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1. Bleeding and the debilitating diet of the mother have an 1undoubted influence on the development of the child duringintra-uterine life.

2. Great use may be made of this method in deformity ofthe pelvis, by substituting it, in certain circumstances, to theinducement of artificial labour.3. It is equally applicable to cases where, in the absence of

any narrowing of the pelvis, the exaggerated size of the faetushas, in former labours, caused it to be destroyed.

4. The influence of a diminished amount of food is muchmore powerful than bleeding, when the mother rigorouslysubmits to it, for a sufficient time; nor could the abstractionof blood be repeated often enough, without danger to the ges-tation.5. ’Venesection ought to be used cautiously, simultaneously

with the lowering diet; and bleeding will be more particularlyuseful in the latter months of pregnancy.

6. When this method is carefully appl’ed, it has no un-favourable influence, either on the progress of gestation, or onthe future health of the mother, or on that of the child.7. It is impossible to lay down unvarying rules for its appli-

cation, for it should be modified according to circumstances,and the end in view.8. To ensure effective results, this method should be en-

forced early, and continued without interruption to the termof gestation. -

Medical Journalism in Germany. IThe twenty-four Universities of Germany are still in full

vigour, in spite of the political commotions which have dis-turbed the country; and, though the professors have lostfavour with the governments, on account of the ultra-liberalopinions of some of them, they are greatly resp, cted by theirpupils. The number of medical journals amounts to sixty,making up a total of 3500 sheets, or 56,000 pages per annum,and the subscription to all of them would reach about .640.Almost every branch of medical science has its periodicalorgan, but there is not one journal exclusively devoted toa- university, or to one of the great hospitals of Germany.Some time ago, a periodical connected with the " Charite," ’’

of Berlin, was commenced, but its publication has been dis-continued.

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Blectro-Muscular Contractility.Dr. DUCHENNE, of Boulogne, addressed to the Academy of

Sciences, on December 3, a paper on some investigations ofhis, made with the aid of galvanism, on the electro-muscularcontractility and sensibility in paralysis of the upper extre-mity. The object of the paper is to develop the followingproposition:-When we study the state of muscular proper-ties, in limiting the electrical action to each of the muscles,or bundles of muscles, we see paralysis of the superior extre-mity subdividing into two very distinct classes. In one, theelectro-muscular contractility and sensibility are diminishedor abolished; in the other, the electro-muscular contractilityis always intact, and the electro-muscular sensibility is eithernormal, or increased, or diminished, and sometimes evenabolished. In the first class lead paralysis may be reckoned,and that which, not being of a saturnine origin, is, or is not,connected with an appreciable lesion of the spinal marrow,or the nerves which arise from it. In the second, cerebralparalysis may be observed, as well as the rheumatic and hys-terical paralysis.

Hospital Reports.WEST CUMBERLAND INFIRMARY, WHITEHAVEN.

CLINICAL REPORTS FROM THE FEVER WARDS.

Reported by T. F. I’ANSON, ESQ.

Fever, with Sleeplessness and Delirium ; Employment of Tartar-Emetic and Opium; Exposure to Cold ; Pulmonary Gonges-tion ; Death by A pncea.

CASE 8.—Patrick B-, aged thirty-three, a robust labourer,has been ill for the last eight days; six days ago took to hisbed, and has been getting gradually worse since; for the lasttwo days and nights he has not slept at all; and last night heraved incessantly, and was very violent; to-day he has beenquieter, but still continues to talk irrationally. He is now(evening of ninth day) busily engaged arranging the bed-clothes, looking suspiciously at the nurse, and. has alreadytried to get out of bed several times since his admission; his

head is hot; face flushed; eyes suffused and brilliant, givinga wild expression to the countenance; he has drank frequentlyand eagerly since his entrance, though, when questioned, hedenies being thirsty; the tongue is moist, furred, and black inthe centre; pulse 110, communicating a sharp, vibratory sen-sation to the finger; skin dry, with a burning heat; surface ofchest and arms scattered over with an indistinct, papular erup-

