Now, these remedies can aid each other in the work of preserv ing life, but they cannot perform each others' work. Can quinine unload the liver and bowels?-can it restore suspended secre tion?-can it stop vomiting and purging?-can it eliminate poisons from the system? Calomel can. Can calomel break up the periodicity of disease?—can it prevent or remove depression, congestion and collapse?—can it give tone and energy to the nervous system? Yes, to a certain extent it can do all these things, though not so well as quinine.. Can calomel and quinine subdue a burning fever, arrest a raging inflammation, or assuage a throbbing or an aching pain? Only to a limited extent, and in an indirect manner; yet the lancet and opium will do it promptly. Is it not strange!"passing strange!" that with all these things, full in view, there are physicians in our midst, whose opinions ought to be entitled to credit, who have openly denounced some of these remedies, (calomel and the lancet in particular,) as unsuited, or unsuitable, in the treatment of some of our most formidable and dangerous diseases, and have offered us for their substitutes, phosphorus! aconite! and bryonia! Nor is it less strange, that large numbers of our southern physicians should have assumed, that the free use of quinine will enable them to dispense with the use of calomel in our dangerous diseases, and malignant epidemics. And, stranger than all, that there should be some old and long tried physicians, who advise that little or nothing should be done, alledging that one system, and set of remedies, work about as well as another, and all are of no avail,

Now, to show all this matter up in its true light, I will give you an allegory: A poor fellow accidentally fell into a river, and in the act of drowning, called to some men on the shore for help. They had at hand a boat, and life-preserver, and a bundle of straws. One of them said to the other, I will throw him my life-preserver, it will hold him up better than the boat; besides, I do not know much about boats, and I am told that they are dangerous things any way; so he threw him the life-preserver. Another one said, that's just what I think about boats; they are dangerous and useless things to my certain knowledge, for I have tried them often; let me throw him some of my straws. The third one said, I know the boat will not do under any circumstances, and I have no con. fidence in your straws, or your life-preservers either-one is as good as the other; let us watch him until he drifts ashore, and then

we will help him. So the poor fellow drowned. And when the facts came to be known, how they had all refused to send him the boat, when they might just as easy have saved his life, the people all thought that it was very strange, that the men did not send him the boat, and give him a chance, at least, for his life. Some said they thought it a very cruel act, not to send him the boat; others said they thought that it was a very foolish one; but the men themselves did not seem to think or care much about it, and it all soon passed off and was forgotten.

Finding that I shall not be able to make a statement of the cases, which I had purposed doing, illustrative of the more important points concerning the action of calomel, I will reserve them until I come to speak of the diseases to which they respectively belong. Having generalized to a sufficient extent, in my next letter I will make a summary review of the general principles which I have maintained, and afterwards will make a therapeutic applica tion of them to some of our more formidable diseases. It is said that "drowning men catch at straws." For mercy's sake, let us offer them something better; and if I can persuade one man only, that there is not so much danger in a boat, I shall consider myself well paid for my trouble.

Respectfully yours, &c.

SAML. D. HOLT.

ARTICLE XV.

Cases of Lithotomy. By L. A. DUGAS, M. D., &c.

CASE I. Henry S., the son of a highly respected professional brother of Coweta county, in this State, had experienced the usual effects of stone in the bladder from early infancy until the age of six years, when the bi-lateral operation of lithotomy was performed in June, 1851. This operation was, however, productive of only partial relief, as he continued to suffer, although at first less severely than before it. In a short time his symptoms became as bad as ever; the wound, instead of healing as usual, was at the end of three months reduced to the size of a quill, and finally closed entirely about three months later.

The little patient was brought here and placed under my charge in February, 1853. On endeavoring to sound him, I found that although the integuments cut in the previous operation had healed,

such was not the case with the urethra, for the sound would pass from this canal into a pouch in the perineum, and could be felt just within the thin skin which covered it. This circumstance rendered catheterism somewhat difficult, as it was not easy to carry the sound into the canal beyond after it had entered the pouch. I succeeded, however, in detecting a large calculus, and at once determined to operate.

On the 22d February I performed the bi-lateral section, under the influence of anesthesia, and seized the calculus, which crumbled into pieces on endeavoring to extract it. The scoop was then used, and about a table-spoonful of chalky-looking fragments removed. The bladder was carefully explored with the finger until every particle was brought away with instruments and repeated injections of tepid water. On the seventh day the wound had entirely closed.

