then died in convulsions, having exhibited no head symptoms until two days before death. The blood was effused under the pericranium, and between the skull and dura mater; it had evidently been poured out in successive layers. The internal clot was nearly surrounded by a ring of newly-formed bone. There was no reason to believe that the tumour resulted from unnatural violence.

XVI. Large opening into the anterior part of the urethra, caused by sloughing, and attended by considerable loss of structure, successfully treated by operation, with remarks; by F. Le Gros Clark, Esq., Assistant Surgeon to St. Thomas's Hospital.

This opening was in the portion of the urethra anterior to the scrotum, and extending a very little way into the scrotal division. Its length, when the penis was turned up, was about 1 inch, and the two margins were so far separated as to leave the upper wall of the urethra entirely exposed. The following is Mr. Clark's account of the operation, which is a modification of that proposed by Dieffenbach :

"A large-sized (No. 10) elastic catheter was passed into the bladder, and the stilet being removed, an assistant was directed to hold the penis against the pubes; with a small scalpel I then first removed an inverted portion of skin which bounded the opening posteriorly at the scrotum. I next made, in succession, four incisions through the integument, each commencing at a little distance from the extremity of the urethral deficiency: two of these extended, in contrary directions, upwards and outwards on the sides of the penis, the other two downwards and outwards on the scrotum. Each pair of incisions thus included a nearly rectangular piece of skin between them; and a flap on each side was thus marked out, which grew broader as it extended outwards. I then proceeded (without paring the edges, on which I did not at all depend for adhesion) to dissect up these flaps, commencing from the margin of the urethra and advancing outwards, so as to raise the two flaps in question. This being effected, I waited for ten minutes or a quarter of an hour, until the surface-bleeding had been arrested, and then undertook the concluding step of the operation, which was to bring these flaps over the urethra, and apply them surface to surface, not edge to edge. For this purpose I had prepared four small quadrilateral pieces of stiff leather, about half an inch square, and perforated. These were applied, two and two, opposite each other, and kept in position by platina wires, which I passed through the leather of each side and the intervening folds of skin, and fastened by twisting the ends together. In this way the flaps were sustained in relation, forming a ridge which projected a little above the pieces of leather, a small intervening portion being left uncompressed. The operation was completed by a semilunar incision on either side of the penis, parallel to the flaps, in order to obviate the effects of any after tension; and three or four sutures were employed

at the extremities of the wound."

The cure was eventually complete, and we think the case reflects great credit on the surgeon.

XVII. The pathology of mental diseases; by John Webster, M.D. F.R.S., Consulting Physician to St. George's and St. James's Dispensary.

This is a sequel to a paper, which we formerly noticed, in the 26th vol. of the Transactions, and contains the account of a number of further dissections of persons who died insane, which furnished the following general results. The number of dissections was 36. In 33 cases the pia mater was infiltrated. In 30, there was turgidity of the blood-vessels of the brain and its membranes. In 26, effusion of water had taken place in

the ventricles. In 16, there was thickening and opacity of the arachnoid. In 12, fluid was met with at the base of the brain. In 9, the consistence of the brain was altered from its normal condition. In 8, patches, or bloody points, appeared on the cut medullary surfaces. In 5, the colour of the medullary, or cortical substance, was altered from its healthy hue to a pink, mottled, or rosy tint; and in 4, blood was effused in the brain. There were also other morbid changes of structure of a less important character.

Dr. Webster gives, likewise, some tables which show that the prevalence of insanity increased with the increased temperature of the season, and that the greatest number of cures took place during the autumnal and winter months.

XVIII. On some of the causes of pericarditis, especially acute rheumatism and Bright's disease of the kidneys; with incidental observations on the frequency and on some of the causes of various other internal inflammations; by John Taylor, M.D., Professor of Clinical Medicine in University College, and Physician to University College Hospital.

