torpid or loaded, and in the strumous diathesis. It, as well as the biniodide of mercury, is very efficacious in the syphilitic scaly eruptions. Mr. DENDY recommends the occasional use of the warm nitro-muriatic foot-bath during the course of this solution. [Dr. EMERY, of the Hospital St. Louis, had his attention turned to the investigation of the different products of tar as remedial agents in the treatment of skin diseases, on account of the successful results he obtained from the use of tar, and because of the unpleasant odour it gave 56. As to the use of arsenical preparations forth. Various preparations were had recourse in psoriasis and lepra, Mr. ERICHSEN very justly to, the most valuable of which proved to be the observes, that they should not be given until concrete naphthaline, which Dr. EMERY tried in the disease had assumed a chronic or inactive fourteen cases. In two cases, one of psoriasis character. As long as there is inflammatory gyrata, and the other lepra vulgaris, it failed in redness, heat, or irritation of the patches, they effecting any good; in the remaining twelve it ought not to be employed, as the irritation of proved more serviceable. Eight of these were the arsenic will augment these symptoms. Be- men, and four women. In two of the cases, sides, during the earlier periods of the eruption, lepra vulgaris of from fifteen months to two a cure may be effected by the antiphlogistic years' duration, arsenical and iodic preparaand other means I have above advised, espe- tions had been previously tried; in the youngcially by depletions, emetics, and purgatives, er patient the arsenic at first seemed to do good, with strict attention to diet and regimen. It but the improvement soon ceased. An ointis only, therefore, in very indolent, or exten- ment prepared with two scruples of concrete sive squamous diseases, and after other reme-naphthaline to thirty of lard was applied, causdies have failed, that any of the arsenical prep-ing the scales to fall off, leaving the skin of a arations should be prescribed; and in all circumstances they ought to be given cautiously, and their effects closely observed; for, if prescribed too largely, or too long, they may injure the constitution much more than the continuance of the eruption, which in many circumstances admits of palliation merely, and not of complete cure. this remedy has an unpleasant odour, which passes off, and it is apt to irritate the skin and cause erysipelas, if it be not carefully watched.] violet colour, with white circles around. A perfect cure was effected in six weeks, and although three months have passed since, there has not been any relapse. In four other cases the men were labouring under inveterate psoriasis; in one of them it had existed sixteen years, and had resisted arsenical, iodic, and mercurial treatment. The tar ointment was 57 g. There are various other medicines had recourse to, and with decided advantage, that have been prescribed, internally, for the but the man becoming impatient on account of scaly eruptions. The chief of these are, the his business, an ointment of naphthaline, twice decoctions of dulcamara, of guaiacum, of meze- the strength of that used in the preceding careon, of elm-bark, the infusions of nettles, of ses, was spread on compresses, and applied marsh rosemary, the decoctions of sarsaparilla, over the diseased parts night and morning. sulphur, and the sulphurets, or the milk of sul- The man was cured in six weeks. When the phur conjoined with magnesia, or with either ointment was applied too strong, it caused a of the alkaline carbonates, and the æthiop's burning heat, which was soon removed by emollmineral and other preparations of antimony.ient baths and poultices. The other six cases Either of these infusions or decoctions may be were also instances of psoriasis cured by the made the vehicles for the administration of oth-naphthaline ointment. Dr. EMERY states, that er more active agents, as the liquor potassæ, with or without the iodide of potassium, the liquor iodidi arsenici et hydarargyri, the liquor hydrarg. bichloridi, &c. In some obstinate cases of psoriasis, after morbid secretions and excretions have been evacuated, I have lately resorted to the use of spirit of turpentine, internally and externally, prescribing this substance either alone or with oleum ricini, in doses of half a drachm, or of one drachm, twice or thrice daily, and, after two or three days, the occasional application of an epithem, or embrocation of this spirit over the part chiefly affected. The turpentine ought to be discontinued as soon as it irritates the kidneys, but persisted in if it acts gently on the bowels. It will be taken with little inconvenience on the surface of a little milk or coffee. I have occasionally prescribed tar-water, internally as well as externally. It will be found a medicine of consider-fluid extract of sarsaparilla, will generally be able power in this and other cachectic disorders, if appropriately employed. Pitch, tar, and the turpentines have been recommended internally and externally for squamous diseases, and generally in the form of pill when administered internally, tar and the turpentines being rendered more or less consistent by means of magnesia. They are sometimes of service; but they often, in this form, pass into the large bowels undissolved, become excrementitial, and hence have little effect. 