necessary to condense the pulmonary tissue by arseniate of strychnine, tannic acid, ergotine and quinine (arseniate, hydroferrocyanate) :— A granule of each, every quarter-of-an-hour. Acidulated drinks, absolute rest, and Seidlitz salt, will also be required. On the cessation of the pulmonary hæmorrhage, a reaction may take place with elevation of temperature (39°, 40°c.), hard pulse, and a return of all the precursory symptoms of hæmoptysis. Venesection must be again performed and defervescents given-aconitine or veratrine and digitaline : A granule of each every half-hour, until complete sedation. : Pulmonary fever of a larval character requires the employment of quinine, preferably the arseniate and the hydroferrocyanate. This fever may be recognised by its abrupt appearance, by the prevalent medical constitution, and by the three stages of cold, heat, and sweating. As soon as the cold stage has passed away, there must then be given : Arseniate of quinine, hydroferrocyanate of quinine; a granule of each every half-hour, until cessation of the symptoms. Hæmoptysis arising from organic heart disease, should be combated by digitaline and arseniate of iron with mineral acids : A granule of each, every half-hour. 15 to 20 drops of neutral perchloride of iron, in a spoonful of iced water, several times a day, according to the importance of the hæmorrhage. Ice to be applied to the chest. Seidlitz salt as a refrigerant. Cardiac Congestions (active, passive).-Active congestions of the heart predispose to organic maladies of that organ. Due, most often to moral causes, they are instantaneous, with a feeling of retro-sternal constriction, followed by a bounding of the heart, as though it would escape from the thorax. If this condition persists, and the pulse continues hard, it will be necessary to bleed, and immediately afterwards to give digitaline and arseniate of strychnine; for it is important, in the first place, to restore the regularity of the contractions, by giving tone to the organ :— A granule of each, until complete sedation. It is an error to suppose that because the patient has been bled, all has been done: on the contrary, only mechanical accidents have been guarded against. What is called nervous disorder of the heart, is only the result of disturbance taking place in the rhythmical movements of that organ from some moral cause. There are no congestions of the heart similar to those of the parenchymatous organs, such as the lungs, liver, etc. It is in the cavities of the heart that the congestions take place, and those cavities auricles or ventricles— become finally distended. Thence, the necessity of giving together digitaline and strychnine, so as to calm, and at the same time give tonicity to the centre of circulation. In consequence of the terrible events of 1792-93, an enor mous number of cases of heart disease occurred, which enabled Corvisart to compile his immortal work. It is probable that if digitaline and arseniate of strychnine had been then known, that great practitioner would have profited by them. Later on I shall treat of inflammations of the heart and its membranes. Hepatic Congestions.-These congestions are rarely active, and are dependent on stasis of the blood in the portal vein and its branches. In lieu of a centre of impulse, nature has given to the liver a contractile capsule or cellulo-vascular membrane (Glisson's capsule). Notwithstanding this precaution, the liver is easily congested, and it must be aided by quassine and arseniate of strychnine, which at the same time cause the bile to flow into the duodenum : Four to six granules of each, daily. The quassine shortly before meals; the strychnine in the intervals. Care must be taken to unload the intestinal canal by Seidlitz salt, which will also have the effect of maintaining the fluidity of the blood, because it is for want of such fluidity that engorgements of the liver take place. These engorgements have the effect of compressing the hepatic cells, and thus preventing the elimination of the bile principles. Hence, the frequency of jaundiced conditions or icterus. Congestions of the liver may also depend on obstruction of the hepatic veins, the result of organic diseases of the heart (nutmeg liver). Strychnine and digitaline must therefore be given together. (Vide Congestions of the Heart.) Splenic Congestions.