The following are the characters which Dr. Barthez regards as distinctive of the two forms of the disease:

1. When the false membranes extend in a continuous layer over the palate, uvula, tonsils, so as to spread into the respiratory passages, he considers generalization of the disease certain; and still more so if the nasal fossæ are attacked. On the other hand, the absence of coryza, the limitation of the false membranes-i.e., their exclusive formation in the larynx, or their slight extension to the tonsils only, are the features which appear to indicate the absence of general intoxication.

2. The grey, greyish black colour, the gangrenous appearance of the false membranes visible on direct inspection, the discharge of a blackish liquid and ichorous blood on the slightest touch of the throat, are certain signs of intoxication; while the grey-yellow, and above all the white tint, of the false membrane indicates local disease.

Diphtheritic intoxication is further characterized by marked tumefaction of the cervical ganglia of a painful character, especially if accompanied by swelling of the adjoining cellular tissue; by the production of false membranes on the skin when deprived of its epidermis, and on wounds; by gangrene of the mucous membranes of the skin or of wounds; by abundant albuminuria, which is independent of all other causes which may produce it (upon this symptom the author was "imperfectly informed" up to the end of 1858); by the leaden, and not purple, hue; the smallness and feebleness of the pulse; the exhaustion apart from the asphyxia, or out of proportion to the apparent asphyxia. Finally, diphtheritic intoxication is characterized by consecutive paralysis, either limited to the pharynx or general.

II. DISEASES OF THE ABDOMINAL ORGANS.

1. Acute Yellow Atrophy of the Liver in an Infant. (Quoted from Jahrb. für Kinderheilkunde ii., 1, p. 42, in Schmidt's Jahrb., Band cv. p. 71.)

A girl, aged twenty-one months, was admitted into the Children's Hospital at Vienna in a moribund condition, having for eight days been affected with icterus. The skin was intensely yellow, the cheeks and lips cyanotic, the abdomen distended with gas; there were convulsions in the upper extremities and of the maxillary muscles, breathing stertorous, coma. Death ensued three hours after admission. Autopsy: The body was well developed and plump; skin and conjunctivæ intensely yellow; both pupils dilated; spumous, serous fluid in the oral cavity; the abdomen tympanitic. The cranium was compact; the dura mater firmly adherent and yellow; the sinuses full of dirty red blood. The inner meninges were also congested; the cerebral tissue very soft, œdematous; icteric. The lateral ventricles, of normal size, containing a small quantity of clear serum. The thymus was above 2" long by 1", bi-lobar, and dense. The bronchial glands were normal; the lungs healthy, except that there were numerous emphysematous patches under the pleura pulmonalis. The bronchi contained spumous, and occasionally sanguineous, serum. The heart and pericardium were normal. The liver occupied the cavity of the diaphragm, being covered in front by the transverse colon, and being reduced to about half its normal size, only weighing 4 oz. 6 dr. The capsule was delicately corrugated; the free margin translucent, flabby; the parenchyma tough ; the portal vessels dilated. On section, numerous smaller and larger dense spots of uniform yellow tint were noticed, in which small vessels were visible. Professor Wedl, who instituted the microscopic examination, pronounced the hepatic cells to be everywhere destroyed and replaced by molecular detritus. The gall-bladder was small, containing mucus and thin bile; the ductus chole

dochus and hepaticus patulous. The spleen was not softened, but swollen. The stomach was empty; the small intestines contained food, gases, and a lumbricus; the large intestines were full of firm, clayey, whitish fæces. The kidneys, with exception of a considerable dilatation of the pelvis and calices on the right side, presented no abnormity.

It is observed that, as there was no important complication, the suddenness of death could only be explained by the interruption to the functions of the nervous system by the diseased state of the blood; it is also remarked that this case disproves what has been stated by Buhl, that the affection of the liver is the result of general atrophy.

2. On the Differential Diagnosis of Abdominal Tumours and Ovarian Cysts. By BOINET, Member of the Society of Surgery. (Gazette Hebdomadaire, Jan. 6, 1860.)

