also be rubbed over with a little lard before being inserted into the bottle, and melted beeswax afterwards poured round it.-Ed. Med. and Surg. Journal, for April, 1831.

2. Obliteration of the Vagina, by the injection of Sulphuric Acid, to produce Abortion.-Cæsarian Operation.-Death.-This singular case is detailed in a letter addressed to M. Guerin. It occurred in a married woman, the mother of four children, and pregnant of a fifth. At the commencement of her pregnancy, she was induced by a female neighbor, to inject sulphuric acid into her vagina, as an extremely easy mode of inducing premature labor; dreadful inflammation set in, the parts swelled, great general disturbance ensued, and finally the vagina was so effectually obliterated, that she could no longer endure the embraces of her husband; nevertheless, she kept the circumstance a secret till the full term of her gestation was expired. The medical men, on examination, found that a kind of irregular band surrounded and obstructed the vagina,beyond which, and on the brim of the pelvis, the head of the infant was distinctly felt, pressed forward by the uterine contractions. was resolved to make an incision through the dense membrane, but when this was done, it was found it had adhered to the bladder, which the incision had completely divided. The delivery was not at all facilitated, and the attendants felt themselves compelled to perform the Cæsarian section. The infant was extracted, dead, apparently for some time, and the mother immediately expired.

It

Absence of the Gall-Bladder. (Lancet Francaise.)-M. Amussat, at the same sitting, communicated the description of a dissection he had recently made of a young female, in whom the gall-bladder was altogether deficient.-London Lancet, April, 1831.

3. On the state of the Liver, in many cases of Icterus. By M. CORBIN.-Icterus is a disease which is very common, but the causes of the yellow suffusion on the skin, are often very obscure. When evident symptoms of gall-stones do not exist, we have nothing but conjecture as to the change in the regular current of the bile. It may be viscid bile plugging up the ducts-or tumors pressing on them or inflammation of the duodenum-or other causes, of which we are ignorant. The disease is not often fatal, and therefore dissection has not thrown so much light on the pathology of the complaint, as on that of some others. It has even been discussed in a concours" at Paris, whether the liver itself be always the seat of the cause which induces icterus. We know, indeed, that jaundice will suddenly arise from strong emotions of the mind; but surely this must be from derangement of the biliary apparatus. But to come to facts.

Out of 1800 patients in the wards of La Charité, between the 1st of January, 1828, and the first of April, 1830, 22 were cases of icterus. From this number were excluded all cases of fugitive or slight tinges of yellow on the skin, from temporary bilious affections or indigestion. The cases were all regular icterus. Ten of them were females, and twelve males. Fifteen were cured, and seven died a very great proportion in the mortality, as compared with experience in this country. Some of these seven became complicated with other severe affections before death-others presented nothing but the jaundice. The following is a concise expose of these seven cases.

1. A young man, 22 years of age, died on the 22d August, 1828, in consequence of small-pox, which had come on a short time after the commencement of intense jaundice. The liver was of a yellower color than usual, and presented brown granulations interspersed in its substance. The biliary ducts were quite free from obstruction.

Case 2. An old man of 64, entered the wards with jaundice on the 13th February, 1830, and died of peripneumony of the right lung on the 7th of March. The jaundice had nearly disappeared before death. The liver was of a pale yellow color; but the biliary ducts were free from obstruction. Case 3. A female was affected with encysted ovarian dropsy of both sides for six years. She was seized with icterus ten days before her death, and the complaint had become more and more intense up to that time. The liver had been compressed by the ovarian cyst, and was softer than natural. The organ was pale yellow; but no obstruction could be detected in the ducts.

Case 4. An unmarried female, aged 30 years, had been twice in La Charité for liver affection, and ultimately died there on the 1st of May, 1829. During life, the liver could be felt projecting below the ribs, and appeared tuberculated to the touch. There was ascites, and for four months before death decided juandice-slight at first, but gradually and regularly becoming more intense.

