their union, so must the united Pharmacopaeias set an example The number of alkaloids and other active principles of plants of self-abnegation. should be increased. Aconitia, of which a certain mode of Thus, as a melancholy indispensable in our new pharmaceutical preparation has been published, should not have been omitted reform bill, I beg to present a list of rotten boroughs for dis- from the last London Pharmacopoeia. The principles of conium, franchisement-a catalogue of drugs drawn from the materia hyoscyamus, tobacco, lobelia, and other active drugs, might be medica of the three Pharmacopoeias whose constituencies, or retained in greater safety if combined with an acid, such as the doctors who prescribe them, have become so extremely sulphuric, which renders them very soluble in water. For limited that it seems scarcely necessary to retain them any convenience of prescribing, and the avoidance of mistakes in longer. dispensing such powerful poisons, I would recommend that Index run as standard of one certain of dose should be My Expurgatorius would much follows :- , solutions strength Absinthium, acetum, acidum aceticum (omit eight of these, ordered in the British Pharmacopoeia. Such solutions would and leave only a strong acid of 85 per cent., and a dilute acid be uniform in strength, and more to be depended on for cer- of 5 per cent.), allium, althsea, anethum, angelica, anthemidis tainty and safety of effect than any tincture, juice, infusion, or oleum, aurantii fructus, balsamum Canadense, barytas carb. et extract of the plant, the amount of whose active principle of sulph., calamina (replace by pure carb. zinc), calamus aroma- course varies much. Mistakes would be next to impossible if ticus, canna, cannabis, carota, cassiae cortex et oleum, casto- all the solutions of the Pharmacopoeia were so diluted that the reum, centaurium, chiretta, cinchona cinerea, cocculus, cornu ordinary dose for an adult man should be just one drachm, and et c. ustum (replace by pure phosph. lime), cyminum, dul- in no case more or less. This is already the case with the liquor camara, euphorbium, gossypium, hemidesmus, inula, lactuca, hydrargyri, bichloridi, and solutions of morphias hydrochloras lactucarium, lauro-cerasus, lauri baccse, linum cath., lixivus and acetas. The liquor ammoniac must be diluted, liquor cinis, lupulina, malva, marmor, matico, melissa, menyanthes, ammonias acetatis concentrated, arsenical solution made ten mori succus, mucuna, origanum, ossa, petroleum, plumbi carb., times weaker, liquor potassa? and liquor potassa3 carbonatis plumb, ox. rubrum, potassse bichromas, potass. carb. impura, diluted with one measure of water; the diluted acids mixed rhamni succus, saccharum commune, sacch. lactis, sagapenum, with three parts of water. This would very much simplify salicis cortex, sassafras, simaruba, spigelia, spiritus pyroxilicus, prescribing, and make dispensing safer. Graduated solutions spongia, stannum, tapioca, terebinthina veneta, ulmus, viola. In of drachm strength may be made of the active principles of all seventy-four. the following vegetables :-hyoscyamus, conium, aconite, hem- This would make a great clearance, after which we should lock, tobacco, lobelia; also of quina and cinchona. Resinous be able to see our way better. Half of the list are superfluous medicines, as guaiacum, jalap, scammony, perhaps rhubarb, -i.e., rendered unnecessary by the existence of better drugs may be exhibited in solution by means of alkali, as I have else- of the same kind. The others are useless, or nearly so. I where recommended. These alkaline drachm solutions would shall be glad, if called upon, to give my especial reasons for be far more easy of absorption than the undissolved resin, wishing to expunge any particular member of the foregoing which must undergo the action of an alkali before it can pass list. into the blood. With regard to the formulae, an amalgamation must of Along with this plan of drachm solutions, it would be highly course be made, and all discrepancies must cease. As far as desirable that tinctures for internal use should be brought to a possible, the present London formu]ae may be retained, because uniform standard of two drachms for a dose, and all infusions, liable to very little exception. But their number, as I have decoctions, and mixtures, to a dose of one ounce. The tinctures said, may be materially curtailed by the removal to the materia of cantharides, aconite, opium, conium, stramonium, &c., being medica list of those pure chemicals of which it is unnecessary thus diluted, would be no longer sources of danger. The solu- to prescribe the mode of preparation. Most of the additions tions not intended for internal use should be kept in a separate to the last London Pharmacopoeia were wisely made. But the part of the druggist’s shop, and labelled Poison. This seems strained preparations of the gums are objectionable, as in the to me to form a simple solution of a pregnant question that has process the essential oil is partly lost. Linimentum saponis is been much agitated of late. solid at ordinary temperature, and requires to be altered. 