litated, inflamed, preternaturally sensible, or under the operation of irritants, the nervous fluid is continually called back from its advances towards gaining its natural balance.

When the vital energy has regained its natural state, balance, or universally diffused state of action, upon every part of the system, the functions all return gradually towards their healthy performance. At this time, however, the nervous fluid is in a vacillating uncertainty, and continually in danger from a concatenation of morbid action, or association of motion, to fall back and lose its balance, from slight causes. To prevent this, we exhibit tonics to condense and strengthen the muscular fibre, and thereby increase the tone of the whole system, and establish the security of the nervous fluid. Mercury acts upon the human system as a universal stimulant, and by this means restores a balance to the nervous fluid, by calling it equally to every part of the system. Emetics may be of benefit in unloading the stomach, but their effects upon the liver, large veins and skin, are far more beneficial; they may also help in diffusing nervous action, when too much concentrated upon the heart, as occurs in congestive typhus,* and in the spotted and yellow fevers. They are, however, prohibited by other circumstances in the two latter diseases.

Diaphoretics assist by throwing the circulation upon the skin, and thus tending to diffuse nervous action, and also relieve an irritation, by relaxing the skin. Cathartics and enemata relieve from the great body of irritation, by evacuating offensive matter from the intestines, which, if not thrown off, renders an otherwise simple case obstinate, dangerous, and, perhaps, malignant.

Alteratives change morbid action, induce a healthy one, and thereby relieve a part from the continual and increased action of the nervous fluid.

This is likewise the benefit of diuretics, which also carry off a portion of any impurity of the blood. I say, impurity of the blood. We have, in my opinion, too inconsiderately forsaken every idea of the humoral pathologists. What effect would be produced, indeed is produced, where the kidneys refuse to act? I believe an alteration in this secretion very often renders cases more malignant than would otherwise be the fact.

Bleeding assists sometimes by relieving irritation, and again by rendering the body sensible to other impressions; and in

calling the nervous action from the brain, muscles and membranes, to the sanguiferous system.

Blisters are serviceable as counter-irritants, in calling the nervous fluid from some positive point to a negative.

To the consideration of this imperfect and hasty sketch, I shall leave my reader for the present, and record my perfect satisfaction, should he obtain but one new idea of importance to the welfare of the human family, from the labors of my pen ;nay, it is happiness itself, to consider ourselves able to alleviate one item of the miseries of mankind.

ART. V.-Notes on the Epidemic Erysipelas which prevailed in the provinces of New-Brunswick and Nova Scotia. Communicated to WILLIAM BAYARD, M. D. of New-York. By ROBERT BAYARD, M. D. D. C. L., of St. Johns, NewBrunswick.

THE disease commenced early in the fall, although the weather had not been remarkable for any peculiar humidity or dryness. It attacked all ages, sexes, and constitutions, indiscriminately, and was prevalent as well among the upper as the lower orders, with those who enjoyed the comforts of life, and occurred in various exposures and localities. It showed itself first in my family, in a child of five years of age, who complained first of vomiting, great thirst, and the usual symptoms of inflammation of the mucous membrane of the stomach; her constant cry was for water, which was quickly rejected. The disease was treated

the general principles of gastritis. Venesection copiously, cupping, warm bath, leeches, and blisters-all seemed unavailing, until a very copious bleeding, ad diliquium, from a large opening, losing 3i. after two previous venesections. This last subdued the disease, which manifested a removal, by the desire for water ceasing. The convalescence was rapid. I may observe, cathartics had little effect; and the child took nearly three drops of oil of croton, before the bowels yielded. The oil was given after the thirst had abated. In two or three days after her recovery, her elder sister, aged six years, was taken sick, much in the same manner. Similar treatment was adopted, with the exception of the oil of croton; but the bleedings were not carried to such an extent, because the sensation of thirst was not so urgent. The disease, however, was more obstinate,

and travelled upwards along the esophagus, attacking the schneiderian membrane, and was reflected from the internal nostril, upon the outer surface, extending itself gradually over the face, neck, head and thorax.

In one case (a child ten years old) the disease commenced in the stomach, passed up the esophagus, pervaded the internal fauces, was reflected upon the face, caused gangrene internally and externally of one half the face, involving one eye, half the nose, the cheek and ear, and ultimately producing death.

In another case, a man of previous intemperate habits was attacked on the arm. In forty-eight hours, general gangrene of the extremity supervened, the entire cellular membrane was disorganized, and death followed in twenty-four hours after the commencement of gangrene.

A young woman injured her finger with a herring bone; erysipelas supervened. The disease involved the arm, and pectoral muscles. The extremities of all the fingers were lost from gangrene, while deep abscesses formed at the same time on the back of the hand, wrist, elbow, axilla, and beneath the pectoral muscles. She recovered.

A blacksmith, of temperate habits, was attacked with the disease in the knee. Tumefaction took place, elevating the patella. An incision was made in forty-eight hours after the tumefaction; large collections of pus were discharged from each side; it insinuated itself beneath the extensor muscles of the thigh. Similar abscesses were formed over the acetabulum, and under the pectoral muscles. The fauces were also affected with inflammatory erysipelas. This man after some weeks recovered.