We refer to this paper because, incidentally, the author mentions a case in which he, by mistake, injected the iodized fluid intended for the radical cure of ovarian cysts into the peritoneum, with the effect of producing a radical cure of aseites, which, he states, had been confounded with ovarian dropsy.

A young lady, of about thirty years of age, came to M. Boinet to be cured of an ovarian cyst, because she had heard of his iodine injections. She objected to an examination, because she had been well assured of the fact of her disease being ovarian by two eminent hospital physicians, and an appointment was accordingly made for the operation. Entirely trusting to the diagnosis of his learned confrères, the author, assisted by Dr. Delarue, and without even attempting a verification of the previous diagnosis, made a puncture, and evacuated above twenty litres (forty-two pints) of serum. He then made the injection; but at the first introduction of the iodine the patient uttered so piercing a cry, and felt such intense pain, that M. Boinet at once felt assured that he had injected the peritoneal cavity. Universal purulent peritonitis resulted, placing the patient in imminent danger. Still, after much anxiety, and repeated punctures made for the purpose of evacuating the pus from the peritoneum, a radical cure followed. The patient is now (six years after the operation) enjoying excellent health.

3. A Case of Pancreatitis. By Dr. C. HALLER, with remarks by Dr. KLOB. (Zeitschrift der Gesellsschaft. der Aerzte, No. 37, 1859.)

T. G., aged sixty-three, had always enjoyed good health until sixteen days before admission into the Vienna Hospital, when he was seized with difficulty of digestion, inability to bear food, and vomiting. When admitted he looked cachectic and pale, but showed no perceptible emaciation. Intellect clear, no headache; tongue with a yellow fur, rather dry; loss of appetite, no great thirst, the neck thin, the cervical glands not infiltrated; respiration unembarrassed, no cough, thorax well formed, percussion normal, breathing here and there coarse; the heart normal; the epigastrium was somewhat distended, and tympanitic and tender; the liver and spleen not enlarged; the abdomen moderately distended; ædema of both lower extremities; vomited matter yellow, thin, and bitter; pulse 90. The pain gradually increased, radiating from the epigastrium over the whole abdomen; the vomited matters streaked with blood; the vomiting gave no relief: sudden collapse, and death took place the day after admission, the vomiting having been arrested for some time previously. The cranial and thoracic cavities presented no abnormity of importance; the liver was of normal size and anæmic; the gall-bladder and ducts healthy; the spleen small, and its capsule furrowed. The stomach was collapsed, and contained a thin, turbid, brownish fluid. The mucous coat was

somewhat tumefied; translucent posteriorly, where the superficial veins shone through as dark-brown streaks. The posterior wall presented three circular openings of the size of lentils, forming funnel-shaped perforations from without inwards through all the ventricular coats. The loss on the peritoneal surface was the largest; the margins of these openings were extremely friable and discoloured. Behind the stomach lay a large ichorous abscess, extending to the spinal column posteriorly, to the spleen on the left, to the pylorus on the right; within it lay the pancreas, which was exposed on all sides, and appeared as a greyish, discoloured, thin, extremely friable, sanious. cord. The splenic artery and vein ran along its upper margin. The former was moderately full of fluid blood; the latter was blocked up by a recent, darkened fibrinous plug, which adhered to the coats of the vein, and extended as far as the junction, with the vena portæ on the one side, and on the other to the hilus of the spleen. The retro-peritoneal glands were scarcely swollen, pale red, and moist. The intestines, kidneys, and supra-renal capsules presented nothing remarkable. Under the microscope the pancreas appeared in a state of disorganization; where the cells were recognisable they were tumefied and turbid; the acini that remained were straggling, partly collapsed, and with fine granular molecules, and large oil-globules intervening. There were also the elements of the exudation, pus-corpuscles, and nuclei, partly preserved, partly in a state of decomposition.

Dr. Klob has no doubt that the case is one of primary inflammation of the pancreas, and that the morbid products gave rise to perforation of the stomach. He observes that inflammation of the pancreas, like the inflammatory affections of other salivary glands, commonly begins in the interstial areolar tissue, and thus induces small scattered abscesses; but that, as in the instance detailed, the inflammation may primarily affect the acini, and thus induce general suppuration of the organ. He states that this is also the view of Rokitansky on the ease in question.

