of the heart for years; urine at times albuminous; no microscopical examination was made; symptoms indicated subacute Bright's disease. Under the treatment of diuretics, digitalis diaphoretics, stimulants, bromide of potassium, etc., etc., he grew worse; on one occasion he remained with him during the night expecting him to die. He was comatose, poisoned, he supposed, on account of the failure of elimination upon the part of the kidneys; urine and feces passed involuntarily; treatment suspended from necessity, as there was inability to swallow. In a few hours he began to improve. He was let alone, and he recovered, and he is now in a good state of general health. Improvement was not preceded by any very free action of the bowels or kidneys.

Dr. Taliaferro had used, in albuminuria and uræmia of pregnancy, bromide of potassium with great satisfaction. Dr. Thomas, of Savannah, reported, at a recent meeting of the State Medical Association, the successful treatment of uterine convulsions by the same remedy. He also used it in threatened convulsions. Several years ago was called to see a pregnant woman in the absence of her attending physician; found her suffering to such an extent from albuminuria, that for her safety, he advised premature labor. He ordered, however, bromide of potassium twenty to thirty grains every four hours. The albumen in her urine rapidly decreased and finally disappeared, and she was delivered, at full time, of a healthy child.

Dr. DuPre, a number of years ago, met with a gentleman, æt. sixty, suffering from anasarca, the result of very serious organic disease of the heart, the right side being hypertrophied and dilated. The patient had passed through the usual treatment for anasarca without relief, and he determined to try the full eliminative value of calomel. Vegetable tonics were combined with the mercury, which was continued until ptyalism was produced, when the daily amount was diminished. The anasarca, as well as a considerable effusion in the pleura and peritoneum rapidly diminished, and almost entire relief was obtained. The mercury was discontinued, and in a few weeks all of the unpleasant symptoms returned. The same treatment was again instituted with similar results. The patient improved sufficiently to attend to business. He passed from under his observation soon after, and has since died. Has seen the urine diminish under the use of diuretics; believes the kidneys to be in a state

of hyperæmia and that this class of remedies is not indicated; should expect advantage from cups and a blister over the region of the kidneys.

Dr. DeWitt thought that generally the most successful plan of treatment in this class of cases consisted in the use of digitalis and tincture of iron.

Dr. Battey regards digitalis as a valuable diuretic; considers much of that in market utterly worthless. Thinks digitalis and ergot should not be officinal in the form of fluid extracts; the necessary manipulation to which they are subjected often destroys their value. Prefers the infusion of the leaves of digitalis and those not pressed into cakes, but loose and properly dried. The same remark applies to ergot, he decidedly prefers the ergot powdered extemporaneously and given in infusion. Three or four years ago was asked to see a gentleman in consultation, who had had a diseased heart for a year, with anasarca. The attending physician had exhausted all the means at his command without any benefit to the patient; among them the ordinary preparations of digitalis and hydrogogue cathartics. He ordered an infusion of digitalis, prepared as above described. In three weeks the dropsy was gone and a very marked general improvement was observed. An occasional dose of the digitalis kept down the anasarca. The patient was very sanguine of a complete recovery, notwithstanding he was warned that he had a serious and necessarily fatal disease of the heart.

Dr. John G. Westmoreland reported a similar case, which had been treated with the common preparations of digitalis without benefit. He gave the substance in the form of pill, with mercury, and great improvement followed. Digitalis is a tonic to the kidneys, and acts without producing either hyperemic or anæmic condition of the organs. It imparts vigor to the kidneys. without exciting them. Digitalis also acts on the heart as a tonic, and not as a sedative. He once thought the so-called cumulative effect dangerous; was afraid to give ten drops of the tincture. It has been demonstrated, however, that a half ounce may be given, and repeated, without poisonous effects. He usually gives one or two grains of the powder, continued as long as the necessity for it exists. Does not believe in its cumulative effects.

Dr. Baird inquired in what way bromide of potassium exerted a beneficial influence in such cases, and why did Dr. W. combine mercury with the digitalis in his case.

Dr. Westmoreland replied that he gave the mercury to increase the secretion of bile.

Dr. Taliaferro was inclined to the belief that the beneficial effects of bromide of potassium were due to its sedative action.

1

Dr. Battey remarked, in reference to the poisonous action of digitalis, he had seen unpleasant effects only in one case, and they were momentary, occurring in a patient under the following circumstances: He had prescribed the infusion for an old gentleman suffering from obstructive valvular lesions of the heart, and consequently congestion of the lungs upon exercise. He, on one occasion, by accident, took a double dose, which very much depressed the pulse and produced other alarming symptoms. This condition continued for an hour, when the untoward symptoms passed off, and very decided relief followed, patient feeling much better than after an ordinary dose. The good effect of bromide of potassium is probably explained in two ways, i.e., by diminishing the caliber of the blood vessels, and thus lessening the supply of blood to the brain, and by obtunding the sensibility of the brain, warding off convulsions and tiding the patient over the critical period. He also believes that, by balancing, as it were, the nervous system, the renal secretion is promoted.

