in the spring of 1826. But it was not till the month of June of the latter year, that the mortality became at all alarming. At this period, a diarrhoea, of a fatal na ture, began to prevail, especially among children. By the middle of July, the epidemic became formidable, taking the gastric and bilious characters, accompanied by violent cephalalgia. It was clearly, however, of the intermittent type, though sometimes only remittent. The diarrhoea was, during one month, the prominent feature of the epidemic-but, about the middle of August, the tertian form of the fever was unequivocal, sometimes changing into the double tertian type-a change by no means advantageous to the patient. During the next two months, the malady raged with great intensity and fatality. The disease, at this period of its acmé, commenced with a rigor of short duration and moderate in degree-slight acceleration of pulse-pains in the head, loins, and limbs, especially in the lower extremities. The tongue was furred, and the patient had bilious vomitings, sometimes during the cold fit-sometimes at the close of the paroxysm. These spontaneous vomitings were the means by which Nature got rid of large bilious secretions, but they were not indications for the administration of emetics or strong cathartics, which generally proved injurious. On the contrary, gentle excitants were more efficacious in removing the diarrhoea and gastric irritability. But the sulphate of quinine was still more serviceable. This specific almost always succeeded, provided it was given in the dose of fifteen to twenty-five grains in the course of the apyrexia. If, instead of this treatment, Nature was left to her own efforts, or the disease was attacked with sanguineous evacuations or drastic purgatives, the patient generally died apoplectic in the next paroxysm, or fell into a state of coma or dysentery, with delirium and prostration of strength, that ultimately proved mortal in the majority of cases. There were few, if any, instances, where the fever degenerated into the typhoid or putrid form, although thousands of unfortunate patients never had any medical assistance whatever, or only some trifling remedies unskilfully administered. In respect to crises, there were few opportunities of observing this operation of Nature, since the most strenuous exertions were made by the physi cians to cut the disorder short by remedies, especially the sulphate of quinine. Still, they had occasion to observe a few instances where the fever seemed to terminate by critical sweats, diarrhoea, vomitings, or copious depositions in the urine. The disease was invariably of an asthenic character, and never inflammatory. This, they think, was proved by the symptoms, by the treatment-and by the termination. They do not add-by the dissections. But of this hereafter. Relapses were very common-nay, almost inevitable. The reasons were twofold-the protracted debility of the subjects, and a continuance of the original miasmatic causes. Dropsy was a very common consequence of the fever, and came on very suddenly. It was sometimes anasarcous-sometimes ascitic. The disease sometimes terminated in a singular eruption of chronic aphthæ on the tongue and throat, evincing their existence also in the esophagus and stomach by acute pain in those parts, or a copious secreThere was, also, tion of viscid mucus. an occasional eruption on the surface of the body, in various parts. The debility of intellect, as well as of body, left by this fever, was sometimes so great, that the patient was entirely deprived of memory for a considerable time after the cessation of the fever. Appearances on Dissection. As the epidemic presented a great uniformity in its symptoms, so there was a corresponding uniformity in the postmortem appearances. Dissections, however, were not so numerous as could be wished, owing to the extent of the mortality, and the inability of the physicians to attend to pathological investigations. Nevertheless, Dr. Hendricks, physician to the public hospital, opened 107 bodies, and communicated the results to the authors of the paper under review. table is given of the different appearances on dissection; and we find, that the spleen suffered much more than any other part. Thus, there were 66 bodies presenting inflammation of this organ out of 107. Next to the spleen, the liver bore the onus of disease among the abdominal viscera. Thirty-two bodies showed this species of lesion. In the whole A 1 569 died in the above period, or about 1 in 14. The city of Groningen presents large and beautiful streets, so that, at first sight, it might be considered a most healthy situ ation; nevertheless, it encloses within its walls many powerful causes of disease. One quarter of the city is too much crowded in its population, and there the epidemic raged severely. But this part is not inhabited by the lower orderstherefore the cause of sickness could not number of dissections (107) there were 26 cases where the digestive tube was inflamed, either internally or externally. Forty-two