pellucid, very scanty, was taken, the vesicles clearly advancing. On the tenth day, the day of maximum development of the vesicles, a slight areola round one of them; all had a very active appearance, and the lymph taken was perfectly limpid and quite as adhesive as before. The decline of the vesicles on the eleventh day was perfectly obvious, and precisely as in the natural, casual, and innoculated vaccine. This was confirmed by the appearances on the twelfth day. On the twenty-sixth day, the crusts having fallen a day or two, the smooth pale rose-coloured scars were observed. Re-inoculation and re-vaccination here also proved unavailing. The lymph taken on the different days was used with different degrees of effect; but, when successful, produced perfect vaccine vesicles."

Mr. Ceely details at some length the experiment just mentioned. For the particulars we must refer to the paper itself, and content ourselves with adverting to some of Mr. Ceely's observations. "In the transfer," he says, "of the above lymph from the animals to man, my attention was forcibly arrested by the difficulties attending the process; and in the entire failure of so many punctures, the production of so many lymphless papulæ, and the formation of so few perfect vesicles, I recognized phenomena so common in similar trials with primary lymph. In some instances the difficulties were not completely overcome even in the second removes. The marked improvement, in subsequent removes, in the development of the vesicles, and the active manifestation of the primary and secondary symptoms, were not less apparent than in the use of natural lymph under corresponding circumstances, except that, in very few instances, and those principally in later removes and in peculiar subjects, there was not observed that disagreeable, inconvenient, and mischievous acrimony so peculiar to the former lymph. The lymph from the vaccine vesicles on the first experiment seemed to have acquired activity without causing the same amount of difficulty in its transmission.

It

These experiments with the variola vaccine lymph on man, show the necessity of having a number of subjects of different temperaments on which to employ it, on its first removes, to ensure success. seems highly probable, too, that the direct transmission of the liquid lymph from the animal to children will save much trouble and conduce to greater success."

We scarcely think that any apology is due for the length at which we have considered the subject of vaccination. Its great intrinsic consequence-its particular importance at the present moment, when doubts are afloat regarding its efficiency-and, last not least, the satisfactory results. of the late experiments, all plead our excuse, and, we trust, successfully. For the identity of the vaccine disease and variola may now be looked on as redeemed from the regions of conjecture, and the fears that existed for the deterioration of the vaccine lymph may now be fairly dispelled. It bears many removes, and at last, when its efficiency is failing, the cow may be confidently resorted to once more.

MEMOIRES DE L'ACADEMIE ROYALE DE MEDECINE.
Bailliere, Paris, 1840.

THESE Memoirs may be considered as similar, in their object and general characters, to the Transactions of our Medico-Chirurgical Society.

To enable our readers to judge of the comparative merits of the two works, as well as to inform them of the progress of medicine and surgery among our neighbours, we purpose to give a condensed summary of the contents of the present volume.

These are as follow:-1. Historical éloge of M. Itard, the author of several well-known works on the Ear. 2. Historical éloge of M. Laennec, 3. Historical éloge of M. Biett. 4. Researches on the Diseases of Old Age, by M. Prus. 5. Treatise on the most common Diseases of Iceland, by Dr. Thornstensen. 6. Memoir on the operation of Lithotomy, by M. Souberbielle. 7. Memoir on the Dysentery of Guadaloupe, by Dr. Cornuel. 8. Researches on the structure of the Cortical Substance of the Convolutions of the Brain, by M. Baillarger. 9. Statistical Memoir on Pleuro-pneumonia, by M. Pelletan. 10. Memoirs, seven, on Poisoning-[a, poisoning from arsenic-b, on the means of ascertaining that the arsenic is not derived from the tests or vessels employed in the experiments-c, on a new process to discover the presence of arsenic absorbed into various organs of the body-d, on the arsenic naturally contained in the body-e, on the soils of cemeteries, and the arsenic which may be found in them-f, on poisoning from the tartrate of antimony-and, g, on poisoning from the salts of copper.] 11. Memoir on Re-vaccination. 12. New Researches on Human Urine, by M. Lecanu. And, 13, on Vaginal Cystocele operated on in a new method.

Passing over the three éloges with the single remark that, on the whole, we highly approve of such public panegyrics on distinguished characters, and that we should be glad to see the practice, carried although it be by our neighbours somewhat to excess, imitated in this country,* we shall at once proceed to the notice of the several practical memoirs whose titles we have just given, beginning with the

Researches on the Diseases of Old Age.

