cases of ataxia joined with adynamia, such as are found combined in typhoïd pneumonia. The musk should not be given in too small a dose, if it is desired to produce a proper effect, and it is useless also to give too much. One gramme (fifteen grains) every day is at least necessary, but may be sufficient in the treatment of a case of pneumonia with delirium. The great objection to the use of musk is its very high price, and its consequent scarcity in many places, especially in the country. The Spirit of Mindererus, which is nothing else than a mixture of acetate of ammonia and empyreumatic products, formerly enjoyed an enormous reputation in the treatment of typhous and typhoid cases, malignant fevers, and typhus itself, but until the beginning of the present century it had fallen into disuse. Dr. Délioux considers it to be a modifying agent of great utility in cases of adynamic pneumonia, and that a soothing action is its peculiar pharmaco-dynamic property. Thus, he has observed in the decline of acute diseases, when the fever remains without any obvious connexion with organic lesion, that the administration of acetate of ammonia has rendered the circulation normal, and has removed from the convalescence the last morbid phenomenon which masked or retarded it. Thus it appears that the physiological action of acetate of ammonia is not identical with that of musk, but is very like it in several respects. Both are antispasmodics, moderators of the nervous perturbation, regulators of the nervous influx, and, as they might be called, anti-ataxics. But musk at the same time sustains, and even stimulates the nutritive organic actions, while acetate of ammonia lowers the circulation, and probably acts besides on the blood by attenuating its fibrin, as all the ammoniacal preparations do, and induces a proportionate degree of debility. Dr. Délioux states, that since he has been in Provençe, where diseases are often complicated with nervous symptoms, and where he has seen ataxic cases of pneumonia perhaps more frequently than elsewhere, acetate of animonia has appeared to him to be more efficacious than musk, and he has therefore employed it with remarkable success. Pneumonia, complicated with eruptive fevers, and which would become malignant and accompanied with delirium, may be mitigated by musk or acetate of ammonia. If an adynamic condition prevails, musk, especially the tincture, together with cinchona, appears to be preferable; but, in Dr. Délioux's experience, acetate of ammonia in large doses relieves the pneumonia, which is consecutive to measles and scarlatina. XV. On the Influence of the Air of the Pyrennees on the Affections of the (L'Union The air which is breathed in the Pyrennees at an elevation of eight hundred mètres above the level of the sea, possesses the peculiar properties of being more light than ordinary air, of containing less oxygen in an equal volume, of being impregnated with a more considerable amount of watery vapour, and of containing a very large proportion of ozone, or oxygen in a peculiar electrical condition. The atmosphere thus constituted exercises a very beneficial influence on the chronic affections of the respiratory organs, and it forms in these particular cases a very powerful auxiliary to the beneficial operation of the sulphurous thermal waters diffused throughout the region. In the case of patients who arrive at the Eaux Bonnes in a state of congestive sub-irritation and nervous excitability, a slow but progressive amelioration is observed, even before the administration of the waters; the gastro-intestinal functions are regulated and fortified, breathing becomes more easy, and the general phenomena undergo an improvement. This improvement may probably be attributed to the peculiar conditions of the surrounding atmosphere, in which there is less oxygen, but an ozonized form of it, and a lighter atmosphere saturated with watery vapour. These facts probably afford an explanation of the more marked efficacy of the mineral waters when drunk at the springs; for chemical reasonings have not hitherto explained the characteristic difference which is presented by the use of the waters at a distance from their source. The attentive observation of the phenomena exhibited in children by a visit to the Pyrenees appears to illustrate the above remarks. For the first few weeks after their arrival, children in general experience the favourable influence of change of air, purity of the atmosphere, and exercise; their vital activity is increased, and a notable change takes place in their system. But subsequently, under the influence of an imperfect oxidation, and of an impoverished condition of blood, the gastro-intestinal functions become deranged, and symptoms of anæmia and chloro-anæmia precede or follow those of nervous