the catheter, there was a new and unusual difficulty. When the water was drawn off Dr. Locock again examined. He announced that the head was fast descending. The improvement had taken place between 7, p. m. and 8, p. m. At 10, p. m. the fœtus was expelled, and immediately afterwards the placenta; the child was putrid; the bones of the head broken up. The tumor was now discovered on the right side, as before delivery, and the left ovarian tumor, which could be distinctly felt, had descended in the abdomen.

In the evening after delivery the abdomen was found as large as ever, partly from an accumulation of fluid, chiefly from a large tumor occupying the whole left side of the abdomen. Purgatives and salines were given, and little alteration occurred till the 17th. There were then what the patient called after-pains, some dyspnoea, some increase of size in the abdomen. At 2, a. m. of the 18th, more dyspnoea, pain in the hypogastrium, sickness, fever. She was bled and had an opium suppository. The blood was buffed and cupped, and though a temporary alteration was obtained, it was thought necessary to repeat the bleeding, with again some relief. cumference of the abdomen 38 inches.

Cir

She passed a very bad night, the symptoms continuing. On the 19th the abdomen measured 41 inches, and, to give relief, Mr. H. drew off with the trocar the abdominal fluid, amounting to five pints and a half of serum. She was relieved, but only for a time. The sickness and other symptoms returned; hydrocyanic acid mitigated the former. On the 22d the symptoms were lulled, but the calm was that preceding dissolution. She became insensible, and in the morning of the 23d she died.

Dissection. "The body was examined seven hours after death, before decomposition could have effected any change in the appearance of diseased parts. The upper part of the body was much emaciated. The lower extremities œdematous. On turning back the abdominal parietes, a large solid diseased mass, having a fungoid appearance, and lying on the left side, presented itself. On tracing this, it was found to be the left ovary, lying in the left iliac fossa and ascending to the diaphragm, having that form of disease termed by Dr. Seymour 'malignant tumour of rapid growth.' On the right side, and lying in the pelvis, was the other ovary affected with the same disease, and forming the tumour which was felt before, and so much obstructed, the birth of the child: it entirely filled the hollow, and was very firmly attached to the bones of the pelvis. To the front, and resting on the tumour, was the uterus, being free from disease; behind which, and between the ovaries, was a portion of intestine very dark in appearance, being, as it were, strangulated by the pressure of the morbid growth. The intestines in the neighbourhood of the tumour, bore marks of inflammation, in some parts severe. The pyloric end of the stomach was thickened, and in a state of scirrhus; the pancreatic glands much enlarged and indurated; the liver healthy in appearance; the gall bladder distended, and baving in it a single calculus: the kidneys very much enlarged, the substance of each containing ill-formed pus of a strumous character. The ureters enormously dilated, each admitting, with facility, the tip of the little finger; this appearance being readily accounted for by the pressure of the tumours, and consequent detention of the urine in its passage to the bladder; the bladder healthy, and containing about two ounces of urine. There were about two pints of serum in the cavity of the abdomen; the left side of the chest contained about four ounces of serum; the heart, large vessels, and lungs being healthy. The head was not examined.

It is an interesting and important fact, in relation to the growth of the tumours, that I had attended this lady in two previous confinements, the last of which took place just eighteen months previous to the present one, and that on neither occasion was there any symptom to warrant the supposition that the ovaries were diseased, her 'getting up' from each being uninterruptedly good. Her health also, during the first seven months of her recent pregnancy, was unusually good; although, from watching at the sick bed of her mother, and other circumstances, she had had much to try it. It was observed, however, by her friends and herself, that she was larger for the period than she had ever been before. The weight of the preparation was estimated at about seventeen or eighteen pounds." 238.

This is certainly an interesting and instructive case. It occupies 13 pages of the Society's volume; our readers will find all the points in two. The obstetrical deductions appear to us to be simple, and such cases are only valuable as facts to be remembered in future difficulties. Such facts, when published, become the experience of the many-when confined to the man who sees them, they form the experience, and they contribute to the professional sagacity, of the individual. It is well to treasure up the recollection of difficulties past, in order that their solution may be applied to the analysis of difficulties to come.

