complete state of insensibility. Dr. Fallot did not see him till eight o'clock in the evening, when he found him in the following condition-face slightly tumefied-mouth closed-teeth firmly in contact-eyes fixed and insensible to the light-sense of hearing apparently obliterated-and the olfactory sense in the same condition, for no sternulatories had any effect. Our author endeavoured to rouse the sensibility of the skin and the mucous membrane of the intestines, by mustard cataplasms to the former, and stimulating glisters to the latter, but without success. Towards midnight strong convulsions supervened on this state of insensibility, and threatened immediate destruction. At this critical moment a profuse perspiration broke out over the whole surface of the body, of the most intolerable fetor, and the convulsions gradually subsided. This fetid perspiration continued all next day, and was of such a nauseabund quality that Dr. F. could not get rid of the odour and even taste of it for many days. The patient was now in a state of such extreme debility that his voice was hardly audible. Some wine was administered, and he revived a little. On the evening of the 13th, his lower extremities were observed to be partially covered with large pustular eruptions filled with purulent matter, (" de gros boutons isolés et remplis de pus,) while from the cautery on the left arm flowed an ichorous discharge, having the exact fetid odour of the perspiration abovementioned. He slept some hours during the nights of the 13th and 14th of December-the appetite returned keenly-the spirits got up-the strength improved, and by the 25th December, he was able to set out on his journey to England, where he has since continued in good health.

The foregoing case is, we think, interesting, and affords a good illustration of those mutations and conversions of diseases, or at least of their forms, which so frequently cross our path in practice. A doubt may exist whether the series of visceral irritations and inflammations were owing to repelled cutaneous affections in the beginning. It is to be remembered that after a life of intemperance and debauchery on the Continent, he evinced dyspeptic symptoms, which were succeeded by acute inflammation in one of the lower extremities, most likely of a rheumatic or gouty nature, and it was after the dispersion of this local inflammation that the train of internal maladies began to make their appearance. Although therefore, we are well aware of the importance of cutaneous eruptions, and of the danger of repelling them; yet we should be inclined to view the series of phenomena above detailed, as owing, in a great measure, to erratic gout or rheumatism. We leave the facts, however for the consideration of our brethren at large.

2. Cymanche Cellularis.*

The case related by Dr. Gregory is, unquestionably, not of common occurrence, especially in the parts here

Dr. Gregory. Med. and Phys. Journal, No. 284.

affected. The patient was a servant maid, 25 years of age, who was attacked, on the 13th of February, 1821, with feverish symptoms, and pains of the back part of the neck, resembling rheumatism, for which she was bled, and had some opening medicine. The following day, she came under Dr. Gregory's care, evincing considerable fever, attended with great difficulty of swallowing, and swelling, hardness, and some tenderness of the external parts of the throatchiefly at the junction of the sternum with the clavicles. Nothing particular could be seen on inspection of the fauces. No hoarseness nor difficulty of breathing. During the night, the difficulty of deglutition increased, and the breathing became impeded. Venesection to sixteen ounces, with very trifling relief. Mucus now began to be collected in quantity about the glottis, and was expectorated with great pain. The difficulty of breathing increased to such a degree, that the tongue assumed a blue colour. Blood was twice drawn from the arm, but without more than momentary relief. Leeches and fomentations were resorted to, but the patient died on Monday, the 19th of February, seven days from the invasion of the disease.

On dissection, the cellular membrane beneath the skin of the throat, and around the trachea, as well as that which connects the pharynx and palate to the surrounding parts, was every where in a state of disease" doubtless the result of inflammatory action." In some places, actual sphacelus had occurred, in others, a state that might be termed imperfect suppuration. The same disorganized condition of the cellular membrane pervaded the whole extent of the anterior mediastinum, even as low as the ensiform cartilage. The mucous membrane of the palate, pharynx, œsophagus, and trachea, was healthy, except that it was covered with a preternaturally abundant secretion of mucus. The lungs and other viscera were sound.

