For my own part, I have found few maladies so intractable. I have derived some advantage in retarding its progress, certainly, though seldom removing it entirely, from confinement to animal diet almost exclusively, with the free use of opium and mur. tinct. ferri.

CYSTITIS-Inflammation of the Bladder-may be acute or chronic. The former is rare, except as supervening on the latter, a fatal instance of which once occurred under my care.

Symptoms. It is readily known by the locality of the suffering, the incessant micturition and dysuria; febrile irritation runs high with restlessness and delirium.

The chronic form is not unfrequent in advanced life, when we have similar symptoms in less urgent degree. The urine is full of thick mucus; is sometimes loaded with phosphates, sometimes alkaline; the frequent calls to pass water wear out the contractile powers of the sphincter, and the fluid dribbles away constantly with scalding, and offensive smell.

The cause of cystitis is sometimes difficult to detect. It follows upon excess, debauchery, and intemperance. It may arise from morbid conditions of the urine when containing irritating matters, solid and fluid; or it may be the result of a gonorrhoeal affection, extending upwards along the urethra into the bladder; or of gleet with stricture; or of the remedies employed for the cure of these affections.

Autopsy shows thickening of the bladder, sometimes to a very great extent, and even ulceration.

Treatment. In proportion to the acuteness of the attack, and the youth and vigor of the patient, the antiphlogistic regimen should be instituted, and carried out with energy.

Venesection will sometimes be required to be repeated; and we may generally leech the pubes or perineum with much advantage. Warm fomentations should be assiduously applied. The bowels must be freely moved with oily or resinous purgatives, aided by large tepid

enemata.

Opiates must be administered to relieve the severe suffering of the patient; they may be combined usefully with relaxants and diaphoretics, as ipecacuanha and camphor. Some advise alkalies and diuretics. I have, however, found them irritating and injurious, with the exception of magnesia and digitalis, which may occasionally be properly prescribed. Subacid mucilaginous drinks may generally be allowed.

These last mentioned remedies are better adapted in chronic cystitis, which is also benefited by the use of the thermal springs and sulphur waters. The repeated use of soothing mucilaginous enemata with opiates in proper amount may be considered as among our very best means of relief in these annoying and obstinate cases. The warm bath is also an excellent palliative.

CYSTERETHISMUS-cystorrhea-"irritable bladder”-demands similar treatment with the affection just spoken of. Indeed it is hardly to be distinguished from it. We may remark the absence of febrile excitement, far less emaciation, and general disturbance of the constitution,

as diagnostic. We may venture upon a less timid employment of diuretics here. Vegetable articles of this class deserve a preference. Infusions of these, and a solution of tannin, are injected into the bladder with good effect. Common green tea is also employed in the same way. I would expect advantage from small quantities of opium dissolved in it, and from time to time thrown in gently.

ADDISON'S DISEASE.-Bronzed Skin.-Disease of supra renal capsules. In the year 1854 the distinguished physician, whose name is inseparably connected with the topic now to be briefly discussed, announced the discovery of a constant relation between certain symptoms of anemious disorder, with morbid change in the ductless glands above named. He had long known the series of symptoms, and had designated them "idiopathic anæmia," as occurring without assignable cause; being preceded by "no loss of blood, no diarrhoea, chlorosis, purpura; no renal, splenic, miasmatic, glandular, strumous, or malignant disease." I cannot do better than to quote his graphic description of the affection, which is of very serious character, and, indeed, usually of fatal malignity. It occurs in both sexes; generally beyond the middle age, and in constitutions predisposed to become fat; approaches slowly and insidiously, so that no date can be fixed for the commencement of the languor, shortly to become extreme. The face is pale, the eyes of pearly white; the frame flabby; the pulse full, but very soft and compressible; jerking under slight excitement; with growing indisposition to exertion, there is faintness and breathlessness in attempting it, the heart readily palpitates, the surface presents a blanched, smooth, waxy appearance; the lips and gums seem bloodless; the appetite fails, the stomach is irritable; oedema of lower extremities shows itself; with the extreme bodily debility, the mind fails, with wandering and a torpid insensibility. The patient dies, retaining after months of such illness and decay, a remarkable bulkiness of frame and seeming obesity. With these phenomena is combined throughout, the characteristic discoloration-the bronzing of the skinwhich gives a second title to the disease. The color is dingy, or smoky, or amber, or chestnut-brown; occurs in patches, mottled or checkered; is strongest on the face, neck, superior extremities, penis, scrotum, in the axillæ, and round the navel. It is occasionally manifest, too, in the form of small black spots beneath the peritoneum of the mesentery and omentum. Dr. Addison has recorded several cases in which the symptoms above described having been present during the life of the patient, on examination of the bodies after death, the capsules were found to be greatly altered by inflammation and its results, or by strumous or malignant deposit. Since the publication of his paper, a considerable number of similar examples have occurred to different practitioners, and have been duly reported. The coincidence of the contingencies thus brought together by him for the first. time to the notice of the profession, must be regarded as an established general fact.

In the farther discussion of the subject, however, physiologically and pathologically, difficulties not yet surmounted present themselves. Disease of the capsules is proved to have occurred without bronzing, and bronzing without capsular disease. The suggested function of these bodies-an action upon, perhaps a removal of pigmentary matter-is not clearly made out by physiological experiments; nor although the ingenuity of Brown-Séquard, and his antagonists, Philippeaux and Harley, have been earnestly exerted, has it been decided whether they are or are not essential either to life or any modification of color. A piece of bronzed skin under the microscope, examined by Harley and by Dalton, presented to each the same appearances. The pigmentary matter was deposited in a granular form in the epithelium cells of the rete mucosum. Dalton says that it could not be distinguished from the pigment of a mulatto. Harley "has examined bronzed skin taken from a patient with healthy supra-renal capsules, and convinced himself that its microscopical structure was in every respect identical with that taken from the other patient with diseased capsules."

I treat of this subject here, because of the anatomical connection of these bodies, their local association I should perhaps say, with the kidneys. Their function is as yet unknown, and absolutely conjectural; it is not supposed to be an integral element in the important excretion, or eliminatory office of the organs, to which they lie so near.

On the whole, I conclude that there is always good reason to infer from the anæmia, bronzed skin and other associated phenomena, the existence of disease of the supra-renal capsules, or one of them; yet that the coincidence not being proved to be uniform, they do not stand to each other in the relation either of cause or effect; but arise as the results of the action of a common cause, hitherto undetected, which may produce either alone.

In

The treatment is altogether unsatisfactory and unsuccessful. the early stages, I would hope something from residence in the country, exercise in the fresh air out of doors, and the cold bath with frictions to the skin; nutritious food, rather albuminous than oily, and an avoidance of starchy, saccharine articles, and above all, fermented drinks. The alkalies might be serviceable, with the preparations of iron and cinchona. Mercury has been proposed, and the combinations of iodine; but I see no reason to expect any benefit from them.