could be established with absolute certainty, re-vaccination was necessary in all cases in order to test the efficacy of the first operation. This opinion very naturally obtained importance from the fact, that few cases of modified small-pox were known to have occurred after a second vaccination, provided the insertion of the vaccine virus produced an action sufficient to prove that it had been taken up by the absorbents; also, from the disease being observed, in numerous instances, to be arrested in families, and in neighbourhoods, where those already reputed to be vaccinated were again subjected to the operation. When vaccination has been repeated in those who have been previously subjected to the disease, it is found to produce a local affection, marked by very different degrees of intensity. In some, slight inflammation occurs on the second or third day, and then fades away. In others, various degrees of inflammation manifest themselves, followed by a pock or pustule, terminating in a brown or yellow crust, whilst, very rarely, a distinct, regular areola is produced, or the other phenomena of the genuine disease, as will fully appear from the table here annexed. The subject of repeated vaccination has engaged a large feld of inquiry in different parts of Europe; a very full abstract of the results of which, will be found in the work of Dr. Condie on the Diseases of Children, page 458. The second question, therefore, submitted to your committee, was to determine the phenomena resulting when those who have been already vaccinated are again subjected to the disease, and the necessity and policy of re-vaccination. It is to the first portion of this question that the committee have been obliged, necessarily, to confine their attention. It must be very evident that to test fully the necessity or propriety of re-vaccination, would either require that after large communities shall have been a second time subjected to vaccination, time be allowed in order that they may be repeatedly subjected to the influence of variolous contagion, during the epidemical visitations of small-pox, or that the direct test be resorted to of inoculating with small-pox those who have been successfully vaccinated, at different periods subsequent to the primary operation, as well as after a secondary operation, and carefully noting the comparative immunity from the impression of the variolous poison exhibited by each class of patients. In order to obtain as wide a field of observation as was in the power of your committee they applied to the comptrollers of the public schools, soon after their appointment, for the privilege of vaccinating the scholars whose parents would consent to the operation being performed; whether they had been previously vaccinated or not; in order to accertain the degree of impression that would be made in each case by a repetition of the operation, and with a view of watching hereafter the effect or influence it may have in preventing the occurrence of small-pox in the subject of our experiments, should an epidemic of that disease again appear amongst us. But the comp trollers did not at that time consent to our request, and the investigation of the subject had to be postponed. In the early part of the present year, small-pox again made its appearance and excited considerable uneasiness in the minds of the public. Your committee entertaining the opinion that the period was propitious for a renewal of their application to the comptrollers, accordingly did so, and their consent was promptly given. Circulars were then sent to the parents of the children, attending several of the schools, requesting their permission, which was in most cases readily granted, and every facility was offered to carry into effect the object your committee had in view. The operation was performed in nine hundred and thirty-one cases; six hundred and thirty-five of whom took on various grades of action; many of these had been vaccinated three, four, and five times before, and stood in relation to small-pox, chicken-pox, and varioloid as stated in the following account: Nine hundred and thirty-five persons reputed to have been protected by previous vaccination, having distinct cicatrices on the arm, or by having passed through the small-pox, were subjected to the action of the vaccine virus. 50 did not appear on the days appointed for examination. 294 exhibited no signs of inflammation from the process. 52 of these were reputed to have been previously vaccinated twice. three times. four times. 76 had various degrees of inflammation on the fourth day, which had faded before the eighth day 15 of these were reported to have been previously vaccinated twice. to have had the small-pox. 66 66 66 66 varioloid. 181 had inflammation more or less severe, accompanied by a yellow or purulent crust, on the eighth day. 30 of these were reported to have been previously vaccinated twice. three times. 95 had very diffusive inflammation, the pustule still moist on the 8th day. 10 of these were reported to have been previously vaccinated twice. three times. four times. 23 of these were reported to have had the chicken-pox. 179 exhibited more or less inflammation and a brown crust on the 8th day, 10 of these were reported to have been previously vaccinated twice. 57 had a pock with various degrees of inflammation; diffused and irregular in its margin on the 8th day. 2 of these were reported to have had the small-pox. 15 66 66 chicken-pox. 3, viz. a boy and two girls, exhibited a well defined pock and the areola characteristic of the perfect vaccine impression as observed on the 8th day. They are stated not to have been affected with the small-pox, varioloid, or chicken-pox. From the foregoing observations, as well as from those derived from previous practice, your committee are justified in the conclusion, 1st, that vaccination is the best preservative of human life now known against the contagion of small-pox; and although it has not answered the full expectations of its more sanguine advocates by protecting the system in all instances against at least a modified form of variola, which is the case with the small-pox itself, nevertheless, life is very generally protected by it, and humanity and sound practice imperiously call for its continuance. 2ndly. Patients who have been once fully subjected to the influence of the vaccine infection, lose, in a great degree, their susceptibility to a second infection; the susceptibility diminishing still more at every subsequent vaccination. 3rdly. That portion of the community who have been once successfully vaccinated are in the great majority of cases fully protected from small-pox or varioloid. 4thly. A second vaccination does not insure the system in every instance against an attack of varioloid; neither does second vaccination prevent an impression being made on the system by a subsequent operation. 