848 disorder. The acrid mucus, a free secretion of which is is, however, often necessary in recommending this step to one of the ordinary phenomena of the catarrhal state, is a parents. Mothers are apt to take fright at the very mention constant cause of fermentation and acidity. It very quickly of cold water; and it is true that in the case of weak children induces an acid change in the more fermentable articles of reaction is difficult to establish, so that a cold bath given in food. Therefore, if the stomach be oppressed by sour matters, the ordinary way would not be attended with benefit. There shown by uneasiness at the epigastrium, or sour smell from is, however, a method by which the most delicate child may the breath, and a feeling of nausea, immediate benefit will take a perfectly cold bath with safety and advantage. The be derived from an emetic dose of ipecacuanha wine. After- method consists in first stimulating the skin by friction, so wards a draught, composed of tincture of nux vomica, with as to enable the body to resist the shock of the cold douche, bicarbonate of soda, in water sweetened with spirits of and then in lessening the shock itself by placing the patient chloroform, taken two or three times in the day, will soon in hot water. Thus, if a child on rising from its bed be well restore the gastric mucous membrane to a healthy condition. shampooed over the whole body, but especially over the Strong purgatives are to be avoided, but as there is usually back and spine, and be then made to sit in a few inches of constipation in these cases, an occasional mild aperient will quite hot water, a good douche of cold salt water over the be required, such as compound liquorice powder or castor shoulders will have a highly invigorating effect, and be oil. If there be fever, which does not subside after the followed by immediate reaction. After being dried, the action of the emetic, the child may be allowed to take fluids body may be rubbed with flesh gloves, and afterwards, if from time to time in moderate quantities. The best are thought desirable, the child can be returned for a short time unsweetened barley-water, flavoured, if desired, with orange- to his bed. Before beginning the process the patient should flower ; toast-water, or fresh whey. take a little bread-and-butter, or a drink of milk. The During the treatment, as long as any signs of acidity of continued use of this bath, besides having a remarkably tonic stomach persist, care should be taken to exclude from the effect upon the system generally, confers great resisting power diet all matters capable of favouring the tendency to fermen- against changes of temperature, and considerably reduces tation of food; and even for some time afterwards, readily the child’s susceptibility to chills. fermentable substances, such as starches and sweets, should By means such as have been indicated, the most obstinate be taken sparingly, lest the derangement be encouraged to cases of gastric catarrh may be treated with success. But it return. At first nothing should be allowed but freshly made should be borne in mind that success depends upon equal atten- broths, with dry toast; and when milk is once more per- tion to all the points which have been insisted upon. A flannel mitted, it must be guarded with a fourth part of lime-water, binder will be of little value if the tendency to fermentation or with saccharated solution of lime, in the proportion of be encouraged by the immoderate use of starches and sweets; twenty drops to the teacupful. While the derangement con- and even cold douching may not be sufficient to neutralise tinues no fruit, cakes, sweets, light puddings, or potatoes the ill effects of rapid changes of temperature acting upon a should on any account be permitted to be taken. When the body imperfectly protected from the cold. In all cases it is appetite begins to return, a little fish, chicken, or mutton advisable to avoid the use of syrups in making medicines may be allowed, but the child must not be pressed to eat; palatable to young children. The Pharmacopoeia syrups are indeed, until its digestive power be completely restored, the not well borne by young subjects, and often do more harm utmost care must be taken not to overload the stomach with than good. It is far better to sweeten a child’s physic with food. glycerine, or a few drops of spirits of chloroform. The above measures will effect a considerable improve- George-street, Hanover-square, W. ment in the condition of the child, but at this point the treatment may be said only to have begun. The patient is in a state from successive attacks of catarrh. weakly gastric CASE OF We have, therefore, to adopt means to strengthen the diges- tive powers, and take such precautions as will ensure him STRANGULATED FEMORAL HERNIA IN AN against a relapse. INSANE PATIENT. To give tone to the stomach and strengthen digestive power preparations of iron are required. A common prac- OPERATION ; PERITONITIS WITHOUT DEVIATION FROM tice in such cases is to administer the preparation of the NORMAL PULSE AND TEMPERATURE; RECOVERY. of iron and lime known as "Parrish’s Chemical phosphates BY S. A. K. M.D. Food." This syrup is a very favourite remedy with mothers, STRAHAN, who, misled perhaps by the name, give it largely, and with was the the worst results. Theoretically, no doubt, it is an active W. S-, aged fifty-one years, admitted into tonic, but practically it is highly pernicious. The reason is East Riding Asylum on the 24th June, 1880, suffering from that the syrup in which the phosphates are dissolved sup- a first attack of insanity-melancholia with strong suicidal materials for and each dose is soon fol- plies fermentation, tendency. On admission he was found to have a large lowed flatulence and so that the medicine by acidity; really scrotal hernia of and a aggravates the mischief which it is intended to allay. The (right) long standing hydrocele of the left tunica testis. He was weak better plan is to give the dialysed iron, or, if there be any vaginalis very bodily- tendency to acidity remaining, the ammonio-citrate, with a evidently the result of having partaken sparingly of food for few grains of bicarbonate of soda, sweetened with aqua some time previous, as he laboured under the delusion that chloroformi. After a time a made to the solution change maybe there was no passage for food through his body. of with the or of strychnia, perchloride pernitrate iron, given For seven weeks after admission he of food in after food. All this time the of ferment- partook directly quantity reasonable under at the end of which able material taken at meals must be restricted, as already quantity, protest; recommended. During the same time a mild aperient should time he refused all food, and had consequently to be fed be given every few days, whether it seem to be required or twice or oftener daily by means of the stomach-pump. This to ensure a relief to the bowels and the not, proper prevent feeding was continued up till Sept. 17th (four weeks), with retention of excess of mucous secretion. any a few intermissions of a or in some cases two In spite of this treatment, however, the child will not be day, days, when he ate on the secure against relapses unless special precautions be taken reluctantly pump being ostensibly put to guard the body against chills. The catarrhal state, in order. whatever be the organ affected, tends constantly to repeat Sept. 18th.—This evening he complained of abdominal itself under the influence of and there is little slight causes ; pain, which he attributed to eating so largely. His abdomen doubt that it induces an extreme sensitiveness to of changes was at once when, in addition to the scrotal temperature. Children who suffer from attacks of catarrh of examined, hernia there was found a the stomach or bowels should wear a broad flannel binder already noticed, femoral hernia applied tightly to the abdomen, so as to reach from the hips (left), about the size of a walnut, tense, painful, inelastic, upwards to the armpits, and the medical practitioner should and giving a dull note on percussion. Gentle taxis was look upon it as his first duty in these cases to see that it is applied without appreciable effect, and afterwards the follow- The binder should be considered as properly applied. part means for facilitating its reduction were tried without of the child’s dress, and be cast off at with ing ordinary night warm and the rest of Ms clothes. In many cases it is necessary, in success-namely, bath, opiate, chloroform, injec- addition to the above precautions, to fortify the resisting tion of water per rectum. power of the child by cold bathing. Some circumlocution 19th.—Symptoms of strangulation appeared to-day, six. 849 teen hours after the discovery of the hernia, and at 4 P. M. NOTES ON A CASE OF the operation for its relief was performed under chloroform by Dr. Whitcombe, medical superintendent. Gimbernat’s RUPTURE OF THE EYEBALL IN A PATIENT ligament was the seat of stricture, but after this was SUFFERING FROM HÆMORRHAGIC divided, it was found necessary to open the sac, because of DIATHESIS. bands formed in its neck. All constrictions having been removed, the hernia-which consisted of about two inches of BY A.