4. A Case of Argyria, with Deposit of Silver in the Intestines, Liver, Kidneys, and Spleen. By Dr. C. Frommann. (Archiv für Patholog. Anat., Band xvii. Hefte 1 and 2.)

The subject of this paper, W. Jordan, aged sixty, was attacked in March, 1856, with epilepsy, the fits occurring three to four times daily during the first month, when they lasted an hour at a time; they subsequently became less frequent, and at the end of the year they occurred once a fortnight, and only lasted about a quarter of an hour. Almost from the commencement of the disease, nitrate of silver was exhibited, and for nine months he took a daily pill containing six grains, so that altogether he swallowed about 3 ounces. Towards the end of July the skin began to be discoloured, gastritic symptoms supervened, but still the remedy was persevered with. In the beginning of 1857, there was hæmatemesis and other undoubted symptoms of gastric ulceration, and scarce any food could be borne. He recovered so far as to undertake a voyage to England, but the fatigue proved too much for him, and on his arrival he was compelled to seek aid at the German Hospital. On his discharge he was able to take food well, but his circumstances being very bad, he had a relapse, and was again admitted into the German Hospital on the 6th November, 1858, in a wretched condition, severe cough and hemoptysis having supervened. The whole surface exhibited a steel-grey colour, which was particularly marked in the face. There was in addition to the gastritis, advanced tuberculosis, bronchitis, and pneumonia. The patient died two days after admission. The following is an abridged account of the autopsy :-The parts in the face which had exhibited a great intensity of discoloration, owing to their containing more blood, now presented a tint uniform with the rest. In the brain the choroid plexuses presented an uniform greyish-blue tint. The

state of the lungs corresponded with what had been observed during life; the left ventricle of the heart was much hypertrophied. The stomach contained a large quantity of acid brown liquid, streaked with blood; the mucous membrane was covered with a considerable layer of dirty red, viscid mucus, inclosing streaks of black coagulated blood. The vessels were much injected, and there were numerous small extravasations. At the upper part of the posterior wall, half way between the pylorus and cardiac orifice, was a large ulcer, seven centimetres by five (2.75 x 1.96 inches), at the basis of which there was an orifice of the size of a crown-piece, which was blocked up by the pancreas, to which adhesions had formed. The pylorus formed an annular stricture, only large enough to permit the passage of a common lead pencil. The mucous membrane of the duodenum and jejunum was dotted over with many small black granules, most closely aggregated along the folds. In the ilium these spots become more and more scanty; examined by the microscope, the villi in these black spots presented, especially in their globular end, groups of black aggregated particles, varying much in form and size, and without a crystalline character; cyanide of potassium rapidly dissolved these deposits here as well as in the other organs in which they were found. The spleen was small; its veins had an ashen hue, which was due to a fine granular precipitate upon their coats. The liver was small, congested, and fatty; the small branches of the vena portæ and of the hepatic veins presented the same precipitate of silver throughout, but the capillaries were free from it. Fine sections of the hepatic tissue showed numerous black dots, each of which occupied the centre of an acinus, corresponding to the point of exit of a central vein, and the colour was produced by a black margin surrounding the calibre of the artery. The dark colour of the branches of the vena portæ was also very characteristic throughout The largest argentean deposit was in the kidneys, where the bundles of vessels in the Malpighian corpuscles and the intertubular capillaries seemed to be its primary seat. The pyramids all exhibited a dark grey colour, which was deepest and all but black near the papillæ. The tubules in these parts were entirely invested with a dense precipitate; so that on a transverse section each tubule appeared surrounded by a black ring. Parts of the skin taken from the temporal, axillary, and digital regions were examined. Transverse sections showed a pale, purplish streak immediately underneath the rete Malpighi, following the undulations of the cutis. At the roots of the hairs it accompanied the external sheath towards the bulb, but nowhere except in the sudoriparous glands was a granular deposit to be found; in them it presented an appearance similar to that seen in the renal tubules. The glandular epithelium uniformly presented fatty degeneration.