58. C. The state of the constitution, as well as of general and local action, should guide the physician in the choice of remedies, which ought to be chiefly antiphlogistic and evacuant, in the acute or early stage, and alterative and depurative in the chronic or advanced states. In many cases, however, alteratives and depurative remedies require to be combined with tonics and even with chalybeates; especially in cachectic habits, and when the eruption assumes a livid or dusky hue. In these, the iodide of potassium with the carbonate or solution of potass and sarsaparilla, or tonic infusions, or the iodide of iron with sirup of sarsaparilla, or the bi-chloride of mercury in the tincture or decoction of bark, with tincture of serpentaria, or the of great service; and, if a cure be not effected by these, aided by external means (§ 61, et seq.), then the preparations of arsenic, or the combinations of arsenic, iodine, and mercury, may be resorted to, as above recommended. 59. D. The syphilitic varieties of squamous eruption should be treated with strict reference to the history of the case, and the means which have already been employed and the period of their employment. Several severe cases of this eruption, some of which had either gone on to extensive ulcerations or become complicated with disease of the throat, or the bones or joints, have at sundry times come under my care. For these there are certain remedies, which, if judiciously employed, may be viewed as specifics.-a. The oldest and not the least efficacious of these is the bi-chloride of mercury, prescribed either in the manner recommended by VAN SWEITEN, or given dissolved in alcohol, and taken in water with the hydrochlorate of ammonia, or in decoctions of sarsa, &c., or prescribed with the decoctions or infusions. or tinctures of cinchona, serpentaria, &c. When the eruption and its antecedent symptoms have not been attacked by a mercurial course, then the bi-chloride should be given in decided doses, and preferably soon after a full meal, either in the form of a pill and in gradually increased doses, as advised by VAN SWEITEN, or as just recommended, in either of which combinations it may be taken in the intervals between meals. Salivation, unless it be slight, need not be produced; although the specific effects should be continued for some time; when either of the other remedies next to be noticed should be prescribed, if the eruptions have not nearly or altogether disappeared. mends the immersion of the part, especially when the extremities are chiefly affected, in warm artificial Harrowgate water; or the diseased parts to be washed or fomented with it twice or thrice daily, for fifteen or twenty minutes each time; and a mixture of equal parts of the weak citrine and tar ointments to be applied after each fomentation. The following formula is given by him for the preparation of this water: Sulph. magnesiæ, 3ij.; supertart. potassæ, gr. x.; sulphat. potassæ cum sulphure (or sal polychrest), 38s. These are directed to be dissolved in twenty-four ounces of warm water, and used for a wash or fomentation. I have lately employed a wash or fomentation, either warm or tepid, with tar-water, containing biborate of soda dissolved in it. 62. If the scales adhere or are accumulated in crusts, sulphureous vapour baths, followed by frictions, or gently stimulating ablutions, or fomentations, with a solution of the biborate of soda, or with a little liquor potassæ, will be of service. The application of steam or vapour, with or without the fumes of sulphur, is always of use. Lotions of diluted alcohol, of solutions of sulphuret of potass, or the decoction of dulcamara, will aid the exfoliation. When the scales are removed, BATEMAN and THOMSON recommend the unguentum picis, or the unguentum hydrargyri nitratis, diluted with the ceratum plumbi compositum, or with simple ointment; or, which is better than either, an ointment composed of equal parts of these two ointments. The ointments which I have preferred are the ioduret of sulphur ointment (gr. xij. or xj. to 3j.), the calomel ointment (3j. to 3j.), the ointment of white precipitate, the zinc and lead ointments conjoined, and the several ointments of the nitrates of mercury and of the iodide of mercury. These last should, however, be employed more or less diluted. The ointments containing