ficient degree of inflammation, but which simply depended upon the insufficiency of the seton threads.

In another case there was a slight suppuration of the cellular membrane of the scrotum, which, however, only interfered with the rapidity of the cure, but was in no other way detrimental to the patient, nor prevented his speedy recovery. In another case, however, there was excessive inflammation and a suppurative process in the tunica vaginalis; and the possibility or probability of this occurrence is perhaps the most serious objection to the operation proposed which may be gathered from these cases. It might indeed raise in the mind a doubt on the principle itself of the operation. You introduce an extraneous body into the tunic, and you allow it to remain till inflammation is produced, and it is possible that the inflammatory action excited by extraneous bodies may tend to the suppurative instead of the adhesive form of inflammation. As, however, the result was only observed in one case, and as no such disposition was manifested in a number of cases, of which the success was perfect, we are perhaps warranted in drawing a conclusion generally in favour of the effects of the seton. Of course future cases (and as I shall continue to adopt the same plan of treatment such will not be wanting) will decide the point; but otherwise, in respect of having a mode of treatment enabling us to regulate the degree of inflammation, the plan here offered presents great advantages."

Thus we see that out of eight cases treated by the seton, two only were quite successful. One was doing well when the patient was dismissed, and the result left undetermined; a fourth was ultimately cured, but nearly two months elapsed, and some suppuration occurred in the cellular tissue of the scrotum. A fifth required two operations for the cure. In a sixth case, two operations were performed, and the patient was not ultimately cured. In a seventh case the seton was twice used, and this patient also was not cured-and finally, in another case, severe suppuration in the tunica vaginalis en

sued. We must own that these results are any thing but satisfactory, and we venture to prophecy that the seton will be frequently found to do too much or too little-to produce only partial adhesion, or to give rise to suppuration. We anticipate little from the subsequent trials of Mr. Green, but we shall take care to lay the results before our readers.

Mr. Green observes that the seton is very applicable to the treatment of ganglions and bursæ. It is a dangerous remedy. We have twice seen death ensue from introducing a seton into the bursa situated over the inferior angle of the scapula. The surgeon should be cautious how he meddles with bursæ in the way of exposing their cavity.

IV. MR. TRAVERS ON ABSORPTION

OF THE CRANIUM.

The St. Thomas's Hospital Reports contain a curious case, that formed the subject of a clinical lecture on the part of Mr. Travers. The case, greatly abridged, is this:

CASE. Absorption of a Portion of the Cranium, following a contused Wound, with remarkable Symptoms of Cerebral Disorder.

For a

A postilion, æt. 46, was thrown from a gig, and struck his head with great violence upon the corner of a stone. This was in January, 1833. The scalp was cut and severely bruised, and he remained insensible for about half an hour, after which he recovered, and was able to walk to the surgeon's house to have the wound dressed. twelvemonth he continued tolerably well, occasionally, however, suffering from severe headache, giddiness, and general depression. This state was relieved by free purging, with abstemiousness and rest. During this period, however, he was generally engaged as a groom. At the termination of a twelvemonth he had a fit, was insensible for three or four days, and unable to resume his occupation for a period of six weeks. He passed the second year in much the same way as the preceding In February last (1835) he was

one.

engaged in the stable, and in the habit of driving the late Mr. James, surgeon, of Uxbridge, who observed that the man was much altered, having become forgetful and stupid. Towards the latter end of the same month, Mr.

was called to him in the stable, and found him labouring under a wellmarked epileptic fit. On examining the head, some irregularity and unevenness of the skull was detected. He remained insensible for four days, though apparently conscious at intervals, and within this period had two or three modified paroxysms, which were slight, and of short duration, but not a single wellmarked epileptic fit as before. There was a prominence about the size of a shilling upon the side of the left parietal bone exquisitely painful, when touched, and when pressed upon, giving rise to a peculiar train of symptoms-viz. dimness of sight in both eyes, singing in the ears, deafness, giddiness, and a sense of intolerable weight upon the head. He had great restlessness-his pulse very weak and quick, but perfectly regular-his bowels obstinately costive, and the alvine secretions very dark and offensive. From this time he gradually, though very slowly recovered, to a certain point; but he still continued to have restless nights and frightful dreams, constant headache, the centre or precise seat of which he referred to the part above noted; his deafness increased; bowels very obstinate; pulse weak and slow; but he was still able to walk about, and the symptoms abated in a degree. At the expiration of two months from the commencement of this attack he was again seized in much the same way, except that the fits were more frequent; his bowels were always very much constipated, and the secretions in a very bad state; the local and general symptoms resembled those of the former attack so closely, as to render a description of them superfluous. He gradually became much emaciated, and continued to have fits, though slight, up to the time he was sent to the Hospital.

