of development, that at last the biliary and renal secretions cease, and death ensues speedily after the occurrence of slight icterus, from uræmia and hæmorrhagic decomposition of the blood. The three cases resemble one another so closely in their pathological aspects, that it will suffice for the author's meaning to adduce one of them here. We may mention, however, that they were all females, and respectively of the ages, twenty-three, thirty-eight, and eight. Franciska Gily, aged thirty-eight, was admitted into the Vienna Hospital on February 26th, 1859, having suffered for eight days in consequence of mental excitement, from constipation, vomiting, heat, and headache. Latterly there had also been spasms in the face and extremities. When admitted, she presented an anæmic appearance, pulse 60, tenderness in both hypochondria on deep pressure; in the night delirium supervened, slight icteric colour on the following morning; in the afternoon, sopor and death. The autopsy was made on the following day.

The body was well fed, fat, feebly icteric. But little blood in the meninges and brain. The lungs pale red anteriorly and above, behind and below full of blood. The sheath of the pulmonary veins of the left side presented a reddishblack suffusion. The pleura, mediastina, and peritoneum extensively suffused. The pericardium contained 1 oz. of yellow serum. The heart collapsed, yellowish-brown, friable, containing a small quantity of fluid dark red blood, with a few scanty flocculi of fibrin. The liver was large, pale yellow, bloodless, pulpy, soft, fatty, with a slightly icteric colour in the centre of individual lobules; the gall bladder contained some drops of grey mucus. The spleen was enlarged, swollen, dark red, pulpy. The stomach contracted, marked with a few hæmorrhagic erosions at the fundus, containing some dark-brown fluid. The intestines were distended with gas, and pale; the colon contained dark brown consistent fæces. The kidneys presented a pale yellow cortical substance, with delicate white spots, and dotted red, with the injected Malpighian tufts; the pyramids were pale red. The renal calices and pelves, the ureters and bladder, contained a turbid mucous fluid.* The uterus was 3 inches long, 5 lines thick, friable, its inner surface covered with a red granulating layer, with numerous Nabothian vesicles in the cervix, a contracting cicatrix above the os tincæ. The uterus contained a small coagulum of blood. The ovaries cicatrized and contracted, the Fallopian tubes normal."

We would draw our readers' attention to the observations on scrofulous enlargement of the liver by Dr. Budd, where an analogous relation is shown to exist between the hepatic and renal affection as that maintained by Professor Rokitansky in his cases. Dr. Budd's cases were all very chronic, and the deposit manifestly different from that observed in Vienna; the microscopic appearances in the liver and kidneys in the latter being essentially those of well-marked fatty degeneration, while in the former the deposit in both organs was mainly albuminous. As cases of acute fatty degeneration of the liver, or, as they are also called, acute yellow atrophy, are rare, we may briefly allude to a well-marked instance‡ which occurred in the wards of Dr. Uytterhoeven, at Brussels, and where death ensued within six days from the first commencement of the illness. The patient was a young woman aged twentyfour, enjoying excellent health up to the time of the seizure, for which no other cause could be assigned than an altercation with her brother a few days previously. The febrile symptoms were followed by icterus, cephalalgia, and extreme prostration, with tympanitis and pain in the hepatic region. The day after she was brought to the hospital-the fourth day after the first seizure-she looked as if suffering from puerperal intoxication, still she was sensible, and relished her food. The diagnosis of acute softening of the liver

The italics are the Professor's.

↑ On Diseases of the Liver. By Geo. Budd, M.D., F.R.S. Third Edition. London, 1857.

Annales de la Société Anatomo-pathologique de Bruxelles, No. 2, 1859.

was verified by the autopsy, which showed the liver of normal size, its convex surface adherent here and there to the diaphragm, with spots of inflammation which extended into the parenchyma; the latter was of a peculiar deep yellow, softened and diffluent. Under the microscope it presented itself as an almost colourless liquid, in which floated enormous globules of emulsified fat. Scarce a trace of the normal tissue was to be found. Treated with ether, nothing remained but an interlobular fibrous tissue, and when put into water, the liver floated. In this case the kidneys do not appear to have been seriously diseased; they are described as congested, the capsule thickened, hyperæmic, and scarcely at all adherent to the organ.