On dissection, the liver was found enlarged, lobulated, interspersed with round bodies of encephaloid substance, and gorged with bile. Yet the biliary conduits were free from obstruction.

Case 5. A man, 63 years of age, entered the hospital on the 27th of April, 1828, in a state of extreme emaciation and debility. He had cough, and other symptoms of pulmonary affection; but he complained chiefly of pain in the right hypochondrium, which, he said, was of long standing. The liver appeared to be considerably enlarged. He was intensely jaundiced.

On dissection, the liver was found to be of great size, and full of tubercles, some of them softened down, and containing a liquid, or soft encephaloid substance. The gall-bladder was enormously distended with green bile. The biliary ducts were entirely free from obstruction.

Case 6. A man, 65 years of age, entered the hospital on the

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15th November, 1829, with intense jaundice. He was in such a state of prostration, that little information could be elicited from him. It was ascertained, however, that the jaundice was of fifteen days standing. He died three days afterwards.

Dissection. There was some yellow serum in the cavity of the abdomen. There was redness, but no ulceration, in the mucous membrane of the stomach and bowels. The liver rose very high in the right side of the chest, without any apparent cause. It was larger than natural. It was full of tubercles of various sizes, consistencies, and colors. The gall-bladder was distended with bilebut the biliary ducts were pervious, and quite free from obstruction.

Case 7. Louis de Moiser, aged 74 years, (formerly Counsellor of Embassy,) entered La Charité on the 24th February, 1828, his whole surface of a beautiful yellow color-belle couleur jaune. This had been of ten days duration. He had lost his appetite, was costive, and extremely weak. The urine was green-the liver ap. peared enlarged. Leeches were applied, and some medicines were prescribed, which appeared to be of use; but on the 9th of March a diarrhoea occurred and continued for some days-then ceased. After this the legs became cedematous-ascites supervened—and on the 28th of the same month he died.

Dissection. We shall pass over the minute details of pathological appearances unconnected with the present subject. The duodenum was united with the liver, or rather with a cancerous mass appertaining to the liver. "Le duodenum fait corps avec le foie, ou plùtôt avec une masse cancéreuse qui tient au foie." This mass was the size of one's fist. The nature of it is somewhat obscurely described. It included part of the pancreas, the biliary ducts, the cervix of the gall-bladder, and a portion of the concave surface of the liver. The biliary ducts were annihilated-or, at all events, totally impervious. The gall-bladder was converted into a solid mass, somewhat resembling the substance of the cancerous tumor above mentioned. In its centre was found a small quantity of inspissated bile. The liver itself was studded with encephaloid tubercles. From each incision made into its substance, a quantity of aqueous bile issued forth.-Medico-Chirurgical Review, April, 1831.

4. Pathological appearances presented in the bodies of the insane dead.--1. Case of Cheerful Monomania. The dura mater much injected, and adhering in many places to the pia mater-the latter softened the brain pale, and rather softer than natural-cerebral convolutions effaced-right ventricle full of water-cerebellum and spinal marrow sound-lungs disorganized-stomach and intestines livid, with gangrenous spots-liver softened.

2. Melancholy Monomania, with tendency to Suicide. Membranes of the brain gorged with blood-no other unusual appearance in the head or chest-small intestines inflamed, as was the whole mucous

membrane of the digestive tube, from the mouth downwards-many aphthæ in this track-liver enlarged and indurated--biliary concretions in the gall-bladder-spleen enlarged and indurated.

3. Mania with Chorea. Effusion under the arachnoid-cerebral substance hard and much injected-sanguineous effusion into the spinal canal, with traces of inflammation along the spinal marrowall the other organs sound.

4. Mania which terminated in Idiocy. Some points of gangrenous aspect in the small intestines-brain very much softened, with much serum in the ventricles-nothing unusual in the other organs.

5. Suicidal Mania. Meninges and cerebral substance highly injected-heart large-traces of phlogosis in the digestive tube, especially in the duodenum and jejunum, whose parietes were thickened.

