We conjectured that it might weigh about twelve pounds. On making a small incision into its peritoneal covering, and raising one of the divided sides of that membrane, the whole was easily detached from the liver, without any effort or laceration. The appearance of this transparent membrane was most beautiful; there were no injected vessels in it. On endeavouring now to make a pressure, even gently, with the finger, on the surface of the liver, its parenchyma gave way, and the finger penetrated quickly within it, forcing out, at the same time, a copious flow of a fluid similar to that which we noticed on the internal surface of the intestines. The same occurred in every other portion of the liver. In fact, this viscus seemed to have been as if macerated in bile, and exhibited, in the most complete manner, the appearances of the foie gras of geese and other birds, the liver of which is made to swell to an enormous size by the skilful hand of the epicurean.

On coming afterwards to that part within which the gall-bladder is lodged, we were struck, as we thought, with a want of the latter. In this supposition we were mistaken. The gall-bladder was indeed in situ, but not as we are wont to find it, membranous, translucid, containing its natural fluid, &c. In the present instance, this receptacle of the bile presented a thick carneous body, the half of which contained, within narrow cavity, a very small quantity of a light-yellowish transparent fluid, wholly soluble in warm water; while the remaining portion was distended, and closely embraced a calculus of a spheroid form, flat, and measuring one inch in its principal dia meter. The orifice of the cystic duct was contracted, scarcely admitted the introduction of a small probe, and was effectually closed from within by one of the extremities of the calculus. Of the nature of the latter I shall speak more definitely when I shall have subjected it to a proper analysis. In its external characters, it appeared to be of a pale or dusky yellow colour, light, rough at its elongated extremities, having crystallized depositions on a few points of its surface. The appearance of the latter gave one the idea of the body of the calculus being formed of an assemblage of small globules of an earthy na

ture.

The accompanying diagrams are intended to convey a portrait of the above appearances; both parts being represented nearly of their natural size.

A, Morbid appearance of the fleshy, gall-bladder, containing the calculus, B, seen through the longitudinal incision, marked by the dotted lines.

I have shown the preparation to several of my friends, and, among others, to Sir E. Home, Dr. Macleod, and Mr. Cliff, of the College of Surgeons; where it will be deposited among their very interesting collection of calculi, which have lately been most judiciously arranged and displayed.

The various ducts exhibited no deviation from their natural arrangement.

My medical conviction in this case is, that the excess of bile, which the common receptacle for that fluid could no longer receive, from the presence of the calculus, was occasionally thrown, in its undiluted state, into the intestines and stomach; where, having for some years produced all the unpleasant symptoms which Mrs. N. experienced at different times, had at last been the cause of that inflammatory state of the mucous membrane which proved fatal. Another, and a natural, consequence of such a combination of circumstances, has been to soften down the parenchyma of the liver, to increase its volume, and, by producing constant irritation, to excite that organ to an augmented secretion of bile.

One other remark I may make, and that is, that, wherever the bile seems to have been stagnant for a time, a considerable production of fat has been the consequence. I have seldom witnessed the abdominal viscera loaded with so much adipose substance.-A. B. G.

Mr. TRIPE in Reply to Mr. SMITH'S Observations respecting the Frequency of Calculous Disorders in Great Britain.

IN

N answer to the call upon me, contained in Mr. Smith's reply to my observations upon his Statistic Inquiry into the Frequency of Stone in the Bladder, I now beg leave to state, that, up to the latter end of 1816, I had cut, in my practice, nine cases. I have also made the most careful inquiry upon the subject, and have ascertained that there have been cut, in these towns and their vicinity, by other surgeons, during the twenty years previous to and ending in 1816, twenty-five cases; but the most of them occurred within the latter half of that period. Since 1816, there have been seven operations for stone, besides the four which I performed in my practice in the same interval. I have not extended my inquiries further back than 1796, be cause it is well known that before that date such operations were rarely, or never, performed in this part of the country.

I am quite certain, from the very candid and liberal manner with which Mr. Smith has proposed to treat this subject, that it was not his intention, by any thing which he has written in his reply, to leave the least impression upon the mind of any individual, which could be unfavourable to my intentions; but, as one part of his paper contains sentences written in such a connexion as are liable to lead his readers into a suspicion that, in my former statement, I have not been accurate, and therefore not strictly just towards Mr. Baines, I trust that I shall stand excused for having any anxiety to prevent the possibility of this effect being produced.

I would beg leave to observe to Mr. Smith, that Mr. Baines's report of the number of cases which had been operated upon at the Exeter Hospital, and published in his Inquiry, does not end in 1816: the words of the report are, "between the years 1806 and 1816, eighteen cases; between 1811 and 1818, nine cases."

