of which they no longer can relieve the system of superfluous water of the system. Dr. Bright states, that the urine is albuminous in all cases of renal dropsy, and he regards this condition as pathognomonic. Dr. Christison has in similar instances detected urea in the blood. As far as our observations extend, we should say that the quantity of urine is very unusually small, and that it diminishes in the progress of the disease. The thirst is also not so consider

able as in other dropsies.

It is still a question, what is the true nature of the changes which the kidneys undergo; it is too much the case in the present day to ascribe every example of ramollissement to a slow inflammation; there is seldom any pain, and if there is, it is rather a dull heaviness than an acute feeling; hæmaturia in several cases has preceded the first symptoms of dropsy. Many cases of what have hitherto been deemed essential, or idiopathic dropsy, are probably of the character of the above-related.

Case 4. A CONTRACTION AND OBLITERATION OF ONE OF THE URETERS, WITH SUPPURATION OF THE KIDNEY.

A man, æt. 73, was brought to the hospital in a state of insensibility; on examining the stomach, a large swelling was felt in the left hypochondrium, extending from the edge of the ribs to the crista ilii; the patient could give no account of it. He died in an epileptic fit on the following day.

Dissection. Ramollissement of part of the cerebellum. The tumour of the left hypochondrium arose from a diseased kidney; it formed an immense cyst, which distinctly fluctuated under the finger; it extended from the diaphragm to the iliac fossa; when punctured, nearly three pints of true pu flowed out. The pus had not been contained in one bag, but in numerous compartments separated from each other by imperfect partitions; and each of which was lined with a distinct mucous coat. The outward walls of the kidney varied in thickness from one to three inches, and here and there presented some traces of cortical renal tissue; no calculous was found. The ureter was

so enlarged as to resemble the large intestine; its upper extremity formed part of, and could not be distinguished from, the pouch of the kidney; it was much thickened, and strongly fibrous; an inch from the bladder, it resumed its natural dimensions, and had been converted into an impervious hard cord. The bladder was healthy. The right kidney double its usual size, and of normal structure.

Remarks. It is probable that the contraction of the ureter was the original cause of all the above mischief.

Case 5. DIABETES MELLITUS, FOLLOWING ANTI-SYPHILITIC

TREATMENT-INJURI

OUS EFFECTS OF AN ANIMAL Diet. A man, aged 24, a short time after he had passed through a course of mercury, found the following symptoms come on: heat and dryness of the mouth; extraordinary thirst; and great increase of urine: he became gradually worse, and when admitted, his face indicated much distress; a yellow circle round his eyes; extreme emaciation and debility; skin dry; thirst intolerable, with a feeling of pain in the epigastrium; bowels costive; in the course of a night he drank more than 12 pints, and voided by urine as much; during the day the drink exceeded the excretion; the urine was transparent, almost colourless and tasteless, but sugar was found on analysis; for 10 days he was put on an exclusive animal diet; but his stomach could not bear it, and moreover no satisfactory result was obtained. A profuse diarrhoea supervened, and while this lasted, the diuresis was greatly diminished. Symptoms of hectic followed and he died three or four months after the commencement of the

disease.

Dissection. Extreme emaciation; no vestige of fat; thoracic viscera sound; chylopoietic viscera nearly normal. There was only one kidney, and this was placed transversely across the spine; on each lateral extremity was found a supra-renal capsule, situated in its natural position; the shape of this single kidney was like that of a horse-shoe, convex above; its thinnest portion was that which

rested on the vertebrae, and in bulk it equalled two kidneys of ordinary dimensions; the transverse length being from seven to eight inches, and its perpendicular from three to four; its texture and consistence were quite normal; perhaps only a little gorged with blood. The two pelves were directed forwards, and not inwards as usual; there were two ureters which were dilated, equalling in dimensions the little finger. In short, in the present, as in most other cases of this disease, the pathology is most unsatisfactory; perhaps we should look not so much to the secreting organ, as to the pabulum of secretion, viz. the blood. Animal chemistry may in time elucidate the subject.—Archives Générales.

