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The greater part of the cases of continued fever were manifestly produced by contagion, and fourteen of them proceeded from a single individual, who had apparently brought the contagion with him from Glasgow (in which neighbourhood we have understood that typhus has for some time past been more prevalent than on the eastern side of the island) into a situation in the Old Town, exceedingly favourable to its propagation.

In one populous part of the town, we observed variola and varicella to prevail together, in October last; and, as for some time the varicella appeared to be confined to children who had been vaccinated, the appearances might have been regarded by some as favouring the idea that the contagion of small-pox may occasionally produce a modified discase in persons who have previously undergone vaccination. By watching the progress of the eruption, however, it was always easy to distinguish the two diseases; and, in one case, a child who had certainly never had either cow-pox or small-pox was observed to take well marked chicken-pox from one of the cases, which, those who entertain that idea, might have considered as doubtful. This child was afterwards vaccinated, and went through the disease in the regular way. In another case, in a different part of the town, the eruption of varicella appeared on the fifth day after vaccination; and both diseases went through the usual course.

With the view of arresting the progress of the small-pox, we vaccinated several children lying along with others affected with the disease. One of these was in the fifth, and another in the sixth day of the eruption. In the former case, the areola formed was not very distinct, but in both the small-pox was prevented.

The subject of cynanche laryngea having, of late, engaged much attention, it may be worth while to state the circumstances of a case of this kind which occurred, though the symptoms were neither so severe nor so obstinate as in most cases described under that head. The subject of the disease was a woman, aged 42, of feeble habit, and labouring under many privations. She had very severe dyspnoea, performing inspiration slowly, with a laborious effort, and a wheezing noise, and expiration with a louder crowing sound. She could with difficulty get breath to speak, and spoke generally in a whisper, which was sometimes involuntarily changed into a peculiar hoarse tone.. She complained of much pain in the situation of the larynx, and of painful and difficult deglutition. No tumour was to be seen in the fauces. She had a hard cough, with a strong croupy sound, and scanty and difficult expectoration, which gave some relief to the pain and dyspnoea. Her face was somewhat flush

ed, and eyes prominent. Her pulse was about 100, and small; tongue whitish; bowels costive; skin hardly hotter than natural. Her complaints had begun by exposure to cold and wet ten days before; but had been much aggravated within two days by the same cause. A large blister was applied to the breast, extending up to the larynx. She was directed to take a dose of jalap and calomel immediately, and after its operation to use the pediluvium, and an antimonial diaphoretic mixture. Next day, her dyspnoea was considerably relieved, and she expectorated pretty freely. The blister and purgative had operated well, and she had had nausea, but no sweating. The symptoms having become more severe in about 24 hours after, two smaller blisters were applied at the sides of the larynx; after the operation of which, the pain, dyspnoea, and difficult deglutition, were much relieved. The febrile symptoms continued some days without much pain of breast, or oppression of breathing, and gradually subsided under the use of diaphoretics, and occasional laxatives; and she got rid of the cough and hoarseness in about three weeks more.

The case of purpura resembled that kind described under the name of the Purpura urticans. It occurred in a lad of 17, a shoemaker, whose diet had been meagre, and who had been accustomed to work in a cold and damp room. The eruption, which had the form of small hard purple.coloured papulæ, intermixed with petechiæ, occupied the ankles, knees, buttocks, and elbows, and was attended by oedema of the ankles, swelling of the knees and elbows, and considerable pain and stiffness of these joints. The excavated skin of an abscess which had formen on the parietes of the thorax, and had discharged itself about three weeks before, had assumed a dark purple colour, and the discharge, from being purulent, had become a bloody sanies. This affection appeared suddenly, four days before he came under our care, having been preceded by distinct rigor and febrile symptoms. When we first saw this patient, he had much debility, and his countenance was extremely sallow and expressive of languor. His pulse was 84; skin cool; tongue clean; and appetite tolerable. His gums appeared healthy, and he had had no hæmorrhage, but slight attacks of epistaxis afterwards occurred.

