stretched, the peritoneum must retreat from the cutting edge of the instrument, and a wound of it supposes some rare condition of the parts, such as excessive emaciation, or an unusual contraction of the size of the bladder. (This sentence is far from being clear.-Rev.) But even when the peritoneum has been wounded, there is by no means that amount of danger which is usually imagined, provided the discharge of the urine is maintained, by means of a syphon introduced into the bladder, for some time after the operation. The accident occurred in two of the forty cases; and although one of these two cases proved fatal, the death was certainly not attributable to any effusion of urine into the peritoneal cavity, but to the co-existence of serious disorganization of the kidneys and bladder. In the other case, no unpleasant consequences followed."

The risk of fatal or even troublesome hæmorrhage after the high operation is exceedingly small. Nevertheless one of the forty cases proved unfortunate from this rare accident; the following are the particulars.

Case. A gentleman, 58 years of age, excessively fat and subject to hamaturia, had undergone several unsuccessful attempts of lithotrity, when he applied to M. Souber bielle to relieve him of a stone in his bladder. The high operation was performed, and two rough calculi were extracted. After the operation the urine was very bloody, and the patient was much distressed with frequent calls to pass it. A large quantity of clotted blood came away with injections, and then fluid blood flowed out in a continuous stream from a catheter left in the urethra. The extreme corpulency of the patient prevented an ac urate examination of the parts to ascertain whether the bladder was distended or not. The patient becoming exceedingly faint and low, M. Marjolin was called in to the consultation; but nothing that was tried was of any avail in restraining the hæmorrhage, and the patient died twenty-four hours after the operation. On dissection the bladder was found to be greatly dilated, and to contain not less than two pounds of coagulated blood; the cellular substance also behind the abdominal muscles, even as far as the umbilicus and the iliac fossa, was infiltrated with blood. The hæmor hage seemed to have come not from any considerable vessel, but from a vascular state of the bladder itself, which was throughout much thickened and hypertrophied.

We have already stated that M. Souberbielle always makes use of the sonde à dard in performing the high operation, whenever he can. He employed it in 37 of the 40 cases. In the three other cases, the contracted state of the bladder and its close application round the calculus prevented the introduction of this instrument, and the operator was therefore obliged to cut directly upon the stone itself, and then enlarge the incision either upwards or downwards with the bistouri caché or with the bistouri lenticulé.

After the operation M. Souberbielle always leaves an elastic gum syphon in the bladder, to evacuate the urine as it is secreted: he has never met with any inconvenience, but on the contrary has always witnessed great advantage, from this practice. When the urine escapes by the wound, it is usually about the eighth day, it then continues to do so for about a week, and generally ceases about the fifteenth day; often however, none passes at all this way; and in one of the cases the wound healed by the first intention, and the patient voided his urine by the urethra on the third day. It is worthy of remark that the patients seldom or indeed never experience so n uch pain when the urine escapes by the wound after the high operation as after the

lateral one, especially when the edges of the wound in the perineum have been bruised by the instruments, or by the calculus itself during the process of extraction..

The syphon was usually kept in the bladder from fifteen to twenty or twenty-five days. Before removing it, M. Souberbielle recommends that for several days previously, it be plugged during three or four hours at a time, for the purpose of ascertaining the solidity of the cicatrix of the bladder; whenever it incommodes the patient, or the contractions of the bladder force it ou, it may be withdrawn. The only inconvenience of this, which M. S. has observed, is that the healing of the wound is somewhat retarded.

In concluding his memoir, our author mentions that seven out of the fifty patients, on whom he operated, were affected at the same time with herniaa proportion which is higher than the average frequency of rupture in other individuals. It is probably from the violent contractions of the bladder and of the abdominal muscles to expel the urine in calculous diseases, that such patients are apt to become ruptured. Now the effect of such a complication must be to draw down the peritoneum lower than it is in a healthy state of the parts; and hence, although its existence does not constitute a sufficient objection by itself to the performance of the high operation, yet more than usual caution should be used by the surgeon in cutting into the bladder in such cases.

In ten of the forty cases the patients were very fat; this circumstance does not increase the difficulty of the high operation of lithotomy nearly so much as is supposed, although certainly the extraction of the stone is somewhat gené by a fatty condition of the parts; but then, on the other hand, in such cases there is less risk of wounding the peritoneum, and moreover the cellular tissue, when filled with adipose substance, can be divided with greater ease and neatness, and is much less likely to admit the infiltration of urine into it than when it is more lax.

The occurrence of vomiting during the first few days after the operation -and indeed the same is apt to occur after the lateral operation-by no means implies the accession of peritonitis: this symptom often subsides spontaneously or under the use of opiates.