The cases I have now enumerated from this neighbourhood, for the purpose of enabling Mr. Smith to rectify the error which he has been unconsciously led into, in the publication of his Inquiry, will, at the same time, prove that the numbers which I before published in my Observations were not over

rated.

The object with which I wrote these observations was to exhibit the mistake which Mr. Baines committed, when he assigned to the Institution, of which he is a surgeon, the merit of performing, with very few exceptions, all the stone-operations for the county of Devon, &c.; and, as well, to prove that the deduction made by Mr. Smith from his Inquiry, as far as it regarded the frequency of the disease in this county, was the

reverse of what it should have been: and I stated the number of operations which had been performed in these towns during the last ten years, (twenty-six,) to illustrate the fact, by comparing it with the last ten years of the hospital report; at least, as far as we were enabled to judge of it, from the manner in which that report is drawn up.

The subjects of those operations were mostly from the poorer classes of society, residing in crowded and unwholesome apart. ments, whose meals consist principally of vegetables, occasionally varied by fish, and these not always in sufficient quantity: it is hardly necessary to add, that their drink is water.

The following interesting fact, communicated to me, in the course of my inquiries upon this subject, by an intelligent medical friend who practises in these towns, is deserving of being recorded.

A few years since, a man, aged about twenty-five, applied to him for his assistance; and, on examination of his urethra, a stricture was found at about three inches from the orifice, which was hard and cartilaginous in its feel. No instrument could be made to pass this obstruction; he therefore had recourse to the bougie, armed with argent. nitratum, which succeeded in forcing the passage at this part, and with but little irritation or trouble, more than is commonly experienced by this mode of treatment. Another stricture, of the same character as the former, was found at five inches; and the application of the caustic had made a considerable impression upon it, when symptoms of great irritation intervened, and arrested its further progress. Inflammation, and a circumscribed tumor, formed in the perineum, which eventually burst, and discharged a quantity of matter, succeeded by a constant flow of urine. The opening made in the perineum soon became very considerable, from the sloughs which were thrown off. On examining the sinus, with a view to ulterior treatment, a calculus, larger than a sparrow's egg, which had ulcerated its way through the coats of the bladder close to the prostate, was discovered lying near that gland: it was immediately extracted by the common dressing forceps. The sloughing, however, increased, and, from the incontrollable and constant extravasation of the urine which followed, it was extended to the surrounding parts; which cause of irritation, together with extensive excoriations, became too much for his previous shattered state of health, and it soon destroyed him.

I have met with two additional cases of calculus since I wrote my former observations: one, a man aged seventy-five, the other sixty-five. The latter having been subjected to the ope ration, and his case being of some interest, I shall take the Jiberty of briefly stating it."

George Harvy, aged sixty-five, a labouring man, and of meagre habit, having been afflicted with an urinary disease during the last twenty-five years, applied to me to ascertain if he had a stone in his bladder, and, if he had, to perform the necessary operation.

The introduction of the sound into the bladder was opposed by a calculus, which, from its extent of surface, inclined me to believe that it was more than of ordinary magnitude. The cavity of the bladder was diminished, and its coats apparently thickened and diseased. For the last five years he had been unable to retain any quantity of urine, being necessitated constantly to discharge it; and it exhibited a copious sediment of puriform mucous.

It was explained to him, that these unfavourable circumstances threw more than usual doubts in the way of his recovery from an operation; and therefore, although I would not recommend it, yet, as it afforded the only chance of prolonging his life beyond a very limited period, if he continued desirous to have it performed, I should feel it my duty to accede to his wishes. Having resolved upon the operation, the difficulty of contending with a large stone naturally occupied our consideration. The operation above the pubis could not be selected, because of the contracted state of the bladder; and, therefore, the only resource was to be provided with the means of breaking the stone, if it should be found necessary. But I have to regret, that an instrument well adapted for this purpose still remains a desideratum. In answer to my application to a respectable surgeon's instrument maker in London, I was informed that the most improved instrument for breaking the stone had very lately so completely failed in the hands of an expert lithotomist, that he did not feel warranted in sending it.

I performed the operation in the presence of many of the most respectable professional characters. Both the external and internal incisions were completed with the common scalpel, and formed an ample and easy passage to the cavity of the bladder. Although every precaution was used to insure a re tention of as much water as possible, yet only a small quantity trickled over the hand, upon the prostate and neck of the bladder being divided. The calculus immediately presented, and the staff, whose extremity could only be introduced just within the neck of the bladder, was withdrawn.

The cavity of the bladder appeared quite filled with calculous matter. The forceps were applied, and every means adopted to carry on the blades between the parietes of the bladder and the stone sufficiently to grasp the body of it; there did not appear for this purpose an adequate space. Enough, however, of the stone was embraced by the forceps to allow of a consider