5thly. Upon the recurrence of small-pox in a family or neighborhood, it is all important that all individuals in regard to whom there is any doubt or uncertainty as to the fact of their having been successfully vaccinated, should be subjected immediately to the operation, this being the most certain means of preventing the spread of the variolous contagion. Your committee have not heard of a single instance of varioloid having occurred in any of the children of the public schools vaccinaed by them, notwithstanding the epidemic was prevailing at the time. and subsequently. D. FRANCIS CONDIE, Committee. Accompanying this report there was presented a table containing the name and age of each individual re-vaccinated by the committee, the number of times each had been previously vaccinated; noting those who had been affected with small-pox, varioloid, or chickenpox; and the appearance of the arm on the fourth and eighth and twelfth days, with remarks on the result of each case.-Summary of the Transactions of the College of Physicians of Philadelphia. Polypus of the Rectum-Clinical Lecture, by M. Guersant, Jun.A little girl was lately admitted into the Hôpital des Enfans under the following circumstances:-Two months since, blood was passed in small quantities with the motions, and during the expulsion of the fæces a red tumour was observed to protrude from the anus. When a child presenting these symptoms is brought to a surgeon, it is natural to suppose that the case is one of prolapsus ani: this opinion must not, however, be exclusively adopted; we have several times detected in such children the presence of polypus in the rectum. It is worthy of remark, that no ancient or modern work on the diseases of infancy has alluded to this form of disease. M. Stoltz, in 1831, was the first to give a history of the symptoms, and two cases only were previously on record: one published in "Hobold's Journal," 1828, by M. Schneider; the other, by Dr. Lange, of Berlin, in 1776. The first signs are those above mentioned, viz., sanguineous motions, and tenesmus; defæcation gradually becomes more and more impeded, in proportion as the polypus increases in size, and is accompanied by violent efforts of expulsion, which force out from the intestine a red, even tumour, at first easily reduced. We have often noticed a sign which we conceive to be of some value-it is the presence of a groove or furrow on the surface of the fæces, caused by the presence of the polypus; but the issue of the tumour through the anus is the only certain diagnostic sign. During the first period of the complaint the swelling is round, and 'slightly flattened at its sides; the external segment is more voluminous than its intestinal portion. Authors do not agree upon the nature of these growths: some consider them to be of a fibro-cellular structure; others, on the contrary, believe them to be always of a mucous texture. Thus, M. Stoltz thinks, that in many cases, they are the result of frequently repeated prolapsus ani, a portion of mucous membrane incarcerated in the ring of the sphincters becoming congested, swollen, and pediculated after a certain period. Such may be, in some instances, the real mode according to which polypus of the rectum is generated, but there are many exceptions-thus, polypus is frequently observed on mucous surfaces unprovided with sphincter muscles; besides, prolapsus ani has other well-known results; let us add, that polypus has been observed in subjects who had never suffered from prolapsus ani. We have usually found these polypi to consist of a mucous sheath borrowed from the mucous membrane of the rectum, enveloping a spongy texture. So long as the tumours do not issue through the rectum, a hemorrhagic discharge from the intestine, and the nature of the stains of the linen, cannot furnish a positive basis to the diagnosis; the finger must be introduced per anum, the pedicle of the tumour accurately circumscribed, and the spot of its insertion precisely ascertained. Although the prognosis must usually be favourable, still the abundance and frequent return of hemorrhage may seriously injure a child's health, and it is therefore necessary to come to a speedy determination when once the nature of the disease has been correctly ascertained. The spontaneous cure can be readily understood; the polypus, gradually expelled by efforts of defæcation, drags more and more upon the pedicle, which daily diminishes in diameter and increases in length, until at last it yields to the frequent repetitions of the efforts; the polypus falls away, and a spontaneous removal of the complaint may be said to have taken place. Perhaps even such polypi may have been the unknown and unsuspecting cause of rebellious diarrhea, which ceased after their spontaneous expulsion, after medicines of various kinds had previously been exhibited without success. We do not approve of the use of caustics, because their action is uncertain, and their application in cavities like the rectum is always inconvenient, and sometimes unsafe. Excision we adopt only when the neck of the tumour is very narrow, because even a slight hemorrhage may endanger the life of a child. We prefer to all other methods, simple ligature, because all danger from loss of blood is obviated, and the little patients suffer no pain: in general, when the implantation of the pedicle is not very high, the threads may be simply carried with the finger round the neck; but, in the contrary case, the introduction of the speculum ani considerably facilitates the operation. London Medical Times. Dislocation of the Shoulder-M. Robert exhibited to the meeting of the Society of Surgery a dislocation of the humerus downwards, artificially produced on the dead subject. The head of the bone rests. upon the ridge of the scapula, immediately beneath the glenoïd cavity, in a sort of groove formed in front by the subscapularis, and posteriorly by the long portion of the triceps muscle. The form of displacement had been admitted by T. L. Petit, Boyer, A. Cooper, &c., and M. Malgaigne, in refusing to admit its possibility, had, M. Robert believed, been guilty of error. M. Malgaigne insisted that M. Robert's artificial luxation was not downwards only, but also forward; the head of the humerus being on the inner side of a line drawn perpendicularly from the glenoïd surface. M. Chassaignac had collected twelve post-mortem examinations of recent dislocation of the shoulder; the head of the humerus was most generally found to lie on the anterior face of the scapula, inside the glenoid cavity; and at a variable distance from the coracoid process. Sometimes it may rise as high as the basis of that bony projection; |