We only draw attention to the fact that although these cases are promiscuously called acute fatty degeneration, acute yellow atrophy, or acute softening of the liver, atrophy is by no means uniformly met with. It did not exist in

the case just quoted, nor in those of Rokitansky. It is not improbable that different morbid conditions may as yet have been classed together, which a more intimate knowledge of the subject may distinguish.

Pathological and Clinical Researches regarding Ulceration and Perforation of the Appendix Vermiformis. By E. LEUDET, Titular Professor, &c. (Archives Générales, Août, Septembre, 1859.)

The

Ulceration of the mucous lining of the appendix has been met with by Professor Leudet in 18 cases, and he is of opinion that phthisis pulmonalis is the most frequent cause of this disease. He is also disposed to discredit the ordinarily received opinion that perforation of the vermiform process most frequently results from the presence of foreign bodies. Here, too, phthisis plays an important part, inasmuch as out of 13 cases of perforation occurring under Leudet's observation, 6 were consecutive upon phthisis pulmonalis. author has not met with one case of perforation of this part resulting from typhoid fever. The consequences of perforation vary: they are, general or local and circumscribed peritonitis, iliac abscess, communication between the perforated appendix and the neighbouring organs, as the small intestine, the cæcum, rectum, bladder, or internal iliac artery; inflammation of the portal vein, &c.; circumscribed peritoneal inflammation has been noticed most frequently by our author; it occurred in 11 out of the 13 cases of perforation, a circumstance that renders the prognosis less unfavourable than it would otherwise be, as it may lead to a limitation of the disease by the formation of adhesions and a cyst. The cæcal perforation is not generally rapidly fatal. Its diagnosis is difficult; we may suspect it when partial peritonitis of the right iliac fossa supervenes in subjects who have been previously well, or in the course of phthisis or chronic enteritis.

IV. DISEASES OF THE BLOOD.

Clinical Lecture on Typhoid Fever. By EDWARD GOODEVE, M.B. (Indian Annals, January, 1859).

We here receive a further confirmation of the fact which we have more than once had occasion to bring before our readers,* that typhoid fever is a disease occurring in India as an idiopathic disease, and quite distinct from those febrile conditions of an adynamic type which are associated with cholera, asthenic pneumonias, and the like. The cases reported by Dr. Goodeve bear out his views, though he has been unable to give any post-mortem account owing to the hospital patients having recovered, and the fatal cases attended in private not having afforded an opportunity for making autopsies. The cada* British and Foreign Medico-Chirurgical Review, Oct. 1857, p. 536, and Oct. 1859 p. 325. 17

49-xxv.

veric evidence has, however, been supplied by Dr. Scriven in the papers already referred to.

Rheumatism and Allied Diseases. By C. A. GORDON, M.D.

(Indian Annals, January, 1859.)

In an interesting paper on rheumatism as occurring in India, Dr. Gordon brings forward evidence to disprove the opinion which has hitherto prevailed, that the disease is not frequent in that country. The rate of its occurrence in the home-service is stated at 6.89 per cent. of mean strength, whereas the author finds it to be in India among soldiers 10-32, among officers 10-26, among women 274, and among children 0-17, per cent. of mean strength. Besides atmospheric alternations, which the author admits to be the most frequent cause of rheumatism, he considers endemic influences to exercise a material influence, because the rate of occurrence varies so remarkably at different military stations. Dr. Gordon admits with Dr. Morehead that acute articular rheumatism is not so common in India, the acute rheumatism which is met with so frequently being, we presune, the diffuse rheumatism of the fibrous tissues of the limbs. Dr. Gordon differs from Dr. Morehead in thinking that cardiac inflammation is really rarer in India than in Great Britain, and that this circumstance is not to be accounted for by the army surgeons overlooking the symptoms of heart-affection. He regards it as a corroboration of this view, that the cases of heart-disease bear a very inconsiderable ratio to the numbers admitted for rheumatism, and that the men invalided for disease of the heart in India is not a tithe so large as in the United Kingdom.

