some medicines, which, from the description given, I presume consisted either wholly or in part of iron. Under this treatment she got rapidly worse. On Friday the 20th, when stooping, she felt, to use her own expression, something give way within her, and the swelling of the abdomen appeared to subside, as did likewise the dragging and tensive pain above-mentioned. Towards evening she complained of diffused pain of the abdomen, which, by Saturday, had so far increased that she was unable to bear the slightest pressure. There was great heat of skin, headache, knees flexed upon the abdomen, some difficulty of breathing, contracted state of the features, nausea and vomiting, with difficulty of, and intense pain over the abdomen, on emptying the bladder. This condition continued until Monday, when she passed gradually into the state in which I found her on the Tuesday morning.

"Autopsy twenty-six hours after death.-On laying open the abdomen, I was surprised to find a large quantity of a dark red and thickish fluid (somewhat similar in appearance to blood, which had been for some considerable time effused) lying in the cavity of the peritoneum, and amounting, I should imagine, to twelve or fourteen ounces. The peritoneum, which was everywhere in contact with it, was stained of a reddish colour. On wiping away the fluid with which it was covered, there was an evident increase of vascularity, and in some parts the membrane was covered with a thin layer of coagulable lymph. 1 searched for the source of this sanguiniform fluid, but for a considerable time without effect. The uterus at length attracted attention; it was considerably larger than the ordinary size of a man's fist, but, nevertheless, flaccid. Upon opening it, I found four or five ounces of a similar fluid to that in the abdomen, contained within its cavity. The fallopian tubes were enormously distended; so much so that I could with ease pass the little finger into them. Close to the fimbriated extremity of the left tube there was a fissure about two lines in length, with ragged edges, thus forming a free communication from the cavity of the uterus to that of the peritoneum: through this the fluid in question had evidently passed. The lining membrane of the uterus was of a slightly reddish colour, depending, as I imagine, on its contact with the contained fluid. On pursuing the examination, I found an obstruction to the passage of the finger or probe through the vagina. This was caused by the opposition of the walls of the canal, and their junction by firm cicatrization. This cicatrix was from half an inch to an inch in length, and contained a hard tough substance in many respects resembling cartilage. I could find nothing at all resembling the hymen." -London Med. Guz. March, 1841.

7. Remarkable Spina Bifida.-Dr. VERRALL relates the following example of this, in a healthy, ruddy looking boy, about 13 years of age. When viewed in front, no deformity is perceptible, but on looking at his back a tumour, as large as a man's head, is seen situated over the lumbar vertebræ. This tumour is some inconvenience to him, but he plays about like other boys of his age. The skin covering it is here and there red, and tense and tight over the entire swelling.

The history of the case is as follows:-It was small at birth, but began to increase in size; at two years of age it was punctured by an empiric, and a quantity of fluid removed from it. The boy became immediately paralyzed, and continued so for several months. He recovered, however, when the tumour again increased in size. It was once more opened by the same person, who on this occasion made an incision of some extent over its surface. Ulceration again took place, and the boy was again paralyzed. He again, after some time, recovered the use of his limbs. The marks of the puncture and incision were quite visible on the tumour. Pressure over the swelling does not affect the patient. -Lancet, February 13, 1841.

8. On Sudden Death.-Mr. WINSLOW read before the Westminster Medical Society, an interesting paper on this subject. After referring at some length to the physiological causes and phenomena of sudden death, he brought before the

