43 laboured under the paralysis for a period of twelve months, 5th.—Could use the hand to take hold of any object, small and that he had suffered from the colic for six months previous or great, and carry it steadily. to the commencement of the paralysis. He had been under 10th.—Galvanism discontinued, the arm and hand having the care of two or three medical men, receiving temporary almost recovered their wonted power. Hydriodate diminished relief from the colic, but with no permanent benefit to his to half a drachm, in divided doses daily. The patient con- arm, although, in addition to the usual remedies, he had tinued to take the hvdriodate till the 20th, the lead being undergone a course of hot-air, water, and sulphur baths on detected in the urine till the 15th, but not subsequently. He different occasions. Notwithstanding these means, he was, to was now put on a tonic regimen, and exercise taken daily. use his own phrase, " as bad as ever again after two or three On the 25th, he returned to work without any trace of days’ work," when he had received any seeming advantage by paralysis. treatment. I saw him again June 15th, np to which time he had not On examination, I found the patalysis was incomplete, the experienced any return either of colic or paralysis. As a flexors of the forearm on the left side being only partithy prophylactic he takes occasional doses of the hydriodate of affected, while the extensors were almost completely paralyzed. potash, strict attention to personal ablution being enjoined. The forearm of the right side was not appreciably diseased, From this case alone, we are justified in drawing the follow- although the patient stated he used it with difficulty. The ing conclusions, for it cannot be thought that the phenomena. bowels were constipated, and the blue line was very distinct appearing during the administration of the iodide were merely round the edge of the gums; in fact, the whole class of sy-mp- accidental coincidences:— toms peculiar to plumbism were distinctly marked in this case. First, that the iodide of potassium acts as a curative agent Before proceeding to place the patient under treatment, I in lead poisoning, by converting the lead into a form which obtained from him, in separate portions, the urine passed in can again be readily taken up by the blood, and evacuated by the morning and evening, for the purpose of chemical examina- one of the natural outlets. tion, which was made in the following manner:—Each portion Secondly, that the iodide acts more speedily in conjunction was divided in two. The first and second of each were sub- with galvanism, when employed for the relief of lead paralysis. mitted to precisely the same tests, and can therefore be de- Redditch, 1854. tailed as two analyses only. No. 1 was boiled with acetic and filtered. The clear was tested in different acid, liquid ON THE portions by sulphuretted hydrogen and bichromate of potash, NITRATE but without any evidence of lead. This of itself might have USE OF OF SILVER IN STRUMOUS been deemed conclusive as to the absence of the lead; but in INFLAMMATION OF THE JOINTS. order to establish the 2 was submitted to a fully fact, No. BY W. L. CORTIS, ESQ., M.R.C.S., Filey, Yorkshire. more searching examination. The quantity tested was evapo- rated to dryness; the residue collected and treated with a I SEND this case as it appears to me to present some points of mixture of hydrochloric and nitric acids (aqua regia), to destroy interest, in the occurrence of acute inflammation im the second organic matters. The remaining salt was fused and boiled for limb so soon after the removal of the first, and the disappetr- some time with carbonate of soda. The precipitate and un- ance of this inflammation under the means used,—the external dissolved portion were then collected and treated with dilute assiduous application of cold, blistering with nitrate of silver, nitric acid, filtered, and the clear solution tested as in No. 1, and internally the administration of iodide of potassium, and but again without showing the presence of lead. I did expect cod-liver oil. The utility of the two latter medicines in stru- by this latter process, it being a very delicate one, to have mous inflammation of the joints is probably sufficiently recs- found some trace of lead, having carefully followed the details. gnised by the profession, but I am doubtful whether this is the From the result of this and the preceding, I considered the case with the application of the nitrate in the manner men- absence of lead in the urine fully established, each analysis, of tioned. I believe it to be much superior in these cases to the course, having been repeated. common fly-blister. Had the disease in the first joint been The patient, on the 9th, had his bowels freely opened by a seen -sufficiently early, and treated as it was in the second, I purgative draught, and an opiate was given at night to allay think the limb would have been saved. a, severe spasm of colic. On the 10th he received the following June 4, 1853.—S. T—, aged eighteen years, of a strumous mixture: Hydriodate of potash, one drachm; aromatic mix- diathesis, hereditary through both parents; has been employed ture, six ounces: two table-spoonfuls to be taken three times in agricultural labour ; came home a fortnight since suffering a day. This he was ordered to take on an empty stomach, to from severe pain in the right knee, for which he has tried prevent decomposition of the hydriodate. This mixture he various applications, but had no professional advice. At pre- continued taking up to the 14th, on which day he complained sent the knee is intensely painful, especially just over the of nausea, and was ordered to take only one dose of the mix- condyles of the femur, which are much swollen, and there is ture, and a purgative draught at bedtime. considerable deep-seated enlargement of the joint generally; March 15th.