Loss of memory, and great despondency were prominent symptoms. On admission his case is described thus:

Much emaciated-skin yellow-appetite bad-bowels torpid. He has a constant distressing heavy pain over the posterior superior part of the left temple, the seat of the blow, where a small circumscribed elevation is perceptible, and pressure on which produces increase pain. The pain also darts to the forehead and opposite temple, and sometimes becomes more severe, and he is then rather violent. He frequently talks incoherently, and only answers questions when spoken to loudly. Both motion and sensation on the right side of the body are impaired. His memory is much deranged, and he especially forgets dates and names, so that it is impossible to obtain from him any satisfactory account of his complaint. His mind is easily excited, and he scarcely sleeps at all. He gradually got worseparalysis of the right side supervened and the faces were passed involuntarily.

On July 3, the operation of trephining was performed. On cutting through the integuments, which had no appearance of recent change, but were somewhat thickened, a perforation in the bone was discovered, about the size of the tip of the little finger, with a thin smooth border which extended through both tables of the skull, leaving the dura mater exposed. The greater part of the margin of this circular aperture was included in the application of the trephine: the under-surface of the bone and the dura mater were perfectly healthy, and had contracted no morbid adhesion, nor was there any thickening or detachment of the pericranium.

After the operation, he became much worse--was unconscious-lost his voice -was unable to protrude his tongueand had total paralysis of the right side.

He was now put on a course of mercury, which salivated him severely. He had one fit afterwards, but gradually improved, and on the 15th of October was discharged cured.

This is a curious and instructive case. No doubt the absorption of the cranium was owing to an increased vascular action originally set up by the blow. The fits, paralysis, and so forth, shew that vascular action was not

limited to the mere absorption of the cranium, which could, of itself, produce no such symptoms, but probably occasioned also some deposition about the arachnoid and pia mater, beneath the portion of the dura mater corresponding to the cranial aperture. The operation may have been of service by acting as an issue, and this, combined with the influence of the mercury, removed the inflammatory action and its consequences going on about the membranes, or beneath them. Such is the probable rationale of the case which we would offer.

Those who are anxious to learn the views of Mr. Travers, may refer to the Report itself. He ably illustrates by this case his peculiar doctrines of irritation.

V. MR. GUTHRIE ON THE REMOVAL OF LARGE CALCULI.

The following very important case we have condensed from a clinical lecture delivered by Mr. Guthrie, and furnished to us by a friend and correspondent. The case is highly interesting.

Lithotrity in the Female.-The case of Mary Ken, who has lately left the hospital, has been one of great interest to us all. She came into it for the first time more than a year back, having then so large a stone in the bladder, that I feared it could not be removed by merely dilating the urethra, which I soon found to be the case, and decided upon breaking it up. She did not however submit patiently to the first trial, and the bladder contained, and could only be made to contain, but little water; I was therefore obliged to abandon the attempt after merely introducing the instrument, from finding that I could not persevere with safety, and she was so frightened that she could not be quiet, or refrain from falling into hysterics. From this time for several months, whenever the urethra was attempted to be dilated she had an attack of fever, apparently from fear, and became so generally ill that I despaired of her recovery, and indeed of her life. She went out of the hospital for a time

to recruit her health if she could, but finding she was fit for nothing she returned, and after having fixed the day for operating many times and as often failed, she at last mustered courage to submit, saying she felt she could not live if she did not obtain relief, and this time she behaved magnanimously. The stone had greatly encreased in size since she first came into the hospital, and seemed to lie across the outlet of the pelvis, like the head of a child, whilst no urine could be retained in the bladder, the neck of which was dilated, so that the stone could be touched by a sound an inch in length. Being placed on a table arranged for the purpose (Heurteloup's,) I divided the orifice of the urethra upwards with a straight bistoury introduced for one third of an inch within it. This admitted of that part being dilated much more easily, the peculiar structure at the very orifice not yielding readily, and often tearing rather than dilating. The urethra was now rapidly dilated by Mr. Weiss's dilator, until two fingers could be introduced, or a large pair of forceps, and I had several made with and without teeth for the purpose. None of them however could be opened so as to grasp the stone, and they merely rubbed or grated off small portions of the anterior part of it in the shape of sand or small grain. More than an hour had now elapsed, and nothing had been done of any consequence. Seeing that I never could open the forceps, I separated them like a midwifery forceps, and introduced one branch with some difficulty under the stone, and after several trials and with greater difficulty, the other branch was placed above it. They could not now however be made to lock at the hinge, so as to act efficiently upon the stone, which was so hard as to resist any moderate pressure, and that when another lithotrity instrument was screwed up upon them, they bent under the pressure until they met. It was therefore necessary to change them for a stronger pair, which was done, and at last the stone yielded in the middle, being apparently divided into two nearly equal parts. More than two hours had now elapsed, and some