Dr. Armstrong stated that the case of meningitis reported by him two weeks ago terminated fatally the next day. Has since that time had another fatal case of the same disease in a child æt. six or eight. A peculiarity of the last case was tumefaction, extending along the course of one of the sternocleido mastoid muscles. Observed this same feature in a fatal case of meningitis last winter. Has met with it during the present winter in cases of ordinary influenza. Saw a case a few days ago of depression of one of the cranial bones. A boy, æt. six or eight, was lying on the ground, when a bale of cotton fell on his head, crushing in the upper border of the temporal bone to an extent equal to the thickness of the skull. When first seen the symptoms of concussion were present; he was sleeping, and pulse very weak. The circulation soon became re-established, and the next day the pulse was 112. Ordered veratrum viride sufficient to maintain pulse at 90. As he has continued to improve without an unfavorable symptom, he determined not to interfere with the depressed bone.

Dr. Battey expressed himself as decidedly of the opinion that in such cases circumstances that would justify surgical inter

VOL. XII-No 1-48.

ference must be imperative. There is a single exception; in punctured fractures the trephine should be used.

Dr. DuPre indorsed the views expressed by Dr. Battey.

Dr. Battey reported progress on a case originally reported by Dr. W. F. Westmoreland, October 27, of a young lady suffering from an extremely painful tumor of the right mammary gland, for which electricity was used with signal and immediate relief. He recently learned from the patient that the paroxysms of pain are not now confined to the breast, and are not so severe. She says they are "general-all over." She has abandoned the use of the battery, as its remedial effects seem to have been lost; and as the pain is "all over," she does not know where to apply it. Her menstrual function is not perfect; regular but scanty. After the positive current, which was first resorted to, began to lose its effect, the negative was substituted, with equally satisfactory results at first, but it soon wore out, and neither then afforded relief. He is of the opinion that the sole benefit was due simply to the nervous shock, and when the system became gradually accustomed to this it ceased to produce any perceptible effect.

ATLANTA, GA., February 16, 1874.

Dr. W. S. Armstrong, President, presiding.

Dr. Battey said, apropos to the discussion at the last meeting, that he was called to see a patient the following day, eight months pregnant, suffering from anasarca and difficult respiration; slight cerebral disturbance, urine scanty-about two or three ounces in twenty-four hours; bowels not constipated; was apprehensive of convulsions. Next day urine somewhat more abundant; no albumen. Ordered bromide of potassium; twenty grains every two hours, for three or four doses, to quiet the nervous system, and dessert-spoonful of the infusion digitalis three times a day. In twenty-four hours the improvement was marked; in sixty hours the anasarca was almost entirely gone; the kidneys responding promptly and freely.

Dr. John G. Westmoreland reported the following case: Girl aged eight or ten; pain in back; experienced great difficulty in moving about; soon became entirely helpless; is unable to move or sit up, from pain in the spinal column. This condition has continued for three weeks. Cups and a blister afforded no

relief. There is no fever; excessive tenderness over the whole spine.

Dr. Battey had a parallel case about two years ago; immediate relief was had upon the expulsion of worms from the intestinal canal.

Dr. Stout referred to a similar case in a boy æt. ten; suffered great pain in spine; limbs drawn up. Was treated without benefit for several months for rheumatism; suspected worms. The action of calomel and turpentine confirmed the diagnosis, with entire relief to the patient.

Dr. Battey stated that a correspondent desired the opinion of the Academy in regard to the treatment of nasal catarrh; also as to the nasal douche.

Dr. Logan has no confidence in any proposed mode of treatment; has had considerable experience in those cases, but no permanent success.

Dr. Armstrong called attention to the difference between simple catarrh and ozona dependent upon carious bone. No expectation of benefit from treatment in the latter disease. He adopted the use of the nasal douche some years ago; has seen great pain result from the employment of medicinal agents of the strength advised by some. In one case inflammation of the internal ear followed the treatment, and it may have been caused by it. Has almost entirely abandoned the use of carbolic acid, nitrate of silver, sulphate of copper, etc. Now uses simply a solution of common salt in water. Has seen several cases cured; only, however, when the disease was confined to the schneiderian membrane; the bones were not affected. Applies the salt and water by means of the nasal douche, and has never seen any ill effect. The application is made one, two or three times daily, and it should be continued for a considerable time after the disappearance of the symptoms.

Dr. Stout had been informed by a number of surgeons in different parts of the country, that they regarded the nasal douche as a dangerous instrument, and that serious consequences sometimes followed the retention of the fluid in the internal

ear.

Dr. Armstrong replied that no doubt such cases do occur, but thinks they are due to the too great strength and the irritating character of the solutions employed.

Dr. Battey's observations corresponded with Dr. Armstrong's.