months is due to a mere mechanical cause, thrusting up the diaphragm; but when dyspnoea is observed at an earlier period it may be due to the nervous condition or to congestion or cedema of the lung, and according to the nature and prevalence of these causes the treatment with regard to bleeding must be regulated. In some cases palpitation of the heart is also due to local congestion, and may call for depletion ; but such cases are rare. Cough, when dependent upon such condition, is best relieved by moderate depletion. (h) Dropsy of the cellular tissue. This is not always due to the obstacles offered to the venous circulation, or to the co-existence of a disease of the heart, and albuminuria must be taken into account, in consequence of the frequent occurrence of convulsions when it is present.

2. On Bleeding in the Intercurrent Diseases of Pregnancy. For the bulk of these the treatment differs but little from that which is proper in the non-pregnant condition. As a general rule, prudence in bleeding is advisable; but there are cases in which the greatest energy is alone sufficient, for not only may some of these affections exert an injurious effect upon the progress of gestation, but they themselves may be influenced by the changes incident upon the increase of size of the uterus. Expectation, which would be proper in the unimpregnated condition, may be misplaced here. The superabundance of fluids, or polyæmia, so frequently met with in pregnant women, should also be borne in mind as an additional reason for employing the lancet.

3. On Bleeding in Narrow Pelvis.-The author agrees with M, Depaul, that in certain cases of narrow pelvis it is preferable to seek to diminish the size of the fœtus by rigid diet and bleeding, to resorting to premature labour...

III. On an Epidemic of Measles which prevailed at Abbeville. By M. HECQUET. Speaking of the town of Abbeville (pop. 19,304), M. Hecquet states that it presents the unfortunate peculiarity that for the last fifteen years the number of deaths has been in excess of that of births, the deaths during 1841-55 having amounted to 8171, and the births to 6967. The essay is based upon 205 cases observed during an epidemic at the early part of 1855, the rubeola being characterized by active inflammation of the buccal and other mucous membranes at its onset, irregularity in its course, and the production of great exhaustion of the powers and various accidents at its close.

Incubation.-A careful examination of the instances of the disease observed in the same families enabled the author to fix the period of this with exactness in 74 cases, in which it was found to vary from three to eighteen days. In 12, the first symptoms were observed at the end of three days; in 13, after the fourth day; in 13, after the fifth day; in 9, after the sixth day; in 10, after the seventh day; in 7, after the eighth; in 10, after the ninth day; and in 20 at still later periods.

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Period of Invasion.This varied from twenty-four hours to six days. Among the affections of the mucous membrane accompanying it was a severe form of laryngitis, closely simulating croup in the

sounds it gave rise to. After three or four days the tone was changed, and the cough became loose. In spite of its intensity, there was only 1 case in which any membranous secretion was present. Convulsions were observed in 14 cases, varying in duration from several hours to two days. The treatment of these consisted in favouring the development of the eruption by warm air, and applying rubefacients to the lower extremities, a little ether being given at the same time internally. The author is convinced that the expectant treatment of the initial convulsions of the eruptive fevers, as indicated by Guersaut and Baudelocque, is very preferable to that of a more active character.

The Eruption.-In 11 cases this manifested itself twenty-four hours after the first precursory symptoms; in 82 instances, on the second day; in 77, on the third; in 31, on the fourth; and 4 times on the sixth. In three-fifths of the cases it became developed between eight P.M. and nine A.M.; and in the other two-fifths between nine A.M. and eight P.M. There was no relation observed between the confluent character of the eruption and the development of complications. In more than half the cases the eruption appeared upon the trunk and limbs before the face; in 9 cases no eruption whatever was observed on the face; and in other cases slight and pale traces could only be detected on the chin and around the alæ nasi, although the trunk and limbs might be intensely affected. The appearance of the eruption was never accompanied by a moderation of the fever or other concomitant symptom, the irritation of the air-passages becoming, indeed, more severe and extended. In 9 cases the eruption disappeared on the first day; in 32, on the second; in 98, on the third; and in 66, on the fourth day. In only 17 patients was anything like desquamation observed.

Prognosis.-During the whole epidemic the rubeola pursued a very irregular and insidious course, complications springing up under the most unexpected circumstances; so that even with the most regular commencement of the disease the prognosis required to be most guarded. The gravity of the disease was always found to be inverse to the age of the patient. Between seventeen months and four years death took place in four-sevenths of the patients; between four and eight years, in a little less than one-third; and between eight and fifteen, in one-tenth, no patient older than fifteen dying. It was especially during convalescence, when all danger appeared to have passed away, that caution was especially required.

