Hence there must happen one of two things; either the remedies employed are inefficient, or they must exert some real effect, which may be useful in one case, but injurious in another. In my opinion, there is not a single decisive instance on record of the solution of a calculus in the bladder. Alas! there are, on the other hand, too many in which the disease has been aggravated by the use of chemical solvents. If the use of these remedies does not tend directly and immediately to promote the deposit of further matter on the surface of the existing calculus, it is, in a multitude of cases, apt to induce various morbid conditions of the urinary apparatus, under the influence of which the grey or white layer, of which I am about to speak, is generally secreted. No one, indeed, who is in the habit of seeing much of calculous diseases, can fail to be struck with the frequency of this layer or calculi, when alkaline remedies have been taken for a length of time."

M. Civiale, like so many of his countrymen, is apt to carry all his doctrines a l'outrance. The abuse of alkaline remedies has, we are ready to admit, often done harm; indeed it must do so on chemical principles. The rule of practice, which is invariably followed by the scientific surgeon, is every now and then to test the urine of a calculous patient, and never to continue the employment of either alkalies or acids beyond the neutralization of the acid or alkaline condition of the secretion. It is therefore scarcely necessary for M. Civiale to condemn the use of alkalies in the phosphatic or oxalate of lime diathesis, or to take any credit to himself for having pointed out the evils of such a practice: no one in the present day is so foolish as to regard alkaline remedies as universal solvents of calculi.

M. Civiale, indeed, mentions the names of Brodie and Prout, as men who have paid attention to the occasional alkaline state of the urine, and the circumstances which are apt to induce it; but his notice of these distinguished practitioners goes no further; and he takes the sole credit to himself for having showed that a diseased state of the bladder and kidneys has a marked influence on the nature of the deposit from the urine. We do not mean to rob M. Civiale of his share of the credit of having improved the treatment in calculous diseases; but let him be satisfied with his own portion.

In illustration of his particular views he makes the following remarks on a case, where it had been alleged that the mineral waters of Vichy had begun to exert a solvent effect on a urate of soda vesical calculus, in consequence of its surface exhibiting a layer of white deposit:

"Now this white layer, which our confrere imagined to be the effect of the mineral waters, was solely the result of a new deposit, which had taken place in consequence of the inflammatory action on the mucous coat of the bladder. Whatever be the nature of the calculus, no sooner is a vesical catarrh induced, than this white or greyish deposit inevitably supervenes, whether alkaline or acid remedies be taken or not. I could quote a thousand cases in proof of this point let one suffice. In an old gentleman, the bladder was the seat of a purulent catarrh, which ultimately proved fatal. Twenty-six minute calculi-all of uric acid or urate of ammonia-were found, on dissection, in it; these were all invested with this ash-coloured deposit. The left kidney contained so large a number of red granules of uric acid that it took a considerable time to count their number. But they were all of a lively red colour, and not one of them exhibited the greyish surface observed on the vesical calculi.

Surely then we must admit that this greyish deposit was the result of the vesical catarrh, as all the calculi, vesical as well as renal, were essentially and primarily of the same nature."

M. Civiale next alludes, in illustration of his views, to the deposit which is apt to take place on the extremity of a sound or catheter, when left so long in the bladder as to give rise to irritation of its mucous membrane: this being always of the greyish character, such as we observe on the surface of calculi.

The quickness with which this takes place is always in proportion to the amount of the irritation excited, and to the degree of morbid action induced in the mucous surface of the bladder. To prove that such is the real cause we have only to omit the use of the sound for some time, and use means to soothe the irritation; and it will be found that, whenever this ceases, the tendency to deposit is at once checked.

The relief, which patients derive from the use of alkaline waters, is in reality often very delusive. The urine indeed, which has perhaps been turbid, may have become limpid and unirritating, and, with this change, the calculous symptoms may be considerably mitigated. Even small calculi, which have lodged for a considerable time in the bladder, may be now discharged; and yet, all this while, the larger calculi, which cannot pass through the urethra, may actually have increased in size.

