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is frequently disturbed during the night by startings and a slightcough. The patient’s articulation is not impaired, though she isreported to have had her teeth firmly clenched, and to have beenunable to speak, upon her reception into the ward. Upon exa-mination of the back, no pain or tenderness can be discoveredover the cervical or dorsal vertebrae, and the cardiac sounds arefound quite normal. t;:J-"’"’:BTwo years ago the patient suffered from a very severe attack

of cholera morbus, since which time she has been very nervous,but has never had hysterical fits. Six days before admission(Feb. 4) she was in her usual health, but in the evening thehouse was robbed, which circumstance caused her a good d(-alof terror and anxiety. The following morning she found, to hersurprise, that she could only partially open her mouth; but shewas at that time able to take solid food. The pain in the headand between the shoulders had begun four days before admission,and the loss of power in the leg three days afterwards. Sheapplied to a medical man, who gave her medicine, and put ablister to her throat, which is still sore.

Dr. Burrows ordered cupping at the back of the neck to tenounces; ten grains of calomel to be taken immediately; and adrachm of mercurial ointment to be rubbed into the thighs threetimes a day. The patient was to have, besides, a purgative enemaat night, and a myrrh gargle for the mouth. She slept verylittle during the night, and complained in the morning of pain inthe head, and also in the right leg, which is, she says, drawn upwhen she coughs or swallows.The trismus was on the second day more marked than on the

first; the patient unable to lift her head from the pillow; she layon her back, and said that she could not change her posture.The skin was warm and dry; the pulse 120, small, and com-pressible ; but the tongue could not be protruded; the bowelswere open twice in the night, the motions being reported dark-coloured and relaxed. Some carious teeth were noticed in theright upper jaw. She was now given a dose of castor-oil, andtook tincture of hyoscyamus in camphor mixture. Dr. Burrowslikewise ordered four teeth to be extracted. On the third day ofthe woman’s stay in the hospital, it was found that immediatelyafter the extraction of the teeth she was able to open her moutha little better ; but the difficulty soon returned, as unconquerableas before. - She had slept well in the night, but in the morningshe complained of a very acute pain extending down from thighto foot on the right side. There was, however, little or no painin the head, though the trismus was much more marked than onthe preceding day; the voluntary muscles were becoming rigid,and the patient could not sit up, but with some difficulty she wasmade to do so. There was now noticed a slight tendency toopisthotonos.

While Dr. Burrows was in the ward, the patient was made toinhale about two drachms and a half of chloroform. When underits influence, the countenance became livid, the breathingstertorous, the mouth began to foam, and spasms occurred as inan epileptic fit. Upon recovery of consciousness, she said thather pains were less severe, but the pulse continued much thesame.

In the afternoon of this (the third) day, she stated, for the firsttime, that one month previous to admission she had tredden uponan awl, which had entered her right foot, and had caused swelling,but without any discharge from the wound. On examination,there was now found a small cicatrix on the outer side of thesole of the foot, about midway between the heel and toes. Shewas ordered chloric ether, and tincture of hyoscyamus in

camphor mixture, with a hip-bath and an enema at night.Fourth day.-After the bath the patient perspired very freely,

but had little sleep during the night. Mr. Wood saw her in themorning, and ordered some laudanum, nfter taking which sheobtained some sleep. When she awoke, Mr. Paget, by Dr. Bur-rows’ desire, made an incision down the outer side of the soleof the right foot, and a transverse one across it, when a blackmark became perceptible, which was supposed to be the coursetaken by the awl. At two P.III. she bitterly complained of thepain in the right leg, which latter was rigid and drawn inwards.Spasmodic movements of all the limbs now came on ; the legswere often forcibly drawn up, the muscles remained very rigid,and the trismus much the same. Twelve leeches were now puton the right foot, the spot to be fomented afterwards, and smalldoses of calomel and opium were given every fourth hour.

