DR. BEMISS:

The specimen sent contains a sediment of urate of ammonia, the only abnormal substance present; the fluid is acid to test paper, but not more so than is usual in the healthy secretion.

Very respectfully and truly yours,

LOUISVILLE, January 13th, 1854.

THOS. E. JENKINS.

A Case of Stomatitis Materna. By W. S. BARKER, M. D. Mrs. G., aged 26, of delicate constitution, was delivered of her second child, August 15th, 1857. She had suffered some from diarrhoea and gastric disorder, during the latter months of uterogestation. She had a mild attack of stomatitis, while nursing her first child. I visited her, with Dr. Asa Horr, Oct. 24th. Her symptoms were as follows: Profuse diarrhoea; acid eructations; great debility, and a hot, uncomfortable feeling of the mouth and fauces. There were numerous small ulcers on the edges and under part of the tongue, and a tender condition of the cheeks and mouth. The difficulty began soon after her confinement; but she had delayed resorting to medical aid, in the hope that, as she had recovered from a previous, though milder, attack, she would also from this. The lacteal secretion was quite abundant, and the child seemed to be healthy. The urine was highly acid. As her illness lasted nearly four months, it would occupy too much space for me to detail, with minuteness, every particular of either the symptoms or the treatment.

A great variety of means were used, most of which seemed wholly ineffectual. At first an effort was made to check the diarrhoea with vegetable astringents. Tannin, gallic acid, and catechu, were given in combination with opiates, to relieve pain, and alkalies to correct the acid eructations. The discharges were only temporarily controlled. They would be less for a few days, and then

return.

I observed, in the early stage of the disease, that when the diarrhoea was checked, the tongue and throat were worse.

In the second week of my treatment, the passages contained some blood, for which I gave acetate of lead first, and afterward an emulsion, containing oil of turpentine.

Nov. 20. Patient no better; inflammation and ulceration more extensive. The ulcers on the tongue were large and painful, and the interspaces of a bright red color. Deglutition difficult; no

a

appetite; much thirst; epigastric pain; diarrhoea copious, thin, and watery. She was very weak, and much emaciated. Although the milk was abundant, I insisted on the weaning of the child at this time.

At the end of the second month, all the symptoms were much aggravated.

The entire alimentary mucous membrane seemed to be ulcerated. The vaginal mucous membrane was also ulcerated, and the labia were sore and excoriated. There was an abundant discharge from the vagina. There were extreme debility, anorexia, hectic fever, etc. In the mean time, I had tried everything that I thought likely to afford relief. In the course of the disease, I administered tannin, gallic acid, opium, oleum terebinthinæ, sulph. zinc, sulph. copper, tinct. ferri, bismuth, soda, chlorate potash, cod-liver oil and brandy, and malt liquors. Having seen an article in the American Journal of the Medical Sciences highly lauding the subcarbonate of bismuth in "phlegmasia of the digestive passages," I tried that also, but found it little, if any, better than the subnitrate. I was quite discouraged, and no one will be surprised that my patient was also. I thought she must inevitably die. She was having never less than five, and often a dozen passages from the bowels daily. At this time it occurred to me to make a trial of glycerine. I gave half a tablespoonful five times a day, giving no other medicine, but an opiate at night. The result was beneficial, quite beyond my expectations. From the commencement of giving this remedy, the convalescence was marked and rapid. The evacuations were less frequent, pain diminished, the ulceration disappeared, the appetite returned, and, in fact, all the symptoms improved.

She had been unable to leave her bed for over two months; but ten days after beginning the glycerine treatment, she could sit up in a chair; in two weeks she was able to ride out, and a few days after I met her as she was walking in the street. She took the glycerine about three weeks, taking two or three ounces daily.

The question will quite likely arise in the reader's mind whether my patient was really benefited by the glycerine, or whether the disease having run its course, there was simultaneously a fortunate discontinuance of all very active treatment, and recuperation followed from the vis medicatrix naturæ alone.

I am firmly of the opinion that she would have died, but for the administration of the glycerine. At two periods during her recovery, she was without the glycerine, and three or four days elapsed

before I could procure it for her of the proper kind. At these times there was a tendency to relapse into the former condition, but all unfavorable symptoms disappeared on resuming the medicine.

The glycerine I used was that made by Mr. Price, of London, and it is much superior to any other that I have seen. It is said to be "free from the lead and earthy salts, and bad smelling vola. tile "fatty acids" of common glycerine.

As to how glycerine produces a curative effect in this disease, my opinion is somewhat conjectural. It seems to counteract the acid condition of the stomach and bowels, thus removing, I think, the principal cause of the disease. It appears to exert a peculiarly soothing effect on the ulcerated mucous follicles, and thus favor their healing. Its nutritive properties are well known, from its effect in phthisis. It never offends the stomach, as cod-liver oil does, and is not the least unpleasant to the taste. I hope it may receive a further trial by those who have severe cases of stomatitis to treat.

DUBUQUE, Iowa.

W. S. BARKER.

REPORT

ON THE

TRUE POSITION AND VALUE OF OPERATIVE

SURGERY AS A THERAPEUTIC AGENT.

BY

J. B. FLINT, M. D.,

LOUISVILLE, KY.

"Chirurgo necessariam esse cognitionem Physices, Chimica, Logices, omnis (fere) ambitus medicinæ ; neque solo manus exercitio veras chirurgas fieri."-HALLER.

VOL. XI.-50