be no larger than just to admit the forceps; and that the finger of the operator, and the opening of the blades of the forceps, will be found the safest, and therefore fittest means of sufficiently enlarging the aperture for the extraction of the stone. If the knife be used for this purpose, there is great danger of the pelvic fascia being cut; and the ill effects resulting have already been dwelt on, as one of the most frequent causes of the failure of the operation." We should conceive that, at this time of day, there cannot be a second opinion upon this point.

Case 13, that of a boy between five and six years of age. The calculus was brittle and broke. The remaining fragments were afterwards removed with a more appropriate pair of forceps, and likewise by means of a scoop. The bladder was then injected twice; and a good deal of fetid gravelly matter escaped with the water. We quite agree with Mr. Cooper, that the necessity for the frequent introduction of instruments into the bladder, under these circumstances, demands the greatest gentleness in their manipulation.

Case 14 was one of calculus impacted in the urethra, behind the scrotum. It was cut down on, and removed with success.

Case 15, that of boy aged 10. The urine was albuminous-the stone was about the size of a pigeon's egg. He recovered slowly but perfectly. Mr. C. remarks that "the urine may present the appearance of an albuminous deposit, by the application of heat only, from its alkaline condition, and without any disease of the kidneys; or it may present a similar appearance when nitric acid is applied, from the presence of lithic; and in every case, therefore, it is necessary to employ both heat and acid as tests of the state of the secretion." In the sixteenth case, there was slight hæmorrhage.

Case 17, that of a boy aged 5. The stone was small-more hæmorrhage than usual at the time of operation, but it ceased on his being put to bed; it recurred, however, about a quarter of an hour after, and apparently proceeded from the artery of the bulb; there was considerable difficulty in stopping it, owing to the extreme irritability of the child, who was constantly crying for two hours subsequent to the operation. A piece of sponge was placed in the wound, and pressure was made, and kept up, by the finger of the dresser. Syr. papav. 3j. was given him; and he was ordered to be kept quite quiet. Ábout two hours after, the dresser having left him, the sponge was forced out by the cries of the child. The countenance was now blanched, with dark areolæ round the eyes; the pulse was hæmorrhagic; and the feet cold. The sponge was replaced, the pressure again applied, and strict orders were given that he should be closely watched: warm flannels were applied to the feet, and another dose of syr. papav. was given him. On the 27th and 29th, hæmorrhage recurred to such an extent as almost to destroy the patient; but was however again restrained by pressure. From this period, by the administration of tonics and generous diet, he rapidly improved in health, and left the hospital on the 6th of December quite well.

Case 18, that of a man aged 25. Operation on the 21st June, 1842, when a large deep arterial branch was divided, and bled rather freely. Free hæmorrhage followed the operation. Constant pressure on the ramus of the left ischium was made, by means of a piece of sponge, and the introduction of the fore-finger into the wound. This was continued for about three quarters of an hour: lint, dipped in cold water, was then applied, and pressure made with a cork.

On the 25th, whilst straining to pass his urine, hæmorrhage again commenced; but was quickly stopped by the introduction of a sponge-plug into the wound, and placing a bottle of cold water between the thighs. He was dismissed cured on the 3d of August.

"These cases require all the care which an attentive assistant can bestow;

as, in many instances, the loss of a small quantity of blood may turn the scale; and unless a person be at hand to apply his remedies immediately, a life, which might otherwise have been saved, is lost. The keeping the patient cool, by free ventilation of the room, the administration of cold drinks, the application of ice to the perinæum, and pressure upon the bleeding vessels, are the principal means indicated.

"I consider, however, the danger of bleeding may be much diminished by the mode of operating followed by the surgeon; and that if the urethra be not laid open in the bulb, there is but little fear of any important loss of blood: while, on the contrary, if the groove of the staff be cut down upon, anterior to the deep fascia of the perinæum, the artery of the bulb must inevitably be wounded. The operation is doubtless rendered more difficult by this deep cut into the urethra, but the safety of the step is a sufficient compensation for its adoption."

