The chief points of distinction between the two diseases are: In chronic pleuritis a large accumulation of liquid causes a visible change in the size, form, and expansibility. In hydrothorax such changes are not seen, for such an accumulation in both sides of the chest is incompatible with life. Only a moderate amount of effusion produces a great disturbance of the respiratory function; there is a higher degree of accelerated breathing, dyspnoea, lividity of the sur face, &c., than belongs to chronic pleuritis in a case in which the whole of one side is filled with liquid. Also, the pathological condi tions associated with hydrothorax, such as ascites, hydro-pericarditis, organic disease of the heart, general debility, render the system less able to bear up under a diminution of the respiratory function, than in a majority of cases of chronic pleuritis.

In cases of cardiac and venal dropsy, the affection is always double. The causes act easily on both sides, their modus operandi being purely mechanical. For this reason it is impossible that the quantity of effusion should ever be sufficient completely to fill the chest, as death must result before such accumulation could take place.

"In hydrothorax friction sounds do not occur. The condition for their production, viz., roughening of the plural surface by a deposit of lymph, is incident to inflammation, and does not obtain in a purely dropsical affection. This is a negative point. A positive point is, that in case of non-inflammatory serous effusion, the liquid as a rule, if not invariably, can be made to change its level by varying the position of the patient; the quantity of liquid ever becoming very large, and the pleural surface remaining free." This test of effusion is generally available, while in pleuritis it is employed successfully in a certain proportion of cases only.

5. HYDROCELE, OR DROPSY OF THE TESTICLE.

A description of this disease is appropriate to surgery rather than to medicine; but, as the usual method of cure serves to corroborate the truth of the homeopathic law of cure, we make some allusion to the subject in this place.

The fluid of hydrocele is situated within the tunica vaginalis testis, commenciag at the lower part of the scrotum, and gradually extending upwards until it reaches the external abdominal ring. The tumor is pyriform in shape, firm and elastic to the touch, and unattended with pain. It is only troublesome from its bulk and weight.

Much difficulty is sometimes experienced in distinguishing this disease from enlargements of the testicle, and in more than one instance we have seen this gland destroyed by injudicious attempts to draw off water from chronic enlargements of the substance of the gland. Gene

rally the dropsy of the testicle may be recognized by its peculiar elas ticity, its lightness, form, its origin at the lower part of the scrotum and its gradual extension upwards; and lastly, by its transparency By placing the swelling in front of a lighted lamp in a dark room, its character will be apparent from its transparency. But in some cases, from the great thickness of the tunica vaginalis, or the dark color and density of the enclosed fluid, no transparency can be perceived. In these instances we must be guided by the fluctuation, lightness, form, painlessness, and general history of the case.

Accumulations of fluid also occur within the membrane of the spermatic cord, constituting the disease known as spermatocele. This is a local affection, analogous in its nature to hydrocele.

Hydrocele occasionally occurs as a congenital disease, arising from an imperfect closure of the tunica vaginalis, and thus permitting the fluids of the abdomen to descend into its cavity.

OPERATION. The most successful means of treating hydrocele is to evacuate the serum by means of the trochar and canula, and then to create a healthy medicinal action in the vaginalis with suitable injections. Merely drawing off the fluid is seldom of any avail in affecting a cure, for the morbid condition of the membrane is still remaining, and the exhalents again fill up the cavity. Change then the morbid condition of the structure, and supersede it by a new and different, though similar action, and you will cure the disease. But it will be said that by applying our remedies directly to the structure, we are obliged to create more inflammation than is necessary to effect a cure. Show us, then, how it can be effected by internal remedies with any kind of certainty,-point us to a specific which will reach the case, and we will be the first to adopt it.

The most reliable medicine we have ever used as an injection, is a mixture of one part of Tincture of Iodine to two parts of water. Let this be injected within the tunica, and remain for five or ten minutes, or until sharp pains are experienced in the gland and the spermatic cord, after which carefully permit the fluid to escape from the canula. The use of Iodine is not likely to be followed by undue inflammation or sloughing, yet it almost invariably suffices to effect a permanent cure.

Other injections have been highly extolled by surgeons, as solutions of Alum, Sulphate of Zinc, and Sugar of Lead, Port Wine, &c.; but they have too often failed in our hands to inspire us with confidence in their virtues, while uniform success has given us every reason to be satisfied with the Iodine.

Case of Cure by Dr. Hastings.-A boy was affected with hydrocele almost from his birth. At the fifth year a skillful surgeon operated upon it, discharging the water. In a fortnight the fluid accumulated. The surgeon proposed a second operation to be completed by

a stimulating injection, but it was postponed till the child should be older. The dropsical accumulation was becoming very large, and Dr Hastings was permitted to prescribe. He gave Rhododendron twelfth dilution, three globules night and morning for three days; then pause three days and repeat. A lotion was applied of:

B. Tr. Rhodod. chrys. 3ij.

Aqua font. vi.

Apply twice a day after fomenting the scrotum. The hydrocele was cured, and the boy, now seven years of age, has continued well.

SCROFULOUS INFLAMMATION OF THE SYNOVIAL MEMBRANE OF JOINTS.-HYDRARTHUS.

