of former inflammation. The right kidney was diseased in a similar manner, but not so extensively.

The spleen was quite small. The rectum was somewhat involved with the bladder, which was adherent also to other surrounding parts.

The microscope revealed, in the fungus of the bladder, the ordinary cancer cell of the encephaloid variety.

December 20, 1854.

Case of Chronic Pemphigus. By J. C. HALSEY, M. D.

TO THE EDITORS OF THE N. Y. MEDICAL TIMES:

GENTLEMEN-Pemphigus being comparatively rare, and the following case having been one of marked character and very severe, a report of it may prove of interest to your readers.

Mrs. H, aged 40 years, of previous good health, and subject to only one form of cutaneous disease, namely lichen, affecting principally the back of hands and fingers, and sometimes alternating with inflammation of the mucous surfaces, was attacked with the latter disorder in the mouth, in September, 1853. It proved very obstinate, and did not disappear until the development of the affection of the skin to be described presently. As another antecedent, it ought to be mentioned that the general tone of her system had been depressed by external causes operating during the year previous to the attack. The membrane of the mouth was florid, with tender and spongy state of the gums, and affected with white ulcers on the inner side of the cheeks and lips, looking like small curds. The worst spot was on the inside of upper lip, and corresponding gum. An odor, not easy to be described, accompanied this disease, and was unlike any which I have hitherto observed. The inflammation varied very much, not only from day to day, but from one hour to another; and the fetor varied in strength directly with the intensity of the excitement of the surface. The treatment was the usual one for stomatitis, but met with small success.

The first appearance of pemphigus was about the 1st of January, 1854, when an isolated blister, three-fourths of an inch in diameter appeared, which was followed by a second, three weeks later. A fortnight later still, numerous small ones appeared on the back of hand and fingers, followed, as to some extent in other parts, by swelling of the surrounding integuments. At a still later period, it attacked the front of neck

and chest, and the abdomen. Many of those in the neck were filled with blood, and the size of the blisters in all the parts varied from the smallest conceivable to those which were one inch in diameter. While these were healing, the skin of the arms was attacked, and subsequently almost every part of the surface of the body; even the thick integuments of the palms and soles were raised by numerous bullæ. On the scalp they seemed to be abortive, but it was not without evidence of a tendency to their formation. Some of the bullæ contained sero-purulent matter. The membrane of the mouth and pharynx, as the former inflammation subsided, was detached in spots to the extent of half an inch in diameter, and the cavities filled with blood. In the course of the complaint every aspect of the limbs was visited, and also the trunk and the face; but in this latter situation the bullæ were not very numerous. Pendants were occasionally seen hanging from chin, ears, &c., half an inch in vertical length. In every part, they commonly formed during sleep, and often were very rapidly developed. Once during a sleep of an hour's duration, the first enjoyed for a number of days, a large number of small collections of serum were scattered over the face, looking as if the natural perspiration had raised the cuticle. The disease reached its height in April, and on some days of that month, from one to two hundred blisters might be seen at one time in every stage of progress, mostly isolated, but sometimes in clusters, and of small size, like eczema. In the first instance, they appeared in an apparently sound skin; but succeeding crops came out upon an inflamed surface. The largest were so painful as to wake the patient, if asleep, and require immediate evacuation. The contents of the bullæ, with the exceptions mentioned above, were perfectly limpid serum, which always gave, on so testing it, a purple tinge to litmus paper. The smaller blisters dried up without interference; and the larger ulcerated, and the surrounding skin was inflamed. A very troublesome itching, it should have been mentioned, preceded the other symptoms, and continued to affect the skin everywhere throughout the whole course of the disease. New blisters ceased to form in June.

The constitutional symptoms were fever, occasional and so slight as to be hardly discoverable, debility, emaciation, restlessness, and for a short time violent jerking of the limbs, but only during sleep. There was also an odor similar to that which accompanied the sore mouth. The appetite for food was good throughout, and part of the time was vora

cious. The alvine evacuations were natural, the urine turbid, but on examination was found to contain only the common lithates.

During part of the month last named, the condition of the patient was lamentable, and apparently desperate; the disease did not seem to have received a check; an immense number of new blisters were appearing; the skin where ulcers had healed, was the seat of a new crop of bulla; the body was wasted, and every part of the surface sore from ulceration. The effusion of serum was so great as to make a change of linen necessary more than once during each night, and oftener still by day, and the strength was becoming greatly reduced by this great drain of the vessels. Nervous restlessness was superadded to the distressing train. of symptoms, and violent spasmodic action of the limbs in sleep required that they should be held by an attendant, to prevent injury.

The diagnosis was not made until the disease manifested itself in the hands, when the patient was put upon the use of quinine, with sulphuric acid, and nutritious diet. So much prostration ensued as the disease progressed as to make stimulants and animal and other concentrated food important. During the continuance of the acid treatment, she used beef, eggs, custard, and similar articles, also wine, ale, or brandy daily.

