together with extravasation or effusion of blood between the dura and pia mater. It is very strange that Dr. M. made no inquiry into this man's history before death. That inquiry would hade been worth the whole disquisition on ante-mortem perfora

tions.

XL.

Essen, sarsa, 3ss. ter die. In the course of a very few days, the character of the sore was completely changed-it looked comparatively healing, was beginning to put on a healthy edge, and lost the curdy matter from its surface. The penis was also not so hard, and the patient, in the course of some days, left the house, thinking he was well enough to return home.-Gaz.

The above case proves that rest, and appropriate remedial means, will frequently exert a salutary influence, even on diseases of malignant aspect. If the above was really an instance of scirrhus, it was cer

PITAL.

I. ULCERATIONS OF THE INGUINAL GLANDS AND PENIS, RELIEVED BY THE CHLORATE OF LIME.

A man was admitted under the care of Mr. Lawrence, on the 9th of July, presenting the following appearances. The penis was indurated throughout its whole extent, and covered with ill-conditioned sores. In the left groin was an ulcerated bubo, the edges of which were thickened and hard, whilst the centre contained a curd-like matter. On the right side was a large irregular swelling, dark in colour, and ulcerated in its centre. The sore was round and hollow, about the size of a shilling, and containing at its bottom the curdy substance existing in the bubo of the other side. The history given by the patient was as follows. He had suffered from gonorrhoea five or six times, and, two years before his admission, had a violent attack, attended with much inflammation and phymosis. The latter ran, indeed, to such a height, that the prepuce was divided, when those ulcers were found upon the glans, which remained at the time of his admission, and had never disappeared. The buboes in the groin were of shorter duration, and had burst of themselves.

He was ordered bread poultice, with the liquor opii sedativus to the sores, and took thirty minims of the tincture of opium night and morning, under which treatment, the irritable state, both local and general, was calmed. He was ordered, on the 11th, five grains of the compound extract of colocynth at bed-time, and the solution of the chloruret of lime to the parts. The health, on the 15th, was improved, and the ulcers perceptibly changing their character.

course be hopeless, or nearly so.

With re

gard to the chloruret" of lime, we have often seen it tried, and cannot but think that its powers are, in general, greatly overrated. In sloughing sores and stumps, it can bear no comparison with the compound tincture of benzoin, and where it is used to correct or destroy the fetor of discharge, the composite odour produced, is infinitely worse, to some noses, than the original smell.

II. All must know how fatal extravasation of urine, from rupture of the urethra, was wont to be. In the present day, however, recoveries are not only common, but far the greater number of cases do well. In the olden time, 'tis scarce some twenty years ago, the practice was, to be sparing of the lancet, and profuse of bark-to make a few punctures in the cellular membrane, with the hope of letting off the extravasated fluid. In the present day, this practice is totally exploded, and a trifling puncture has now given way to numerous and bold scarifications, a practice alike scientific and successful.

Casc. A sailor was received into Bartholomew's Hospital, with immense distention of the scrotum and penis, and great inflammation of the neighbouring parts, from rapture of the urethra and extravasation of urine, in consequence of an old and obstinate stricture. The rup ture would appear to have occurred two days before, and in this condition the man had walked very nearly a mile to the hospital.

Mr. Earle, at his visit, made four or five incisions in the scrotum, and likewise cut down to the urethra behind the

stricture, when a large flow of urine took place. Fomentations were applied, three grains of submuriate of mercury with one of pulvis opii given forthwith, and a saline mixture every four hours. The inflammation of the scrotum, and neighbouring parts, was relieved, the cellular membrane came away in the form of a slough, and, Nov. 10th, three weeks from his admission, the wound was doing well. At this time, the water chiefly came away by the natural channel, although no instrument could be passed through the stricture.-Gaz.

A case of a similar kind lately occurred at St. George's Hospital. Free scarifications in the scrotum, the penis, the pubes, and groins were made by Mr. Brodie, who, likewise, cut down upon the stricture, and tried, but ineffectually,to introduce an instrument thence into the bladder. Free suppuration took place in the cellular membrane, but sloughing was prevented. The patient was affected for the first few days with rather untoward and typhoid symptoms but subsequently rallied. The treatment consisted in salines with laudanum, and afterwards bark.

XLI.

CORK-STREET FEVER

HOSPITAL.

REMARKABLE INSTANCE OF EXTRA-UTERINE FETATION, WITH THE APPEAR ANCES ON DISSECTION.