6. Mania with Pride. Meninges thickened and injected, having the appearance of parchment-strong adhesions between the two hemispheres-brain itself much injected-intestinal tube slightly in

flamed.

7. General Mania. Much effusion between the membranes of the brain-pia mater inflamed, even to suppuration-cerebellum sound, as were the thoracic and abdominal viscera.

8. Melancholia. Considerable inflammation in the small intestines—cerebral meninges injected-the other organs sound.—Ib.

SURGERY.

5. Interesting case of Lithotomy.-John Wilkinson, æt. 19, by occupation a chair-maker, was admitted by Mr. Green, February 3d, 1831, from High Wycomb, Buckinghamshire. About six years ago, we are informed, he had some symptoms of stone in the bladder, such as pain in the region of this viscus and in the penis, and the passage of blood with his urine; and from these he has not been free during this period, although they have been productive of little or no uneasiness up to the last six weeks. A greater degree of pain having latterly come on without any assignable cause, he was sounded by a surgeon in the country, and a calculus detected, a fortnight since. The patient says, that on Christmas night, he was first attacked with severe pain, which has since recurred at short intervals and become more intense. His urine is clear, and he is devoid of pain in the loins; such did exist three or four years back. At night his rest is disturbed, he being often obliged to make water eight or ten times during the period he is in bed; but his general health is not affected, the pulse being seventy, and the tongue clean. There is slight constipation of the bowels. He has been addicted to drinking rather in excess, and the face is thickly covered with

black pimples, the complexion being dingy and unpleasant to the sight, and of an unusual leaden hue.

Feb. 8. Was sounded to-day by Mr. Green, and a calculus found, situated over the vesical extremity of the urethra, so that it was instantly struck by the instrument. It appeared to Mr. Green to be very rough, and probably of the mulberry kind. Patient's bowels are regulated by the house-medicine, and he makes no complaint other than what is referrable to the above obvious source. He is free from cough and every other symptom of pulmonary disorder, and his urine is quite transparent, and slightly acidulous. The face is not, however, clearer from the black spots.

11th. The operation of lithotomy was this day performed with the instruments used by Mr. Green, viz., a knife, to make the incisions down to the staff, and a gorget, wherewith to cut into the bladder. When the calculus was grasped with the forceps, it was found to be of larger size than was anticipated, and its surface very irregular. Some attempts were made by the operator to remove it with the instrument, but this being found impracticable, the internal wound was dilated with a bistoury, after which the calculus was withdrawn by means of a larger pair of forceps. Rather profuse hæmorrhage occurred from the transverse artery of the perineum, which was pouring forth blood during the whole operation, and this lasted upwards of 20 minutes. The difficulty in the extraction, arose from the size and nearly spherical figure of the stone; and it was also increased by the unusually rough (or aculiate) surface of the latter, which we might say was studded with pointed excrescences of nearly a sixth of an inch in length.—Ib.

6. New mode of Operating for Nævus. By Dr. M. Hall. This operation consists in the introduction of a couching-needle with cutting edges, at one point of the circumference of the nævus, close by the adjoining healthy skin. From this point the instrument is made to pass through the tumor in eight or ten different directions, so as to produce slight incisions through its textures, parallel with the skin, but not so as to pierce the tumor in any other part. The first point of puncture is to be made the centre of several rays of slight incisions effected by merely withdrawing, and again pushing forward the instrument, in the manner and in the various directions already mentioned. This plan was practised, under Dr. Hall's observation, by Mr. Heming, of Kentish-town, on a nævus somewhat larger than a shilling. A little pressure was applied over the tumor -there was no pain-no hæmorrhage. For several weeks, nothing appeared to have been effected by the operation, and it was concluded that the operation had failed. "What a short time did not effect, however, a longer period accomplished completely. Half a year after the operation, the tumor was found to have disappeared, and the color of the skin to be nearly natural."