characterized by one common feature-a peculiar kind of cell; to which, however, no such specific value can fairly be attached, since it is a product of late formation in the degenerative stage, and quite undistinguishable from an ordinary compound granular corpuscle. Virchow held that tubercle was a new growth, allied to connective tissue, whence it was derived and in which it was always found; and that it was characterized by no single element, but rather by the whole assemblage of these and the method of their association. According to this observer, there are two forms, the cellular and the fibrous, the latter of these differing from the former chiefly through the accident of its position. The cellular variety is best seen on free surfaces, where it is more or less oviform; the fibrous in dense structures. Abnormal growths continue longest in their stages of growth and decadence; normal in the stage of maturity. Tubercle can be affirmed to attain permanence in both the first and last of these states-the fibrous form in the embryonal, the cellular in the necrobiotic. Tubercle, in its typical or cellular form, is seen to greatest advantage in the fat cells of the omentum. It is heterologous by descent, proceeding by endogenous proliferation out of the connective, or rather some embryo connective tissue cell, and altogether heterotopic. It is organized, but not highly; and as to its characters, these must not be read from the stage of detritus, in which they are altogether obliterated. The typical form of tubercle can usually be best seen in tubercle of the meninges, where it seldom exceeds the size of a pin's head. As to form and shape, these would vary with situation, but it might be said that the fibrous form of Virchow corresponded with the infiltrated tubercle of the older writers. As to its origin, the shedding of cells into the fluid bathing the new tumour, had given rise to the idea that they originally existed there, and were subsequently deposited in the tissues. The tendency of tubercle, Dr. Southey said, was to fatty degeneration, but this differed from that usually seen affecting the organs of the body, the cells diminish in size, and the oil does not run into globules inside them. Moisture was deficient; hence the tendency was to produce a cheesy, friable mass.

With regard to the progress of tubercle, when superficial, as in the larynx, it was very rapid; after this came the bladder; and, strange to say, as moisture was the great thing necessary for the disintegration of tubercle, bone was third in the list. Dr. Southey then described in a most perspicuous manner, the progress of

tubercle in other organs of the body, as in the brain, the kidney and the liver, and in its mixed form with ordinary hyperplastic fibrous tissue in the mesentery; he further showed how it never implicated cartilage, except by secondary interference with its supply of nutrition. He finally insisted on the importance of not confounding phthisis with tuberculosis, which was too frequently done, and urged that the former disease was often due to other causes, as chronic pneumonia, scrofulous ulceration, and simple abscess only in a particular tissue. The whole lecture might be looked upon as an amplification of the views originally brought forward by Virchow, and will, we doubt not, tend to bring these into more general favor.

In his second lecture, Dr. Southey proceeded to point out how, long ago, tubercle was supposed to be secreted by the glands, and that, curiously enough, the most recent opinions tended to place it among those tumors which resembled imperfectly formed glandular tissue. For a long time tubercle was confounded with the white cells of the blood; but when found in the walls of a blood-vessel, it had been supposed to originate from the granular layer of the external covering of these. The theory of a blood dyscrasia was at the foundation of all theories of tubercle, but in its history it was better to begin with the substance itself. This substance must be considered as distinctly heterologous, seeing that it originates in cells (mostly connective-tissue cells) entirely different from those which constitute its own structure. Cells might be described as originating in two ways: by cell division-i. e., cleaving of the whole body, both periplast and endoplast-or by endogenous formation, when the endoplast alone divides, the periplast not sharing in the process. By the former mode homologous growth is effected, the new cells in every way resembling their parents; by the latter, heterologous formation results, as the cells might differ to any extent from their progenitors. In the latter way tubercle and cancer originate; therefore both are heterologous, consequently resembling each other in this and other respects. Thus both are accompanied by constitutional dyscrasia; both have sites of proclivity, both are hereditary, both tend to spread and ulcerate. They differ, however, in as far as cancer can grow, while tubercle has no independent power of maintaining itself. Rokitansky thought that the one excluded the other, but this is not exactly

correct.

