the temperature of the body for a month or more are tuberculosis, rheumatism, ague, abscesses, suppuration (such as occurs in empyema, large, open psoas abscesses, &c.), and certain forms of chronic induration of the lung with ulceration of the bronchi and the formation of cavities. With the exception of tuberculosis, all these diseases are accompanied by such characteristic symptoms that we usually have no difficulty in forming a correct diagnosis. The chronic induration of the lungs alone closely simulates tuberculosis, and we hope to soon be able to show that by means of the temperature this disease can be correctly diagnosticated and distinguished from tubercular disease of the lungs. Tuberculosis of the lungs or other organs of the body may exist, as we know, without any physical signs being present, while the rational symptoms may be very slight and insufficient for a correct diagnosis. If, then, we have a daily elevation of the temperature for more than a month, and this be not due to the diseases noted above as of easy diagnosis, we are justified in considering such elevation to be due to a tubercular deposit in the body.

In connection with the above remarks, which are a brief abstract only of the paper in the Medical Times and Gazette, the propositions laid down by Dr. Ringer, in his recent work on this subject, and which has not yet been republished in this country, may be of interest to our readers.

1. There is probably a continued elevation of the body in all cases in which a deposition of tubercle is taking place in any of its organs.

2. This elevation of temperature is probably due either to the general condition of the body (tuberculosis) or to the deposition of tubercle in its various organs (tuberculization).

3. This elevation is probably due to the general condition (tuberculosis) rather than to the deposition of the tubercle (tuberculization).

4. The temperature may be taken as a measure of the amount of the tuberculosis and tuberculization, and any fluctuations in the temperature indicate corresponding fluctuations in the severity of the disease.

5. The temperature is a more accurate indication of the amount of tuberculosis and tuberculization than either the physical signs or the symptoms. 6. By means of the temperature we can diagnosticate tuberculosis and tuberculization long before the physical signs and symptoms are sufficient to justify such a diagnosis.

7. By means of the temperature we can diagnosticate tuberculosis even when during the whole course of the disease there are no physical signs indicative of tubercular deposit in any of the organs of the body, and in which cases the symptoms (apart from the temperature) are inadequate to enable us to arrive at such a diagnosis.

8. It is probable that by means of the temperature we can conclude that the deposition of tubercle has ceased, and that any physical signs that are present are due to obsolescent tubercle and the chronic thickening of lung tissue between the tubercular deposit.

9. It is probable, though further observations on this point are necessary, that the temperature of the body affords a means by which we can diagnosticate between diseases in which the symptoms and physical signs are either too scanty or too much alike to enable us to decide between them.

SUMMARY.-Observations on the Present Epidemic of Typhus Fever. By ROBERT PERRY, M.D. (The Glasgow Medical Journal, January, 1866.)

Dr. Perry here gives an interesting paper which he read before the Glasgow Medical Society in December, 1865. The whole article is replete with important observations and contains statistical tables of great value. Its length precludes any thing more than an allusion to the results of his treatment. To the use of the mineral acids so strongly recommended by Dr. Murchison and others, Dr. Perry attaches very little value. The results obtained from the employment of permanganate of potash were so unsatisfactory as to lead to a discontinuance of the remedy after its careful trial in a few cases. The use of the sulphites and hypo-sulphites, as first recommended by Polli, of Milan, met with but little better success, and Dr. P. is convinced that in all the cases in which he tried this remedy no amelioration of the disease was produced. Alcoholic stimulants he never uses as a routine treatment, nor is he guided in their use by the age of the patient; but judges each case by its particular requirements, and administers or withholds alcoholic stimulants accordingly. The conclusions which he arrives at on this point are almost identical with those so forcibly enunciated by Dr. Gairdner, of Glasgow, in his "Facts and Conclusions as to the Use of Alcoholic Stimulants in Typhus Fever."

Clinical Inquiries into the Influence of the Nervous System on the Production and Prevention of Dropsies and on the Means and Methods of Successful Treatment. By THOMAS LAYCOCK, M.D., Professor, etc., University of Edinburgh. (Edinburgh Medical Journal, March and April, 1866. Following up a series of investigations which he began a few years since, and the results of which have already been given to the profession, Dr. Laycock here enunciates his views on the pathology of certain classes of dropsies, which are quite at variance with the hitherto generally accepted ideas on the subject, and, indeed, with the exception of Virchow, scarcely entertained by any of our modern pathologists. He analyzes carefully a number of cases in point, and submits the following propositions:

1. That the nervous system, as a whole, or else some special division of it, has a direct influence both on the production and prevention of anasarca. 2. That anasarca is produced when innervation is defective. 3. That anasarca is prevented being manifested locally when the general causes are in operation, by more vigorous because more healthy innervation of the exempted tissues. 4. That centric disease or disorder may have the double effect of facilitating the effusion in one lateral portion of the body and preventing it in the other lateral portion. 5. That production or prevention alike follow upon changes in the innervation, which are induced in the same way and according to the same laws as other neuroses; and finally, 6. That it is not the sensory, motor, or vaso-motor systems which are specially involved.

