hours the aspect of the disease would apparently warrant its being termed inflammation of the chest. At the period of the first attack, the paroxysm had existed for some hours when I was called in to see the patient, and I regarded it as an inflammatory affection, and treated it by large bleedings. The blood first drawn did not exhibit any buff, but at the third bleeding there was a slight appearance of it. The pain was little affected. Leeches were applied, blisters and the strictest antiphlogistic regimen enforced; but the influence of these measures on the disease was by no means satisfactory. After about ten days the pain subsided into a dull aching sensation; and this I could not relieve by any plan of diet, or by medicines, sedative, tonic, or purgative. Mercury also was tried in vain.

After about two months, another severe paroxysm, with a precise reiteration of the symptoms, was treated on the same plan, and with a result perfectly similar. The pain remaining after the severer paroxysm had subsided was sufficient to give the patient great annoyance, and to cause a constant depression in her spirits.

A third attack occurring, I was sent for sufficiently early to see the successive changes in the symptoms, and remarked that all had their origin from the pain. This time stimulants and narcotics were depended on, with such variation as the circumstances suggested; but this plan succeeded no better than the former. The dull harassing pain left was accompanied by no deviation from a healthy state of the functions, except rather a feeble appetite and sluggish bowels; the latter readily obviated by any mild aperient. Change of air, perfect rest, then exercise and various modes of living, were tried, and without any apparent effect on the pain.

In another month the attack returned, with more than ordinary severity: having then recently seen the effect of acetate of lead in cases of nervous pain, I gave three grains of it every three hours, followed by a draught of very dilute acetic acid, (ten minims of the strong acetic acid to two ounces of water.) In about thirty-six hours the pain was greatly relieved; more strikingly so than it had ever been by former remedies. Then, extending the interval of the doses first to four, and afterwards to six hours, it was continued for four days longer, when the pain was completely removed, and not the slightest vestige of it has existed since, and the patient perfectly recovered her health and spirits.

In administering the acetate of lead, it is necessary to be

aware that, in some constitutions, the first few doses may produce a griping pain in the bowels: this has, however, happened but in one or two instances in my practice, and was immediately relieved by a small dose of sulphate of magnesia. Costiveness is a more frequent effect, and happens after the acetate has been taken for a day or two: it always may be readily removed by some mild purgative, castor oil, jalap, rhubarb, &c.; but all salts should be avoided. While the acetate of lead is taken, the stools are black, making it apparent that some of the lead must get into the larger intestines, and be combined there with sulphuretted hydrogen. After continuing it for a period varying in different individuals, from a few days to a week or more, it appears to act on the nervous system specifically, the disease yields, and a numbness is felt in the ankles and wrists, attended with shooting pain; the evidence that the influence of the medicine is exerted on the system. These effects, resulting from a slow exhibition of the acetate of lead, as compared with the comparative inertness of a single dose, closely resemble the variable uses of other remedies, (calomel or colchicum, for instance,) according to the mode of their employment. When these symptoms occur, the medicine should be discontinued; but, indeed, it will seldom be found necessary to proceed further.

CASE II. Mrs. H., a pale but stout female, aged thirtyfive, had lost all her children from scarlet fever, and, with her husband, had herself gone through a severe attack of the disease, and suffered much from the sequelæ, ædematous swelling of the legs and other parts. Before her strength could be restored, she was attacked by a pain in the face, at first slight in degree and constant, but it soon became aggravated and intermittent: in a word, it was unequivocally tic douloureux. It is unnecessary to describe the paroxysms of this well-known affection, and the causes exciting them in greater or less severity: suffice it to say, the patient's sufferings were tremendous. The carbonate of iron and sulphate of quinine were severally tried, and fairly, but without the least apparent benefit. I then had recourse to the acetate of lead, exhibited in the same manner as in the preceding case. The numbness and pain in the joints were produced in five days, and the pain in the face was entirely removed. Aperients were called for during the administration of the remedy, and for a short time afterwards, which, with the assistance of a light tonic, restored the patient to her accustomed health.

CASE III. The next case I shall quote tends rather to illustrate the views I have ventured to give in pathology, than to be decisive of the value of the acetate of lead. It was, indeed, the first case in which I employed that remedy for pain of a nervous character, directed by reflections on the effects usually seen when it has been given in hemor rhagies, and one or two cases of gastrodynia relieved by it.

A young man, about eighteen years of age, applied to me for relief from a pain in the right side. The history he gave of his disease was, that it had occurred first when he was at school, about four years before; that he could scarcely ever say he was entirely free from it, but that, at uncertain intervals, from a day or two to several weeks, he was liable to pain of extreme severity. He had been treated by several medical men, and, as far as I could learn from his own relation, on the general principles of bleeding, purging, counter-irritants, &c., but he had never experienced any decided benefit from any thing. The pain was situated exactly in the region of the gallbladder, chiefly in a space of about three fingers' breadth, but spreading around into a larger space. There was no tenderness on pressure, no evidence of any disturbance in the function of the gallbladder, liver, stomach, lungs, or bowels; the pulse quickened during a paroxysm, the tongue became furred, and skin hot and dry; but at other times no marks of febrile action were present. The patient's appetite was good, and there was no sickness; he followed a laborious occupation, that of a butcher, ate heartily of animal food, and was ca pable of much muscular exertion.