society an analysis he had made of 200 cases in which life was suddenly extinguished, from which it appeared that 40 arose from diseases of the heart; 20 from affections of the brain; 25, brain conjoined with disease of the heart; 18, abdominal affections; 20, aneurismal tumours; 10, convulsions; 32, mental excitement, with and without bodily disease; whilst under the use of mercury, 2; from lightning, 2; during parturition, 6; idiopathic asphyxia, 4; drinking cold water, 5; pulmonary apoplexy, 5; hæmorrhage from the Fallopian tubes, 1; air in vessels of brain, 2; blows on the stomach, 4, &c., &c. The majority of these cases were women. In 1838, Mr. Farr states that, out of 2012 cases of sudden death that occurred, 1840 were males, and 1772 were femles. Women, it appears, have less chance of dying suddenly than men, in the proportion of 10 to 18. The majority of cases of sudden death arise from hemorrhage. From January 11 to October 17, 1840, 524 instances of sudden death took place in the metropolis alone. Between the ages of 1 and 15, 142; between 15 and 60, 246; and from 60 upwards, 131. Mr. Winslow then considered in the following order the organic affections which commonly give rise to this awful calamity:-1, Diseases of the heart and large vessels; 2, Diseases of the lungs, and those causes that interfere with the functions of respiration; 3, Diseases of the brain and appendages; 4, Diseases of the stomach and abdominal viscera generally. The affections of the heart, that often predict a sudden suspension of life, are as follows:-Rupture of the heart; relo-condition of the heart, or asphyxia idiopathica; syncope angina pectoris; hydatids of the heart; metastasis of disease of the heart; the sudden bursting of aneurismal tumour. Mr. Winslow related many instances of fatal rupture of the heart. The first case is related by Harvey, and Morgagni, who himself died suddenly of this disease, narrates many similar cases. He considered that the symptoms which usually indicated liability to this affection are-violent pain beneath the sternum and in the arms, pain in the præcordia and epigastrium, cold extremities, &c. In the majority of cases the heart has undergone some previous disease, either ulceration or softening, or there is a disproportion in the thickness of its muscular parietes. When the heart has undergone a structural alteration, it requires but a slight cause to rupture it. Mr. Winslow referred, at considerable length, to sudden death from asphyxia idiopathica, a decisive point noticed by Mr. Chevalier, which consists of a sudden loss of power in the minute vessels to propel the blood they have received from the heart; in consequence of which this organ, after having contracted so as to empty itself, and the dilated organ, continues relaxed for the want of the return of its accustomed stimulus, and dies in that dilated state. This affection seizes the patient suddenly, and, if proper remedies be not administered, death ensues in a few moments. It is often mistaken for apoplexy. Mr. Winslow then alluded to sudden death from protracted syncope. A person drops down in a fainting fit; relief is not instantly afforded, the heart never recovers its action, and death ensues. A case of this kind was related, caused by wearing tight clothes. Mr. Winslow thought that death often resulted from spasm of the heart. Hippocrates, Herophilus, and Bichat, relate cases of this character. In this way the latter physiologist considered that great mental emotion caused death. Mr. Winslow entered into the consideration of sudden death resulting from the transmission of disease to the heart, to the bursting of aneurismal tumours, hydatids in the heart, vomica suddenly bursting in the substance of the lungs, effusion in the chest, pulmonary apoplexy, which disease was considered generally to be conjoined with disease of the heart. The affections of the brain that caused sudden death were next dwelt upon; viz., 1, Cerebral apoplexy; 2, Latent inflammation, causing suppuration; 3, Abscesses suddenly bursting; 4, Generation of air in the vessels of the brain. He considered that sufficient attention was not paid to the latent or insidious affections of the centre of the nervous system; that inflammation and the formation of pus often took place, and extinguished his life before we were aware of its existence. Many cases, illustrative of this position, were related. Morgagni conceived that sudden death often resulted from what he termed "a repletion of the blood-vessels of the brain by air," which had been developed there spon

taneously, compressing, by its rarefaction, the organ of the nerves, and thus destroying life. Mr. Winslow related the particulars of several instances of sudden death, in which the vessels of the brain were found filled with air; but expressed a doubt as to whether it was in our power to trace a connection between the extinction of life and the generation of this fluid in the vessels of the brain. The affections of the stomach and intenstines were next considered. Many fatal cases of ulceration of the stomach and intestinal canal were referred to, caused by the presence of lumbrici, in which death was suddenly and unexpectedly induced. The other affections which Mr. Winslow brought under the notice of the society, as deserving of its consideration, were as follows:-Death from mental excitement; drinking cold water; rupture of the biliary ducts; hæmorrhage from the Fallopian tubes in utero-uterine conception; inhalation of noxious gases, whilst under the influence of mercury, caused by exposure to intense cold, or to the heat of the sun.-Lancet, November 21, 1840.