The explanation of these seemingly contradictory occurrences is not so difficult as may be imagined. The diuresis induced by the use of the alkalies will account for the change in the appearance of the urine; and as to the relief of the calculous symptoms at the same time, this is very often owing to the sharp edges of the calculi becoming rounded from the deposit of the white layer upon them. M. Civiale is decidedly of opinion that in numerous cases the prolonged use of alkalis and alkaline waters, such as those of Vichy, Carlsbad, &c. has the effect of inducing irritation of the vesical lining, and of consequently favouring, instead of checking, the further deposition of earthy matter on the surface of calculi in the bladder.

The relief in such cases is altogether attributable to the surface of the calculus becoming smoother and its edges more rounded, and not to any incipient solution of its substance, as is generally imagined. That such is the truth, we have often a most satisfactory proof in the treatment of calculi by lithotrity.

The fragments of a calculus, if they lodge in the bladder for some time after it has been broken, and especially if their presence has excited irritation of its mucous membrane, are found to acquire gradually a more rounded figure, in consequence of the sharp angles becoming invested with a coating of the greycoloured deposit. There has been no wearing down of the angles, but on the contrary, an addition of substance to and around them. That such is the case may be easily shewn by breaking the white crust on their surface; and then all the sharp angles are at once perceived.

Because this white crust often exhibits a roughened, and as it were corroded, surface, it has been hastily imagined that the alkalies, which have been administered, have been exerting a solvent action on the crust, whereas, in truth, a continued deposition of new matter has actually been taking place all the time. That small calculi are occasionally discharged by the urethra, after a prolonged use of alkaline remedies, is quite true; but such an occurrence is generally attributable not to the diminished size of the calculi in consequence of partial solution, but to the rounded form, which they have acquired, causing less irritation and spasm of the urinary passages.

M. Civiale has, in his fifth letter, adduced many cases in proof of the prece ding views.

In particular, he mentions that of Dr. Bigel, a physician at Warsaw, who, after undergoing the operation of lithotrity, went to Carlsbad for the purpose of drinking its celebrated waters. While residing there in 1835, be passed a number of minute calculi of a white appearance and not very firm consistence, whereas immediately and for some time after the operation the fragments, which were discharged, were all hard and of a brown colour.

Dr. Bigel was so delighted with this seemingly most favourable change, that he published a memoir on the remarkable solvent powers of the Carlsbad waters. He there stated that the calculi in his own case were white, not only on the surface, but nearly throughout their entire thickness. When however they were

examined by M. Creusburg, a chemist, a very different report was made; he found the exterior white crust was very thin and might be readily detached with the nail, and that it enveloped a hard red kernel, so to speak, which required the blow of a hammer to break it in pieces. The calculi were of different kinds; some were of reddish-grey exterior, others of a brownish red, and others were nearly white. The first set consisted of uric acid, urate of ammonia, oxalate of lime, and of a minute portion of oxide of iron; while in the white-coloured ones the nucleus consisted of the same ingredients, now enumerated, but the outer crust or envelope was composed of phosphate of lime with a minute proportion of phosphate of soda, urate of ammonia, and mucus. "All these results," says M. Civiale, "are highly important; more especially the last-named one; as we may fairly infer from it that no particular action had been going on in the bladder of Dr. Bigel different from what occurs in calculous patients who are not taking any mineral waters."

The relief, which Dr. Bigel experienced whilst at Carlsbad, was far from being of long duration. Two months afterwards he began to experience all his former distress, and again he was obliged to have recourse to a lithotritic operation. For the next twelve-months he continued free from any urinary concretions, although, every now and then, he passed a quantity of gravelly matter. M. Civiale, adds:

"Dr. Bigel, who does not seem latterly to believe in the solvent virtues of the Carlsbad waters, attributes the cessation of his gravel symptoms to the return of gouty rheumatism in his shoulder, to which he had been subject for nearly thirty years before his urinary complaint commenced, and which, he thinks, has been recalled by the use of the sulphureous waters of Warmbrun."

