indeed there was no regular quarantine service before that country again came under the legitimate sway of the Sultan. That it continues to prevail there, is most probably owing to the still unsettled state of the province, and to the consequent difficulty of establishing, all at once, a system of prohibitory regulations affecting the transit of goods and the intercourse of the inhabitants.

"On the contrary, the other parts of the Turkish empire, and chiefly Constantinople and Smyrna, owe their exemption from the plague to the strictness with which the quarantine laws are carried into effect. During the course of last year, the pestilence was brought into the lazarettoes of these cities by ships from Alexandria, but was fortunately extinguished by the use of proper precautionary

measures.

"The same remark may be made of the lazarettoes in Candia, Rhodes, Cyprus, the Dardanelles, and Salonica; in all of which places, the health has been more or less directly compromised by the arrival of infected vessels from Egypt-but, in each case, without wider diffusion of the pestilence.

"M. Salle, in a subsequent part of his work, says that, 'all the world knows that the young Sultan Abdul-Medgid has always set the quarantinaires at liberty, and treated them as he would do common prisoners, to whom he shows his royal favour on the occasion of any happy event.'

"This statement is utterly devoid of truth, as every official person at Constantinople can amply testify. It is true that, in 1839, when the sanitary service was imperfectly organised, and during the last moments of the late Sultan Mahmoud of glorious memory, a few days grace was granted to those who were then detained in the lazaretto of the capital; but, since that time, there has been no one instance of the remission of the established regulations in favour of even the most distinguished persons, as Muhib-Effendi and Rifaut Bey, or Said-Pacha, the son of Mehemet Ali, or Moustapha Pacha, the present minister of war. These and many other persons of not less note have remained in the lazaretto the full time appointed by the rules of the quarantine service.

"As to the notorious negligence with which this service is conducted, according to M. Salle, it is now, perhaps, scarcely necessary to say much. If, instead of drawing his information from uninformed or prejudiced quarters, he had looked into things with his own eyes, and if, at the same time, he had been less presumptuous towards his correspondents in the East, he would doubtless have arrived at very different conclusions. As many physicians, however, who have resided amidst the plague, are and have been anti-contagionists, we are not, as a matter of course, at all surprised that M. Salle should hold the same opinion.

"But we have no hesitation in saying that it is our strong and decided conviction-a conviction that is founded on no little experience of the disease—that the immunity in the present day of many places in the Turkish empire (which a few years ago were not unfrequently visited with the pestilence) is entirely attributable to the system of quarantine regulations that have been recently adopted.

"In 1833, when the sanitary service was first definitively organised, the plague was then existing at Rousteink, Totrakan, Silistria, Philippopoli, and at Choumla and Varna-towns in European Turkey, where, although the same local and atmospheric conditions continue to exist now as they did then, the disease has not been known-thanks to the precautions that have been taken during the last three years. The result of this pleasing change has been that the Austrian government have greatly relaxed the rigour of their quarantine on this frontier, and now grant free pratique to travellers, &c. coming from any part of Turkey in Europe.

"We may also inquire, how comes it that in our own country, Marseilles, which has often suffered so severely from the pestilence, has been quite exempt from it, notwithstanding the constant communication which it has with different parts

in the East, ever since it had a well-established quarantine? and that Greece, too, should have so well escaped of late years, since it has become an independent kingdom?

Let it not, however, be supposed, from what we have now said, that we approve, in all respects, of the existing quarantine regulations of different European countries. While we contend that it is by them alone that we can reasonably hope to arrest the devastations of the plague, we willingly admit that a reform of the sanitary administrations is generally wanted, and that much of the rigour of the existing rules might be abated with no risk to health, and with great benefit to general commerce."-Gazette Medicale.

ON THE HEALTH OF THE LAZARETTO AT ALEXANDRIA, DURING 1842.

M. Grassi, head physician of this establishment, has published a report of its sanitary condition during the past year: from it we derive the following particulars :

Although the number of persons attacked with the pestilence this year has been much less than during the preceding one, the severity of the disease and the ratio of the mortality have been nearly the same. The treatment, too, pursued was very similar as on former occasions, with the exception of bleeding being discontinued; both Dr. Grassi and Dr. Colucci, his colleague, finding it rather hurtful than otherwise.

Of 97 plague patients admitted into the hospital, 62 recovered, and 35 died: of the latter, 14 sunk after being seen once, and 1 died during the period of convalescence, from a complication of internal lesions. Of 166 patients attended at their own homes, no fewer than 151 died-a very great mortality; attributable no doubt to the unfavourable circumstances in which the sick were placed, and the want of the many advantages which are found in a hospital.

The course of the plague at Damietta, too, affords another striking confirmation of the circumstance now mentioned. None of the patients in this city were in such a position as to oblige them to go into the hospital; and hence, of 97 persons attacked and attended at their own homes, only 26 recovered.

M. Grassi appears to be strongly convinced that the plague is not so often spontaneously engendered in-whether from the overflowings of the Nile, the climate or soil of the country, the habits of the people, &c. as many writers have alleged-as it is conveyed to, Egypt, and then diffused by contagion from one sick person to another.