tion ; abdomen full, tolerant of pressure; bowels said to beconfined; when he is questioned as to his feelings, he repliesthat lie is quite well. To have the head shaved and six leechesapplied to the temples. To take five grains of calomel directly;and a quarter of a grain of tartarized antimony, in an ounceof camphor-mixture, every two hours.Tenth day.-No sleep was obtained last night, though he

several times remained quiet for the space of half an hour, asif about to fall asleep; he would then become very talkative,arguing loudly about an amount of wages which he supposesis his due; occasionally he has been very violent; and once,when he was thought to be near falling asleep, lie elucied thevigilance of his nurse, got out of bed, and could not be in-duced to return for some time. His general aspect is thesame as yesterday: pulse 112, with the same kind of vibratorystroke; skin hot and dry, with the exception of the forehead,which is bedewed with perspiration; the bowels relieved oftwo dark, semi-fluid motions; the tongue moist and furre 1;and the same eager desire for drink; he has now taken twograins of tartar-emetic. To take a quarter of a grain oftartar-emetic, with five minims of sedative solution ot opium,in camphor-mixture, every hour, until sleep is obtained.Eleventh day.—He fell asleep yesterday evening after the

sixth dose; awoke but once for a short time during the night;fell asleep again, slept till morning, and is now quite rational.He complains of no pain, but says he feels excessively weakand fatigued. The head is cool, countenance and eyes natural,thirst abated, tongue moist and cleaner; skin natural tempera-

’

ture, and moist, there having been profuse and general perspi-ration during sleep; pulse 105, fuller, soft, and undulating;bowels twice relaxed with bilious stools; eruption disappear-ng from chest.-To take the eighth of a grain of tartarized

antimony every four hours, and to have some weak beef tea..

Twelfth day.-The improvement continued yesterday even-ing, but at night he obtained no rest, from a pain and sense ofweight in the chest and between the shoulders, to which weresoon added difficulty of breathing, short cough, and viscid ex-pectoration. There is now evidently much dyspnoea; respira-

tion short and hurried; copious viscid, rust-coloured sputa;f countenance anxious and dusky; pulse 120, very weak andi feeble. Small crepitation very distinct over both lungs, ante--riorly and posteriorly. A large blister-plaster to the chest.? Cupping-glasses between the shoulders. Calomel, two grains,and opium the eighth of a grain, every hour. Wine, six ounces.;, In the evening there was orthopnoea, lips blue, pulse thready,,- the extremities cold and blue. He died about midnight.

A utopsy, seventeen hours after deat7a.-Cranium: The duramater, arachnoid, and pia mater, perfectly healthy themselves,but the sinuses and large vessels gorged with much fluid blackblood. The substance of the brain firm, no serous effusioneithe’r on its surface or in the ventricles.- ’l’horax: On openingthe cavity of the chest both lungs found fully expanded, theanterior edge of the left one exhibiting a few vesicles of em-physema ; the whole of this lung, but especially the lowerlobe, was intensely congested, but no part of it had advancedto the state of hepatization; the pleura on this side apparentlyhealthy, without serous or plastic effusion. The pleural sac onthe right side contained about half a pint of reddish serum;and the membrane itself covering the lower lobe of the lungwas thickly covered with layers of plastic lymph; the wholeof the lung on this side had sun-ered more in proportion thanthe opposite, the upper lobe being excessively engorged, thelower one hepatized, though not firmly, as in idiopathic innam-mation; and the middle one advanced to a state of hepatiza-tion, gris, its texture readily giving way under the pressure ofthe finger, and the cavity thus formed being immediately filledby a mixture of sanguineous and purulent fluids. The cavitiesof the right side of the heart were filled full of fluid blackblood, the lining membrane being slightly stained by thecolouring matter; the left side was comparatively empty, asmall, loose clot only being found in the ventricle.

