The rupture of the foetal cyst is far more frequent in tubal pregnancies than in the other kinds, the difference being due to the amount of distensibility of the tissues. M. Goupil thinks that intestinal tubal pregnancies terminate by rupture very early; but Dr. Farrel supposes that the thickness of the surrounded tissues is a protection, and that they are likely to allow of the foetus to develop to a much greater extent than in other kinds of extra-uterine pregnancies. Professor Schultze, of Jena, relates a case where the foetus was thirty weeks old, no rupture took place, but fistula formed by ulceration into the rectum and bladder; the abdominal wall also opened by abscess, through which the foetal bones were removed. The patient recovered her health perfectly. There are two symptoms premonitory of the rupture-pain and syncope; the latter is often repeated. The prognosis, if hæmorrhage takes place, is invariably fatal; but if the foetus die before this occurs, many extra-uterine pregnancies terminate happily. M. Goupil thinks that surgical intervention is hardly warrantable; but Frerichs has published a case in Virchow's Archiv,' xxix, 3 and 4, where the growth of the foetus was arrested by injections of morphia through the vaginal wall. Dr. Greenhalgh, in the Lancet,' April, 1867, reports a case where he passed a hair trocar into the cyst and drew off the liquor amnii: the patient did well after the operation: Galvanism is not unlikely to be of service, and gastrotomy may be sometimes legitimate. When intra-peritoneal hæmorrhage has taken place without death speedily following, we must keep the patient at rest, and try to ward off death by food, stimulants, and ice. In other respects, an expectant treatment is the only course left us. As before said, we purpose noticing the second volume of Bernutz and Goupil's work in our following number. REVIEW IX. Official Report of the Committee appointed to inquire into the ALL such reports as the one now before us are pretty sure to be more or less instructive as well as interesting; for whatever may be the ability with which they have been prepared, or the soundness of all the conclusions arrived at, a number of authentic data relating to the epidemic in question are made public; and these data cannot fail, when carefully investigated, to throw some light on the history of the disease. The present is not the first record of the sort which has, of recent years, been published in respect of visitations of this pestilential scourge in the Bermudas, as we shall have in the sequel occasion to note. This numerous group of small islands, clustered from east to west, is in mid ocean, intermediate between the Bahamas and Nova Scotia, and nearly 600 miles distant from the American continent. Their latitude, about 32°, is the same as that of Charlestown, the capital of South Carolina. The most easterly island of the group is St. George; it is the chief resort of the mercantile shipping, and there too the principal military forts are situated, and a large portion of the troops are situated. Ireland Island, the most westerly, is the seat of the dockyard and naval establishment. Hamilton, the chief town, where the governor resides, is on the central or main island. There is no highland in any of the islands; their general elevation above the sea-level is seldom greater than between 20 and 30 feet; the highest point in the whole group does not exceed 300 feet. The prevailing rock consists mainly of a calcareous sandstone, very porous, and generally so soft as to be easily cut with a handsaw. The soil is very scanty on the hills; but in the hollows it is sometimes two or three feet deep, and very fertile. There are marshes of considerable extent on the main island; the water in them is always more or less salt; it rises and falls with the tide, showing its connection with the sea. There are no fresh-water springs anywhere; consequently, rain-water is universally made use of for drinking and culinary purposes. It is collected from the roofs of the houses, and stored in underground cisterns, which are often in dangerous proximity to cesspits. The greatest rainfall is in July, August, and September; the average fall for the year is about 60 inches. The climate resembles in many points that of the Northern Bahamas; the heat of the summer is tropical, and not refreshed by regular land and sea-breezes as is the case in most of the West India islands. The frequency of storms maintains the character given to the group of being the "still-vexed Bermoothes." Nothing unusual in respect either of the weather, or of the ordinary prevalent diseases, had been observed by the medical men prior to the appearance of yellow fever in 1864. The only remark on this head worthy of notice, relating to the antecedent atmospheric condition, was made by Dr. Hunter, a resident civil physician at St. George's where the earliest cases occurred, and who had witnessed the two previous epidemics of yellow fever, to the effect that, for some time immediately prior to the occurrence, "the atmosphere had been in a very dense and oppressive condition; there were evidences of the presence of great moisture, and in general it appeared to be in so unwholesome a state as to induce me to mention to Dr. Franklyn (the principal medical officer of the troops), Dr. Burland, the healthofficer, and Dr. Everett of the 39th Regiment, my conviction that fever would speedily develope itself-an anticipation which in a few days was verified."1 There was, however, no want of predisposing local agencies at the time to give force and wings to any zymotic poison which might find its way among the inhabitants of St. George's; a seaport town, close and confined, abounding in filth and nastiness everywhere, underground as well as on surface, and without any appliances whatever to get rid of the abominations that meet one in every direction; with many houses, at all times unwholesome and ill-ventilated, then crowded to overflowing with a reckless and dissolute floating population from the numerous blockade-runners and other vessels (which during the American civil war constantly plied between Wilmington in South Carolina, the Bahamas, and Bermuda), and also with a large influx of laboring people to provide for their wants, and to assist in coaling the steamers. Crowds of drunken seamen often spent night after night sleeping in the open air. The demands for provisions of all kinds increased enormously; meat, in consequence of the high rate of wages, being freely and generally used. The slaughter-houses, all of them in the town, were in constant requisition; and as they, in common with privies and other foul outlets, drained into the harbour, in which there is very little current, there was a pretty constant presence of floating blood, offal, and