flatulence and tenesmus were increased he had had several scybalous stools, with excruciating pain during their evacuation. Complained of feeling a large hard body in upper part of rectum. From this time till 10th there was little change-his countenance was pale and exhausted. The treatment consisted in frequent and copious injections. On the 15th he had a violent attack of pain referred to the rectum, but nothing could be felt there. He was ordered hyosciamus and camphor, and other soothing measures. For three days he seemed better, but on the morning of the 22d he was found dead in his bed.

"Dissection. On opening the abdomen, a hard tumour was discovered lying over the last lumbar vertebra, between the lamine of the mesentery, near the inferior part of the ileon, and which pressed on the sigmoid flexure of the colon, where it is about to become rectuin. The surrounding mesentery exhibited no thickened or diseased appearance, and only adhered to the surface of the tumour by loose cellular attachments, easily destroyed by the finger. It was about the size of a small lemon, of a hard bony feel and appearance, and a very irregular shape. When sawn through, the exterior part was evidently bone, and varied in thickness, at different parts, from a quarter to half an inch, whilst the centre was filled by a yellowish-white substance, in appearance and consistence like adipocire, intersected in various directions by spicule of bone. Two small cavities in the centre were lined with innumerable transparent, needle-like crystals, which, however, disappeared after the tumour was dried, and before I had an opportunity of submitting them to chemical analysis. The mucous coat of the bladder was considerably thickened, of a dark vas. cular-plaited appearance, especially about the neck, and coated by a muco-purulent secretion. There was a tumour at the fundus about the size of a small marble, containing purulent matter, which issued into the cavity of the bladder, through two fistulous openings in the mucous coat at that part. The prostate gland was enlarged, and firmer in texture than natural, but without the fibrous appearance of scirrhus. The mucous coat of the rectum was highly inflamed, and there was considerable induration and thickening of parts between this gut and the base of the bladder.

This dissection afforded a satisfactory explanation of what had been previously only matter of speculation. The long-continued and painful tenesmus was obviously to be referred to the pressure of the osseous tumour, on the commencement of the rectum, producing an impediment to the regular discharge of the feces, tympanitic swelling of the abdomen, and great irritation. From the situation and connexions of this tumour, it would appear, that when the diaphragm and abdominal muscles were called into action in expelling the feces, it would be forced back on the termination of the colon, by the pressure of the surrounding parts, and not only impede the feculent evacuations, but also, from its extreme hardness and inequality, irritate and injure the bowel in no small degree.

Occurrence.

In scrofulous habits, the mesenteric glands are sometimes filled with calcarious matter; but bony-depositions are stated by Dr. Baillie, (Morbid Anatomy, p. 134,) to be of rare The few recorded cases of this disorganization, which I have had an opportunity of examining, appear to have originated in disease of the glands of the mesentery, and to have been complicated with organic disease of the bowels. Dr. Donald Monro narrates a case in the Medical Transactions, (vol. ii. p. 361,) in which all the mesenteric glands, varying in size from a pea to a walnut, were hardened and ossified. They were not, however, as in the case above detailed, made up of one large firm osseous tumour, but, like spongy carious bones, they were composed of a number of small pieces, joined together by membranes." 120.

Professor Thompson, analyzed the stone and the bone.

The former was

chiefly uric acid. The latter was not adipocire, nor muscle, nor ligament, but "a little fat was separated," "and, when heated, it behaved like cartilage." We are afraid this does not add much to our stock of positive knowledge.

We relate all the fatal cases, because such are always instructive. Yet they are not so much so as they might be. Dr. Macfarlane, for instance, makes no mention of the state of the wound in the bladder, its size, direction, &c. Yet this is important; for surgeons have attached great importance to the prostatic incision. Mr. Brodie believes that if the left half of the prostate be wholly cut, or, at all events, if the prostatic capsule be cut, the risk of cellular inflammation is very much augmented. Other surgeons have said that the prostate should rather be extensively cut than stretched. How are such points to be decided, if they should ever admit of a decision? By a rigid observation of facts, and by that only. But if facts are superficially observed or recorded, they might almost as well be withheld. We address this remark to the profession, rather than to Dr. Macfarlane individually.

CASE 8. Lithotomy-Extensive Disease of the Prostate and Bladder— Death Eight Weeks after the Operation. J. N. æt. 68, admitted Jan. 18th, 1832. Has very frequent desire to make water, always accompanied by prolapsus of the rectum, which he must replace before the catheter can be introduced, and by paroxysms of excruciating pain extending along the penis to the glans-urine containing a copious whitish-coloured sediment, and occasionally small coagula, decidedly alkaline, loaded with muco-purulent secretion, and depositing mortar-like masses. On introducing a sound, a calculus detected. Prostate about the size of half an orange, hard, irregular. A large catheter passing easily, the prostate was thought to cover the vesical orifice of the urethra, like a valve, which was the fact. The general health was impaired. He had suffered from the complaint for several years, and for the last three and a half required the introduction of the catheter nearly every second hour.