Lastly, it is worthy of notice in reference to M. Souberbielle's fifty patients, that the operation was performed on two who had undergone it some years previously. He remarks-"I have in general been successful with my second. operations. The most remarkable cases on this head, which have occurred in my practice, are those of MM. Suire, Daumy and Seraphin, each of whom I cut for the stone four different times."

Such is a brief summary of the contents of M. Souberbielle's memoir, which well deserves to be consulted in the original by all operating surgeons. The practice in some of the cases seems to have been rash, as the prognosis was far too unfavourable to justify the performance of so serious an operation as that of lithotomy, either by the high or by the lateral method. The success however on the whole, even under such disadvantageous circumstances, sufficiently shews that the high operation in the hands of a dexterous surgeon is by no means so dangerous as it is generally believed to be. We again recommend the attentive perusal of the memoir to all lithotomists.

As

The next memoir which comes under our notice is one On the most frequent Diseases in Iceland, from the pen of Dr. Thornstensen, a Danish physician, who has for many years been resident there: it is written in Latin. might be supposed, inflammatory, febrile, and rheumatic complaints form the staple of the nosological catalogue among the hardy Icelanders: syphilis, it is stated, is unknown; scurvy is not unfrequent.

The following extracts on a disease, which is common in hot climates but rare amongst us, are interesting :

"The most frequent of all spasmodic diseases in Iceland is the Tetanus of newborn infants, which is almost endemic in the adjoining island of Vestmanney. It usually commences on the fifth, sixth, or seventh day after birth, with a rigidity of the muscles of the nucha, at first temporary and occasional, and then more continued; the rigidity extends to the jaws and throat, so that deglutition becomes difficult, and the mouth can scarcely, or not at all, be opened. Gradually the muscles of the back become tetanically contracted; then convulsive motions arise, during which the head is powerfully drawn backwards, and the face be comes livid and convulsed. These attacks return more and more frequently, and are now of longer duration, and at length every part of the body becomes stiffened with spasm. In almost every case the infant dies before the close of the seventh day after birth.

Nearly three-fourths of all the infants-usually about twenty per annumborn in the island of Vestmanney, perish from this disease, and in Iceland not more than one in ten infants, who are affected, is saved.

It is difficult to account for the much greater frequency of the disease among the inhabitants of the one island than of the other. Some have conjectured that it is owing to the people in Vestmanney living more upon certain seabirds.

The treatment of this disease is exceedingly difficult. Internal remedies seem to have little effect: what has proved most useful in my practice is the rubbing in of an ointment, consisting of one ounce of the ung. hydrarg. cinerei and two drachms of powdered opium, after the administration of purgative enemata, upon the neck and back every hour: the internal exhibition of the tincture of musk at the same time may be resorted to with advantage.”

Among the more frequent chronic diseases among the Icelanders is induration of the liver: we certainly were not prepared to expect that a disease, which is usually supposed to appertain more particularly to hot climates, was of so frequent occurrence in the frozen regions of the north. The following description of it by our author is worthy of notice.

"Induration of the liver is a very common (admodum vulgaris) disease in this island. We meet with numerous invalids who, for a number of years, sometimes from an early period of life, have suffered from a dull oppressive pain in the right hypochondrium, which is usually found to be more or less distinctly enlarged. They are usually affected with dyspepsia, constipation, loss of appetite, and general debility. In many cases, the swelling of the side, after extending more and more until almost the entire abdomen becomes occupied, becomes soft and fluctuating. The induration has then been followed by suppuration; and the contents of the hepatic abscess may at length be discharged either into the cavity of the peritoneum, or outwardly at the umbilicus or at some other point of the abdomen. I have often opened these abscesses with the knife, and given exit to an almost incredible quantity of most fætid pus, blended in some cases with hydatids and loose floating substances, like partly-dissolved cysts: these cases have usually done well ultimately. In other instances the hepatic induration never passed into the suppurative process, but the greater

part of the viscus is converted into a large stratomatous mass. On examining the abdomen after death in such cases, we often meet with numerous hydatidiform bodies, either attached to the liver or floating loose. In a very remarkable case of hydatidic degeneration of the hepatic parenchyma, which occurred in a man 30 years of age, the liver was found on dissection to be immensely enlarged and looked like a huge leather bag filled with water; on dividing it, nearly twenty pounds of pure serum flowed out.

These diseased states of the liver often commence in youth, and continue for a great number of years before the viscus becomes seriously altered."

Another Icelandic disease is one, too, whose habitat we usually associate with warm climates-Lepra orientalis.

"I have observed," says Dr. Thornstensen, "three species of the disease here. The first and most frequent of these is characterised by the following symptoms: impairment of all the mental and bodily faculties, roughness of the voice, a scorbutic livid aspect of the countenance, fætor of the breath, and a greater or less loss of the sensibility of the surface, and of the sense of touch. In various parts dark-coloured patches make their appearance on the skin, which is there always somewhat raised and more or less insensible; these spots or livid tubercles are sometimes observed on almost every part of the body, face, and extremities.