Dr. Prus has had unusually extensive opportunities of studying the diseases of old people, having for seven years past been attached to the medical staff of that immense establishment, the Hospice de la Vieillesse in Paris.

He first takes a rapid review of the various organic changes which gradually take place in the system as old age advances, and then points out the

* We observed by the public prints, that over the grave of our distinguished countryman, Sir Sidney Smith, who died within the last twelvemonth at Paris, three éloges commemorative of his private virtues and public services were pronounced, and that two out of the three were spoken by Frenchmen !—an act of generous and noble feeling. (Rev.)

practical conclusions which the enlightened physician will draw from the consideration of these in the treatment of its diseases. The imperfect mastication of the food in consequence of the loss of the teeth, the attenuation and atrophy of the muscular and mucous coats of the stomach and bowels, the diminution in the size and number of the lacteal vessels, and the contraction and induration of the mesenteric glands must necessarily retard and impede the formation and absorption of the chyle; the progressive lesion of all the respiratory organs, the shrinking of the chest, the gradual wasting of the pulmonary parenchyma itself, and its diminished dilatability by the inspired air, the hardening and contraction of the larynx and bronchi, the thickening of their mucous covering, &c. all tend to render the aeration of the blood more and more imperfect; then the gradual changes in the substance of the heart and large blood vessels,* too well known to all to require even a passing remark, the contraction and ultimate disappearance of the minute capillaries, to which is owing in a great measure the dryness and wrinkled state of the skin, the gradual enlargement of all the veins of the body, the inactivity of the lymphatic vessels in every part, the atrophy of the brain, spinal-marrow, and their nerves, the wasting of the muscles, the brittleness of the bones, not to mention numerous other organic alterations in every structure and tissue of the body-all these are most expressive indications that the machine of the body is becoming less and less able to perform its functions, and must therefore be less able to resist the encroachments of disease.

Besides these alterations in the solid parts of the body, equally obvious changes are going on in the composition and qualities of its fluids: these it is unnecessary to particularise; and we shall therefore now proceed to examine the interesting question, What are the most common and most fatal diseases of old age?

The following data will enable us to form an opinion on this subject.

Dr. Prus examined the bodies of 390 patients, between the ages of sixty and ninety years of age, who died in the Bicetre during the years 1832-3-4.

Of these, 149 died of diseases of the respiratory organs-viz. 77 of pneumonia, 26 of pleurisy, 18 of tubercular phthisis, 10 of asthma, eight of bronchitis, four of pulmonary congestion, two of asphyxia caused by exces. sive tympanitic distention of the abdomen, one of laryngitis, one of cancer of the larynx, and one of cartilaginous granulation of the lungs.

* Dr. Prus remarks that, in consequence of the various changes which age induces in the arteries, we should always examine the state of the pulse at the heart, and not at the wrist, in old persons. "How often," says he, "have patients, whose radial pulse was feeble and irregular, but whose heart announced an energetic resistance, been bled with marked advantage, and thus escaped a speedy and inevitable death." (This precept requires to be received with caution; a strong tumultuous action of the heart is not unfrequent in old people, especially when there is incipient hypertrophy of its ventricles or contraction of its orifices, (a common occurrence,) which by no means indicates the necessity for depletion; and even when this is deemed necessary, it is often safer to draw blood by cupping over the cardiac region than by opening a vein in the arm.-Rev.)

Lesions of the nervous centres are next in point of frequency; 101 deaths being attributable to this class-viz. 25 to meningitis, 23 to cerebral ramollissement, i8 to recent cerebral apoplexy, six to apoplexy of old date, six to meningeal apoplexy, five to cerebritis, (in which purulent matter was found blended with the substance of the brain,) four to serous apoplexy, four to coups de sang or sanguineous congestions without laceration of the cerebral substance, two to capillary apoplexy of the convolutions, two to apoplexy of the annular protuberance, one to apoplexy of the cerebellum, one to contusion of the brain, and one to general paralysis.

Then follows the class of diseases of the circulatory organs, which amounted to 64. These cases may be subdivided as follows:-54 of diseases of the heart, three of arteritis, or arterial ossification giving rise to dry gangrene of the extremities, two of aneurism of the aorta, two of pericarditis, one of obstructed vena cava from an enlarged lumbar gland, and one of vegetations in the aorta, accompanied with periostosis of the clavicles.

