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quietude, looseness of dress, fresh air, and the absence of light being also insisted upon. When the vertigo has arrived at such an extent that the patient loses consciousness, we should also endeavour to assist the passage of the nervous system from the collapse by the employment of aromatic or spirituous frictions, aromatic stimuli, the inspiration of ammonia, &c.; and we may also avail ourselves of any substance which the personal experience of the patient has taught him the advantage of Generally speaking, however, the paroxysms are not so violent; and we have rather by hygienic means to combat the vertiginous habit dependent upon a morbid activity of the encephalon. It is by gentle stimuli, and especially by those remedies termed by the ancients "nervine," or "cephalic," that this habit is to be treated. In this class the author includes infusions of sage, mint, balm, &c., which, supported by the authority of MM. Andral and Trousseau, the author declares are not the inefficient remedies supposed by some. Other authors recommend more active agents, as valerian and assafœtida. In the vertigo of dyspepsia, treatment is often of avail, and Trousseau attaches great importance to counteracting the excess of acid secretion by alkalies. In the vertigo of hypochondriasis, moral and encouraging means must be resorted to, for the patient always regards it as portending apoplexy or sudden death.
V. On the Sudden Death of Puerperal Women. By M. MONDRET. -This prize essay, expanded to a somewhat tedious extent, gives a detailed account of the different forms of functional disturbance observed in pregnancy, which may predispose to disease and death. The various forms of sudden death are then considered, accordingly as they arise from affections of the respiratory, circulatory, or nervous systems.
In the numerous cases he has collected, the author has found that of the affections of the respiratory organs which oftenest give rise to sudden death in puerperal women, pulmonary congestion and apoplexy stand foremost. Amongst those of the circulatory organs, disease of the heart may be very unfavourably influenced during pregnancy, and rupture of this organ takes place more readily. The possibility of the admission of air into the uterine veins after delivery seems to have been demonstrated as one of the causes of sudden death; and although the spontaneous development of aeriform fluid is not so certainly established, it appears to have been so in two eases cited. Although organic affections of the nervous centres are of the gravest import in the puerperal state, and a predisposition is often established to apoplexy, yet these seldom give rise to sudden death in the above acceptation of the term; complications by some affection of the lung or heart usually also existing when death is so produced. Among puerperal diseases, peritonitis sometimes terminates very suddenly, after having passed through its stages in a latent and unsuspected course. Injudicious purgation and excessive tympanites have, too, in some instances been the cause of sudden death. In some of these cases the appearances after death may scarcely seem to explain its occurrence; but we
have to take into account their operation upon the morbid nervous sympathies, and especially upon those of the ganglionary system.
"My last chapter is the most important, as it contains the knot of the problem to be solved; for I have sought in it to determine what are the causes of inorganic origin which may give rise to sudden death in puerperal women. First, we have to observe that death is accompanied by nearly the same symptoms whether a lesion of an organ be present or not; for it is always, in fact, the arrest of one of the three cardinal functions of the economy-respiration, circulation, and innervation. But as these three functions are mutually dependent, and as besides any material lesion, there can be but a dynamic lesion, that is, a lesion of innervation, it is always to this that death must at last be referred in these cases. This must be the case whether the innervation has undergone sideration in its totality, the cause of death operating on the vital principle itself, or whether the innervation of an important organ be alone affected and death produced by the arrest of the function depending upon it. Thus, we may have three kinds of death-nervous apoplexy, nervous syncope, and nervous asphyxia-in which we may find no material cause of death, unless, indeed, this has not been very sudden, for then we may find indications of the condition of suffering under which the function had for a time been carried on. But such signs should not be confounded with those derived from a primary material lesion, and they imply nothing as to the essential cause of death. Moreover, these three causes of death may be combined and separated with difficulty from each other. Nervous apoplexy may sometimes be recognised as existing alone; but it seems impossible to distinguish nervous syncope and asphyxia in all the cases in which they give rise to sudden death. Authors, indeed, have united the two into one affection, under the name of idiopathic asphyxia." (tome xxii. p. 325.)
The author has not met with a case in which death could undoubtedly be said to have resulted from nervous apoplexy alone. This offers indeed the greatest analogy in its symptoms to apoplexy from effusion; and the puerperal state seems equally to predispose to the two affections, so alike in appearance but so different in reality. The term idiopathic asphyxia cannot be said to correspond to a single morbid entity, authors seeming to have designated under the same name different affections, the nature of which is as yet undetermined, which are developed silently, and terminate suddenly and unexpectedly -unexplained by any apparent organic lesion. Flaccidity of the muscles of the heart and emptiness of its cavities are negative characters which may depend upon various causes. Fatty degeneration of the organ can at the utmost be regarded as predisposing to syncope. Admitting death by idiopathic asphyxia, or some affection related to syncope, that this may be expected not infrequently to occur in the puerperal state may be deduced from a consideration of the various anatomical and physiological modifications determined by that condition.
