tioned, there was softening of the tunic where it was not ulcerated, and induration and elevation round the edges of the ulcerated patches.

“Liver.—The liver was congested in one instance; larger than usual in two cases. It was anemious in two cases where the patients died early, and on two other occasions when death took place long subsequent to febrile action. In the latter cases this organ was of a pale gray colour, and had a dry appearance on being sliced. This condition was not confined to one lobe.

"Gall-bladder.—The gall-bladder was distended with bile of the colour and consistence of tar in three cases: one of which was fatal on the third, one on the seventh, and the other on the ninth day. In another instance the gall-bladder was nearly filled with bloody bile. The man in this case died suddenly, many weeks after the fever had left him.

"The enlarged condition of Peyer's glands, which is regarded by Chomel and Louis as constant in the typhoid fever of France, occurred in three cases out of eight that were examined. In four cases, the subjects of which with one exception died early, slight ulcerations of the gastro-enteric mucous membrane were observed. This fact is worthy of attention, inasmuch as it would seem to imply that the cause of the river fever, in whichever way it is introduced into the system, induces an unhealthy action in mucous surfaces much more rapidly than even the low typhoid fevers of France. Chomel does not consider that ulcerations take place in typhoid fevers earlier than the twentieth day, when there is, also, softening of the mucous membrane around the follicles, or in that part of it which covers them. Louis found the patches of Peyer natural in twenty autopsies, made by himself, of yellow-fever cases at Gibraltar, during the epidemic of 1828.

66

Spleen. In one case the spleen was enlarged, soft, and breaking down under the fingers; in another enlarged, gorged with blood, but firm. This viscus was not altered from the normal condition in the other cases examined. The pancreas was not in any case otherwise than natural. The kidneys were mottled and larger than usual on one occasion. The bladder was in general collapsed. A case in which bloody urine was voided was not inspected.

"The morbid appearances observed in the intestines are very like those so often found in fatal cases of the typhoid fever of this country. This is not the place to recapitulate the evidence opposed to the doctrines of Broussais, regarding the nature of fever; but every day's experience tends to prove that the ulcerations and other lesions of the bowels are a specific effect of the fever poison, and not the cause of the fever itself." 147.

Morbid changes of this kind were found in the intestines in all cases— but none of these changes were constant-and therefore not essential to the fever. In two cases the blood was found in a fluid state after death.

The main sequence of the African fever was an irratibility of the mucous membrane of the bowels, continuing for a long time after the fever disappeared, and, no doubt, dependent on lesions contracted during the fever. This intestinal irritability occasionally rises into enteritis, and is then, too often, fatal.

Hepatic disease not unfrequently followed the gastro-enteric affection, either by sympathy, contiguity or extension.

CAUSES.

The author has not been able to make any additions to what has long been known, or rather conjectured, respecting the etiology of remittent and intermittent fevers. That a certain something-the nature of which we know not—is emitted from marshy localities—is acknowledged by all,

as causing miasmal fevers, &c-and that is the sum total of our knowledge!! The banks of the Niger offered no exception.

In respect to the latent period of the poison, our author remarks as follows:

"When it is considered, as has been already noticed, that the vessels were constantly exposed to endemic influence, while they remained in the Niger, it is impossible to say at what time the miasmatous poison was first inhaled: but I hardly think that it was imbibed by any individual before we left the mouth of the river if this were so, then fever may be said to have ensued on the sixteenth day from the period of its earliest imbibition. Quarter-masters, seamen, and marines, whose duties were chiefly on deck, stokers in the engine-room, cooks, and in short, men of various occupations and constitutionally dissimilar, were simultaneously affected with fever.

"Upon the whole, I am inclined to think that in those cases which appeared at Iddah, the germs of the disease were contracted in the Delta. The stagnant state of the atmosphere, (relieved by occasional tornadoes,) and the causes of malaric exhalation being still abundant, and accumulated in the lower part of the atmosphere, from the want of a wholesome agitation, were favorable in its development at Iddah. Up to this point, the south-west breeze had always been felt during part of the twenty-four hours. The miasma in this state of condensation, so to speak, acted energetically upon men whose vital powers were already enfeebled, and who may have been for some time insensiby under its insidious influence.

"Moral causes came also into operation after leaving Iddah: many of those who were well were dispirited, and not a few, when taken ill, became speedily despondent.