8. The object of the changes which I have recommended may I may mention some drugs and forms at present peculiar to be stated in one word as simplification. Out of manifold re- either the London, Edinburgh, or Dublin Pharmacopoeias, but forms on a subject which has much engaged my attention, I which should by all means be introduced into the new one. have culled a few of the more prominent, in order to present In the London Pharmacopoeia : atropia, its sulphate; phos- them to the notice of the profession. The British Pharma. phorus ; granati rad. cort.; sulphur precipitatum; the distinct copceia must soon be taken seriously in hand; but ample time oils of vegetables; the concentrated infusions (cinchona); tinct. must first be given to elicit all discussion that may pave the quins co.; the ammoniated tinct. colch. co. In the Edinburgh way for the compilation of a volume that, whatever its faults Pharmacopoeia we find filix mas. In the Dublin Pharmacopoeia, or its excellencies, must serve as our prescribing manual for- glycerina. I would exclude the valerianates of the Dublin many years to come. Let us hope that the result of these de- Pharmacopoeia, which are not to be relied upon; also the liberations, in the hands of a body of men who have been pulvis ferri of Quevenne, preferring much the saccharine carbo- selected as most worthy to represent all grades of the profession nate of the London Pharmacopoeia. ’ in the three kingdoms, will be worthy of them and of us. 7. What remedies and forms may most advantageously be ’, introduced in addition to those now remaining? On this point i Two rules be very great caution must be observed. may safely CASTRATION AND MUTILATION. laid down for our guidance. 1st. Remedies and forms exten- II sively used in practice, where not obviously irrational, should CASES SHOWING THE IMMUNITY OF INSANE PERSONS FROM be introduced. 2nd. Remedies and forms which may safely be INFLAMMATION AFTER INJURIES. recommended on sure theoretical grounds, or which chemical knowledge enables us to substitute for substances already in BY WM. C. HILLS, ESQ., M.R.C.S., Maidstone. use, may be included, but with greater caution. To the lists of preparations of the alkalies, the sulphurets ofi CASE l.-J. B-, a homicidal and suicidal maniac, had for potassium and sodium, which are an admirable means of ad- a occasioned ministering sulphur internally or externally, may be added; long period much anxiety in consequence of the also the phosphate and benzoate of ammonia, both advisable as severity of his symptoms. On the 29th of April, 1856, during having the power of keeping uric acid in solution in the urine. the temporary absence of his attendant, he castrated himself in To the of iron the lactate be and a preparations may added, the watercloset; a little of pointed lath to make tincture of the potassio-tartrate substituted for vinum ferri, using piece an in the which he with which is of very uncertain strength. For antimonial powder, ’, opening scrotum, enlarged by tearing the preparation of which is most unscientific, and which in the ’i his fingers so as to lay open each tunica vaginalis. The wound last London Pharmacopoeia is reduced to the verge of absolute bore the shape of a Y inverted. The exact way in which the inertness, a mixture of a small proportion of teroxide of anti- spermatic cords had been severed could not be ascertained; it mony with phosphate of lime may be adopted. In the prepa- seemed probable, however, that they had been jerked asunder, ration of mercurial pill and ointment the use of some old mass the naked testis being firmly in the hand. The re- to oxidize the quick metal should be prohibited, and about 1 per grasped moval of both testes was one he had thrown down cent. of protoxide of mercury, the chief active element of these ’, complete: compounds, may be