ei 60. b. The next specific remedy for this species of eruption is iodine. I believe that this substance, or any of its preparations, had not been prescribed for any form of syphilitic disease when first I ordered it in the summer of 1825, the formulæ, as well as an ioduret of sulphur, having been prepared by Mr. MORSON, the eminent operative chemist. At first I employed the iodine either in the form of a weak tincture, or in combination with potash, or the iodide of potash with the addition of pure iodine. Subsequently I preferred the iodide of potash, conjoined with liquor potassæ and sarsaparilla; full doses of PLUMMER'S pill being taken at bedtime. The iodides of mercury have more re-ther of the iodides are most suited to very obcently been employed for this eruption, and are generally beneficial; but they are not superior to the treatment which preceded them. They are, however, advantageously given in the form of pills at night, or night and morning, the iodide of potass being taken during the day, with liquor potassæ and sarsa. In the syphilitic species, also, Mr. DONOVAN'S Solution is an excellent remedy, and may be advantageously adopted in the more protracted cases. stinate cases, the others for slight or recent cases. The iodide of sulphur ointment was first employed by the author in 1825. The ointments should be applied at night and washed off in the morning with a saponaceous or alkaline lotion (as 3iij. of liquor potassæ in vij. ss. of water), after which a solution of the bi-chloride of mercury in dilute alcohol (gr. ij. in 3i. p.) may be applied slightly by a sponge over the part. Besides these ointments, others, with the acetate or phosphate of mercury, with the ioduret of ammonia (3j. to 3j.), with camphor, or with concrete naphthaline (two to four parts to thirty parts of lard), have severally been recommended by different writers. A principal advantage derived from ointments is the protection of the inflamed surface from the action of the air, to which very insufficient attention has been directed in the treatment of cutaneous inflammations. Therefore, after the surface has been cleaned by any of these ointments, they should be washed off, and some 61. E. The internal and external use of mineral waters, either natural or artificial, and of sim-sulphate and deutoxide of antimony, with an ple or medicated baths, will generally promote a cure. It is preferable, however, not to have recourse to these until morbidly increased action and vascular or excrementitial plethora is removed by depletions, emetics, purgatives, antimonials, &c. But this end being attained, the sulphur waters of HARROWGATE, LEAMINGTON, MOFFAT, CROFTON, and of other springs in this country; or of those of Bareges, Cauterets, Bagneres, Bagnoles, &c., on the Continent, will be employed with great advantage. A frequent use of warm baths, the patient re-gelatinous, albuminous, or gummy preparation maining in them for a considerable time, and using gentle friction over the affected parts, will often be of service. A small quantity of the sulphuret of potash may be added to the bath. If the eruption be attended by much itching, the biborate of soda dissolved in the water will prove very beneficial. Dr. DUFFIN recom applied to it, so as to exclude the air, as advised for PITYRIASIS (§ 27); and this preparation should be allowed to remain as long as it answers this purpose, when it should be removed by fomentations and ablution, and reapplied until the parts are completely restored. I have lately employed for scaly eruptions a lotion of one part of Glycerine, to three, four, or five parts | mentioned by some writers; but I have seldom of water, with marked benefit; and Dr. GLOVER has recommended lodoform externally (388.-31. to the j. of cerate), and internally, in doses of two or three grains twice or thrice daily.* observed much benefit derived from them, and have even believed them to have been sometimes injurious. In a few cases, however, after a due evacuation of accumulated secretions 63. As I have shown in the article PITYRIASIS, and excretions, the liver still continuing torpid, the chief causes of the obstinacy of scaly and the nitro-muriatic acids given internally and other cutaneous eruptions, are, 1st. The action employed externally have appeared of some of the air, from which they are not sufficiently use; and the sulphuric acid has occasionally protected during the treatment; 2d. The want been added, with marked advantage, to the of due attention to the state of the assimilative neutral sulphates, dissolved in bitter infusions, and depurative functions of the blood; and, 3d. and taken in quantities sufficient to keep the Insufficient restrictions on diet and regimen. bowels freely open. Dr. C. SMITH and Dr. CuBut, even when a cure is obtained, or nearly MIN, however, are of opinion that dilute sulobtained, a relapse or