This is one of those productions that defy analysis. The facts are too numerous for condensation, and too necessary for the argument to allow of omission or abridgment. We have rarely perused any paper that conferred more honour on the writer, and we feel that we are doing an act of simple justice in urging our readers, not merely to go through, but to study its contents. Expanded, and further illustrated, it would form one of the most valuable monographs we possess, and we sincerely hope the author will give it to the profession in this shape. The main object in view is to establish the very important fact, that by far the most frequent causes of pericarditis are two blood diseases, viz. acute rheumatism and Bright's disease of the kidney. This doctrine is supported by extensive statistical records, and, in our opinion, is conclusively proved. The final conclusions at which the author arrives are thus briefly stated. 1. That acute rheumatism and Bright's disease, in its advanced stages, have an equal tendency to produce pericarditis and endocarditis. 2. That acute rheumatism has a greater tendency to produce pericarditis and endocarditis than has Bright's disease when in its earlier stages. The originality of these views will be at once evident to all. They are worthy of the deepest attention, and open up a wide and most interesting field for future investigations.

XIX. Case of excision of the upper end of the femur, in an example of morbus coxarius; by W. Fergusson, esq., Professor of Surgery in King's College, London.

The case terminated most favorably, being only the second of the kind which has had a like result in Britain.

XX. On the minute structure of the lungs, and on the formation of pulmonary tubercles; by G. Rainey, esq., M.R.C.S., Microscopist to St. Thomas's Hospital.

The lungs are made up of bronchial tubes, bronchial intercellular passages, and air-cells. The intercellular passages are the continuation of the bronchial tubes, the distinction between the two being the deficiency of the mucous membrane, which terminates abruptly about one eighth of an inch from the surface of the lungs, the remainder of the passage and the

air-cells being lined by a very fine, delicate, and distinctly fibrous membrane which has no epithelium. The intercellular passage terminates in an air-cell, which is not dilated, as stated by Reisseissen, but of about the same diameter as the passage. We can bear testimony to the accuracy of this observation.

The air-cells are small, irregular, but generally four-sided, cavities of various sizes, the most central being smallest and most vascular; they communicate freely with each other, and with the intercellular passage. The walls or partitions, by which they are separated from one another, consist of a single plexus of vessels, inclosed in a fold of membrane. The structure, above described, can be seen in the foetal lung; and, therefore, the cells are not produced, as Mr. Addison describes, by dilatation of the "lobular passages."

According to Mr. Rainey's observations, tubercular matter is poured into the cells from their lining membrane, gradually fills them, compresses the septa, and obliterates the vessels, and thus gradually becomes disintegrated. He denies the inflammatory origin of this morbid product.

XXI. Two cases of aneurism, in which there was neither pulsation nor abnormal sound; by T. A. Barker, M.D., Physician to St. Thomas's Hospital.

XXII. An account of a singular case, in which there was a black secretion from the skin of the forehead and upper part of the face; by W. TEEVAN, esq., M.R.C.S.

Guy's Hospital Reports.

ART. VI.

Second Series. Nos. IV, V, and VI; Oct. 1844; April and Oct. 1846.-London.

WE feel ourselves in the same predicament with these Reports, as with the Medico-Chirurgical Transactions previously noticed. We shall, therefore, proceed at once to our task without further ceremony.

No. IV.

I. Case of poisoning by opium; by A. S. Taylor. This case is interesting from the quantity of poison taken, and the length of time that elapsed before death. The subject was a male child, aged 14 months: it must have had at least three grains of opium, and probably much more, and yet it lived for eighteen hours. No poison could be detected in the contents either of the stomach or intestines.

The narration of the case is followed by some valuable remarks on the various tests for opium, and the method of employing them. As a trialtest, Mr. Taylor gives a decided preference to the solution of sesquichloride of iron, which will detect the meconic acid contained in the 160th part of a grain of opium. "In order to employ it, a portion of the suspected liquid, if viscid, should be slightly diluted with water; if coloured, it should be so diluted that any change of colour, on adding the test, may be at once perceptible. The test should be saturated and neutral, or as nearly so as possible; it should be added guttatim to the suspected liquids, an equal portion of the untested solution being placed by the side of the glass, for the sake of comparing the effects. If opium be present, a dark

red colour will be immediately brought out (permeconate of iron); and it will be found that this red colour is not destroyed by the addition of a few drops of a solution of corrosive sublimate. If no change of colour should be produced by the sesquichloride, and the liquid be, at the same time, in such small quantity as to admit of no further reduction in bulk by concentration, then it will be useless to seek for opium; as the quantity, if any be present, will be too small for any known process of separation.'

