can spare to it at present, we have postponed its appearance until our November issue, when we promise our readers a full analysis of one of the ablest works that has yet appeared on this most intricate subject. In the meantime we can only wish success to a society that has inaugurated its career in so auspicious a manner.

Amongst the series of papers now before us, far the most prominent position is allotted to M. Bretonneau's memoirs on Diphtheria-in fact these, five in number, constitute fully one half of the volume, and, taking into consideration the advanced position in reference to this disease occupied by this learned and zealous physician for considerably more than a quarter of a century, we consider that the post of honor has been justly conceded to his deservedly acknowledged supremacy. To our minds a great charm is thrown around this gentleman's writings by the mixture of earnestness, frankness, and simplicity, by which they are characterized; thoroughly imbued with the importance of the views that he advocates, he never for a moment seems to be ashamed to put on record the errors he unintentionally fell into in his search after truth. An air of candor seems to pervade all his writings on the subject, and he appears to have written with but one sole motive in view, the establishment of correct views about this disease, based on the only sure foundation-sound pathological investigation-and on these to raise up a superstructure of rational, and, because rational, successful treatment. As an example of these statements, we shall extract the very first case he has put on record:

"CASE 1.-A child, five years old, healthy, and of good constitution. Coryza, rather severe pain of the ear, which was relieved after the appearance of a serous discharge through the auditory canal. For two days only there had been slight pain in the throat; deglutition was so little affected that the child supped in the evening with its parents, and with its accustomed appetite. The third day the throat appeared to be obstructed, and on examination of the back of the mouth, at 11 o'clock, a. m., large grey spots were seen covering the tonsils, the bases of which were red and swollen. Eight leeches were applied to the sides of the neck, and produced an abundant flow of blood; and kermes mineral was given in emetic and repeated doses. There was a hoarse cough, with alteration of the sound of the voice; in the evening there was aphonia, extreme fetor of the breath, a blackish grey tint of the eschars which extended over the whole surface of the pharynx; frequent and small pulse; dyspnea, lividity, and sinking, which terminated in a peaceful death during the early part of the night."

"It appeared to me very evident that death was caused by gangrene of the back of the mouth; but I asked and obtained permission to make inquiries into the extent and true seat of the disease, which had had so rapid and fatal a termination." "NECROPSY-EXTERNAL APPEARANCE.-Body stout; lividity; tumefaction of the sides of the neck. Internal appearances, observed eight hours after death! The velum palati was of a blackish grey tint, as far as the hight of the palatine arch; the putrid decomposition of the surface of the tonsils appeared still more advanced; the eschars extended from the guttural opening of the nasal fosse as far as the commencement of the oesophagus; they penetrated into the glottis, where they assumed a dull white tint. Their margin was marked by a bright red line. The mucous membrane of the trachea exhibited no trace of inflammation; a small quantity of mucous was accumulated near the bifurcation of the bronchi. This gangrenous alteration, which had extended with so much rapidity, had gained so little in depth,

that the velum palati, divided from before backwards, presented a vermillion section between two grey lines, which were quite superficial. The fetid odor exhaled by the patient had ceased to be perceptible after death."

"It was impossible to make a more imperfect investigation. To what a degree may prejudice blind the judgment! The prepossession in favor of the existence of a grangrenous affection prevailed over evidence. Although no excuse can justify the want of attention in so severe a case, where every thing demanded the most accurate investigation, some circumstances may at least explain the hurried nature of this autopsy, which was made in the middle of the night, in a confined place, and under the eyes of parents, whose sorrow inspired me with the fear that I had already carried my zeal for science too far."

"Doubt was the first result of this case. Indeed, how could gangrene be limited to such slender surfaces, and deviate in this respect from its habitual character? A disposition which was so peculiar to this epidemic affection required a new and especially a more severe investigation. There was reason to fear that the occasion would not be long wanting, for it was observed that the number of those who were dying of Gangrenous Angina was daily increasing. Children were particularly attacked by it, and at this age the disease appeared to be transmitted by contagion."

Another charm about M. Bretonneau's writings is the graphic manner in which his cases are described. The reader is irresistibly interested in their success or failure; his sympathies are all enlisted on behalf of the poor sufferers, and he alternately triumphs or mourns as the result proves fortunate or otherwise. The first case in which M. Bretonneau successfully employed tracheotomy, that of Mademoiselle L. de Puysegur, may be quoted in illustration of this statement; and we should not envy the feelings of that man who would not participate in the feelings that must have throbbed in M. Bretonneau's breast on restoring to the father, already bereaved of three children by this insidious disease, the fourth subject of it, after a prolonged struggle with death, and only saved by the skill, judgment, and dexterity of her medical attendant.

