ing delayed this too long. The precise moment when we should cease to place any reliance on bleeding, antimony, fomentations, &c. is not, certainly, so easily determined, as in the case of occlusion; but, much more danger is to be apprehended, from the too long delay, than from the too early resort to the operation. Dilatation with the finger cannot be performed with the same impunity, as where there has been no structural or local malady producing the rigidity; and the case is in no-wise analogous to that in which we dilate a healthy os, for the arrest of hæmorrhage. "Where the cervix is rigid, contracted, and diseased, and the os so small as scarcely to be recognised, powerful, and long-continued, artificial dilatation must be a dangerous remedy. It is scarcely to be expected that it should relax the parts, and lead to dilatation; it is much more likely that it should irritate, and thus induce inflammation, gangrene, and death."

Incision, even, is not always so simple a matter as it would seem at first.

"The simplest, perhaps, of the examples of rigid os uteri, is where a very contracted orifice is surrounded by a structure almost entirely undilatable. In such a case, although there may be little indication of organic change, still, if there be a total absence of the power of dilatation after the use of free venesection and antimony-time having been allowed for their beneficial effects-such a case cannot be trusted long with safety, either to the natural efforts or artificial dilatation. Other examples are not so simple as this. Many, probably the majority, are the consequence of some previous morbid occurrence. The os and cervix may have been injured in a former labour; abscesses, ulcerated surfaces, and cicatrizations may have taken place; thus, the uterine orifice may have become nearly, if not entirely, closed; and the relative situation of the bladder, urethra, and vagina, so altered, as to render the division of parts much more hazardous and difficult; or it may be, that a hard tumor, or a more malignant and active deposit, has imbedded itself in these parts, totally altering the os and the natural structure of the cervix." 452.

We have, however, no choice. Artificial dilatation is inefficient, or, if powerful, dangerous; delay is death. Incision, when performed in proper time, is safe and effective, and causes very little pain. In one of the cases detailed, the patient submitted, with good effect to the operation, in four successive pregnancies.

"The safety of incision consists in its preventing unlimited and extensive laceration. So long as division by the knife, and the subsequent tearing of the parts, is confined to the os and cervix, and does not extend beyond the reflection of the mucous surface of the vagina over these parts, recovery is almost certain; whereas, if the parts be left to rupture of themselves, the body and fundus of the uterus, and their peritoneal investment, are pretty sure to be implicated, and the result will then most probably be fatal." 468.

In concluding a careful analysis of this volume, we must express the great satisfaction we have derived from its perusal; and urge its purchase upon those who wish to be in possession of a really valuable work. Each division of the subject is illustrated by a well chosen selection of cases, which being printed in a smaller type, while they much increase the value of the work, do not proportionally augment its size or price. Works of

any magnitude, are much better issued in parts, their purchase being thus rendered more convenient; but both authors and publishers should make it a point of honour, as they would find it one of profit, that these should appear punctually at the periods promised. The paging of the present work being continuous, the three parts may be bound in one volume.

MEDICAL HISTORY OF THE EXPEDITION To the Niger, during THE YEARS 1841-2. COMPRISING AN ACCOUNT OF THE FEVER WHICH LED TO ITS ABRUPT TERMINATION. By James Ormiston M'William, M.D. Surgeon of the Albert, &c. 8vo. pp. 287. Churchill, 1843.

WHO has not heard of the ill-fated expedition to the Niger? It is curious that deaths and disasters, on a small scale, make a more vivid and distinct impression on our minds, and excite more acutely our sympathies, than wholesale slaughters and the destruction of whole fleets and armies. The shipwreck and sufferings of Byron and his little crew will be read and remembered, when the battle of Borrodino-perhaps even of Waterloo, will be forgotten! We can form a distinct idea of the personal misfortunes, privations, and hardships of an individual, or of a boats' crew-but the destruction of Napoleon's army, in the retreat from Moscow, overwhelms us with astonishment, and leaves no accurate picture on the mind's eye. On the other hand, we can easily conceive a dozen men groaning in fever, under a tropical sun, and between the decks of a small vessel, while one solitary man is left for duty-and he steering the vessel and attending to the engine without the assistance of a single hand!

The medical portion of the volume-the account of the fever—is a very small one-and we dare not indulge in giving much of the mere nautical narrative, which, though interesting to the public at large, is not adapted for a medical journal.

