incomplete, 18 per cent. exhibited the modified, and all the rest the genuine cow-pox.

At the present time, among the German medical men, little or no value is attached to the state of the cicatrices on the arm, as an index of the susceptibility of the system to be affected with re-vaccination. That this opinion has been the result of observation may be fairly inferred from the circumstance that the early ordonnances, issued by the Prussian government, prescribed the operation to be performed only on such of the soldiers as did not exhibit cicatrices having the characters indicated by Dr. Gregory of London. In consequence however, of the extension of variolous and varioloid disease among the army, the medical officers have unhesitatingly recommended the universal practice of re-vaccination on all the soldiers, without exception.

In conclusion, we may state that the German physicians are of opinion that the vaccine virus has not in reality lost any of its original powers or become deteriorated, by having been transmitted through so many individuals; but rather that its preservative quality against variolous disease is only temporary, and therefore that vaccination ought always to be repeated after the lapse of 10 or of 14 years.t

The increase of variolous and varioloid disease of late years they attribute not to the decay or deterioration of the cow-pox virus, but to the cause we have now mentioned its protecting power seeming to be limited to a certain time.

Such are the prevailing doctrines of the German physicians; and as the experiments, upon which they are founded, have been made upon a very large scale and under the sanction of the government, they are certainly entitled to great respect.

(We had intended to have described shortly the present state of medical opinion on vaccination, and the questions connected with it, in some other countries of Europe; but this we must reserve to the ensuing number, as the Printer has ordonné that

"Here is our journey's end, here is our butt,

And very sea-mark of our utmost sail.”—Rev.)

* These calculations will be found to vary exceedingly in different reports: they are not therefore to be taken as affording any general conclusion. Thus, in one of the reports from the Prussian army, out of 7845 re-vaccinated soldiers, in all of whom the cicatrices on the arm were distinct and normal, 31 per cent. exhibited the genuine, and 29 per cent. the modified cow-pox; whereas in the remaining 40 per cent. the operation failed in producing any effect. The state of the cicatrices cannot perhaps be at all depended upon, as affording any means of judging as to the liability of the parties to be affected either with the vaccine, or with the variolous, contagion.

+ According to this view, it is not necessary to have recourse to the cow for supplies of fresh lymph. There cannot however be any objection to this; and, as the subject is certainly not determined, it might be wise to renew the virus occasionally-especially as we are told that, during the last five years in Wurtemberg, the pock is known to have appeared on 188 cows dans toute sa perfection. -Rev.

MISCELLANIES.

RESEARCHES ON SUPPURATION. BY GEORge Gulliver, ESQ. ASSISTANT-
SURGEON TO THE ROYAL REGIMENT OF HORSE GUARDS.

THE object of this paper is to shew the Frequent Presence and the Effects of Pus in the Blood, in Diseases attended by Inflammation and Suppuration. The paper was read before the Royal Society on the 14th of June, 1838, and is contained in the Philosophical Magazine for September last.

As Mr. Gulliver observes, the humoral pathology has latterly begun to reassume some consequence, and, although it is not likely ever to appear in its ancient form, or to be invested with its former importance, still there can be little doubt that it has been undeservedly neglected.

The facts which have principally contributed to direct the attention of physiologists to the state of the blood, have been the cases of purulent deposits after injuries and operations, or in connexion with phlebitis. They have gone far towards establishing the probability of a vitiated condition of that fluid, as a leading morbid state, and have rendered the existence of pus in it a more than plausible conjecture. We look on the paper before us, which establishes the fact, as a highly important one, and as forming the commencement of a series of enquiries, which will, perhaps, exert a great influence in medicine.

Mr. Gulliver has detected pus in the blood on numerous occasions and under various circumstances. He details the steps of the examination, which was very simple, partly chemical and partly microscopic.

"

Those who are acquainted with the minute constitution of the animal fluids are aware of the rapid and energetic action of water on the blood-corpuscles : now the globules of pus undergo no change after having been long kept in water; accordingly, if the suspected blood be mixed with this fluid, the bloodcorpuscles will soon become invisible, and any globules of pus that may be present will subside to the bottom of the vessel, and may be easily seen, and their characters determined, with a good microscope. Ammonia instantly renders the blood-corpuscle invisible, while that of pus is acted on but slowly by the alkali; and the different action of acetic acid on pus and blood is equally remarkable. Hence I have employed these agents advantageously in conjunction with the other means; and I have also seen pus-globules in the blood, though rarely, without any preparation. With water, however, the examination is most easy, simple, and satisfactory, if the observer be thoroughly familiar with the microscopic characters of the fluids under examination. A good instrument, nevertheless, is necessary; and the admirable deep object glass of Mr. Ross is the one I have principally employed. It is hardly necessary to add, that chyleglobules are not likely to be mistaken for those of pus, since, independently of other distinctions, the medium diameter of the latter is at least ths of an inch, which is about twice that of the former."

