bath, on the employment of nux vomica in habitual constipation, in which he observes: I first tried the extract alone, in half grain doses, two or three times a day, and was disappointed with the result. I was then lead to use the extract in combination with aloes, rhubarb and scammony, and was surprised at the result." Mr. Boult seems to think that it has the power of increasing the action of other purgatives; and he says: "Generally speaking, a pill containing three quarters of a grain of Barbadoes aloes, three-quarters of a grain of extract of rhubarb, and half a grain of extract of nux vomica, taken at bed time, will produce one or two evacuations the next morning." And he continues: "I have prescribed the pill already mentioned for months together, and at the end of that time the effect has been produced as certainly as at first, and no bad consequence has arisen: on the contrary, I think it will be found that, when the medicine is discontinued, the tendency to costiveness will be found to be diminished." The correspondent of 'The Medical Gazette,' November 10th, 1855, in his Notes on Hospital Therapeutics, has the following admirable remarks on the subject: "Among the conditions over

which nux vomica, and its active principle, strychnia, possess most useful powers, is that of habitual constipation from muscular atony of the intestinal tube. At the City Hospital for Diseases of the Chest, we observe that Dr. Peacock and Dr. Andrew Clark are both in the habit of frequently resorting to it for this purpose. It is generally given in combination with the compound rhubarb pill, and in doses of the extract of from one-sixth to one-half a grain. Of itself it can scarcely be deemed an aperient; that is, it does not so much excite peristaltic action as supply tone to the weakened muscular coat, by which it is enabled to reply efficiently to other irritants. Hence the need of combination with aloes, rhubarb, or some similar drug."

Dr. Peacock has mentioned to us a case in which a man of feeble intellect and torpid nervous system generally, had derived great benefit from its employment. At first, the bowels were ob stinately costive, and lavements produced no action; but since the use of nux vomica they have so far increased in power and sus ceptibility that simple injections are quite sufficient to procure all the action that is necessary.

With the observations quoted I generally concur, but specially with those of Mr. Boult and of the correspondent of the "Medical Gazette."

From the facts and opinions adduced I think we may safely infer

1. That in the nux vomica we have a new agent in the treatment of constipation: not a purgative or aperient, but a substance which, added to very minute doses of various purgatives and ape rients, forms a kind of tertium quid, which combines the advanta ges of purgatives without the disadvantages, which does not leave the bowels debilitated and indisposed to act after its operation, but which, on the contrary, imparts tone, rendering their action more certain.

2. That the agent does not lose its power by continued use. 3. That it is a perfectly safe remedy when used in the mode suggested.

4. That it is not an accumulative medicine.-[Assoc. Med. Jour.

On Hepatic Dropsy. By Dr. G. BURROWS, F.R.S., Physician to St. Bartholomew's Hospital.

[In a clinical lecture on this subject, Dr. Burrows first noticed the symptoms which most commonly attend these cases. They may be briefly mentioned, as, a swollen prominent abdomen, distinct fluctuation, sallow complexion, slightly jaundiced conjunctiva, pain and tenderness in the right hypochondrium, hard mass projecting below the ribs towards the umbilicus, high-coloured scanty urine, slight fever. Most frequently these symptoms will

have been produced by intemperate habits, which generally bring on cirrhosis of the liver.]

The treatment of dropsy is, at all times, confessedly difficult; but according to my experience, these cases of hepatic dropsy are not so intractable as they are represented to be, in some modern trea tises on diseases of the liver.

The first measure to be adopted will depend greatly upon the duration of the complaint. If the patient complain of pain in the right hypochondrium, or if there be tenderness there on pressure, together with febrile excitement, and the strength of the pulse will permit, I recommend you to resort to local depletion. A few ounces of blood may be taken by the cupping glasses or by leeches, from the region of the liver, and this depletion should soon be followed by the application of one or more blisters in the same region. In many cases the symptoms hardly call for vascular de pletion, and we commence the local treatment by the application of a blister.

2ndly. Evacuate the intestines by a freely acting purgative, and repeat this once or twice in the week; this evacuation affords relief, and, I think, is less distressing to the patient, and less irri tating to the alimentary canal, than the daily use of less active aperients.

3rdly. Having premised these measures, I advise you to lose no further time in resorting to the internal and external use of mercury, not in such doses as to affect the system rapidly, and as would be proper in cases of acute hepatitis, but very gradually.

I usually prescribe the pil. hydrarg. gr. iv., cum pulv. scilla gr. j., nocte maneque, and find this quite sufficient for the purpose. But then, as soon as the blistered surfaces will permit, I order mercurial friction over the abdomen twice in twenty-four hours, and here I prefer the stimulating effects of the lin. hydrarg. to the simple inunction with the ung. hydrarg. According to my expe rience, there is no remedy so powerful in exciting the absorption of the products of inflammation within the abdomen or of fluid from the peritoneum, or of stimulating the liver to increased secretion, or the intestines to more energetic peristaltic action, as mer curial frictions over the abdomen. This remedy is not only, in my hands, most efficacious in the treatment of ascites arising from chronic hepatitis, but also of inflammatory effusions within the abdomen; and likewise in obstinate constipation, sometimes erroneously supposed to depend upon mechanical obstruction of the bowels. I advise you to place confidence in these means in the treatment of ascites depending on cirrhosis; but remember it will be necessary to sustain the mercurial action for several weeks. It may be necessary to suspend the mercurial friction occasionally, and then, if any tenderness be detected in the epigastrium or hypochondrium, a blister may be applied there.