We pass over much of the author's paper, and confine ourselves to reproducing his general conclusions:—
"1. When a woman dies suddenly during the puerperal state, it is highly probable that her death should be referred to that state, whether there did or did not exist an organic affection of a nature to give rise to sudden death. Such affection would then be mischievously influenced, and its termination may have been precipitated. 2. When a woman dies suddenly, a latent organic
affection may have existed prior to pregnancy or have become developed under its influence. In these rather numerous cases an autopsy can alone reveal the true cause of death. 3. The introduction of air into the uterine veins is possible soon after delivery, before contraction has taken place; and this is a material cause of sudden death that may easily be overlooked. The spontaneous development of gas in the blood may be of easier occurrence in the puerperal state; but facts are not yet sufficiently assured to maintain its reality. 4. There is reason to believe that the puerperal state predisposes to the formation of sanguineous concretions in the heart and large vessels. This is a material cause of sudden death which may often be misunderstood. 5. The chloro-anæmic state, frequently met with in pregnant women, seems to predispose them to sudden death. At all events it is a debilitating cause, diminishing vital resistance. 6. All debilitating causes would seem to predispose to the occurrence. It seems to me that this is why sudden death occurs oftener among multiparæ than primipare, and in persons of a lymphatic and nervous constitution than in those who are more robust. 7. All sudden puerperal deaths, inexplicable by an anatomical lesion, seem to be the result of a nervous affection, the point of departure of which may be located in the cerebro-spinal or in the ganglionary system. 8. The pernicious effects upon the pregnant woman of pain, of vivid moral emotions, errors of regimen, &c., are incoutestible. Under all these circumstances the nervous element is powerfully affected; and it is highly probable that we should not seek elsewhere for the cause of inexplicable sudden deaths, which take place in the puerperal state, beyond all prevision, and without any organic lesion." (tome xxii. p. 332.)
VI. On the Yellow Fever. By M. DUTROULAU.-In this memoir M. Dutroulau, a medical officer in the French navy, describes two epidemics which he witnessed at Martinique in 1851, and at Guadaloupe in 1853-6. We confine ourselves to his observations on the treatment of the disease. In his view, the disease consists in a peculiar alteration of the blood, determined by a specific miasm, and passing through two phases entirely opposed to each other; one of these is inflammatory, giving rise to the early series of symptoms of irritation. and vascular congestion; and the other is the stage of decomposition or dyscrasis, indicated by ataxo-adynamic phenomena. In the first period bleeding was resorted to; one or two venæsections, together with numerous leeches, were employed during the first twenty-four hours, warm and aromatized drinks and mustard poultices or foot-baths being used at the same time. Ample evacuations were also induced by purgatives given by the mouth or in clysters. Whenever the yellow fever had been preceded by one or more intermittent paroxysms, or whenever abundant and deceptive sweating masked the true characters of the affection, quinine was exhibited, but it never exerted any effect on the course or ultimate gravity of the disease. Although this antiphlogistic treatment is the rational one to employ in the early stage of the disease, it often failed in its effect or the cases were unsuitable for its application. The author was therefore glad to try the effect of various empirical remedies, which were said to have been of use in former epidemics. From these, however, little or no benefit accrued; and he found the best plan was to modify the antiphlogistic treatment, so as to bring it in harmony with the powers of the patient. When the second stage had set in, the individual symptoms-such as
vomiting, hæmorrhage, cerebral complications-were met as they arose. Whatever these predominant symptoms might be, the ataxoadynamic state which accompanied them was usefully combated with quinine, employed in frictions and lavements. Stimulating drinks were also found useful-such as Madeira diluted with Seltzer water; but musk, camphor, or ammonia, given on account of the typhoid complications, seemed but of slight utility.
