and a fistulous opening beneath the superciliary ridge, admitting a probe to the back part of the orbit. A fortnight after his admission, he was seized with shivering, nausea, quick pulse, somnolency alternating with restlessness, hot and dry skin, flushed face. These symptoms subsided; but suddenly, on the 30th of March, he became insensible, and the muscles on the right side of the body were paralysed. There was stertorous breathing, immovable contraction of the pupil to a point, slow pulse. Some white curdy matter escaped from the fistulous opening above the eye, and trepanning of the frontal bone above the orbit was proposed but not done. Leeches were applied to the head-blood drawn from the temporal artery, and the bowels with difficulty opened by strong purges and clysters of turpentine. All was in vain, for in five days after the appearance of the apoplectic symptoms, he died.

"Examination of the body, 24 hours after death.-A tumour white and cheesy, of the size of a large walnut, lay above the left Orbit, about the middle of the Superciliary Ridge. It appeared to have been formed between the tables of the Frontal Bone, which it had separated from each other, producing absorption of the Cellular Structure; also of the Inner Table, and of the Orbitary Plate, so that the Tumour was in contact with the Eye-ball beneath, and the Dura Mater behind. The Dura Mater was adherent to the Tumour on one side, and to the Pia Mater on the other, and at the place of adhesion was blackened for the space of a shilling. Immediately behind the Tumour was an Abscess, occupying the whole anterior Lobe of the left hemisphere of the Brain, and containing three ounces of fetid pus. The Medullary substance of the Brain, around the Abscess, was softened, and had a yellow tint. The vessels of the Brain were turgid with blood, and there were two ounces of serum in the Lateral Ventricles."

What extensive mischief in the brain had occurred, and yet how insidious, how trifling the symptoms were ! This is not uncommon in cases of abscess of the brain, and should teach the practitioner caution in diagnosis and prognosis. As the case turned out, it was well that trephining was not had recourse to.-Midland Reporter.

VIII.

HOPITAL DES VENERIENS.

ON THE INFLUENCE OF MERCURY ON THE FUNCTIONS OF THE UTERUS BY ALEXANDER COLSON, M.D. Formerly HouseSurgeon of the Hôpital des Veneriens, &c.

The functions of the uterus, both in a state of menstruation and impregnation, are often disturbed by strong medicinal agents; and as mercury is used in this country, to a greater extent than in any other, excepting, perhaps, America, it may be interesting to inquire, what are the effects of this medicine on the uterine functions. Such inquiry can best be prosecuted in a Lock-Hospital; and it is to this subject Dr Colson has directed his attention.

The uterine derangements produced by amenorrhoea, and abortion. These effects mercury, he observes, are, mænorrhagia, Dr. C. illustrates by a series of cases, one or two in each class we shall briefly state.

1. Manorrhagia. A young woman, 18 years of age, was received into hospital on. the 17th October, for the cure of vegetations about the labia. She had been regular in her menses for four years previously. She was put on the use of Van Sweiten's liquor, (solution of oxymuriate of mercury) and eight days afterwards complained of pains in the abdomen, but especially in the loins and hypogastrium The menses came on eight days in advance, and they continued to flow during more than two months that she remained in hospital. The mercury had no effect on vegetations. They were excised-and in eight days afterwards, the patient was discharged cured. Four or five other cases are detailed, showing the manorrhagic influence of mercury; but the above is a sufficient illustration.

2. Amenorrhaa. C. Virginie, aged 19 years, had contracted a syphilitic complaint, three months after she went on the town. She entered the Venereal Hospital, and was put on the use of the oxymuriate, which affected her mouth. Hitherto she had been regular in her courses; but now they stopped, and

continued so all the time she was at the bospital. Two applications of leeches to the vulva were made in vain, as well as sinapisms, pediluvia, &c. She continued nearly three months in hospital, and left it in a state of amenorrhoea and general bad health, though the syphilitic complaint was cured.

IX.

GUY'S HOSPITAL

tal, the menses re-appeared. Six other cases of a similar kind, are detailed by the author.