Fifth day.-The patient has become restless and noisy; onthe previous evening, however, after taking calomel and a pur-gative enema, she had a little rest after a dose of laudanum. Thebowels were moved in the morning by means of another purga-tive dose; at one o’clock in the day there were some convulsions,but the tendency to opisthotonos became less, the right foottill remaining bent and somewhat inverted. The trismus was

as marked as before, and the woman lay on her back with alanguid and exhausted aspect, the forehead becoming transverselyand longitudinally wrinkled.On the sixth day it was found that the patient had had some

sleep in the night. In the morning the spasms were less frequent,(occurring about once in two minutes.) On the right side thevoluntary muscles were quite rigid and contracted, but on theleft side rflaxed. She says that she feels very low and weak,but has no pain. The symptoms are unchanged; she has takenall her food, but the feet are very cold. In the evening she wasvery faint and exhausted, and refused to take nourishment andmedicine. Beef-tea injections were tried, but she gradually sankon the seventh day, without any increase of the spasms or de-lirium.The post-mortem examination was conducted, fourteen hours

after death, the weather being fine and cold, by Dr. Kirkes,demonstrator of morbid anatomy to the hospital. Frame wellnourished; several papulse on the epigastrium, produced by amustard plaster the day before death. The parts about the soleof the right foot were carefully examined, but no trace of inflam-mation, suppuration, nor other recent mischief, was found. Therewas only noticed a little altered blood in the track of the incisionmade shortly before death. On the under surface of the fourthmetatarsal bone, near its phalangeal extremity, there was, how-ever, observed a rather deep circular hole, as if drilled into thesubstance of the bone; it was of a reddish-brown colour, but nometallic substance was observed at the bottom of the perforation,and there was no apparent inflammation of the periosteum aroundit. The posterior tibial nerve appeared healthy, as did also itsexternal and internal plantar divisions. It should, however, benoticed that the external plantar nerve seemed to be directly inthe line of the puncture made by the awl. There was nothingremarkable in the contents of the cranium ; but as to the spinalcord (which was closely examined) it was found that its cervicalportion was perhaps rather firmer than ordinary; but the firm-ness gradually diminished downwards, the lower portion of thedorsal region being very soft, and even in places almost puipy.The softness extended through the whole thickness of this por.tion of the cord, and affected each half alike, but the membranesappeared quite healthy. The heart and pericardium, and theother thoracic and abdominal viscera, were sound, or presentednothing worthy of note.

Dr. Kirkes has kindly communicated to us that he has just had(May 20, 1852,) another post-mortem examination on a case ofwell-marked tetanus, in a child six years old, occurring withoutany obvious cause, and proving fatal in less than thirty-six hoursfrom its onset. As usual in such cases, the examination afterdeath threw no light on the real pathology of this frightful dis-ease. Nor should it be passed unnoticed, that cases of idiopathictetanus have of late been rather frequent; for we find, in theRegistrar-General’s report for the week ending April 24, 1852,two instances of the disease, one in a boy sixteen years of age,and the other in a woman of thirty-six. The Registrar veryjustly calls these cases apparently idiopathic; and that suchdiagnosis should often be thus qualified, will be rendered strikinglyobvious by the following case.

ST. GEORGE’S HOSPITAL.

Apparently Idiopathic Tetanus; Death; Autopsy.(Under the care of Dr. NAIRNE.)

HENRY M-, aged sixty-three, was admitted Jan. 10, 1851,under the care of Dr. Nairne. He was said by his friends tohave been ailing for some days previously, and that he had seem-ingly been attacked with a kind of slight fever. At nine o’clockin the morning, on the day of his admission, he had suddenlybeen seized with trismus, which very soon assumed the appear-ance of general tetanus. He was brought to the hospital half anhour afterwards, when he was found to be in a state of universalspasm, with all the characters of opisthotonos.