We may mention that concentrated sulphuric acid, as well as cyanide of potassium, dissolved the argentean deposit; though the latter did so with the greatest rapidity. Portions of the liver and kidneys analysed by Dr. Versmann afforded the following result: 217 grains of dried liver yielded 0·009 gramines of chloride of silver, or 0.0068 grammes of metallic silver, or 0.047 per cent. of metallic silver; 133 grains of dried kidney yielded 0.007 grammes of chloride of silver, or 0.0053 grammes of silver, or 0.061 per cent. of the latter.

5. Contributions to the Pathology of Diabetes Mellitus. By RUD. LEUBuscher. (Archiv für Pathol. Anat., Band xviii., Hefte 1 and 2.)

The following are the results obtained by Professor Leubuscher and Dr. Passauer from a series of experiments on the influence of various articles of diet in a case of diabetes mellitus upon the secretion of sugar, urea, and chloride of sodium, and upon other circumstances:

1. The temperature of the skin was throughout below the average; it was generally only 35° C., and even under the influence of an acute affection, which

ultimately caused the patient's death, it did not exceed 36° C. Diet appeared to influence the variations less than the temperature of the room.

2. The quantity of urine did not correspond to the quantity of liquid drunk, but exceeded it materially. On one day when six ounces of red wine, three ounces of rectified spirits, and 1000 cubic centimetres of water were taken, the quantity of urine amounted to 3300 cubic centimetres, or less than usual. The tendency of the patients to deceive in these matters renders the fact less trustworthy.

3. With a mixed diet and preponderance of starchy diet with much water, the quantity of chloride of sodium and urea secreted exceeded the average materially.

4. A preponderance of animal food increases the quantity of urea secreted, and diminishes the amount of sugar without material alteration of the chloride of sodium.

5. A free use of milk with mixed diet produces no change in the relative proportions of the sugar, chloride of sodium, and urea.

6. Alcoholic beverages, with chiefly proteinaceous diet, increases the secretion of sugar materially and diminishes the urea, the chloride of sodium remaining unaltered.

7. Iron given in the form of the lactate from the middle of November to the middle of December, in doses of four to six grains, left the sugar at the average quantity, produced no effect upon the urea or chloride of sodium, the patient feeling generally well.

8. Pepsin taken from the middle of December to the beginning of January, twice daily, in ten grain doses, diminished the quantity of urine; the specific gravity rose to 1.044; all the constituents, sugar as well as urea and chloride of sodium, were relatively as well as absolutely increased. The general health of the patient continued good.

9. Benzoin, in the form of benzoic acid, benzoate of soda, or ammonia, taken for a month daily in doses of six to eight grains, produced no material influence. Acute symptoms of pulmonary disease, gastritis, and enteritis, resulting from a cold, supervened, during which albumen appeared in the urine, and the patient died comatose on the fourth day of the attack. From the post-mortem account we merely extract the remarks that the vessels of the meninges, and especially the longitudinal sinus, contained an emulsified liquid in which were red coagula. A close examination of the blood exhibited much free fat and white blood-corpuscles, with a considerable quantity of sugar.

QUARTERLY REPORT ON SURGERY.
By JOHN CHATTO, Esq., M.R.C.S.E.

I. Account of the Results of Amputations observed at Constantinople during the Crimean War. By M. SALLERON. (Recueil de Mémoires de Médecine et de Chirurgie Militaires, deuxième série, tome xxii., pp. 262-420.) THIS is another testimony to the enormous sufferings of the French army during the Crimean war, and a silent protest against the disparaging comparisons heretofore instituted between it and the British army. M. Salleron was in charge of the Dolma-Bagtche Hospital at Constantinople, which he represents as of faulty construction and defective in hygienic appliances. Any mischief which would have resulted from these circumstances alone was augmented by the unavoidable over-crowding of its wards with the wounded soldiers.

The immediate object of the author's paper is to give an account of the