There is one pathological circumstance not unworthy of attention. The urine was prevented from getting with facility into the bladder, or with freedom out of it, by the pressure of the pelvic tumour. The ureters became dilated, the kidneys enlarged, the urine retained in them. This is what occurs in cases of old stricture of the urethra, and, accordingly, we find the same state of kidney-"pus of a strumous character in its substance." In cases of old stricture, nothing is more common than to find the kidneys occupied with many small abscesses, containing pus of the character mentioned. It is also common to call these strumous abscesses of the kidney. The pus resembles in appearance that found in the pulmonary tubercles, in the stage of softening, and there, so far as we can see, the analogy between such an affection of the kidney and scrofula ceases. The disease appears to be clearly the result of mechanical obstruction to the flow of urine. The kidneys are loaded, impeded in their function; that is demonstrable. They then become irritated, fall into a state of chronic inflammation, become unnaturally vascular, and subsequently studded with partial formations of pus. Chronic inflammation is probably the cause of these, but whether it be or be not, chronic inflammation accompanies them. We refer our readers to the valuable remarks of Mr. Brodie on calculous diseases.

The shorter remaining papers in the volume before us will be noticed in the Periscope of our present number; the longer must be deferred till our

next.

III.

RECHERCHES PHYSIOLOGIQUES ET MEDICALES SUR LES CAUSES, LES SYMPTOMES, ET LE TRAITEMENT DE LA GRAVELLE. Par F. Majendie. 2d edit. 1828, p. 151.

Or all animal products the urine perhaps has attracted the most attention, not only on account of the facility with which it is subjected to examination, but also from its connexion with diseases, a fact recognized by the earliest medical writers. To the more scientific analysis of this fluid by modern animal chemists must be attributed the beneficial changes which have been produced in the treatment of its disease; proving the benefits which result from the attentive study of animal chemistry, as well as the necessity of an accurate knowledge of this branch of medical science to the practitioner. The physician is as well acquainted with the composition of gall-stones, as with that of the various urinary concretions; and why should he not be as able to prevent the formation of cholesteriné as of uric acid? This is owing in great measure to his ignorance of the chemical changes produced in the bile by disease; his knowledge of that secretion is almost wholly confined to its healthy state, for the analysis is made of the contents of the gall-bladder removed after death; in practice he is content with observing the colour alone of the excrement which is tinged by this fluid, and thus his examination is confined to the most unimportant part-the colouring principle. The difficulties which oppose the examination of the pathological condition of bile are probably insurmountable, and unless the animal chemist had the unwearied patience of Swift's philosopher of Laputa, who spent his whole life in endeavouring to extract from fæces their nutritive principles, it is to be feared that our knowledge of bile, will, for at least a long period, be confined to its normal state. The attempts of the older writers to account for the formation of urinary concretions were generally as ridiculous in theory, as they were useless in practice. Hippocrates imagined that the neck of the bladder became inflamed, and refused exit to all but the thinnest part of the retained urine, whilst the thickest subsided forming calculi. Paracelsus believed them to be produced by an animal resin hardened by the spirit of urine! Even Van Helmont, in the 17th century, who was most inclined to explain the phenomena of health and of disease by chemical laws, compared the formation of gravel to the deposition. of tartar from urine. Scheele, in 1776, was the first who discovered the true nature of urinary concretions, he proved that they were most frequently formed by a particular acid which he named lithic, and which he recognized as one of the ingredients of healthy urine. Fourcroy and Vauquelin, in France, Wollaston, Marcet, Proust, Brande and Prout in our country, have since confirmed the discoveries of the Swedish chemist, and added much to our knowledge of both the healthy and morbid principles of the urine. M. Majendie has in the work before us applied some of his physiological discoveries to actual practice, and has endeavoured to explain in what manner various foods act in producing depositions in the urine. It has been too much the fashion in this country to attribute almost invariably the various forms of sand or gravel to indigestion: M. Majendie has explained in a VOL. XVIII. No. 35.

6

much more satisfactory manner the action of animal food, and of all those articles of diet which contain nitrogen; he candidly confesses his inability to explain many causes of gravel which are not comprehended in this class, but he falls into an opposite error by denying that a disordered secretion of urine can be produced by a disordered state of that organ which prepares the pabulum for the kidneys themselves. We shall give a careful analysis of this work, which is the only one which M. Majendie has published as a practical physician; his reputation as a physiologist alone would command attention to a subject so closely related to his chief pursuits. It embraces the causes, symptoms, and treatment of gravel. When a person discharges habitually or at intervals with his urine, a sand, most frequently of a reddish colour, or small stones, of various forms, colour, and size, he is attacked with gravel. It is a disease more particularly of middle and of old age, those who are fond of the pleasures of the table, and who take little exercise are most subject to it. In some cases there is little inconvenience or pain except at the moment of expulsion, when there is slight ardor urinæ, but usually there is general indisposition, often fever, acute pains in the lumbar region and in the course of the ureters, suppression of urine, a copious flow of blood per urethram, want of sleep, disturbance of all the functions; these symptoms last many days, and do not entirely cease until after the expulsion of one or more gravel stones. If such fits of gravel are frequent or constant it is not only a painful disease, but one likely to shorten life. It is but the first stage of many very intractable diseases, as stone in the pelvis of the kidney, or in the bladder, for which lithotomy or lithotrity are mere palliatives as the cause remains. When this disease is prolonged it may produce nephritis, retention of urine, abscess, urinary fistulæ, hematuria, &c.

