one instance only I have seen it, and that was entirely unconnected with inflammation. It was in a child who died at about four years old, of hooping-cough. I had expected, from the oppression, and other previous symptoms, to have found the trachea stuffed with mucous matter; but it proved otherwise, for the passages of the trachea and bronchie were very free. The apparent cause of suffocation was an effusion of blood into the cellular texture of the lungs. The appearance was that of large macula or spots of a deep red colour, shining through the membrane covering the surface of every part of the lungs. When cut into, the extravasated blood ran freely out. It seemed to have operated by compressing the air cells, in this way preventing the blood from cir culating freely through the lungs.

"I have once seen violent inflammation produce an immense effusion of serous fluid into the cellular texture of the lungs, which very quickly proved fatal, the following are the particulars of the

case.

"Serous Effusion into the lungs.

"A robust man, and a very hard drinker, about thirty years of age, complained in January 1809, of having taken cold. His pulse was soft and natural, but he had some oppression and an occa. sional pain in the chest. A blister was ordered, and some medicines.

"The following day, he said the pain was much better, and that his respiration was very free. He was, therefore, directed to continue the medicines that had relieved him, and put his feet into warm water at night. During the evening, however, his breathing became suddenly worse, and his complaint now rapidly increased. He said he had no pain, but an extreme oppression, and sense of suffocation about the breast.

"At a late hour in the evening, he had entirely lost the power of speaking. The pulse was soft, small, and regular, at about 90. There was a cold clammy moisture upon the skin. The counte nance was full of despondency. The respiration was noisy, and laborious beyond description.

"The following morning he was still alive, and had coughed and spit up some thin frothy matter. From the suddenness of his attack the preceding night, it was considered not improbable that a collection of matter had burst into the lungs, and, in this view, his living through the night was more than was expected. The diffi culty of breathing continued to be extreme the whole of the day, but towards the evening he was still worse, and the countenance was manifestly changing. The pulse now became extremely low and weak. He fell into a comatose state, and expired before the morning.

"Examination.-On opening the chest, adhesions were found in various parts, apparently of remote date. The structure of the lungs, however, was sound; and readily yielded to pressure. Оп cutting into the lungs, an astonishing quantity of thin, frothy, mu

cous

cous fluid poured out; this seemed to flow principally from the air cells and cellular texture of the lungs, for, when the lungs were squeezed, it was seen to issue thence clearly. In some parts of the lungs, the same fluid was found in the bronchial ramifications, and was evidently the same with the matter expectorated. Wherever the substance of the lungs was cut into, that part of the section nearest the surface immediately poured out copious streams of fluid matter, apparently of a mediate consistence, between pus, mucus, and serum. It was extremely thin, and limpid; it was frothy, yet flowed out like water, although here and there it was tinged with a streak of faint yellow, as if from the admixture of purulent matter."

We have copied this passage, that the reader may compare the first paragraph with the last. Inflammation of the substance of the lungs rarely induces any considerable pain, as the author remarks; but, if it continues long, it becomes much more dangerous. Instead of adhesions, as in inflammation of the pleura, in which the pain induced never fails to give alarm, we have effusions into the lungs which suffocate before the patient or the inexperienced practitioner is sensi ble of the danger. Some remarks follow on hemorrhage from the lungs, in which a case is described of such a discharge being vicarious for the menstrual, from the fortyfourth to the forty-sixth year of the patient's age. This is less remarkable at that age, as before and during such changes many anomalous symptoms occur, which, in our opinion, are too much under-rated. The following case is, in many respects, similar to one related in the Philosophical

Transactions.

"James Butler, aged sixty-five, employed by Chippendale, of St. Martin's lane, was working in the repair of an ornamented ceiling. He had two nails in his mouth, and, while looking upward at his work, a little irritation set him coughing, when one of the nails was thrown out of his mouth, and the other in recovering his breath, to use his own words, slipt down his wind-pipe.'

"Incessant irritation, pain, and cough, directly followed, and so continued till the man was worn away to a skeleton, spitting up blood and mucous phlegm.

"All the faculty who were consulted pronounced his case hopeless; and, if rightly represented, (in themselves convinced, that had such an occurrence taken place, it must quickly have proved fatal,) assured him it went down into the stomach, and must have passed off through the bowels. They said that what he expe rienced arose from the irritation it produced when in the stomach, but that it was not in his lungs, as he imagined, or suspected.

"Dr. Pitcairn, Mr. Cruickshanks, and others, saw him. Mr. K. of St. Martin's-lane, was with him directly after it happened. Prescriptions mitigated his sufferings a little, but could not remove them. The pain and all his complaints were fixed in the right lobe

of

of the lungs, and he could then, as at the first instant after the accident, cover the exact spot with his hand. Spitting of blood continued to recur at intervals, and the poor fellow was consigned to certain death.

"This lasted from the 15th of April, to the 12th of August following, when, after a copious spitting of blood, with a sudden fit of coughing, he threw up something with violence towards his teeth, against the roof of his mouth, mixed with blood. Perceiving it a hard substance, and ever having the nail in his mind, he spit into his hand, and found it to be the identical nail that had slipt down the trachea so long before, The head of the nail was rusty when thrown up.

"April 1815. Eleven or twelve years have elapsed since this event took place, and the man has enjoyed pretty good health ☀ subject, however, to occasional cough, slight spitting of blood, and a painful sensation precisely in the old spot."