irritability. The pale complexion, emaciation, the bruit de souffle in the carotids, and the restlessness of disposition, leave no doubt as to the pathological conditions. The children are ill because they are deprived of a certain quantity of oxygen, and they are improved by ferruginous preparations, codliver oil, and cinchona. Thus, the effects of an atmosphere which contains too little oxygen may be easily understood; it is useful for the pulmonary invalid, because he requires to breathe as little as possible, and to introduce a less quantity of oxygen into his lungs; but it is injurious to children because they do not absorb the quantity of oxygen which is necessary for their complete organic support. The sulphurous waters of the Pyrennees are in their nature essentially of an exciting character, but this property is counteracted by the atmospheric conditions of the localities which are sedative and tranquillizing. Dr. De Pietra Santa, from a full consideration of the climate of the Pyrennees, thinks that he has discovered the explanation of the facts that patients there experience a more acute sensation of cold than is always commensurate with the thermometric degree; that certain mineral waters are much more efficacious when drunk at the spring; and that the action of the waters is more immediate when there exists a certain degree of humidity in the atmosphere. HALF-YEARLY REPORT ON PATHOLOGY AND PRINCIPLES AND PRACTICE OF MEDICINE. BY FRANCIS C. WEBB, M.D., F.L.S., Member of the Royal College of Physicians, Physician to the Great Northern Hospital. I. On Cerebro-spinal Lesions in the Diabetic. By Dr. MARCHAL (de Calvi). Communicated to the Academy of Sciences Oct. 12, 1863. (L'Union Médicale, Oct. 20, 1863.) THE paper of Dr. Marchal had for its object the establishment of the position that cerebro-spinal lesions are frequently the consequence and not the cause of the diabetic condition. Experimental physiology having demonstrated that various lesions of the cerebro-spinal axis are followed by glycosuria, it has been the natural consequence of that discovery to regard all lesions of the nervous centres observed in diabetic patients as primitive rather than consecutive. In the same way the anthrax which occurs in the same disease has been supposed to give rise to it, whereas the author asserts that there is not a single example in which this connexion has been established. In 1853 the observation of a furunculous eruption in a diabetic patient, who at the same time was paraplegic and amaurotic, led him to formularize the proposition, "That it is possible diabetes may produce paraplegia as it produces amaurosis, and that it is therefore as essential to examine the urine in the former as in the latter affection."* This he believes to have been the first mention of the production of cerebro-spinal lesions by diabetes. Since that time numerous cases have come to his knowledge in which changes in the nervous centres appeared to be produced during the diabetic condition. Notes of twenty-three, collected from various authors, compose the bulk of the present paper. The symptoms in these cases varied considerably. Some of them were cases of apoplexy; in others there were various affections of the special senses, or of motion and sensation. In some the intellect was affected. One of the facts he considers most striking is taken from a paper by M. Fritz, "On Diabetes in connexion with Cerebral Maladies." A woman, aged thirty-eight, diabetic for seven years, suddenly succumbed to a cerebral attack. On examining the brain a superficial ulceration was found, covered with sanious detritus, between the back part of the left thalamus opticus and the corpora quadrigemina, its base softened, and exhibiting points of capillary extravasation. Here M. Marchal observes that the pre-existence of diabetes was beyond doubt, for it was anterior by seven years to the cerebral accidents. He concludes, that even if we admit that some of his facts are debateable, it is not the less established that diabetes may act in the same manner as gout in predisposing to lesions of the cerebro-spinal axis. II. The Transmission of Syphilis through Vaccination. By Dr. H. Boнn, (Schmidt's Jahrb., A very careful and elaborate essay on the history and literature of the question whether secondary syphilis can be communicated by means of vaccination, the possibility of this being, as Dr. Bohn remarks, the only one remaining of the many serious accusations from time to time launched against vaccination. After remarking that inoculation was in its day charged with the same risk, Dr. Bohn notes that Prof. Monteggia was the first, in 1814, to declare that vaccination might be the means of communicating syphilis, he believed that when a syphilitic patient was vaccinated the resulting vesicle