His first application to me was in November 1827. He had been accustomed to seek the temporary relief of an opiate, and strong pressure on the part, after a blister and a free purgation. I gave him the acetate of lead in small doses, and combined with opium: this not relieving, I ventured on larger doses and uncombined, and it succeeded beyond my expectation. The patient felt more benefited by this than any former plan, and in a fortnight he was free from pain.

In March 1828, he had again a slight attack, but it was immediately subdued by a few doses of the remedy. From this time he continued well until the 17th of December in the same year, when, after feeling a slight degree of pain for a few days, an attack of extreme severity suddenly

came on

No small portion of the public unfortunately entertain the extravagant notion that a remedy, to be of any value,

must not only cure a present malady, but must prevent the possibility of a future return, in spite of every opposing habit and circumstance of the patient. In the present instance, as I was not immediately at hand when summoned, a physician was sent for: I communicated my opinion of the nervous character of the disease to him, but he saw reason to adopt a different view, and treated the case as inflammatory, by bleeding, purgatives, salines, cupping, leeches, blisters, warm baths, and every other means that could be devised, and without the slightest benefit. Indeed, as the patient became weakened, the paroxysms of pain became more frequent and severe, and at length there was scarcely any intermission. Sedatives, opium, and henbane internally, belladonna in the form of extract externally, were equally unsuccessful. Again, the depletory measures were gone over, and a period of three months had now elapsed since the first commencement of the attack; and, although the strength of the patient was by this time dreadfully prostrated, the patient being put under my care, I determined on a trial of the acetate of lead. After three days the pain was relieved, but the ankles and wrists were severely affected. Light tonics and aperients followed, and the patient left town for the country better, yet with a constitution dreadfully shattered by the long-continued suffering. The change of air did not rally him, and he returned to town, and sought the advice of another physician, under whose care he continued for a month, apparently improving, but not very rapidly. During this time the remedies employed were various; tonics, bitters, aperients, &c. No severe pain was experienced, but occasional pains wandering over the body and limbs were relieved by small doses of Dover's powder.

The patient thought himself able to return to his employment, and essayed to superintend the business of a slaughterhouse: he was tempted to make some violent exertions, and the result was that he was attacked by peritoneal inflammation, that quickly destroyed life.

The post-mortem examination of this case furnished a striking illustration of the extent to which disease may proceed in the production of suffering, without leaving any trace in the structure of the body. The marks of recent inflammation, effusion of serum and floating lymph, were all evident enough to account for death, and of recent origin; but the liver, gallbladder, stomach, and indeed every other organ, were entirely healthy, except a small spot of the stomach, the appearance of which was consi

dered very equivocal. I cannot avoid the conclusion that, had the acetate of lead been given in this case, before the plan adopted in December, it would have removed the primary element of the disease, the nervous pain.

CASE IV. Pain in the region of the spleen is common to young unmarried women, whether arising from sympathy with the uterine system, or being a simple nervous affection per se, it is by ordinary means very little influenced.

Mary Heygatt, æt. twenty-five, has suffered very greatly for a long time with this pain, aggravated at uncertain intervals, and independent of any mode of living, exercise, or rest. None of the vital or animal functions are at all impaired, except when severe pain produces effects perfectly analogous to those mentioned in Case I. I had twice treated her by bleeding, but the result was so unsatisfactory that I resolved on adopting other means should it again return. The opportunity was soon afforded, and the acetate of lead perfectly removed the pain in two days.

It would be easy for me to add a multiplicity of cases where lead has been beneficially employed. I have selected the foregoing, because they appear distinctly to answer the purpose of standing as exemplars of a great number and variety constantly met with.

In conclusion, I would observe that, should it be supposed, from the absence of particulars, the cases are not sufficiently authenticated, and that this would involve some difficulty in private practice, I should be very happy to satisfy any one on the subject, and also to receive any communications either tending to establish or invalidate my conclusions.

TARTAR-EMETIC OINTMENT.

On the Use of Tartar-Emetic Ointment in Chorea, &c. By CHARLES BYRNE, M.D. United States' Arsenal, near Baltimore.*

SINCE the period when the illustrious Jenner drew attention to the external use of tartarized antimony, and produced so many interesting cases in proof of its efficacy in the treatment of a variety of troublesome diseases, very little experience has been offered to the profession as a test of the value of the remedy, or the soundness of his speculations. All that has been offered, however, is well calculated to increase our confidence in its virtues, and to entitle it to a more extended trial.

*American Journal of Med, Sciences.