3. Aborption. A female, aged 24 years, six months pregnant, was received into the hospital, in the month of October, for the cure of gonorrhoea. She was subjected to mercurial frictions! At the end of a fortnight of this treatment, she complained, that she no longer felt the motions of the child, which previously were very distinct. She also complained of a sense of weight at the lower part of the abdomen, and in the groins. This state continned three or four days, and ended in the abortion of a foetus dead, and apparently of about seven months.-ARCHIVES.

This case is followed by five others, where the premature expulson of the foetus was reasonably referrible to the exhibition of mercury. The author remarks, that miscarriages are very common in the Venereal Hospital of Paris, though this accident is usually attributed to the syphilitic complaint, and not to the mercury employed for its

cure.

Dr. C. is of a different opinion, and attributes the abortions to the mercury. We do not deem it necessary to enter into the reasonings adduced by our author, respecting the modus agendi of mercury on the fœtus. The facts are of more value than the arguments; and, as far as these facts go-and they are not very few in numberthey offer fair testimony of the injurious effects of mercury on the functions of the uterus. How far the particular mode of administration in the Parisian Hospitals, may increase these bad effects of mercury, we are not able to determine, but this short notice of a lengthy memoir may convey some useful precautionary hints to the English practitioner.

An unmarried man, ætatis 30, entered this hospital with a tumour in the right breast as large as one's fist, hard, and irregular. Five years previous to adinission, he had met with a blow upon the nipple, and two months afterwards noticed a small, soft tumour, quite unaccompanied with pain. The tumour gradually increased in size, but continued soft for two or three years, when he found it growing harder; after which time it chanced to be exposed to repeated blows, and became the seat of frequent lancinating pains. Five months before his admission, two nipple-like projections appeared, and over these the skin became discoloured as if about to fall into ulceration.

Under these circumstances, Mr. Cooper removed the disease by the knife, when dissection of the tumour disclosed its true nature. A body as large as a walnut, consisting of fibrous lines radiating from a central cartilaginous hardness, formed the nucleus, around which there appeared condensed cellular membrane. The patient bore the operation ill, and the reporter of the case observes that he possessed "a womanly disease, a womanly aspect, and a womanly spirit."

Schirrus of the male breast is undoubted

ly rare, but instances certainly occur now and then. We remember having witnessed a tumour having all the characters of scirrhus in the breast of an octogenarian, who had neither a womanly aspect nor a womanly spirit at all. Considering that at his time of life the disease was not likely to prove of any material detriment, the operation was not recommended by the surgeon.

X.

ROYAL WESTMINSTER OPH

THALMIC HOSPITAL.

There are now 23 cases of cataract attending at this hospital, some lately operated on, others in a more advanced stage of recovery, and a greater number either under

going, or awaiting treatment or operation. In three cases the cataract is combined with glaucoma. Those students who have attended for even three months, have been able to point out the complication with the greatest ease. Mr. Guthrie has on several Occasions lately described the difference between them. Where glaucoma existed he said, "the disease usually came on about the middle period of life, from 45 to 55. In women, it generally followed the cessation of the catamenia, and was a point of great importance to be attended to at that period, inasmuch as most of the defects of sight which women laboured under about that period might be attributed to some negligence in their treatment at this time. Pain is usually felt in the head at intervals, which soon becomes fixed over the eyes, and on the side of the head, sometimes over one temple and eyebrow, sometimes on both; this is often excruciating, and with its increase the sight fails. At the end of from two to three years, the pains cease of themselves, even where no medical assistance has been sought; but not before the sight has been destroyed." It was very remarkable Mr. Guthrie said, that Nature seemed to be satisfied with the mischief done, as soon as vision was lost; the pains then ceased, and the sufferer remained in comparative comfort, save that sight was gone. During this period, several slow, gradual changes took place in the internal structure of the eye, accompanied by corresponding external appearances. The cornea became very early less brilliant, the iris slightly discoloured, the sclerotica gradually changed from its natural white, to a yellowish, or even a shade of a leaden colour; tortuous vessels of a dark red colour slowly developed themselves at the circumference of the eye, spreading out their ramifications as they approached the cornea, which was frequently surrounded by them, the vessels seeming to penetrate, or in other words, to come out from within at a very little distance from it. Whilst these changes were going on, others of more importance were taking place within; the choroid coat was becoming varicose, the retina thicker and opaque, the iris irregular, the pupils fixed, irregular, and dilated; vision daily decreasing. At last the lens becomes opaque, and of a greenish colour, is protruded against the iris, which is convex in appearance, and apparently changed in colour as well as in structure, and is pressed forwards against the cornea; or the pupil