ON THE FORMATION OF GRAVEL.

Urine consists of water holding in solution a certain number of different substances which have a greater or less tendency to leave the liquid in which they are dissolved, and to precipitate themselves under various forms. Sand, gravel, small calculi, &c. are substances which the urine had held in solution, and which are precipitated within the urinary passages. Sand and gravel differ in many important particulars. 1. In size: they vary from a small hazel-nut to the finest dust. 2. In form some gravel stones are polished spheres; others are pyriform, with their surface smooth or rough; others are angular fragments, evidently detached from larger calculi in the bladder, of which they have formed one of the concentric layers, most frequently they are isolated, and are expelled successively; in a few cases they have been connected by hairs. 3. In colour: generally a yellow red; sometimes a yellowish white, or a cindery grey; very rarely a deep brown or almost black. 4. In consistence. In some instances they are extremely hard, in others they crumble beneath the slightest pressure. 5. In opacity or transparency. M. Majendie found in one case transparent gravel, with this exception, it is opaque.

Chemical Composition of Gravel. 1. It is most frequently composed of uric acid united to a small quantity of animal matter. 2. Of the salts which are contained in healthy urine; these are the ammoniaco-magnesian phosphate, and phosphate of lime united to a small quantity of phosphate or carbonate of magnesia. 3. Of substances which are

foreign to healthy urine; these are oxalate of lime, cystic oxide, fibrine, and hairs. M. Majendie has found six species of gravel. The red, white, grey, yellow, hairy, and transparent.

1. Red Gravel. In order to comprehend the origin, and to establish the basis of successful treatment of this species of gravel which is by far the most frequent, it will be neces sary to enter into the history of uric acid.

The urine of man, and of many animals which are nourished with highly azotized foods contains uric acid. Its proportion varies according to the nature of the food; in those animals whose diet is wholly animal, the urine is abundantly charged with it, and even is entirely formed of it, as the researches of Vauquelin and Wollaston, on the urine of birds, have shewn. Still no uric acid has been found in the urine of the lion and tiger, but urea in great abundance. In truth, the nature of the food does not influence the secretion of uric acid alone, but also that of the other substances in solution in the urine, a fact which is of the highest importance in ascertaining the causes of gravel. If the food of animals is herbiverous no trace of uric acid is found. In a paper which M. Majendie read before the Academy of Sciences, some years ago, a series of experiments was detailed which shewed that, by depriving a carniverous animal of all azotized food, and by feeding it on sugar, gum, oil, and similar substances which are considered as nutritious, but contain no nitrogen, the urine at the end of three or four weeks was deprived of uric acid. A small, healthy, and fat dog, three years old, was fed on white sugar and distilled water, he was allowed to take as much as he could of each. For the first seven or eight days this diet appeared to agree perfectly well with him, but in the second week, although his appetite was always good, so that he eat six or eight ounces of sugar in the twenty-four hours, he grew thinner, his stools were neither frequent, or copious, but his urine was secreted in abundance. In the third week the emaciation increased, he became weak, dull, and had less appetite; a small ulcer formed in the centre of each cornea, which penerating them, evacuated the humours. He gradually became more emaciated and weaker, until he could neither eat nor swallow liquids, and died on the 32d day. The body was carefully examined, there was a total deficiency of fat, the muscles were reduced to five-sixth of their ordinary volume, and the stomach and intestines were very diminished in size, and strongly contracted. The gall-bladder and urinary-bladder were distended with bile and urine which were sent to M. Chevreul to analyze; he found that they had all the characters of these fluids. in herbiverous animals, that is, that the urine instead of being acid, as in the carniverous animals, was sensibly alkaline without a trace of uric acid, or of the phosphates; the bile contained a considerable quantity of picromel, which is the case with the bile of the cow, and of herbiverous animals in general. Similar experiments were tried with other dogs who were fed with oil, butter, gum, &c. and always with the same results, the nature of the excrementitous fluids being entirely changed became nearly like those of the herbiverous animals. M. Majendie deduces from these facts an important practical principle, that there is an evident relation between the diet and the presence of uric acid in the urine, or in other words, that no uric acid exists in the urine of those animals who do not eat flesh or other azotized food. M. Chossat, in a paper published in the fourth volume of the Journal de Physiologie, has confirmed this by numerous experiments on his own urine. Bérard, of Montpellier, has recently analyzed uric acid, and, according to him, 100 parts are composed of—