a return of the eruption is phuric acid possesses considerable efficacy in a frequent occurrence-a relapse generally pro- the treatment of squamous eruptions; the latceeding either from the causes just specified, ter physician believing that the acid is decomor from a premature relinquishment of treat- posed, and that the system is thereby impregment; a subsequent return of the disease re-nated with sulphur. This may be the case sulting from the same causes as produced it at when the quantity taken is small or very modfirst, or from inattention to the several digest-erate; but in some experiments I found that ive and excreting functions. Both these unfavourable contingencies are most likely to occur when the functions of the several abdominal organs have not received due attention du- | ring the treatment, and a restoration of them to the healthy state has not been effected; and also when the healthy conditions and colour of the parts affected have not been completely restored before the successful means were relinquished. These two causes, especially when acting simultaneously, with errors in diet and regimen, are most influential in producing relapses, and returns, at more or less remote periods, of scaly eruptions; and they are of greater importance than they have hitherto been considered. the dilute acid, when given in large and frequent doses, could be detected unchanged in the urine. Acids, however, ought to be employed with caution, and with strict reference to the excretions, especially the urine and its saline constituents. 66. The diet and regimen are of the greatest importance in the treatment of all the scaly eruptions, and are often more beneficial, if strictly enforced, than even medical means. Animal food should be used sparingly; and pork, veal, ham, dried or smoked and preserved meats; fish and shell-fish, especially fried and rich fish; rich sauces, doughy articles, pastry, or pie-crust; pickles and preserves; heating and stimulating beverages, especially spirituous and malt liquors, coffee, punch, acid wines, &c., ought to be constantly avoided; and sugar, butter, and sweet or acidulated articles very sparingly taken. The remarks offered on this topic in the article PITYRIASIS (§ 34), a species of the eruption now treated of, strictly apply to the treatment of these eruptions. 64. The local forms of psoriasis and lepra, mentioned above (§ 16, et seq.), require chiefly the adaptation of the general and local treatment | already described to the circumstances of each case. (a) Psoriasis palpebrarum will often be benefited by the application of three or five leeches behind the ears, and by a lotion consisting of a weak solution of the nitrate of sil- BIBLIOG. AND REFER.-Hippocrates, De Usu Humidover, or a lotion of sulphate of zinc, or diluted rum. Epidem., ii.-Galen, Method. Med., xii.-De Caus. Sympt., iii., 6.-Oribasius, Morb. Curat., 1. iii., 58.-Celsus, tincture of iodine, to the part. The calomel De Med., 1. v., 28.-Actuarius, Meth. Med., ii., 11.--Paulus ointment, or the zinc ointment, or a diluted ni- Egineta, Trans. by Adams, iv., 2.-Avicenna, Canon., iv., trate of mercury ointment, may be severally 7, 2, 9.-Haly Abbas, Theor., viii., 26.—Pract., iv., 4.Mercuriali, De Morbis Cutaneis, 4to. Venet., 1585.-M. applied in this and the other local forms of the Czanakius, Encomium Scabiei ad Scabinos Reipublice Scaeruption. (b) For psoriasis genitalium, emoll- biane, 12mo. 1627.-Sennertus, Med. Pract., t. i., cap. 30. ient local baths, and the use of the lotions and Mead, Medicina Sacra, cap. ii. - Turner, Treatise on Diseases of the Skin, 8vo. Lond., 4th edit., 1731.-D. Lyointments just mentioned, are most beneficial. sons, Practical Essays, &c., 8vo. Bath, 1772. (On Elm If these forms be attended, as they usually are, Bark in Cutaneous Diseases.)--J. F. Carrère, Traité de la with much itching or irritation, a solution of Douce Amère dans les Dartres, 8vo. Paris, 1789.-Vogel, De Cognosc. et Curand. Homin. Affect. Cl., viii., s. 699.— the bi-borate of soda in tar water, or in some Sauvages, Nosolog. Method. Cl., x., ord. 5.-Linnæus, emollient fluid, containing creasote, applied as Amonit. Acad., vol. viii., p. 285.-Et Dissertatio de Lede a lotion, or by a sponge, will generally give re- Palustre. Upsale, 8vo., 1775.-Lorry, De Morbis Cutaneis, lief and remove the eruption. Sulphur and cin- 4to. Paris, 1777, p. 365.-Falconer, Memoirs of the Med. Soc. of Lond., vol. iii., p. 369.-J. C. Smyth, Medical Comnabar fumigations are usually successful when munications, vol. i., p. 191, 8vo. Lond., 1784.-Meckel, De the scrotum or anus is implicated.-(c) For pso- Lepra Squamosa, 8vo. Halæ, 1795.-Moriarty, A Treatise riasis palmaria, after soothing the parts with on Mercurial Lepra, 12mo. Dublin, 1804.-C. H. Wilkinson, Remarks on Cut. Diseases, 8vo. Lond., 1822.