A female was confined, and the delivery was followed by profuse hæmorrhage. This was combated by cold applied to the hypogastrium, and by the introduction of lemon juice into the cervix uteri. On the fourth day, the lochia became suppressed, and the abdomen became the seat of severe pain. She was admitted into LA CHArite, her belly immensely distended and tympanitic, and accompanied by fever of the puerperal kind. Leeches and the usual means were employed, but without advantage. Next day she became completely jaundiced-and on the 3d day of the present illness she died.

Dissection. Great quantities of gas were confined in the intes tines-these last were covered with albuminous effusions-and whitish puriform secretions were collected in the pelvis. The mu cous membrane of the stomach was pale; but that of the duodenum was inflamed. On minute examination, no affection or obstruction of the liver or its ducts could be detected. The internal surface of the uterus was inflamed.

Dr. Andral thinks that the tympanitis may have ocsasioned the peritonitis. But extrication and accumulation of air in the bowels are such usual attendants on peritoneal inflammation, that we can hardly regard it in any other light than as the effect of the inflammation.

Here we must quit the subject of acute peritonitis. The symptoms of this dangerous disease are nearly as unequivocal as those of any other inflammation, though the treatment is more difficult. It is chronic inflammation of the peritoneum which produces such havoc, and which so generally passes undetected till it is too late for remedy. There are many cases of chronic peritonitis, where the disease goes on to fatal effusion--to tuberculation-or to adhesion of the intestines into a mass, and yet no pain may have been complained of at any period of the disease. More generally, however, chronic, is a sequel of acute peritonitis. We shall be able to introduce but two or three cases, offering peculiar features, before we close this article.

Case 5. A tailor, 24 years of age, was seized with abdominal pains, in the beginning of December, attended with diarrhoea. He kept his room for three weeks, and then came into LA CHARITE. The abdomen was distended, and fluctuation was obscurely perceptible. The diarrhoea continued--the tongue was red at the pointvomiting-quick pulse-cough. Auscultation and percussion could detect no disease of the lungs; but they had no doubt of inflammation, both of the peritoneum and mucous membrane of the bowels. Leeches, fomentations, low diet. During the next four or five days there was no diarrhoea, but the symptoms of peritonitis continued. During the remainder of January, the abdomen got larger, the pulse very quick, and the skin dry and rather hot. In the beginning of February, the cough increased, and some oppression was felt. The

chest, however, sounded well, and the respiration was heard throughout, without any wheeze. He died, exhausted, on the 15th February.

Dissection. The abdominal parietes were strongly adherent to the intestines-and there was an effusion into the abdomen, of a brown colour and fæcal odour. The small intestines were glued together, and covered with false membranes, which membranes were studded with tubercles. Beneath these membranes, the peritoneum was found of its natural colour and structure. Between the peritoneal and mucous membranes, a number of tubercles were developed, some of which were softened down, and had burst through the peritoneal covering. Within a few inches of the ileo-cæcal valve, the the coats of the ileum had given way, and there existed a perforation. The mucous membrane of stomach and bowels was pale and healthy. There were some crude tubercles at the summit of each lung-and the pericardium was adherent to the heart by a thick layer of false membrane, studded with tubercles.

Remarks. The above is a very well marked case of tuberculated accretion of the serous membranes, with effusion-all, no doubt, the consequence of chronic inflammation. This case also presents a specimen of perforation of the intestine, proceeding from without inwards, and caused by the softening down of tubercles. The following is another striking example of the ravages which chronic peritonitis is capable of effecting before death.

Case 6. A shoemaker, aged 19 years, experienced, in the month of May, some acute pain in the abdomen, which did not however, prevent him from work for some days. At last he took to his bed. There was pain on pressure, but no vomiting or diarrhoea. There was cough and fever every evening. In July, there came on a diarrhoea, and, on the 12th August, he entered LA CHARITE. His face was pallid and swelled--some oedema of the ankles--pain about the umbilicus augmented by pressure--belly rather tumid and presenting fluctuation--three or four liquid stools daily-slight cough-quick pulse-morning perspirations-great emaciation of the thoracic parietes and the arms. In the course of the month of August, a strict regimen and fomentations entirely relieved the pain; but the cough increased-the diarrhoea continued-the perspirations became more profuse--the debility and marasmus made rapid advances, and the patient died on the 31st of the same month.

Dissection. There were several ounces of serum in the pericardium, the heart itself being apparently sound-superior lobe of the left lung converted into a tuberculated mass, leaving scarcely a trace of parenchymatous structure. Numerous tubercles in the rest of the lungs. In the abdomen, a considerable quantity of yellow serum

epiploon greatly indurated and tuberculated-intestines glued together by false membranes, these membranes being studded with tubercles-internal surface of the stomach pale, except near the pylorus, where it was discoloured an ulceration close to the ileocæcal valve above-and one or two below that apparatus. The valve itself was ulcerated, and a complete perforation of the coats effected.

The above case offers an instance, to which the attentive practitioner would often find parallels, where ulceration of the intestines takes place, attended with so little pain, that the disease would not be at all suspected. We believe, indeed, that, in the present state of our knowledge, there is really no pathognomonic sign by which we can ascertain the existence of this dangerous generally fatal malady! This uncertainty, however, should put us on our guard against that system of drastic purgation, now so indiscriminately put in practice by routinists, without thought or consideration.