In joints we meet only with different examples of the connective tis sues, bone, cartilage, synovial, areolar, and fibrous tissues. A connective tissue may be said to consist of " a number of cells still retaining their nuclei, round each, or each group of which a quantity of tissue material is collected; the quantity of the tissue is derived from the consistence and constitution of the inter-cellular substance. Thus the cells of cartilage, bone, fibrous, and areolar tissue, have probably the same proteine contents, but are surrounded-the one by chondrine in a solid form, the other by lamellated bone material, the third by gelatine in a fibrillated arrangement, and so on. The function of these tissues is not vital, but mechanical; the inter-cellular substance, therefore, whereon the function depends, has no vital constitution, but each district or band is dependent upon its own cell for its support. The nutrition of these tissues is kept up by the selecting and organizing quality; their repair by more abundant multiplication, their absorption by excessive generation of the cells. Thus it is that the connecting tissues are capable of repair by like material through fresh formation of cells, which, by the law of organic descent, develop similar tissues. The means of this repair are the simplest form of the inflammatory process, as we see in the union of a wound by the second intention." (Barwell.)

A scrofulous synovitis is, in its first characteristics, not essentially distinct from another slow inflammation of that tissue, but the difference lies in the indisposition to further development. If there have been a breach of tissue from a wound, the gap must be filled up by cell-generation, which in such a case is called granulation. As long as the patient remains in a good state of health, the older cells-that is, those of the deeper layers of this formation-assume the fusiform shape, and form gradually into the fibrous material, which forms the scar; but, when the health begins to flag, the granulations do not change in that manner, but cells remain, generally, round, increased

unduly, and form those large, flabby exuberant growths which require repression, caustic, or other means to stimulate them to healthy action, and to keep down their generative tendency.

On this principle we distinguish between the healthy and strumous synovitis. In the former the membrane and sub-synovial areolar tissue generate cells, which, if the constitution be good, form new fibrous tissue, causing some thickening, and only to a slight degree interfering with the action of the joint. In the latter cells also are generated; but, instead of making fibrous tissue, they remain in the form of spongy granulation tissue, and produce that form of disease which Sir B. Brodie has named "Morbid change of structure of the Synovial Membrane." The best remedies are Kali-hydrio., Mer-iod., and Sul.-iod.

8. SPINA BIFIDA.

PATHOLOGY-In some cases the opening does not extend far into the canal; and the spinal marrow is not compressed or deranged in function. Of these many may be cured. The external tumor in these cases is generally covered with integuments and appears very firm, not easily compressed, very elastic to the touch, and yet fluctuation is perceptible; the dura mater is the only lining membrane of the cavity in the tumor, and the fluid contained does not extend far into the canal after passing the aperture in the spinal apophysis.

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In the other cases which are much the most frequent there is a thin almost transparent membranous covering in many parts of the tumor, and sometimes on the greater portion of it. The tumor is easily compressed and there is less of voluntary action some of the muscles, sometimes with derangement of the secretions. Here the fluid is contained in the arachnoid membrane, and may extend the whole length of the canal. M. Bichat and other anatomists say it may extend even to the lateral ventricles of the brain. There have been some cases in which the head was enlarged like that of a child with chronic hydrocephalus. Such cases have perhaps been uniformly fatal.

The Ligature. This mode of operation is preferred when the base of the tumor admits its application. Apply it first tight enough to produce moderate inflammation. Afterwards draw it closer as it does not then produce so much pain or so extensive sympathetic effects. All cases cannot be cured in this way.

In some this treatment would destroy the child. Dr. Trowbridge (Louisville Med. Jour., 1840,) says he has seen about thirty cases, some of which were in every portion of the spine, and were of various sizes and appearances. He had tried their treatment by puncture, incision ligature, &c., and in many of them he failed. But some were curable.

Case by Dr. Trowbridge.-Miss B., of Jefferson County, New-York, aged 25, phlegmatic temperament, mind retiring, delicate, was born with a considerable tumor over two of the lower lumbar vertebræ. The tumor was protuberant, and was pronounced spina bifida; and it was expected to prove fatal in a few weeks from birth. For twelve years she suffered but little from constitutional derangement, except feebleness; the tumor enlarging with the growth of the body. From this time to the age of twenty-five she had much extreme pain in the cerebrum, disturbance of mind, with vertigo, confusion of intellect, and some neuralgic symptoms. The secretions were natural; and the natural developments of childhood and womanhood were without unusual delay. She was of middle stature, and with perfect use of all the muscles of the body. She was during these paroxysms of pain and nervous excitement injudiciously treated by bleeding, cathartics, and Opium; but the tumor continued to enlarge. Dr. Trowbridge found it fifteen inches in circumference, covering the upper part of the sacrum and four lumbar vertebra, of conical form, rising about seven inches, covered with the integuments and distended with fluid. She had managed her dress to prevent the deformity from being noticed. Riding in a car. riage had pressed and injured the tumor, adding something to the pain and nervous excitement; all exercise increased her sufferings; and thus enlargement and concussion of the tumor continually added to her distress as well as her danger.

Operation.-Dividing the upper part of the tumor with a scalpel five inches, I encircled the prominent part of the integuments within two elliptical incisions. Twenty-two ounces of fluid resembling pure alcohol was discharged. On its standing till cold, it did not show serum or lymph, but remained clear like distilled water. These incisions and removal of the tumor exposed its interior and bottom. It was lined with the dura mater, distended and enlarged by the fluid. Two of the lower spinous processes were wanting. A cavity was presented showing the spinal cord in its natural position. The divided parts were brought together by adhesive straps, and compresses were applied, with a bandage over them. She suffered little except from the former symptoms of concussion, which were troublesome for a few months. For the first five days there was constant secretion and discharge of fluid, with neuralgic symptoms, with increased arterial excitement, these were checked by morphine and warm fomentations over the spine. Suppuration was free. On the tenth day there was mitigation of all the symptoms. There was a sound state of the parts with depression of the skin over the part. She had had continued good health when seen eight years afterwards. The proper constitutional treatment, which has often succeeded alone, consists of Sulph., Calcarea, Calc. phos., Kali-hyd., Silic.