-The draught produced loose stools. The no fluctuation. Leeches and cold applications, hot poultices, mixture was resumed. poppy fomentations, &c., failed to give the slightest relief. 16th.—Colic proving troublesome, an opiate was given. 14th.—A cle.h incision just above the inner cnadyle brought An increase found in the quantity of urine passed to-lby. away two ounces of pus, and on the 16th, on enlarging the 18th.-I obtained from him the whole of the urine passed in opening about twelve ounces, more came away, but without the twenty-four hours, which was submitted to analysis the least relief from the pain. The probe passes freely down to according to the second method pursued on the urine previous to the bone, and along its po&cerior surface to the opposite side. the administration of medicine. On the addition of the sul- The pus evidently comes from the i’lterio" of the joint. Am- phuretted hydrogen a dark-brown precipitate was readily putation was advised, but the friends decidedly refused to con given, but the lead was not present in sufficient amount to be sent to this, and the advice of my friend. Dr. Harland of Scar- appreciated quantitatively, nor was I at any time during the borough. was requested. This refusal was persisted in for some course of treatment able to obtain an exact per-centage. time, during which the pain continued inter, the discharge 30th.-Up to this date he continued to take the mixture. profuse, and the patient of course got weaker, tiil at length Having now taken 1090 grains of the hydriodate (he wa3 he and his parents, seeing death rapidly approaching, con- necessitated by nausea to refrain from the medicine two days) sented ts the operation. At this uime the probe passed freely it was expected some improvement in the symptoms should about ths femur from the condyles upwards, half the length of have appeared. The colic had entirely ceased, but there was the bone. There is some cough and expectoration, with dulness very little improvement in the arm. It was therefore decided on percussion, and of the respiratory sounds in both sides of the to try the effect of galvanism, as the man desired to return to chest in front. He was now so weak that two medical friends, work. The lead could now be readily detected in the urine -whose assistance I procured, thought he had hardly strength to by the first method of analysis. He was subjected to a undergo the operation However, as it was evidently his only galvanic action daily from the 31st, still continuing the chance, on the 14th July i amputated at the juction. of the hydriodate. upper and middle thirds. Very little blood was lost during April 2nd.-The effect of the galvanism was such that he the operation, and not much pain suffered, the patient being: could grasp anything feebly, opening and closing the hand. kept under the influence of chloroform, to which Dr. Harland 3rd.-Raised a ball of cotton from the table, and caught it kindly attended. as it rolled. The lead still readily detected in the urine. On examination the cartilages of the knee-joint were found . Mixture continued. Purgative draught at bedtime. to be entirely dsstroyed by ulceration, the condyles and lower 4th.-The draught again operated freely. Two doses of the portion of the femur very much enlarged by inflammation, mixture taken. which extended to within an inch of the point through which 44 amputation had been performecl, the periosteum being de- method of preparing this salt according to the formula of stroyed. For two days after the operation he went on well, previous editions of the Pharmacopœia;’ as if the work of Dr. but on the 17th complained of violent pain in the outer condyle Pereira-his Encyclopedia of Materia Medica—were written of the knee. The bone was found to he distinctly opposite for no other purpose than to illustrate the formulae swelled, very tender, the skin red, and, in short, the symptoms insignificant of the London If we turn to the of the were exactly those which had characterised the disease in the College. preface amputated limb. The nitrate of silver was pencilled over the volume, we shall nnd that the editors have committed them- affected spot, so as to produce a blister twice the size of a selves to a very high-sounding promise. "They have, on cold lotion and cod-liver oil crown-piece, C’’ssidnousl.1J applied, their own responsibility, made such alterations and additions and iodide of administered potassium internally. as the state of science in their to Under this treatment the inflammation subsided, the chest present appeared judgment render This statement would lead the symptoms disappeared in a day or tivo; the patient gradually necessary." naturally recovered, was down stairs in less than three weeks after the reader to suppose that many important alterations and addi- operation, and now walks about in good health, and is stouter tions had really been made, and that the present state of than before his illness. science, in its applications to pharmacology, was fairly repre- Filey, Yorkshire, 1854. sented. Let us ascertain if this be the case. As far as we can estimate the labours of the editors, it appears that they have Reviews and Notices of Books. contributed about twenty pages to the 776; of these twenty, sixteen are devoted to verbatim reports of articles which were The Elements of Materia Medica and Therapeutics. By long since published by the late Dr. Pereira; and it is worthy JONATHAN PEREIRA, M.D., F.R.S., &c. Third Edition. of note that they are indebted for these very articles to the 1853. liberality of Mr. Jacob Bell, "who freely placed at their WHEN the late Dr. Pereira commenced the first edition of disposal the numerous papers contributed by