Predisposing Causes. First, as to age, 93 of the patients were between one and four years old; 76 between four and eight; 25 between eight and fifteen; and 11 between fifteen and twenty-eight. There were 108 males to 97 females. All classes of society furnished their quota; but the mortality was much less considerable in the upper classes-bad and insufficient food, owing to the dearness of bread, having placed the children of the poor in a very unfavourable condition for struggling against the epidemic influence. M. Hecquet observed the meteorological phenomena with great exactitude, but we have not room for his details. One of the results was, that of the

140 cases of pneumonia complicating rubeola, seen by himself and a colleague, the great bulk occurred in March, April, and May, months in that year remarkable for their sudden changes of temperature. Without denying the great part cold plays in the production of pneu← monia, this complication of measles is dependent upon other than mere thermometrical conditions of the air. In this epidemic children were seized with it who were in nowise exposed to cold or to any other anti-hygienic influence. The medical constitution will alone explain the great prevalence of pneumonia on this occasion.

Complications.-1. Pneumonia.-Of the 108 males and 97 females the subjects of rubeola, 43 males and 30 females also suffered from the complication of pneumonia, the females, therefore, showing a somewhat less disposition to contract pneumonia than the males. The pneumonia set in suddenly and rapidly, when the mildness of the symptoms inspired no inquietude, the affection of the air-passages only a few hours before seeming a mere secondary element of no conse quence. Initiatory shivering was only noted in fifteen instances; and the crepitant râle was less distinct and less durable than in ordinary pneumonia, owing partly to the presence of mucous rales, and partly to the rapidity with which the disease ran its course. Sometimes the souffle, which announced its passage into the second stage, was heard at the end of forty-eight hours. In 3 patients the disease terminated fatally between the fourth and sixth days. Of all the symptoms the dyspnoea was the most prominent and the most important. The number of inspirations were carefully noted, and were found to vary between thirty and sixty. This symptom was found to be a valuable one for the prognosis in the cases of children. Of the 73 patients, 22, or a little less than one-third, died. The influence of age upon the mortality is seen from the following figures: between 15 months and 4 years, there were 37 patients, with 21 recoveries and 16 deaths; between 4 and 8 years, 25 patients, 19 recoveries and 6 deaths; between 8 and 15 years, 7 patients, 6 recoveries and 1 death; and between 15 and 28 years, 4 patients and 4 recoveries. The diminu tion of the rapidity of respiration was the only sign of approaching recovery that could be relied on. All others might be present, and yet without this, would prove fallacious.

2. Stomatitis. This complication was observed in the erythematous, ulcero-membranous, and gangrenous forms. Erythematous stomatitis was observed in almost all cases in different degrees, an intense redness of the mucous membrane persisting long after the exanthem had disappeared. In several cases the gums were turgescent, softened, and easily made to bleed. Borax constituted the best application, and when the affection tended to become chronic, tincture of rhatany was employed. Ulcero-membranous stomatitis: In some cases the mucous membrane became more or less deeply ulcerated, pseudomembranous exudations covering deep ulcers, and being soon reproduced when removed. The breath was terribly fetid, though not in the same manner as in gangrene. This form was observed in 27 instances, and in 16 of these it accompanied pneumonia or other com

plications. Of the 27, 9 died during the course of the stomatitis, 8 succumbing to pneumonia, and 1 to enteritis. Of the 18 cases which recovered, in 11 the ulceration, as fast as it healed up in one part spread to another, much prolonging the case; and in the others, in which it was confined to its original seat, from ten to fourteen days elapsed before it was healed. Gangrenous stomatitis: Of the 7 subjects in whom this appeared, it came on during pneumonia in 6, and during gastro-enteritis in 2. In 4 of these, the gangrene was limited to the gums, but in three others spread to the face. Five of the cases proved fatal and 2 recovered. All the children belonged to indigent families, and were exposed to various anti-hygienic influences, especially over-crowding. The details of several of the cases are

furnished by the author.