The great mortality from yellow fever, whatever mode of treatment may be employed, has led to great attention being paid to the subject of prophylaxis, and in the author's opinion experience has now sufficiently shown, at least the means of arresting an epidemic. The disease never spreads beyond a short distance, either in extent or height, from the shore of an infected spot. It is true that the rigorous determination of such distance has not yet been made; and it is probable that it may vary in different localities. Nevertheless, the magnificent establishment at "Camp Jacob," at Guadaloupe, placed at five and a half kilometres only from the coast, and at an elevation of 550 metres above the surface of the sea, has in no wise disappointed the hopes entertained concerning it during the six years of its existence, and may be regarded as the type of preventive localities in the French Antilles. As soon as an epidemic breaks out, the portion of the garrison and of the European civil population not acclimatised, should be evacuated on such spots, all communication being cut off with the infected locality. Vessels at anchor, too, should, when invaded by the disease, evacuate their crew upon the heights; or, better still, if they can put to sea prior to any accident appearing. To retain a garrison at the seaside, or to set sail for more favourable latitudes, having the disease already on board, will almost certainly expose to irreparable misfortune. Vessels already infected, or coming from infected places, should be sequestrated in healthy spots at a distance from European populations, or the preservative means already indicated should be applied to them.
VII. On the Origin and Development of the Fungus of Muguet (Oidium Albicans). By Dr. GUBLER.-The following are the conclusions with which M. Gubler terminates his memoir:
"1. The concretions of a pultaceous appearance known by the name of muguet are formed by the fungus oidium albicans. 2. Without having recourse to the hypothesis of spontaneous generation, we may admit that the oidium is the product of spores disseminated in the atmosphere, some of which become attached to the entrance of the digestive tube, and there undergo development. 3. As the muguet originates in spores transported through the atmosphere, such spores must be necessarily more abundant where the disease prevails; and the invasion by the cryptogam is more imminent for those inhabiting such localities. 4. Another mode of propagation has been confounded with contagion properly so called. This has been demonstrated by successful experiments, in which the byssoid filaments taken from the mouth of one child, and applied to the healthy mouth of another, have given rise to muguet in the latter. 5. But the spores held in suspension in the atmosphere, or the filaments applied to the mouth, do not necessarily induce muguet, the
development of this microscopic fungus requiring conditions which are only found in certain morbid states. The diseases in which muguet has oftenest been met with are derangements of the digestive organs in young infants; and in the adult, the latter stage of phthisis, typhoid fever, and augina. In all these affectious there is oue common character-viz., a morbid state of the alimentary canal, with a changed condition of the buccal fluids, which from being alkaline have become acid. 6. All leads to the opinion that it is upon this acid reaction that the development of the oidium depends. On the one hand, it is constantly present as long as the cryptogamic vegetation is progressive, or at least stationary; and, on the other, acidity of liquids holding organic matters in solution remarkably favours the production of mould. Finally, clinical practice teaches us that, with the exception of mechanical or caustic agents of destruction, there is no better means of ensuring its radical dispersion than the employment of alkalies. 7. The spores of oidium, then, meeting with an acid medium, germinate rapidly in a soil congenial to them. Their filaments become developed, either among the masses of epithelial cells in a state of desquamation, mingled with concretions of altered mucus or parcels of food, or in the intervals left between the raised epithelium and the mucous dermis, or, again, in the glandular cavities. The fungus lives exclusively at the expense of this humus, and does not penetrate into the interstices of the tissues, nor abstract anything from the circulatory juices. It is then a false parasite. 8. The production of muguet is, then, a simple accident, an epiphenomenon observed in the course of affections varying both as to their nature and their gravity. 10. It may, however, constitute a complication, inasmuch as by obstructing the glandular ducts, by lining the mucous surfaces with a thick and continuous layer capable of impeding sucking and deglutition, by keeping up the acid fermentation of the products of secretion, and by irritating the surfaces to which it has become attached, it may for a period prevent a return to the normal condition. 11. From these propositions we may deduce some therapeutical consequences. In the first place, we must remove healthy children from the vicinity of, and especially from contact with, the subjects of muguet. When it has become developed, it must be mechanically removed from the parts to which it has become attached, the parts being well washed with strong alkaline lotion. Where there is no contra-indication, Vichy water may also be given internally." (tome xxii., pp. 460-2).
VIII. Observations on the Toxicological Search for Arsenic. By M. BLONDLOT. The author is of opinion that by the process employed by most toxicologists for the destruction of organic matters by sulphuric acid, a more or less considerable portion of the arsenic is lost, to the risk, when the tissues only contain traces of the poison, of missing it altogether. His attention was drawn to the subject by observing, during post-mortem examinations after poisoning by arsenic, portions of this substance in the stomach converted into a beautiful yellow colour by the sulphuretted hydrogen engendered by putrefaction; and he came to the conclusion that arsenious acid dissolved and disseminated in the parenchymata may, under the influence of putrefaction, be converted into an insoluble sulphuret, which MM. Danger and Flandin's method is powerless to detect, inasmuch as in the process of carbonisation by sulphuric acid the sulphuret undergoes no change, and remains as insoluble as before. Moreover, carbonisation by sulphuric acid also gives rise to the formation of a certain amount