A laboring Irishman, in the poor house, complained of the usual symptoms of erysipelas; and, notwithstanding copious depletions, suppurations eventually took place in almost every joint, in the wrists, fingers, shoulders, hips, knees, ancles, with extensive insinuations along the muscles of the legs, and the longissimi of the back. He died; and the matter, in many parts, lay within the capsular coverings of the joint.

Puerperal women were peculiarly liable to the disease; and it was very fatal to many. In one case after death, the disease presented very general ravages; the whole intestinal canal was flushed with inflammation, which, in some parts, had terminated in gangrene. In one case, the peritoneal covering of the uterus and bladder was completely injected; whilst, at the same time, the ovarium was entirely disorganized with gangrene.

I have frequently seen the orifice of a vein, when opened, form the nucleus of erysipelas. In one man whom I bled, the next

day the orifice became erysipelatous, and a cicatrix on the opposite arm, which had been bled some months before, puffed up, and assumed the disease.

When the erysipelas first made its appearance in this city, it exhibited a prevailing tendency to terminate in gangrene. During this period, it was very fatal. After a few months, it varied its termination, and run rapidly in deep abscesses, characterized with very little swelling. The previous existence of pain was a sufficient authority after three or four days duration, to plunge the lancet deeply into the affected part, and evacuate matter. I have plunged it into the knee, the pectoral muscle, the gluteus, &c., when there has been but little apparent tumefaction, and incredible quantities of matter have been discharged. Such determined and seasonable openings, I considered, as having alone saved my patients. I have discharged upwards of twenty ounces of pus from beneath the pectoral muscles, where there had been but little general swelling, and no redness indicating any disposition to point outwards.

The matter insinuated and undermined parts, without showing any tendency to point externally. I did not consider the disease contagious, although whole families would be attacked with it. It seemed to depend upon some unknown peculiarities in the atmosphere, occasioning a morbid action upon the skin, vitiating, by consent, the biliary secretions, and thus ultimately deranging the digestive functions, and causing membranous inflammation. In suppurations of the knee, I have passed the probe beneath the patella, from one side of the knee to the other, and upwards some distance, under the extensor muscles. The patients recovered, but the joints were stiff. The disease assumed a variety of attacks, from a mild to a very malignant form.

The treatment was modified by circumstances, and the part affected. I generally found evacuants, and most determined bleedings, to succeed. If the stomach was not affected, and the disease was external, a gentle emetic, moderate aperients, and venesection, sufficed. In one puerperal patient, the disease appeared on the face, head, and breast, the day after labor; I bled her; and after some days she convalesced, and, contrary to orders, ate freely of meat. In a few hours the disease returned. I gave an emetic, with relief. But small abscesses between the membranes of the eyelids were formed and opened.

When the disease manifested inflammation of the mucous membrane of the stomach, internal remedies seemed hurtful. In this case, most determined bleedings answered; the quantity drawn was regulated by the effect, viz. the cessation of thirst; afterwards mild diluents, and gentle aperients, were serviceable.

Early openings after the patient complained of deep seated local pain, unaccompanied with external redness, were indispensably requisite. The absence of swelling was no guide, contra-indicating the opening. I have known decided internal erysipelas without any external redness; and extensive suppurations, with little or no swelling, and no other cause to suspect matter, than the prevalence of the epidemic.

Mild mercurials, when the stomach would allow, with a view to correct the bilious secretions, were serviceable. Fomentations over the region of the liver, and the antimonial ointment with mercury, with the same intention, were useful co-adjutors. Bark and wine, which have been advised in ordinary erysipelas, were used by some, but always with injury.

Blisters were serviceable in some cases; not so much from any curative property, as from their causing cutaneous irritation, and becoming the seat of cutaneous erysipelas.

The disease continued to prevail first under a gangrenous for three or four months, and subsequently under a suppurative character for eighteen months. I have met with occasional mild attacks of the suppurative disease, for two years from its first appearance. It was principally fatal among the poor, and childbed women; with the latter of whom I found bleedings and the warm bath, and large poultices over the bowels, generally successful. I have kept child-bed women in a hip bath for several hours during the day. The bath was kept warm by the bed, and the order was, to get in as often as the pain was urgent upon pressure, and to remain in as long as they could.

This disease prevailed throughout Nova Scotia, and this Province. Occurring as well upon high and elevated situations, as in low and marshy exposures; as well in the formerly salubrious airs of the country, as in the dense and unwholesome confinements of city; and it was equally frequent in hospital and private practice.

ART. VI.-Notice of Communications made to the Royal Academy of Medicine of Paris, on the high operation for Stone in the Bladder, by M. AMUSSAT. BY CHARLES CLEEVE, M. D. of New-York.

[IN our last number, we had the gratification of laying before our readers, the history of the first case of Lithontripty performed in this country. The profession in the United States are