lon, or eaten with a piece of bread and a little rum, they are perfectly contented. This manner of living, no doubt, tends to produce a grossness of habit, of which there is no want of proof, to any person, who has had an opportunity of seeing, and treating their diseases.

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Again, the disparity of seasons in that climate, may have some influence in arousing affections, which, in a more uniform temperature, and better regulated habits, might for ever have lain dormant. In a climate, where in summer it is no unusual occurrence for Farenheit's thomemeter, placed in the shade, to rise as high as 96°, and in winter to sink to 25° and 30° below zero, one would suppose that a considerable modification of dress would be absolutely necessary. But this the Canadian in a great measure disregards. He may be seen in summer in his jacket and trowsers of coarse homespun, and his bonnet rouge on his head, and in winter he makes little addition, except a great coat of the same stuff, with a sash for the middle; but these are so carelessly put on, that they appear to be worn more from fashion, than from any necessity arising from the weather. I have frequently seen so much indifference displayed by these people, that in the coldest weather, they would drive over the snow, with their clothes so loosely fastened, that their bare bosoms would be exposed to a piercing atmosphere. That this exposure to the inclemency of the weather is calculated to call into action the predisposition to the disease may be inferred from the fact, that the higher classes of society, are comparatively little affected,-the English settlers never, and their children very rarely."

We fancy that few are now inclined to attribute very much in their theory of causation to the snow-water, but that the water in one way or other operates in the production of goitre, we have ever maintained and do still believe. Diet may have some effect in certain places, but in the Alpine regions, the cradle of the cretin and the land of goitre, nothing is more certain than that children fed in very various

ways are almost equally liable to bronchocele. With regard to the exposure of the Canadian to atmospheric changes we shall simply observe that such exposure does not produce bronchocele elsewhere, nor is it probable that of itself it should prove a material cause of the disease. Mr. Bowie believes that it is connected with a scrofulous diathesis, and as there is no great novelty in this opinion we need dwell on it no longer. We pass to another point.

With regard to the treatment of goitre, it is unnecessary to enlarge on the different remedies which have been employed for this purpose. It may be sufficient to state, that I have tried almost the whole of them, and never saw any good effects produced except from the iodine. So extraordinary have I found the efficacy of this remedy, that frequently while the tumour was rapidly disappearing under its influence, I have purposely stopped it, and substituted some such remedy as the potash, and most commonly the curative action was immediately suspended, and no farther progress made until the iodine was resumed.

"It seldom happens, that the Canadian peasants apply for medical advice at an early period; it is only after their own receipts have been long made use of in vain, and the complaint existed probably for a number of years, and attained such a size, as to become a deformity, that they consent to apply to the surgeon. Their backwardness will appear the more excusable, when we consider that until very lately, they were sceptical as to the power of medicine in the cure of bronchocele. This want of faith, however, is rapidly disappearing, and a belief, that medicine has some influence over this hitherto intractable complaint, is now manifested by those children of the forest, who form an opinion from the effects which they themselves have seen produced, without regard to traditionary prejudices.

"Very few cases that were not of longer standing than five or six years, failed either to be cured, or very materially alleviated, by a sufficiently long continuance in the use of iodine. The

form used, was that of tincture, made by dissolving 48 grains in an ounce of spirit of wine. It was generally commenced in the dose of ten drops, and gradually increased until it reached thirty, three times a day. The time that elapsed before any effect was produced, was very various; sometimes there was a diminution in about eight or ten days; at others it was a month or two, before much progress was made. Occasionally a case occurred, over which the tincture of iodine seemed to have little control. In such, an ointment of the hydriodate of potash, rubbed on the swelling, was substituted, and often proved a powerful remedy. Very few cases occurred (with the exception of those of very long standing, where probably the derangement of the gland was so great, as to be altogether irremediable,) that withstood the use of these two remedies combined. In general, however, either of them was sufficient to effect a cure. It may be necessary to remark, however, that in recent cases, where pain and inflammation existed, the iodine or the ointment were not primarily employed. In such cases, it was found necessary to adopt an antiphlogistic plan of treatment, until the inflammation had abated. It was when the tumour had become somewhat indolent, that the beneficial effects of this specific were most marked."