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Deliriuna and Sleeplessness treated by Antimony and 01-)ium- 9 Short A melioration, then Embarrassed Respiration, Subsultus,Tendinum, and Death.CASE 9. - C-, aged forty-five; a tramp; brought from’

‘

a low lodging-house, where lie was taken ill five daysago; the

18

people who brought him say he complained of shivering antheadach, and that for the last two nights he has raved inces-santly. Of his previous history nothing is known, but he appears very thin and emaciated. He lies on his back in bed

looking earnestly at some imaginary object, and talking indistinctly to himself; by speaking sharply to him his attention i:fixed for a moment, and he will answer that lie is suffering-greatly from headach, but is otherwise well. His skin ihot, and covered with maculao of a light rose-colour; pulse] 100rather sharp; the tongue clean, inclined to be dry, but notpreternaturally red; some thirst; abdomen full,- but not tym-panitic, and quite tolerant of pressure; respiratory murrnuiheard through both lungs, though weak and indistinct. Tohave cold lotion to the head; five grains cf mercury-with-chalk, directly. An acetate-of-ammonia draught every threehours. Fever diet.

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Seventh day.-He obtained no sleep, but was talking to-himself the whole of the night. When questioned, he repliesthat he is quite well. There is much heat of scalp; eyes blood-shot ; pulse 110, sharp and vibratory; bowels opened twice.To have a blister-1>laster behind each ear. A quarter of agrain of tartarized antimony every two hours.Eighth day.-He continued sleepless and talking all night;

the aspect is stern, though he uses no threatening language;- sealp less hot; eyes still bloodshot; pulse 110, sharp and con-tracted ; tongue dry; thirst remaining. He is now taking thetartarized antimony every hour, with five minims of sedativesolution of opium.Ninth day.-After taking five doses of the fresh medicine

yesterday, he fell asleep, and slept for nearly six hours; onaevaking he still wandered slightly, so the antimony was con-tinued without the opium; he again fell asleep, and is nowquite rational ; early this morning he had a shivering fit, andcomplains at present of feeling sore all over. Pulse 106, fullerand softer; skin less hot than yesterday. Towards evening, hebegan again to mutter to himself; convulsive twitchings oc-curred in the extremities; pulse 130; respiration very quick;- small crepitation very distinct in the lower lobes of bothlungs. He died in the night.

Aufops, fourteen hours after deatlt.-Cranium.o Great en.gorgement of the vessels of the pia mater, not, however, pro-.ceeding to minute capillary injection. Much sub-arachnoideffusion, especially seen in the interstices between the convolu-tions ; the arachnoid membrane itself thickened in patches,and of a pearl-white colour; no minute injection, however, orother mark of recent inflammatory action in the vicinity ofthe patches; convolutions not flattened; substance of brainhealthy; no effusion in the ventricles.—Thorax: Throughoutboth sides, the lungs were completely bound to the wallsof the chest by old and very firm adhesions; in no part did theadhesions appear as of recent formation. The anterior andupper margin of the left lung was slightly emphysematous.The lower lobe of the left lung, and the whole of the lung onthe right side, were intensely congested, dark brown-red>coloured, and when cut into giving exit to a large quantity of- frothy and deeply tinged sanguineous fluid, a piece submittedto the action of water not recovering its natural colour; and;-the mucous membrane of the bronchial ramifications of adark colour, and covered with a tenacious rust-colouredrfiuid.

