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and lumps, continues to exude. Pulse varying from 106 to112; respirations from 26 to 31; temperature from 100’9° to1027°.7th.-Shortly after midnight the patient was attacked with

dyspnoea, cough, and rattling breathing; violent tremors, withoccasional starts. During this paroxysm the pulse was notcountable, the respirations were 36, and the temperature was1044°. The tremor subsided about 1 A.M., and she remainedquiet until after 2 A.M., when she had a similar attack, ratherless violent, and lasting a quarter of an hour. At 2.30 the

respirations were reported 32, and the temperature 105.25°.-11 A.M. : Raises her hand when told ; speaks a few words in-distinctly ; has frequent tremors.-ll P.M.: Pulse jerking,hardly countable; respirations very laboured. To have eggsand eight ounces of wine.

C,

8th.-2.30 A.M. : Convulsive sighing; general tremor; muchworse ; muttering delirium.-7 P.M.: Face flushed ; pupilsdilated; insensible.She continued in this state until 2.30 A.Dq. on the 9th of

December, when she died.The post-mortem examination was conducted by Dr. Lees,

and only the facts bearing on the case are here recorded.The trephine opening was on the left of the median line,about two inches above the orbit, and had a diameter of

three-quarters of an inch. The dura mater was adherent tothe margin of the bone opening. In the cavity of the arachnoid,a thin layer of purulent lymph coated the upper and undersurfaces of the left anterior lobe. In the front of the left

hemisphere there was an opening capable of admitting theforefinger, leading backwards and outwards to an abscess-

cavity, two inches and a half in length, and rather less thanan inch in transverse measurement. This cavity containedpus, a coagulum, and broken-down brain-substance ; its wallswere uneven, and the brain surrounding it was softened, andshowed numerous points of blood-extravasation. In the lowerlobe of the left lung were two pyaemic abscesses : a larger oneabout the size of a walnut, near to the posterior margin of thelung, containing grumous-looking pus; and a smaller one,nearer to the upper part of the lower lobe. Both lungs wereelsewhere much congested. The kidneys were congested, butotherwise nothing abnormal was detected. No pysemio de-posits elsewhere.

Provincial Hospital Reports.DORSET COUNTY HOSPITAL.

TWO CASES OF LITHOTOMY.

(Under the care of Mr. TUDOR.)THE following cases possess some interest: one, on account

of the size and difficulty in extraction of the stone; the other,from its situation in, and attachment to, the bladder.CASE 1. -G. S-, aged fourteen, was admitted July 15th,

1867. The history of this case extended over a period of sevenyears. It was, however, sent to the hospital as "chronic ure-thritis." Until a short time previous to his admission, theboy had been occupied in the stone quarries of Purbeck. His

general aspect was that of anoemia, with a peculiar expressionof the face, indicative of prolonged suffering. He was other-wise in a sad plight, his linen being saturated with offensive-smelling urine, stained with blood, and the penis swollen, in-flamed, and excoriated. Stone was at once suspected, and, onexamining the bladder, a calculus was detected, supposed tobe in size equal to a large walnut. An operation was pro-posed ; but the mother objecting, the patient was discharged.Greatly increased suffering ensued. The boy was conse-

quently brought back again, and readmitted at the end of tendays. The symptoms were now very severe, and the boy’slife for some time seemed in jeopardy. The irritation of thebladder was most distressing, accompanied with a continuousdribbling away of the urine, mixed with blood and mucus.In addition, there was considerable mischief going on in therectum-frequent paroxysms of tenesmus and prolapse of thebowel, with dejections of muco-purulent matter and blood.There was at the same time loss of appetite, and little or nosleep. Soothing applications were applied externally over theregion of the bladder and perineum, and opiates were freelygiven by the mouth and rectum. The diet was milk, beef-tea,and farinaceous food.August 23rd.-The patient’s general condition being now

more satisfactory, the usual lateral operation was performed,under the administration of chloroform. There was some dif-

ficulty in the commencement of the operation, owing to theurgent and forcible protrusion of the rectum. When the blad-der was opened, it became apparent that the stone was largerthan had been expected, and the attempt to extract it at first

failed, in consequence of the forceps slipping, although repeatedattempts were made, and with different-sized instruments.The scoop was tried, with a like result. The wound in theneck of the bladder was then very carefully enlarged, partlyby incision on the right side, but chiefly by dilatation with thefinger. The scoop and the forceps together were then employed.The former, carefully guided by the finger, was passed wellbehind the stone, which was held firmly in position againstthe neck of the bladder whilst Mr. Tudor again introduced theforceps. By ’these combined means the extraction was sooneffected. The use of both these instruments required muchcaution, as the bladder was contracted firmly around thestone, which turned out to be a large-sized " mulberry" cal-culus, measuring six inches byfive in circumference, and weigh-ing three ounces. In comparing, in this case, the dimensions

of the stone (the outline of which is well shown in the accom-panying woodcut) with the limited space at the neck of thebladder, in so young a subject, it seems surprising that solarge a body could be removed without inflicting irremediableinjury; but it is evident that, with due precaution, the partsare susceptible of a considerable amount of stretching, andadmit of the employment of what might appear to be roughusage, provided the knife is used sparingly and with judgment,and the scoop and forceps handled carefully. The use of thescoop was very important in this case, because of the firm con-traction of the bladder around the stone. There was verylittle hsemorrhage; and although the patient was a consider-able time under chloroform, he had no bad symptom followingthe operation. The wound healed favourably in about theusual time, and the boy made a satisfactory recovery.CASE 2. - J. T-, four years of age, a diminutive, sickly-