Case 19. A man, aged 27, had had symptoms of stone for twenty years. After the first incision, considerable hæmorrhage took place, owing to the large size of the superficial vessels: some difficulty was experienced in seizing the stone, from its large size and form. After the operation, which occupied about two minutes, hæmorrhage, to the amount of two or three ounces, occurred; which was checked by making pressure upon the perinæum with ice in a bladder. He complained of being faint, and felt inclined to vomit: pulse 82, feeble. Pressure was afterwards removed, but the ice continued to be applied.

Hæmorrhage recurred on the 28th and 30th, and August 1st and 2d, without any apparent cause, to such an extent, as considerably to lessen the hopes of recovery; but, by applying ice to the perinæum, and the introduction of a plug into the wound, it was completely stopped; and he eventually quitted the hospital perfectly well.

The calculus was of the mulberry kind.

Case 20. A shoemaker, aged 40, had had stricture five years previously, and laboured under incontinence of urine. Ten days before admission, tumefaction and redness were observed at the umbilicus; to which he applied some shoemaker's wax: about ten or twelve hours after its application, about a pint and a half of urine passed off, in a full stream, from a small orifice in the umbilicus, now for the first time observed; and the flow through the urethra then stopped. At the time of admission into the hospital, on the 8th day of January 1830, his symptoms were, an alternate flow of urine from the orifice of the umbilicus and urethra; scanty in quantity from the latter, very turbid, and of a reddish colour, apparently from an admixture of blood: pain, on pressure, over the right lumbar region; and, moreover, on pressing the right iliac region, an irresistible desire to micturate was induced. His general health good: cutaneous perspiration scanty. The catheter has been daily introduced, and small quantities of urine been drawn off.

Pressure over the umbilicus failed to arrest the discharge through it. A metallic elastic catheter was directed to be worn continually in the urethra. This had a great effect on the umbilical fistula. In July, however, the instrument broke, leaving about three inches in the bladder. Extraction with the urethral forceps was attempted in vain. On the 3rd August, Mr. Cooper performed an operation for its removal, which was in every respect similar to the lateral operation of lithotomy. The second incision opened the membranous portion of the urethra, and divided a part of the left lobe of the prostate gland: several attempts were now made to seize the portion of catheter, by means of the urethral forceps, but ineffectually. The prostate gland was then completely divided, and the bladder opened; and after a few efforts, the broken portion of catheter, about three inches in length, was extracted with the lithotomy forceps.

The patient recovered.

Spirit of the British and American Periodicals.

PATHOLOGY.

ΤΟ

OBSERVATIONS ON A PECULIAR NERVOUS AFFECTION INCIDENT TRAVELLERS IN SICILY AND SOUTHERN ITALY. By J. HUNGERFORD SEALY, Esq. M.D. A.B. late resident Physician at Florence, Messina, &c. (Condensed from the Dublin Journal of Medical Science, May, 1844).

THE author had frequent opportunities of witnessing the disease he is here about to depict.

It is characterised by an excessive irritability, attended with extraordinary mental and muscular activity, and seldom attacks the new comer, but more frequently those who have been resident between two and three years, and just beginning to suffer from nostalgia. There exists in it an inexpressible consciousness of disease, the mind is disturbed by visions; the imagination is morbidly awakened, yet the judgment still possesses its control over the mind, with scarce a capability of obeying its dictates.

