of thirst; pain in the side and region of the liver; great sexual inclination; frequent dyspnoea; cough with mucous expectoration; stitches in the chest and side; weakness and stiffness in the smal of the back; restless sleep, with frequent waking; skin tender and sensitive; sweat on waking; sensitiveness to cold air; faint and discouraged; symptoms worse at night and when at rest; palpitation of the heart and intermittent pulse; weakness of memory; inability to think or reason; giddiness from walking; melancholy, discouragement, and irritability.

REMARKS.-Chlorosis of nervous and delicate females, with a thin and delicate skin, and in whom menstruation has always been irregular, may be cured by Sepia. If the patient sweats profusely when walking, and is particularly sensitive to cold air, this remedy is still more necessary.

In inveterate cases, attended with extreme prostration, trembling of the limbs, coldness of the surface, entire suppression of the menses, dropsical swellings, great difficulty of breathing, palpitation of the heart, loose state of the bowels, frequent and protracted turns of faintness, we may examine Ferrum, Arsen., and Veratrum. Cala ea-carb. and Platina are indicated when the menses are too frequent and abundant. These medicines are especially adapted to young female organisms.

ADMINISTRATION.-The remedies should generally be employed at the first, second, and third attenuations, and a dose administered once or twice daily, until there is apparent effect. No repetition should then be allowed so long as the slightest amendment is perceptible.

Helonin. (Helonias dioica, False Unicorn Root.) Cases of constitutional debility, anæmia and dyspepsia, associated with irregularity of the uterine functions; women subject to abortion; suffering from prolapsus uteri, leucorrhoea, frequent heavy pressive pains in the uterine region; uterine atony causing amenorrhoea or dysmenorrhoea. It is regarded by Dr. Hale and others as a uterine tonic.

Dr. Wolf says:-Chlorosis in its present form and immense extension depends on the sycotic poison; in many cases it is congenital, or shows itself first after vaccination. It resists all other treatment, or is at best palliated by it. Tartar-emetic partially antidotes the sycotic poison, at least so far as depends on vaccination. Thuja is considered best capable of eradicating it.

METRITIS.-Treatment.-If swelling, heat, pain, tenderness and fever furnish sufficient evidence of inflammation of the substance of the uterus the disease is not so uncommon as it is generally represented by medical authors.

Remedies.-Aconite, Belladonna, Nux-vomica, Mercury, Sepia, and Macrotin are the most effectual remedies in cases where there are

yellow and purulent uterine discharges, whether there is superficial ulceration or not.

In nine cases out of ten of metritis, or peritonitis, the alternate and persistent use of the first dilution of Aconite and Belladonna, will effect cures. After a large experience we have arrived at this conclu

sion.

Macrotin exerts a most controlling influence over the uterine functions, but in many cases cannot be given lower than the 6° or 9° dilution, without aggravation, especially if the uterus is rendered sensitive by anything like active disease. I have seen it restore the menstrual function more frequently and more promptly than any other drug. Pregnancy has often followed its use, after it has been long prevented by functional uterine disorder, or by chronic inflammation.

Case.-A lady, aged twenty-six, strumous constitution, had for some months uncomfortable sensations in the pelvis, pain in the back; has for a week had leucorrhoea, now constant, large in quantity, unequivocally purulent, but little tenderness over the pubis; feverish in the afternoon and night; occasional night sweats; is languid and weak; the cervix swollen, soft and puffy; has been confined to bed for a week. Regarded as an inflammation of the mucous membrane of the uterus, secreting pus, with probable ulceration. Aug. 16. Give Mer. Sol. 32, one grain morning and evening. There was progressive improvement for twelve days. Sept. 3, Sepia 6°, three times a day. In two weeks the discharge was but little; health greatly improved. Sept. 17th. Macrotin 3, one grain morning and evening. In a week the discharge ceased. Considered herself well. A partial return two weeks afterwards. Give Mac. 3°, one grain three times a day. This seems to have made the cure permanent. (Dr. J. S. Douglas.)

9. CYRTOSIS TALIPES.-CLUB FOOT.-KYLLOPODIA.

CAUSES. These deformities, whether congenital or acquired, have the generic name talipes, referring to the ankle or pastern of the beast.

Varieties: 1. Vara-foot turned inwards.

66 3. The foot from extreme tension turned upon

itself, and rests upon the ground by the superior surface.

It has long been believed that these deformities result from irregu lar conformation of the bones, or defect of equilibrium in the action of the muscles, or wrong action of the tendons. M. Duval, of Paris, more than twenty years ago proved to the French Academy that the pri mary cause of club-foot was-first, in the cerebro-spinal axis, and secondly, in spasmodic contraction of the muscles. The child in utero

is subject to violent and protracted motions; and seems in that state more subject to spasmodic and nervous affections than to any other forms of disease; unnatural posture may produce deformity. Mental emotion of the mother is considered an original primordial cause of deformities and marks. Hereditary descent is one well-established cause. Dr. Richardson, of Louisville, says: "A young man of the South, with double club-foot, assured me in 1839, that there was a family of six or seven children, male and female, all children of a clubfooted father."

The effect of position and weight of the body in walking in after life, need not be considered here; we see its effect every day, especially up to the age of adolescence. In every position in which the foot may try to adapt itself to its duties, nature, true to herself, endeavors to adapt it to its position by forming a thick skin wherever the surface is applied to the ground; and if it be the top of the foot that is turned downward, that intended for the sole is turned upward, and has the delicate skin of the natural upper surface.