Here our review of M. Andral's work must terminate, for the present. The work abounds with ample illustrations of abdominal inflammation, drawn from the clinical practice of a public hospital. They are highly deserving of attention. We are gratified to observe that, in all our medical discussions, in the various societies of this metropolis, the subject of pathology, as cultivated by our continental neighbours, is now exciting universal interest, and that what we have long urged in this Journal, is confessed with one voice--the superiority of continental pathology over that of this country. It is humiliating to observe the sneers with which our fashionable physicians, in this metropolis, regard the study of pathology. Dr. Hodg kin, in his paper on Medical Education, lately read and discussed at Guy's Hospital, alluded to the disgraceful fact, that—in the theatre of the Royal College of Physicians of London, a systematic attempt was made to depreciate the study of morbid anatomy! Such a fact will place us in a pretty light on the Continent! But we trust the present, and especially the rising generation, will wipe off this foul disgrace to science, and prove that Englishmen, when once aroused, will evince that native energy so strongly inherent in them, and show that they are not to be outdone in any pursuit, where the health and comfort of their countrymen are concerned.

VII.

Memoirs of West Indian Fevers; constituting brief Notices regarding the Treatment, Origin, and Nature of the Disease commonly called Yellow Fever. By JAMES WILSON, M.D. of the Royal Navy. Octavo, pp. 217. Burgess and Hill, October, 1827.

ALTHOUGH WAR has long ceased to afford victims for yellow fever, on a large scale; yet, the disease has not altered its character. Whenever the seasons suit, and the European comes within the range of its pestilential breath, this devouring angel proves itself as merciless and destructive as during the disastrous expeditions and campaigns of the revolutionary war. The number of works which issued from the press, in the course of that prolonged struggle, on the subject of yellow fever the jarring and conflicting testimonies respecting its nature--and the general inefficacy of treatment in the more concentrated forms of the disease, produced a kind of reluctance in the public mind to listen any longer to the declamations of the brawling controversialists-and the consequence was, that we have had but little on the subject, in the English language, for several years past. On the Continent, indeed, a species of desultory warfare still reigns between the contagionists and anti-contagionists; but, in this country, we are hear tily sick of such discussions, as the parties have never been able to convert each other to their respective creeds; nor have they succeeded in producing any general conviction in the minds of the public, as to the true state of the questions agitated.

Dr. Wilson, the author of the work under review, although he touches on all the different points of controversy, yet writes like a medical philosopher and a practical man, investigating calmly, and observing accurately, the phenomena of the disease, its real or supposed causes, and the means which have proved efficient or ineffectual in the treatment. On this account, Dr. Wilson is entitled to a candid perusal, although he may be found to have embraced some tenets and views which are hardly tenable in the present state of medical knowledge.

The work is dedicated to the Medical Commissioners of His Majesty's Navy--Drs. Weir and Burnett; and in his Preface, the author states it to be his chief object to point out the difference between the inflammatory and congestive modifications

of West Indian fever, and to indicate the principles of practice adapted to each. In this place, Dr. W. takes an opportunity of paying a just tribute to the deep thought and talented researches of the late Dr. Jackson, whose writings on fever were never generally appreciated in the manner they deserved, owing perhaps, to a want of perspicacity-or, at all events, to want of power in conveying his own thoughts to the minds of his readers.

The work contains five memoirs-the first consisting of cases, illustrating the mild inflammatory-violent inflammatoryintense inflammatory-slight congestive-aggravated congestive-and apoplectic congestive, forms of fever. The second memoir is on the cause of yellow fever :-the third memoir developes "new opinions" as to the cause of fever:-the fourth memoir discusses the question, whether West India fever be or be not, a peculiar disease and the last memoir is dedicated to an investigation of the manner in which the cause of fever impresses the body.

We shall pass very lightly over the first memoir. A severe visitation of this endemic among the crew of the Rattle-snake, appears to have furnished Dr. Wilson with examples of the six forms or modifications above alluded to, and we believe they are carefully copied from life. The following extract will convey a good idea of the different grades of the inflammatory genus.

"The most constant and prominent symptoms of the inflammatory were, with or without rigor, frequency and strength of pulse, wiry, compressed, or full; a hot non-secreting condition of the skin, particularly at the præcordia and across the forehead; headach, confined generally to the sinciput, with sense of fulness in the eyes and tightness between the temples; jactitation, and constant rolling or otherwise moving of the head; flushing of face, with prominence, wildness, and sometimes inflammation of the eyes; pain in the back and loins, shooting across the anterior parietes of the abdomen, involving the whole contents in tumult; aching in the lower extremities, especially the knee joints, calves of the legs, and tibiæ; sometimes abdominal tension and tenderness in the early stages, sense of emptiness and exhaustion there as the disease proceeded. In the course of the second evening the symptoms, were generally aggravated, and the stomach in many cases became irritable; but this symptom did not occur in the intense, and was very tractable in the mild species; in the violent it was exceedingly unmanageable, and often could not be arrested till fatal symptoms came in its train. Delirium was an early symptom in the violent and intense species, and was always attended with great danger. Costiveness was generally obstinate at the commencement, but was sometimes succeeded by troublesome purging and tenesmus. The tongue varied much