In his remarks on diseases of the abdominal cavity, we conceive the author runs too much into a common opinion concerning the mysenteric glands. In Case 67, p. 224, we are more at a loss than ever to find the slightest connection between the supposed cause and the effect, or even exactly to ascertain either. It would give us much pleasure to be favored with a communication on this subject, for which we are the more desirous as the history throughout is involved in an obscurity very different from the general tenor of the work. This chapter contains some remarks, ingenious if not new, on the effects of peritoneal inflammation. The complaints of the liver are such as have been often described -induration, abscess, and hydatids. Among the diseases of the intestinal canal, a case occurs in which a living worm escaped through an aperture in the parietes of the abdomen during life. This history has some other peculiarities well worth recording. A case of hernia is described, which the author speaks of as very rare. We have, however, seen two such, in which the intestine is strangulated in the openings of coagulated lymph, the effect of previous inflammations. One follows still more rare, excepting in very young subjects, in which the intestine was strangulated in a preterna tural opening of the mysentery. Cases of hemorrhage from the intestine follow, and one of a peculiar secretion voided by the rectum. This was no other than the adipocere which Sir Everard Home so lately offered to the public in his paper on the formation of fat. This part of the work concludes with some useful practical remarks, illustrated by cases of the diseases in the rectum.

The succeeding chapter commences with the "Passage of the Testicle into the Scrotum." On this curious subject we were prepared to expect some useful information, but the NO. 221.

I

only

The

only cases related are, of the late descent of one of the testes. In all these subjects, the parts were left entire; that is, the patients recovered without an operation; so that, whatever obscurity might attend them was never developed. diseases described in the testicles and scrotum are not new. The author's "Account of some Diseases of the Uterus and its Appendages," commences with that very frequent and often dreary complaint, the ovarian dropsy. Here we are presented with something like a theory, the best part of which is its brevity, though the conclusion is somewhat abrupt. We could supply our readers in a moment with two or three other theories, if we had not profited by the example of the author and of a good many other writers. The last related case, in which the operation of tapping was performed, contains an incident which we think it right to

notice.

"In withdrawing the canula, (says Mr. Howship) the slit in the extremity of the tube was found to have pinched the adjacent mar. gin of a membranous expansion, a small part of which was unavoidably drawn out with the canula, before it could be perceived, and, when the end of the tube was disengaged, in the moment of turning round to lay down the canula, a considerable extent of this substance was protruded. The occurrence was new, and it was proper to conceal it from the patient, while, at the instant, a doubt passed through my mind, what should be done with it, provided it could not be returned. On unfolding, it appeared so moderately vascular, that I determined, if its removal should appear necessary, tocut it off with a pair of scissors, in, the mean time endeavouring to pass a part of it back, and fortunately the attempt succeeded; for, although the opening bore a very small proportion to the size of the protruded mass, it was returned with the greatest facility. This incident was neither attended nor followed by the least sensation of pain or uneasiness to the patient.

The quantity of this prolapsed membranous substance was equal to a small pear. It was at first suspected it might have been part of a large hydatid, but a near examination of its structure, its vascularity, and general appearance, argued its being a part of a thin ovarian cyst. An hydatid possesses a uniform and dull colour, and is entirely destitute of red vessels; but this substance had many small vessels ramifying upon it, having also the bright and variable hue which sometimes is observed in an ovarian cyst."

Let us now attend to the dissection.

"On laying open the cavity of the abdomen, the viscera in general were found healthy; neither was there the least trace of pe. ritoneal inflammation. The intestines were in their usual situation, but there was no appearance of diseased ovarium. I, therefore, passed my hand down into the pelvis, and found a large cyst, which felt so thin and equal in texture as to exactly resemble a

Jarge

large collapsed hydatid. When, however, this cyst was brought into view, it was found to be connected with the uterus.

"The parts were, therefore, dissected out, and the cyst turned out to be the right ovarium, which was dropsical, and, what is not very commonly observed, it had in this case formed a single cavity, capable of containing many pints of fluid. The external surface of the diseased ovarium was like the other expansions of the peritoneum, perfectly free from inflammation.”

In considering a work, the object of which extends to almost the whole of the human body, a dissertation on hydatids would be out of place, we shall, therefore, take the case as we find it, and regret that advantage was not taken of the "drawing out so much of this membranous bag" as to continue the extraction as long as the substance, whatever it might be, was uniform, and the patient remained free from the least sensation of pain or uneasiness." We will even go so far as to acknowledge we have sometimes felt a wish, that a very delicate pair of forceps should, at the end of such operations, be introduced through the canula, to seize, if possible, the interior surface of the posterior parts of such a cyst, whether it should prove hydatid or the ovarium. We would propose the attempt at drawing should be continued no longer than whilst it can be done without force, and without exciting the least sensation in the patient. That afterwards, if not detached by our very gentle attempts, it should be left out with no other provision than such as would prevent its return. We have even felt an inclination, when such tumors have appeared more solid, and we were satisfied they were attached to the thin parietes of the abdomen, that a small puncture should be made. If the contents are melicerous, this will be sufficient for the escape of them; if solid, the puncture may be enlarged, if we find, as is usual, that the cyst adheres to the peritoneum, and the latter to the external parts. What has been said can only be considered as a hint it is, however, one we make no scruple to say it is our intention to pursue when a case offers favorable for the attempt, and which, without such an attempt, is considered by others as necessarily fatal. This part of the work concludes with an account of some diseases and malformations of the female organs. We were disappointed in meeting with nothing, in so judicious a writer, concerning the malignant ulcer, or, as it is usually called, cancer of the uterus. Probably, having nothing new to offer, he might wish to waive a mere description of unhappy cases, several of which must have occurred in his practice.

A chapter follows on lumbar abscesses, in which we think less credit is given to Mr. Abernethy's improved mode of treating

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