mortem discoloration. There was a copious escape of whitish foam from the mouth and nose, that from the latter was slightly reddened. The rigor mortis was almost absent, except in the fingers and legs, where it was slight. The cicatrix on the right eyebrow was healthy in appearance. The eyes were clear and lustrous, the pupils moderately dilated, the left one oval and larger than the right.

Head. - Ínteguments rather exsanguine; superficial vessels of brain moderately congested. About half a drachm of clear fluid in each lateral ventricle, and very little at the base of the brain; the membranes healthy. The cerebral substance, both white and gray, very slightly and uniformly softer than usual. The vertebral and basilar arteries had a dark greenish appearance. The superficial vessels of the cerebellum and medulla oblongata were generally and pretty fully congested; the gray matter of the cerebellum rather deeper in colour than natural.

The cranial nerves were carefully examined, more especially the pneumogastric, both where it leaves the medulla oblongata, and at its place of origin in the floor of the fourth ventricle, but without detecting anything unusual.

Spinal Cord.-The dura mater normal. The pia mater in the dorsal and lumbar regions more congested than in the cervical, but not more so than usual. The same slight general softness which was observed in the brain existed in the cord, but to a less extent, more especially at its upper part. The medulla oblongata was normal, and firmer than any part of the cord.

Chest.-A considerable quantity of blood had escaped from the body when the head was examined, and before opening the thorax. There was no fluid in the pleuræ. Both lungs presented at the posterior part a few spots of sub-pleural ecchymosis, and at the lower and anterior borders a few ridges of interlobular emphysema. Numerous lobules were observed of a darker colour than the others, well defined, and depressed slightly below the general surface. About two drachms of clear fluid were found in the pericardium. The visceral pericardium presented several small spots of ecchymosis. The right ventricle and auricle contained two or three half decolorised clots, and a considerable quantity of frothy fluid blood. The left ventricle and auricle were well contracted, contained a little blood, but not the slightest froth.

The Tongue, Pharynx, and Esophagus were perfectly natural, the mucous membrane presenting its usual pale colour. The arytenoepiglottidean folds, and the mucous membrane for half an inch below them, posteriorly, were of a faint rose-red colour, but not deeper than natural.

The Sublingual Glands were natural; the other salivary glands. were not examined.

The Trachea was coated throughout with a sanguinolent froth. The mucous membrane of the epiglottis and larynx was natural; that of the trachea was of a rosy hue, and minutely injected, the red

ness, commencing about half an inch below the cricoid cartilage, and becoming deeper towards the bronchi. The bronchi contained much frothy mucus; their mucous membrane was of a deeper red than that of the trachea. The pneumogastric nerve was carefully examined on both sides of the neck, and was found perfectly natural.

Abdomen. The stomach contained about half a pint of dirty greenish coloured fluid. The mucous membrane in the posterior surface presented a considerable amount of finely arborescent injection, with some ecchymosis. The other abdominal viscera presented nothing unusual.

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Remarks. This is the third case of hydrophobia that has occurred in this neighbourhood within the last twelve months. The first of these occurred at Dalkeith, an account of which will be found in the report of the proceedings of the Medico-Chirurgical Society for last year; the second in Edinburgh, and was published by Dr Sidey in the last number of this Journal. The present case I consider worthy of being recorded, its history being complete, and a careful postmortem examination having been made.

The state of the dog at the time of the accident, as described by those who saw him, was certainly such as to lead to the belief that he was mad. He was apparently suffering severely; and his bark was of that character which is considered pathognomonic of true rabies in the Dog. The animal also had been previously familiar with the boy, and bit him without any provocation.

The bite was in an unfavourable situation, the part being uncovered, and very vascular. The chances of inoculation taking place were thus rendered greater than if the bite had been given on a part covered with clothes, by which the teeth would have been wiped in passing. The most unfavourable view of the case having been taken at the time, the whole of the surface through which absorption might take place was immediately and thoroughly destroyed; and although an hour and a-half had elapsed, and the wound had ceased for some time to bleed, I entertained good hopes that the parts had been destroyed in time to prevent absorption of the virus. I gave, however, a guarded prognosis to the parents, and cautioned them against irritating the boy, or referring to the dog in his presence.

