On the Preparation and Therapeutical Employment of Subcarbonate of Bismuth.

The following is the mode of preparation of the subcarbonate of Bismuth described by M. Hannon, Professor at the University of Brussels. The bismuth is first purified by melting this metal in powder with ten times its weight of powdered nitre. After cooling, the metal is again powdered and mixed with ten times its weight of nitre, and after a second fusion the bismuth may be considered as entirely free from the arseniurets and sulphurets which it almost always contains. Then three parts of nitric acid are put into a retort, and one part of pure bismuth is added. When the reaction is complete, about a third of the liquid is evaporated, then the solution is poured drop by drop into a solution of carbonate of soda, and a white precipitate is obtained, which is subcarbonate of bismuth. The precipitate, after having been washed five or six times with distilled water, is thrown upon a filter, and washed again to remove the last traces of carbonate of soda. It should be preserved in well-stopped bottles. The physiological properties of the salts of bismuth are very little known, for the simple reason that the subnitrate is the only salt which has been employed in medicine. The operation even of this salt is not well understood, as its insolubility offers an obstacle to the observation of the physiological phenomena which might have been observed in the other salts of bismuth, such as the citrate, the tartrate, or the carbonate. It is also the insolubility of the subnitrate which renders it inefficient in the greater part of the cases in which it is indicated; and it also occasionally produces a very inconvenient sensation of weight at the stomach. The subcarbonate is soluble in the gastric juice, its action is rapid, it produces no sensation of weight at the stomach, it rarely constipates, colors the stools less than the subnitrate, and may be employed for a long time without oppressing the stomach. The action of the subcarbonate appears to be sedative during the first days of its employment, and subsequently to excite all the phenomena which result from the action of the tonics.

As to its therapeutical action, it may be noted that all cases of gastralgia consecutive upon phlegmasia of the digestive passages, cases in which the tongue is red and pointed, and cases in which the digestion is laborious and accompanied with putrid or acid eructations, or in which there is a tendency to diarrhoea or spasmodic vomiting, demand the employment of the subcarbonate of bismuth. This salt is also required in the vomiting of children, whether caused by dentition or succeeding to frequent fits of indigestion, and in the diarrhoea of weak children, especially when occurring at the time of weaning. One great advantage possessed by the subcarbonate of bismuth is, that it neutralizes the acids in excess which are found in the stomach. The subnitrate, as is well

known, fails always in this respect. In all the cases where the subcarbonate has been taken, the pain in the digestive passages is first found to disappear; then the eructations cease, together with the vomiting or diarrhoea; the digestion becomes less and less laborious, the tongue gradually receives its normal form and color; and if the use of the subcarbonate is continued, the appetite increases from day to day, the yellow tint of the countenance disappears, and the face becomes colored at the same time as it ceases to be shrivelled.

The subcarbonate of bismuth is perfectly insipid, and excites no repugnance. It is given before meals. Adults take it in a little water, and children in honey. It may also be made into lozenges. The dose for adults is from one to three grammes, taken three times a day in increasing doses.-[Bulletin de Thérapeutique, and British and Foreign Med. Chir. Rev.

On a Case of Diabetes treated by the Use of Rennet. By Dr. IVERSEN.

Dr. Iversen relates the case of a patient, in the lower class of life, who had well marked diabetes, who was treated with rennet, and the details of whose case were carefully recorded day by day. As all the usual plans of treatment had been unsuccessful before the patient's admission into the hospital under Dr. Iversen's care, he made an experiment of the rennet treatment. In order to obtain as accurate a result as possible, it was determined, in the beginning of the treatment, not to alter the diet of the patient, except to recommend the greatest possible abstinence from drinking. By the table prepared by Dr. Iversen, the treatment seems to have been successful in diminishing the quantity of sugar in the urine; but from some circumstances which are not explained, the patient was seized suddenly during the progress of the case with fainting, followed by spasms, ending in death. No post-mortem examination was permitted, and the case is therefore imperfect. Notwithstanding the unfortunate result, Dr. Iversen considers that the constant diminution of the urine, both in its actual quantity and in its saccharine ingredient, was very remarkable. He shows that in the first four days, during which the patient took no medicine, the average quantity of urine voided, amounted to 10-108 cubic centimetres. In the following period of seven days, during which she took the rennet, the quantity of urine reached only 7.927 cubic centimetres, with a quantity of sugar amounting to 324 grammes. In the next five days, during which she took the rennet in combination with phosphate of soda, the average daily quantity of urine sank to 6.988 centimetres, with 250-317 grammes of sugar. The patient herself attributed to the rennet the power of allaying in some measure the burning thirst which she experienced.—[Archiv. des Vereins für Gemeinschaftliche Arbeiten, and Ib.

In selecting the following short report, we call attention to the fact that a lesion of a nervous centre here produces symptoms of chorea. This case rather corroborates our remarks at the end of Dr. W. C. Brandon's case in the original department of this number of our Journal, page 585. Since Dr. Brandon's case, with our remarks, have been in print, we have had the opportunity of witnessing a case resembling his in many points, and especially in the Chronic symptoms.

Miss F., aged about 68 years, fell from her bed on the morning of the 11th inst. Dr. R. Campbell visited her some hours after: found her perfectly rational, and able to give an account of the accident in intervals of spasms. Her head was bent forcibly forward and rested upon her knees. She was convulsed almost unintermittingly in her arms and lower extremities, but more violently in the left arm. There was a severe contusion on the left side of her head and face.