"It is mathematically demonstrated," says he, "that, about the middle of the year 1834, it was imported into this city (Alexandria)—at that time, and for nine years before, perfectly healthy-by a Greek vessel with passengers from Cyprus and Jerusalem, where the disease had been prevailing. Since this period, it has been reproduced here every successive year, simply because the germ of the poison has been retained in one or two spots, from which it has extended itself elsewhere."

M. Crassi, like M. Robert, (whose opinion we have given in the preceding article) is quite assured, in his own mind, of the great contagiousness of the plague, and that the only hope of keeping it out of any district is by a judicious system of quarantine regulations. "If," says he, "it follows from the statements now made that, even after all necessary precautionary measures of sequestration have been taken, the plague not unfrequently is observed to re-appear in a place, it deserves to be remarked that (according to the results of my observation) it has never broken out after the measures, which have been pointed out, have been enforced for five days. From this fact, we might infer that the period of incubation of the disease does not exceed this period of time—an infer

ence that agrees with the opinion recently announced by M. Auber at the Academy of Sciences."

To avoid as much as possible the chances of the physician himself conveying the poison of the disease from the Lazaretto to the inhabitants of the city, the following precautionary measures are adopted :—“ Before entering the hospital, we have to pass along a terrace that is assiduously watered. All the stairs too are kept in the same state. The wards, in which the patients are lying, are perfumed and continually ventilated by means of numerous windows in all the sides of the building. The beds are kept considerably removed from each other; and the physician, accompanied by the apothecary, visits each at the legal distance; an officer of the establishment being always in attendance to see that all the sanitary regulations are strictly attended to."-Il Filocamo.-(A Maltese Journal.)

ANTHRAX CAUSED BY THE CARBUNCLE IN CATTLE.

The following remarks are from the pen of Dr. Müller of Hombourg, who, in his opening paragraph. says, "For two and twenty years I have been practising in a district where anthrax, arising from the carbuncle in cattle, is of such frequent occurrence that the number of cases which I have treated exceeds a hundred."

The disease in the human subject has almost invariably been observed in those seasons, when horned cattle were affected with the carbuncle, or what some authors have called the "malignant pustule." I have seen only one case in which it was attributable to the application of the nasal mucus of a diseased horse this occurred in a groom, who nearly lost his life from the consequences that ensued. In the majority of my cases, I have been able to trace the operation of direct infection-usually in the hands of the peasants-from the contact of the blood of the diseased cattle, during the process of skinning them. In a few cases, the disease arose from a slight wound of the finger, while bleeding the animal during life; and in others from the pricks of gnats and other insects, which had previously been settling on the dead carcasses. On no occasion did it ever seem to be produced by merely eating the flesh of the diseased cattle.

The early symptoms are usually very simple. The person observes a small pustule over the affected spot; this is accompanied with a feeling of slight heat or itching in the part, but nothing more; and for several days there is probably no change. But then the surrounding cellular tissue begins to be affected with a diffused hardness, and the integuments become covered with numerous pustules, which are at first white and more or less transparent; then opaque, and of a yellow colour; and lastly put on a livid appearance. The induration increases, and the tubercle, always diffused, becomes larger, until it acquires the size of a pigeon's egg, or even sometimes of a man's fist. The character of the surrounding swelling is in part oedematous, and in part erysipelatous.

It has been usually at this stage that my patients have applied for advice, so that I have not often been able to use the caustic with the view of destroying the characteristic tubercle, while it was yet small-a plan of treatment which, on more than one occasion, has perfectly succeeded in my experience. I have never practised the excision of the part, as recommended and adopted with great advantage, we are told, by Dr. Wetzer of Bonn.

The most dangerous seat of the malady is the face; and unfortunately this is of by no means rare occurrence, I have seen many patients die from the effects of the swelling extending inwardly to the throat, and causing suffocation, before any typhoid fever had supervened. Often in those alarming cases, neither bleeding from the arm-which is frequently of the greatest service, if resorted to sufficiently early-nor deep incisions in the swollen parts, so as to cause profuse

bleeding will avail anything; and the medical man has the miserable task of seeing his patient asphyxiated, without being able to relieve him. (Might not tracheotomy be practised with advantage?)

Dr. Müller says that it is usually a favourable symptom when the centre of the tumour becomes gangrenous; for then the surrounding tumefaction—which, when the face is the seat of the disease, often extends up along the scalp, and down even to the chest-generally subsides more or less, and the pain is considerably relieved. If a line of demarcation is formed around the sphacelated portion of integuments, the case will, in all probability, do well. In general, the formation of sinuses (fusées de pus) beneath the dead cellular tissue has in my practice been prevented by the use of timely incisions, and by the removal of the gangrenous parts as early as possible. In one case, where the adoption of these means was delayed, it was necessary to make a counter-opening over the top of the sternum for a carbuncle on the cheek; and, in another case, at the elbow for one on the hand. In the latter case, the arm became almost as large as the thigh of the patient, and the swelling extended even to the integuments of the chest, so that the patient experienced much difficulty and distress in breathing. In both cases, however, the swelling quickly subsided after the gangrene had made its appearance; and ultimately a complete cure was effected. In the second one, the entire surface of the arm up to the shoulder was covered with livid spots, like large petechiae, which yielded to the application of warm bread poultices prepared with a concentrated decoction of cinchona. Although the local disease was so formidable, the attendant fever was not very severe, and not of a typhoid type; while in other cases, in which the local affection was much less threatening, the patients have sunk under the constitutional disturbance.

