Of eleven cases of ovarian dropsy admitted into Guy's Hospital, seven were tapped, three of which were unsuccessful. The proposal of injecting stimulating fluids into the emptied sacs, has, we believe, either never been tried, or entirely abandoned.

The following three tables will exhibit a coup d'œil of the results of almost all the cases on record. It has been constructed with great care and labour by the able and indefatigable author.

TABLE II.-Cases of Ovarian Disease in which the Operation could not be completed.

TABLE III.-Cases in which the Operation failed from an Error

Thus, the entire number amounts to 66, of which 42 recovered and 24 died— or about 1 in 24. Of the 49 cases in which the ovary was extirpated, 16 died, or 1 in 3. Of the nine cases in which the operation could not be completed, four died-or 1 in 24; and of the eight cases where the operation was unnecessary, 4 died, or 1 in 2.

Áge does not appear to have had much influence, beneficial or otherwise, and the same may be said of marriage. Adhesions render the result of the operation much more dangerous than freedom from the same, and yet not so much so as one would, a priori, expect. Where other organic diseases co-existed with ovarian, the termination was almost always fatal. It is strange that the operation should have been ever performed, where no tumor has existed; yet the mistake has been made by eminent surgeons, and without any negligence on their parts. Dr. Montgomery mentions a case where he felt a distinct tumor in a female's abdomen, which suddenly vanished in the very act of examination! The abdominal muscles, in fact, often act in such a way as to imitate organic enlargements of the liver, spleen, ovaries, &c., and thus deceive even the most careful practitioners. After many judicious remarks, cautions, and comparisons, our author comes to the following conclusions:

"Even after the details I have given, it is very difficult to come to a definite

2. The

and perfectly satisfactory conclusion, because, 1, we have not sufficiently accurate data to estimate the progress of the disease unaided by surgery. table quoted from Mr. Southam is clearly too limited to afford a fair average of the results of tapping, and it is not easy to obtain sufficient facts to enlarge it. 3. The cases in which ovariotomy has been performed are of such a mixed character, that it is impossible to select with fairness those cases in which the operation was demanded for the relief of urgent suffering, and suitable to the nature of the disease, without the appearance of partiality. And 4, from the obscurity of the diagnosis, it is too much, perhaps, to expect that our practice in future will be free from those drawbacks on the operation.

"But bearing in mind these difficulties, and making allowance for those drawbacks, I think we may conclude that there are cases in which the operation would be justifiable; and on these grounds, we find the general opinion is against the curability of the disease by medical means;—that after a time the patient will die from local disease or accident, or constitutional disturbance, and that meantime she suffers more or less inconvenience;-that tapping in almost all cases affords but temporary relief;-and that, as far as the limited statistics we have adduced are admissible as evidence, it is attended with great danger: i. e. 1 in 5 died of the first operation, and of twenty patients, fourteen (more than two-thirds) died within nine months of the first tapping; whilst of the entire number of those who underwent the operation of ovariotomy, about one-half have absolutely recovered so far."

The foregoing paper is very creditable to the industry, the talents, and the judgment of its author.-Dublin Journal, July 1844.

EMPYEMA-PERFORATION OF LUNG, &c.

Mr. Harrison, of Reading, has related a case of this kind in our Provincial contemporary, of which we shall give an abstract.

Sarah Lukeman, aged 50, was admitted at the Reading Dispensary, July 3, 1843, after nine weeks illness. Severe rigors had been followed by pain in left side, with fever, cough, and some expectoration. At present the left side contracted, and fixed in respiration, with universal dulness on percussion there. Respiration, anteriorly and latterly, distant and audible, with large crepitation in the scapular region. Loud vocal fremitus-puerile respiration in the opposite lung. Lies on the right side-cough frequent-expectoration profuse and purulent. Diagnosis.-Pleuro-pneumonia with effusion. Calomel and Dover's powder, with hydriodate of potash. She was admitted into hospital under Cowan, and remained there three weeks, without benefit, when she was discharged at her own request. She was re-admitted, under Dr. Harrison on the 31st July. The contraction of left side was still advancing-gurgling crepitation at apex of lung -expectoration profuse. The apex of right lung also was dull. Acetate of lead with opium every six hours; with good food and wine. Under this treatment she greatly improved.

Aug. 11. Yesterday felt as if something had given way in her chest, and she immediately expectorated a tea-cupful or more of nauseous purulent fluid. She is now much relieved, and the cough and expectoration, since yesterday, but trifling. The heart's pulsations are now more distinct at the apex of left lung, than in the ordinary place. For some days she was so well as to go down stairs, and even walk in the garden. On the evening of the 14th of August, she suddenly experienced a sense of suffocation, and brought up about half a pint of the nauseous matter. Frightful dyspnoea continued, with some mitigation, till her death, seventeen days afterwards. During that period, she daily expectorated a large quantity of the above-mentioned fluid.

Post-mortem.-On opening the chest, the right lung was seen projecting beyond the median line-the left was shrunk and hidden, and the cavity closed by adhesions of the pleura to the pericardium. When the cavity was opened, there was about a pint of thick purulent fluid in it. The lung was compressed to the vertebræ, and to the diaphragm. The costal pleura was lined by an adventitious substance, partially osseous, and presenting a worm-eaten appearance. On separating the osseous layer, several small pouches or cavities were disclosed-the extremities of enlarged bronchial tubes. The lung was of a dark grey colour, soft, and, at its apex, in a state of incipient gangrene. The bronchial tubes were enlarged, and the lung through them, had received air throughout, till they were filled with purulent infiltration. There was an aperture of communication with the left bronchus. Right lung large, spongy, and free from congestion. No tubercles in either of the lungs. Heart small and feeble-pericardium and endocardium healthy.

