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various anomalous symptoms observed in succession, in whichshe seemed to undergo much suffering, and her screams wereoccasionally such as to alarm the neighbours. During the lastfew months she had fits, apparently of a cataleptic character,with insensibility, but unaccompanied by delirium or coma.It was at this period more particularly that the tetanic spasmswere seen, commencing in the legs, and assuming more or lessthe characters both of emprosthotanus and opisthotanus. Shedied exhausted at the age of eighteen years.Post-mortem examination.-Emaciation extreme. Cranium

large and thin; arachnoid opaque; a good deal of subaracbnoidfluid. Brain large; lateral ventricles each containing abouthalf an ounce of serum; substance normal. Spinal cord wasfirm and natural in every portion; arachnoid opaque. Theheart was small, but healthy; slight pleural adhesions at theupper part of the chest, and firm consolidation of one portionof the right lung. A pouch-like dilatation of the duodenumexisted at its lower portion; in other respects all the abdo-minal viscera were healthy. The uterus was small, but showedno indication whatever of disease.

Reviews and Notices of Books.De la Nature, du Traitement, et des Preservatifs du Choléra.

Par Fr. X. POZNANSKI. St. Petersburgh, 1856.THE author of this tract made observations in Russia and

Poland during the cholera epidemic of 1848 and subsequentyears, in respect of irregularities of pulse in persons of appa-rently good health. The number he examined was large, about300, and in many of these persons there was very sensiblediminution of the circulation, the pulse not exceeding 60, andin some cases scarcely 45 a minute, indicating a superabund-ance of blood in the heart and arteries. The disease (he says)chose for attack only those persons who had not combatedthis symptom by the proper remedies. When bleeding wasresorted to as a preventive, he noticed that condition of blood,peculiar to cholera, which Caunstatt and others have observed.From these facts, believing them to be well ascertained, Dr.Poznanski undertakes to solve the cholera problem. It turnson the proportion of the active force to the resistance.The vital conditions which determine the centrifugal move-

ment of the blood: the functions of the heart and other muscles,the elasticity of the arteries, and quantity of blood supplied ina certain time to the vascular system, -these measure the activeforce to each individual, which force meets its resistance in thematter which composes and surrounds his organization, in air,water, &c., and chiefly in the capillary vessels and those organswhere they are most developed. Physical and dynamical causes ’,contract and expand the bloodvessels, and especially the capil- lary, and so increase or diminish the power of resistance. The iactive force in the degree of its increase accelerates the bloodyand tends to produce congestions in parts least provided withcapillary vessels, and therefore least resistant, as the peri-toneum, &c.; as it decreases in proportion to the resistance,the result is stagnation in the resistin’ organs.The transudation of serosity through the walls of the arteries

is in the measure of the quantity of blood, its liquidity, andthe activity of the heart. The elimination of carbonic acidand urea will be in proportion to these conditions.

Stagnation of the blood in the peripheric organs will produce- 1, deficiency of blood in these organs and a suspension offunctions; 2, a proportional congestion of blood in the centralorgans, and augmentation of their activity; 3, increased trans-sudation of blood through the parietes of the surcharged arteries;4, coagulation and compact obstructions formed by the solidparts of the blood; 5, deficiency resulting therefrom; and 6, asa consequence, that which the Doctor terms a secondary stagna-tion in the parts that offer less resistance.

Proceeding on these principles, the writer asks what are thechanges which an organism submitted to excessive atmosphericpressure would present, and finds that they entirely correspondwith the choleraic phenomena. A high pressure will produce

a defect of blood in the veins exposed to it, and in the capillaryvessels, and a proportional excess in the heart and arteries,The heart distended will contract more slowly, and be resistedmore vigorously by the contracted capillaries; the arteries willbe saturated, their elasticity and transudation augmented; apulse, "élevé, lent, et promptement disparaissant," (magnus,tardus, et celer;) vomiting and purging. Then the circulationwill be depressed; all the functions, reproductive, secretory, andrespiratory, enfeebled; accumulation of carbonic acid; venollsplethora; deficiency of fibrine and serous parts; excess of cor-puscles and albuminous parts of the blood. The1’e will be set

up the primary stagnation. After a time come condensation inthe blood; thence diminished capacity, and frequent contrac-tions of the heart; depressed circulation in the central organs-i. e., the secondary stagnation. Central obstructions are formed,and produce typhoid symptoms; whilst in the peripheric vesselsthe blood begins to liquefy, and the circulation to be increased;the pulse is small and frequent; a disagreeable heat, sweat, andother secretions follow. In the preliminary depression of thecirculation, and the primary and secondary stagnations, we tracethe three stages of cholera, the predisposition, the algide andthe typhoid symptoms.