contained a double virus-the syphilitic virus and the vaccine virus. He was followed, and his doctrine supported by cases, by Dr. Marcolini, in the same year, and in 1821 by Prof. Cerioli. In France the question was first taken up in 1831 by Bidart, and was, after an experimental examination, decided in a contrary sense to the Italian professors. From that time many imputed instances of infection are recorded, and the question has been many times discussed in different parts of Europe, all of which cases and discussions Dr. Bohn notices and critically examines. The first criminal accusation against a surgeon for thus communicating syphilis took place in Coblentz in the and resulted in his punishment by fine and imprisonment. year 1849, Dr. Bohn fully notices the examination made into the subject by the General Board of Health of England in 1855, by a series of questions addressed to 539 physicians and medical societies. The third question proposed was, you ever seen any grounds for believing or suspecting that lymph taken from a perfect Jennerian vesicle can become the vehicle for infecting a vaccinated person with syphilis ?" The 539 answers are arranged in four classes: Have 1. The question is answered shortly in the negative, partly on theoretical grounds, partly from a long and rich experience. In this class were Chomel, Rostan, Rayer, Velpeau, Ricord, and most English physicians. 2. The possibility of "vaccino-syphilitic inoculation" is combated on the ground of direct evidence. Here are found Oppolzer, Sigmund, Hebra, and the whole of the Austrian school, and joined with them is "the learned and * Moniteur des Hôpitaux, Sept. 8th, 1853. sagacious reporter of the General Board of Health," Mr. Simon, whom, by the way, Dr. Bohn dignifies with the title of "Sir John." 3. A few physicians questioned whether, physiologically, the contents of a vaccine vesicle in syphilitic persons might not be infectious as well as their blood. 4. This class, including Bamberger, Rinecker, and Whitehead, considered that the instances of infection were singular and exceptional. The result was to leave the question very much where it was before. Then Viennois, of Lyons, took it up, and examining all the recorded cases, classed them in two groups. The first contained instances of persons who when vaccinated had latent syphilis, the eruption of which was caused by the vaccination. The second contained the cases of individuals truly syphilized by the act of vaccination; but Viennois declared that in these instances blood had been mixed with the lymph, and that while the vaccine lymph only produced true vaccination, the syphilitic inoculation was due to the admixture of blood. Dr. Bohn then examines by the light of this doctrine all the recorded cases and all the dissertations up to the present time, and concludes that an already existing syphilis is excited to a more general, more lively manifestation by vaccination; and that vaccino-syphilitic inoculation-i.e., the cotemporaneous communication of vaccination and syphilis-is a fact, but that pure lymph can only communicate vaccination, and when syphilitic blood is mixed with it then only can syphilis be at the same time communicated; that true and pure vaccination is therefore purged from the only accusation remaining against it, and that the title "syphilis-vaccinata” must therefore be abandoned. To this essay a sort of supplement is added by Dr. Millies, who states that when it was received by the editor he was himself engaged on a similar work, but that the "solidity" of Dr. Bohn's communication has induced him to abandon the design, and content himself with only adding to Dr. Bohn's essay some observations which appear not to have been at Dr. Bohn's command, and "which would possibly have led him to a different conclusion." He then quotes some additional cases. Glatter's, Haydon's, &c.—and notices at some length Melchior Robert's paper against Viennois' hypothesis, and his conclusion that "in the communication of syphilis through vaccination the commingled blood is not the contaminating medium." He points out that Ricord, Cullerier, and many other physicians deny that there is any causal connexion between vaccination and syphilis, and that Ricord, Max, Albertetti, and others believe the Rivalta cases were due to a fortuitous concurrence of circumstances, not to any relation of cause and effect between the vaccination and the outbreak of syphilis. And, finally, he remarks that when Devergie's cases were discussed in the French Academy, Ricord confessed that he could no longer dispute the possibility of the communication of syphilis through vaccination; and that as to whether the medium of infection was the pure lymph, matter, or blood, he thought that it was a proved fact that syphilitic blood was