It is a question often asked by juries, -how small a quantity of such and such a poison can you detect? To supply an answer to this question in regard to opium, Mr. Taylor performed a series of experiments with the following results.

In the tables below, the first column represents the absolute quantity of the substance detected; the second, the quantity of opium to which it is equivalent; the third, the weight of water or liquid compared with the absolute weight of the substance tested; and the fourth, the actual quantity of liquid used in the experiment :

From this it is clear that iodic acid is the most delicate test for morphia, but it is open to the greatest number of objections, for an account of which we must refer to the original.

The next table shows how small a fractional quantity of meconic acid Mr. Taylor has succeeded in detecting by means of the sesquichloride of iron. The columns have the same significance as in the former one.

It must be remembered that in these experiments the substances used

were pure.

II. On the action of digitalis, and its uses in diseases of the heart; W. Munk, M.D., Physician to the Tower Hamlets Dispensary.

This is one of those performances which we hail with the greatest satisfaction; were they more numerous we should be in a better position to contend with disease, and (what is of far smaller importance, but still of some moment) to answer the frequent taunts of our homœopathic opponents.

Dr. Munk has drawn his conclusions from upwards of 400 experiments with this drug, made with care, and recorded with accuracy; and he has, we think, established some very important points.

It is well known that digitalis exerts its influence specially on two organs-the heart and the kidneys. Now it appears from the researches before us, that these results depend very much upon the preparation employed-the tincture affecting the heart-the infusion acting upon the kidneys. If it be desired to lower the action of the heart decidedly, as in cases of hypertrophy, the tincture should be given alone, in

moderately full doses. If we wish to relieve the palpitations, dyspnea, &c. which form so large a portion of the distress of those who suffer from valvular disease, dilatation, &c. the tincture should be given in combination with camphor, assafoetida, musk, or other antispasmodics. In either case the patient should abstain from all exertion of mind or body. A plethoric condition is unfavorable to the action of the drug, and should be removed before its administration.

When the diuretic action is required, the infusion should be given in doses of from half an ounce to an ounce every six or eight hours, and the patient should take moderate exercise, and have the loins warmly clad, avoiding the production of diaphoresis.

Dr. Munk suspends its use if the pulse falls below 60, and does not persevere longer than a week, if the medicinal effects are not readily produced. With these precautions he has rarely seen any injurious effects from its employment.

III. Remarks on the pathology of iritis; by J. F. France, Assistant Surgeon to the Eye Infirmary.

The principal object of this paper is to establish the reality of the distinction between syphilitic and arthritic iritis, to point out the chief diagnostic marks, and the modification of treatment required.

In well-marked cases of syphilitic iritis, the first morbid changes in the membrane itself are commonly observed at or close to the margin of the pupil, where the iris is found not only to have its mobility impaired and its brilliancy tarnished, but the sharpness of that margin lost; and, as the disease advances, the natural colour of the iris, at one or more inflamed points, which appear thickened, is seen to give place to the development of a dusky reddish-brown hue. This colour, as the disease and tumefaction advance, becomes more striking, but it is sometimes obscured to a certain extent by fibrin effused into the cavity of the anterior chamber. Generally, however, there is only sufficient exudation from the free surface of the aqueous membrane to attach parts of the edge of the pupil to the capsule of the lens, and perhaps cover, more or less, its contracted aperture. In some cases, very minute dark-brown circular specks, with well-defined margins, appear in the lower segment of the cornea, and these, when present, are strongly presumptive evidences of the nature of the disease. The rusty colour of the tumefied spots on the iris Mr. France has found to depend upon a network of distended vessels ramifying over them.

In arthritic iritis the dullness of the anterior chamber is much more extensive and considerable; and, if the disease be not quickly checked, the entire circle of the pupillary margin is soon fixed by lymph to the capsule of the lens, and even the whole area of the pupil may be thickly overspread with this effusion, which presents very generally a white or yellowish-white appearance. The surface of the iris is not partially discoloured in rusty-looking spots, but has an uniform greenish or yellowish hue. In fact, in this form, the lining of the anterior chamber and the serous covering of the iris are, in common with the sclerotic, the principal seat of disease, while, in the syphilitic form, the inflammation chiefly attacks the parenchymatous structure.

In treatment of the arthritic variety, antiphlogistic measures must be