"After the use of acids, frequent doses of the Oleum Ricini, the hip-bath, anodyne enemata, &c., by which the bowels were unloaded, and the appearance of the urine greatly improved, I was reluctantly induced, by the earnest intreaties of the patient, who was suffering most acutely from the disease, and by the recommendation of a consultation, to try the chance of an operation. This was accordingly performed on the 5th of February, and a rough calculus, about the size of a walnut, extracted. He bore the operation, which lasted about a minute, with remarkable firmness, and not more than six ounces of blood were lost. Before he was removed from the table, a large gum elastic tube was introduced through the wound into the bladder. He continued to improve steadily from the third day after the operation. The elastic tube was withdrawn every fourth day, when its extremity was usually coated with calcareous matter, and its cavity filled with viscid mucus. It was near the end of February before I could pass a catheter along the penis into the bladder. This was also removed every third or fourth day, cleaned and re-introduced,―it being thought more likely to hasten the closure of the wound, by retaining the catheter in the bladder for several days at a time, than by introducing it every two or three hours, when the urine required to be drawn off. On the 25th of March, the wound was nearly closed; he had no pain; his bowels were kept regular by medicine; his appetite was good; he had improved decidedly in flesh and strength; and his general health was better than it 13

VOL. XVIII. No. 35

had been for many years. He was, in fact, considered to be out of all danger from the operation; and the symptoms of diseased bladder were much less troublesome than could have been expected. On the following day, (the 26th,) he complained of slight pain in the anus, which became prolapsed. On the 28th, as the urine was turbid, and contained a thick chalky sediment, the catheter was withdrawn, and introduced only when he felt inclined to empty his bladder. There was some febrile excitement; the pulse was about a hundred; the tongue dry and furred, and the bowels loose. He complained of pain and confusion of head; and his eyes were suffused. These symptoms increased; vomiting, hiccup, delirium, and subsultus tendinum supervened. His tongue and teeth were covered with sordes; and, altogether his appearance resembled that of a person labouring under typhus gravior. He died comatose, at the hour of visit, on the 3d of April,-eight weeks and two days having elapsed from the time of the operation.

The body was inspected on the fourth, and the following morbid appearances discovered. The bladder was greatly thickened, contracted, and indurated; its mucous coat was covered with a dark-coloured muco purulent secretion, and in one or two places it was slightly ulcerated; the ruga were in some places so deep, as to produce the appearance of small sacculi. All the lobes of the prostate gland were enlarged, and of a hard, almost cartilaginous texture: the middle one, which projected into the bladder, was of a pyriform shape, and completely covered the orifice of the urethra; on its apex there was a small patch of superficial ulceration. The right kidney contained a cyst, the size of a pigeon's egg, which was filled with a straw-coloured fluid, like urine. It was seated in the cortical substance of the gland, but did not communicate with its pelvis. The inferior half of this kidney was soft and disorganized. The left kidney was small, and its natural structure completely changed. It contained a number of hard, greyish-coloured tubercles, as also pus and small calcareous particles. The rectum, immediately within the sphincter, was surrounded by a large indurated ring of hemorrhoidal tumours of a deep purple colour,” 124.

It will be observed, that in the preceding case the prostate was ulcerated, the bladder in a state of chronic inflammation, and the kidney affected with "greyish-coloured tubercles, pus, and calcareous particles." Mr. Brodie has warned surgeons against operating on patients with ulcerated prostate, and relates, if we remember right, three cases in which the operation proved fatal. In this instance the ulceration was probably not so extensive. In patients who have suffered long from stricture, or stone in the bladder, it is not an uncommon thing to find one or both kidneys studded with numerous small abscesses. They appear to commence as small, solid, yellowish depositions, which gradually soften, and become as they enlarge converted into pus, or pus takes the place of the more consistent deposition. The kidney thus affected would seem to be in a state of chronic inflammation, its capsule peeling off with facility, and its substance being more or less injected. Patients thus affected bear operations on the urinary organs extremely ill. We have seen a man die from the introduction of a catheter, and after death this condition of kidney was found, with a small abscess at the neck of the bladder, opening into the urethra. This patient had an old and bad stricture of the urethra. Such persons die with typhoid symptoms, and, as in other affections of the kidney, there is a great disposition to coma.

Dr. Macfarlane adds to the cases already mentioned, four in which lithotomy was successfully performed in children. The fourth is the only one possessed of interest. The child in that instance was in a very unfavourable

state of health, and every thing seemed to conspire against the success of an operation. But it was successful and completely so. We regret that we cannot find room for the details, but we insert with pleasure the following exposé of Dr. Macfarlane's sentiments on an important question in practice.