Mr. Gulliver details, in a very brief manner, seven experiments and eleven
We shall quote all the experiments.

cases.

Exp. 1.-A weak solution of corrosive sublimate was injected into the sub. cutaneous cellular tissue of a dog's thigh; great swelling of the limb took place, and he died forty-five hours after the injury. A good deal of serum mixed with fibrine was found in the cellular tissue of the thigh, but there was no puru. lent deposit.

No. LIX.

T

Several pus-globules were detected in some blood obtained from the right ventricle of this dog's heart.

Exp. 2.-A large dog had both his tibiæ injured by some operations connected with necrosis; great swelling of the limbs, with violent fever, succeeded, and he died forty-three hours subsequently.

A large quantity of fibrine was found effused into the cellular tissue of the extremities, mixed, in one of them, with a very scanty proportion of purulent

matter.

In some blood, obtained from the vena cava, numerous globules of pus were observed.

Exp. 3.-An irritating fluid was injected into the peritoneum of a dog; he had great thirst, refused food, and died the third day after the operation.

A large quantity of coagulated lymph and sanguinolent serum with some pus was found in the belly.

In some blood obtained from the inferior cava vein many globules of pus were

seen.

Exp. 4.-Two ounces of pus were injected into the left pleura of a dog, and very carefully confined there; he was thirsty and feverish for fifty-five hours after the operation, when he was killed.

An ounce of fluid, almost entirely serum, was found in the pleura, and some fibrinous exudation on the membrane.

Blood from the heart, as well as from the vena cava was examined, and found to contain several pus globules.

Exp. 5.-Four ounces and five drams of pus were injected into the peritoneum of a dog, and the wound carefully closed; he died thirty-seven hours after the injury.

There were only nine drams of a sero-sanguinolent fluid found in the peritoneum, and a considerable quantity of coagulated lymph on the membrane. Pus was detected in the blood.

Exp. 6.-Half a dram of pus, mixed with half an ounce of water, was gradu ally injected into the crural vein of a dog.

Some fever followed, and he refused solid food for two days, but recovered at the end of a week.

The same quantity of pus was soon afterwards injected into the other crural vein, when similar symptoms were produced, and he perfectly recovered in a few days.

Exp. 7.-Six drams of pus having been injected into the crural vein of another dog, he was not much affected at first, but in a few hours became very weak, was stupid, thirsty, and refused his food. After thirty hours he took but little notice of surrounding objects, his respiration was hurried, and he died thirty-six hours after the operation. In the blood of the inferior cava some pus-globules were readily detected.

We pass to the cases.

Case 1.-A girl died of confluent small-pox on the ninth day of the disease. There was great swelling of the integuments.

In the blood of the right ventricle numerous pus-globules were found.

Case 2.-A woman had confluent small-pox, uncomplicated with erysipelas or inflammation of the viscera.

On the eighth day of the disease some blood was drawn from a vein in the arm several pus-globules were found in this blood.

Case 3.-A male child, æt. 15 months, died on the ninth day of small-pox, Only a few pustules appeared, and these were imperfectly developed there was considerable swelling in the face, slighter in other parts.

At the post-mortem examination, it was observed that a small quantity of a white opaque fluid might be squeezed from the cut surfaces of the lymphatic glands of the neck and groin: this fluid had the microscopic and chemical characters of pus.

In some blood obtained from the right ventricle and from the inferior cava vein, pus was detected.

Case 4.-In a woman who died of puerperal peritonitis, the peritoneum contained a large quantity of coagulated lymph, serum, and purulent matter.

Pus was detected in the blood obtained from the right ventricle of the heart.

Case 5.-James Green, æt. 27, was admitted into hospital with an ulcer of the leg. Seven days afterwards, the limb began to swell, and there was hardness in the femoral vein, with some redness in the course of the absorbents on the inner side of the thigh. The swelling of the limb increased gradually; he had first pain in the head, thirst, and quick pulse; then purging, pain in one wrist, with restlessness, incoherency of speech, and offensive breath; finally, low muttering delirium, accelerated respiration, and coma preceded his death, which took place on the 12th day after his admisssion into hospital.