—Willan, local baths of the decoction of bran, &c., oint- On Cutaneous Diseases, 4to. Lond., 1811, p. 36.-A libert, ments containing the iodide of sulphur, or the Maladies de la Peau, fol. Paris.-J. W. Perkins, Boston iodide of mercury, or the other ointments al- Med. and Surg. Journ., No. 182. Et Journ. des Progrès, &c., t. xvii., p. 272.-F. S. Bidon, Reflect. Pratiques sur ready mentioned, may be employed in aid of le Mal. de la Peau appel. les Dartres, 4th ed. Paris, 1828. the constitutional remedies recommended. In-Duffin, On Squamous Disorders, in Edin. Med. and Surg. the more chronic states of psoriasis palmaris, Mr. WILSON advises a spirituous lotion of bichloride of mercury, followed by water dressing. 65. The mineral acids have been favourably [Gun cotton dissolved in ether is one of the best applications in these cases.] Journ., vol. xxv., p. 1.-T. Bateman, Practical Synopsis of Cutaneous Diseases, 7th ed., by A. T. Thomson, p. 35.Plumbe, Practical Treatise on Diseases of the Skin, 8vo, 2d ed. Lond., 1827.-M. Good, Study of Medicine, vol. iv., p. 457.-Chevalier, Journ. de Chimie Med. Mars., 1826.--Richter, Specielle Therapie, &c., b. vi., p. 440.Rayer, Traité des Maladies de la Peau. Transl. by Willis, Svo. Lond., p. 631.-Et Dict. de Med. et Chirurg. Prat, . art. Lepre.-J. L. Alibert, Descript. des Mal. de la Peau, Observées à l'Hôpital St. Louis, &c., fol. Paris, 1825.L. A. Struve, Synopsis Morb. Cutan. secundum Classes Genera, Species of variet., &c., fol. Berl., 1829.-R. Willis, Illustrations of Cutaneous Diseases, &c., fol. Lond., 1839-Donovan, in Dublin Journ. of Med. Science, Nov., 1839, and Sept., 1840.-J. Houghton and W. Cumin, in Cycloped. of Pract. Med., vol. iii., p. 25 and 543.-J. Green, Pract. Compendium of the Dis. of the Skin, 8vo. Lond., 1835, p. 199.-E. Wilson, Pract. and Theor. Treatise on the Diag., Pathology, and Treatment of Diseases of the Skin, 8vo. Lond., 1842, p. 214.- Th. H. Burgess, Manual of Diseases of the Skin. From the French of MM. Cazenave and Schedel, 8vo. Lond., 1842, p. 200.-Et Diction. de Med., 2d ed., art. Psoriasis.-W. C. Dendy, On the Causes, Nature, and Treatment of Lepra and Psoriasis, fol. Lond. (with plates). And a Treatise on the Cut. Dis. incidental to Childhood, 8vo. Lond., 1827.-J. E. Erichsen, in Lond. Med. Gaz., vol. xxxii., p. 197.-R. M. Glover, in Monthly [AM. BIBLIOG. AND REFER.-American editions of Rayer, Green, Cazenave and Schedel (by Bulkley); Good, Plumbe, Bateman, &c., and reviews and medical journals already Journ. of Med. Sciences. Feb., 1848, p. 578. noticed.] PUERPERAL STATES AND DISEASES. cedema, and congestion of the sinuses within the cranium, with the dangerous consequences of this condition. The effects produced by the large size of the uterus are very much aggravated if pressure upon the lower bowels be allowed to interrupt the regular process of fæcation and excretion, and if this cause or indigestion should give rise to flatulent collections in any portion of the alimentary canal. 3. With the increased development of the pregnant uterus, the peritoneal envelope of the organ, and even the ligaments experience a remarkable change, and are inordinately stretched, so as to favour the supervention of inflammation, especially upon the removal of the distending cause, when additional influences come into operation. With the ascent of the fundus of the uterus, the omentum is more or less displaced, and carried upward; its exact position and influence upon adjoining parts varying with the quantity of adipose substance it may contain. 4. It is obvious that changes of the position and condition of the viscera must influence more or less the functions performed by these 1. Several of the diseases incidental to par- viscera; and that, both during the progress of turition and to convalescence from this act are these changes and at their consummation, vadiscussed under their special denominations; rious disorders, noticed under PREGNANCY, are and to these I shall refer as they successively liable to appear; that the secretion and excretake their places in the group of maladies usu- tion of urine should be disturbed or impeded, ally called "Puerperal." In this place, there- or even arrested, the functions of digestion and fore, it chiefly remains to discuss, 1st. The path- assimilation disordered, the intestinal secreological relations of the puerperal state; and, 2d. tions and excretions interrupted, and sensibiliThe very dangerous and often malignant maladies ty and motion materially disturbed. At the incidental to it, which are not treated of under oth-full period of gestation, the circulating and reser heads. That a view of the pathological relations of the puerperal state, impartially exhibited, and without reference to peculiar doctrines, will be of use, it is hoped, in guiding the inexperienced during their intercourse with the deviations from the more common procession of morbid phenomena which will occasionally be met with by them, is only a reasonable expectation; and hence an inducement to undertake the labour which a faithful exhibition of this view involves. piratory organs, and still more the nervous centres, owing to the congestions to which they are exposed at this period, are severally liable to the most serious attacks as soon as the congestion, in which these attacks originate, is carried to the pitch requisite for their development. 