Every one knows that the extinction of the slave-trade was the benevolent purpose for which this unfortunate expedition was projected, besides the still greater object-the spread of Christianity among the natives of Africa. Three steam-vessels, the Albert, the Wilberforce, and Soudan, were fitted out with every possible attention to the health, the comfort, we had almost said, the luxury of the officers and crews. Divines, Medici, Geologists, Mineralogists, Botanists, Astronomers, &c. were liberally supplied-as well as a profusion of medical stores and culinary preparations. The crews of the three vessels consisted of 178 men, of which there were 53 officers, inclusive of civilians and engineers-67 white, and 28 coloured seamen. We must pass over the voyage outwards, as it does not present anything particularly interesting. The expedition entered the Mouth of the Niger on the 13th of August 1841, and two days afterwards, a German died of fever, with delirium and tremors, but not supposed to be of an endemic character. A considerable part of the narrative is occupied with

the nautical difficulties attendant on the ascent of the river, and with descriptive sketches of the topography and population on both banks of that pestilential stream. These we must pass over. They had passed the great Delta of the Niger, and were preparing to explore the valley of that river, without any symptoms of illness, when, on the 4th of September (1841), a fever of the most malignant nature broke out in the Albert, and almost simultaneously in the other vessels-not abating till the whole expedition was entirely paralyzed! Between the 12th and 17th of September, the sickness still increasing, the model farm was established at Stirling Hill, and it was now evident that some decisive step must be taken. One vessel, therefore, the Soudan, was selected to descend to the open sea, and on to Fernando Po, with all the sick. She did so on the 19th September-but it was soon found necessary to despatch the Wilberforce in the same direction, leaving the Albert to prosecute the voyage farther up the river.

The settlement of the now famous MODEL FARM, at the confluence of the Niger and Tchadda rivers, includes a tract of land 16 miles by 5 in extent. Stirling Hill is two hundred feet above the level of the river, and near it rises Mount PATTEH, to the height of 1160 feet.

Having located the settlers, the Albert, sadly reduced in the number of her officers and men, but full of hope, started on her ascent of the river, with the view of reaching Rabba; but on the third day, (22nd Sept.) three officers, including the captain, were laid up with the fever-and three others, in the course of the evening, were added to the list. By the 3rd of October, there were only one white seaman, one sergeant and one private marine-Dr. Stanger, Mr. Willie, Mr. Huxley, and Dr. M'William, himself, capable of doing duty!! The season was advancing, the river beginning to fall, and, under such circumstances, it would have been sheer madness to attempt a further prosecution of the expedition. On the 4th of October, therefore, the Albert weighed, and began to drop down the fatal river. Dr. Stanger undertook to manage the engine, while our author was necessitated to work the ship, in addition to his professional duties. In steaming downwards, they touched at Stirling Hill, and found the white part of the new settlers in a sad plight. They therefore reembarked all but the blacks, and continued their course towards the longwished ocean. On the 16th October they fell in with the Soudan, at the entrance of the river, and both vessels proceeded to sea, bound for Fernando Po.

From this time, the expedition may have been considered at an end, though many of the officers and men fell victims after their departure from the pestiferous stream.

VITAL STATISTICS.

Of the total number of whites in the squadron, viz. 145, there were no less than 130 cases of fever, and 40 deaths! There were 158 blacks, of which none died, though eleven had fever. This speaks for itself.

THE FEVER.

There was little uniformity in the premonitory symptoms. A number of the patients had head-aches-scintillations along the spine-and chilliness, preceding the attack-others complained of debility, and some of burning sensation in the epigastrium. Then came giddiness, lassitude, tremor, foul tongue, small quick pulse, and general oppression. The eyes looked heavy-the pupils sluggish.

He

"Character, course and duration of the symptoms.-The accession was seldom accompanied by very marked shivering, yet previous to the period of vascular excitement, the patient usually experienced a sensation of coldness, and for the sake of warmth would fain have exposed himself to the rays of the sun. would shortly express a wish to lie down, and would complain somewhat suddenly of increase of headach or giddiness, and intense heat of the skin, which had a dry parched feel, restlessness, intolerable nausea, and difficult breathing. The dyspnea in several instances, particularly in my own case, was extremely distressing, and continued from one to four hours, until relieved by spontaneous vomiting, or the occurrence of diaphoresis. Headach was with some the prominent symptom during the hot stage, and the feeling was described as that of a cord being tightly girded round the temples. The thirst was very urgent: the tongue was foul in the centre, moist, clean or reddish, and invariably marked by indentations on the edges. The countenance was more or less flushed, the eye occasionally suffused and always looked wild. Pulse rapid but small, frequently feeble; thirst urgent, bowels constipated, and urine passed often and in small quantity. There was in general tenderness of the epigastrium, sometimes acute, but often not discoverable unless upon pressure.