XXXI.

DOTHINENTERITE.

OUR readers are probably aware that this appellation has been given by M. Bretonneau and others, to the diseased states of the glandule Brunneri et Peyeri, which are the mucous follicles found on the inner coat of the intestines, chiefly of the small ones, and are arranged either in groups, or are solitary; hence they are also named congregatæ et solitaria. In the duodenum they are very distinct, especially near the pylorus, and in the ileum towards its lower extremity. Some physicians have ventured so far as to attribute the proximate cause of typhus fever to ulceration of these glands; but this opinion is certainly erroneous, as we shall be satisfied by reporting a case or two.

Case 1. A man, aged 21, had been troubled for a few days with diarrhoea; suddenly all the symptoms of adynamic fever came on, viz. prostration, stupor, deafness, starting of the tendons, &c. &c., and he died on the 10th day after.

Dissection. Patches of redness on different portions of the stomach and intestines; here and there the mucous surface presented numerous small ulcerations; the glandulæ Brunneri were tumefied, encircled with a VOL. XVIII. No. 35.

red areola; some of them already ulcerated, so as to expose the subjacent infiltrated cellular substance. Towards the cæcal end of the ilieum, numerous groups of distinctly projecting lamina, which were hard, white, or slightly tinged with bile, and altogether resembling the crusts of some herpetic eruptions (dartres crustacées). These laminæ or crusts were easily removed, being attached only by very slender filaments to the enlarged orifices of the mucous glands, which, however, did not appear ulcerated, but only redder and more prominent than is natural. The ileo-cæcal valve was nearly destroyed by these crusts. In the large intestines many aphthous spots were found.

Case 2. Was very similar in symptoms to the preceding, but no dothinenterite ex. isted. A man had for some time an apthous ulceration of the mouth, but most unexpectedly he sunk rapidly, in the course of one night, into a state of typhoid prostration; a profuse diarrhoea had also supervened, and he died two days after.

Dissection. Traces of extensive gastroenteritic inflammation, especially in the jejunum and ileum, towards the cæcal end of which the redness became more and more intense. The large intestines were similarly, but in a much slighter degree affected; no mark of disease in either set of glands.

Remarks. The preceding case was one of extreme rapidity. M. Bretonneau has never found the morbid alterations of the glands earlier than on the fifth day of the dothinentiritic fever, and even at that period they were by no means much reddened or tumefied. It appears, therefore, that the worst, or adynamic cases of typhus, do not always, if ever, depend solely on any affection of the mucous intestinal glands; and the truth of this statement is still further confirmed by the fact, that these glands may be greatly diseased, and yet not give rise to any symptoms of fever, as in phthisis: we relate one case as it occurred at the same time that dothinenteritis existed in the hospital.

Case 3. A young girl died of phthisis; a diarrhoea had existed for some time.

Dissection. We need not specify the thoracic disease. The stomach and duodenum were normal; the rest of the small intestines presented the appearance of capillary injection, which was more distinct towards the lower extremity; the mucous glands were red, inflamed and prominent; near to the cæcal valve they were ulcerated.

General Observation. From the preceding cases, we infer that the only uniform and constant symptom of disease in the glands is an obstinate diarrhoea.-Ibid.

XXXII.

camel-hair pencil. Chronic buboes he blisters first, in order to remove the cuticle, and then he cauterizes the denuded surface with a solution of a scruple of the sublimate to the ounce of water.-Révue. Med.

We can confirm the accuracy of M. Malapert's remarks, by appealing to numerous cases of primary syphilis, which we have for several years past treated in the above way. The surface of the sore is rendered

white on the application of the strong wash, and the surrounding skin is cauterized; the diseased action appears to be speedily changed, and we find, in the course of a few days, perhaps a much larger exposed surface, but certainly one that is much healthier, and disposed to cicatrize quickly, instead of the obstinately indolent base

COTIAN OPERation.

