voiding the urine, and sometimes extreme pain in coitu, whilst the discharge will be frequently tinged with blood. These symptoms become modified or severe, according to the degree of descent which has taken place, or the excitability which exists in other and distant organs; hence, in a case of simple relaxation, there will oftentimes be merely a sensation of weakness, and fulness about the pubes, with an increased, but mild, mucous discharge from the vagina. I have seen several cases of prolapsus uteri, in their incipient state, most effectually relieved by the application of the means hereafter named." 29.

Inflammation of the mucous membrane of the vagina-" an important cause of leucorrhoea "-may be acute or chronic-the latter being the most common and the most insidious. One of the first symptoms, he observes, is often an increased secretion of thin mucus, unaccompanied by pain or irritation. The progress, however, of the disease, is marked by a sense of itching or burning, with occasional swelling about the labia. As the complaint advances, the vaginal secretion changes in consistence and appearance, becoming thicker, and staining the linen of a yellow colour-or assuming a brownish hue, when it is usually offensive. The glands of the groin seldom enlarge, nor is there usually much ardor urinæ, unless the discharge be extremely acrid, the vaginal surface highly sensible, or excoriation exist. After the subsidence of these symptoms, which may continue for a longer or shorter period, the patient complains of languor and debility-looks pale, with want of animation in the countenance, and a dark semicircular appearance under the eyes. The digestive functions become much disturbed, and some degree of uneasiness with distention is usually complained of in the

stomach.

"Inflammation of the mucous surface of the vagina may arise from any of those causes which produce the same action in other textures, and which may be classed under two heads :-general and local excitement. The circumstances which induce the former state, may be considered as follows; namely, a high nutritious diet, and the free use of wines, spirituous or fermented liquors; violent exertions of the body, such as dancing; pyrexia, or fever, and exposure to cold. In short, such complaints may arise from any unnatural activity in the vascular or nervous systems. Among the various local causes, may be noticed, difficult parturition, blows, the lodgement of extraneous bodies, as a pessary or piece of sponge, too frequent coition, &c.; whilst misplacements of the uterus, or its various diseases, such as scirrhus, hydatids, polypus, &c. will commonly produce irritation and inflammation, with a discharge of unhealthy mucus from the vagina. Local excitement, either in the vagina, or neck of the womb, or both, is often produced by hemorrhage, or abortions. Painful menstruation, in which there is commonly congestion of the uterine vessels, will occasionally be preceded and followed by an increased secretion from the mucous membrane of the vagina." 38.

M. Blattin examined the bodies of 24 females who died from excessive leucorrhoeal discharges, with the view of ascertaining the seat of the disease. In nine of these cases, the morbid secretion was found to arise from the uterus-in thirteen, from the neck of the uterus and vagina-and in two, from the fallopian tubes. A mucous discharge is not unfrequently discovered to arise from excoriations about the nymphæ-a species of the disease purely local, and for which Mr. Jewel thinks the nitrate of silver peculiarly adapted.

This brings us to the 3d chapter of the work, treating of leucorrhoea in children-in pregnant women and at the "TURN of LIFE."

Mucous and muco-purulent discharges are very apt to occur in children, in consequence of dentition, want of cleanliness, exposure to cold, &c. attended with ardor urinæ, inflammation, excoriation, and other troublesome symptoms. Again, in females about the age of puberty, the regular action of the uterus is prevented by leucorrhoea.

"In the treatment of vaginal discharges in children, the strictest cleanliness ought to be observed, as the secretions so soon become acrid. The parts should therefore be washed carefully with a little tepid vinegar and water, (or if this wash should occasion pain, milk and water may be substituted,) and wiped perfectly dry, at least twice a day. It often happens in young children, as well as in females arrived at the age of puberty, that there is a preternatural fulness in the system, indicated by head-ache, thirst, and a quick hard pulse; in which case, active purging, or blood-letting, should be premised, to diminish arterial action, before the nitrate of silver, or other local remedies are employed. It is only necessary to add, that the uterus seldom takes on its regular and healthy function, until the leucorrhoea be removed: an object which, in most instances, may be accomplished, by attention to the rules laid down in another part of this work." 43.

From the many instances of this discharge which we have seen in female children, and all readily giving way to cleanliness and common astringent injections of the sulphate of zinc, we cannot but consider the use of the nitrate of silver as, at least, unnecessary in nine cases out of ten of such affections. Mr. Jewel himself cautions us not to be too free with the nitrate in the leucorrhoea of utero-gestation. It has been remarked by Denman, that those females who suffer most from this complaint, have easiest labours. Our author saw one remarkable illustration of this maxim, but is not prepared to say that the rule is absolute. In general there is a state of local repletion induced by pregnancy, and Mr. Jewel thinks that, as the leucorrhoeal discharge acts as a depletion on the internal organs, it ought not to be suppressed until the congestive state of the uterine system be first removed. One thing ought to be attended to strictly-frequent ablutions during labour to prevent the infant from being affected by leucorrhoeal oph

thalmia.