M. Civiale, after some further remarks on the indiscriminate and prolonged use of alkalis and alkaline mineral waters, informs us that one or two of the most experienced physicians in Paris have been led by his writings to entertain similar opinions to those now announced.

"MM. Leroy and Segalas, in 1837, spoke most favourably of the solvent effects of the mineral waters of Vichy; but since that time they have found reason to change their opinions. They have communicated to the Academy several facts, which tend to prove that, under the influence of these waters and also of alkaline preparations, calculi have increased in size."

In conclusion, M. Civiale repeats his opinion, that there is not one authenticated case on record of a solution of a urinary calculus in the bladder from the use of any remedies, and that, on the contrary, we have too much reason to suspect that, in a great number of instances, the long-continued administration of pretended solvents has seriously contributed to the aggravation of the evil.—La Lançette Française.

ON THE OPHTHALMIA IN THE BELGIAN ARMY.

M. Caffe was appointed in 1838 by the minister of commerce to visit Belgium, Holland, and Prussia, with the view of examining, on the spot, the epidemic ophthalmia which for many years past has affected the troops of the Belgian army. This ophthalmia was first noticed, at least as an epidemic, in 1814; but it has been more particularly since 1830, after the movements of the last revolution, that it has prevailed with great severity, and to such an extent that it has usually attacked at least one-eighth of the entire army, and in some regiments nearly one-half of the soldiers. Upwards of a hundred thousand persons in Belgium have suffered from it since its first invasion; and an immense number of these have in consequence totally lost their sight.

The Belgian Government appointed a permanent committee, composed of their most distinguished surgeons and physicians, and authorised them to invite, at the national expense, some of the eminent oculists of Vienna and Berlin to investigate the cause of this wide-spread pestilence, and to consult as to the best means of arresting it. But it would seem that not much success has resulted from their enquiries; for in 1838 there were still 5000 ophthalmic patients in an army of not more than 50,000 men. A great number of the soldiers were blind, and there were no signs of a cessation of the epidemic.

The characteristic symptoms of this ophthalmia may be briefly described to be an extreme vascularity, tumefaction and softening of the conjunctiva, the development of granulations on the folds of this membrane, and the secretion of a fluid, at first serous, then muco-purulent, and lastly entirely purulent. When the disease is severe, the tumefied eyelids become of a purplish red colour, the purulent discharge is immense, a pulpy whitish spot is observed at one point of the cornea, which at length gives way, either from ulceration or gangrene; and then the humours of the eyeball escape and the sight is irrecoverably lost. In less severe cases the entire thickness of the cornea is not affected; but even then the sight is perhaps left almost wholly interrupted, in consequence of an extensive and permanent opacity. In other cases again-and these seem to be most common at present-the ophthalmia is chronic from its commencement, or becomes so after a very short acute stage; the conjunctiva remains injected and swollen, the granulations continue, the discharge is less copious and of a muco-serous character, and the cornea becomes nebulous: this state may last for a considerable length of time.

M. Caffe is himself quite satisfied that the Belgian ophthalmia is truly contagious, and communicable from one person to another, not only by the direct application of the discharge, but also through the medium of the atmosphere by some infectious miasm.

Indeed no one can possibly doubt that the disease may be communicated by the inoculation of the purulent matter on a healthy eye: the proofs are too obvious and decisive. But it is certainly more difficult to establish the miasmatic infectiousness of the disease; M. Caffe however feels equally satisfied upon this point also.

The contagious character of the epidemic does not exclude the idea of its spontaneous development; although, it must be confessed, the actual cause or causes of the disease have hitherto escaped detection. Some writers indeed have imagined that it has been imported from Prussia or Egypt; but this seems quite fanciful.