Soon after the commencement of this course of treatment, Dr. Bulkley visited her with me, and continued to aid me by his counsel during the remaining stages of the complaint. By his advice the compound tincture of gentian was substituted for the quinine, and the nitro-muriatic for the other acid. This was followed up for two months without decisive effect, although in April there was some amendment; but before this was quite certain, the acid was discontinued, and Fowler's Solution was administered, and continued for three weeks. Improvement was now more manifest. The other alterants tried to some extent at previous periods, but without favorable effect, were tinct. mur. ferri, sulphur, tartaric acid, and sup. tartr. potass.; also occasionally mercurial cathartics. In May, animal food and stimulants were suspended, and the diet changed to one of vegetables and fruits.

The local management consisted of evacuating the contents of the large bullæ by careful puncture, and dressing with mild ointments, chiefly those made with oxyde of zinc. The mouth was immediately improved by the use of a wash of creasote. To allay inflammation, heal ulcerations, relieve the distressing pruritus, and check effusion, there were employed, at different periods, hot water, cold water, spirits and water, infusion of oak bark, and tannin in the form of ointment. Of

these, the first named relieved best the itching, while bandages with cold water improved the ill-conditioned ulcers more than any other one application.

In all respects, there has been improvement since April. During part of the summer, no medicine has been employed, and vegetable and fruit diet pretty rigidly observed. In October, a few solitary blisters appeared, also a papular eruption, with itching, on the lower limbs. This continues in the present month (November), although the general health is entirely established. There is also a very delicate and tender condition of the skin in these parts. The only constitutional treatment this fall, has been the use of nitric acid and a solution of tartrate of potash.

In reviewing the treatment of this case, the change from the acidtonic to the arsenical solution, just at the time it was made, is to be regretted, inasmuch as we are left in doubt to which of the agents we are indebted, if to either, for the favorable changes which occurred. The first, however, had been persevered in for a long time, and had not answered expectations; and dealing, as we were, with a malady the etiology and management of which are not well understood, the alteration seemed called for. Authorities had been examined, and according to them, the tonic-acid treatment was the most reliable; but since the occurrence of this, a resumé of cases of pemphigus has been published, establishing the arsenic as the most reliable remedy. If called to treat the disease again, I should first give a trial to it, resorting to the acid-tonic plan in case of failure of the other; and if the low condition of the patient did not call for animal food and stimulants, as it did here, I should employ vegetable diet and acids of either class.

Yours, very respectfully,

Brooklyn, Nov. 29th, 1854.

J. C. HALSEY.

Case of Malformation and Displacement of Organs. By STEPHEN WOOD, M. D.

To the Editors of the Medical Times:

Should the following anomalous case be deemed of sufficient importance for publication in your valuable and interesting Monthly, please give it an insertion. In this case we have exhibited another of those singular freaks which nature is now and then playing, wonderful in these her defective, as in her most perfect works.

The postmortem examination was undertaken chiefly to satisfy the mother as to what might have been the cause of the death of her child, as she had said that "it was smothered in the birth." On this point, however, her doubts were entirely removed, after the examination, as well as those which her friends might have had, who were present and witnessed it.

Very respectfully, etc.,

STEPHEN WOOD.

At 9 o'clock P. M., on the 15th inst., I was called to attend the wife of J. W, in labor, at No. 37 M St. The head presenting favorably, labor was speedily completed. The child-a female-was of ordinary size, and externally well formed. It cried for a few moments after birth, made several peculiar, convulsive-like attempts at respiration, for legitimate respiration it could not be called-but these soon ceased. On now applying my hand over the region of the heart, or rather where pulsation of this organ is usually felt, I could not find any; but, in moving my hand over different portions of the chest, and placing it on the right side, I there discovered a strong pulsation a little below, and to the right of the nipple of that side. This continued for some fifteen or twenty minutes. I now thought it best to try artificial respiration to restore life; and this failing, made use of other means for that purpose, but all without effect. I then made up my mind that there was serious derangement of the thoracic organs, on account of the singular location of what appeared to be the cardiac pulsation, and because of the impossibility of producing natural respiration.

On postmortem examination of the body next morning, the following was the condition of things. The external surface presented a general livid hue. Internally, I found the heart of usual size, inclosed in its pericardium, in the right side, directly under where I had felt the beating, and extending from the third to the eighth rib. The lungs were very small, and solid, like liver, lying immediately posterior to the heart, and compressed between it and the ribs behind, apparently also completely impervious; these two organs taking up but a portion of the right side of the thorax. Commencing at the upper part, and in the order enumerated below, the remaining portion of the right, and the whole of the left side of the cavity of the chest were occupied by, first, the small intestines; next, a part of the large intestines; then, the stomach, the gall-bladder; and lastly, the lower lobes of the liver;