In respect to the profuse leucorrhoeal discharge which sometimes occurs about the cessation of the catamenia, it must be looked upon with suspicion of structural disease. To secure a female from those ailments which occasionally shew themselves about the TURN OF LIFE, the diet should be regulated, and exercise enjoined. The usual obesity which occurs about this period renders females little inclined to corporeal exertion. Depletion is often necessary at this critical juncture, to relieve the plethora of the venous system.

"There is one symptom, the effect, in most instances, of the acrimonious quality of the discharge, which is oftentimes excessively harrassing, namely, pruritus, or itching of the parts; and it is one which demands the attention of the practitioner, inasmuch as it not unfrequently indicates disease of the organs within, as of the uterus, bladder, &c. It appears to arise from the lodgement of the irritating secretion in the vulva, or vagina. I am of opinion, that pruritus rarely comes on, without there being an acrid vaginal secretion, or an efflorescence upon the internal surface of the parts, although it may be so trifling as to escape the observation of the patient herself. A lady who had laboured onder incessant pruritus, with a slight leucorrhoeal discharge, for a period of four months, was completely restored, by injections of the solution of the nitrate of

silver. Dr. Dewees, by whom the aphthous efflorescence above alluded to was first brought to the notice of the profession, recommends, in strong terms, for the cure, a solution of borax in water, both as a wash and as an injection. An injection of the liq. ammoniæ puræ, in the proportion of a tea-spoonful to a pint of water, has been found useful; but I would place the greatest reliance upon injections of the solution of the nitrate of silver. Blood-letting, local or general, together with a low vegetable diet, will be essentially necessary to the cure of the complaint, although I have seen more than one obstinate case yield, in the course of a few days, to the injection last named, without any other aid." 56.

The 5th chapter of the work treats of the predisposing and exciting causes -the influence of seasons-of a contaminated atmosphere, &c.

Among the most common of the predisposing and exciting causes, Mr. Jewel reckons a scrofulous diathesis-irritable nervous system-derangement of the menstrual secretion-frequent parturitions or abortions-protracted lactation, &c. Mr. J. accords with Leake and some others, that leucorrhoea prevails more in the Autumn than in any other season of the year. Moisture and cold unquestionably predispose to the disease. The impure atmosphere of large cities and crowded apartments conduces much to the propagation of the malady.

The sixth and last chapter is on the treatment of leucorrhoea. Our author, as may have been anticipated, "places the most perfect reliance on the nitrate of silver," while he is anxious to impress on the attention of practitioners, the necessity, in all cases, of adopting what may be termed general principles. The state of the general health, therefore, and that of the circulation, should be examined into. Upon these points we need not dwell. Mr. Jewel thinks that more harm than good is done by cold sponging the loins, so often had recourse to, with or without advice. He prefers a tepid ablution consisting of one part of vinegar to two of water. The cold bath is often hazardous, where the patient is enfeebled by the discharge, easily put out of breath, and whose digestive organs are disordered. Of the lytta Mr. Jewel does not seem to entertain much opinion. Astringent injections, he observes, have very generally failed to cure this complaint.

"There is one medicine which hitherto has been employed upon a very limited scale in leucorrhoeal diseases, but which, I have every reason to believe, is pe culiarly adapted to assist in their removal. I allude to iodine. The efficacy of iodine over the absorbent system is now so completely established, as scarcely to require further comment, indeed, it may be stated, without fear of contradiction, that we have no article in the materia medica, possessing more influence over, or so capable of producing such extraordinary and important changes in the glandular parts of the body, as this medicine. Its effects upon the uterine system in particular, in almost all the cases in which I have employed it, have been marked and decisive.

I may here notice a case of diseased ovary, in which this little, but important, organ had morbidly increased to the size of the fœtal head. The general and visceral disturbance occasioned by its presence in the pelvic cavity, had become so distressing, that the patient, notwithstanding the fatality of an operation had been represented to her, often expressed an earnest desire to have it removed. After various means had been employed, without any beneficial result, she was put upon a course of iodine, commencing with ten drops of the tincture three times a day, gradually increasing the dose to thirty-five. She has been under the influence of this medicine about ten weeks, and at the present time, the tumour is scarcely to be felt. She has suffered nothing from such

large doses of the medicine, but, on the contrary, her spirits are greatly im proved, and she anticipates, with great confidence, a perfect restoration to health, Dr. Thomson, the able professor of materia medica at the London University, has related a case of ovarian dropsy, in which, after the woman had been tapped in the usual manner, and seven quarts of albuminous serum, mixed with pus, removed, iodine was administered, and carried to the extent of thirty-six drops of the tincture three times a day. The result was, that the tumour wholly disappeared, and the woman was perfectly restored." 80.

The mode of applying the nitrate of silver is detailed at length in our 24th No. p. 517, and therefore we need not reprint it here.