The symptoms of diphtherite are by this time too well known to our readers, and too ably described in the numerous memoirs that, both in this country and abroad, have appeared on the subject, to render it necessary for us to reproduce them here in detail; however, we should not be doing justice to our subject did we not allude to a sign laid down by M. Bretonneau in his fifth memoir, dated 1855, as pathognomonie of Nasal Diphtheria; we shall reproduce here in his own words:

"Under these circumstances, a minute and attentive vigilance is imposed upon us. When the Egyptian disease prevails and is propagated with the intermittent march which characterizes its irregular outbreaks, and when, from one year to another, it has raged so extensively as it has been seen do do in Paris within the last six years, it is incumbent on us not to wait for visible symptoms, but at the least sign of snuffiing, at the slightest indication of coryza, to feel and not to look beyond the angie of the lower jaw, below the lobe of the ear, and thence down the sides of the neck. If in this region we should find any swollen lymphatic glands, our attention should be redoubled, for if we feel a glandular swelling, it is more than probable to be a consequence of the absorption of the Egyptian virus."

"Do not be satisfied with this examination, for it is necessary that the diagnosis should leave no doubt. Examine, therefore, the upper lip below the nostrils: in the most simple coryza the skin is reddened equally under each nostril, while in the case of the Egyptian disease it is only on the side of the glandular swelling. If the swelling exists on both sides, it is unequal; on the side where the swelling is least, the redness of the lip of the same side is least. From the period of this

discovery, we are certain that there is a special affection, in fact the Egyptian disease.

Then let me advise you to act instead of talking, and with a glass syringe, the padded extremity of which ought to be yielding and incapable of causing pain, injeet into the nostrils alternately a solution of nitrate of silver, and although the injection may flow back through the nostril which has not been injected, it will be well that the latter should also receive an injection of suitable strength, if, on the corresponding side, there is the least swelling of the cervical glands."

M. Guersant's memoir is devoted principally to that form of diphtheria represented by croup. He takes very proper objection to the confounding true with false croup, a mistake, we fear, but too prevalent even at the present day; the former, the pseudo-membranous pharingo-laryngitis, a most formidable disease, characterized by the formation of the diphtheritic membrane; the latter, the laryngismus stridulus, never presenting this complication. From his statistics we are entitled to augur favorably for the success of the operation of tracheotomy in this disease, he stating that

"Out of one hundred and seventy-one cases of post mortem examinations in croup, one hundred and fifty exhibited false membranes in the a'r passages, and there were seventy-eight in which these false membranes were confined to the trachea, and only fo ty in which they penetrated to the bronchi. This result is very favorable, as will be perceived, to the success of tracheotomy."

But it is to the memoirs of MM. Trousseau and Bouchut that we are principally to look for important details respecting this operation. The advocates for tracheotomy in croup will derive some additional arguments to strengthen their position from the summary of M. Bouchut:

"Although the success of tracheotomy is not very striking, yet the results are such as ought to encourage.its adoption by a physician placed in charge of an infant half asphyxiated by croup. On the one hand, M. Bretonneau, in twenty operations, saved six children; out of one hundred and sixy, I have saved forty-five. M. Leclerc, of Tours, who has adopted the same treatment, reckons one favorable case in two operations. M. Velpeau has cured two children in ten. M. Petel of Cateau Cambresis, who has followed the same system, has performed successfully three operations out of six which were operated upon. Thus out of one hundred and ninetyeight cases of tracheotomy we reckon fifty-seven cases of success; that is to say, rather more than a fourth."