Treatment. Our author very distinctly says, that in scarcely any case did moist applications answer well. Poultices usually increased the swelling of the parts; while dry herbs in a bag appeared to agree much better. We have already said that, if the infected spot be excised or destroyed with caustic potash sufficiently early, the future mischief may very generally be prevented. When the gangrenous process has been fairly established, it is almost always proper that one or two deep incisions should be made-as in the treatment of ordinary spontaneous anthrax-in order to give issue to the purulent matter and sloughy cellular texture underneath, and thus obviate the formation of sinuses in the neighbourhood. "Since I have known,” says Dr. Müller, “the utility of chlorine (chlore) against the effects of the bites of serpents, I have tried it in severe cases of carbuncle, and always wish good consequences. In some of the worst cases that I have seen, I have trusted to the use of chlorine, after an emetic, (which he generally administers at the commencement of the treatment,) and have had ample cause to be well satisfied. The dose, which I usually give, is from half a drachm to a drachm every hour or two, either alone or mixed with water or other vehicle. As an external application, I employ an ounce of the chloruret of lime with four or six ounces of chamomile flowers, introduced into a bag, which need not be heated when applied it usually retains its virtues for two or three days, as the odour will testify.

"I do not propose these remedies as specifics; far from it. All that I say is, that they have proved more useful in my practice than any others which I have ever employed."-Annales de la Chirurgie.

INTERESTING CASE OF DEEP-SEATED ABSCESS IN THE GROIN.

In the last number of this Review, p. 550, the reader will find the history of

some interesting cases of suppuration occurring in unusual situations, by Mr. Henry James Johnson. The following is in some respects not unlike No. 4.

A middle-aged man, of a healthy constitution, and who had never exhibited any symptoms of coxalgia or spinal disease, was suddenly seized, while in the act of stooping down to lift up a burden, with a sharp pain in the right groin. The pain did not last above a minute; but it was followed by a sense of a dull and deep-seated uneasiness in the part, extending downwards for some way along the inner side of the thigh, and upwards in the direction of the lumbar vertebræ. Flexion of the thigh on the pelvis increased it; and the general movements of the limb were considerably impeded. The man's health now becoming not so good as it used to be, and the local uneasiness not mending, he entered the Hôtel Dieu under the care of M. Roux. At this time there was a firm swelling, of about the size of the fist, in the groin, apparently right under Poupart's ligament. The symptoms were obscure, and it was not easy to determine exactly the nature of the case. The patient, however, after being some time in the hospital, was seized with a shivering fit; and next morning the swelling was found to be more diffused, and an indistinct sense of fluctuation was perceptible in it. The question now for consideration was, where was this abscess exactly situated? Was it in the sheath that envelopes the psoas muscle and the crural vessels and nerves? or was it connected with the sheath of the spermatic cord? and, if the former were the case, was there any reason to suspect the presence of lumbar disease? After well weighing all the circumstances of the case, it was deemed most probable that it was an idiopathic abscess situated in the sheath of the psoas muscle, and caused by the accidental rupture of some of its fibres, at the time that the patient experienced the sharp pain in the groin. After the lapse of a few days, the swelling acquired a larger size, and was then freely opened with the knife: it continued to discharge pretty freely for about a fortnight. At this time the integuments over the trochanter began to become swollen and puffy, and it was therefore suspected that the abscess might extend in this direction. This was found to be the case by introducing a probe into the wound in the groin; the instrument passed down deep among the muscles, so that its point could not be felt outwardly. It was deemed prudent that a counteropening should be made, to prevent the burrowing of the matter. The incision was necessarily deep, to reach the extremity of the sinus: a large quantity of matter flowed out, when the opening was made into it. A tent was introduced to prevent the adhesion of the edges and keep the passage free. In the course of a few days, the discharge ceased from the wound in the groin, and came only from the one over the trochanter. It gradually decreased in quantity, and everything promised a speedy cure at the time when the report of the case was published.— Gazette des Hopitaux.

M. ORFILA ON A NEW ANTIDOTE OF CORROSIVE SUBLIMATE.

M. Mialhe recently announced to the Royal Academy of Medicine that, having taken a solution of the corrosive sublimate into his mouth, he found that the disagreeable taste was almost immediately dissipated by washing his mouth out with some proto-sulphuret of iron recently prepared and mixed with water. From this circumstance he inferred that the latter substance might act as an antidote of the former, and decompose it, giving rise to the chloruret of iron and the sulphuret of mercury-compounds which do not act poisonously on the living body. To ascertain the correctness of this opinion, I instituted, says M. Orfila, the following experiments.

a. I prepared 100 grammes of the proto-sulphuret of iron by decomposing the proto-sulphate of the metal with the hydrated sulphuret (sulfhydrate) of