The simultaneous occurrence of these two cases, the simi-larity in’their mode of attack, in their progress, in the reme-dies required, and in their termination, was very remarkable.In both there was sleepless delirium, benefited by the exhi-bition of opium and antimony, but this amelioration was fol-lowed by the occurrence of pneumonia in each; this naturallyleads to the inquiry as to what circumstances were present to,determine the latter phenomena. We know, or at least be-lieve, that for the production of metastasis there must be an:alteration of the nervous sensibility of the part, in the state ofthe capillaries, and perhaps some changes in the blood itself;the capillaries especially are thought to be concerned in thetranslation of disease. Now, in the first case, (B-,) theorder of circumstances seems pretty evident; the poison oftyphus, being present in the system, had especially attackedhe head; dislodged, at length, and become floating in themass of the blood, .it was ready to seize on any organ which itound predisposed to its reception; just previous to this, ex-posure to cold had taken place, which was more likely to affectthe capillaries of the lung than of any other organ, thus layingt open to the full force of the disease, the whole mass of theblood, in its most deleterious condition, having to pass through4 and undergo the necessary vitalizing changes in its texture. I

In the second case, (C-,) we cannot fix the cause of themetastasis quite so clearly, but, most probably, cold had beenin operation previously; his mode of life and circumstanceswarrant the supposition; he was evidently of a broken consti-tution, as the emaciation, theproducts of old inflammation in thepleurae, and the existence of previous disease in the arachnoid,fully proved. It was evidently a case of metastasis, and notprimary inflammation of the lungs, masked by the head affec-tion, for the lungs were free at the commencement, and ÍInme-diately before they were observed to be attacked he had ashivering fit, and those general flying pains which are so fre-quently observed immediately before the translation of diseasefrom one part to another. One question with respect to thestate of the capillaries may arise from the treatment: Hadthe opium any effect in causing congestion? It will be seenthat they had neither taken more than half a drachm ofBattley’s solution. We are certainly cautioned against the useof opium in inflammation of parenchymatous structures, and,above all, of the lungs; but then its combination, in the abovecases, with antimony, should have tended effectually to preventcongestion from that cause; and we have, moreover, the posi-tive or presumed effects of cold, quite sufficient to account forthe determination.These cases are good examples of the comparative rapidity

of the progress and termination of pneumonia, in typhoid overidiopathic cases; one of them also, of the preference whichexists in these cases to run on to purulent infiltration, ratherthan to throw out lymph, and thus form red hepatization.

Revíems and Notíces.

first Medical Report of the Hospital for Cm;s1lmption andDiseases ojihe Chest. By the Physicians of the Institution.

; London: Churchill. 1849. 8vo, pp. 42.l IT has been a constant object of THE LANCET to stimulate the

medical officers of hospitals to a due discharge of those re-sponsibilities which their opportunities for advancing profes-sional knowledge so obviously entail, and we hail with satis-faction the example presented by this Report, of the faithfuland efficient discharge of such responsibilities.A Report, the result of the united action of the medical

officers of au hospital, exhibits a cheering specimen of pro-fessional harmony, whilst it is calculated to ensure accurateconclusions by excluding any bias to partial opinion or one-sided observation.The statements in the Report are deduced, it appears, from

an analysis of more than four thousand cases of consumption,and are arranged under three heads-the first contains obser-vations on the influence of sex, age, social condition, occupa-tion, and hereditary predisposition, upon the development ofthe disease; the second treats of some of its symptoms; andthe third, of the results of treatment-the whole being illus-trated by a number of well-arranged tables.The conclusions upon the influence of sex show the in-

correctness of the general opinion, assigning to females agreater liability to phthisis than males, the tables provingthat the number of men attending the hospital was about sixty-one per cent., whilst that of the women amounted only to thirty-eight per cent. That this could not have resulted from a

greater number of males being in the habit of attending hos-pitals generally is shown by a comparison with two metro-tan hospitals, in both of which the very converse takes place.It is interesting to observe, that the tables published by theregistrar-general agree upon this point with those furnishedby this Report.

It is shown that the period of life most prone to consumptionis between the ages of twenty-five and thirty-five; that femalesare much more frequently attacked than males before theyreach twenty-five, but that, after this age, and increasingly soin more advanced life, the liability is considerably greater onthe side of males. No age seems to be exempt from phthisis,the years of infancy and the " threescore years and ten" alikecontributing to the tables.