The Action of Fungi in the Production of Disease. By TILBURY FOX, M.D. (Edinburgh Medical Journal, April, 1866.)

A paper of interest in connection with the investigations of Dr. Salisbury, of Ohio, as related in the American Journal of Medical Sciences, 1865, and January, 1866.

On Rupture of the Heart. By A. DUNLOP, M.D. (Edinburgh Medical Journal, May, 1866.)

Dr. Dunlop here gives an analysis of twenty-nine collected cases of this affection, from which it would seem, 1st. That fatty degeneration is the most common cause of spontaneous rupture of the heart. 2d. That death is, in the majority of cases, instantaneous. 3d. That in those cases where the patient has not died suddenly the symptoms have generally been oppression of the breathing and more or less severe pain in the chest, frequently of a paroxysmal character. 4th. That most of the deaths took place between the ages of seventy and eighty; and, 5th. That most of the patients have been females.

In speaking of the usual seat of the lesion, he remarks: "Bouillaud says that there are six ruptures of the left side of the heart to four of the right. Rokitansky states that the laceration is most commonly found in the left ventricle; that it is almost invariably in its convex or anterior wall, and generally near its middle, and close to the septum. Mr. Bayle, in the Lancet for September, 1824, states that out of nineteen cases which he had collected, the left ventricle was ruptured in fourteen, and generally on its anterior surface; the right ventricle was ruptured in three instances; in one case perforation took place at the apex, and in another the septum ventriculorum was ruptured. Laennec was of opinion that rupture occurs most frequently in the wall of the left ventricle, and that it rarely takes place at the apex. Out of fifty-two cases collected by Gluge, the left ventricle was the seat of the lesion in thirty-seven, the right ventricle in eight, the left auricle in three, the right auricle in two. Out of nine cases, mentioned by Dr. Aitken in his Practice of Physic, rupture occurred in the left ventricle in five; in three of these the laceration was across or along the anterior wall, and in the other two at the apex or in the posterior wall."

Two cases of rupture of the heart have recently occurred at St. George's Hospital, London, under the care of Dr. Barclay and Dr. Page. They are reported in the Lancet of July 21, 1866. The simultaneous occurrence of two cases of ruptured heart at the same hospital is a somewhat curious coincidence. In both these cases there was evident fatty degeneration of the muscular structure. It is worthy of note, too, that in both these instances the rupture was of the right ventricle and was multiple. Multiple rupture of the heart is rare. Ollivier states that it occurred in only eight of the forty-eight cases which he collected. Dr. Dunlop, in the article above noted, gives several cases from different sources.

On Prognosis in Heart Disease. By W. H. BROADBENT, M.D. (British Medical Journal, June 9, 1865.)

On Mixed Types of Fever, in Relation to the Identity or Non-Identity of the Typhus and Typhoid Poisons. By HENRY KENNEDY, M.B. (Medical Press and Circular, June 20, 1866.)

Dr. Kennedy stoutly maintains that the poison of typhus is capable of engendering not only its own specific type of fever, but also that known as typhoid or enteric, as well as other types, such as nervous, gastric, cerebral,

etc. He has previously published a large number of cases in the Dublin Quarterly, substantiating these views, and now brings forward an additional series of cases in proof of his position.

II. OBSTETRICS AND DISEASES OF WOMEN.

1. Forty Cases of Artificial Premature Labor. (British and Foreign MedicoChirurgical Review, Jan., 1866.)

Dr. Robert Barnes, in commenting on these cases, says that Kiwisch's method is so uncertain as to time, and moreover so disastrous in its results in many cases, that it ought henceforth to be abandoned. Krause's method on the whole appears the more certain and safe in ordinary use.