When goitre is endemic and prevails to some extent it would appear to be more under the influence of iodine, than in counties or districts where it is sporadic only. At least, if this be not the fact, it will be difficult to account for the discrepancy of results between the iodine practice in Switzerland, and in Mr. Bowie's hands in Canada, and those obtained in this country. In the former it is hailed as almost a specific, in England it is a valuable remedy, but by no means infallible. We have witnessed its failure in several instances, and the statements in Dr. Bardsley's recent Hospital Reports, are very decisive on this point. This may be unpalatable to enthusiasts.

Locomotive Apparatus.-Very much enfeebled, scarcely able to walk.

Digestive Apparatus.-No appetite. He did not complain of pain in any particular part. Ordered valerian tea.

November 25th.-I visited him again, and found him labouring under hallucinations, of which he was sensible; for he observed that though the figures were before his eyes, yet he knew they were deceptive. He complained also of pain in the epigastrium, and suffered from a retention of urine. The muscles of the abdomen were rigid, and drawn towards the spine. He had spent several nights without sleeping. Ordered opium two grains, and camphor one grain, to be made into a pill, and repeated every three hours till sleep be procured. Four of these pills produced the desired effect, and he slept soundly the following night.

The next day forty leeches were applied to the epigastrium with much advantage in diminishing the pain there, and two days afterwards a blister was put upon the same region.

December 1st. His speech became suspended; great tenderness occurred in the abdomen, and the most excruci ating pain in the lower extremities upon their being moved. His tongue became covered with a thick yellow coat;

and his strength exceedingly prostrated. Volatile alkali was administered in a julep to the amount of five grains every two hours. He took several doses of it, and the next day I found that the moisture of the tongue had disappeared, and the yellow coat had dried up into a dark brown one. In the further progress of his treatment up to the day of his death, a mild cathartic was administered on three or four occasions, also a decoction of serpentaria and bark at intervals. His nourishment was wine whey, arrow root, and such light articles as he could be induced to swallow. It was attempted twice to leech him on the head, but the leeches refused to bite; he was then cupped on the temples. He was also cupped along the spine, half a dozen cups on each side; and had mustard poultices applied to his ankles. He sunk gradually, and died this morning, December 7th, at four o'clock. From the day on which the retention of urine first occurred till the day of his death, the bladder continued paralytic, and an extremely fœtid, dark urine was daily brought off by the catheter. Also, for several days before death, he was incapable of moving the lower extremities, notwithstanding their extreme sensibility to the touch.

Autopsy. Twelve hours after death. Head. Very strong adhesion of dura mater to bone. In attempting to remove the latter, several drachms of serum were lost, which were supposed to come from beneath the tunica arachnoidea. The latter was turbid, and raised in vesications.

roots of posterior fasciculi, but still having a superabundance of blood,

Thorax.-Ancient universal pleuritic adhesion on both sides; lungs healthy; heart healthy, its blood not coagulated. Abdomen.-No peritoneal disease.

Stomach universally inflamed, and within of a deep pink colour, not coming from extravasation as in fever, but from the immense number and the fulness of its veins, which ran along the surface of the internal coat. At many places their capillaries were so numerous as to look at a little distance like small spots of extravasation, which, however, with the aid of a microscope were found to be congeries of very fine vessels. Near the cardiac orifice there was a round patch, two or two and a half inches in diameter, consisting of thickly interwoven veins, containing black blood, and looking as if they were varicose; they were on the internal surface of the mucous membrane. In the pyloric region were two reddish slate-coloured patches, the indications of a chronic irritation there, and about twenty-four lines in diameter. Pylorus thickened; stomach small; scarcely any gas in the bowels.

Mucous coat of duodenum and jejunum inflamed to almost the same red colour with that of the stomach; ileum and colon of a bright pink colour internally; no ulceration of intestines; colon contained some well-elaborated fæces.

Liver common size, degenerated into a drab colour, hard, diminished vascularity; acini consisted in little hard scirrhus-like grains. The secretion of bile seemed to have been suspended, for the gall-bladder contained only a little black-coloured mucus.

Pancreas healthy; spleen healthy; kidneys healthy. Mucous coat of bladder inflamed, being injected with a network of veins, large and small, which were particularly abundant about the neck."*

We shall not attempt to decide on the priority of disease in the brain or

American Journ. Med. Sciences,