The diseases of the alimentary canal amounted to 49;* there being 27 cases of enteritis, 10 of cancer of the stomach, four of gastro-enteritis, three of colitis or dysentery, two of gastritis, two of diarrhoea without inflammation, and one of softening of the mucous membrane of the stomach.

In addition to the causes of death enumerated, eight patients died of diseases of the liver, and the remaining 19 either of erysipelas, nephritis, fever, or some other casual malady.

We need scarcely mention that, in almost every case, the disease which appeared to be the more immediate and primary cause of death was seldom solitary, but was accompanied with morbid changes in other parts of the body at the same time.

The frequency of certain diseases, especially of inflammatory diseases of the lungs and also of apoplexy, will be found to vary very considerably in different years: hence the importance of attending to what has been called the medical constitution of the seasons on the development of certain maladies. Dr. Prus insists particularly, and with much propriety, on the neces sity of aged people being warmly clad, and of guarding as much as possible against the influence of atmospheric vicissitudes. Neglect of these precautions is, he thinks, one of the chief causes of the great frequency of pneumonia among the inmates of the Bicetre and the Salpetriere hospitals at Paris.

So much for the relative frequency of the diseases in the different systems of the body in old age: let us now endeavour to determine the average number of deaths or the ratio of mortality among sick persons above sixty years of age.

Dr. Prus states that in the course of three years he lost 430 patients out of 1345 received upon the sick list at these two immense establishments. The mortality in the practice of the other physician, his colleague, was quite as great; so that we have a total of about 860 deaths in the course of three years, or of 287 yearly, among 2500 persons-the usual number of the

It was long erroneously imagined that the most frequent diseases of old age were those of the abdominal viscera.

resident inmates; giving the average or ratio of about one to eight and four-fifths, for the entire number of these inmates; and of one to three and four-eighths for the 1345 patients who were under medical treatment.

Dr. Prus proceeds next to give several tables to illustrate the actual and relative mortality in the different months of the year: suffice it to say that the greater number of deaths occurs during the cold seasons. He then enumerates the diseases of 685 patients who were cured or relieved during his three years' practice at the Bicetre and Salpetriere hospices. Of these there were 216 cases of affections of the respiratory organs, 151 of affections of the nervous centres, 144 of abdominal complaints, 54 of diseases in the organs of circulation, 22 of cutaneous affections, and the remaining 98 of diverse and occasional diseases.

Having treated of these subjects, our author makes some useful remarks on the great difficulty of accurate diagnosis in many of the diseases of old age.

"What must frequently astonish the physician," says he, "is the want of reaction in most organs, and even in those which are immediately connected with life. For example, the lung may pass into a state of grey induration, and the stomach may be the seat of a cancer, without the attendance of any of those symptoms which almost invariably accompany them at earlier periods of life. The heart itself, as long ago remarked by Bichat, is often found in old age to exhibit lesions which would have quickly killed an adult or child, although during life no disease may have been suspected. Hence the necessity of a most watchful care in the examination of old people's maladies......... How much has auscultation done in reference to the lesions of the respiratory organs! Before the knowledge of this great discovery, the diagnosis of many thoracic diseases among the aged was almost quite impossible; a circumstance which explains how such a man as the illustrious Pinel, who had passed many years of his life in the Hospices de la Vieillesse, has described under the name of adynamic fever a state which is now recognised by all pathologists as belonging to the second and third degrees of senile pneumonia.'

Another circumstance with respect to the diseases of old age, which is no less remarkable, is that the mutual sympathy and co-operation of the different organs for the preservation of life are greatly impaired. Each organ seems to live isolated; and hence it may succumb to disease, without the other organs coming as it were to its assistance. Thus the lung may become impermeable to air and even completely disorganised, and yet the heart will often not announce the existence of any lesion by an increased frequency or by any other change of the pulse.

"I have often," says Dr. Prus, " made a comparison which seems to me exact. Go into a ward devoted to the treatment of the diseases of old age, and you will be astonished at the complete indifference with which a patient witnesses his neighbours and co-inmates die around him. It is the same in the economy of the old man; it will become demolished piece by piece, without there being any re-action of the ensemble, or without any preservative effort being made by the system."

In a future paper Dr. Prus proposes to describe the leading specialties or peculiarities which he has observed in some of the most frequent and most fatal of the diseases of old age.