V. DISEASES OF THE INTEGUMENTS, AND MISCELLANEOUS.

Note on Aden Ulcers, compiled from Official Documents. By W. C. COLES, M.D. (Transactions of the Medical and Physical Society of Bombay, No. IV., New Series.)

The Aden or Yemen ulcer is a disease common in the place from which it takes its name, among the native poor and destitute. Dr. Craig, the medical superintendent of Aden, is of opinion that it is not, as has been hitherto supposed, a form of scurvy, but another form of Beriberi, dependent upon cachexia, or general weakness of the muscular and circulating system, produced, or at all events accompanied, by a more or less watery or other abnormal state of the blood, whereby the reparative power is weakened. It is remarkable that the Jews appear exempt from the disease, a circumstance attributed to their circulation being more vigorous, and to the fact that although poor, none are destitute. We are not favoured with an exact account of the ulcers; but it appears that they affect the legs, putting on a very ugly appearance, sometimes surrounding the whole limb, and frequently sloughing. Dr. Craig was of opinion that an accumulation of these cases in the hospital was one great reason of the ulcers proving so serious, in fact, he regards hospital gangrene as the real cause of the mortality which has been noticed at Aden. "The hospital," he says, "was imperfectly ventilated and badly situated, immediately on the high-water mark, each receding tide leaving an extensive surface of mud, mixed with much decaying marine animal matter. The floors of the hospital were damp-sufficient of itself in cold weather to convert healthy ulcers into foul. The walls, constructed of matting, acted as a sponge for sucking up putrid and other emanations, becoming in the end a focus of infection." Accordingly Dr. Craig suggests that ulcers should no longer be received into hospital, but treated in dispensary style, a system which appears to have proved beneficial, and to have arrested the disease.

On Eczema. By Professor Hebra. (Prager Vierteljahrsschrift, xvi. Jahrg. 1859; and Allg. Wien. Med. Zeitung., 1859, 6 et seq.)

In order to simplify the conflicting views entertained with regard to the nature and appearances of different forms of eczema, the author suggests that we should establish a type by an artificial process which induces an eruption resembling eczema in its characteristic form. For this purpose he selects croton oil, which, as is well known, when rubbed on the skin commonly induces a vesicular eruption. When, however, applied on several persons at the same time and in the same manner, certain differences are observed in the effect: at first, there is a diffuse reddening of the surface, and if the skin is delicate there will be vesicles after a few hours, the type of an incipient eczema; in others, there will only be some prominent papula; again, in others there are only red dots, and in one or two cases no effects whatever will result. The papule and vesicles, as we have ourselves frequently noticed, are to be found at the orifices of the hair-follicles, and are caused by hyperemia and exudation of the part. If croton oil be repeatedly rubbed in there will be vesicles in all after a time; they become larger, more numerous, and confluent, the epidermis at last bursts, owing to the increased distension by its fluid contents. This gives rise to a new series of appearances, and we now have to do with a moist surface, studded with red spots, the basis of the former vesicles. In accordance with these effects, Professor Hebra establishes four varieties:-1. Pityriasis rubra. 2. Eczema papulosum, lichenoides sive lichen eczematodes. 3. Eczema vesiculosum (Willan's eczema solare). 4. Eczema rubrum sive madidens. If the rubbings are now stopped, the nodules or vesicles collapse and the epidermis desquamates, or the moist parts form crusts. If the rubbings are continued, pus forms in the clear fluid, which becomes opaque and thick, the pus dries and forms crusts. In this way we obtained an analogue to the fifth variety of eczema, eczema impetiginosum or impetigo eczematosa.

Variations are also observed according to the locality in which eczema appears; which will be easily understood by a consideration of the anatomical relations and a reference to the above principles.

Case of Herpes Zoster occurring a second time. By J. FORREST KENNEDY, M.D. (American Journ. of Med. Sci., July, 1859.)