At the post-mortem examination, the large veins of the limb were found to be occluded throughout by firm clots of blood, mixed with pus and coagulated lymph,' and the lining membrane of the femoral vein was in many places of a red colour, and coated with fibrine. In the iliac vein no such signs of inflammation appeared, although there was a large coagulum of blood, which had lost its red color, containing in its centre a small quantity of matter resembling pus. Several purulent deposits presented in the sheath of the femoral vessels, and in the intermuscular cellular substance.

The matter resembling pus in the clot of the iliac vein had neither the chemical nor microscopical characters of that fluid.

In some blood obtained for examination from the right ventricle and from the vena cava, numerous globules of pus were found.

Case 6.-J. H. æt. 22, had a superficial wound of the tibia, succeeded by much swelling of the limb, and effusion of fibrine and sanguinolent serum. A few pus-globules were found in blood from the cava.

Case 7.-M. J. æt. 42, had erysipelas of the face, succeeded by jaundice, and effusion of an ounce of turbid serum, with a little purulent matter into the right pleura, and eight ounces of sanguinolent serum into the left. Some blood was obtained for examination from the larger veins, and found to be greatly contaminated with pus.

Case 8.-Sergeant Dunn, æt. 29, had profuse suppuration between the muscles and beneath the integuments of the thigh; he died, after some weeks' s uffering, exhausted by hectic.

The purulent matter was extremely offensive, putrefying with great rapidity; and sometimes coagulating spontaneously, when set aside for a short time, It was poor in true pus-globules, but contained a large quantity of flaky fibrinous matter, to which its opacity was chiefly owing. Many pus-globules were found in the blood, obtained from the right ventricle.

Case 9 was one of pulmonary phthisis. In the blood obtained from the vena cava and right ventricle, many pus-globules were found.

Case 10 was one of irritative fever from a large abscess behind the trochanter femoris. An ounce of blood was drawn by cupping from the neighbouring sound parts, and some pus was detected in this blood.

Case 11. In a horse who died with vomicæ, and sero-purulent fluid in one pleura, pus was detected in the blood of the vena cava inferior.

Mr. Gulliver has found pus in the blood in other instances. Dr. Davy has also found pus in the blood in consumptive cases. The latter gentleman, indeed, has found pus in the blood in seventeen instances after death, in sixteen of which there was declared suppuration, and in one none could be detected: in the latter, the patient died of acute inflammatory disease.

Mr. Gulliver offers some observations on the formation of pus and on the nature of suppuration. But we believe that he intends to prosecute this subject. We shall not, therefore, touch on it at present, but content ourselves with laying before our readers, the conclusions which Mr. Gulliver draws from his experiments and cases.

"The term suppurative fever is not new, and its signification is probably now extended; for it seems to be an appropriate one for the different forms of constitutional disturbance under consideration. If the presence of pus in the blood and the fever in these cases be not related as cause and effect, the coincidence would appear to be no less interesting than remarkable.

What a field of inquiry this view opens to us! Henceforth, whenever a patient is affected with inflammatory fever, or that low typhoid state which is so generally a fore-runner of death, as a consequence of traumatic or idiopathic inflammation, the state of the blood will present an interesting subject of investigation. And this is not merely a matter of curiosity; for the question will arise, whether, in the treatment of such cases, it would not be advantageous to produce suppuration as soon as possible on the surface of the body, so as to establish a drain by which the blood might be deprived of the offending matter. It may be asked also, whether the benefit so often effected by blisters, setons, and issues, in certain internal inflammations, or by incisions which cause suppuration, in inflammatory affections of the integuments, be not explicable by this theory? It is well known that in cases of traumatic or idiopathic inflammation, attended with great swelling and febrile excitement, the establishment of suppuration in the part is generally a favourable symptom, the separation of the pus from the blood being a sort of crisis to the symptomatic fever. In small-pox, it is a popular belief that the striking in,' as it is termed, or suppression of the pustules, is a bad symptom; and this is so far true, that the worst cases of this disease are those in which there is great swelling of the integuments without the due formation of pus in the usual situation. In every instance in which I have examined it, I found pus in the blood of patients affected with small-pox. In the fourth and fifth experiments the pus which was injected into the serous sacs would appear to have been absorbed. A more careful inquiry, however, would be requisite to warrant this conclusion; for in some experiments made by Dr. Davy, the quantity of matter injected seemed to be increased; and I have since made an experiment with the same result.

The absorption of pus being the cause of hectic fever, is an old hypothesis, which the detection of pus in the blood in cases of chronic abscess and in pulmonary consumption might be supposed to confirm. It does not seem necessary, however, to assign two causes for one effect. When pus in large quantities is incessantly forming in the capillaries, it is easy to imagine how it may become mixed with the blood.

I have related instances of pus in the blood, independently of suppuration out