dilated irregularly to its utmost extent, leaves scarcely a distorted ring of iris visible at the edge of the partially obscured cornea through which it is seen. The eyeball is harder to the touch. The patient has now lost all sense of light, but is free in general from pain.

Charlotte Johnson, aged 49, lost the sight of the left eye more than two years back, and applied for advice the 20th Nov. 1828. Says she suffered great pain at first over the eye, in the eyebrow, and on the side of the head, but that she has none now, and has applied because she thinks the other eye is failing. A large cataract of a whitish colour, with a slight shade of green, is immediately seen on looking at the eye; the pupil is dilated to its utmost extent so as to appear a mere ring, of an irregular form; the sclerotica is of a dull, and somewhat leaden colour, some three or four large, tortuous vessels of a dark red colour, run from the circumference to near the cornea, which is not clear and shining. She has no sight whatever, and cannot distinguish light from darkness. There is little alteration to be observed in the other eye, save perhaps a less degree of brilliancy than is natural to the cornea, and a little sluggishness in the motion of the pupil; the sight is diminishing. The treatment has been cupping behind the ears, a blister to the neck, and purgatives from day to day, such as the pulv. jalap. c. or the pil. hydrarg. c. gumbogia. The woman thinks her sight rather better. In another case in which the disease had commenced in both eyes it has been arrested; and in a third fully formed and combined with cataract, the pains have been removed, and the patient rendered comfortable. Mr. Guthrie said it was in the treatment of these and other unfortunate cases of a similar description, that the students should accustom themselves to examine the eye, so as to do it with sufficient firmness and gentleness; but which would be only acquired in perfection by doing it on each other. In all operations for cataract, the surgeon should do the whole without an assistant, particularly in that by extraction, and in every case, almost without an exception, the incision should be made upwards. It was equally practicable, and as easy of execution on the left as on the right eye, when the surgeon had been properly taught. Mr Guthrie then proceeded (Tuesday, Dec 9th) to operate on the left eye of Mrs. Fordham, affected with hard cataract. Being seated on a

high chair which supported the head, he elevated the upper lid, with one finger, and fixed the eye with another, the hand being passed from behind over the head. The lower lid was pressed by the little finger of the right hand brought round in front, which also rested upon the edge of the orbit, and formed the point of support for the hand. The incision of the cornea upwards was then made by one steady equal passage of the knife through it; Mr. Guthrie stating at the same time, that he generally left a small portion of the cornea at the upper part undivided, in order to prevent any sudden spasm deranging the internal structure from the want of resistance occasioned by the whole of the upper part being too rapidly divided. The right angular hook was then introduced and the capsule torn. The lens readily came through the opening, when the eye was bound up. Little or no pain followed, there was no occasion for either bleeding or cupping, and on the fourth day, the patient was walking about, with only a shade over the eye, seeing very well.

and she was now sunk into an extreme state of dejection. She begged to be continually watched, lest she should yield to this strange propensity. The appetite is bad-bowels loose-stools dark and offensive-has occasionally discharged portions of tape worm from the bowels. Pulse natural; sleeps ill. This account is taken from the Dispensary report-book, October, 1824, and the treatment need not be men. tioned, as the symptoms continued without alteration till March, 1825, when the patient took the small-pox. During the eruption, the mind was serene and happy, and she was free from the dreadful tempation by which she had been previously harassed; but, upon the subsidence of the smallpox, the disease returned with its former horrors.