The above disease appears to us, to be an unequivocal specimen of that dangerous species of erysipelas, which attacks the cellular membrane under the skin and between the muscles. In the year 1809, the crew of His Majesty's ship, Royal Oak, suffered severely from this disease, while cruising in the Bay of Biscay. Some lives were lost, and the disease appeared to be contagious, running through a considerable number of the ship's company. It would destroy the whole cellular membrane of a limb in a few days, and when the integuments were slit open, they would fall completely off the muscles, which were left as clean as if they had been carefully dissected. Nothing but free and early incisions through the integuments, so as to allow of the exit of matter and cellular sloughs, saved the life or limb. In several instances it attacked the trunk of the body, and two or three cases proved fatal. The carpenter, Mr. Dalrymple, died in a state of coma. The fever attending the disease was of a typhoid type, and did not bear depletion.

Mr. Thompson, who is now in one of His Majesty's yachts, was surgeon of the Royal Oak at the time, and had a most arduous task to go through. The writer of this article occasionally visited his patients with him.

3. Variola-Vaccina. Dr. Forbes, so favourably known to the profession by his translation of Laennec, has witnessed one of those unfortunate epidemics, occasioned by the want of a general adoption of vaccination, and the artificial introduction of variola among unprotected subjects. Dr. F. considers it not only unfair, but decidedly injurious to the cause of vaccination, for medical men to attempt to maintain the same high ground which they formerly assumed, in respect to the almost infallible prevention of small-pox by cow-pox. Yet, "happily, the plain truth is still extremely consolatory;" for every successive year, and every fresh diffusion of the variolous pestilence, tend, more and more, to confirm the belief that the proportion of cases in which vaccination affords perfect security against small-pox, will be extremely great. The same progressive and accumulating experience proves that, "in the small proportion of cases wherein cow-pox fails to prevent variola, it almost invariably, and greatly, mitigates the terrible symptoms of that disease." Our able author thinks, that if, on the promulgation of vaccination, we had been promised one half of the benefits which are now proved to result from it, we should never have heard those lamentations, fears, and despondencies, and still less any of that decided preference of small-pox, which are to be found among many members of the community, and even of the profession. The mind is dissatisfied because it has been disappointed—

Jam tenet Italiam, tamen ultrà pergere tendit.

The district which was the scene of the variolous epidemic under review extends along the coast, about 20 miles, and inland about 10 miles, bearing a population of about 30,000 souls. Since the year 1812, variolous inoculation had been almost entirely disused, so that nearly all the children born in the district, since the period abovementioned, had either been vaccinated, or left unprotected in toto. A considerable proportion were, unfortunately, in the latter condition, owing to vaccination having been much less practised, especially among the lower classes, than it ought to have been. In 1821, when the inhabitants of Chichester were in great trepidation, the importunities of many persons among the middle and lower orders, to have their children inoculated, were very great; but, to the honour of the profession there, variolous inoculation was uniformly denied― except to such persons as were decidedly exposed to the infection, and whose parents refused the protection of vaccination. Some extra-professional inoculators, however, were at work, and there were nearly 300 cases, casual and inoculated, of small-pox in Chichester. In the vicinity, several extra-professional inoculators spread the disease in all directions, some two or three thousand people having been inoculated!

"A few instances of the failure of vaccination entirely to prevent the attack of variola, were magnified into a total failure of its pro

Dr. Forbes. Med. Repos. September, 1822.

tecting powers, while the opinion of perfect security, afforded by the variolous inoculation, was loudly and eagerly proclaimed." In this state of alarm and prejudice, one of the regular practitioners gave way, and his example was followed, as a matter of course and almost of necessity, by his brethren. Accordingly, the surgeons of Emsworth, Havant, and the vicinity, inoculated with great vigour during a period of six or eight weeks-most of these gentlemen, however, representing to the parents and friends of the unprotected, the preferable security of vaccination.