bodies showed affection of the brain or its membranes, or serous effusion into the ventricles or between the meninges. Thus, each theorist had something to support his doctrine, but nothing to confirm it. Broussais and Clutterbuck would have found it difficult to maintain their exclusive hypotheses from these documents. There is certainly more to support the doctrine of fever being a general disease in the beginning, and taking a local determination in the course of the malady. Of the 107 patients above-mentioned, twenty exhibited, during life, symptoms of disturbance in the cerebral and nervous system-23 had dysentery-engaged, though not in any very large 14 had diarrhœa-13 showed signs of putridity-and 16 were dropsical before they died. Nothing transpired during this epidemic to sanction the idea of its possessing any contagious character. Between 30 and 40 medical men (physicians) were busily employed, but none of them died. Some of them were taken ill, either from fatigue, or subjection to the same causes of disease with their patients. In respect to the remote causes of the epidemic, they were ascribed, first, to an unusual increase of aqueous emanations -2ndo, to the high temperature of the Summer heat, which greatly augmented the said emanations-3dly, to the sudden vicissitudes of temperature-4thly, to the drying up of many marshy plains and pools, by which a great surface of mud, &c. was exposed, and a copious disengagement of miasmata effected. From the above causes, resulted a bilious fever, early in the Spring, which soon changed into a pure intermittent, and afterwards into a remittent, with affection of various viscera. The same remedy (the sulphate of quinine) succeeded throughout all these changes and seasons" and many hundreds of the citizens of Groningen would have been saved, had there been a sufficient supply of this invaluable febrifuge." Groningen contained about 28,000 inhabitants previously to the epidemic, and during the months of August, September, and October, 1826, there were not less than 8,000 people affected with the fever -or more than a fourth part. Of these, be attributed to want of cleanliness, good food, &c. But there was another cause, the immediate vicinity of the canal which leads to the sea, and from whose bottom and edges miasmata were doubtless dis quantity. This city, however, is exposed mata, namely, the numerous cloace which to a still more powerful source of miasare every where met with. These cloaca are always filled with animal and vegetable matters in a state of putrefaction, and, in the hot weather, disengage an immense quantity of stinking effluvia, which contain, without doubt, the seeds of fevers and other diseases. This terrible epidemic will probably induce the local authorities of the place to pay more attention to the state of drains, canals, and common sewers, in order to guard against another visitation of so terrible a scourge. -JOURN. GEN. DE MEDECINE, April, 1827. In a late Number of M. Broussais' Journal, we have the case of a boy five years of age, which presents some characters of interest. This boy, of vigorous, but irritable constitution, was seized, on the 1st of May, with symptoms of gastroenteritis, which were removed by leeches to the epigastrium and diluent drinks. In the night of the 12th May, he awoke from his sleep with a loud laugh, which was quickly followed by piercing cries, and then convulsive movements of the whole body. His face was flushed, eyes sparkling-and he attempted to bite, and to squeeze tightly in his arms, every thing that came in his way. The parents frequent in the female than in the male. It is thought that it is sometimes owing to hereditary disposition, as it is found that the children of parents who have organic diseases of the heart, are apt to be similarly affected. There are some other predisposing causes enumerated, but we do not deem it necessary to notice them. On dissection of subjects who die of this disease, we generally find the venous system of the brain gorged with blood, the ventricles distended with serum, and one or both phrenic nerves swollen and indurated, or else in a state of atrophy. In the heart, the foramen ovale is open. The blood throughout the whole system is found quite liquid-the lungs partially ulcerated the liver enlarged. The cure of the disease is beyond the reach of art, since we cannot remedy the malformation of the heart, on which it mainly depends. But the author thinks that something might be done by getting the individual past the period at which the disease usually terminates fatally. This is to be done by the greatest repose -by avoiding aliment of a hydrogenated quality-by living chiefly on vegetables and water, &c. And as the oxygenation of the blood in the lungs is very imperfectly performed, this defect is to be remedied as much as possible by soliciting the action of the other secretory organs with which the lungs are in accordance, as the kidneys, liver, skin, &c. At the same time, the respiratory organs are to be