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as in the preliminary discourse, and the editor seems to limit much more than we have done the evidence which is to be deemed satisfactory.

At page 141, in the same volume, the subject of quaran tine is adverted to, and the wish is expressed, that the matter may be more fully inquired into, and the necessity of the practice considered impartially. It is certain, that the qua rantine laws are the source of great inconvenience. If they are useless, the burden should be removed. It is in this country that the subject should be investigated; for, at present, we not only suffer at home by this practice, but we give occasion, by this very circumstance, to many foreign powers to subject our trade to great embarrassment abroad, in cases where it certainly is not necessary.

At page 215, vol. i. we learn that Dr. Caldwell adopts the opinion originally proposed by Dr. Lubbock and Mr. Allen; or rather, if we remember right, by some Italian physician first of all. This is, that the impetus of the blood through the vessels of an inflamed part is diminished, not increased, and that the vessels are debilitated. It does not seem evident to us, that the impetus is necessarily either increased or diminished during inflammation. The enlargement of the vessels is not to be explained mechanically, but by the power of elongation possessed by the fibres of their muscular coats, which has been taught by Hunter and by Barthez. But that it is essential for vessels to be debilitated, in order to the performance of the new and extraordinary functions of inflammation-this is hard to believe. In regard to Dr. Wilson's experiments, we are satisfied that they are not worthy of any regard on this point.

While considering the process of suppuration, the editor claims for one of our countrymen, an honour, which has, we believe, been commonly thought to lie between the celebrated De Haen and John Hunter. We have never seen the disser. tation by Dr. Morgan; but the British physicians will ask, whether the doctrine it asserts had not been already promul gated by Hunter in 1765.*

* We are glad to see this answer from another quarter. Our known partiality might have been suspected. We have often heard with regret, from the disciples of one of the London schools, that, a similar doctrine has been promulgated there. Whoever compares either De Haen or Morgan with Hunter, will require no other arguments in favour of the latter.-Add to this, Mr. Hunter gave public lectures in the year 1755.-English Editor.

pursue his usual occupations with great ardour, till the moment he was attacked. He was suddenly seized with pain in the breast, cough and expectoration of blood; on the fourth day, he became delirious, and the cough ceased; on the sixth, he was comatose, and died. The body was examined by Dr. Warren, and presented these appearances. The stomach, liver, and other abdominal or gans were in a natural state. The heart was large, and full of liquid blood. The lungs dense, inflamed. One or two considerable cysts were found, which had, probably, been formed by a collection of blood from a former occurrence of hæmoptysis; a complaint to which he was occasionally subject. The mucous membrane of the lungs was in a state of high inflammation. On opening the skull, a quantity of water was discharged from the surface of the tunica arachnoidea; this membrane was opaque, and contained a quantity of water between itself and the internal covering of the brain. The surface of the brain was flattened, and exhibited a shrunken or coinpressed appearance. The veins, on its surface, were small. The substance of the brain was firm. When the ventricles were opened, there appeared, to the surprise of all present, a great quantity of transparent water; and, when the ventricles were emptied, they retained their form perfectly, no doubt, from having been distended for a long time. The quantity of water, collected from the brain, was about eight ounces; but as no preparation had been made to receive it carefully, much was lost. No one will believe, that these appearances of the brain were caused by a disease of five days' duration. It is more probable, that the water had been collecting for a long time, in a very gradual manner. Hence the functions dependent on the brain, were not interrupted, for they had time to accommodate themselves to the change in that organ. This case has been thought more worthy of note, since observing one very similar, lately published by the distinguished Dr.Heberden, in the Lond. Med. Trans. especially, as it is remarked by him, that the brain is not often enough examined, nor its appearances recorded. This case may be considered even. more remarkable than that related by Dr. Heberden; since the subject of the latter was a person eighty years old, had been occasionally unwell some time previous to death, though he possessed his intellectual faculties, until the very day on which he died. It is well remarked by Dr. Heberden, that since a few drops of blood, a slight puncture or blow on the head, will frequently produce such derangement of the brain as to prove fatal we have reason to admire that wonderful power in the animal fabric, of accommodating itself to the greatest changes, when they take place slowly, and by small degrees.