In the above period, the surgeons inoculated more than 1400 persons not previously vaccinated-the whole number, by regular and irregular practitioners, being considerably above 3000. The inoculated small-pox was very mild, the surgeons not having lost more than six or seven cases out of 1450. What was the proportion of deaths in the practice of the itinerants could not, of course, be ascertained—it was evidently, however, very small. There were not more than 130 or 140 cases of casual small-pox among the unprotected. Such was the diffusion of the variolous infection, that it is highly probable that, every individual, who had been vaccinated for many years past, was now exposed to its influence.

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Many striking facts, illustrating the very thorough exposure of the vaccinated, were mentioned to me by almost every surgeon. In a vast number of families, children were inoculated with small-pox, whose parents or elder brothers and sisters had been vaccinated, and who now acted as nurses to their less fortunate juniors. In one family, consisting of eleven, the four elder children had been vaccinated a good many years ago; on the present occasion, the remaining seven were inoculated with small-pox. All the former completely escaped, though they all lived, and some of them slept, together. In one family, consisting of a good many members, all the children were inoculated, except one, to whom the surgeon, on account of a recent burn, refused to give so severe a disease. This child was vaccinated, and resisted the small-pox infection, though living surrounded by, and sleeping with, its pestilential brethren. Hundreds of instances, affording precisely similar results, and many of them equally strong, could be mentioned. In a good many families the remaining children were vaccinated, after the casual small-pox had made its appearance in some of the members, and all escaped (with a single exception,) in whom the vaccine vesicle had time to form. This effect was witnessed in several families, in which death followed the natural small-pox.

"Under all these circumstances of most extensive and most intimate exposure, about eighty cases of small-pox, in persons previously vaccinated, came under the observation of all the surgeons of the district (nineteen in number), during the whole course of the epidemic. All these cases (with a single exception) were completely modified, according to the now technical meaning of that word; and, although a few had considerable eruptive fever, and a still smaller number had a considerable eruption of pustules, the disease almost

uniformly exhibited the rapid declension characteristic of the secondary affection, and none of the patients were at any time considered to be in danger. As all these subjects exhibited the disease in the modified form, it seems to follow, as a necessary consequence, that they had all been vaccinated, and had properly undergone the vaccine process, as it is only thus we can account for the modified character in any case; it is, however, proper to state, that only a very small proportion (about one-sixth) were known to the surgeons to have undergone the process satisfactorily. In a great majority of these cases of secondary or modified small-pox, the disease was extremely slight, consisting, in some, of a trifling degree of febrile disorder for one or two days, followed by an eruption of a few pustules; and in others, of an equally slight eruption, with scarcely any perceptible fever."

Dr. Forbes has mentioned one exception to the modifying power of vaccination. This was a child twelve years of age, who, after having been casually exposed to the infection of small-pox, was vaccinated by one of the surgeons in Chichester. The arm put on the usual appearances, and the disease went through its regular stages. Three weeks, however, after the period of vaccination, and apparently without being again exposed to variola, the child was seized with the latter disease and died.

Dr. F. received accounts from his medical friends of 680 cases of previously vaccinated individuals subjected by them to variolous inoculation. Of this number only about 30 cases are reported as exhibiting any indication of a constitutional affection from the smallpox virus. In all these cases the resulting disease was completely modified, and with one or two exceptions, extremely mild.

So much for the protection of vaccination. There were seen, during this epidemic, nineteen well authenticated cases of second attacks of small-pox-in most instances after inoculation. Some of these secondary attacks nearly proved fatal.

Upon the whole, the effect of this epidemic is, our author thinks, "a diminution of prejudice against vaccination, and an increased confidence in its preventive powers," among the common people. This is a great advantage, and we have only to thank our able author for his clear, perspicuous, and well written communication on so important a subject.

4. Puerperal Fever.* Mr. Moir relates a case of puerperal fever, and accompanies it with some observations which we deem to be of an extraordinary nature. We shall first give the outline of the case itself. A lady, in the 28th year of her age, was delivered (breech presentation) at three o'clock, on the 19th June, 1822, and seemed to be doing well through the night. Next morning, however, her pulse was feeble, and she had a fatigued appear

Mr. Moir. Ed. Journal, No. 73.