other offensive matter, mixed with seaweed, floating lazily past the wharves. And all this under the fiery heat of a nearly tropical summer. The description of the place reminds the reader very much of the account given of Gibraltar in the early years of the present century, when there was a large congregation of troops and of crews of ships during the war, and the "Rock" was reeking with festering impurities in every direction. Yellow fever, it will be remembered, raged with destructive fury on several occasions among the garrison and civil population. As to the origin and primary source of the pestilence in 1864, 1 Prior to the appearance of the epidemic in 1853-and the same had been the case in that of 1843-there was an unusual prevalence of severe bowel complaints, several of the cases assuming all the characters of malignant cholera, and proving rapidly fatal. In 1853 more especially, the expectation of some impending great sickness seems to have been very general, for some time before the first cases of yellow fever occurred that season. there was, as usual, great discrepancy of opinion; some maintaining that it sprang up, no one could say how; while others, the Bermudians themselves especially, held it was no product or growth of their country, and therefore that it must have been imported from abroad. That yellow fever had existed at Nassau in the Bahamas, and in several places in the Mexican Gulf, for some time before it appeared in Bermuda, is beyond doubt: the fact, however, was not, it seems, officially known to the Bermudian government. Most probably, the disease was present in Wilmington also, as it certainly was in some other seaport towns of the Southern Confederacy, during the year. From a list of thirty vessels "entered at St. George's" between the 4th of June and 30th of July, nineteen were from Wilmington, seven from Nassau, two from St. Thomas', one from Jamaica, and one from Porto Rico. The prevailing belief among the Bermudians was that the pestilence was brought to them by the ship Fannie, that arrived on June 13th from Nassau, which place she had left four days previously. As she had entered the port without hoisting the yellow flag, the quarantine doctor did not deem it necessary to visit her at the time; and it was not till several hours after her arrival, when, in consequence of the governor informing him of a rumour that yellow fever existed at Nassau, he went on board to learn all the particulars. He was "quite satisfied that there was then no trace of infectious disease on board, and reported accordingly;" but by this time the crew and passengers had already landed, and were dispersed about the town in different directions! The only persons who had had any ailment during the voyage were one of the passengers, a paralytic, and another man, a carpenter, Alton by name, who had been suffering for some time from intermittent fever. This man had taken up his quarters in one of the lodging-houses on shore; "its sanitary condition would be considered bad." On the 18th, he consulted Dr. Hunter, who recognised his illness as tertian ague, and prescribed the usual remedies, which speedily made him feel better. From the day of his arrival on to the 23rd, Alton continued to "walk about and enjoy himself." On the latter day, feeling very unwell, "he again applied to me," says Dr. Hunter, "with suspicious symptoms, which I treated as for yellow fever, and attended him up to the time of his death on the 30th." There seems to be 1 In none of these vessels had any cases of yellow fever, as far as was known, occurred during the voyage, or existed on arrival. The first vessel quarantined for yellow fever during the voyage was the Apus, from Nassau, which reached Bermuda on the 29th June. She, with all on board, was kept in quarantine for upwards of a week, and then cleaned and fumigated. No fresh case occurred. The Fannie left Bermuda on the 14th, the day after her arrival, for Greenock, which she reached on the 27th, without having had any sickness during the voyage. no doubt that this was certainly the first death from the pestilence in St. George's; but whether it was the first case seems somewhat uncertain, for one of the resident medical men maintained that he had treated two, at least, of the native labourers who had been engaged on the wharves (one of the men, it is stated, had been at work on board the Fannie), for what he considered to be attacks of the fever, a few days previously to the 23rd, the date of Alton's seizure. As both men recovered, there may be a doubt as to the exact nature of their illness; but the fact is nevertheless noteworthy, as it serves to show that it was certainly about the end of the third, or the beginning of the fourth, week in June that the earliest manifestations of the impending sickness were recognised in St. George's. To complete the history of Alton's case, it must be added that a coroner's inquest was held (for what good purpose it is not easy to understand), when a verdict was returned that "he died by the visitation of God, but whether of yellow fever or not the jury could not determine." The lodging-house was ordered to be forthwith emptied, and the inmates were placed, by the advice of the health officer, under canvas, " and guards posted over them for eighteen days to prevent communication." The house was then thoroughly cleansed and fumigated, and no case of fever appeared there again until late in August, when it was raging all over St. George's. So much for the first unequivocal and fatal case. The second case also occurred in a stranger, who, after living entirely on board a vessel (which arrived at Bermuda from Wilmington and Nassau on the 10th of June) in the harbour until the 24th, went on shore to a lodging-house, where he continued, it would appear, in health till July 10th, when he was attacked and died with black vomit on the 17th. He had had no communication with Alton, or with the house where he died. On the 18th July, a sailor, who had been found drunk in the streets on the previous day, died with black vomit. "Nothing was known about the history of this man." The disease had by this time appeared among the troops at St. George's. A serjeant of the 39th Regiment was attacked on the 16th, and died on the 22nd. The regiment left for England five days later, and no other case occurred subsequently in the corps. The 2nd Regiment, which replaced it at Bermuda, and which had arrived from Gibraltar only on the 16th, was, as might be expected, soon infected. Two men were attacked on the 23rd and 24th; and soon after this date, the disease became general among both civilians and the military in the town, and its neighbourhood. By this time also, the disease had begun to appear in the other islands of the group; most of them seem to have |