-The same considerations are attached to splenic congestions, which are accompanied by a pain in the side (stitch), which might cause them to be mistaken for pleurodynia, if plessimetry (mediate percussion) and the splenic complexion* or the colour like old ivory did not permit a diagnosis to be made. These congestions often give rise to hæmatemesis, on account of the reflux of the blood in the gastro-splenic veins. The same treatment must be employed as in hepatic congestions. Paludal miasm produces congestion of the liver and spleen, by preventing the oxydation of red globules, probably on account of the hydro-carbonated gases which exist in the water and air of marshy regions; for it is as much by gastrointestinal as by pulmonary absorption, that the gases are introduced into the blood. Arseniate of soda and arseniate of quinine, are the two modifying agents which must be employed :- Ten granules of each a-day, two by two, between meals. Since the discovery of quinine, and its administration in intermittent fevers, the upholders of cinchona in substance * Splenic cachexia may be recognised generally by a peculiar anæmic appearance of the mucous membranes and skin, the former being pale and bloodless, and the latter of a waxy, earthy, or sallow aspect.-H.A.A. have pretended that its alkaloid would produce engorgements of the liver and spleen. This was a singular reasoning on the part of those who were abusing so enormously the bark of the Peruvian tree. It has been observed, on the contrary, that since that epoch, dropsies, caused by obstructions of the liver and spleen, have become less frequent. The alkalines are generally abused in abdominal engorgements. Of mineral waters, choice must be made particularly of those which contain saline, ferruginous, and arseniated elements, such as the waters of Bourboule. These waters are thermal (54°c.), and contain :-bicarbonate of soda, 2 grammes 27 centigrammes; chloride of sodium, 3 grammes 245 centigrammes; bicarbonate of protoxide of iron, 6 centigrammes; arseniate of soda, 617 centigrammes; free carbonic acid, 900 centigrammes in a litre of water.* It is evident that these are, in a great measure, the inorganic elements which the blood contains in its normal state, and which are deficient in engorgement of the portal vein. On that account, the ancients said: "Vena portarum, porta malorum." Those whose means do not permit them to visit these waters, should substitute for them the Seidlitz salt and the arseniates, as I have previously mentioned. Intestinal Congestions.-These congestions are caused, generally, by a sudden chilling of the peripheral surface of the body, especially of the feet. They may depend also on miasmatic agency, as in Asiatic cholera and the pernicious fevers. The cyanosis extends then by degrees to all the organs and to the periphery of the body. Haste must be made to restore the heat by energetic frictions, and not by artificial warmth, which would have no other effect than to hasten mortification, as is observed in cases of frost-bites. The patient must be warmly but lightly covered (with an eider-down coverlet, for example), and frictions The gramme is about 15 grains troy; the centigramme is equal to 1-6 grain; the litre is about of an imperial quart.-H.A.A. should be made under the coverings with a warming liquid (brandy, aromatic vinegar, etc.). The ethers must not be given, as they increase still more the asphyxia of the blood, neither should the essential oils (mint, camomile, etc.) be administered, because they burn the mucous membranes. On the contrary, small pieces of ice must be given to the patient, who is suffering from inward heat. (Vide Cholera.) Colics must be combated by hyosciamine and strychnine. A granule of each, together, every quarter or every half-hour. In reference to what might at first sight appear contradictory in the above treatment, I would observe that in colic there is a rupture of the equilibrium between the circular and the longitudinal fibres. It is so in saturnine colic, where no result is obtained except by the association of hyosciamine and strychnine. In order to promote the sliding of the intestinal matters, a table-spoonful of olive oil should be given in preference to castor oil, which contains an acrid principle when it is not quite fresh, as is usually the case with the castor oil of commerce. I would mention here, relatively to the employment of castor oil, that it contains, first, a solid matter, representing two-thirds of the weight of the oil, and which constitutes the residue; second, a colourless volatile oil, very homogeneous, crystallising by cooling, and which, on saponification, yields three fat acids, ricinic, elaidic, and margaric, of which the two first are extremely acrid; hence the colics which castor oil causes with many persons, and the more so when there is congestion of the intestine.* * It is a common custom with most persons when suffering from "pain in the bowels," congestive or otherwise, to fly to strong purgatives for relief. Their belief is that a "good purge" will remove the pain, and cause a subsidence of all the other symptoms. In fact, a purgative is considered to be a remedy of universal application in every manner of disease, no matter how different. To illustrate the danger of this socalled "clearing out," the following article from the British Medical |