A farmer, aged sixty-six,came under Dr. Kennedy's treatment for a well-marked case of herpes zoster, and stated "that he had had an eruption similar to it about twenty-five years ago, and that his physician then called it shingles." In the present instance it occupied exactly the left half of the body, from the linea alba to the spine. Except that the attack was preceded and followed by more than the usual amount of pain, it ran the usual course. Although the evidence as to the first attack having been herpes zoster may not be quite satisfactory, we put Dr. Kennedy's statement on record, because the occurrence of the disease more than once in the same individual is certainly exceptional and has been questioned.

Researches into the Development and Propagation of the Trichocephalus and Ascaris Lumbricoides. By Dr. C. DAVAINE. (Journal de la Physiologie, Numero VI., Avril, 1859.)

As a result of numerous examinations, Dr. Davaine states that the trichocephalus dispar, a parasite which he estimates to affect the cæcum of every other inhabitant of Paris, is not developed from the ovum in the intestine, but that the ova were always expelled in the same condition in which they were laid. He tried to induce their development by placing them in water, but failed for a long time. At last he succeeded in the following manner: the ova were washed (Sept. 1857) repeatedly for several successive days, until the water was

colourless and odourless. This water was renewed from day to day, and the ova examined by the microscope every week. It was not till six months after (April, 1858) that symptoms of development presented themselves in those of the ova which had preserved their vitality. The yolk then assumed the form of a rounded mass, and became more consistent. A few days later the yolk in some of the ova divided into two, and then into four parts. Each part subsequently underwent further division, so as at last to have a mulberry shape. This appearance continued until the 12th June, when a well formed embryo resembling the adult became visible, and showed distinct movements. Dr. Davaine satisfied himself equally that the ova of the ascaris lumbricoides are not hatched in the intestine, and that when treated like those of the trichocephalus dispar, they require six and more months, according to the temperature to which they are exposed, to induce the development of the embryo.

QUARTERLY REPORT ON SURGERY.

By JOHN CHATTO, Esq., M.R.C.S.E.

I. On Tibio-tarsal Amputation. By Professor MICHAUX.

Belge, 1859, No. 33.)

(Presse Médicale

M. MICHAUX, Professor of Clinical Surgery at the University of Louvain, recently presented to the Brussels Academy of Medicine an interesting memoir upon tibio-tarsal amputation, as compared with supra-malleolar amputation, and amputation at the place of election. The following are the conclusions:

1. Tibio-tarsal amputation is an operation properly admitted into surgical practice. 2. It should replace supra-malleolar amputation whenever the lesions which render it necessary are limited to the constituent parts of the foot, to the upper part of the malleoli, or even to the articular surface of the tibia. 3. It should only be performed when a flap can be formed of the soft parts of the heel, so that these may constitute a mattress for the bones. 4. If the soft parts of the heel are destroyed, or have undergone such alteration as to be unfitted for the purposes of a flap, the tibio-tarsal amputation should be renounced, the supra-malleolar operation being, as a general rule, substituted for it. 5. The best mode of performing tibio-tarsal amputation is by Syme's procedure, as modified by Jules Roux, of Toulon, taking, however, the precaution of preserving less integuments at the external side of the articulation (a modification of the author's) than is done by the latter surgeon, cutting the tendo-Achillis sufficiently high, and excising the posterior tibial nerve, as recommended by M. Verneuil. 6. Pirogoff's operation may be had recourse to when the calcaneum is entirely healthy, or has undergone but little alteration at its anterior part. 7. Tibio-tarsal amputation is more difficult, more dangerous, and more slow in its after-treatment than supra-malleolar amputation, but standing and walking being performed directly on the stump, are better executed after the former than after the latter. 8. The prothesis after tibiotarsal amputation is far more simple and less expensive than that employed after supra-malleolar amputation. Syme's boot constitutes an excellent apparatus. 9. The best procedure for supra-malleolar amputation consists in forming an anterior flap, which, falling by its own weight, covers the bones. This is the elliptical operation with anterior flap of M. Poupart. 10. A procedure similar to that described by Baudens for disarticulation of the knee, should be adopted in amputation at the place of election, whenever the lesions admit of the preparatory mode being chosen. 11. Amputation at the place of election is more difficult and far more dangerous than supra-malleolar am