"When out of the whole expedition there were only fifteen whites that were not attacked with fever in the Niger, it is scarcely possible to offer any opinion as to how far the susceptibility to this treacherous disease was influenced by temperament or idiosyncracy. Of the blacks, consisting of natives of various parts of Africa, including Kroomen, Americans, West Indians of African origin and East Indians, to the number of 158, eleven only were affected by the fever in the river: they (the eleven) had all been in England, and for some years absent from their respective countries. The disease in them assumed a comparatively mild form, and in no case did it prove fatal; showing that the immunity from endemic disease in warm countries, which is enjoyed by the dark races, is to a certain extent destroyed by a temporary residence in another climate.

"The question as to whether contagion contributed to the spread of the disease on board of the ships may, in my opinion, be briefly disposed of. All were exposed to the same influences; and nearly all were attacked with fever. Two only of the four medical officers who died had been in attendance on fever patients. Dr. Pritchett, Mr. Thomson, Mr. Stirling and Dr. Stanger were among the few who escaped being seized with fever, although they were in constant intercourse with the sick; and I was the last person in the Albert laid down with fever. The nurses on board the Albert were among the latest taken ill, and one escaped altogether. No fact came under my observation affording the slightest evidence that the disease was communicable from one person to another. "Does one attack of river fever afford any protection against a second?

My own experience, added to information obtained from many of my brother officers, and from Mr. King, the surgeon of the Ethiope, who has been more in

"The Quorra, M'Gregor Laird's vessel, entered the river on the 19th of October, and fever broke out twenty-one days afterwards, on the 11th of November."

the Niger than any other medical man, is wholly unfavorable to the opinion that one attack of river fever affords any immunity from a second. On the contrary, those who have once suffered from this treacherous disease seem particularly predisposed to it, if they again venture within malarious influence." 181.

As a prophylactic, Dr. M'W. thinks himself authorised to recommend the daily use of quinine, with good diet, and a moderate allowance of wine.

TREATMENT OF THE FEVER.

This is a very unsatisfactory subject. The very best mode of treatment is to get out of the range of the cause as soon as possible-that is to get out of the Niger into the open sea!" Pessimum Ægro cœlum est, quod Ægrum facit."

General bleeding was not found to be successful in this fever. On the contrary, it was injurious. Local bleedings, as cupping the temples, were sometimes beneficial.

Blisters were often of great use.

Mercury. In some of the Niger cases gentle ptyalism "certainly did good." In many cases "the full action of mercury would have been attended with danger." "Calomel combined with opium, and afterwards with quinine, appeared to me to be the best mode of exhibiting the remedy."

Purgatives.-The bowels were generally constipated, and required active purgatives, especially in the early stage.

"Calomel, jalap, and the bitartrate of potash were given at first, so as to cause free evacuations, which were in general dark or of a bilious character. After the bowels had been well emptied, castor oil and the milder aperients answered better than strong purges; which then indeed do much harm. Enemata were given with benefit, when epigastric tenderness or irritability of the stomach, rendered the administration of purgatives by the mouth inadmissible." 197.

Diaphoretics--The best of these was the true James's powder, which kept up the action of the skin without producing nausea. Sometimes quinine was combined with it, and with good effect.

Quinine." In general when the tongue began to clean, and the other symptoms indicated that the functions were returning to their normal condition, quinine was given in large doses with great benefit. But it was not to this period alone that the use of this valuable remedy was restricted, for there were many cases in which, from the tendency to sinking from the very beginning, it was necessary to commence with quinine, wine, and light soups. In a disease like the Niger fever, so little amenable to treatment, no rule can be laid down for the exhibition of a particular remedy; but no medicine was found so efficacious as quinine in diminishing the severity of the paroxysms. In some of the more protracted cases, the red tinge over the sharp features would occasionally indicate that whatever power of reaction remained in the wasted system, was exerted to establish a feeble exacerbation, the exhaustion following which was often lessened by the liberal use of quinine.

"Brandy, wine, camphor, opium, and ammonia were freely given when the pulse began to flag, and when the symptoms generally denoted depression of vital energy; and often with almost miraculous effect, as in Case XIII.

Sponging the body with tepid water and vinegar, in general afforded relief, but I never could carry the cold affusion further than the application of large wet clothes to the head. The warm bath was not much used, and in those cases in which it was tried the benefit obtained was only temporary, the relaxation and exhaustion produced by it, contra-indicated its general use in a disease which was marked by debility and tendency to sinking; tenderness at the epigastrium was, however, often relieved by applying to it a japanned case filled with hot water, and concave so as to fit closely to the abdomen. A large oblong case of similar construction was advantageously applied to the feet during the low stage of the disease; and at earlier periods, when the nervous depression retarded the development of the stage of re-action, in which case the extremities often continued cold after the chest and abdomen had become quite hot." 199.