"It is hardly possible to meet with a case more unfavourable for operation than the one now detailed. I believe that all those surgeons who are ambitious to acquire and maintain a reputation as successful lithotomists, and who are careful in selecting their patients, would have declined operating on this case, as well as on some of the others already narrated. I am not satisfied, however, that any surgeon, from a morbid anxiety about his own reputation, and a wish to be able to exhibit a long list of successful cures, is justifiable in denying to the diseased, even in doubtful and unfavourable cases, that professional assistance which both humanity and science claim at his hands. I am by no means an advocate for the knife, unless there is a prospect of its being successfully employed; nevertheless, when it is the only means we possess of prolonging existence,-why, even when the prospect is not inviting, should any selfish feelings prevent us from having recourse to it." 1238.

The succeeding case is one of much interest, and our readers will readily see why.

Here the present notice of this work must terminate, but many of the remaining cases will be noticed in the Periscope department of this Journal at convenient opportunities. None have been more earnest than ourselves in recommending our provincial surgeons to publish the results of their experience, and we feel convinced that, if they follow the example now set them by Mr. Fletcher of Gloucester, Mr. Clement of Shrewsbury, and Dr. Macfarlane of Glasgow, they will materially contribute to the advancement of their profession, and raise the reputation of provincial surgeons and of themselves. It is not every one who can write a book worth reading on any one subject; but all well-informed and candid practitioners can communicate what they have seen, and contribute to the accumulating stores of facts. The advice which we should give would be this :-Be scrupulously accurate-be concise without niggardly and unprofitable brevity-and endeavour to group and arrange your cases so methodically, that while each individual shall have its value as a separate fact, they shall still act en masse, and serve for those generalizations without which science can never be materially advanced. Thus we would have surgeons give the general expression of their experience with remedies or with operations, whilst they select such particular cases for particular notice as they deem most fitting. In fine, we hope, ere long, to witness a systematic plan of clinical reporting adopted by our provincial brethren. None will be more happy than ourselves to aid this most excellent object in every possible manner.

XIV.

THE SUBSTANCE OF THE OFFICIAL MEDICAL REPORTS UPON THE EPIDEMIC CALLED Cholera, WHICH PREVAILED AMONG THE Poor AT DANTZICK, BETWEEN THE END OF MAY AND THE FIRST PART OF SEPTEMBER, 1831, AS TRANSMITTED ΤΟ THEIR LORDSHIPS, &c. &c. By John Hamett, M.D. Octavo, pp. 190. (With a Map.) Highley, 1832.

OUR readers are aware that in No. 31 of this Journal, for January, 1831, we inserted a long paper, containing extracts from this Official Report of Dr. Hamett, not then published, and which we accidentally got possession of. The whole Report is now before the public, and is highly deserving of their attention. For the above reason it will not be necessary for us to do much more than announce the publication of the work, our former paper being an analysis of its contents. We deem it proper, however, to observe that the intelligent and zealous author was commissioned by Government, in June, 1831, to proceed to Dantzick, in order to investigate and report upon the epidemic raging in that city. He did so; and discharged his duty with equal assiduity and talent. But, alas! Dr. Hamett is not a "man of the world!" Had one of the contagion-hunters of London gone to Dantzick, he would have returned with a budget of stories, dressed up for the "Powers that be," or rather the powers that were, filled with all manner of tales and hearsays tending to keep up quarantine restrictions, and elevate the crests of the Doctrinaires! But Dr. Hamett was an honest man-that is to say, a fool for his own interest (no man should think of the public when himself is concerned) and reported the truth to the Privy Council. The Lords of the Privy Council could be small judges of the matter, and as his Reports were necessarily referred to other tribunals, it was easy to foretell their fate.

The author was marked as a black sheep

Hic niger est-hunc tu Romane caveto

was written upon the Official Report-and one of the most important documents was no more! It happened, however, that Dr. Hamett took the precaution of having them copied and authenticated at Dantzick, otherwise the missing paper would never have seen the light.

"On arriving in London, I learned that a Committee of the College of Physicians had received instructions to draw up, in a concise form, the facts in my Reports connected with the Epidemic at Dantzick, together with the description and treatment of the disease. This task the College transferred to myself, and my Reports were directed to be given up to me accordingly. I received all back, except Medical Report A, containing a mass of circumstanstial evidence, in support of my conclusions, that the disease had not been imported into Dantzick, and that it did not prove contagious in that city. This Report, it will be proper to state here, comprised certain authentic isolated cases of Cholera, and the four first acknowledged cases of the Epidemic, which had all occurred previously to the first arrival of vessels from Russian ports, together with authentic communications from