its healthy excretory action; and, thirdly (through the natural stimulus given to that healthy action), by depurating the blood of those effete matters which the checked excretion of the skin had locked up in it.

Should you think the inclosed cases likely to be of any public use, I shall feel a pleasure in having recorded them; remembering, as I do, how deeply I am indebted to you for the instruction and benefit I have always received from the perusal of your valuable Journal.

I remain, dear sir, yours, most truly,

J. H. STALLARD.

Notes of Cases of Fever treated in the Leicester Temporary Fever Institution, October 1846.

CASE I. Coleman, Henry, æt. 10, admitted October 5th, from a close and most unhealthy yard. He complained of rigors; skin very hot and dry; bowels quite open; slight cough. He was ordered simple febrifuge mixture, with low, simple diet.

October 6th. The skin very hot and dry; the tongue red and very foul; bowels open; he complains of slight cough and headache. There is no apparent congestion of the lungs.

He was ordered to be surrounded with a cold wet sheet, to be placed in a blanket, and to remain in it for ten minutes.

Vespere. About half an hour after the cold application he broke out in a profuse perspiration, which continued during the whole day. He appears much better this evening, is more lively, and his head is relieved; still slight cough. Contin. med.

7th. Tongue cleaner, moist; bowels open; complains of headache. His nose has bled during the night. Cough as before. Slight crepitation observed at the base of the left lung, but he has perspired freely through the whole night.

To have cold water applied to the head, and to continue the fever mixture. 8th. Much better; crepitation gone; no recurrence of fever. Ordered to get up.

9th. There was a slight recurrence of fever last night, and he was again placed in the wet sheet; perspiration was induced, and it continued during the whole night. His tongue clean, and bowels regular; cough gone. To have rice pudding, and omit medicine.

10th. Continues improving. To have beef-tea. 11th. Discharged cured.

CASE II. Tomlinson, Spring, æt. 26, admitted October 2d, consequently had been ill a week when I first saw him on Oct. 9th. He had been taking simple fever mixture, and had had diarrhoea and pneumonia. His tongue was dry and foul; bowels still purged; cough; mucous râles were heard over both sides of the chest, at the back part; pulse very feeble, upwards of 100; skin had never been moist since his admission, and is now remarkably harsh and dry. Ordered the wet sheet to be applied as above, and to have 1 oz. of port wine every four hours, with a little beef-tea. No medicine.

10th. Much relieved. Shortly after the removal of the wet sheet he broke out into a most profuse perspiration, which has not yet entirely gone off. Tongue is now clean and moist; his bowels have been open twice. He had no beeftea yesterday, from an error of the nurse, but it was again ordered.

11th. Skin is quite wet; his cough is gone; his tongue is much improved; and his bowels have been costive since yesterday's visit. To have ol. ricini. 3ss.

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12th. Better. Bowels opened by the oil; he coughs occasionally; but a thick whitish phlegm is easily expectorated. To have meat diet [too soon?] 13th. Tongue dry; bowels open twice; no thirst; his skin is quite moist; and otherwise he is much better. To omit meat, and recur to beef-tea. 14th. Tongue is to-day clean and moist.

He continued to improve, and was discharged on the 16th.

CASE III. Thomas Harris, æt. 14, admitted October 3d. He had been ill seven days previous to his admission, but had so far improved that he was ordered to get up on the 7th. On the 8th I found him with a foul tongue, very red at the tip and margin; bowels open once in twelve hours; great thirst; aching of limbs, back, and head; a frequent pulse; and his skin very hot and dry. He was ordered the wet sheet and no medicine.

9th. He perspired freely after the cold application, and the perspiration continued all night, but had entirely ceased at the time of my visit, 9 a.m. The tongue is still very foul and red. To have the wet sheet again this evening.

10th. Skin is now quite wet with perspiration, which has been the case ever since the cold application; the tongue is not improved; the bowels are costive; the pulse is much more feeble; and he complains of weakness, but neither of fever nor headache. To have ol. ricini 3ss; to be repeated in four hours if necessary. The cold application to be repeated if the fever should return.

11th. Better. Bowels open; tongue cleaner. The skin preserved its moisture all day yesterday, so that the wet sheet was not employed; but as the skin is now hotter and drier than at my visit yesterday, it was ordered to be used to-day. The pulse is more feeble, and he was ordered half a pint of beeftea in the twenty-four hours.

12th. Very much improved. The tongue is clean; the bowels are open; perspiration occurred after the cold sheet, and has continued ever since; the skin is now quite cool; he complains of weakness.