Dr. Nairne ordered a turpentine injection to be thrown up im-mediately, and a draught was prescribed, containing half adrachm of turpentine, to be taken every four hours. The injec-tion produced a copious evacuation from the bowels, and in admi-nistering it the attention of the nurse was drawn to a small ulcerunder the right knee, which was afterwards stated to have beenproduced by applying something tightly round it for support, asthe patient had been suffering from weakness in the joint. Verylittle of the turpentine draught could be swallowed, and thetetanic spasm continued unrelaxed, until the man sank into acomatose state, in which he died at two o’clock in the morning,the day after his admission.The body was examined thirteen hours after death, and found

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well formed, and in good condition. There was a small ulcer,with livid margins and signs of inflammation, behind the rightknee, a-little below the flexure of the joint, and to the outer side.The spinal cord appeared somewhat softer in consistency thanusual, but there was no redness nor other indication of diseaseabout it. The brain was also a little softer than usual. One ortwo cysts were observable in the choroid plexus, but the organwas, in other respects, in a perfectly normal state. The chestand abdomen did not present any important deviation. It wasnoticed that the integuments and areolar tissue near the above-mentioned ulcer were hard and consolidated, and the periaeealnerve was found imbedded within them, just before turning rouncthe fibula. There was no redness no" ̂ their mark of injury to thisnerve, nor was it, apparently, compressed to any extent.

medical Societies.

ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

TUESDAY, JUNE 8, 1852.—MR. HODGSON, PRESIDENT.

ON TSE PROTECTION AGAINST S31ALL-I?OX AFFORDED BY

VACCINATION, ILLUSTRATED BY THE RETURNS OF THE

ARMY, NAVY, AND THE ROYAL MILITARY ASYLUM. ByT. GRAHAM BALFOUR, M.D., Surgeon to the Royal MilitaryAsylum.ONE of the principal difficulties in the investigation of this

subject, the author thought, arose from the impossibility of ascer-taining what proportion of the general population was unpro-tected by vaccination. Accurate deductions could, however, befounded on the returns of the army, navy, and Royal MilitaryAsylum. ’Although the returns of the first department did notshow the actual number of soldiers who had been vaccinated orhad the small-pox, yet a tolerably accurate approximation mightbe obtained. From returns forwarded to the Army MedicalBoard, it appeared that out of 90,092 recruits medically inspectedand found fit for service, 20,132 bore marks of small-pox, 64,096had marks of vaccination, and 5864 bore no distinct traces ofeither. By the rules of the service, the latter would be im-mediately vaccinated; added to the second class, a total of 69,960,or 78 per cent. of the whole, would be protected by vaccination;22 per cent. representing the proportion of those protected byprevious small-pox. The question next arising was, what numberof admissions into hospital and deaths by small-pox had occurredin this number. Abstract No. 1 in the Appendix furnished thisinformation, and it showed the proportion of cases of small-poxto have been 66, and the deaths 8, in every 100,000 men servingthroughout the army. But the prevalence and mortality variedin different portions of the force. Thus, the deaths had beenfour times as numerous among the troops in the United Kingdomas in temperate colonies, and eight times as numerous as in

tropical colonies; while a still greater disproportion was foundto exist in the admissions into hospital. A comparative state-ment of the proportion of small-pox among the black troops andEuropeans serving in tropical colonies during several epidemics,was furnished, by which it appeared that the disease literallydecimat.ed the black troops, while not a single death occurrecamong the European soldiers serving in the same garrisons. Th<author observed, that if the hypothesis be correct, that the pro.tective power of vaccination became gradually weaker, and alength died out, the mortality from small-pox should be greatesamong the old soldiers. The following return illustrated thi!

pint :

Returns from the navy exhibited the same satisfactory evidenceof the protective power of vaccination. The vaccination registerof the Royal Military Asylum had been kept with great care, andreliable evidence could be obtained from it. During a period of