The other case, not less remarkable, is related in the words of the physician who attended.

The child of S. W. aged two years, was attacked on the third day of February, with violent symptoms of fever. After a few days, the febrile symptoms subsided, leaving the child in a state of stupor, which was now and then interrupted with violent shrieks, and appearance of much distress and agitation. The head was constantly

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rolling

rolling from side to side; the occiput inclined backward. The e e eyes were dim, pupil insensible to light, and somewhat dilated. Vision was evidently impaired or lost, as no notice was taken of objects approximated to the eye. The sense of hearing was thought to be diminished, and might be wholly lost. The left arm and leg remained immoveable; the opposite extremities were occasionally agitated. The tongue, at first, foul, afterwards became clean. The intestinal evacuations were always of a green mucus; but never occurred except from the use of purgatives; drinks were swallowed, when presented, in a wild, idiotic manner.

These symptoms resisted the use of the most powerful remedies; and about the 14th day appeared to indicate a confirmed hydrocephalus, of the most distinct character. All medicines were, therefore; omitted, and the parents resigned themselves to the loss of their child, which was daily expected. In fourteen days after, I was called to the house, and, to my great surprise, found the child still living, though insensible to external objects, yet seeming to suffer pain, as it occasionally shrieked in the most distressing manner. The pulse was slow, intermittent. The skin cold and loose from great emaciation. The mother was advised to give opiates, in order to keep the child easy, and to relieve its bowels periodically by purgatives. On a second visit, I found the pulse regular, though very slow. The eyes now and then open, and presenting a strange appearance from the enlarged state of the pupil. The hopes of the mother were revived, and I felt sufficiently encouraged to recommend to blister the head anew, and to give a purgative dose of calo'mel, with jalap, every other day. On the operation of these medicines, a rapid amendment took place. This child, after remaining insensible to external objects for nearly four weeks, began to notice things around it; soon after to reach out to the spoon: then it attended to things calculated to amuse it, began to smile and stretch out the hand. It appears perfectly sensible now. Eats freely of solid food, and gains strength daily. The pulse continues very slow. The skin is cold. The pupil is very much dilated; but contracts, on turning the head to the light.

it

For a few days, there has been a slight discharge of matter from the left ear; but I cannot discover any other mark of disease in the external auditory passage,

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There has not, at any time, been the slightest appearance of worms, living or dead; nor of the remains of worms. The discharges have been uniformly of a green mucus, as well during, as after the operation of the most powerful purgative, until since the other changes in the symptoms of disease. They are now quite healthy, yet appear only in consequence of taking purgatives.

Since the above was written, the intestines have begun to perform their healthy functions without medicine. The child uses its legs, can stand a little, and appears well, except that it is still feeble. The pupil of the eye remains dilated.

There cannot, in my opinion, be a question as to the propriety of considering

considering this as an instance of recovery, from a collection of water in the brain.

