days. The delirium and nervous agitation seem to result partly from the sudden withdrawal of the stimulus. I have remarked that the men generally are much worse two or three days after they have left off drinking, and that they are aware that a glass of grog steadies them. But I would only give wine or spirit when opium had failed to procure sleep, and when the delirium had persisted some days after the patient had discontinued drinking. Another important point in the treatment of delirium tremens is, that the patient should be removed as much as possible from all causes of excitement: his room should be quiet, and few persons should be allowed to visit him. The last point that I wish to impress on you, is, the great importance of narrowly watching the patient. I have already stated to you that in this disease, even in its lighter shades, the patient is possessed by gloomy ideas, and has often a He should therefore be narstrong propensity to suicide. rowly watched, and every instrument by which he can effect self-destruction should be placed out of his reach. For want of these precautions we had a very tragic scene on board the Dreadnought, in the summer of 1838. Three men, Parrymore, Baily, and Forster, were brought into the hospital the same day in delirium tremens. They were treated in the usual manner, and I believe a straight-waistcoat was placed on each. The day after their admission, Parrymore was very much better, and gave me a clear account of many of the particulars of his case--as, of the voyage he had last made, the time he had been in port, and the money he had The same spent. All restraint was in consequence left off. evening he cut his throat with a clasped knife, which sailors generally carry about them. The surgeon, who was in immediate attendance, found him sitting up in bed, bleeding profusely, and still hacking away at his throat, to all appearance perfectly insensible to pain. The divided vessels were tied, and the hæmorrhage stopped; but he died at the end of a few days, from the secondary effects of the wound. Baily also, the day after admission, gave me a clear account of many particulars of his case; and I considered him in no danger. The excitement and commotion in the ward consequent on the attempted suicide of Parrymore, again threw him into the most violent delirium, in which he continued for two days. On the fourth day after his admission, I found him very hoarse from vociferations, but tranquil and rational. The straight-waistcoat was taken off, and orders were given that he should be narrowly watched. The same evening, however, he eluded the vigilance of those about him, and threw himslf out of one of the port-holes into the Thames. A boat was immediately sent after him, and he was soon picked up, swimming lustily between the Dreadnought and the shore. When in the boat, he struggled violently to throw himself again into the river; and such was his muscular power, that it was with the greatest difficulty the two men in the boat could master him. They succeeded, however, in doing this, but Baily, apparently exhausted by his struggles, almost immediately expired. He was lifted into the Dreadnought a corpse. We could not examine the body before a coroner's inquest had been held; and as this was not done for some days, and the weather was very hot (it was the middle of July), the body was too far advanced in decomposition to enable us to form a satisfactory opinion of the cause of his sudden death. I believe, however, that he died of pure exhaustion-the consequence of the powerful efforts he had just been making. He was one of the most muscular men I ever saw, and had no organic disease. These cases, as you might expect, have made me very watchful over patients in delirium tremens. They should not be left a moment unguarded; and in hospitals where they cannot have a person in constant watch over them, I would always put on a straight-waistcoat, whenever I could do so without using violence or increasing the agitation of the patient. I make this exception, from a sense of the ill effects of excitement, and of the exhausting influence of great muscular exertion. But delirium tremens, or at least a condition very similar to that brought on by excessive drinking, may be caused by any great shock to the nervous system, especially by surgical operations, or severe injuries. When induced by this last cause, it is called traumatic delirium. But its characters are precisely like those I have before described:-nervous agitation, trembling, inability to sleep, and hallucinations, generally of a dismal kind. Du The insensibility to pain (which I have before noticed in the case of Parrymore) in these cases is truly remarkable. puytren, who has left a beautiful description of nervous delirium, says, that he has known patients in this state, with a comminuted fracture of the leg, slip off the bandages and walk about, using the broken limb without evincing the slightest pain; and others who had been operated on for hernia, introduce their finger into the wound, and amuse themselves with twisting about the gut, as if they were doing it on the dead body. He also particularly remarks, as all writers on the subject do, the state of the pulse. He says, 'the most remarkable symptom, in the midst of this disturbance of the intellect, is the calm of the circulation, and the absence of every febrile symptom. You see a patient furious; his face covered with sweat; his eyes glistening; his cries heard at a distance: you believe him affected with the most intense arachnitis. Approach him: his pulse is calm and regular; and the state of his skin removes every suspicion of inflammation.' But, in other circumstances, you will occasionally meet with a condition of the nervous system very similar to delirium tremens. In the 19th volume of the Med. Chir. Trans. is a paper by Dr. Seymour, containing three cases of mania, successfully treated by morphia. They all occurred in women. In the first case the woman became affected, after suffering severe distress, in consequence