About the middle of April, the disease, without any apparent cause, began to decline, and she was, at the end of the month, discharged from the dispensary by her own request: her child was now six months old. She nursed it herself from its birth, and continued to do so till it was twelve months old. She remained free from any disorder until the Spring of this year, 1828, when she had another child, and, about a month after the birth of it, she was assailed by this propensity to destroy it. The symptoms continued till the child was half a year old; and from that time have gradually declined. Occasionally for a few days, a sort of metastasis takes place; the propensity to destroy the infant entirely subsides, and the place of it is supplied by an equally strong disposition to suicide. It is worthy of remark, that during the most distressing periods of her disease, she is perfectly aware of the atrocity of the deed she is so powerfully impelled to, and prays fervently to be enabled to withstand so great a temptation. She has repeatedly told Dr. Hawkins, that the inclination to destroy her child has been so powerful, that she should certainly have yielded to it if she had suffered herself to use a knife even at her meals;-for a knife is the instrument which she feels necessitated to employ in the perpetration of the act. Whilst this extraordinary state lasts, the bowels are uniformly relaxed and the stools of a dark colour and offensive odour. She has suckled all her children

for twelve months: she has had three children, but this dreadful state of mind has supervened on the birth of the two last only. It may be proper to observe that, when suffering from any bodily indisposition, the mind is serene and happy, and free from any kind of morbid feeling. This poor woman is by no means deficient in affection for her infant even in the most trying period of her disease. This case appears of much importance in a medicolegal consideration. Is she of sound or unsound mind? And supposing, in this case, suicide were committed, and a verdict of insanity were returned, should not the same verdict be returned, supposing infanticide were the crime which the jury had to consider? The case altogether presents a very remarkable moral phe

An incision was made from the upper edge of the swelling, to the extent of three inches and a half. The cellular texture and fasciæ, which latter were not distinct, were divided, and a very thin peritoneal sac exposed a small opening being made towards the lower part of it, the omentum appeared; and on the sac being slit up, a little fluid escaped, and the contents were fully brought into view, being a very large portion of omentum and colon, amounting to half a hatfull, the omentum being thin, membranous, of a grey colour, with its vessels ramifying on it in a very distinct manner. The colon inflated and inflamed. The fascia of the external oblique

having been slit up, the stricture was seen to be at the inner ring, which was divided upwards, so as easily to admit the forefinger, which could be passed either before or behind the intestine into the abdomen Portions of intestine and omentum were drawn down, in order to facilitate their reduction, but the efforts of the patient, who could not be held steadily, or kept from calling out, together with the weight of so large a quantity of intestine and omentum, caused each part to protrude again as fast as it was returned. Mr. Guthrie, with that coolness and presence of mind for which he is so remarkable in all operations, seeing the cause of the difficulty, requested Mr. Lynn to return the intestine, whilst he had the patient's body bent forward, and collected and supported all the protruded parts, with both hands, so as to take off their weight, when the whole was returned without the slightest difficulty, and Mr. Guthrie placed his three fore fingers in the incision through the stricture, to show the size of the opening. The wound was closed by a suture, sticking-plaster, and bandage. An enema was directed to be given and repeated, and sixteen ounces of blood to be drawn from

the arm within the hour, if no signs should occur forbidding it. Before Mr. Guthrie left the hospital, he found the pain in the abdomen had returned, he therefore directed 20 ounces of blood to be immedi

ately drawn from the arm. Half past four. -Mr. Guthrie visited the patient, and directed 12 ozs. more blood to be drawn, which almost immediately lowered the pulse. Half past eight.--Mr. Guthrie, finding the patient had had four evacuations, and that the symptoms of inflammation were fast disappearing, ordered:-R. Hydrarg. submur. gr. vj. Ext. opii, gr. jss. statim. Ol. ricini, 3j. mane.

16th. Mr, Guthrie visited the patient at 8 o'clock, who had passed a tolerable night; but there being some pain near the wound, he directed 20 leeches to be applied to the abdomen over the spot; pulse 108, neither hard nor full. Half past three.The leeches bled well, and he is much relieved-has had four motions since morning: diet, weak tea only. R. Ol. Ricini, 3ij. sextis horis.

17th. Going on well; pulse 94-bowels well open.