small pieces only had been got away. The urethra had also contracted, and the neck of the bladder also, and it became necessary to re-dilate these parts with the dilator, which was done in two or three minutes. I now separated Mr. Weiss's lithotrity instrument into two parts, and introducing the lower branch below one of the broken halves that of the right side, I drew it forward and fixed it against the pubes. The difficulty was now how to introduce the other branch without injuring the upper part of the urethra and neck of the bladder, but this was effected at last by placing a small scoop, such as is used for removing small pieces of stone on the point of it, and in this manner carrying it forwards very carefully. The instrument once fixed in this manner, acted well and broke the large piece of stone into many small ones by one crush. Several of these were now readily extracted, and the remaining half was also broken into two or three pieces by another proceeding of a similar kind, and four ounces and a half were extracted, together with the end of one of the first forceps tried, and which had been broken under the pressure of the screw-instrument on the branches. More than three hours had now elapsed, and Nature was nearly exhausted. I was therefore obliged to cease. She had taken several ounces of wine during the latter part of the time, and had borne the tedious and painful steps of the whole remarkably well. She was more exhausted however by the length of continuance of the operation than by the severity of the pain, as I took care the whole time to do nothing hastily, and to allow none of the instruments to do more than was intended. She was put to bed in the same room (the House Surgeon's,) was diligently attended to, and had two grains of the muriate of morphia immediately, which quantity she was accustomed to take at night, and a grain from time to time until rest was procured.

It was quite delightful to find that she suffered little from so serious an operation; a great many small pieces of stone came away for several days,

and a great deal of detritus, and one large piece was extracted by passing a probe behind it. Aware of the existence of another large piece in the bladder, she was anxious to have the operation repeated, and as soon as she was strong enough she fixed her day, and heroically submitted to it. I was now well prepared with instruments, the principal addition being a narrow sort of blunt gorget, which on the urethra being dilated, and one branch introduced, was passed in, and made to rest on the stone, so that the second branch of the screw lithotrity instrument could be readily run along it up to the stone, which was then crushed. The pieces thus broken up were brought away by a small but strong pair of forceps. There was great inconvenience experienced in using all these instruments, from the contracted state of the bladder, which grasped the larger pieces in such a way as to prevent their being easily seized or brought away. This was only overcome by opening the forceps well, and by that means dilating the bladder, when each piece was more easily grasped and brought away.— This operation was perfectly successful, and, by washing out the bladder from time to time, all the small pieces were brought away, and she has gone out perfectly free from calculus in the bladder. She is now quite fat, well, and a handsome young woman, free from pain, except a little in her back at times. She cannot however retain her water, and is obliged to wear an elastic bag, made for her liberally by Mr. Weiss, Jun. who furnished most of the instruments used in the different operations. The orifice of the bladder is contracted, so as to admit a common-sized female catheter less readily than usual, but it has not recovered its elasticity so as to shut the part close enough to prevent the urine escaping. She has improved on this point however, and I am in hopes she will continue to do so, and suffer less inconvenience. I have collected eight ouncess and a half of calculus, principally of lithic acid, and she says herself she is sure as much more was lost-so as to make in all more than a pound by weight. How far

this was the case I know not; but the stone certainly seemed to be by examination per vaginam as large as the head of a small child. The most valuable point for observation in this operation is the length of time the bladder suffered under the first attempt without sustaining any mischief; and I have satisfaction in thinking that this arose from the great care taken to let no instrument do more than it was intended it should do. I have reason to think that time is of much less consequence than is often supposed in the operation of lithotomy, and a man or a woman had better be an hour on the table than have the bladder either torn or materially injured. Some years ago I operated on a young man of nineteen, who had had a stone in his bladder from his birth, from which he had suffered excruciating torment, the bladder being always nearly empty, and incapable of retaining a couple of ounces of urine. I cut into the bladder and seized the stone in a minute, but it would not come out. I enlarged the opening with as little success;-the bladder greatly thickened, was firmly contracted round it, and processes from it appeared to adhere to the bladder. In 58 minutes it baffled all my efforts, my fore-finger resting upon its sharp processes, which

seemed ready to tear the bladder before them. In this dilemma it struck me that I should never get it out, unless I could guard all these sharp points, and keep them away from the bladder as the stone came out. I sent for a very large pair of forceps, very much resembling a pair of firetongs, which I introduced, pushing the stone back before them. I then opened them forcibly, dilating the bladder as I did it, when the stone fell between the blades, and was removed in a moment. I cried out I have found out the use of the tongs, and very happy I was to do so. The stone looked exactly like a piece of coral rock, and was quite as irregular. It is an unique specimen of oxalate of lime. The man was bled the same evening, and never had a bad symptom afterwards, nor a return of his disease. The opening in the bladder in this case was as large as could well be made with safety and certainty, and far exceeded the boundaries of the prostate gland. I attributed his safe and speedy recovery to the care taken to do no violence to the bladder beyond what was always intended to be done. I might perhaps have pulled the stone out within the first few minutes, but I should have lost my patient.

THE CYCLOPÆDIA OF ANATOMY AND PHYSIOLOGY. Parts II. and III.

We prophecied in our 45th Number, when the first part of this work came out, that, if the writers went on with the same spirit which marked their commencement, the issue would be successful. The two successful parts have convinced us that no diminution of energy, zeal, or talent is visible in the progress of the Cyclopædia. We beg to recommend this Cyclopædia in an especial manner to the profession, in consequence of the great attention which is paid to comparative anatomy No. 63.