incorporated instead. A tincture of chloro- I the pan, the other in a corner. The man was faint from the form, of about 10 per cent. strength, may be used instead of the shock, but no haemorrhage occurred, and no vessels required variable mixture prescribed so widely as " chloric ether." I tying. Sutures were used to hold together the torn scrotum 436 which became reunited in the course of a moderate suppuration, - without sloughing. The patient complained of great tender- it in the West Indies. ness in each inguinal canal, where there was swelling from Edward (——, aged twenty-four, a respectable young man, effusion in the course of the spermatic vessels. This swelling employed as a Government clerk at Trinidad, was admitted gradually subsided, and no ill consequences followed the violent under Dr. Wilks’s care on the 9th February last. He stated operation he had performed. He confessed having made in-i- that, ten years before, he had ague, followed by abscesses on proper use of himself, when asked the reason for his act. His his body; and that on recovering he experienced uneasy sen- mental state appeared to be one of real improvement, and at sations and numbness in his left arm, and subsequently in the end of a period of satisfactory probation he was discharged, other parts; at the same time, the limbs being somewhat as recovered, on the 25th March, 185 :< since which time he swollen and painful, he was thought to be suffering from rhen- has followed his employment as a shoemaker, and up to this matis:n. Of these symptoms he got better, when in 1850 it period remains quite well. It is a question whether the self- was clear that he had been attacked with elephantiasis; he inflicted operation may have aided his mental restoration. was beginning to lose sensation in his arm, which was also dis- coloured, and subsequently other limbs became affected in like CASE 2.-R. on the 10th of March, S-, aged twenty-two, manner. About a year and a half ago all these symptoms a severe maniacal broke a of 1859, during very paroxysm, pane were aggravated, and then the nose and ears became swollen. with a of which he inflicted a wound about a glass, piece quar- On admission, he was very weak, although able to walk of an inch in situated an inch and a half to the ter length, there was no alteration in the the nose of and below the umbilicus. At the time of about; face, except right discovery, being swollen and of a colour; the chest had a brown showed a desire to those purplish he strong injure himself, soliciting on as and over this " patch it if painted with iodine, all sensation around him " to cut out his entrails." The incision was super- was lost; the gluteal region was in the same condition; nearly and of no and on the ficial, apparently importance, following the whole of the left was discoloured and ansesthetio, the there was no alteration in its The leg morning appearance. patient right partially so, and the forearms in the same state; the continued in the same excited and on him in state, undressing hands and feet were swollen, of a livid colour, and scaling on the of the second a substance about the size of after-part day, the surface. He was anxious to try a remedy which he heard an walnut was seen from the and ordinary protruding wound, was in use in Paris, called hdnocotde; but while inquiries to be a of the omentum. It was from proved portion evident, were being made about it, he left the hospital, having had an the blood on his that he had divided the finger-nails, roughly offer made him of a return to his own country. peritoneum; and as, during the fits of excitement, he violently contorted himself (resting only on his occiput and heels), the LEPRA TUBERCULOSA (LEONTIASIS OF THE WITH muscular exertion used the occur- ANCIENTS), great sufficiently explained PARTIAL ANESTHESIA. rence of hernia through so small an opening. Having oiled the congested protrusion, I gradually returned it with the aid (Under the care of Dr. GULL.) of a director. I used an uninterrupted suture, and over that a An example of the other form of elephantiasis, included in the and a In three the wound slight compress bandage. days sup- division of Danielssen and Boeck, we are enabled also to record, purated, and continued to discharge healthy pus until the 6th through the kindness of Mr. R. Innes Nisbett, clinical clerk, of when the became thin; and on the llth of the April, pus who has carefully reported it. It is very rare that the student same month the wound was