12.-Vomits still the same kind of fluid, though in a greatly less degree; and the pain is much slighter. R Natr. mur. 3. 14. Says that with the exception of great debility she feels quite well. R China A qq. h. 15. Does not feel so well this morning. The abdominal pain has somewhat returned, the bowels not having been moved for some days. R Nux v. B. qq. 3te. h. 17.-Felt much better yesterday, the bowels being relieved after the third dose of Nux v. To day she left the hospital feeling quite well. Remarks.-Acute inflammation of the mucous membrane of the stomach is generally admitted to be a somewhat rare disease. That the case now related was an example of it, we have but little doubt. So extremely low and weak was she, on admission, that her recovery was deemed almost impossible. Nux v. appeared to be the medicine which produced the most marked effects upon the disease. The rapidity with which she recovered was very striking. Dysentery. W. M., a cab-driver, æt. 28, admitted into hospital February 26, 1852. The day before yesterday he had several distinct rigors, followed by heat of the skin, and other febrile symptoms, with severe shooting pains in the lower part of the abdomen, dysenteric diarrhoea and tenesmus. On admission all the febrile symptoms have subsided under the early exhibition of Aconite. Pulse 82; skin of a natural temperature; tongue thickly loaded with a white fur; nauseous taste in the mouth; no appetite; feels extremely weak. R Merc. c. 3, post sing. sedes liq. 27.-Abdominal pain rather less; bowels moved very frequently during the night-about fifteen times during the last twenty-four hours; stools still of a dysenteric character. Repeat. 28. This morning he is considerably better. Tongue cleaner; appetite returning; stools still dysenteric, but less frequent in number. R Merc. v. trit. 1 gr. 4, post sing. sedes liq. 29.-Is much improved to-day. There is no trace of blood in the stools; bowels moved three times during the night, Repeat. March 1.-Appetite better; feels stronger; stools this morning of quite a natural appearance. Repeat, ter in die s. 3. Had slight return of the abdominal pain yesterday, but is quite free from it to-day. Says he feels well with the exception of some debility. R Sulph. 3. 4.-Discharged to-day quite well. Remarks. The specific action of Mercury in cases of dysentery has long been known to homoeopathic practitioners; and indeed not a few allopathic authors, who have treated of this disease, appear to have felt that this drug had some directly curative relation to the disease in question. But notwithstanding, that army surgeons of great experience in the treatment of dysentery- the scourge of armies '-have insisted on the use of Mercury, it has not been found so successful in the civil practice of this country. And why is this? And why is this? Dr. Alison, in his work on The Pathology and Practice of Medicine, supplies the answer. After commenting on the discrepancy of opinion on the use of Mercury, he states (if I recollect right) his belief, that it is a remedy whose use requires the greatest caution, as it has been frequently found to aggravate the symptoms; a result, he says, not to be wondered at, when we consider the effects of Mercury in poisonous doses. He rejects the employment of Mercury, therefore, on the very ground that affords the only argument for its use, and indeed for the use of every known remedy-viz., its homeopathic action. The reason being that his practical application of it is too coarse-a scruple of Calomel being administered several times during the day. Had Hahnemann's perceptive faculties been so limited homoeopathy might have been even now in the bosom of the future! Though many drugs are unwittingly prescribed homœopathically by the old school practitioners, there is perhaps not one among them which illustrates more forcibly the necessity of reducing the dose from its old-fashioned magnitude, than does the employment of Mercury in dysentery. 395 THE PATHOLOGY AND TREATMENT OF CROUP, BY DR. ELB, of Dresden.* WHAT induced me to undertake the following essay was the request made by Dr. Koch ten years ago, to publish observations respecting the action of Iodine in croup. As my observations led me to believe with Dr. Koch that this remedy could not be looked upon as the sole and universally applicable one, it was requisite to detail the circumstances under which other remedies were applicable. Whilst it was at first my intention to state these only, I soon became aware that it was impossible to lay down the indications plainly without taking into consideration the pathological processes,—it was in fact requisite to enter first on the pathology of the disease. I would fain hope that the indulgent reader would look with favour upon this first attempt at a pathological therapeutical contribution to the subject, founded upon original observations. Before proceeding to a description of croup itself, I think it may not be superfluous to precede my remarks by a short historical exposition of the diagnosis of this disease. Although we find not the slightest mention of any disease at all resembling this among ancient writers, still many modern commentators are of opinion that it must have presented itself to the