Lithotomy.-An accident occurred to Dr. Warren, in performing the operation of lithotomy, which it may be useful to record. The patient was about fifty years of age; of a very gross habit, and refaxed fibre; bad laboured under his complaint for many years, during the last two or three of which, he had been endeavouring to prepare his mind for the operation. His sufferings became, at length, so excruciating and so constant, that he consented to take the risk of baving the stone extracted, although the state of his system, and the size of the stone, contributed to lessen the probability of success. On sounding him, the stone was readily perceived; but could not be directly struck by the instrument, which appeared rather to rub it in passing, than to strike it. On examining by the rectam, both in the upright and horizontal posture, the stone could not be perceived. The patient being properly prepared; the external incision made, and the urethra opened, the gorget was passed along the staff; but, bet fore entering the bladder, was found to strike hard upon the stone, and its further passage was impeded. The direction of the staff was then altered; and the gorget, being pushed steadily on, and carefully kept to the staff, overcame the resistance, and a stream of urine im mediately appeared. The gorget being felt to strike the stone, the staff was withdrawn; but, on passing the finger along the gorget, it appeared that the opening into the bladder was too small to be per ceived in so deep a wound. The gorget was withdrawn, and a round sound was passed through the urethra into the bladder; then a female staff was passed through the wound till it struck the sound, where the uretlira was opened, and, by means of the sound, was conducted into the bladder, and the stone was struck with it. Then a curved kuife was passed along the groove of this staff into the bladder, and both, being turned to the left, a free incision was made in the bladder. The forceps was then guided by the staff to the bladder; the wound being too deep to admit of the finger's reaching the bladder. The shortest diameter of the stone was found, and then it was drawn to the wound, but was found too large to pass through it. A bistoury was, therefore, passed to the stone, and insinuated between it and the bladder, so as to cut the external angle of the wound; and then, by gradual movements, the stone was brought out, without the use of great force. On examining the stone, it was found to be large, smooth, except at one part, where for about an inch, it was rough and covered with transparent crystals, to some of which were attached small portions of membrane. At the largest end of the stone, was seen the mark made by the beak of the gorget; and, on examining the instrument, it appeared, that about a quarter of an inch. of its edge was knocked off, where it had struck the stone. The patient did well on the three days following the operation. On the fourth, the abdomen became tense, and occasionally painful. His strength diminished rapidly, and he sunk on the seventh day. The body was examined by Dr. Warren, in company with Dr. Jackson. The swelling of the abdomen was found to arise wholly from air con

fained in the large intestines. A slight blush from inflammation was diffused through these intestines. The peritoneum, over the upper part of the bladder, was discoloured. The bladder had, internally, a dark coloured appearance, and, at the part corresponding with the symphysis pubis, the mark of adhesion of the stone was observed. Extending from this part to the left side of the pelvis, appeared some purulent matter, in the copious cellular membrane, which enveloped the bladder. The incision of the bladder was found to be as exact as possible, through the left half of the prostate gland, and three-quarters of an inch of the bladder. This organ was not wounded, torn, nor hurt in any other part. The rectum, on its fore-part, was in perfect state. On the part attached to the coccyx, it was discoloured from a small portion of coagulated lymph. The external wound, and the scrotum, were dark coloured and gangrenous. The stone, being measured, was found to be nearly three inches in length, and five in diameter.

There are many histories of stones being inclosed in a sac of the bladder; but there was nothing of the kind here. The impossibility of discovering the stone by the rectum, the resistance opposed to the gorget, the appearance of the stone, and the appearance of the inner coat of the bladder, all concur in showing, that this stone adhered strongly to the fore-part of the bladder; from which it was separated by the stroke of the gorget. The separation of the stone from the bladder was the cause of the inflammation of the peritoneum covering it; and this inflammation, propagated by sympathy to the colon, was the cause of death; although the inflammation was not so considerable but that the patient would have recovered, if his constitution had not been impaired by disease and confinement. The gangrenous appearance of the scrotum and external wound was not produced by contusion, as there was none applied to those parts, and the pressure, on the internal wound, was not so great as that often employed in cases which terminate well.

The peculiar occurrence, in this case, forms an objection to the use of the gorget. The operator was led to it, in this instance, from observing, that in three preceding cases, in which he had used the knife, the cures were more slow than where the gorget had been used; and also, from a comparison of the wound, made by the gorget and by the knife, in dead bodies, operated on and dissected for the purpose of this comparison. The wound, made by the knife, was never so exact, as to size nor situation, as that made by the gorget. Nor can it be, since the gorget is always conducted by the staff, while the knife necessarily quits the staff to make the incision of the prostate gland.-New-England Journal.

(From Paris.)

Observations on a Strangulation of the Small Intestines, terminated by Gangrene and Death; by M. BOUGON, Surgeon to Monsieur. The records of medicine present no example of an aċcident similar to the present; but this may be only for want of that attention

NO. 222.