5. In connexion generally with the changes now mentioned, if not always dependent upon these changes, the nervous system generally acquires increased sensibility and susceptibility of impression; and, through the medium of this system more directly, and through that of the vascular system more indirectly, the whole frame intimately sympathizes with the uterus, independently of the mechanical effects pro 2. I. The PATHOLOGY OF THE PUERPERAL STATES.-i. OF THE ATE OF THE FEMALE AT THE MOST ADVANCED OR FULL PERIOD OF PREGNANCY.-The changes, as well as the principal deviations from the healthy state, during utero-gestation, are described in the article PREG-duced by it upon the other viscera. The nerNANCY, and under various other heads. It only vous development of this organ, and the vascuremains to notice the state presented by the fe- lar determination to it, influenced by the nermale economy when gestation is approaching, vous organization, renders the womb the centre or has reached its full period. The uterus then of numerous sympathies and the source of many has attained its utmost size; and it then en-morbid phenomena, all which increase and bejoys a copious determination of blood for the come more prominent with the progress of nourishment and growth of the fœtus, and for pregnancy, and still more manifest at the full the preservation of its own augmented struc-period, during parturition, and for some time ture. The distended uterus, especially in a after delivery. The activity of the nervous infirst pregnancy, presses more or less, accord-fluence, and of the vascular circulation of the ing to the size of the female and the capacity of the abdomen, upon the other viscera, especially on the urinary bladder, the kidneys, the rectum, and large bowels, the liver and biliary apparatus, and stomach; and, consequently, the descent of the diaphragm is impeded, and congestion of the lungs is favoured. But the pres-other-notwithstanding interrupted excretion, sure also influences the circulation through the large venous trunks, and often, in some degree, through the heart and lungs; hence arise congestion of remote parts, especially of the veins of the lower extremities, often followed by uterus at an advanced stage of pregnancy, influences remarkably the conditions of both the nervous and the vascular system generally, notwithstanding the various pathological conditions tending to impair the energy and sensibility of the one, and the tone and action of the and the various circumstances favouring excrementitial contamination of the blood, and congestion of it in venous trunks and sinuses. 6. ii. OF THE CHANGES TAKING PLACE DURING THE PARTURIENT PROCESS, AND THEIR INFLU ENCES IN CAUSING DISEASE.-The uterus, hav- | inflammation may have attacked a portion of ing completed its function of fortal develop- the pregnant uterus and occasioned softening, ment, or having carried this function as far as or impaired action and tone, or even a greater is consistent with the health and subsequent lacerability of that portion, in consequence of safety of the mother, experiences that state of either of which changes rupture of the uterus, action which is the best calculated to preserve or dangerous hemorrhage may take place duboth the child and the parent from injury and ring parturition; or, if either of these do not disease. But during this action, and the chan- supervene, inflammation of the uterus, or of its ges in the nervous and vascular systems which veins or sinuses, or peritonitis, or puerperal feit more or less remarkably produces, various ver, may follow delivery, the previously dismorbid conditions are apt to appear. The pain- eased state, and the exhausted tone and conful contractions of the uterus, although occur- tractile power of the organ especially favouring ring only at intervals, tend to excite or react the occurrence of these maladies. upon the nervous systems generally, but more remarkably upon the spinal cord, and through it upon the brain. These contractions also tend to diminish the flux of blood to the uterus, and to determine it in greater quantity to the brain, and thereby to change a pre-existent state of passive congestion into active and increased congestion, or to carry a condition of the vascular system, which was insufficient to produce acute disease, to that pitch which instantly develops such disease. 