It appears to Dr. Poznanski, that he has established theidentity of the two processes by the following facts :-1, Cholerais endemic in India, Persia, and other countries exposed to highatmospheric pressure; 2, the epidemic has been always pre-ceded and accompanied by excessive pressure, and its intensityproportioned to this excess; 3, cholera chiefly infests low situa.tions, such as the banks of rivers, and in Russia., the low coun-tries on the Caspian; 4, it propagates itself in the direction oflow levels; 5, mountain heights afford a refuge from its attacks;6, the specific weight of the air is increased in periods of cholera,as shown’’by the observations of Prout; 7, cholera is generallypreceded and accompanied by unusual calm, and, on the otherhand, is mitigated, if not extinguished, by a storm, condensa-tion of the air being the consequence of the former state, rare-faction of the latter; 8, if there is wind, the disease moves to-wards the point from which it blows, because the air is morecondensed in that direction; if, on the other hand, it were amiasma, as is supposed, it would flow with the current ; 9, ageneral depravation of the blood is observed during an epi-demic-an effect which could only be produced by an agentuniversally diffused like the air; 10, occupations which affordproper exercise, and thereby increase the active force, protect,to a certain extent, against the disease, whilst a sedentaryhabit predisposes to it; 11, things which are known to be in-jurious in times of cholera, are those which diminish the activeforce, prolonged sleep, especially after meals; fear, and otherpainful impressions; insufficient diet; excess; vegetable food(Tytler called cholera the rice disease) wanting azote, and

abounding in carbon; beer; unboiled water; milk; prolongedcold baths; and, generally, those agents which increase thequantity of carbonic acid in the system; 12, bleeding, if em-ployed before coagulation, has a quickly beneficial effect, prov-ing that the disease depends on an excess of resistance; 13,Casper has observed that sudden death is more frequent inperiods of great barometric elevation; this circumstance hasbeen also noticed in cholera; 14, the Doctor’s personal observa-tions on the pulse, already mentioned.The treatment will be guided by the abundance or de-

ficiency of blood. In the first stage of the disease, bleeding,evacuants, and sudorifics, will diminish the specific weight ofthe blood, increase the fibrine, and thereby, increasing its elas-ticity and consistency, will promote its efficiency as a conductorof the active force. Under another phase, the same treatmentwould be injurious.The author arrives, in conclusion, at the following definition

of cholera:-Venous plethora, caused by an excessive 2-esista?2ce,which produces stagnation of the blood with its consequences.We have thus presented to our readers, with as much con-

ciseness as possible, a theory which at least will be admitted

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to have the recommendation of novelty, and which the authorsupports and illustrates with much ingenuity and research. Buthe is too sparing in his meteorological facts; for the only contri-bution of this kind with which we are favoured is a diagram ofthe barometrical readings at St. Petersburgh during the years1830-53, which might have been constructed in such a manneras would bring out the comparative results with greater clear-ness and effect. The statistics of the barometer, consisting offacts- carefully observed and well compiled, and derived fromall countries in the old world and the new which cholera has

attacked, in years of sickness and years of health, would forman.acqaisition of the highest value; and if the excess of pressurein epidemical seasons were fully-established, it would be thenext, and not a difficult, step to construct a pathologicaltheory. Meanwhile the change of pulse which Dr. Poznanskihas observed at such periods, is a subject well worthy of atten-tion, and if English observations agree with Russian, this

symptom would be of the greatest use in house-to house visita-tion,, and probably even more important than the premonitorydiarrhoea, which, if it always precedes the malignant form ofthe disease, precedes it in some cases only by a short interval.

Dr. Poznanski cites the following passage from Huxham, inthe introduction to his pamphlet, which we shall place at theend of this notice :-

" But neither does this morbid sluggishness arise suddenly,nor in all persons alike; for it comes gradually when the northwind and dryness have long, prevailed, and it depends, notonly on the state of things at the time of the disorder, but onthat which precedes it. Moreover, this condition of the atmo-sphere may be not only innocuous to relaxed, pituitous persons,but highly invigorating."

Foreign Department.ELEPHANTIASIS OF THE MAMMÆ.

M. ROUSSEAU gives the following in the Revue de Théra-peutique Médico-Chirurgicale, 1856 :-C. Bayard, aged twenty-eight, of strong make, fair, and of a lymphatico-sanguine tem-perament, has h td very large breasts since puberty; her sistersand first consins present a similar development. One of thesisters noticed a considerable enlargement of her breasts duringpregnancy, but they returned to the ordinary size after herconfinement. The present patient began to menstruate at

fifteen, and even at that time the breasts were so large thatremarks were made, although she strove to conceal the fact.She married, and menstruated for the last time in March, 1856,so that she was considered pregnant. But at that period thepatient was attacked with typhoid fever, in the course of whichthe breasts enlarged in an extraordinary manner, and haveever since taken further development. The poor woman is at,the present time obliged to be constantly reclining, as, onaccount of the size and weight of the breasts, she can neitherstand nor sit. Each breast is twenty-four inches long, andthirty inches in circumference; the skin is thick, but of thenormal colour, and the follicles are very large. On handlingthe mass, it is found of a spongy character, without infiltrationor oedema. The left breast has no nipple ; the latter had beeninvaded by an excrescence, and both were cut off together. Theright nipple presents a hard and blackish mass, with a gan-grenous smell, and a superficial and fcetid suppuration. The

patient’s face is thin and pale, the appetite good, the voice firm,and pu12e 86. No remedial means have as yet been employed,and the hypertrophy seems to be increasing.