Case. Ellen Bryan, aged, 30, became pregnant in 1821, and about the expected period of parturition, felt something give way within her. The period passed, without delivery, and the size of the abdomen did not diminish. In a year and half afterwards, a second impregnation took place, and terminated in the birth of a full grown infant. In the course of two years more, Ellen Bryan gave premature birth to a live babe, of about six months intrauterine existence. For the fourth time, she became pregnant, in 1826, and was delivered in the CORK-STREET HOSPITAL, after seven months utero-gestation. original tumour remained unabated. She was re-admitted into the above institution,

The

on the 19th of May, 1827, under Dr. O' Rearden. The following state of disease presented itself at this period.

Countenance pale, dejected, and expressive of long suffering; eyes sunken ; much general emaciation; pulse slightly accelerated and extremely weak; abdomen of immense bulk and prominence, palpably enclosing a large solid substance like a fœtus; the centre of this promi. nency pointing forwards, and exhibiting an encrusted ulcer on its apex, a little be low, and to the right side of the umbilicus. Diarrhoea, 21st May-The encrustation at the apex of the above-mentioned promand has left an aperture into the abdomi inency has detached itself and fallen off, nal cavity from which there is a discharge of much fetid matter, partly ichorous and partly purulent. 27th. May-Diarrhoea unabated: abdominal pain not acute, except when it is rendered so by pressure or by an unfavourable position of the patient; a most offensive odour emitted from the open abdominal ulcer--a gradually increasing dilatation of this aperture-a feeling, on the part of the patient, of being hurt interiorly by a bone. She takes a night pill containing one grain of opium; and, with a view of obviating as much as possible her hourly increasing debility, she is ordered four grains of sulphate of quinine twice a day, and twelve ounces of port wine, which she likes much. 9th. June. The abdominal aperture was hourly becoming larger. It was so wide yesterday as to expose to view the entire cause of this poor woman's tedious malady, viz: the inanimate body of a full grown male infant, which lay out of the womb in the abdominal cavity during more than the preceding six years. It has been taken out by a very intelligent surgeon, Mr. Trant, and is preserved in spirits of wine. It is covered with a semi-coriaceous cutis, which is particularly distinguished over almost the whole of the surface of the shoulders, back, and seat, by an adipocere-like appearance. Her pulse is scarcely perceptible. Portions of intestine have been destroyed by abrasion and sphacelation, and the faces pass out anteriorly through the opening. 13th. June.--Died.

Dissection. Of the appearances exposed to view by the anatomical examination of the body, the following are the

principal: An ample cyst, containing much pus, is situated behind and a little above the right side of the fundus uteri. The thick envelope of this sac consists in a prolongation of the peritoneum, especially of the right ligamentum latum The right fallopian tube is distinctly traceable from both ends towards its centre, where it is connected with the external side of the parietes of the cyst, and is there lost in consequence of its being confounded with this envelope. The right ovarium is somewhat flattened on its posterior side, where it is close to the adjoining side of the cyst. The left ovarium, and corresponding fallopian tube are sound, and in their natural situations. The uterus is sound, and does not bear the slightest vestige of any former laceration, or of any kind of disease.

XLII.

Institution in the month of April, in a very weak condition, being apparently worn down by a slow fever, and lactation beyond her powers. The digestive functions were very much deranged--the urine scanty and turbid-thirst-constipation. The great distention of the abdomen by effusion, prevented any accurate examination of the viscera, as to their state of soundness. There was general emaciation, and a highly cachectic aspect. After a fair trial of diuretics, purgatives, mercurials, and the usual remedies, Dr. Speranza declined to recommend paracentesis abdominis, from a conviction, that this operation is never of any ultimate service; he had recourse, therefore, to the bandage of Monro. Under the influence of the pressure thus produced, the urine became copious, so that, at length, it amounted to fifteen pints daily! In the course of three weeks, the abdomen was reduced to its natural size, and there was no further effusion. The sulphate of iron, squills, and a nourishing diet contributed to a completion of the cure. She was ultimately discharged from the Hospital in perfect

PARMA.

ASCITES CURED BY PRESSURE.

Our readers are aware that Sir Gilbert Blane proposed pressure on the head, for the cure of hydrocephalus, and that the plan has been adopted by some othersnot, we should suppose, with great success, otherwise we should have heard of it. Anasarca of the legs is every where treated by pressure, in the form of bandages, to promote absorption--or, rather perhaps to force the serous infiltration into another and worse locality. Indeed, we have generally observed, that patients have complained of oppression about the chest, or sense of fulness in the abdomen, when tight bandages were applied to prevent or remove anasarcous swellings. Till the secretions and excretions are set free, there is little permanent relief obtained in dropsy of any kind. The principle of pressure has been applied in the following case of ascites, by Dr. Speranza, physician to the Clinical Institution of Parma.