The foregoing general remarks are illustrated by numerous cases with their details; but to these we need not refer. A good many pages are dedicated to the economy of the vessels, as ventilation, provisions, medicines, &c. &c. as well as to meteorology, &c. which will prove very interesting to naval surgeons, and naval officers whose destiny may lead them to the pestiferous shores of Africa-and especially into that fatal river, the Niger.

The volume is written with great modesty, and indicates, in every page, good sense, discernment, and both practical and scientific knowledge.

CATALOGUE OF THE PREPARATIONS ILLUSTRATIVE OF NORMAL, ABNORMAL, AND MORBID STRUCTURE, HUMAN AND COMPARATIVE, CONSTITUTING THE ANATOMICAL MUSEUM OF George Langstaff, &c. &c. London, Churchill. 1842.

It was, we believe, old Dr. Gregory of Edinburgh, who used so earnestly to impress on the minds of his pupils the vast importance of assiduously perusing Morgagni's celebrated work De Sedibus et Causis Morborum in the terms, Nocturná versate manu, versate diurnd. The habit of connecting the morbid appearances found after death with the symptoms observed during life, and of placing them, as it were, in juxta-position, being the very best, nay in fact the only means of preparing and qualifying the medical practitioner for attaining and forming a correct diagnosis at the bed-side of his patient. To point out the value and importance of studying morbid structure and of tracing it through all its stages and gradations from the first blush of capillary redness to the final disorganisation of parts, would at the present day be a work of supererogation. That the thing is fully recognized, the numerous Anatomical Museums of Morbid Structure throughout the metropolis evince. The opportunities of studying this important branch of pathology in London, containing as it does, the Hunterian Museum, that stupendous monument of human industry, together with the numerous other Museums attached to the

The

various hospitals, and contributed to by the hands of such men as Cooper, Brodie, Lawrence, &c. &c. are to be surpassed nowhere. The collection of the specimens of morbid structure, of which we now present the catalogue to the notice of our readers, was commenced some thirty years ago, at a time, says the author, when the study of morbid anatomy was but little practised, and almost every post-mortem examination offered subject of interesting and novel investigation. In forming his collection, Mr. Langstaff was assisted by several of his medical friends, to many of whom he here expresses his acknowledgments. The preparations are intended to illustrate not only morbid, but normal and abnormal structure. arrangement is physiological-he commences with the OSSEOUS SYSTEM, and gives cases of some of the principal diseases of the bones. Then the VASCULAR SYSTEM, under which he gives the Normal, Abnormal, and Morbid Anatomy of the Pericardium and Heart, and of the Arteries and Veins-then the NERVOUS SYSTEM, including the Brain and Spinal Cord, with their membranes, and the nerves. Next the Organs of Respiration— Organs of Digestion-Urinary Organs-the male and female generative organs. Then, under the head of Miscellaneous Preparations, we have two Chapters, containing the descriptions of some matters which should have come in before, but had escaped notice. Several specimens of Comparative Anatomy find a place in Mr. Langstaff's Catalogue.

We shall present our readers with some extracts from the most interesting parts of this work-and shall commence with the Vascular System, there being nothing very striking or novel in the Chapters descriptive of the Osseous System. In extracting the cases we shall retain the numbers affixed to the originals.

Malformation of the Heart.

282. In the heart of a boy eight years old the cavities were found to be very large, and the muscular structure very firm. Nearly three ounces of water found in the pericardium-foramen ovale open-valvula mitralis shortened and thickened; the Eustachian valve extensive and reticulated. The aorta and its vessels were very large; the sigmoid valves of this vessel and of the pulmonary artery thickened. From birth he had all the signs of hydrocephalus, with symptoms denoting malformation of the heart; his lips of a purple color, skin rather cold; pulse full and irregular; these signs were attended with dyspnoea. He was attacked with pertussis, convulsions came on, and he expired in one of the paroxysms. The head was immensely large; the arachnoid membrane and pia mater were much thickened, and a milky fluid was effused between them; the vessels of the brain were surcharged with blood, and the structure of the cerebrum was very dense; the septum lucidum and fornix softened-four ounces of fluid in the lateral ventricles, and the third ventricle was filled with water which produced pressure on the optic nerves.

286. Here we have the heart of a boy ten years of age. From birth he had symptoms denoting mal-formation of the heart; he was a complete cæruleus; pulse generally very full and irregular. About a fortnight before death he had a severe attack of scarlatina; purpura hæmorrhagica nearly all over his body; this was followed by hydrothorax and ascites-in both sides of the chest there was a considerable quantity of serous No. LXXVIII.

C c