As a tumor, tubercle is of a lymphomatous nature i. e., one having its type among the normal structures, in ductless glands, as those of the intestines and the lymphatics. Tumours of this class are of two types-one hyperplastic, that is, simply excessive formation of normal elements; the other heteroplastic, whose constituent cells differ from their progenitors. To the latter type tubercle belongs. First among lymphomatous tumors comes the leukæmic lymphoma, the enlarged condition of the glands seen in leucocythæmia-really the cause, not the consequence, of the latter disease. Next comes typhoid lymphoma-the condition of the glands, especially of the intestine, in typhoid fever, and in which, as they tend to become caseous, there is an approach to tubercle. Hence, also, acute general tuberculosis might be, and often is, confounded with typhoid fever. In scrofuloid lymphoma, the next variety, the new formation is no longer of a simple hyperplastic nature; anatomically, it is related to tubercle, and might be seen in syphilitic subjects. In lympho-sarcoma there is a sarcomatous enlargement of the glands, with a scrofulous diathesis. The new formation is gray or ashen-hued, the glands are larger than in scrofula, and they seldom ulcerate or become caseous. The cervical and bronchial glands are most frequently affected in this manner. Turning to scrofula, the build of body serves to distinguish its diathesis from that of tubercle. Scrofulous people are largely and heavily built; their complexions are muddy; generally they are torpid. Those, again, with a tendency to tuberculosis are tall and thin, with small heads and muscles and fine hair, and are unusually precocious, nervous, quick and irritable.. In scrofulous constitutions there is a tendency to chronic inflammation of an unhealthy character, whilst the tuberculous habit has a tendency to one special disease only. The transition from ordinary to scrofulous disease is by insensible gradations, and the whole tendency of the condition might be summed up in its producing an excessive vulnerability of body.—[Medical Times and Gazette.

On Rigid Perineum. By DR. BEATTY. From Dublin Journal of Medical Science, July, 1857.

The management of the last part of the second stage of labor is often attended with difficulties that demand the utmost care, and

are productive of serious anxieties in the mind of the individual charged with the conduct of the case. This remark applies more particularly to the phenomena of parturition in primpara; though, at times, circumstances of a similar nature are found to create embarrassment in those who have already borne a child at the full period.

All persons who have been any time engaged in the practice of midwifery, are well acquainted with the tantalizing torments of a rigid perineum. Hour after hour the attendant sits by the bedside; every pain distending the soft parts seems destined to be the last; the structures, strained to the utmost, seem incapable of further resistance, yet they do resist, until finally a rent at the fourchette takes place, most commonly to a small extent, sometimes to a more considerable one, and the head of the child escapes from the pelvis. In many cases of moderate rigidity, the delivery is accomplished without any rent; but in the more obstinate cases, the greatest amount of care, exercised by the most skilful hand, will fail to prevent some amount of laceration. A knowledge of this fact should lead us to be very cautious in dealing with the reputation of the attendant who has had the misfortune of having such a case under his charge. Every man in practice is likely to encounter such cases, and in some of them no man can prevent the accident. In speaking of this subject, Dr. Denman makes the following remarks:"That some degree of laceration should sometimes occur will not be surprising, if we consider the great change and violence which all those parts sustain at the time when the head of the child is passing through them, or that when a laceration begins it should extend through a part rendered at that time extremely thin, and suffering an equal degree of force. When the the perineum is indisposed to distend, or if, when distended, it cannot permit the head of the child to pass with facility, the anterior part of the rectum is dragged out, and gives to the perineum a temporary elongation. The true perineum, and the temporary, as it may be called, thus forming an equal uninterrupted space; if a laceration should commence at any part, it might, without the greatest care, extend through the whole.

"That kind of laceration of the perineum which commences at the anterior edge, and runs obliquely or directly backward, is alluded to in every dissertation on this subject. But there have been many instances of another kind of laceration, which may be called

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a bursting or perforation of the perineum at that part which is connected with the circumference of the anus, when the anterior part is preserved, and through such perforation, it is said, children have been sometimes expelled."

A remarkable case of this kind occurred in the practice of the late Dr. Beatty, in the year 1808, from whose case-book I now quote it: -"October 17th, 1808. I saw this patient in labor with her first child, about seven o'clock in the evening, after having had slight pains during the day with very little effect on the os uteri. I saw her again 10 P. M., when the progress of labor appeared to be slow. While I remained with her the pains became more frequent, and in a very short time the head rested on the perineum; but what appeared strange to me was, that though the pains continued to be very severe, and the tumor caused by the head distending the perineum to increase, there was not the slightest dilatation of the os externum beyond its original size. In about an hour the head of the child was entirely expelled from the bony pelvis, and the external parts formed a bag or cap for it, which was forcibly distended at every pain. My fears for a laceration now increased so much that I thought it necessary to explain them to an intelligent woman who was with us, and to make her examine the parts, that she might be convinced of the impossibility of preventing it; at the same time I used lubricants, to satisfy the friends that I would do everything in my power for my patient. At length I found the perineum begin. to chip or crack at the prominent part, and soon after give way to such an extent that the child was passed through the aperture, though it did not communicate with the os externum. The placenta was delivered through the same passage; and when I told the lady that she had had the most painful labor I had ever met with, she said she expected such, from a contraction which had taken place iu those parts when she was young, after a fever, a contraction which had almost prohibited coition.

"The os externum had left an oval mark on the child's head, which I measured, and found to be 23 by 1 inches, and which was. the full extent to which the vulva would yield.

"October 28th-this day examined the state of the parts, and found both the sphincters of vagina and anus entire and undisturbed, and the rectum uninjured. The patient was able to walk a little through her room. The wound was in a healthy state, and likely to heal."