guarded by the greatest attention to a regulated temperature, and defending them from catarrhal affections. We shall now give some particulars of a case in illustration of this formidable disease. Case. A. Gotlieb, aged 16 years, was said to have enjoyed good health till the year preceding, when he became affected with pains in the left side of the chest, dry cough, dyspnoea, and fever. The vil lage barber was called in, who practised a large bleeding from the arm. This measure diminished the pain in the side; but the other symptoms continued the same. On the 28th January, the tenth day of the illness, the author was called in. He soon discovered the radical defect in the central organ of the circulationas evinced by the usual symptoms of cyanose, described above. The pain in the nœa. side had now returned, and the difficulty of breathing amounted almost to orthopThe fever was slow, the expectoration mucous, the appetite gone. Quietude, aqueous drink, and vegetable diet, were prescribed; while digitalis, nitre, hyosciamus, &c. were ordered. In a few days, the oppression and pain were diminished, but the expectoration had become sanguinolent, and the fever was increased every evening. Eight grains of calomel were given night and morning, in order to procure stools. 3d. Feb. The expectoration is now pure blood; but the cough and oppression are somewhat relieved. Acids were given, and a tepid muriatic acid bath ordered once in 48 hours. By these means the hæmoptysis was checked; but purulent expectoration succeeded. On the 26th March, there was another discharge of blood from the lungs, and life was threatened. Venesection and acids again stopped the hæmoptysis; and again the purulent expectoration became copious. The disease now made rapid progress, and the patient was carried off early in May, having evinced for some time, considerable disturbance of the cerebral system. Dissection. The venous system of the brain was gorged with blood-some serous fluid was found in the ventricles. with blood, especially the upper part of The lungs were gorged in several places the left lung, where there were several recent abscesses. The phrenic nerves were enlarged and indurated-and the left par vagum reduced to a kind of bouillie. foramen ovale was open-the two auriThe pericardium contained serum-the cles were prodigiously enlarged, but all other parts of the heart were natural. The liver was enormously enlarged, and quite lacerable.-Journ. de Progres. No. 4. 9. LITHOTOMY. Two cases are reported from Panton Square, the first of them fatal. Case. H. Morgan, æt. 10, had been labouring under the symptoms of stone in the bladder for five years. When admitted, his sufferings were exceedingly severe, but the general health was good, although he was subject to febrile dis turbance of the system. Having sounded, &c. Mr. Wardrop, assisted by Mr. Lawrence, proceeded to the operation, which was performed with a common staff, having a deep groove, and a large scalpel with straight and rounded back. The incision of the prostate not being sufficiently free, it was necessary to introduce the knife twice to enlarge it, when a stone, weighing above an ounce and a half was extracted. When put to bed, he had a severe rigor and much pain, for which he took a large opiate. Vespere. Very low-pulse 100, small, and fluttering-pain in the abdomen and wound, through which the urine passed freely. Another large opiale. In the morning, the countenance was sunken and anxious-the pulse 140, but weak and fluttering-much internal pain, with tenderness of the abdomen. A large opiate was again given, with camphor and ammonia, but the patient continued to sink, and expired next morning. Dissection. The bladder was greatly contracted, and the incision into it remarkably large. The peritoneum, generally, was vascular, particularly over the fundus of the bladder, where there was recent coagulable lymph, exactly resembling thick pus. The left kidney bore very decided marks of ancient inflammation.-LANCET, 208. Remarks. It is evident that this patient sunk, not so much under the local inflammation, as in consequence of the shock given to the system generally by the operation. These cases, as Mr. Wardrop justly observed, are exceedingly difficult to treat-you dare not deplete for fear of the exhaustion-you are afraid to stimulate because of the inflammation. But might not the local action have been moderated here by local means, leeches, fomentations, &c. whilst at the same time, the system was supported by the camphor and ammonia? We think so, though we are quite ready to grant that the odds were fearfully against recovery, whatever treatment was employed. The reporter makes a very silly remark. He observes, that he was particularly struck, in this case, with the facility with which the largest stone may be extracted by the scalpel operation, after the incisions have been made sufficiently free! This is rather unfortunate, considering that, in this very case, they were obliged to em ploy repeated introductions of the scalpel, before the incisions actually were "sufficiently free" 10. ON EXTIRPATION OF THE UTERUS.