4thly. Simultaneously with this use of mercurials, you may

employ diuretics freely, if careful analysis assures you the urine is free from albumen. Some writers of high repute upon diseases of the liver speak disparagingly or doubtingly of the efficacy of diuretics in this form of dropsy, or of the ability to reduce ascites by the use of diuretics. This latter class of remedies are notoriously uncertain in their operation, but nevertheless, I have found them far from useless in the treatment of ascites, especially where they have been combined with the remedies already enumerated. The diuretics I prefer are the salts of potash combined with sp. æth. nit. and sp. juniperi comp. I generally combine two or more of the following salts of potash in varying proportions-the potash bicarb., potassæ acetas, potassa tartras, potassæ nitras, and potassæ iodid. When this plan of treatment has not a sensible effect in diminishing the ascites in the course of three weeks or a month, I should recommend you to resort to paracentesis abdominis at once, and not wait until abdominal distension has become enormous and the different internal organs almost paralysed in their functions by the long-continued pressure of the effused fluid.

and

Many advantages may be derived from one operation of tapping, which will not follow upon its repetition; indeed, the frequent withdrawal of the fluid by tapping causes much exhaustion, may be followed by fatal peritonitis. The first removal of the fluid generally affords great temporary relief to the patient, but other advantages may be expected from the operation. If the operator's hand be carefully passed over the right side of the abdomen, when it is emptied of the fluid, he may ascertain with more exactness the real condition of the liver, whether it be enlarged or small, or retracted; whether its upper surface be smooth or nodulated by deposits in its substance. Such information may encourage a persistence in former treatment, or may dissuade from the use of all further exhausting remedies. Moreover, it not uncommonly hap pens that, while the abdomen is enormously distended, diuretics and purgatives have little or no effect; but that, when the internal pressure is removed, the kidneys and bowels begin to evince their susceptibility to the influence of remedies previously administered with no success.

Lastly, I may warn you, that patients laboring under this form of dropsy have generally been accustomed to intemperate habits, and will not bear a very low diet. A moderate quantity of dry nutritious food is better digested than slops, and you will find the nervous system and the flatulent stomach require a small amount of some stimulant daily.-[Med. Times and Gazette..

Displacements of the Womb.

It is our impression that there is not a sufficient recognizance of the uterus as a "floating" body, or rather as a body whose mechanical conditions of equilibrium make its support more nearly

analogous to that than to any other mode of support. The most considerable solid support of the uterus is the vagina. These two conditions lead to an easy understanding of many phenomena of the minor motions of the uterus, called mis- or displacement. The destruction of the vaginal support by relaxation (sometimes a sort of paralysis) of the tube, often accompanied by a similar condition of the rectum, leads to the most complete displacements of the womb itself healthy,-leads also to all the ordinary symptoms of uterine ailment in the most aggravated form, and curable only on condition of curing the vagina. Again, enlargement, and consequently increased weight, of any part of the uterus, leads to sinking of it. Enlargement of the cervix leads to depression of the organ. Enlargement of the body, causing top-heaviness, leads to retro- or ante-version, or flexion. It is almost certain, that the ligaments of the uterus have almost no function as ligaments, but quite the reverse, and that in those cases of displacement, where symptoms are ascribed to dragging on them, there is no such dragging at all, the uterus having free motions afforded to it by these ligaments, which are not to be put on the stretch by any ordinary misplacement. It must also be remembered, in regard to uterine flexions, that the organ is sometimes so softened, as not to be ca. pable of bearing its own weight-a circumstance sometimes connected with leucorrhoea and painful symptoms. These considera tions we could with pleasure follow out to much greater length. We shall only say, that their comprehension is a great object to all obstetricians, for as surely as they attain to a 'correct appreciation of them, so will they acquire confidence and skill in prescribing for or advising the sufferers from them.-[Edinburgh Med. Jour.

On the Ligation of Arteries. By T. P. GIBBONS, M. D.

The danger of secondary hemorrhage is well known to be one of the great drawbacks to the ligation of the large and deep-seated arteries. This is particularly true with regard to the femoral ar tery, owing to the number of its collateral branches. Indeed, so many unfortunate results, from this cause, have occurred in the ligation of this vessel, that some surgeons prefer, rather than resort to it, in certain cases, to amputate the limb.

The method usually recommended for the performance of ligation, is to cut down upon the vessel and open the sheath, without disturbing the tissues more than just sufficient to carry the aneurismal needle, armed with the ligature, around it. By this plan of procedure, it is contended, that the danger of extensive sloughing is avoided. This is unquestionably true. But how is the danger consequent upon the application of the ligature immediately below a large collateral branch, to be obviated by such a process?

Of all the animal tissues, that of arteries is least liable to slough;