Case. A female had laboured for some months under considerable effusion into the cavity of the abdomen, the consequence of peritoneal inflammation, which had succeeded to a laborious accouchment. She entered the Parma Clinical

It would be a very curious fact, if proved by subsequent experience, that pressure on a distended abdomen caused an increase of the urinary secretion. We could only acount for it in this way :-the pressure augmented the action of the absorbents, or checked the activity of the exhalents, or both-and the blood-vessels being replete with serous fluids, the secretion of the kidneys was augmented, and thus the ascites cured. We think the remedy, especially if combined with diuretic frictions, might be well worthy of trial.

XLIII.

ROYAL WESTMINSTER OPHTHALMIC HOSPITAL.

In our last number we gave a report of a clinical lecture delivered by Mr. Guthrie to the students of the hospital, on the use of several remedies which had been introduced by him, and used on different principles from those usually entertained. The result has in many instances, been something resembling magic-cures hav

ing been effected in cases in a very short time, which cases long resisted all previous treatment. In acute diseases, the success had not been less; and it is our intention, from time to time, to report the treatment of a certain number of cases of each kind of disease, so as to bring before the public the practice of this hospital in every species of complaint to which the eye is usually liable. We may premise with advantage, that the patients, of ten amounting to 160 and upwards, have tickets given them on their arrival, and are called up in succession, a proceeding which prevents the crowding and crushing which took place before it was adopted. Each case is given in charge to a particular student, whose name is at the bottom of the letter, and on whose diligence and attention the statement of it depends; Mr. Guthrie merely superintending the treatment, as his intervention may seem to be necessary, or is required by the student.

Case 1. Thomas Levignon, aged 18, admitted September 23d, 1828, having been ill one month with an affection of his eye, apparently catarrhal inflammation, which had nearly deprived him of sight, when he received a blow from a pot, (on the 19th,) which gave him great pain, and augmented the swelling. He applied alumwater to it, which caused it to subside. At present the conjunctiva is inflamed, the cornea muddy, the discharge viscid, tears hot, pain extends to the side of the face and teeth, and cannot sleep at night on account of it. Mr. Guthrie said this was a case which appeared to require, in almost an imperative manner, the abstraction of blood; but he was disposed to give the students an opportunity of seeing the effect of a different mode of treatment, and applied the ung. argent. nitrat. directing the patient to attend next morning.

24th. Says he is much better, and greatly relieved from pain. The treatment was severe, but it did him good, and he wished it to be repeated.

26th. Rep. ung. 30th. Rep. ung. tober 2d. Rep.

Oc

October 14th. Ointment repeated every second and third day. Patient discharged cured. Case kept by Mr. Taylor.

both eyes, of three months' standing. Ordered the ung. argent. nitrat. to the left eye only on the 7th October.

9th. The left eye, to which the ointment has been applied, is better.

11th. The ointment to be applied to both. Pulv. jalap. c. 3j.

14th, 16th, 18th, 22d, 23d, 25th, 28th, 30th. Ung. argent. nitrat. pulv. jalap. c. 3j. Nov. 11th, Discharged cured. Case kept by Mr. Griffin.

Case 3. Joseph Caries, aged 25, admitted October 18th, 1828. Was attacked five months ago by inflammation of the left eye, in consequence of having got cold; complained of pain in it, attended with itching, and accompanied by a copious flow of tears, which considerably increased the pain. When he applied here for relief the symptoms were these. The eye suffused-chronic inflammation of the cornea and sclerotica, with opacity of the former-the iris slightly irregularslight tarsal inflammation. Ung. argent. nit. No constitutional treatment.

20th. Repeat. 23d Has obtained considerable relief. 25th. Repeat. 28th. Much better-sees now pretty well, which he could not do when he first attendedinflammation nearly gone. 30th, 31st, Nov. 4th. Repeat the ointment. Nov. 19th. Discharged cured. Case kept by

Mr. Molineaux.

Case 4. Louisa Todd, eight years old, admitted October 16th, having been ill four days. Numerous red vessels run on the conjunctivæ of both eyes and eyelids -blush of redness on the scleroticaslight chemosis of the right eye-great lachrymation, with discharge of yellowish matter-intolerance of light, and considerable pain in both eyes. Tongue clean. Ung. argent. nitrat. to both eyes. Palv. jalap. c. 3ss. 18th. Eyes greatly improved. Repeat ointment and powders. 25th. Better, and repeat. 28th. Improving. 30th. Repeat.

Nov. 11th. The ointment and powders have been repeated every second or third day. All appearance of inflammation is gone, and she says she is well. Discharged. Case kept by Mr. Nicol.

Case 5. Ann Allen, æt. 23, 14th Oct. 1828, admitted. Catarrhal inflammation