9. Obliteration of the Inferior Vena Cava.-Dr. GELY has recorded, in a recent number of the Journal de la Section de Médecine de la Société Académique du Département de la Loire-Inférieure, the following interesting case of obliteration of the inferior vena cava.

Gerard, a seaman, 48 years of age, strong constitution, sanguineons temperament, was admitted towards the close of the winter of 1838, into the hospital of Nantes, with symptoms of anasarca, ascites, febrile oppression, extreme varicose dilation of the veins of the lower extremities, and of the abdomen, which were also excoriated over several spots. He stated that the varicose state of the veins came on during the winter of 1823, when he had the misfortune to have his legs frozen. He however recovered so far as to be able again to go to sea, where he contracted one of those cutaneous affections so common amongst negroes. Ulcers and abscesses formed on various parts of his legs, and he was long confined to bed; the varicose state of the vessels increased; and, for the last five or six years, he had been unfit for work. After a residence of a few weeks in the hospital, he died, with all the symptoms of some serious affection of the circulatory organs.

On dissection the superficial veins of the lower extremities presented the appearance of thick cords, doubled on themselves a great number of times, in the same way, indeed, as the vas deferens is at its origin. This mass, as it approached the crural arch, increased in volume; but after passing this, in its progress over the abdomen, it diminished in bulk till it reached the false ribs. The varicose veins were perceptibly larger and more flexuous on the right than on the left side. The varicose vessels over the trunk of the body were the abdominal tegumentary vessels, which anastomosed on each side with a large external mammary branch, which terminated in the axilla. The femoral and iliac veins of the right side were filled with false membranes to such an extent as to diminish the calibre of the venous canal to a tenth of its natural diameter. The false membranes became more numerous as they approached the vena cava, which was reduced to the state of a cartilaginous cord, as far as the point where the emulgent veins unite with it, above which portion it was pervious, but reduced in diameter.

The right epigastric vein was somewhat narrowed in diameter, but that of the left side was enormously dilated, ascended towards the umbilicus, coursed along the suspensory ligament of the liver, and followed exactly the course of the umbilical vein. The two renal veins were very much dilated, and on the right side an abnormal branch opened into the vena cava, and was continuous with the vena comes of the crural nerve, which was much dilated, and seemed to receive the blood from the deep vessels of the thigh.

The heart was hypertrophied, with dilation of all its cavities; and osseous concretions were met with around the aortic and auriculo-ventricular orifices, as well as in the coats of the aorta.

This case is extremely curious, as showing the mode in which the venous circulation had been kept up in spite of the destruction of the canal of the vena

cava. Thus, on the right side, the blood from the lower extremity, collected by the superficial veins, passed along the tegumentary veins and external mammary into the axillary vein, and from that into the superior cava; whilst the blood of the deep portions of the same limb was emptied into the vena comes of the saphena nerve; and from it into the vena cava inferior, above the contracted portion, and lumbo-vertebral venous plexus. On the left side, again, the superficial blood returned to the centre of circulation in the same manner as that on the right side; whilst the venous blood from the deep porticns of the limb was poured into the epigastric vein, and from it into the sinus of the vena portæ by the umbilical vein.

The opening of one of the epigastric veins into the umbilical vein, and the enormous dilation of the vein which accompanies the crural nerve, and communicated with the vena cava inferior, were the two most striking anomalies in this case.-Gazette Méd. de Paris, November 7, 1841.

MEDICAL PATHOLOGY AND THERAPEUTICS AND PRACTICAL

MEDICINE.

10. Results of Re-vaccination in the Deaf and Dumb Institution of Paris.-The number re-vaccinated was 128-124 pupils, whose ages varied from ten to eighteen years, and four adults, servants of the institution. Of the entire number, 60 were males and 68 were females. The operation was performed from arm to arm; the vaccine lymph was abundant; and the number of punctures made in each arm varied from two to six.

In 25 of the individuals, there neither were any traces of previous vaccination on their arms, although they had no doubt been vaccinated in infancy, nor were there any marks of smallpox on their face or body. (The mere absence, however, of cicatrices cannot be taken as a proof that the parties had never been vaccinated, nor had passed through variola.) Of these 25 cases, the vaccination produced no vesicles in 18; imperfect or false vesicles in four; and genuine cow-pox vesicles in three only.