48 years, 31,705 represented the aggregate strength of the boys,and among these only 39 cases of small-pox occurred, of whom4 died. It must be borne in mind that every child bore marks ofcow-pox or small-pox, or had been subsequently vaccinated ; so

that, in a population completely protected, the average was but123 cases, and the deaths but 12, in every 100.0GO, being a stilllower ratio than in the army serving in the United Kingdom.Another return displayed the comparative amount of protectionafforded by vaccination and previous sma"l-pox. The ratio ofcases per 1000 of the latter was 6 15, and the deaths 2-05; whileof those previously vaccinated, the ratio of cases was 7’06, andthe deaths 0. All the deaths were thus from secondary small-pox. The author thought the preceding facts afforded most con-clusive evidence of the protective value of vaccination, while theextensive numbers, and the per:od of time over which the obser-vations extended, justified a very firm reliance on such evidence.He thought this evidence had an important bearing on the propo-sition recently made to legalize inoculation. While so large aproportion of the community remained unprotected by vaccina-tion, he thought such a course most unjustifiable. Absolute im-

munity from small-pox was not to be expected, but the foregoingreturns showed the great exemption obtained by vaccination.Vaccination should be made compulsory. It had been said thatthis would interfere too much with the liberty of the subject; butso to a certain extent did all measures relating to the public health.The prejudices of the few must be made to give way before the

. interests and safety of the many. In Factory Acts, parliamentrecognised the principle of protecting the young against anamount of labour calculated to be injurious, and this in spite, notof the prejudices, but of the so called rights of parents; and it

’ would be but an extension of this humane principle to make’ vaccination compulsory, and thus afford protection against a’ malady of so fatal a character as small-pox.ON THE DIMINUTION OF THE CHLORIDES IN THE URINE, OR

THEIR ABSENCE FROM THAT FLUID, IN CASES OF PNEU-MONIA; AND ON THE CHEMICAL COMPOSITION OF THE

SPUTA IN THAT DISEASE. By LIONEL SMITH BEALE,M.B. Lond.

(Cnnzmunicated by Dr. TODD, F.R.S.)The author’s attention had been first drawn to this subject by

some observations of Dr. Redtenbacher, who had noticed the ab-sence of chloride of sodium from the urine in pneumonia, andwho, in 1850, had published the fact that the chloride graduallydiminished until the period of hepatization had occurred, whenit disappeared altogetherfrom the urine, and gradually reappearedas resolution progressed. A diminution of the quantity of chlo-ride in a variety of diseases of the inflammatory type, had beennoticed by Franz Simon; but in these diseases they appeared onlyto suffer diminution, and not to be invariably absent from thisfluid, at the period of inflammatory condensation, as Dr. Redten-bacher had shown to be the condition in pneumonia. The author,with a view, if possible, of making out the channel through whichthe chloride of sodium was eliminated from the system in thisdisease, or of determining the locality in which it was stored

up, and desirous also to trace the connexion between the ab- .

sence of the salt from the urine and the occurrence of hepa-tization, had instituted the observations which formed thesubject of the paper. The observations were made on casesin King’s College Hospital, and were taken indiscriminatelyfrom amongst the mild and severe. The mode adopted by Dr.Redtenbacher, to estimate the quantity of chloride present, ap-peared to be simply approximative. The author desired to obtainquantitative results, and pursued a closer and more accuratemethod of analysis. He showed that if the chloride was esti-mated merely by nitrate of silver and nitric acid, volatile chlorideswould be thrown down, as well as the fixed chloride of sodium,and he had not overlooked the fact of the presence of hydro-chlorate of ammonia as one of the ordinary constituents of urine.By the rude method just mentioned, chloride of sodium might beentirely absent from the urine, and yet an abundant precipitatebe furnished by nitrate of silver, insoluble in nitric acid. Thefollowing was the method pursued:-The reaction and specificgravity were first observed ; 1000 grains were then evaporated todryness over a water-bath, and subsequently at 200&deg; in a water-oven, and the dry residue weighed for the amount of water. Aweighed portion of the solid residue was incinerated, and care-fully decarbonized at a dull-red l.eat; and the weighed residue,by calculation, gave the amount of salts present in 1000 parts.The soluble portion of this saline residue was taken up by dis-tilled water, acidulated with nitric acid; nitrate of silver beingthen added, thz presence of fixed chloride was at once detected.The precipitate, if any, was washed, dried, ignited in a porcelaincrucible, and weighed, and the chloride of sodium calculated