Dr. Sealy is satisfied that it is a disease of climate. The modifications of it are great, and its grades various, from slight excitability to serious and formidable disease, affecting mind and body. According to the Doctor 'it seems a hyperelimination of the nervous principle, a peculiar elastic evaporation, of a spiritual consciousness and capability, aroused by electrical agency or invisible atmospheric influence." The imagination and sanguineo-nervous temperaments are particularly liable to it, and suffer much during the prevalence of the Scirocco-wind, especially at Rome and Palermo, and at Naples and Sicily, when the atmosphere is charged with electricity. That all should feel excitement in that elastic atmosphere is not to be wondered at-it is when such excitement becomes excessive and permanent that it requires control. The extraordinary rarity of the atmosphere contributes much to this, the force with which impressions are conveyed to the senses. In Sicily the air is so attenuated and transparent that distance seems almost annihilated and sounds come on the air with appalling force. Some parts of Italy are found to possess this exciting influence more than others.

Whilst residing at Florence several cases of this nervous affection presented themselves to Dr. S. affording curious, and some of them most amusing traits. The severest case of it ever witnessed by him was in Messina in Sicily. On his arrival at Messina, from Naples, he was waited on by a gentleman stating that their resident clergyman was dangerously ill and requested his immediate attendance; he stated that the town was in a ferment about him, the Church of England service having been suspended for some weeks. Dr. S. immediately waited on his patient-he found him in bed-countenance haggard-eyes glaring out of his head and deeply suffused and bilious; skin dry and parched, and almost verging on the icteroid tint-tongue dry and red at edges, and covered with a brown fur in centre and back portion-pulse small and quick,-his general expression denoted the deepest misery, though his mind was perfectly clear-he had been ill three weeks. He had been under the care of a Sicilian physician, and had taken very little medicine, none of a purgative kind, though he felt he wanted it, as his bowels had not been moved for some days. The Sicilian doctor declared his complaint to be March fever, and was treating him accordingly with quinine-the only other medicine he had taken was an infusion of taraxacum, the Sicilian panacea for all diseases. Dr. S. advised blue pill in a smart dose, combined with compound colocynth pill to excite the biliary secretion-to this No. LXXXI. R

were added leeches to the head-mustard sinapisms to the feet-the pills to be followed up by a bitter saline mixture to full purging. After 12 hours there was a perceptible improvement-the patient had been well purged-his mind became more tranquil, and his nervous system much quieted. During the progress of his disease, his mental hallucinations were extraordinary, almost amounting to what the French Mesmerisers denominate clairvoyance, and his visions were frightful-bis pervading wish was to tear everything near him, to shout, to sing and curse-he fancied he saw his limbs leave his body-he was convinced of the unreality of the vision, and of its being the result of a diseased imaginationyet so palpable was the delusive vision that he could scarcely correct the delusion by the utmost effort of his reason.

The bodily disease, separated from the mental hallucination, evidently had its origin in the biliary and chylopoietic viscera--this was indicated by all the symptoms as well as by the alvine discharges. This was the disease in its severest type. The minor modifications of the disease, met elsewhere, were not attended with such severe constitutional symptoms, and in many cases, where severe and distressing mental hallucinations existed, were unaccompanied by morbid appearances. Dr. Sealy states that he could almost always trace the disease to some engorgement of the chylopoietic viscera-he considered the disease as a modification of hypochondriasis, the nervous system being over-exerted by atmospheric influence, while the biliary and digestive systems were deranged at the same time.

The most successful treatment, according to the Doctor, is a modification of mercurial and vegetable purgatives, with a modified anodyne and stimulating plan of treatment.

IN

CASE OF DEATH FOLLOWING THE EXCESSIVE USE OF ARDENT SPIRITS; WHICH APPEARANCES SIMULATING IRRITANT POISONING WERE FOUND ON DISSECTION. BY JOHN INGLIS NICOL, M.D. Inverness. (From the London and Edinburgh Monthly Journal, June, 1844.)

J. F. a young man about 26 years of age, had indulged in drinking a considerable quantity of whiskey in company with some friends. On his return home, two of his companions accompanied him, as he seemed much intoxicated. They had walked but a short way up an acclivity, when he fell, uttered a few words, and immediately became quite insensible. His companions, supposing him merely to be very drunk, carried him home, and after very considerable difficulty they succeeded in placing him in his bed. They could not say whether he was drunk at the time; they only thought him to be drunk. He was found dead next morning.