M. VELPEAU records an interesting case; it had existed for more than a year, and several surgeons, among whom was Dupuytren, had attempted in vain to heal it, by incising its edges and approximating them. A flap was dissected from the front of the neck, below the fistula, reflected upon itself upwards (so that the cutaneous surface was made the central or interior one), and fashioned into a plug or stopper, which was kept in its place by two needles and the twisted suture. The greater portion united, and one application afterwards of the cautery, to the part which did not heal, completed the cure,-Ibid.

XXXIII.

SYPHILIS, TREATED BY THE EXTERNAL USE

ALONE OF MERCURY.

M. MALAPERT, a military surgeon, communicates the results of his experience, which, he states, is highly in favour of merely employing a strong solution of the corrosive sublimate, without any internal medicine. He has, in this manner cured chancres of the throat, lip, penis, anus, and legs, by using a lotion of 8 grains to an ounce of distilled water, and applied with a

chancre. Once or twice, we have discussed chronic glandular tumours by the topical use of the corrosive sublimate lotion.-REV.

XXXIV.

CANCER OF THE TONGUE, BY WHICH THE ORGAN WAS WHOLLY DESTROYED. PROFESSOR DELPECH reported the following

case.

A young man, aged 20, of a weak and irritable constitution, was the patient. At first, a pustule appeared on the left side of the tongue, midway between its edge and centre. Although its base was hard, and its edges were ragged, lunar caustic had been repeatedly applied; the ulceration increased and became more painful. In a short time, the cancerous mass attained the size of an orange; the mouth could not be closed, and the saliva dribbled from the lips. In this state Delpech saw him, and, as the tumor appeared to be circumscribed, and not blended with the substance of the tongue, he resolved to operate. He made a deep perpendicular crucial incision through its entire thickness, but not beyond its inferior margin or cyst, in order that the lingual and ascending pharyngeal arteries might not be cut; for, says Delpech,

the normal vessels, around a defined tumour, never pass through its envelope or cyst; it has vessels of its own, and these are separated from the vessels of the adjacent parts by the proper and generating envelope of the diseased growth. The operator then laid aside the knife, and, with his fingers, worked or scooped out the four parts of the tumour from the inner surface of the sac, without any hæmorrhage. The muscles of the tongue had been absorbed by the pressure of the mass, and only the point had been left; and this was joined to the inside of the mouth merely by the mucous membrane, in which ran the ranine vessels. The next object was to destroy the cyst: for this purpose the cautery was employed, the lingual arteries having been previously tied in the neck; the cautery was applied twice again, at the intervals of six and ten days. The cavity thus left would have admitted an orange; it healed up most favourably. On the 15th day after the operation, the patient could articulate some sounds, and in course of time he recovered his speech astonishingly well. The guttural and labial letters he could pronounce distinctly, but the lingual, such as L, R, S, T, feebly and incorrectly. The sounds formed from L appeared to be rendered more liquid, as in the word "Llorente" of the Spanish language, or in the French word "bataille;" the sounds of R were given in a lisping manner-those of S not well-but those of Th much better. The greatest difficulty was in articulating the sounds of T and D. The sense of taste was not much impaired; and, from the result of this case, it appears that, if any portion of the skin of the base of the tongue is saved, the gustatory power remains.― Ibid.

The apparent success of the preceding case reflects the highest honor on the boldness and skill of the distinguished surgeon.

XXXV.

ON THE ETIOLOGY OF CHOLERA.* I. "AN Examination into the Etiology of Cholera, founded on the Phenomena of the Disease, as exhibited during its prevalence in Glasgow and suburbs," has been sent forth by Dr. Bryce, and a perusal of it induces us to lament that its author had not been "bred to the bar," for assuredly he would have proved to be one of its brightest ornaments, as far as the art of making "the worse appear the better cause," or rather of proving to a demonstration, that "black is white and white is no colour at all." He has gone so artfully and casuistically to work, that one would suppose, from the train of data which he first lays down, and from the candour of his arguments and deductions, in the beginning of the paper, he was a man in search of truth, and not enlisted under the banners of any party, in the controversy respecting the etiology of cholera; but a deeper acquaintance with his lucubrations, shows that he is the very champion of the ultra-contagionists!