3. Enteritis. This was observed at different periods of the rubeola and its incidental diseases. It was, indeed, seldom present without other complication. In only 2 out of 26 patients dying as a consequence of the rubeola, could their deaths be attributed solely to enteritis. Intestinal affections, particularly entero-colitis, were chiefly observed appearing towards the end of pneumonia or stomatitis. The diarrhoea, which frequently set in during convalescence, was not of serious moment.

Convalescence. This was always difficult and prolonged, and often disturbed by accidents; and its duration was not always proportionate to the intensity of the disease. Often when the disease had seemed to pursue a favourable and uncomplicated course, accidents would occur when the patient seemed out of all danger. In 18 instances the persistence of the bronchitis delayed convalescence; in 5, abscess of the face or cervical region appeared towards the decline of the disease; and in 4, anasarca, unattended with albuminuria, was developed during the convalescence from pneumonia.

Treatment,-In consequence of the serious nature of the epidemic, every possible means was resorted to in order to preserve children from its influence. In 40 instances, the belladonna treatment was pursued, but only in one of these did the child escape the disease. The author is of opinion that although in benign rubeola expectant treatment is alone called for, that more active procedures are required on the occurrence of serious complications. While treating the phlegmasiæ, attempts were made to reproduce the exanthem, when this had disappeared, by means of rubefacients, but only in two cases were these successful. Bleeding, as a principal means of treating the pneumonia, was not found useful, the cases in which it was employed resisting most; but in robust children, when the pneumonia was very intense, leeches to the malleoli were sometimes of use. Tartar emetic, too often without effect, was sometimes useful, and at others did harm by increasing the tendency to prostration. In 60 cases large doses of the white oxide of antimony were tried, and in 46 of these it seemed to have been of service. Blistering the thorax was also sometimes of use.

IV. On Nervous Vertigo. By M. MAX SIMON.After adverting to the few accounts of this condition given by the older writers from the time of Sydenham, M. Simon observes that there is scarcely a writer of the Paris school, with the exception of Trousseau and Sandras, who acknowledges the existence of vertigo otherwise than as a symptom of some anatomical cerebral lesion. M. Simon adduces his own and other cases in proof of the occurrence of such vertigo independently of cerebral congestion. Considering it, then, as an essential affection, without appreciable lesion of the nervous system, and without the concomitance of other general conditions of the economy which explain its nature, he divides the individuals liable to nervous vertigo into two groups. The first are persons who, the subjects of vertigo, exhibit no dynamic or statical disturbance of either the nervous system or any other of the apparatuses of the economy that can explain its occurrence. This is idiopathic vertigo, properly so called, a pure neurosis. In the second group are placed those cases in which the vertigo takes its origin in the functional disturbance of some other organ than the brain, and consequently becomes mingled with various accidents, from which, however, it is separable by the clearness of its manifestations, its intensity, the frequency of its return and its duration. This is sympathetic vertigo. Of the organs thus acting sympathetically in inducing vertigo, the stomach and genital organs stand foremost. Idiopathic vertigo is observed under different forms and 'degrees of intensity; and the author pursues the subject of sympathetic vertigo at length, as it is met with in dyspepsia, hypochondriasis, venereal excess, spermatorrhoea, the convalescence of disease, and seasickness. The duration of the disease is very various; but the prognosis of purely nervous vertigo is usually not very unfavourable. That a different opinion upon this point prevailed among the older writers arose from their not having distinguished between it and the vertigo which is merely symptomatic of other diseased conditions. · Diagnosis.-M. Simon details the distinctions which exist between nervous vertigo and the vertigo observed in anæmia, which is fre'quently characterized by syncope in addition to the symptoms observed in pure vertigo. The elements of diagnosis are not found in the subjective symptoms of the two conditions, which much resemble each other, but in the objective symptoms furnished by the anemia. In the vertigo of plethora other symptoms are usually present imparting to it particular characters. When in a doubtful case the establishment of a diagnosis becomes urgent, this may be effected by an analysis of the blood, exhibiting the globular element in excess in plethora. The vertigo met with in organic disease of the brain may sometimes be confounded with nervous vertigo, but in most cases there are sufficient accompanying symptoms to distinguish between them.

Treatment-Idiopathic Nervous Vertigo. It is in this form that nervous vertigo is liable to irregular periodical returns, such as are met with in other neuroses; and even when not periodical, it is rare for it not to be attended with more or less prolonged intermissions. During the paroxysm the patient should assume the horizontal position;