inoculable. III. Epidemic of Spotted Fever occurring in the vicinity of Philadelphia in the year 1863. By Drs. W. W. GERHARD and LAMB. From the Transactions of the College of Physicians, Philadelphia.' (American Journal of the Medical Sciences, No. 91, July 1863.) Dr. W. W. Gerhard, whose well-known observations on typhus and typhoid fevers entitle anything he may advance on the subject of fever to be received with attention, has given an account of a new form of fever lately observed by him in Philadelphia, which he considers entirely distinct from any of the recognised forms of continued or exanthematous fevers. The form of fever he describes he believes to be entirely unknown in Europe; and the only account of it extant is an imperfect description given of it by a number of physicians in New England, where the disease appeared between the years 1807 and 1816. About the middle of February, 1863, Dr. Gerhard was called to see a boy, aged sixteen, who was taken suddenly ill with intense pain in head and back, with occasional delirium, and nausea and vomiting. In the intervals of the delirium he was dull and heavy, but able to answer questions correctly. On the second day there was an eruption over the whole body of spots varying in size from such as would be caused by the prick of a pin, to an inch or more in breadth. These spots were of a dull-red colour, not in the slightest degree elevated, and rather resembling ecchymoses such as might be caused by the puncture of an insect than a proper eruption. There was no diarrhea; moderate heat and fever; the tongue was scarcely coated. The patient died in four days from the attack, sinking in a state of coma. A sister of the patient, aged twenty, was afterwards taken ill with the same symptoms and eruption. She died in twenty-six hours from the commencement. No distinctive lesions were found after death. A few days after the disease showed itself at the Falls of Schuylkill, five miles from the city; it was there exceedingly fatal. In each of two families there were three deaths, in another two. Besides there were about twenty scattered cases, of which ten proved fatal. The symptoms exhibited were sudden chill and intense headache, and pain in the back, followed by fever; the patient became dull and heavy, either not answering at all or only when loudly spoken to. In some cases there was delirium, but in the majority the cerebral disturbance tended rather towards stupor or coma. In fatal cases there was always coma a few hours before death. There was often vomiting in the commencement, but no epigastric tenderness. There was constipation and disgust of food; the urine was perfectly healthy; the degree of fever varied; the pulse was frequent, not strong, and frequently diminished in strength and rapidity; the heat of skin was comparatively moderate. In some instances the patient exhaled a peculiar odour. The eruption consisted of spots varying in size from a pin's point to ecchymoses an inch or two in breadth. Each spot was of a dull-red or purple colour, varying in shade; the lighter spots became somewhat lighter on strong pressure, but the darker were not modified in any way; they were evidently due to effusion of blood in the true skin. They were in no degree elevated, and were scattered pretty equally throughout the body, being perhaps a little more abundant in the extremities than the trunk. They usually appeared at the end of twenty-four hours, sometimes earlier, and in some cases were perceptible after death, although not very visible during life. The duration of the spots was very variable: in some cases they lasted a week or two, disappearing in the same way as the dark colour of a bruise. The complexion was dull and slightly yellow, but there was no jaundice. The eyes were moderately injected in some instances, but rather in the veins than in the arteries. In one case an eye was destroyed by suppuration. There were no glandular enlargements. No age was exempted, but the larger proportion of patients were between fifteen and twenty. Morc females than males were attacked. In one case examined after death there was congestion of the brain, and an effusion of serum at its base and in the ventricles. The lungs were slightly congested posteriorly; the right side of the heart contained very dark fluid blood, with a very small and flaccid coagulum. There were ecchymoses under the serous layer of the pericardium and under the serous covering of the stomach, and there was an ecchymosis a quarter of an inch in breadth in one of the glands of Peyer. The fever appears to have originated in the army in Virginia, before it reached Pennsylvania; but it does not seem to have spread by contagion. There was no positive evidence of its having been transmitted from the sick to the healthy; whilst in many cases in Con |