"In some cases, coldness of the stomach was complained of some days before death. A subsidence of febrile action in general followed in from three to six hours, or at all events, the symptoms if continued beyond the latter period became much mitigated. Diaphoresis came on, the thirst moderated, and the signs of oppression in a great measure disappeared. The principal complaint at this period was from the disagreeable odour of the perspiration, particularly in those cases that subsequently proved fatal. I was not sensible of this peculiarity in the smell of the perspiration in my own case, but I perceived it very distinctly in several others. The sweating continued until from eight to twelve hours had been occupied by the whole paroxysm. The patient, although considerably exhausted, expressed himself as free from all trouble, and the countenance also indicated improvement. This seemingly favourable change did not last long, for the accession generally returned in from six to ten or twelve hours. Occasionally the respite extended to twenty-four hours. In a few cases, there was a treacherous interval of forty-eight hours, in the early period of the disease; but these invariably assumed afterwards a low malignant type. The fever in them seemed to have rested only to give strength for a fresh accession.

"The accessions did not seem to observe any law of periodicity. They came on, disappeared, and returned at all hours of the day and night. The evening, however, was a more common time of accession than any other; in which case, after the cold sensation had passed off, the paroxysm generally ran through its stages in the course of the night, and had suffered a considerable remission by the hour of breakfast (eight) the next morning.

"In a few instances the remissions were as complete as in the interval of ague. These were, however, only exceptions to the general rule, for total absence of fever was indeed of rare occurrence during the course of the disease." 134.

If no material improvement took place by the 8th or ninth day, the

prognosis was gloomy-the fever then assuming a low asthenic form. Local pain was seldom complained of-and, in several cases, the patients never made any complaint at all!

In favourable terminations, the remissions became more distinct, and the intervals more marked and lengthened-the countenance assuming a more natural expression-the skin more moist-the thirst diminished-and the pulse softer. At this period, diarrhoea was by no means uncommon-and also a copious diuresis, with a desire for food. Of the contingent symptoms the most prominent were delirium, yellowness of skin, and convulsions of various parts of the body. In no case was there "black vomit.”

PATHOLOGY.

The following were the appearances in eight cases examined on board the Albert.

"Head.—In two cases where the head was examined, softening was found in the corpus callosum and walls of the ventricles. In one case there was a small quantity of serous fluid in the base of the brain, and an unusual proportion in the ventricles. The dura mater was always sound. The pia mater in one case red and injected. No subarachnoid effusion was observed.

"Thorax.-The contents of the thorax were in nearly all cases healthy in appearance. Adhesions between the costal and pulmonary pleuræ were found in one instance, with tubercular deposits in the lungs in the state of induration. In another, a cartilaginous state of the tricuspid valves, with serous effusion in the left pleural sac.

"Abdomen. The peritoneum and its processes, as well as the surface of the intestinal tube, had in general a bilious tinge.

"The Stomach.-In several cases the stomach contained from one to five ounces of yellowish-green fluid. The mucous coat was invariably softened, whether this fluid were present or not. In three cases livid patches were variously distributed over the inner surface of the stomach, becoming more distinct when the mucous tunic was scraped off, exhibiting stelliform nuclei in their centres. In two cases, the livid marks were arranged in the form of parallel streaks. These pathological appearances were chiefly in the splenic extremity of the stomach and near the pylorus. In one case there was remarkable venous arborescence on the exterior of the stomach, attended with general engorgement of the portal system. Small points of ulceration were observed in three cases, and slight thickening of the mucous lining in one instance only.

"Duodenum.-The lesions observed in the duodenum were of the same nature as those in the stomach, but much less marked. In one case the lower portion of this gut contained a yellowish secretion, of the consistence of mucus.

"The Jejunum was free from disease, and likewise the ileum, until within three feet of its lower end, where were observed, softening of the mucous lining generally and livid spots. A series of small ulcerations were seen in four cases. In one, the membrane was thickened, rough, and the ulcerations had nearly perforated the bowel; this case proved fatal by terminating in dysentery. The agminated glands of Peyer were distinct and enlarged in three cases.

"Colon. The colon was usually nearly empty. On these occasions a dark, bilious, pultaceous matter was found in this portion of the tube, but in small quantity only it was viscid and tenacious, adhering to the mucous tunic: where lividity or ulcerated points were found at the lower end of the ileum, the same lesions were seen to exist on the arch of the colon. Softening of the mucous coat was remarkable in three cases. In that of the case of dysentery already men