the late Dr. this work, his object was simply to furnish the medical Pereira to the pages of the Pharmaceutical Journal," (p. vi.) student with a class-book on therapeutics; but, since that This is rather a startling announcement to begin with, for it time, the work has so expanded itself under his hands, that argues either that they were ignorant of the existence of those it has entirely lost its original character, and has become, papers, or else that they had not the opportunity of consulting what indeed he now styles it, an encyclopaedia, of materia them-two conclusions which would, in either case, seriously medica. This has doubtless resulted from the very extensive endanger the reputation of any one who had the smallest patronage bestowed by the public on the two former editions. pretence to be regarded as a pharmacologist. The rest of the . In short, it is almost needless to say that the name of Dr. editorial notes occur in about sixty places, and they average Pereira has long been recognised as that of a great autho- about four lines and a half each. They are chiefly devoted to rity in all matters relating to pharmacology, and that his an account of the alterations which have been made in the writings have deservedly obtained a high place among the new Pharmacopœia of the London College; and of all these standard medical literature of the day. notes, the only one that has any pretence to originality is to We refer to these facts because we believe that they are be found at p. 1685, where, after giving the author’s account worthy of grave consideration on the part of all who are con- of Uncaria Gambir, they say, "Gambir is the name applied to cerned in the future prosperity of this truly great work; and, the extract of the leaves, while catechu is the extract of the indeed, we are urged by a sense of duty to remark that the inner wood." The inner wood of what ? Not of the uncaria, reputation of the late Dr. Pereira, as well as the intelligence gambir, the plant in question, for there is nothing said and patronage of the public, alike demand that the soundest throughout the entire article, or anywhere else that we know judgment should be exercised in the choice of its future of, of the wood of this plant yielding catechu. The fact is, the editors ; for, although the work itself is based on a solid foun- term catechu is a generic expression, and is applied to several dation, and is composed of very durable materials, yet, like astringent substances, derived from very different sources; and all other human productions, it cannot withstand the inroads as it happens that the wood of acacia, catechu yields such a of Vandalism and neglect. substance, and that the leaves and young shoots of the uncaria It is not, perhaps, a fair question to ask how the present catechu furnish another, the editors have bungled upon the editors have accomplished their task; for, we can understand idea that the name gambir is applied to one of these extracts, the difficulty in which the publishers were placed by the un- and catechu to the other. This fact is shown by the author expected death of Dr. Pereira, and the very small opportunity himself at p. 1852, where he states that "in the Edinburgh which they then possessed of finding one, or even many persons, Pharmacopœica catechu is correctly stated to be the extract who could at once supply his place. Besides which, it can hardly of the wood of acacia catechu, of tiie kernels of the areca, be imagined that Drs. Rees and Taylor have been invested cutechu, and of the leaves of uncaria gambir; probably, too, with the perma.iient execution of so important an office; it is from other plants." Some persons might imagine that this is more probable, at least we hope so, that they were appointed a very unimportant errcr-rerhaps a mere slip of the pen- in the confusion of the moment, merely to supervise the con- but it is really a very grave one, for it discloses the fact of an cluding sheets of the present part. And yet, small as this utter ignorance of the whole subject. duty was, it has been so wretchedly performed that we are Others of their notes are but mere repetitions of former compelled to make especial reference to it. statements. This is exemplified at page 1734, tvhere they A mere glance at the pages of this volume will show to the mention a test for conia, which has been referred to by the most superficial observer where it was that the pen of our author five times in the preceding pages. lamented friend was laid aside. In fact, the contrast between Another startling fact which exhibits itself in this edition is the very last article in which he was engaged and that which that the editors never, or but seldom, give their authority for follows is so manifest, that we cannot but feel the deepest what they say; they merely remark, in a very dogmatical regret that he was not spared to finish his task, or even to manner, that so-and-so has been done or said. This is an un- delegate it to the care of some one who would at least have pardonable fault; for, as the work of Dr. Pereira is used as sustained his reputation. The very first ivords that are much for reference as anything else, it is in the highest degree written by the editors exhibit the spirit of their intentions, important that every statement of fact should be made on and the littleness of their purpose. They say, at page 1678, authority, and that the reference to that authority should be ’Although the disulphate of quinine is now placed by the fully and accurately recorded. This rule was invariably followed London College among the articles of Materia Medica, we have by the late author, and it was incumbent on his editors to considered it proper to retain the author’s description of the respect it. But the following list of pages will illustrate the