The examination of the body of the dog did not tend to remove the suspicion as to his having been mad. The appearances met with were those most frequently found in cases of hydrophobia, but they might have been caused by other diseases. The result of the case, however, puts it beyond all doubt that the dog must have been mad at the time of the accident; the symptoms of the disease were too well-marked to leave the slightest doubt as to the case being one of true hydrophobia, or canine rabies.

A fact incontestably established by this case is, that absorption may take place within an hour and a-half; and I think it not improbable that, in similar cases, unless the parts be thoroughly destroyed

ease.

before bleeding has ceased, we can have no security that absorption has not already taken place to an extent sufficient to induce the disThe period of incubation was here thirty days, which is rather under the average. It is doubtful whether the fright the boy received had any influence in accelerating the appearance of the symptoms; no doubt the affection would have shown itself independent of this; but in a disease where the susceptibility of the nervous system is so intense, any shock must have a hurtful effect, and may give the first impulse to the development of the symptoms. The convulsions in this case were very severe during the last ten hours; they were strongest in the muscles of respiration, and in those of deglutition, which at first were the only ones affected. They resembled those of epilepsy, the efforts at expiration being strong, frequent, and ineffectual, while the face and neck were much congested.

The post-mortem appearances were such as could only be considered as secondary consequences of the disease. Those met with in the lungs, bronchi, and trachea,-viz., congestion, ecchymosis, and emphysema, are those most constantly found both in man and animals that have died of the disease, and correspond in frequency to one of the most constant of all the symptoms,-viz., convulsions of the muscles of respiration, to which they may fairly be attributed. The existence of frothy mucus in the trachea and bronchi after death, and the circumstance that the flow of frothy fluid from the mouth, commenced only after the convulsions had become severe and constant, would seem to point to the lungs and air passages as the source of that fluid-the bave-which collects in the pharynx and back of the mouth, and is hawked up by the patient; and in which, and not in the saliva, the virus has been found most active. There was no cough throughout the whole course of the disease, the only approach to it being short and continued hawking. Inflammation or congestion of the pharynx and oesophagus, which has been noticed in some cases, was entirely absent, the mucous membrane being quite natural and free from any unusual moisture. The most uncommon appearance met with was the frothy state of the blood in the right cavities of the heart. This has been noticed by two observers only-Morgagni and Trolliet, the latter of whom found it present in three out of six cases, and in some of these it existed in the left as well as in the right side of the heart.

The nervous centres and roots of the nerves have in some cases been found much congested or inflamed; but here there was absolutely nothing which could indicate that the disease was other than a purely functional affection of the nervous system. The eighth pair of nerves, which some have supposed to be specially concerned in this disease, were carefully examined in the neck and at their origin, along with all the parts of the medulla oblongata; and all of us present at the post-mortem examination, being familiar with the appearance of these parts, were unanimously of opinion that we had never seen them with less appearance of disease.

ARTICLE V.-Case of Popliteal Aneurism. By JAMES SYME, Esq., Professor of Clinical Surgery in the University of Edinburgh.

The

T. M., aged 35, a seaman, sent from Banff by Dr Milne, to be under my care, on account of an aneurism in the left popliteal artery, was admitted into the hospital on the 18th of November. tumou. filled the popliteal space, and pulsated strongly. It was first noticed about six months before, by the patient, after lying one night with his leg hanging over the edge of his hammock. He had been either at sea, or actively engaged in harbour duties, ever since, and always remarked that exertion was followed by an increase of pain. With exception of occasional rheumatic pains, he had enjoyed good health.