13th. Better; and he was ordered meat diet.

The convalescence was at once established, and he was discharged on the 15th.

CASE IV. Joseph Timson, æt. 23, married, admitted October 8th. He had been seized with shivering on the 4th, and had had an attack every day since. He complained of muscular prostration, pain of head, limbs, and back, great thirst, and loss of appetite; his tongue was foul; his skin hot and dry; and his bowels costive. He was ordered the wet sheet immediately.

9th. Almost well. He perspired freely after the application of the cold sheet, and the perspiration still continues. His pain of head and limbs is gone; the tongue is foul, and his bowels are costive, which makes him feel uneasy. To have ol. ricini 3j, and wet sheet if necessary.

10th. Perspiration has continued. The skin is quite cool and moist; the tongue is much cleaner; and the bowels are quite open. He was ordered meat diet, and to get up.

11th. Skin still continues moist. He feels much better; his tongue is not quite so clean; and his bowels have not been moved since yesterday. Repeat ol. ricini.

12th. Same as yesterday. Bowels still costive. Repeat ol, ricini.

13th. Feels quite well; his appetite is good; he has no return of shivering or fever; his bowels are freely open; and he wishes to go home. Discharged.

CASE V. John Foreman, æt. 16, admitted October 5th; but the wet sheet was not applied until the 8th. His state was little better than when he was

admitted; his bowels were purged; his skin was very hot and dry; and his tongue very foul.

9th. He is greatly relieved, having perspired freely ever since the application. He was ordered to have it repeated if the fever should return.

10th. Much the same as yesterday. The sheet was not again applied. 11th. Much the same. There was a return of fever last night, and his skin is not very moist, and rather hot. The wet sheet was administered.

12th. Has perspired freely all night; his tongue is clean; bowels open. Ordered to get up; to have rice pudding.

13th. Says he feels quite well. His discharge was delayed until the 15th.

CASE VI. Foreman, Mary Ann, sister of the above, æt. 20, single, was attacked with shivering fourteen days back, but continued her work until the 14th of October. She was admitted on the 16th, late in the evening.

17th. Had a shivering fit after her admission last night, and when reaction came on she had the cold sheet applied as in the former cases. I found she had perspired freely all night, but her skin, though still moist, was very hot; her tongue was foul and red; her bowels open. She complained of great prostration and headache. She was ordered the liq. ammon. acet. and camphor mixture every four hours, low diet, and the wet sheet at night.

18th. She has been in a comfortable perspiration all night. The tongue is much improved; bowels are costive; headache much relieved. Cont. med.; omit the sheet.

19th. Bowels still costive, but tongue nevertheless cleaner. She has perspired freely, and her skin is now cool and moist. Omit medicine. To take ol. ricini 3ss.

20th. Convalescent. Her discharge was delayed two days, on account of her peculiar work.

CASE VII. Thomas Kean, æt. 19, admitted October 9th, from a dirty yard, where fever has been very severe. Had been seized with shivering on the 7th, and when seen was in a high state of fever, and was specially noted as proinising to be a very bad case. I sent him immediately to the fever house, with orders to place him in the wet sheet immediately. This was done for ten minutes, and about twenty minutes after the sheet was removed he began to perspire.

10th. Relief is very marked. He has had a good night, and his head and back aches are gone, whilst his skin continues quite wet with perspiration; his bowels are costive. To have low diet, and ol. ricini 3ss.

11th. His skin became hotter last night, and his pain and thirst slightly returned, and the wet sheet was therefore repeated. He is not much better. His tongue is clean, though red; bowels have been relieved four times. He was to get up, and have rice pudding.

12th. Bowels costive. Complained of headache towards the afternoon. Ordered to have the sheet if necessary, and ol. ricini 3ss directly.

13th. Tongue less red; bowels open. Did not require the sheet; headache relieved.

14th. Better. He was discharged cured the day following.

CASE VIII. Jane Smith, æt. 42, mother of six children, was admitted October 11th. She had been seized with shivering fourteen days before her admission, and had felt chills ever since. She was taken much worse on the 9th, so as to be unable to attend to her family. Her bowels were very costive, and on the morning of the 9th she took salts and senna, which have acted very violently. She now complains of intense headache, and aching of the back

and limbs, with thirst and great prostration. She was ordered the wet sheet and low diet; no medicine.

12th. Perspiration came on after the cold application, and has continued all night most profusely. The headache and lumbar pain are quite gone, and she complains only of slight weakness. To have meat diet, but to remain in the fever house.