After a time, they pass into fætid lardaceous sores, which in some cases are attended with pain, and in others with a want of feeling in the parts. The whole organism of the body becomes vitiated, the senses of sight and hearing becomes weaker and weaker, the eyes are sometimes utterly destroyed, and the cavities of the orbits are occupied with foul ulcers, the bones of the nose and palate become soft and carious, and occasionally the brain itself is involved in the general morbid decay. The duration of this form of lepra varies from two to ten years or upwards from the character of its symptoms I have been in the habit of designating it the Scorbutic Lepra.

The second species is called by the natives limafallssyki, Lepra decidua; its diagnostic character being the tendency of the fingers and toes to mortify and fall off. The disease commences with loss of sensibility in the fingers or toes of one of the hands or feet: there is usually no swelling, but there is always a burning pain around the affected part; the integuments burst, an ulcer is formed, and, after the lapse of some time, one or more bones come away in a carious

state.

The surface of the body, at the same time, is usually the seat of a squamous eruption, and the muscles of the extremities become excessively wasted and feeble; the functions, however, of the brain and other viscera &c. are not apt to suffer. So great is the insensibility of the limbs in some cases of this form of lepra, that the patients feel little pain from amputation of the diseased extremity; the substance of the muscles is found to be converted into a semi-cartilaginous tissue, and the divided arteries pour out very little or no blood. Notwithstanding these serious changes, the stump will often heal favourably; and, even after the loss of more than one limb, patients have been known to live for several years without any severe suffering.

The third and rarest form of lepra met with in Iceland is most closely allied, if not identical with the Lepra Arabica. The integuments of almost every part of the body become indurated, squamous, insensible and elephantine; the muscles and all the other organs are attenuated and wasted, although the appetite usually remains good; and the cerebral functions are always more or less impaired. There is no tendency to the formation of ulcers, as in the preceeding form of the disease.".

......

The following memoir is one by Dr. Cornuel on Dysentery, as observed by him at Guadaloupe.

There is little that is novel or very interesting in it, and we shall therefore only allude to one or two of the author's remarks on the treatment of some of the forms of the disease.

Opium is certainly the most important of all remedies, and is required in almost every variety of the disease. As a matter of course, its administration as to dose, frequency of repetition, and so forth, must depend on the seve rity and peculiarities of each case. The combination of ipecacuan and opium is of especial benefit in numerous examples. Of late years, a pill containing these two ingredients with calomel, and known by the name of the English pill, has been used with remarkable success at Cayenne by Dr. Segond, and more recently by Dr. Cornuel at Guadaloupe. The formula is eight grains of powdered ipecacuan, four of calomel, one of the watery extract of opium, -to be divided into six pills; one to be taken every two hours.

In some of the milder and more chronic forms of dysentery, Dr. Cornuel has found much benefit from the use of mild aperients, such as Epsom salts in the dose of one or two drachms dissolved in four ounces of herb-tea, or manna in the dose of half an ounce, taken early in the morning; an opiate having been administered on the preceding evening at bed-time. The chloruret of sodium, with small doses of morphia, was administered both by the mouth and in enemata with excellent effects, when there was reason to believe the presence of slight ulceration of the intestinal mucous membrane.

Researches on the Structure of the Cortical Substance of the Cerebral Con volutions by Dr. Baillarger.-The object of the author is to shew that the cortical surface of the nervous centres is distinctly stratified, consisting of several alternating layers of grey and white medullary matter, and that these strata may be aptly compared to the alternating plates of different metals or other substances in a Voltaic pile.

the

After minutely describing numerous anatomical examinations of the corti cal substance of the brain in man and in the lower animals, he sums up results of his enquiries in the following, among other, conclusions:

"1. The cortical substance of the cerebral convolutions consists of six layers alternately grey and white, proceeding from within outwards. If we examine a thin slice of the grey substance placed between two pieces of glass, the six layers appear alternately transparent and opaque.

3. The white strata, which exist in the thickness of the cortical stance, are formed of two rows of vertical fibres.

grey

sub

14. The superposition of six strata, alternately of white and grey nervous matter, in the cortical substance of the brain, suggests the idea of a galvanic pile.

15. This analogy between the structure of the cerebral surface and the arrange ment of a galvanic apparatus may be adduced as an argument in favour of the following two propositions.

The nervous, like the electrical action, is in relation to surfaces and not to The nervous influx, like the electrical stream, is transmitted by sur

masses.

faces."

The opinion that there is some analogy between electricity and the mysterious cause of nervous action is now admitted by many of the leading