TALIPES CONGENITA.-CLUB FOOT.

TALIPES.-Club-foot.-Treatment.-Club-foot is generally a con genital disease, and the treatment by which it may in a good degree be remedied, should be commenced at the earliest period of the birth. When great deformity exists in later periods of life, efforts to correct it by surgical interference is not always successful. The bones have become more unyielding, adapted to the shape assumed by the deformity, and are more firmly bound by the ligamentous bands in that position; operations which divide the tendons leave the tension of ligaments to be overcome, with all the adaptations of the metatarsal bones and their peculiar articulations. If the limb be straightened by the operation, it is also weakened in muscular power.

The treatment should be commenced in the earliest stage of infancy in an effort to control the wayward muscles, and restore the regularity of the articulations at the earliest possible moment. While the tendons are flexible, and the bones and cartilages soft and yielding, apply some apparatus that will control the foot and bring each part in proper position. A small splint and foot piece may be adjusted with broad adhesive straps to the foot, and a small pad placed over the ankle joint beneath the splint, which should have a hole in the upper end to tie the ends of another adhesive strip through, the broad surface of which should pass around the calf of the leg and be tightened at pleasure. Now place a strip of adhesive plaster so that the ends shall adhere to opposite sides of the thigh from the groin, and let the open loop pass a little below the knee. Wind another strip behind the

ankle over the top of the foot and under the foot piece, so that when it is brought up and tied in the loop of the thigh strap, it will hold the foot in a proper position. By attending to the proper angles of the splint and foot board, and tightening the two strips spoken of as they may require, the deformity of the bones can be prevented to a great degree. These dressings should be renewed once or twice a week, or as often as the straps fail to adhere, and care should be taken to have the strips as wide as possible, and not to bring any part so tight as to interfere with the circulation.

OPERATION.-But one cutaneous incision is to be made with a narrow and delicate bistoury. Avoid detaching and separating the cellular substance surrounding the tendon, and preserve as far as posssible the cellular sheath, which is to perform an important part in the work of reparation; give the least possible pain, open few vessels, thereby avoiding ecchymosis and serious inflammation. Commence flexion of the foot by the application of the appareil immediately after cutting the tendon; but avoid exciting pain in the seat of the operation.

The position of the patient is on the breast, the feet and legs are over the sides of the bed; an assistant holds the tendon slightly tense. With a common bistoury a short incision is made through the integuments upon the side of the tendon in a longitudinal direction, opposite its greatest prominence. Through the incision just made a narrow, convex probe-pointed bistoury is introduced, with which a passage is easily made by separating the cellular substance without endangering the puneture of the skin on the opposite side. The section of the tendon is made, by Stromeyer, by introducing a convex knife in front of the tendon (thereby avoiding injury to the posterior tibial vessels and nerves), allowing the point barely to issue on the opposite side of the skin. The limb is now extended to its proper position, and an appareil for support is applied to sustain it there, trusting to the reparative power of nature to fill up the space between the separated ends of the tendon. In the same manner we cut the contracted tendon in strabismus, the medical treatment of which is given p. 558, Vol. II. On the second or third day after the tendon is divided the cellular theca or sheath is thickened on each side, more consistent than natural and it is open only on the side where the instrument entered, and embraces both extremities of the tendon. The internal surface is ecchymosed, bright red, in contact with itself, or with the tendon's extremities. By the ninth day the connection is already adherent to the end of a gray colored substance without the appearance of fibres. Between the ends of the tendon is a contracted canal without an opening; its walls are in contact, and generally empty, sometimes partially filled with coagu lated blood.

CLASS VI.-DISEASES OF THE EXCERNENT FUNCTION.

ORDER I.-AFFECTING INTERNAL SURFACES.

ABSORPTION IN CAUSING AND CURING OF DISEASE.

The function of absorption is one of the most important of the human system in a state of health; its influence, therefore, in the cause and cure of disease becomes equally important. As the absorbing and circulating systems are distinct from each other, their offices present a striking contrast and seem to be entirely opposite to each other. Thus, the blood-vessels possess a susceptibility to excitement by other agents besides the blood which flows within them, and we see the arteries excited to various degrees of action, from the excessive action which ends in gangrene to the lowest grade of direct debility. We see all organs except the absorbent system under the control of the circulation, and we measure the violence of disease by the strength and frequency of the pulsations of the radial artery. But the absorbents, being unconnected with the circulation except by their attachments at their terminations, have a distinct source of independent action of their own. No external stimulant provokes them to high action, and no narcotic exerts on them any perceptible sedative influence. The heart communicates its impulse, and impels with quicker or slower motion; but the absorbents never feel its influence; and they continue their uniform action after the heart has ceased to beat. (See De Puy on Uniform Action of the Absorbents, N. Y. Med. Phys. Jour., June, 1828, p. 220, &c.)

The absorbents open on every external and internal surface of the body, and absorb and convey into the general circulation substances which may be presented to them without the body, as well as all the waste materials which are being thrown off from the various organs, and the products of disease formed in the textures of these organs, or the various secreting surfaces.

1. Absorption on the Skin.-Contagious and chronic affections of the skin may be communicated to others by absorption, either through the entire skin, or more conspicuously, when the cuticle is removed. Through the same channels remedies have been often introduced by means of baths, lotions, fumigations and inunctions. The Sulphate of