Two purgatives on the following days produced free evacuations of fetid fœces, and the swelling and pain of the joints abated; but immediately after their operation, severe pain, with fulness and hardness of the abdomen, supervened; the pain was aggravated by pressure, and was accompanied by vomiting, hiccough, quick and full pulse, and dry foul tongue. These

symptoms were relieved by a bleeding to 12 ounces, but recurred after two days in an increased degree, and required three additional bleedings, each to 14 ounces, and the application of two blisters, before they were completely subdued. He bore the bleedings well, and was each time after the operation relieved in every respect. The coagulum was firm, and covered by a buffy coat of considerable thickness. About the 9th day of the eruption, small hard black scales, apparently of dried blood, had begun to form under the cuticle, in the places of the papula. These soon fell off, and this process gradually went on in all the spots till the 24th day, when the eruption had entirely disappeared. The colour of the integuments in the abscess in the chest, and the appearances of the discharge, began to improve soon after the first bleeding, and after a week, during which the subsequent bleedings were employed, the skin had regained its natural appearance, and the discharge had become healthy. After this, the sore rapidly contracted and healed under the usual means. The bowels were not obstructed, but during the whole progress of the complaint were irregular, and required to be kept open by purgatives. The patient was long of regaining his strength, and his recovery was much retarded by a severe cough, which was brought on by the coldness of the house in which he lay.

In the midwifery department, out of fifty-two women who have applied for assistance, there have been delivered

39

34

Out of these the natural labours were

The preternatural

The complex

Of the last, two were cases of twins, and one of hemorrhage from the implantation of the placenta over the os uteri.

It must be remarked, that the practice at this Dispensary cannot afford the means of ascertaining the average proportion of laborious, preternatural, or complex, to natural labours, as part of the plan of the institution is to give assistance to midwives in difficult cases.

In-patients this year, 800.
Out-patients this year, 1575.

Table of the various Species of Hernia which have occurred in the General Infirmary at Northampton, between August 1813 and August 1814; also a Table of Fractures and Dislocations which have occurred in the same time. Communicated by WILLIAM MONEY, House-Surgeon.

Of Bubonocele, or Inguinal Hernia.
The total number, 62

3

3

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Of herniæ appearing at situations not reducible to the foregoing tables.

Total number 5, as follows:

1st. Richard Brookes, ætat. 65; at the external edge of the musculus rectus abdominalis, on the left side, near to the inferior linea transversalis. Contents; intestine.

2d.-David Stern, ætat. 80; left side; direct through the external ring.

3d.-Ann Croxen, ætat. 42; right side; protrudes under

that part of Poupart's ligament, within two inches from the anterior superior spinous process of the ilium; the hernia passes from this point across the thigh, and terminates at the inside of the limb. The contents are intestine and omentum; a portion of the latter adheres.

4th.-William Billing, ætat. 54; right side; four years ago the hernia was strangulated, for which he underwent the operation. He has since constantly worn a truss, but the hernia does not appear.

5th-William Wallis, ætat. 55; right side; the external abdominal ring communicates directly with the cavity of the abdomen, as well as by means of the internal abdominal ring, so that one portion of the hernia comes direct from the abdomen to the external ring, whilst the other takes the usual course through the internal ring; the contents intestine and omentum, principally the latter. A truss constructed with a pad, corresponding with each opening retains the hernia.

Total Number.

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Bubonocele

Scrotal

Femoral

Umbilical

Congenital

Prolapsus Uteri

Situations not reducible to the foregoing table

Radius

Ulna

Radius and Ulna

Femur

Tibia

Fibula

Tibia and Fibula

Clavicle

Humerus

Coracoid process
Metacarpal bone
Metatarsal bone

157

Seven of the above cases were strangulated, one of which was femoral in a female; the remaining six were scrotal. The operation for strangulated hernia has not been performed during the period which this table includes.

Total Number of Fractures and Dislocations, 52.

FRACTURES.

No.

FRACTURES.

11

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Ribs

Compound fracture

Numbers of fractures

DISLOCATIONS.

62 66

12

At the elbow

Head of the humerus

Lower extremity, tibia

First phalanx, thumb

3

4

2

2

1

1 Number of dislocations

635

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Extract from a Letter of DR RODMAN, Paisley, in reply to the "Observations on Premature Births," p. 126.

It is a rule with many men to be slow in giving heed to the sceptical statements of anonymous writers. But this rule is

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