The principal line of treatment advocated throughout all the memoirs is cauterization, performed either with strong hydrochloric acid (as urged by M. Bretonneau in his earlier memoirs), or with nitrate of silver. Emetics, mercury, and, when symptoms of asphyxia seem imminent, but previous to their development to any great extent, the operation of tracheotomy. Depletion, by the abstraction of blood, objected to by both MM. Trousseau and Bretonneau as being worse than useless, is admitted in exceptional cases by M. Bouchut; and when locally performed by the means of leeches applied in relays, as the urgency of the symptoms demand, is spoken highly of by M. Daviot. M. Bouchut, on the contrary, prefers general blood letting to leeches, stating that, in children, the operation of

venesection is more easily performed than the application of leeches a statement in which we are not inclined to concur. He also alludes to the difficulty of stopping hemorrhage from leech-bites in the neighborhood of the neck-a difficulty which, we think, has been much overrated. It is true that, in the neighborhood of the trachea, you have no point d'appui on which to make pressure, but we always have it in our power to pinch up the leech-bite in a fold of the loose integument, and make pressure on it between our fingers; or, if a more protracted compression become necessary, we can easily extemporize a most effectual instrument, by employing a pair of small spring forceps, to be found in every surgeon's case, to open which it is necessary to press them. Envelop their extremities in a little pad of lint, to prevent their injuring the soft structures in this neighborhood; press the blades; the extremities divaricate; grasp the bleeding leech-bite with them, and allow them again to approximate by simply removing the pressure, and, from practical experience, we can promise our readers that they shall have no more trouble from the leech-bite. Since we have commenced employing this plan we never have had recourse to nitrate of silver, ligature, needle, or any other manœuvre recommended for the arrest of hemorrhage from this

cause.

All forms of moist applications, in the shape of poultices, fomentations, etc., are deprecated as being worse than useless; purgatives also are not in favor; but blisters are especially indicated as being a fertile source of mischief, the blistered surface invariably developing pellicular inflammation, in other words, cutaneous diphtheria, a subject, whether occurring in this manner or as an idiopathic affection, is always to be looked on as most serious, and to which full consideration has been given in more than one of these memoirs.

It remains now for us but to express our opinion as to the manner in which Dr. Semple has discharged the duty of selecting and translating these memoirs. Whilst admitting that those he has selected are of great interest and importance, we think that, on the principal of "audi alteram partem," he would have better consulted the interests of his readers, and at the same time rendered fuller justice to all parties, had he incorporated with the present memoirs some of those by equally distinguished authorities, in which a different line of treatment from that suggested in the present volume has been advocated. We would instance Lemercier, an advocate for active bleeding; Baron, the suggester of the alkaline treatment; Gigot, also a supporter of the alkaline plan of treatment, and an opponent of the use of caustics; Stiles, Heslop, and Haughton, supporters of the plan of treatment by muriated tincture of iron; Hutch

inson and others, suggesters of the employment of chlorate of potash, etc., etc. As to the manner in which he has translated his authors into English, it has been done in such a manner as even to entitle him to the unqualified thanks of the writers themselves, presuming that their knowledge of the English language qualified them to be judges. We never have met with a translation so faithful which has so little the appearance of being one.

The work concludes with a most admirable bibliographical account of the disease, from the date of Bretonneau's first memoir on the subject up to the present year,-an account that bears equal testimony to the extent of his information as to the immense amount of industry and research expended on its preparation by its author, Mr. Chitto.

EPIDEMIOLOGICAL SOCIETY.

Dr. J. B. Sanderson read a paper entitled, "An Account of an Epidemic of Diphtheria."

The epidemic in question occurred in the small rural parish of Hertingfordbury, in Hertfordshire. This parish occupies a somewhat triangular space between the river Lea and its branch, the Mimeran, which unites with it immediately above the town of Hertford. The epidemic was confined to the village of Hertingfordbury, favorably situated on a gravelly slope on the southern bank of the river Mimeran, and to a few small hamlets on the elevated ground between the two rivers, where the slight inclination and the impenetrable nature of the subsoil are alike unfavorable to the removal of surface water. The outbreak commenced at the end of October, 1858, attained its acme early in December, and suddenly ceased towards the end of the year. Fifty-three persons were attacked in a population of 750, of whom 47 were children. There were 14 deaths, all of children under twelve.

1. Characters of the Disease.-Pain in the throat, generally inconsiderable, sometimes severe; either preceded by slight pyrexia or not; coryza occasionally preceding all other symptoms for some days.

Local Changes.-Fauces at first congested: membranous exudation, commencing on one, or both, tonsils, usually within twenty-four hours from onset, spreading continuously to soft palate, uvula, pharynx; forming, when first seen, a white opaque patch, with elevated edges, surrouuded by a narrow border of bright carmine. It is soft and inelastic, and can be easily detached, leaving an intensely congested, bleeding sur