AN ARTIFICIAL LOWER JAW.

M. MAISONNEUVE, of Paris, lately removed the whole of thelower maxilla from a man aged thirty-three. The case did

well, and an artificial jaw has been made for the patient byMessrs. Fowler and Preterre, American dentists residing illParis. M. Robert, on the 2nd of December last, presentedthis piece of mechanism to the Academy of Medicine, when itwas found to be composed as follows:-

1. An upper piece composed of a gold plate, with the ftilcrtimon the superior dental arch and the anterior portion of the hardpalate.

2. A lower piece, forming a complete set of mineral teethwith their gums, secured on a gold plate, which is moulded onthe soft parts. This piece articulates with the upper by meansof a hinge- and two springs, which allow of easy movementsbetween the upper and lower dental arches.By means of this apparatus support is gained for the lower

part of the face; the lip is borne upwards, and the face re,

covers its harmony. The mouth can be widely opened; thepatient speaks with comfort, and can raise his voice loudly;he can, moreover, triturate such substances as crusts, meatifruit, &c., which advantage he did not possess before the arti-ficial jaw was applied.

ETHER AND CHLOROFORM GELATINIZED.

PROFESSOR RUSPONI has succeeded in turning ether and chlo’roform into gelatine, by shaking them with white of egg in aclosed receiver. The compound obtained, with the ether issemi-transparent ; with the chloroform it is white and opaque.This gelatine is soluble in water, and may be spread on linenin the form of a poultice. It will likewise mix with morphine,cantharidine, conicine, &c., and may thus become of great the-rapeutical’use.

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ELECTRICAL CHOREA.

FOR the last twenty years, the physicians of Milan and Paviahave observed this disease, as presented by persons comingfrom the country into the hospital. It is characterized bypartial clonic spasms in the upper or lower extremities, thetrunk or face, but generally on one side of the body only. Themovements are very like those excited by electricity-hencethe name. Dr. Dubini, of Milan, described the disease first inthe Annali of 1846; and Dr. Pignacca has lately given, in’the Liguria Medicct, an excellent paper on the complaint,grounded on thirty-eight carefully observed cases. It wouldappear that the affection generally proves fatal, and the author.thinks that it depends on a softening of the spinal marrow,analnnous to the same kind of change of which the brain issometimes the seat.

TURNING IN FACE PRESENTATIONS.1’o the Editor of THE LANCET.

SIR, -You did me the honour, a few weeks since, of inserting’a short communication of mine relative to the Marshall HallReady Method, which appears to have given dissatisfaction atleast to one, a Country Doctor, whose reflections on my caseare certainly anything but complimentary to my judgment. Itrust therefore that you will allow me to trespass again on the’pages of your invaluable journal, in order that I may set thaCountry Doctor right. I am fully aware that no one should.presume to take up your valuable space, unless he has some-

thing new to communicate or something old to confirm. It was*with the latter object that I sent you my paper, well knowingthat a case of face presentation could hardly interest yourreaders, and feeling sure that, although only an obscurf student,travelling on the great common highway of human knowledge,I might, perhaps, without being censured, stop to add anotherfact to consolidate one of the brightest stones that has in my’time been added to medical science-viz., the Marshall HalfReady Method, a discovery pregnant with more advantages..to:humanity than his brilliant microscopical investigations, and’upon which his fame will pass on to posterity more than. onany other of the modern discoveries which he has made.However, as the Country Doctor has taken up the critic’s

baton, I may explain that the first stages of labour commenced-between nine and ten o’clock A.M.: the same day, when visited’-at eleven A.M., it was found that an accoucheur’s aid could beof no avail, and directions were given, that directly the pains.followed up quickly, to send on, which summons arrived be-tween ten and eleven r.M. When visited at eleven P.M., upon.examination, all the parts were well dilated, and after waitingone hour and a half, during’ which the pains were extremelyhard, I found the power of life of my patient giving way.Iresorted at once to turning, and I am only too happy to beablet-to add that the mother and child have done exceedingly well.I was certainly very anxious about the case, for I was informedthat my patient’s sister had, a few months previously, died’shortly after the delivery of her first child.

I am, Sir, your obedient servant; .

Mile-end, August, 1857. F. J. RuLLY, M.R.C..S.F. J. RILLY, M.R.C.S.

. CHOLERA AT ST. PETERSBURGH.-This disease is- gra-I CHOLERA AT in St. Petersburgh. disease is gra-