Of seven individuals, who had distinct marks of smallpox on their faces, limbs and bodies, the operation succeeded perfectly in two, and failed altogether in five of them.

In the remaining 94 cases, there was distinct cicatrices of a former vaccination, the number of these varying from one to four or six; in some, one or more cicatrices were observed on each arm, in others on one arm only.

Now of these 94 persons, ten exhibited distinct cow-pox vesicles (after the re-vaccination,) 16 imperfect or bastard vesicles, and, in the remaining 70, the operation failed in producing any effects.

If we take, therefore, the entire number of persons "all well re-vaccinated by me, says M. MENIERE, the reporter, "we find that in 15 cases only out of the 128, regular cow-pox vesicles were formed over the punctures on the arms; in 20 the vesicles were imperfect or bastard; and in 93 none at all were developed. From these data it appears that the operation took effect in about one-eighth of the whole; in about the same proportion, one-eighth, in those who had never had smallpox, and who exhibited no traces of vaccine cicatrices on their arms, although they had been vaccinated at some former period of life; in one-third of those who had had smallpox in their youth; and in about one-tenth of those in whom the cicatrices of a former vaccination were still distinct." In estimating these results, it may be proper to attend to certain circumstances connected with the cases.

Of the fifteen persons in whom the re-vaccination took complete effect, ten were under thirteen years of age, and the other five were a few years older. In the two young girls, in whom it succeeded after previous smallpox, (which had left numerous and most distinct traces on the face and elsewhere) five years had elapsed in one case, and seven in the other, since the date of the attack

Among the pupils who had been vaccinated in their infancy, and in whom the re-vaccination took complete effect, two were twelve years, and the third was fourteen years old.

From these data, we may infer that the preservative or counteracting power of smallpox does not exceed that of cow-pox; since, under very similar circumstances, those who had passed through the two diseases were submitted to the same contagious influence, and experienced nearly the same results.

But we are unwilling to draw any general conclusions from the preceding report; as we are well aware that experiments must be made on a much more extensive scale before we can safely do so.

In conclusion, we may state, that several infants were vaccinated for the first time from the vesicles on the arms of those in whom the second operation took effect, and that the virus thus obtained seemed to be perfectly genuine and active. -Med. Chirurg. Rev. from Journal des Connaiss. Med. Chirurg. Sept. 1840.

11. General result of the Vaccinations and Re-vaccinations in France.-There is in a recent number of the Annales d'Hygiène et de Méd. Légale a table, prepared by M. VILLENEUVE, the reporter of a commission appointed by the Royal Academy of Medicine, exhibiting the general results of the vaccinations and revaccinations performed, and of the number and issue of the cases of smallpox in those who had been vaccinated, compiled from reports sent from forty-one departments. The results of those reports only are given in which the vaccinators have recorded their unsuccessful as well as successful cases; and wherever the re-vaccinations were described as doubtful, they have been omitted. We give only the totals.

1. That the proportion of cases in which vaccination failed, compared with that in which it took effect-estimated by some writers as one to eight, or one to ten-is not more than about one to fifty-four.

2. That of 2199 cases, in which re-vaccination was performed on persons of different ages and sexes who had been successfully vaccinated at some previous period of their lives, the operation took effect in 223 cases only-which would give the proportion of about one to thirteen or fourteen.

3. That of 365 cases of confirmed smallpox, occurring in persons, who had been at some previous period successfully vaccinated, there were only eight that proved fatal-giving a proportion of about one in forty-five or forty-six.

We know that sporadic smallpox, usually carries off about an eighth or a tenth of those who are affected with it; and that, when the disease becomes epidemic, the mortality is often as high as one in four, and sometimes even higher.

M. Villeneuve, in submitting the above table as containing the results of the labours of the commission, admits that the data hitherto supplied are far from being sufficient to solve the question submitted by the government to the Royal Academy-whether it is necessary to have recourse to re-vaccination as a universal measure throughout France.