These are the naked facts of the case, to which Mr. Harrison has appended numerous comments and quotations, for which we must refer to the Provincial Journal for June 26, 1844.

ON THE PULSE OF THE INSANE. BY PLINY EARLE, M.D.
American Journal of the Medical Sciences, April 1844.)

(From the

It is but seldom that allusion is made to the state of the pulse in the writings of those who have treated of mental alienation. This arises from the generally admitted fact, that the state of the pulse is a less certain index of the true nature of the disease, of its mildness or intensity, than it is in other affections. To this general truth there are however many exceptions, of which the following is one: "whenever it (the pulse) exhibits very considerable changes, without any obvious causes or corresponding symptoms, sudden death frequently closes the scene." In phrenitis accompanied with delirium, the pulse is frequently contracted, small and apparently feeble. Under these circumstances it almost invariably becomes fuller and stronger after the abstraction of blood from the arm. Dr. Spurzheim barely alludes to this condition when speaking of the treatment of cases in which there is a hypersthenic state of the brain. In patients of a nervous temperament, where great irritability is present, the pulse may be not only unnaturally frequent but abnormally developed, full and hard. Yet were the physician to be influenced by this sign and to resort to venæsection, he would in most cases only aggravate the disease. It has been observed, as a peculiarity worthy of attention, that the pulse differs in the radial and carotid arteries, and, when soft and weak in the former, is full and hard in the latter, though the number of pulsations in the minute be the same in both. In cases where this is observed, there is generally an abnormal determination of blood to the brain, with flushing of the face, preternatural heat of the head, and coldness of the extremities. The pulse in some maniacs is affected by the most trifling causes; in others it suffers little variation, however violent the attendant symptoms. With respect to the value of the pulse, as a guide in cases of insanity, Dr. Rush speaks as follows: "should all the above marks fail of deciding the state of the mind as to sanity, recourse should be had to the state of the pulse. It is, with but few exceptions, more frequent in all grades of madness than in health. In "melancholy madness," says Van Swieten, "the pulse beats slower and the body feels colder." Esquirol, in reference to the same type of disease, says, "the pulse is ordinarily slow, feeble, concentrated; sometimes it is very hard, and a kind of fremissement of the artery is felt under the finger." The same author says, among the insane, some are plethoric, others lymphatic, some strong, others feeble; in the former, the pulse is full, hard and developed, in the

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latter, slow, soft and concentrated." From a variety of statements and experiments made and instituted by the writer of this Essay, corroborated also by those of others, he comes to the general conclusion, that the pulse of lunatics is more rapid than that of the sane. When, however, it is recollected that the circulation differs greatly in different persons, even in health, and that there is a vast diversity of influences, which, in health or disease, may determine the acceleration or diminution of its rapidity, but little value can be placed upon the pulse as a test in insanity.

HYDROCELE.

Dr. Porter, of the Meath Hospital, Dublin, has published some Practical Commentaries on the various Operations for Hydrocele, and has tendered his own to the profession, through our Dublin contemporary for July last.

:

"This operation is partly that by incision, the only difference being, that instead of dividing the tunica vaginalis in the entire extent of the tumour, my incision extends only from an inch to an inch and a half in length and partly that by the tent, an operation first proposed (it is said) by Franco, but revived and recommended by the celebrated Larrey. Having first punctured the tumour in order to examine the state of the parts, and satisfy myself that it is a case in which an attempt to cure the disease radically may be safely made, or at least in which such attempt would be justifiable, I allow the sac to fill again. When the disease has re-appeared, and the tunica vaginalis is as much distended as it previously had been, I perform the operation thus: Having that part of the scrotum in which I intend to operate shaved, I make the incision of the length above mentioned, down to the tunica vaginalis, and examine carefully whether any vessel has been wounded that could possibly furnish a considerable quantity of blood. I then pass a bistoury into the tunica vaginalis at one extremity of the incision, out at the other, and divide it by a rapid withdrawal of the instrument. Having completed the incision, a tent of rolled lint, moistened with oil, and secured with a ligature, so as to be easily withdrawn, is introduced. The operation is then completed. The patient may be placed in bed. On the succeeding day I generally bleed from the arm to the extent of ten, twelve, or fourteen ounces, and particularly if the scrotum is red, and shews a tendency to inflammation. Latterly I have adopted this practice as a preventive in all cases with apparently the most satisfactory results. The tent is left to become loose, and drop out of itself, which usually takes place on the third or fourth day, and need not be replaced; but it is desirable to break up any adhesions that may be formed between the lips of the wound, and to introduce the finger occasionally into the cavity of the tunica vaginalis until the sixth, after which it may be treated with light superficial dressing, and the cure is generally perfect in about three weeks."

Dr. Porter has now practised this operation for fifteen years, and comparing it with others, has no reason to feel dissatisfied. It is scarcely more painful, he avers, than the ordinary puncture of the common trocar; and, if carefully performed, is free from the possible occurrence of any untoward accident. Future experience must determine whether the tendency to relapse is greater after this than after other operations which are termed radical.

TWO CASES OF ICTHYOSIS INTRA-UTERINE. By J. Y. SIMPSON, M.D. F.R.S.E. &c. &c. (London and Edinburgh Monthly Journal of Medical Science, July 1844.)

Case 1.-This case was communicated to Dr. Simpson of Edinburgh, by Professor