of the death of a relation who died in her presence. She was occupied with gloomy ideas, and a belief of having committed indescribable crimes. Her nights were sleepless, and there was continual watchfulness, and restlessness of the body. Her pulse was not weak, and her bodily health was unusually robust. She recovered in six weeks, taking a grain of acetate of morphia every night. In the second case the history is obscure. The woman had been bled and blistered for what was conceived to be inflammation of the lungs. She was extremely violen:; fancied that her children were murdered, and their spirits returned to torment them. Her sleep was broken. There was no fever. She recovered under the same treatment. In the third case there was great previous affliction, and the mania came on after childbirth. The symptoms were nearly the same, and she recovered under the same treatment. It is impossible not to perceive the analogy between these cases and those of delirium tremens. There is the same absence of fever, the same restlessness, the same want of sleep, and the occurrence of visions and dreams of the same character, in both. All the instances I have mentioned agree in the absence of fever, and in the regularity of the functions of the body in the midst of the general nervous disorder; in the presence of gloomy ideas and frightful dreams. It seems, then, probable that opium will be beneficial when ever there is a combination of these conditions. Dr. Seymou says, 'Morphia appears to be of more use in what is termed melancholia, where the mind is tortured by imaginary want, ruin, or crime, than where the derangement partakes of more brilliant ideas; as of superhuman knowledge, dexterity, or wisdom; or than in those cases where one single idea occupies and absorbs the mind.' I have seen one or two instances in which a state very like that in the cases related by Dr. Seymour, resulted from excessive study. One was in a man with whom I was well acquainted at Cambridge. He became insane after an attack of scarlatina in the summer of 1828. He had been reading excessively hard, and was much exhausted, when he was attacked with scarlatina on his way to the Lakes, to spend the summer vacation. He was laid up with scarlatina a fortnight; and soon after was placed in an asylum, where he remained two years. At the end of this time he was released, resumed his reading at Cambridge, and took a wrangler's degree in the year after that in which he would have taken his degree in the ordinary course. The character of his insanity was like that of persons in delirium tremens. He fancied that he was constantly surrounded by devils; and even now, ten years since leaving the asylum, he is convinced of the reality of these apparitions. My attention has lately been called to another case of the same kind. A man, like the former, became insane after hard reading; and his insanity was of the same character. He was placed in an asylum, where he continued some years. Since his release he has turned author, and the books he has witten display considerable talent. I have little doubt that such cases are allied to delirium tremens-that the insanity is the cause of nervous exhaustionand that it is best treated by opium, generous living, and quiet; means so efficacious in the various forms of delirium tremens. It would certainly afford a medical man a high gratification to cure a case of this kind-to restore an educated and gifted man to his family and himself; but there is very little satisfaction in curing a man of the delirium that results from drinking, because he is almost sure to get into the same state again. The only chance for him is to become a tee-totaler. Experience of the 'horrors' has certainly very little influence in deterring sailors from a repetition of the excesses by which they are brought on. Embleton told us that he had had the 'horrors' twice before; and men have often confessed to me that they have had them as often as seven or eight times. I am afraid, therefore, that Burns' parting advice, in Tam O' 'Whae'er this tale o' truth shall read, Experiments on Kiesteine, with observations on its application to the diagnosis of pregnancy. By ELISHA K. KANE, M. D. The following extracts are from a valuable paper under the above title, in the last number of the American Journal of the Medical Sciences. The paper was an inaugural dissertation for the degree of Doctor of Medicine, and is pub lished in accordance with the recommendation of the Medical Faculty of the University of Pennsylvania. "My mode of conducting the experiments was this. The recent urine was placed in open glass cylinders, of diameters varying from an inch and a half to that of a common_tumbler, and protected from the dust by paper covers. Those were arranged in a dry, well ventilated room, where the temperature was uniform and moderate, and were exposed in groups to the equal action of air and light. I examined them frequently during the day; but as the changes were not rapid, I determined after a little while to note only one set of observations in the twenty-four hours. My notes were made upon the spot. If from any cause, an individual observation or a series was unsatisfactory, or inconclusive; or if it led to a dif ferent result from others, I repeated it at once with increased care; and I was always careful to observe the constitution, habits and circumstances generally of each patient. The examination of the first group of cases satisfied me, that the urine during pregnancy assumes appearances differ ent from those witnessed under other circumstances, and which I was therefore disposed to regard as characteristic of that state. Subsequent inquiries confirmed me in the general accuracy of this opinion, but compelled me at the same time to admit its liability to exception. The more obvious of these appearances regard the superfi cial formation described by Dr. Bird, and recently investigated by Drs. McPheeters and Perry; but there are others which point to a series of intestine changes somewhat more obscure, |