quite healed. has the afforded him in this of of opportunity country witnessing The extreme restlessness the patient through the ensuing the two varieties of this remarkable disease. The hideous and fortnight, during which period he thwarted as far as he could terrible given to the of the patient, measure taken for his safe made it expression physiognomy every treatment, surprising who is the subject of the following case, the result of the tuber- that no inflammatory symptoms followed. Care was of course cular swelling of the forehead, eyebrows, lids, cheeks, alse nasi, taken that the himself should meddle no further. patient and lips, together with the gradations which it goes through,, the case affords another of the Nevertheless, proof frequency rise to the name of leontiasis the which. with which the insane the of gave amongst ancients, escape ordinary consequence very graphically expresses the appearance of the patient. injuries. John H-, aged forty-two years, a native of Kingston, Lunatic near County Asylum, Maidstone, of was admitted into Job ward on 1859. Jamaica, European parents, April, May 3rd, 1858. He has been engaged during the last twenty- six years as a blacksmith in the navy, living on board ship, and principally on tropical stations. During the whole time he enjoyed robust health, and has had no disease except syphilis A Mirror (which he contracted several years ago in the West Indies, but OF THE PRACTICE OF from which he states he soon recovered under medical treat- ment) until the commencement of his present malady. He says MEDICINE AND SURGERY that he has never been a drunkard, but has always been much addicted to venery. His present symptoms commenced about IN THE sixteen months previous to his admission into this hospital: first by cedema of the lower extremities, followed by an erup- HOSPITALS OF LONDON. tion of small red tubercles or lumps, which very soon began to ulcerate in various places. He continued in this state for seve- ral months, the ulcers in some and out Nnlla est alia pro certo noscendi via, nisi quam plurimas et moyborum et healing places, breaking afresh in was succeeded a severe attack of dissectionum historias, tam aliornm proprias, eollectas habere et inter se com- others; this by ery- parare.-MORGAGNI. De Sed. et 0"U8. Morb., lib. 14. Proaemium. sipelas of the head and face, following a scalp wound; from this he recovered in about three weeks, after which the tubercular eruption broke out afresh, and in a much more aggravated GUY’S HOSPITAL. form, affecting the whole body, with the exception of the scalp’ The tubercles he describes as under the ELEPHANTIASIS GRÆCORUM, OR LEPRA ANÆSTHETICA. hard lumps skin, vary- ing in size from the bulk of a small pea to that of half a walnut, (Under the care of Dr. WILKS.) the larger being on the trunk, the smaller on the face and ex- tremities ; they were of the same red colour as at first, but this THE above name is given to the present case in accordance time they were attended with such excessive itching and un- with the division made by Danielssen and Boeck into Lepra easiness that he was compelled to give up work on board ship. tuberculosa and anresthetica, and who follow the French in (He was then on the Mediterranean station.) He was sent to and was transferring ordinary to psoriasis, and the term " ele- England, admitted into the Dreadnought Hospital, lepra where he had another attack of on the subsidence This case erysipelas, phantiasis" to Barbadoes leg. strongly contrasts of which the whole of the tubercles disappeared, leaving the with the fellow one now in the as (the iuberculosa) hospital, skin in some places of a dark-reddish, and in others of a tawny- there was very little swelling or disfigurement, the skin being brown colour. He continued free from the tubercular eruption merely aÍfectéd by patches of discoloration; these were desti- for two months, at the end of which he had erysipelas a third his became affected as at the with tute of feeling, the adventitious matter (whatever it may be) time ; legs again first-viz., an eruption of tubercles quickly proceeding to ulceration. being exuded, according to the above-named authors, along Hitherto his general health during the intervals of these attacks the course of the nerves rather in than forming protuberances had been comparatively good; but now his appetite became in the skin, and thus causing anaesthesia and subsequent disordered, sometimes failing, at other times quite voracious. 437