We care little how many converts he may make in this cause, since we are perfectly convinced that, among those who have seen most of the epidemic, and who are most capable of forming a true estimate of its etiology, few indeed will come to the conclusions which Dr. Bryce has drawn. We shall give the DATA first, and then offer a few remarks on Dr. Bryce's inferences.

"The principal facts, connected with the phenomena of cholera, as these have been exhibited during its prevalence in this city,

are,

1st. The disease was officially announced to exist in Glasgow on the 12th February; but it is certain that unequivocal cases occurred for some days prior to this date.

2d. Its commencement was not preceded, nor accompanied, by any sensible unusual constitution of the atmosphere, as regarde temperature, moisture, or electricity.

* Glasgow Journal, No. XIX. Aug.

3d. It augmented gradually until the sixth week of prevalence, when the weekly returns showed 140 cases. From this time it declined steadily till the sixteenth week, during which only 5 cases were reported, and at the end of which one case remained under treatment. Independent of any cause referrible to atmospheric intemperament, cases again multiplied rapidly to 120, the nineteenth week, since which time it has been gradually diminishing.

4th. A very large proportion of the cases occurred in lanes, closes, and houses, remarkable for domestic and pulic filth.

5. Of these cases, many occurred in the same dwelling, within one, two, or three days of each other.

6th. It has been observed, that several cases have followed one another in the same tenement, so long as one diseased remained in the tenement; and that the disease has disappeared immediately and effectually therein, on the temporary removal of the infected, and all the healthy persons, from the locality, and on employing various means of purifying the same.

7th. The persons attacked in these localities, were for the most part, ill-fed, badly clothed, of dissipated habits, residing in densely crowded, imperfectly ventilated, dwellings.

8th. Under the preceding circumstances, females formed a large majority of the cases, and of those, persons of irregular lives.

9th. Comparatively few instances of the disease happened, among the middle and upper ranks of the community, and no example was reported in these ranks of a succession of cases in a family; even although members of the family attended, as nurses, on the patients; nor did any case occur of a child or young person having been seized. During the second exacerberation of the disease, the exceptions to this, and the two preceding conditions, were more numerous.

10th. Numerous examples have offered, where children have slept with infected parents, nurses with patients, without contamination, as well in the chamber where the disease occurred, as in hospitals.

11th. The town's hospital was the only public institution in which it prevailed.*

12th. Many examples have occurred of persons being seized while occupied at public works; yet, in no instance did it prevail in any particular work, and several remained altogether exempt.

13th. Of 52 nurses employed, in succession, at the Albion Street Hospital, 8 took the disease, and of 5 at the Dalmarnock Road Hospital, 2.

14th. No one of the several medical attendants at the cholera hospitals, nor, with one exception, any one of the district surgeons, or their pupils, has been affected with unequivocal symptoms of the disease.†

15th. The disease did not advance in any particular direction, nor follow any regular or cognizable route.

16th. Cases have appeared on the same day, in quarters of the town most widely apart, in dwellings the most dissimilar, and among individuals the most different in their habits of life.

17th. Districts of the city having the greatest intercourse with, and approximating closely to, each other, have exhibited the opposite states of great prevalence, and total exemption, and this, too, for considerable periods.

18th. The disease appeared suddenly, and prevailed largely in the Gorbals, a quarter strikingly exemplifying the conditions last specified.‡

* "Persons apparently healthy, removed from infected houses to places of refuge, have been subject to attacks at different periods, not more than three or four days after their removal. Five cases occurred in Bridewell, apparently under similar circumstances with those which happened in the Houses of Refuge."

"At least 150 practitioners and students have attended on cases of cholera, yet, with the above exception, as far as is known, not one of them, nor of their households, was infected."

"I have the satisfaction of stating, in