down nor return the presenting part. With great care I scratched the membrane which was before me, and on perforating it, had the satisfaction of finding another within; and on prolonging the incision, clearly exposed intestine. Through a considerable part of the tumour, there were more adhesions within than without the sac, and there within the was no fluid. The stricture being divided, I separated the adhesions and replaced the contents. She did well, without a bad symptom. Considerable adhesions sac. No fluid. In this case, the adhesions within, and their absence without the sac, the absence of fluid, and the appearance of the presenting part resembling intestine, all combined to obscure the nature of the case; and these, it will be remembered, are the tests usually relied on. I may add that the constant bleeding, in a case operated on by candle light, still more completely destroyed all evidence which might have been collected from appearances. The following case does not bear upon the points which I have particularly proposed to consider, but it possesses some interest as relating to one, which has not received much attention as diagnostic of the contents, by any author I am aware of, except Sir C. Bell.* CASE XII.-Oct. 26, 1832, at 3 p. m. I saw Mr. B. about 40 years of age, who had laboured under some of the symptoms of strangulated hernia since the 24th, when, from a sudden effort, a protrusion had taken place. A similar event had occurred some years before. # Surg. Obs. vol. 2, p. 102. At the groin the tumour was firm and tense, but in the scrotum, though it was large, it was neither tense nor painful. He had had four stools since the strangulation. Blood had been taken from the arm, and tobacco had been tried, but fruitlessly. As none of the symptoms were urgent, and from the evacuations the tumour appeared to be merely omentum, I thought it possible either that it might get quiet again, or might be reduced without the operation. A tobacco injection was again tried, without success. Some leeches were applied, and a purgative was given. On the 27th there had been three more stools, dark and bilious. There was a disposition to hiccough, but no vomiting. The pulse was getting frequent and sharp. The tumour larger, with considerable tenderness. There appearing to be little chance of reduction, and a prospect of serious inflammation occurring, 1 determined to operate. The contents were omentum and a large quantity of fluid. The patient recovered without a bad symptom. Gradual reduction of a portion of the tumour, without noise and without re presumption of the presence of a quantity of fluid. In this case, while attempting the taxis, I could clearly perceive that I returned a portion of the contents into the abdomen, gradually, and without noise, but that as lief, affords a soon as I intermitted my pressure, they came down again. The quantity of fluid found in the scrotum, during the operation, explained this. A clear understanding of this circumstance would lead us to place no reliance upon this apparently favourable circumstance, but it would lead us to judge, that there must be a considerable portion of fluid present. CASE OF HYDROCEPHALUS. BY THOS. STEWART TRAILL, M. D. Late of Liverpool; now Professor of Medical Jurisprudence in the University of Edinburgh. THE Symptoms which are usually found in cases of acute hydrocephalus, appear so strongly marked in the following instance, that I have no doubt of the patient having laboured under that peculiar cerebral affection, of which the usual termination is effusion of serum into the cavities of the brain.. That these symptoms may be present, and this formidable disease may terminate fatally, without such effusion, we learn from a case published by Lallemand; a second by Senn; and two more given to the world by Dr. Abercrombie. These comparatively rare instances would appear to prove that the effusion of serum into the ventricles of the brain, is rather the consequence than the cause of the disease; and that the symptoms of what nosologists have termed hydrocephalus, are indications of an inflammatory affection of that organ. This is sometimes confined to the meninges of the brain; but, in the most usual form of acute hydrocephalus, the inflammation attacks the substance of the brain; and, of this form of the disease, the most formidable con sequence is not inaptly termed, by the French pathologists, ramollissement. That the most urgent symptoms are not owing to the presence of fluid in the ventricles, would appear to be proved by the cases mentioned by Morgagni and Heberden, in which half a pint of serum was found in the ventricles of persons who had not exhibited any symptoms of cerebral affection. The possibility of absorption of a fluid, once effused into the cerebral cavities, has been strenuously denied by some physiologists; but, as far as the pathology of hydrocephalus is concerned, this is an idle speculation; for we have no diagnostic by which we can, with certainty, determine the morbid collection of fluid in the ventricles of the brain; and analogy to other serous cavities would lead us to believe, that a perpetual exhalation and absorption are going on in them: while the researches of Lippi, Dutrochet, and other modern physiologists, have rendered more than probable the old doctrine of absorption by the veins. In the following case, there is a great similarity to other instances in which I have found the fatal termination attended with copious effusion of serum into the cerebral cavities, and ramollissement of the brain itself. In the treatment of such cases I have, for several years, discontinued the application of severe blistering to the scalp, which was once a very general practice; from having observed little benefit from that mode of treatment, and having, in some cases, thought that it tended to aggravate the symptoms. I have, of late, applied the blisters more frequently to the nape of the neck, under the impression that the inflammatory state of the brain was more certainly combated by deriving the fluids from the head, than by increasing the activity of the vessels of the scalp; while the application of cooling lotions, at the nearest possible point to the seat of the inflammation, has appeared to me a more successful method of treating this very fatal disease. With this mode of local treatment, I have long been in the habit of conjoining the abstraction of blood, either by leeches or the lancet, according to the age and strength of the patient; and, as the influence of mercurials in controlling inflammation, and in promoting absorption, appears to me well established, I usually endeavour to induce a constitutional effect, in such cases, as speedily as possible, both by giving it internally, and applying it as a dressing to the vesicated surfaces. Indeed, I believe that mercury will, in this disease in particular, enter the system much more readily by cutaneous absorption than by the lacteals. As pressure on the brain would seem more quickly to paralyze the activity of the absorbents of the alimentary canal than of the dermoid surface, probably because of the immediate dependence of the former on the great sympathetic nerve. In the case about to be given, these were the indications which were chiefly followed. William Da C. æt. 20 months, previously a fine healthy boy, became a patient of my friend, the late Mr. Reay, on the 24th of April, 1830. He then laboured under a slight remitting febrile attack, seemingly arising from the state of his digestive organs, attended with some cough, and occasional fits of screaming. Calomel with jalap, scammony, and antimonial powder, were successively administered with relief to the symptoms, but still the remit |