9. There are various circumstances connected with parturition productive of disease either of the uterus or of adjoining and associated parts. The interferences arising out of impatience and want of confidence in the efforts of nature, a premature or inconsiderate, or a too long delayed recourse to medicinal or mechanical aids of parturition, and the injury which these may occasion either to the uterus or to parts in the vicinity, or even to both, are among the most influential causes of disease, 7. The uterine actions, although often thus not only of the parts thereby injured, but of the productive of seizures depending upon the frame generally through the media of the nerstates of the cerebro-spinal nervous centres, vous and vascular systems. The means which especially as regards the circulation of these have recently been recommended for the precentres and the peculiarities of that circulation, vention of pain during parturition, although are yet independent of these states. This fact quite competent to the production of this reis undeniably demonstrated by the occurrence sult, cannot be viewed as altogether innocuous. of uterine action independently of the will, and Several instances have already occurred, evinduring abolition of the functions of the cerebro- cing not merely dangerous, but actually fatal spinal system; by natural parturition taking effects from recourse to them. A fatal issue place during paraplegia as well as hemiplegia, may certainly be prevented from taking place and as shown recently by the regular progress immediately from these means; but the chanof the parturient process, while sensibility and ges which may terminate fatally cannot be so voluntary motion are abolished by the inhala- readily prevented in all cases, and at the same tion of ether or of chloroform. It is obvious time accomplish the intention for which they that the muscular contractions, and the pain-are employed. These anæsthetic agents have ful excitement of the uterine nerves during par- been demonstratively shown not only to deturition, will occasionally develop morbid ten-stroy sensibility for a time, when inhaled for a dencies in the nervous system when these already exist, owing either to hereditary or to acquired predisposition, and consequently that convulsive or apoplectic seizures, or phrenitic or maniacal attacks will occasionally appear during this process; the convulsive seizure presenting more or less of the apoplectic, of the epilectic, or of the simply convulsive character, according to the predisposition and peculiar circumstances of the case; the maniacal attacks rarely appearing during parturition, although frequently after this process. Convulsive seizures are not confined to parturition, for they occasionally take place previously to, as well as after, this process; but during it they are more apt to assume an apoplectic or epileptic, or a mixed form-in consequence of the greater liability to active congestion of the brain and spinal cord during the parturient act -the apoplectic being characterized by profound coma and stertorous breathing, with slight convulsions, the epileptic by the violence of the convulsions, by frothing at the mouth and injury to the tongue. (See articles CoNVULSIONS, PUERPERAL; and INSANITY, PUERPERAL.) short period, but also, in comparatively short periods of inhalation, to produce congestion of the lungs, a manifest change in the state of the blood, and even a rapidly fatal result. That these agents, when adroitly and cautiously administered, may not occasion any inconvenience subsequently to their inhalation may be the case, in nine out of ten instances in which they have been employed, will be readily admitted, but the tenth instance may be one of serious puerperal disease, of convulsions, or of mania, or of fever, or of congestive pneumonia, or bronchitis, owing to the previous state and predisposition of the patient: events which cannot be anticipated or guarded against by the physician. Pain is often salutary as respects its effects, and especially in enabling the economy to resist, and to rally against, the depressing operation of shocks upon the vital influence; and, when neither its violence nor its continuance is productive of injury to the constitution, or of exhaustion of vital power, to endure it is preferable to the annihilating of sensibility by an agent which acts so remarkably, and so immediately upon the chief manifestation of anımal life, arrests the usual processes of nature, 8. Certain changes in the uterus itself may and even terminates existence itself if employtake place during pregnancy, or even may have ed a few seconds longer than is required to deexisted previously, and may arrive at a danger-stroy this the highest function of living creaous or even fatal termination upon the acces- tures. sion or in the course of parturition. Thus in [On the other hand, it is not to be forgotten |