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 doc uments. 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 dysentery14 had diarrhoea-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,

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 ordersbe attributed to want of cleanliness, good therefore the cause of sickness could not 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 disengaged, though not in any very large 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.

6.

were alarmed at hydrophobia, and summoned two physicians. When they arrived, the patient was in an interval of calm-lying without sense-his eyelids shut, but the balls rolling about underneath-pupils greatly dilated, but still sensible to light-face of a purplish cast skin burning hot-pulse contracted, hard, and quick-carotids beating strongly. Twelve leeches were applied to the regions of the jugulars--sinapisms to the feet--cold lotions to the head. In five hours the physicians returned, and the scene was greatly altered. The little patient seemed in the jaws of death. His whole surface was pale and cold-pulse imperceptible--the respiratory movements were the only indications of life. These phenomena resulted from an excessive hæmorrhage. The leech-bites were stopped-stimulating frictions were applied, and some spoonfuls of soup were injected into the stomach. The boy gradually recruited, and a corresponding reaction took place, when diluents were prescribedDuring the succeeding day and night he bad repeated vacillations between paroxysms of excitement and alarming states of collapse. The latter, however, were the more predominant; but, at the end of the third day, he had become sensible -his appetite gradually re-appeared, and by the 22d May, the boy was convalescent, and the physicians took their leave.

Remarks. M. Broussais observes that the above is a good example of the energetic effects of local bleeding carried to syncope, for the cure of acute inflammation in young subjects. Cerebral inflammations are the most rebellious of all, in this class of patients, and the Professor doubts whether this boy's life would have been saved, had the hæmorrhage from the leech-bites not gone on unintentionally to syncope. Notwithstanding the authority against us on this point, we much doubt whether the above patient was actually affected with acute inflammation of the brain and stomach, as he is stated to have been. The manner in which he was seized-the violent vacillations of the phenomena, from intense excitement to frightful collapse, three or four times in the 24 hours, are not the phenomena which we have observed in acute inflammations of either brain or stomach. The complaint, in our humble opinion, was some powerful irritation of the gastric or intestinal nerves, affecting sympatheti

cally the whole nervous system, and thus imitating inflammatory action, when nervous irritation was at the bottom of the whole. Many are the examples which we have seen of this deception. Neither do we observe any phenomena in this case, which can authorise either M. Broussais or the physicians who attended the patient, to say that there were "quelques symptômes de rage" manifested by the boy. If attempts to bite be indications of hydrophobia, there is many a female affected with that disease in common paroxysms of hysteria. We wonder that such a man as M. Broussais should permit the above observation in this statement of the case, as compiled by the attendant physicians.--Annales de Med. Phys.

7. SPONTANEOUS PARAPLEGIA. Mr. Iliffe lately read a case at the Medical Society, Bolt Court, which has been reported in the LANCET, and headed "Spontaneous Paraplegia." We know not why the term "spontaneous" should be applied to a disease of the spinal marto a disease of the brain causing total or row causing paraplegia, any more than partial paralysis. Be this as it may, the case gave rise to a hot discussion in the Society. The following are the principal features of the case.

A gentleman, ætat. 25, became indisposed in the Summer of 1827, complaining of "a gradual diminution of strength," with pains about the wrists and ankles, and towards the end of August, a slight difficulty in making water. On the 2d September he dined in Fleet Street, and in the evening was sick. The difficulty of making water increased, as did the weakness of the lower extremities. Mr. J. saw him, and ordered some medicines. On the 4th, he had nearly lost the power of the inferior extremities-pain in his loins--water dribbling from him—no general febrile symptoms. 5th. "Has had considerable uneasiness, during the night, along his back, and under each scapula,' -no power of the bladder. Mr. Callaway called in consultation-catheterism--blister to the spine-ammonia and cascarilla -Plummer's pill. 7th. Little alteration. 8th. Pulse 80-no pain-appetite good

spirits depressed-still no power in the limbs. 9th. Passed a restless night, and is rambling to-day-thirst-hot skintongue dry-bowels torpid. 11th. Dr. Back called in. Calomel and cathartic extract—nourishing diet-blister to be healed. 12th. Pulse 120-quinine- calo mel and colocynth-in the evening, the pulse 164-abdomen tense. Died on the 13th September.