Dr. Simon Thomas, of Leyden, relates forty cases in which labor was artificially induced. The indications were chiefly contractions of the pelvis; and these were determined less by the histories of previous labors than by accurate measurements expressly made. Thus, in five cases, the patients were primiparæ. The first method employed was to place a bougie for a short time a a few inches between the uterus and membranes, changing it every day for a larger one. Labor only came on in ten days, and the forceps was used. In another case, Kiwisch's douche was used. Labor followed in five days. The mother died of pyæmia. In other cases the bougie was used, or the douche; generally days elapsed before labor. Afterwards Krause's method, the leaving an elastic catheter in the uterus, was used. The time expended was from six to ninety-two hours, the majority taking from twenty-four to forty-eight hours. Of the 32 children born after Krause's method, 25 lived; of the 32 mothers, 25 had a quite natural puerperal history; 4 died of pyæmia or endometritis.

2. Double Uterus and Vagina. (Idem, Jan., 1866. )

A healthy woman, aged twenty, was admitted in May, 1865, into the Town Hospital of Dresden, for blennorrhoea and excoriations of the vulva. She had menstruated since sixteen. The external genitals were normal, but the hymen was wanting. The vagina was double, the lower end of each half being provided with a hymen-like fold of mucous membrane. In the summit of each vagina was a small, firm vaginal portion of uterus, each possessing a small transverse os. The uterine sound passed freely into the left os uteri, but only slightly into the right, so that it remained doubtful whether the body of the uterus had two distinct cavities.

The British Medical Journal, of Feb. 10, 1866, gives, from the Wiener Medizin. Wochenschr., another case of this unusual malformation, viz.:

At a meeting of the Medical Society in Vienna, Dr. Späth related the following case, which had recently come under his notice. A girl aged 13, primipara, was admitted into hospital. On examination, there was found to be a double os uteri, and the existence of a bilocular uterus was therefore suspected. After the first labor-pains had set in, the patient was seized with convulsions, which recurred, and ended fatally, in spite of the hypodermic injections of acetate of morphia. During life, it was found that both orifices were dilated, and gave the sensation of an os uteri divided by a band; this VOL. III.-No. 18. 30

was divided by scissors, and the child was discovered presenting transversely. After death, the uterus was found to consist of two cavities, of which the right was somewhat larger than the left. In the septum was an opening, which, Drs. Rokitansky and Späth believed, had been formed during pregnancy. A corpus luteum was found in the left ovary.

Another interesting case of this malformation is given by Dr. A. B. Hoyt, in the Boston Medical and Surgical Journal for October 26, 1865.

The subject of it, aged 57 years, died of a cancerous tumor occupying the left iliac region. She has always been healthy until this disease made its appearance. She had given birth to three children; her labors were always severe-the last one unusually so; this occurred twenty years before her death. Her husband, during the patient's life, was ignorant of the fact that any unnatural condition existed. At the autopsy it was found that there were two vaginæ, about equal in size, the left one perhaps a little the largest, and similar as to walls, rugæ, etc. They extended from just within the vulva to the uterus, and were separated by an interval filled with compact cellular tissue. Close to the uterus the vagine communicated with each other through an opening of about one-fourth of an inch in diameter. From each vagina a probe passed into a separate uterine cavity. The os uteri in each vagina was small and imperfectly developed, as also was its orifice. The organ, as thus composed, was hardly larger than the normal uterus, but about one and a half inches from the os it bifurcated into two symmetrical cornua, as large round as the forefinger, and about one and a half inches long; these terminated in the Fallopian tubes, which, with the ovaries and broad ligament, were natural. There was but one ovary to each cornu. The cornua were covered with peritoneum, except where the two layers of the broad ligament separated, and it also covered what might be called the fundus of the compound portion of the uterus. There was nothing to indicate that one side of the uterus had been impregnated and not the other, unless it was the greater capacity of the left vagina.

3. Apparent Vicarious Menstruation. (British and Foreign Medico-Chirurgical Review, January, 1866.)

The subject of Mr. d'Andrade's case was a stout, healthy Parsee lady, aged eighteen. She had menstruated regularly from thirteen to fifteen and a half, when catamenia became first irregular, then ceased, being replaced by bleeding at the gums and nose, and vomiting of blood. Menstruation returned; no pregnancy. Mr. d'Andrade observed blood to ooze from the healthy skin of the left breast and of the right forearm. The blood exuded showed red and white globules under the microscope. The skin-hemorrhage recurred every month or two. Subsequently blood oozed from the forehead.

4. Retained Catamenia from Imperforate Hymen. (Boston Medical and Surgical Journal, June 21, 1866.)

Dr. H. C. Robbins, of Dement, Ill., describes the case of a young miss, æt. 15, who had never menstruated, but presented at intervals evidences of a mens' nal molimen taking place without show. A catharto-emenagogne treatment was adopted, but without avail. A vaginal examination was then re