* By Dr. GUSTAVUS HESSE. A German This operation, though one of the most formidable in surgery, has been practised for centuries past-and more frequently by ignorant or audacious Charlatans, than by regular surgeons. surgeon, however, (M. Osiander) rescued this operation from the hands of quacks, but, unhappily, he could never be prevailed on to give the details of his practice to the world at large. He simply stated, from time to time, that he had performed the operation, and promised a book on the subject; but he died at an advanced age, and has left no records of his cases-at least, that are available by the profession. Osiander's operation was seldom imitated till of late years, when several cases have been published of partial and even of total ablation of the womb. It would be wrong to form too sanguine hopes from this operation, especially in cases of cancer uteri; but the experience of Osiander enabled him to aver, that extirpation of scirrhous uterus was as successful as extirpation of that disease in other parts of the body. All of his patients recovered from the immediate effects of the operation, though some of them relapsed afterwards, and died of the renewed malady. This operation (extirpation of the uterus, is said to have been performed in a relates nineteen cases; and Schenk a far great many instances formerly. Baukin greater number. But it is justly doubted, whether many of these were not partial amputations of the organ, or removals of largements of the womb. Baudelocque, polypi, which had been mistaken for enhowever, considers it as incontestible, that the extirpation of the uterus had been successfully executed before his time. The operation has been performed *Allegemane Medezin. Annalen. May, 1826. frequent in the female than in the male. It is thought that it is sometimes owing to hereditary disposition, as it is found that the children of parents who have organic diseases of the heart, are apt to be similarly affected. There are some other predisposing causes enumerated, but we do not deem it necessary to notice them. On dissection of subjects who die of this disease, we generally find the venous system of the brain gorged with blood, the ventricles distended with serum, and one or both phrenic nerves swollen and indurated, or else in a state of atrophy. In the heart, the foramen ovale is open. The blood throughout the whole system is found quite liquid-the lungs partially ulcerated-the liver enlarged. The cure of the disease is beyond the reach of art, since we cannot remedy the malformation of the heart, on which it mainly depends. But the author thinks that something might be done by getting the individual past the period at which the disease usually terminates fatally. This is to be done by the greatest repose -by avoiding aliment of a hydrogenated quality-by living chiefly on vegetables and water, &c. And as the oxygenation of the blood in the lungs is very imperfectly performed, this defect is to be remedied as much as possible by soliciting the action of the other secretory or gans with which the lungs are in accordance, as the kidneys, liver, skin, &c. At the same time, the respiratory organs are to be guarded by the greatest attention to a regulated temperature, and defending them from catarrhal affections. We shall now give some particulars of a case in illustration of this formidable disease. side had now returned, and the difficulty of breathing amounted almost to orthopnœa. The fever was slow, the expectoration mucous, the appetite gone. Quietude, aqueous drink, and vegetable diet, were prescribed; while digitalis, nitre, hyosciamus, &c. were ordered. In a few days, the oppression and pain were diminished, but the expectoration had become sanguinolent, and the fever was increased every evening. Eight grains of calomel were given night and morning, in order to procure stools. 3d, Feb. The expectoration is now pure blood; but the cough and oppression are somewhat relieved. Acids were given, and a tepid muriatic acid bath ordered once in 48 hours. By these means the hæmoptysis was checked; but purulent expectoration succeeded. On the 26th March, there was another discharge of blood from the lungs, and life was threatened. Venesection and acids again stopped the hæmoptysis; and again the purulent expectoration became copious. The disease now made rapid progress, and the patient was carried off early in May, having evinced for some time, considerable disturbance of the cerebral system. brain was gorged with blood-some seDissection. The venous system of the rous fluid was found in the ventricles. with blood, especially the upper part of The lungs were gorged in several places the left lung, where there were several recent abscesses. The phrenic nerves were enlarged and indurated-and the left par vagum reduced to a kind of bouillie. foramen ovale was onen--the two auriThe pericardium contained serum-the re prodigiou ts of the h normous Journ. |