13th. No return of shivering or fever. Her skin is moist, and tongue clean; feels very feeble, but is anxious to go out, as she thinks she can attend to her family. Discharged.

CASE IX. T. Cooper, æt. 30, living in a dirty, ill-ventilated house, was seized with shivering on the 9th of October, and has been unable to do anything since, the shivering having occurred every day, accompanied with the usual symptoms of the epidemic. When admitted on the 12th, he complained more especially of thirst, sore throat, and back-ache. His tongue was foul; his skin hot and dry; and his bowels reported open. Ordered to have the wet sheet.

13th. Has been in a good perspiration all night. Tongue is much cleaner; his bowels are costive. Altogether he feels much better, but he still complains of his throat. The fauces were red and swollen. Ordered ol. ricini 3vj, and a mustard sinapism to the throat.

14th. Bowels not well relieved; skin cool and moist; tongue cleaner. To repeat the ol. ricini.

15th. Much better. Bowels freely open; no headache. To have meat diet. 18th. Discharged cured.

CASE X. Elizabeth Holmes, æt. 12, had been confined to bed a fortnight, admitted on the evening of October 16th, and first seen on the morning of the 17th. She had had a very restless night, and had moaned frequently. She was quite sensible, and complained of no pain. Her tongue is dry, brown, and cracked; the skin hot, very harsh, and dry. She has had frequent sickness, which is always removed by the exhibition of the medicine which she had been taking under the direction of her previous medical attendant. Bowels have been moved three times since her admission; there is no pain or tympanitis; pulse very feeble; the second stroke of the heart very indistinct; no cough or congestion of the lungs. To take potass. bicarb. gr. vj, ex aquâ 4tis horis; to have wine and beef-tea, and to have the wet sheet in the evening.

18th. She perspired after the cold application, and the perspiration_continued until I a.m. to-day; after this she was very restless, and crying. Bowels are open; tongue same as yesterday; sickness ceased after the exhibition of the medicine; urine moderate in quantity high-coloured, clear; Cont. Mist. To have morphiæ acet. gr. horas omni. Diet as before. The sheet not to be repeated.

19th. She slept a little after the draught, but again became very restless, About 1 a.m. dyspnoea came on, which increased until 11 a.m., when she died. I saw her about 8 a.m., when the powers were failing, and the lungs were much congested. No post-mortem examination was allowed.

PART FOURTH.

Original Reports and Memoirs.

REPORT ON THE PROGRESS OF PRACTICAL MEDICINE,

IN THE DEPARTMENTS OF

MIDWIFERY AND THE DISEASES OF WOMEN AND CHILDREN,

IN THE YEARS 1845-6.

BY CHARLES WEST, M.D.,

Member of the Royal College of Physicians, Physician-Accoucheur and Lecturer on Midwifery to the Middlesex Hospital, and Senior Physician to the Royal Infirmary for Children.

THIS Report refers to a period of fifteen months extending from the 1st of July, 1845, to the 30th of September, 1846; and its general arrangement differs in no respect from that followed in the two previous Reports.

1. ON THE PROGRESS OF MIDWIFERY.

A reprint of Dr. Murphy's Lectures on Parturition, which were originally published in the 'Lancet,' is the only new work that has appeared on this subject. Dr. Rigby's Lectures on Midwifery are now in course of publication in the Medical Times,' and Dr. J. H. Davis has contributed to the Lancet' very numerous papers on the management of difficult and preternatural labour.

PREGNANCY.

Signs of Pregnancy. Dr. Mikschick has been led, by the examination of the urine of 50 pregnant women, to the same conclusion as many other investigators have already arrived at, with reference to the little value to be attached to the presence of kysteine in the urine as a sign of pregnancy. He found that in the majority of cases, an opalescent membrane formed on the surface of the urine after it had been allowed to stand for several days, but the same appearance was observed in many other instances independent of either lactation or pregnancy.

Disorders of Pregnancy, Mr. H. B. Lanet relates a case of that rare occurrence, anteversion of the pregnant uterus. The patient was a woman 35 years old, who fell down stairs in the 6th week of her pregnancy, striking her back and hips. Soon afterwards she began to suffer from tenesmus, dysuria, and frequent desire to pass water, and a varicose condition of the veins at the entrance of the vagina came on. When her pregnancy was 3 months advanced, her state became much aggravated, and she could no longer pass water except in the horizontal posture. The os uteri could not be reached,

* Oesterr. Med. Jahrb., Dec. 1845.

XLV.-XXIII.

+ Lancet, Sept. 27, 1845.

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