Under the head of gonorrhea, Mr. Jewel informs us that the nitrate of silver is as effectual in that complaint as in leucorrhoea. The use of this remedy is not new in gonorrhoea, as it was very commonly employed, to our knowledge, by our naval surgeons during the late war. In females we find that Mr. Jewel employs the nitrate in the proportion of three grains

to the ounce of water.

We return Mr. Jewel many thanks for the perusal of his little volume, which contains much judicious observation, with the open and liberal communication to his brethren of a remedy which promises to be of considerable service in a troublesome and obstinate complaint.

ING

XIII.

I. ON THE RECENT IMPROVEMENTS IN THE ART OF DISTINGUISHTHE VARIOUS DISEASES OF THE HEART, BEING THE LUMLEYAN LECTURES DELIVERED BEFORE THE ROYAL COLLEGE OF PHYSICIANS IN THE YEAR 1829. By John Elliotsan, M.D. Cantab. F. R.S. &c. &c. Folio, pp. 35, double Columns, with Eight Plates. Sept. 1830.

II. CASES OF PERICARDITIS. By M. Louis, Physician to LA PITIÉ.

We believe there is no hospital physician in this metropolis, who labours more strenuously to convert a public institution into an instrument for increasing knowledge and alleviating human sufferings, than the author of the work under review. Besides his excellent translation of Blumenbach's Physiology, Dr. Elliotson has, at various times, favoured his professional brethren with a work on hydrocyanic acid in affections of the stomachand many papers in the Medico-chirurgical Transactions, especially on antimonial powder-the use of opium in diabetes-on the medical properties of quinine-on subcarbonate of iron in chorea-on the same in tetanuson sulphate of copper in chronic diarrhoea-on rupture of the stomachFallopian pregnancy-glanders communicated from the horse to the human subject, &c. In all these works and insulated memoirs, our author has shewn himself a close observer and an active practitioner, who rarely or never suffers himself to be seduced from useful facts by the allurements of

theory or wild speculation. Hence it is that a great practical interest is kept up in the reader's mind, while perusing Dr. Elliotson's papers, which is not the case with the generality of works coming under our notice. There is another point which is deserving of attention. Dr. Elliotson is very scrupulous in the statements which he makes, and highly candid in the results of all his cases. We have no trifling reason to know that inattention to scrupulous veracity and unequivocal candour has been a great draw-back on the progress of medical science.

In an eloquent introduction to the first lecture, Dr. Elliotson draws the attention of his brethren to the means by which improvements are most likely to be effected in the art of medicine-namely, by increasing our knowledge of the nature of diseases-in diagnosis-and therapeutics. The knowledge of diseased structure cannot be acquired without a knowledge of the healthy-that is, anatomy is necessary to pathology: but anatomy alone will give us little insight into disease.

"An anatomist is not necessarily even a physiologist and Mery was accustomed to say, 'We anatomists are like the porters of Paris, who are well acquainted with all its streets, as well as all its lanes and alleys, but know nothing of what passes within the houses.'" 1.

The structure of the brain would never have led us to know that it was the organ of thought and feeling, without observation of those functionsin other words, physiology. Before proceeding to the immediate subject of this lecture-Pericarditis, we must indulge in an extract or two respecting the utility of auscultation.

"In improving diagnosis, it is impossible to discover only what is obviously useful. The research must be made generally, and what is at once useful and what is not, must turn up together.

In the diseases of other organs, we always aim at accuracy of diagnosis without any hope of utility. When a solid tumour exists in the abdomen, we endeavour to ascertain whether it is the liver, the spleen, the pylorus, an ovarium, a new formation, or whatever else, although the treatment would probably be the same in all.

But there is immediate utility in the discoveries of Avenbrugger and Laennec. No one will pretend that the diagnosis in chronic diseases of the chest is, with perhaps the exception of phthisis, generally satisfactory. Before I adopted auscultation, I know that I frequently discovered disease of the heart after death, where I had not previously suspected it; and frequently found the organ sound when I had supposed it diseased. When I was correct in expecting to see organic affection of the heart, I was often wrong as to the precise nature of the lesion. Too often has auscultation at once revealed disease of the heart to me, when by good practitioners no affection of the heart or even of the chest had been suspected, or the case had been named nervous palpitation or asthma; when the lungs had been regarded as the seat of the malady, or the case been treated with the more violent remedies of hydrothorax. Repeatedly have I seen chronic bronchitis with extreme congestion in the lungs mistaken for hydrothorax, and unavoidably so from the omission of percussion and auscultation, because the symptoms were precisely the same, with the exception of those which percussion and auscultation only could disclose. Inflammation of the substance of the lungs takes place continually during other diseases without being obvious before death to any but the auscultator and percussor. Without the aid of the ear, who can ever distinguish emphysema of the lungs, or in every case pneumatothorax. Both may be readily mistaken for hydrothorax. The symptoms may