Dissection. This was made in a very able mauner by Dr. Hodgkin. We shall pass over many of the minutes of dissections, as not bearing on the immediate seat of disease. The arachnoid was partially opake and remarkably firm-considerable effusion beneath the arachnoid -pia matter injected-substance of the brain natural. The dura matral covering of the spinal medulla was sound-the pia mater considerably injected-in two spots, of an inch or more in length each, the pia mater was black-the medulla ap peared to have experienced "consider able pressure from its pia matral envelope." The consistency of the medulla was, throughout, softer than usual, and almost the whole of the dorsal portion was "much softer." Opposite the black patches above-mentioned, the medullary matter" contained numerous minute darkcoloured ecchymosed points." In one place the medulla was so broken down as to produce the appearance of a cavity." "Some spots were nearly black." This state existed, in a greater or less degree, throughout the dorsal region. "The consistency of the most softened portions was similar to that of cream." The mucous membrane of the bladder was of a livid colour.

In the discussion which ensued, it was maintained by Dr. Johnson that the above appearances were the legitimate products of chronic inflammation, and it was as resolutely maintained by Mr. Callaway that neither the symptoms nor the appear ances on dissection evinced the slightest connexion with an inflammatory process. It is not for us to pronounce on this point, and we leave it to the public to decide between Mr. Callaway and Dr. Johnson. We think there can be little doubt that the disease (by whatever name we may call it) had been going on for a considerable time before either Mr. Iliff or Mr. Callaway saw the patient-and, consequently, that it was far beyond the power of art when these gentlemen were conVOL. VIII. No. 15.

26

sulted. The question, therefore, is principally pathological-and we would refer Mr. Callaway to the writings of Ollivier, Abercrombie, and many others, on this point. If Mr. C. will turn to the first volume of this Series, page 39, he will see a case quoted by Dr. Abercrombie from Professor Brera, which bears a very close analogy to the one in question.

P. S. In a conversation with Dr. Hodgkin, who made the dissection in this case, and, than whom, there is not a better pathological anatomist in London, that gentleman expressed his entire conviction that the appearances in the spinal marrow of the above patient were the legitimate pro ducts of inflammation.

8. PNEUMO-PHTHISIS CYANOTICA.

In the 4th number or volume of our respected cotemporary, the JOURNAL DE PROGRES, there is a short article under the above head, extracted from Hufeland's Journal for February, 1827. This terrible affection (pulmonary phthisis with the blue disease) has engaged the attention of Professor Schonleim, who has described it minutely. It is generally developed at the age of puberty, and is rapid in its course, rarely continuing more than three months, and is remarkable for the affection of the venous system, the pulsations of the heart and arteries, (which are not always synchronous with each other-by the blue colour of the face and lips-the narrowness of the chest--the meagreness of the extremities, except at the tips of the fingers which are generally swollen, and the great incurvation of the nails. To these symptoms succeed cough, pain in one or both sides, oppression about the chest, expectoration, at first sanguinolent, and afterwards purulent, accompanied by hectic fever in the last period of the disease. It differs from common pulmonary phthisis by the rapidity of its course, by the want of general emaciation, the dryness of the skin, the paucity of expectoration, the constipation of the bowels, and the cerebral phenomena.

The effective cause of the malady is non-obliteration of the foramen ovale, which experience has shown to be more

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 no

tice 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 accord ance, 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.

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 se

rous fluid was found in the ventricles. with blood, especially the upper part of The lungs were gorged in several places recent abscesses. The phrenic nerves the left lung, where there were several 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 opiate. 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. War drop 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

10. ON EXTIRPATION OF THE UTERUS.* By Dr. GUSTAVUS HESSE.

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.

A German

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 polypi, which had been mistaken for enlargements of the womb. Baudelocque, however, 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.