ancients, but was either not recognised, in consequence of the obstacles that presented themselves to post mortem examinations, or was confounded with other diseases, such as asthma and paralysis of the lungs, on account of their defective means of diagnosis. Notwithstanding this, however, it is difficult to believe that the older authors, who were good observers, would have entirely overlooked the expectoration of tubular membranes, rare though that be, and that they should have been totally ignorant of the existence of this disease. Moreover as croup is, as is well known, by no means the only disease that has only developed itself in modern times, it is quite allowable to ask why it should be wrong to deny the possibility of its production by the altered circumstances of modern times (compare below the predisposing causes). *From the Hom. Vierteljahrschrift, Vol. II. It was only at the commencement of the 17th century that a Frenchman of the name of Baillou first made mention of a disease apparently identical with croup: he states that he had found on dissecting children who had suffered from dyspnoea along with slight fever, a tough, hard mucus like a membrane in the windpipe, whereby the entrance of the air was impeded and occasioned their suffocation. Although after him, Rhodius in 1660, Horris in 1691, Ridley in 1703, Starr in 1744, Ghisi in 1749, Nobleville in 1750, (the two last observed the first regular croup epidemics, the first at Cremona, the second at Orleans,) and Bergen in 1764 seem to have observed this disease, as far as we can judge from their descriptions, yet it was Home in 1765 who gave us the first accurate description of it under the title of An Inquiry into the nature, cause, and cure of the Croup; not long afterwards, in 1771, Crawford followed with his Dissert. med. inaug. de Cynanche stridula; and in 1778 Michaëlis wrote a treatise, De angina polyposa sive membranacea, which is not altogether without value. From that time to this the disease appears to have occurred always more frequently and to have spread farther, for from that period, not only did many English, French and German physicians furnish valuable monographs, but the subsequent authors had more frequent opportunities of observing the croup than their predecessors. Although croup presents the same phenomena in almost all cases, yet we cannot fail to perceive some variations in respect both to the prevalence and the absence of some symptoms, and also to the duration and subsidence of the more important symptoms. Hence it has been attempted to arrange croup into different classes; and for this purpose the most various circumstances have been seized upon whereon to ground the classification. Thus croups have been divided into perfect and imperfect (depending upon the presence or absence of expectoration of membrane), into sthenic and asthenic, into simple and complicated, into polypous and membranous (in the former kind the formation of the membrane is said to take place in the trachea and its branches), or, according to the seat, into laryngeal, tracheal, and bronchial croups. All these classifications, and many others of a like character, appear to us untenable, as they are valueless both for the diagnosis and the therapeutics of the disease. To our mind the only useful one is the classification given by Hagen in his essay on torpid croup, into catarrhal, spasmodic, irritable and torpid croup. As this classification exactly corresponds to the chief modifications of the disease, and as we are unable to discover a better one, we shall consider it as completely sufficing for our object, which is to consider the croup in its various forms, and to state the remedies suitable for them, only we shall take the liberty to make the slight variation of denominating the irritable form the inflammatory one, whereby its character is more distinctly indicated, and to reckon the spasmodic, which Hagen makes his second form, as our fourth. Accordingly, we arrange the varieties of croup as follows: 1. Angina membranacea catarrhalis. 2. Angina membranacea inflammatoria. 4. Angina membranacea spasmodica. To subdivide these several forms again into different stages, for example, into an inflammatory and a suppurative stage, or as others have it, into the premonitory stage, the stage of the commencing disease, that of its perfect development, that of torpor, and that of paralysis or recovery, would be useless, because the disease does not in all cases pass through all the stages, as might be inferred from the description of the various kinds, nor can the stages be accurately separated from one another. Before, however, proceeding to the consideration of the several forms of the disease, we deem it necessary, in order to avoid repetitions, to give the diagnostic marks of an indisposition which is common to all forms, and which usually precedes in the greater number of cases by a shorter or longer time the disease properly so called. The physician has rarely an opportunity of observing these preliminary symptoms himself, as they are frequently overlooked by the friends, or medical aid is not sought for such a trivial indisposition, and the physician is only told of it after the outbreak of the disease. Most frequently, |