Seven hours after he had been discovered in this state, a post mortem was instituted a few scratches on left cheek-back and depending parts of the body very livid; and under the angles of the jaws and along the sides of the neck, the colour amounted to a deep purple.

Thoracic viscera healthy. In the abdomen the distention of the larger gastric and gastro-epiploic veins attracted immediate notice-liver congested. On opening stomach, there was an evident odour of ardent spirits. The oesophagus, stomach, and a large portion of the intestines being opened to view, the whole of the mucous membrane, from about half-way up the esophagus, along the whole extent of the stomach and for about 18 inches along the intestines, was found highly injected. The vascularity of the corrugated part of stomach was of a deep crimson colour-oesophagus and intestines presented a like appearance. Whilst the head was being examined, a large quantity of liquid blood flowed from the divided vessels; apoplectic congestion of the vessels of the investing

membranes was very evident. The opinion given was that death was caused by apoplexy. After a careful examination not a trace of irritant or corrosive poison could be detected. Dr. Yellowly has given a paper published in the fourth volume of the Transactions of the London Medical and Chirurgical Society, from which it would appear that such cases as the present are of more frequent occurrence than is generally supposed.

SOLITARY CONFINEMENT.

The effects of this system of prison discipline on mental and corporeal health, can only be determined by time and careful statistical records. The fifteenth Report of the Pennslyvania State Penitentiary lies before us, and is a very important document. In that establishment the silent and solitary system is carried out with great punctuality, and is under the care of an experienced physician, Dr. Hartshorne. It appears that the whole number of prisoners, during the preceding year (from March, 1843, to March, 1844) was 487, of whom, 325 were whites, and 162 coloured. The mortality was 11-5 white and 6 coloured. The per centage of mortality was therefore 1.53 as to the whites, and 3.66 as to the coloured. This shews a remarkable difference. During that year, 60 white prisoners and 23 coloured, were admitted in good health-and 53 white and 20 coloured, in imperfect health.

These facts proclaim no unusual mortality among the prisoners; and when we consider the habits of such persons, prior to imprisonment, the proportion of deaths is remarkably small-it is as nearly as possible the same as that of the citizens generally. The hygienic means employed are merely cleanliness of person and cell-free ventilation-good bedding-regular exercise in the cell yardsmoderate diet-comfortable temperature-good cloathing, and constant occupation. Flannels next the skin have been found very beneficial in preventing rheumatisms, neuralgiæ, and coughs. Acute diseases have been few and of short duration. The chronic diseases have been chiefly those of the digestive organs, rheumatism, and venereal affections-occasionally scrofula and phthisis. The latter diseases rare among the whites. Dr. Hartshorne declares that he has not been able to discover any disease peculiar to the Penitentiary. The amount of tubercular disease, says he, has been much less than is generally imagined. In respect to the effects of this system on the mental functions, the physician avers that, from what he has seen, he has no reason to believe that it has any tendency to produce mental derangement in a person not constitutionally predisposed to that complaint.

"Instead of stultifying the intellect, as some imagine, I am fully satisfied that separate imprisonment is more apt to produce the opposite effect. The percep tions are evidently rendered more acute by continued exertion under the difficulties of restraint. The reflective powers also are increased by their unwonted activity under the exigencies of a seclusion, uninterrupted except by intercourse with intelligent and considerate men.

"The acuteness of perception among criminals is proverbial in all prisons; and the experience of this one long since proved that these faculties are by no means blunted there. Nor are the statements in regard to the subdued temper, and improved habits of reflection among separate convicts, mere idle assertions; as all those who have watched the mental developments in this place must be prepared to admit.”

It can hardly be doubted that the silent and solitary system of prison discipline is that which most effectually corrects evil habits; and if, as these documents seem to prove, it is not injurious to health and life, the popular clamour against it goes for nothing.