It is worthy of remark that the history of the blennophthalmia, which exists almost permanently in the Foundling Hospital and in the Orphan Asylum at Paris, confirms in almost every point the opinions of M. Caffe on the nature of the Belgian ophthalmia; there being a very striking resemblance between these two forms of the disease.

M. Caffe had in 1832 observed a similar epidemic at the temporary hospital of Bons-hommes, where upwards of a hundred children were crowded together during the prevalence of the cholera;-a purulent ophthalmia made its appearance among them, and several of the nurses and one or two of the medical attendants caught the disease. There had been no ophthalmia in the hospital before.

As to the treatment of the Belgian ophthalmia, it is admitted by all that the severity of the disease is aggravated by the crowding together of many patients in the same ward, and decidedly mitigated by dispersing them. M. Caffe advises that, when the disease makes its appearance in a regiment, the soldiers ought to be bivouacked in the open air, provided the weather be sufficiently warm and dry. It is at least quite necessary to separate at once every man who is even threatened, far less already affected, with this disease. If this

practice were more rigidly executed, M. Caffe is of opinion that the epidemic might be arrested. He had seen almost every remedy tried; he was sorry to confess that no line of treatment seemed to have that influence in arresting the disease, which might warrant him in giving it a decided preference.

M. Baudelocque, in commenting on the observations of M. Caffe, and other preceding speakers, mentioned that, on more than one occasion, he had observed at the Hôpital des Enfans an epidemic purulent ophthalmia seemingly arrested by thinning the number of the children in the wards, and dispersing them in separate rooms. Until this was done, every remedy that was used proved inefficient; but afterwards it was observed to be comparatively easy to treat the disease. It is doubtful indeed whether the purulent ophthalmia in infants and children be decidedly contagious; but at all events it is wise to separate the diseased from the healthy, and keep the latter quite apart. No remedy is on the whole so efficacious as the local application of a solution of the nitrate of silver, not omitting at the same time the application of one or more leeches to the temples, of a blister to the neck, and the internal administration of appropriate medicines.

M. Velpeau confessed that he had not seen the Belgian ophthalmia, but he was strongly impressed with the idea that the same mode of treatment, which was so successful in his practice in the other forms of purulent ophthalmia, would, if rightly pursued, be found most useful in the cure of the disease. He alluded to the use of a strong solution of the nitrate of silver-from half a drachm to a whole drachm of the salt dissolved in an ounce of water. As a matter of course, the employment of other means, constitutional as well as topical, is not to be neglected.-Gazette Medicale.

ON THE PURULENT OPHTHALMIA OF CHILDREN.

The following remarks apply to that form of purulent ophthalmia which usually occurs epidemically among children of three or four years of age-a form of the disease which is very different from that which is often observed in infants soon after birth, and which, it is believed, arises from the contact of the acrid mucus of the vagina with the eyes of the infant during the process of delivery.

The former is of frequent occurrence in Paris, and is usually observed during the early months of the year. It is observed not only to attack number of children at the same time, but also, especially in a hospital, to propagate itself from one patient to another, who may happen to be next to him—thus seeming to be contagious as well as epidemic.

It is one of the most alarming diseases of childhood, in consequence of the extreme rapidity of its progress, and the tendency there is to perforation and consequent destruction of the eye, if the symptoms are not promptly subdued. Occasionally it proves fatal; but such a termination is generally, we believe, attributable rather to the improper treatment which may have been pursued than to the mere severity of the disease itself-unless indeed the child is in an unhealthy state at the time of its seizure.

The following two cases may be aptly quoted here in illustration of this remark.

Case 1.-A child, four years of age, had been suffering with cough and purging for several days before the right eyelid was observed to have become of a purplish-red colour, and to be swollen and quite closed: a purulent matter also kept oozing out in considerable quantity. Leeches were applied to the temples, and emollient washes to the eye. Four days afterwards, the cornea was perceived to be much softened, and to threaten immediate perforation. The left No. LXV. P