The child returned home, with the injunction to use vegetable acids as freely as possible, so as to prevent a reproduction of the calculus, which was evidently ammoniaco-magnesian. How long these instructions were carried out I am unable to say. In a letter received from his father, I am informed that the child "for twelve months after the second operation enjoyed fine health, and was growing rapidly, without any symptoms of a return of the disease. After the expiration of this time he was attacked again, and suffered as much as he had at any time previous, discharging quantities of pure pus, occasionally mixed with a little blood and small fragments of stone, which very much resembled those you extracted. He continued in this way some two or three months, suffering by paroxysms, when he was suddenly attacked with violent colic, accompanied with vomiting and purging, which terminated fatally in two or three days." He died on the 27th September, 1854.

REMARKS. This case derives interest not only from the fact that the patient underwent at so early an age two operations of lithotomy, but also from the persistence, or rather recurrence, of the calculous diathesis even after the second operation. I say recurrence, because there is no evidence of any reproduction of the disease for upwards of a year after the second operation. From the little relief afforded by the first operation, the non-closure of the wound for many months, and the continually increasing severity of the symptoms, it may be questioned whether some portions

of the calculus had not been left in the bladder. Yet the operation was performed by an experienced surgeon, who could hardly be presumed to have committed such an error. I am informed by the parent that the first stone was of the same character as that I removed, and that it was likewise crushed in the extraction.

CASE II. James F., of Dooly county, about twelve years of age, had suffered with symptoms of stone in the bladder from early childhood, but his general health was unusually good. Finding, upon examination, that the calculus was small, I determined to try to crush it with the lithotrite. Dilating bougies were accordingly used some days, but occasioned so much irritation in the urethra that they had to be discontinued, and I had to wait until this had subsided before making any further attempts. His urethral canal being very small, a correspondingly small lithotrite was passed into the bladder, and the stone seized; but its hardness was such that it could not be crushed by any force that could be applied without danger of breaking the instrument. A few days later another attempt was made, with similar result.

Lithotomy being now the only alternative, the bi-lateral operation of Dupuytren was performed on the 29th July, 1855, under the influence of concentrated chloric ether, and a calculus of oxalate of lime removed. Its shape was a flattened ovoid, seven-eighths of an inch long, three-quarters of an inch wide, and half an inch thick. It weighed seventy grains.

No unpleasant symptoms manifested themselves, and on the 9th August, being well, he returned home.

CASE III. Columbus A., of Columbia county, had experienced symptoms of stone from early childhood, and was very much emaciated and debilitated. Although in his eighteenth year, his physical development had been retarded by excessive suffering to such a degree that he did not appear to be more than ten years of age. For several years his urine was continually dripping, so that there was rarely any accumulation in the bladder. Sometimes he would pass off once in the course of twenty-four hours as much as two or three ounces of urine. It was remarkable that moderate walking, or riding in a carriage, did not aggravate the symptoms. Having been put under the anaesthetic influence of chloric ether, the bi-lateral operation was performed on the 13th November last,

and an hour-glass shaped calculus was removed, of which the accompanying wood-cut is a faithful delineation. It weighed about an ounce and a half, and was composed of ammonio-magnesian phosphate of lime.

Upon making a longitudinal section of this calculus with a fine saw, a nucleus of darker and more dense material was found occupying the centre of the neck, and projecting about equally into the two enlarged portions of the stone. This nucleus presented more length than breadth, being about three-fourths of an inch long and half an inch wide. The shape and size of this nucleus will serve to account for the position occupied by the calculus, the large extremity being found to be within the bladder, while its lesser end was in the urethra, and its neck consequently grasped by the orifice of the bladder. It would therefore seem that while small, as represented by the nucleus, it attempted to escape from the bladder, but was caught at the origin of the urethra, and remained there until by deposits upon its surface it reached its present dimensions. The deposit being more copious within the bladder, this portion of the stone grew faster than that in the urethra.

The abnormal position and form of the calculus rendered the introduction of instruments quite difficult, and much care was required not to break it in the extraction. On being removed, the pouch in the urethra was found lined with soft detritus, which had to be scooped out. The bladder was then carefully and repeatedly washed out until no vestige of fragment remained. On the fourteenth day after the operation the patient began to pass his urine per urethram, and he went home on the 10th of December.