Having come so far, nearly 200 miles, the patient was kept quiet in bed, with restricted diet and gentle aperients, to prepare him for the operation. In the course of a day or two, the aneurismal pulsation became much less distinct, and could not be felt at all on the 23d, when the tumour was also observed to be greatly reduced in size, and no longer the source of any uneasiness. On the 9th of December, the patient being completely relieved from the disease, proceeded homewards.

A case precisely similar to the one just related, occurred under my care some years ago. The patient having come over from Kirkcaldy in Fife, where he had pursued his occupation as a weaver until the day he was admitted into the hospital, when the perfect rest there afforded was immediately followed by coagulation and the other steps of a spontaneous cure. These facts seem to suggest a suspicion that the one or two very rare instances of pressure being quickly followed by recovery, may really have owed the beneficial change to assistance of the vis medicatrix, from rest in the horizontal posture, and not to the effect of compression. Certain it is, that if the two cases just mentioned had been subjected to pressure, they would have appeared triumphant examples of its successful employment. The Dublin writers allege that no confidence can be placed in trials of pressure on this side of the Irish Channel, accounting for all its failures and bad consequences by attributing them, with characteristic frankness, to prejudice and ignorance on the part of the operators. Well aware of this peculiarity in the estimation of evidence, I have calculated the average length of time requisite for the duration of pressure, from the facts supplied by the advocates of this system. In twenty-three cases of aneurism, reported by Dr Bellingham, from the practice of seventeen surgeons, as successfully treated by pressure, I find that the average duration, not of the treatment, but of the actual compression, excluding the intervals of its discontinuance, amounted to thirty-eight days. Thirty-eight days and nights of misery, to escape a few minutes of trivial uneasiness!

If the cases treated in the Dublin hospitals since the publica

tion of Dr Bellingham's work, have been less protracted than those he has recorded, it would be well to acquaint the profession with them. But if this be done, I trust that the results of all the cases will be given, together with a full statement of the means required to render the patients able to endure the prolonged torment of compression.

ARTICLE VI.-On Leucocythemia, or Blood containing an unusual Number of Colourless Corpuscles. By JOHN HUGHES BENNETT, M.D., F.R.S.E., Professor of the Theory of Physic and of Clinical Medicine in the University of Edinburgh.

On the 19th of March 1845, I examined the body of a man, who died under the care of Professor Christison, in the Royal Infirmary, labouring under hypertrophy of the spleen and liver, and whose blood was crowded with corpuscles which exactly resembled those of pus. The case was published in the "Edinburgh Medical and Surgical Journal," for October 1845, under the title of "Case of Hypertrophy of the Spleen and Liver, in which Death took place from Suppuration of the Blood." Dr Craigie, who was present at the dissection, recognised its similarity to one he had had under his care four years previously, the blood of which had been examined microscopically by Dr John Reid, who found "that it contained globules of purulent matter and lymph." It was from the January number of Schmidt's "Jahrbücher," for 1848, I first learned that Virchow had dissected a body in the Charité Hospital of Berlin, on the 1st of August 1845, in which the blood examined microscopically presented the same increase of colourless corpuscles, also associated with enlargement of the spleen. This case was originally published in the 780th Number of Froriep's "Notizen," under the name of white blood, or "Leukhemia." On the 31st of December 1845, a man was received into St George's Hospital, London, in whom Dr Fuller detected, both before and after death, the increased number of colourless corpuscles in the blood. This man, like the other individuals, had great hypertrophy of the spleen. A notice of the case is inserted in the "Lancet," for July 1846. Since this, several similar cases have been published, in which this morbid condition of the blood has been determined to exist, by an accurate examination with the microscope; and a reference to the records of medicine has shown the previous occurrence of like cases. In these, it is true, the blood was not physically proved to contain an unusual number of colourless corpuscles, although now, on looking back upon the facts which are mentioned in regard to them, we can have little doubt that such was the case.

The term "Leukhemia," or white blood, given to this disease by

NEW SERIES.-NO. XIII. JANUARY 1851.

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