By the use of sedatives and quinine with brandy, the general spasmodic symptoms were arrested. She became apparently much relieved, ate with appetite, and conversed rationally and composedly, but the spasmodic action of the left arm never abated, except during sleep, from the time of her fall till her death, which occurred on Saturday, 19th inst., by gradual sinking, eight days after her first attack. Her mind, from first to last, did not manifest the least aberration whatever.

On Tubercle of the Crus Cerebelli, with symptoms simulating Chorea. By T. H. SHUTE, M. D., Physician to the Torbay Infirmary.

As any case tending to elucidate the physiology and pathology of the brian is of importance, I send the following, thinking it presents many points of interest to the readers of The Lancet:

Elizabeth S- -, aged twenty-six, married three years, no family, was admitted under my care March 11th, reported to be suffering from chorea. She presented the following appearance:-Countenance not sunken nor pallid, and not evidencing pain; features not distorted; muscular and adipose tissues sufficiently developed; tongue furred, protruded with a jerk; head constantly moving to the left side; articulation very imperfect; understands and answers everything that is said to her; constantly talking whilst awake; left arm in perpetual movement, being jerked across the chest (during sleep the convulsive movements cease, and she is quite tranquil); total inability to support herself on her legs; but she can move them up in the bed; sensation not affected; has a

constant short cough, as if caused by accumulation of mucus; pulse 90; urine acid; no albumen. There was much difficulty in examining the chest. Left side appeared duller than right; mucus and subcrepitary râles, with respiratory sounds of the diffused blowing type, on that side.

The history of the case was very obscure. We could not ascertain that she had ever complained of headache; had had occasional cough for two years; had never spat blood. Four months since, whilst out walking, she suddenly fell against a wall, but without loss of consciousness, since which time she has been in her present condition.

Diagnosis. Organic disease at the base of the brain, probably softening, near the pons Varolii; tubercular disease of the left lung. She was ordered blisters to the calves of the legs; compound ipecacuanha powder, ten grains.

March 12th. The Dover's powder had been repeated, and at the period of the visit she was in a profuse sweat, and in a quiet sleep; the movements of the arm had ceased.

13th. Still quiet; takes her food when roused.

14th. Very noisy; movements of arm and head have recommenced. Ordered, acetate of morphia, potassio-tartrate of antimony, of each one grain; water, one ounce; one drachm to be taken every three hours till she was quiet.

16th. Only two doses of mixture had been taken, and she was in such a state of prostration as to require brandy and ammonia to rouse her.

16th. Recovered from the state of prostration; movements of arm had ceased, and did not return; right pupil dilated, contracts under the influence of light, but dilates again immediately.

She died on the 6th of April.

Autopsy, forty-eight hours after death.-Vessels on convexity of brain congested; arachnoid membrane adherent along the upper and posterior edge of the longituninal fissure; no evidences of recent inflammation of the membranes; consistence of brain firm, somewhat congested; no effusion into the ventricles; in slicing downwards, no appreciable lesion discoverable. At the base of the brain the right crus cerebelli was softened to the depth of a line on its anterior aspect, and in its substance were imbedded three crude tubercles the size of a pea, one in the centre, and two on each side, forming a triangle. The lungs were not taken from the thorax, but the posterior portion of the left was infiltrated with crude and softened tubercles.

Remarks. The diagnosis in this case was somewhat obscure. On the one hand, we had all the symptoms of chorea, such as the constant agitation of the arm and head, the jerking protrusion of the tongue, difficulty of articulation, and perfect quietude during sleep. On the other hand, the age was not that at which chorea commences in the great majority of cases, and the mode and sud

denness of the invasion of the malady was opposed to the idea of its being a purely nervous affection. Therefore we came to the conclusion that there was organic lesion, and that its seat was the base of the brain, which was verified by the autopsy. The deposition of tubercle in the brain of the adult is very rare, though common in children, "so much so that Louis only met with one case in 117 cases of phthisis; and Ingol, in his extensive practice at St. Lonis, has only met with eight cases, and in six of these no symptom existed during life."-(Solly.) It will be remembered, that in the experiments of Magendie, when he divided one of the crura cerebelli, the animal immediately began to rotate to the same side. Now here, although the patient in all probabillty fell sideways against a wall, the perpetual movement of the arm took place on the opposite to the diseased crus, the fibres of which were all but destroyed by disease; but the case is confirmatory of the proposi tion, "that individual parts of the brain answer individual purposes, as regards the power of regulating our movements."

[London Lancet.

On the Age in which Hysterical Affections are most likely to be devel oped. By Dr. BRIQUET.

Dr. Briquet passes in review the doctrines taught by various writers on the subject of the occurrence of hysteria, and then analyzes a series of 467 cases occurring in his own practice in the course of ten years, in which the commencement of the affection was carefully noted. Some of his inferences would probably not be universally adopted, but his numbers are important, the more so as they are in the main corroborated by the analysis of numerous cases collected by Dr. Landouzy, whose results are also given in the following table:

Dr. Briquet attributes the differences that are manifest between his table and the numbers given by Dr. Landouzy to the circumstance of his having exercised great care in determining the exact commencement of the disease. The following are his chief conclusions:

1. A considerable number of cases of hysteria occur while the sexual organs are yet in a rudimentary state.