looking child, admitted .Tune 20th, 1867, with symptoms ofstone in the bladder. A few days subsequent to his admissionMr. Tudor passed a small sound, but after a most carefulexamination failed to detect any calculus. The symptoms stillcontinued, but, the general health being very unfavourable, asecond examination was deferred for several weeks. On thisoccasion Mr. Tudor was clearly satisfied as to the presence ofa stone, which, however, required the use of an ordinarycatheter, or a sound with a large curve, to be reached withfacility. It was also observed that there was a muffled soundgiven off when the stone was struck, and that the peculiargrating sensation commonly imparted through the instrumentwas absent. Unforeseen circumstances prevented an operationuntil December, and during the interval the child’s health hadgreatly improved, and there was remarkably little irritation inthe bladder. On Dec. 10th, the child being placed under theinfluence of chloroform, Mr. Tudor performed the lateral ope-ration, and proceeded to remove the stone in the usual way,but without success, in consequence of its situation in thebladder, apparently resting on and attached to the anteriorsurface of the fundus behind the pubes, where it could be feltby the finger. Mr. Tudor withdrew the forceps and employedthe scoop, first passing the finger above and behind the stone,and then carefully guiding the instrument upon the finger to

. the front, making a sort of forceps ; by this means the extrac-

281

tion was easily effected. The stone (phosphate of ammonia)is in shape and size like a large cobnut, measuring in circum-ference about two inches and a half ; and on its surface thereare three small nodular excrescences, from which springs athin membranous tissue encysting the stone. Mr. Tudor re-marks that he cannot explain the development of this ; but itsexistence seems enough to account both for the difficulty indetecting the stone except by the use of a large curved instru-ment, and also for the failure with the forceps. It also mayexplain the subsidence of the severity of the local symptomswhich occurred for some time before the operation. The childmade a rapid recovery.

Reviews and Notices of Books.Clinical Lectures and Re;ports by the Medical and SurgicalStaf of the London Hospital. Vol. IV., 1867-8. Edited byDr. CLARK, Dr. DOWN, Mr. HUTCHINSON, and Mr. MAUNDER.London: John Churchill and Sons.

BOOKS of all kinds accumulate so rapidly upon our librarytable that when our reviewing branch once gets into arrear-which, by the way, it is peculiarly apt to do in these days, whenthe proceedings of the Medical Council and the medico-politicaldoings of our various Universities have to be reported-the taskof examining them all conscientiously seems hopeless. We makethese remarks in an apologetic tone in consequence of the ap-parent delays which take place before many good works arenoticed. The fourth volume of the " London Hospital Reports"fully maintains its character. It is ably conducted by its pre-sent Editors, amongst whom that indefatigable worker, Mr.Hutchinson, figures prominently. His contributions are both

good and extensive on the present occasion. His Hints on the

study of Skin Diseases, and his Lectures on the Use of theOphthalmoscope, are clearly written. Mr. Curling has somefurther observations on Lumbar Colotomy, with the details offour cases of operation. Mr. Maunder contributes a paper on

Ligature of a Main Artery to arrest Traumatic Inflammation,with others of a practical character. Dr. Sutton has some

good clinical remarks on Tricuspid Regurgitant and MitralPre-Systolic Bruits, with a carefully-written Report on theMorbid Anatomy of Cholera. Dr. Hughlings Jackson con-tinues his investigations into Diseases of the Nervous System;and there are several other good papers on surgical, medical,and other subjects by Mr. Couper, Mr. Little, Dr. Head, Dr.Mackenzie, and others.

OUR LIBRARY TABLE.

Essays on Educational Reforrners. By ROBERT H. Qmex,M.A. Trin. Coll. Camb., late Second Master in the SurreyCounty School. London: Longman, Green, and Co. 1868.-We have read this work with interest. It contains a gooddeal of information on a subject that is just now attract-ing attention, and which is destined to attract much more.The author speaks very modestly of his own labours. Thesources of original ideas in any subject are, he says, few, "butfor irrigation we require troughs as well as water-springs, andthese Essays are intended to serve in the humbler capacity."They are, however, more than this. The author evidently hasa practical acquaintance with his subject; he thinks clearlyand writes unaffectedly. Besides some very good chapters onthe School of the Jesuits, Comenius, Locke, Jacotot, andHerbert Spencer, which we read with great satisfaction, theauthor has thrown together his own thoughts and suggestionson various subjects connected with education, and these are I,shrewd, sensible, and well worth reading.

Synopsis of the Pathological Series in the Oxford Museum,provisionally arranged ,/<)?- the use of Students after the Plan Ofprovisionally arranged for the use of Students after the Plan ofthe Hunterian Collection, and chiefly under the Divisions of theHunterian Catalogue. 8vo, pp. 51. Oxford, 1867.-The titleof this work sufficiently explains its nature. The synopsis is

preceded by an introduction written by Dr. Acland. Wewould give prominence to the following appeal. " Shouldthese pages," writes the learned Professor, "meet the eyeof any who can serve the progress of scientific education in

Oxford, they may give real help by presenting to us good dis-sections, and especially microscopic preparations, in morbidanatomy. Some illustrations of the minute morbid changes ofthe nervous system are much required.......... Whatever willillustrate the pathology of vegetable or animal life, taken inthe sense of this introduction, whether drawings, plans, che-micals, or dissections, will at once find its natural place in theclassification of the series to the elucidation of which these

pages are an instalment." There must be many workers whowould be glad to respond to this appeal.Notes on Epidemics. For the use of the Public. By FRANCIS

E. ANSTIE, M.D., F.R.C.P., Senior Assistant-Physician to theWestminster Hospital. London: Hodder and Stoughton.-We are very sceptical of the advantage of most medical booksmeant for the public. But we are delighted to see Dr. Anstie’sNotes on Epidemics published in a cheap form. We do notknow any book of the kind so worthy of careful reading bynon-professional persons; and even medical men will read itwith great pleasure. Dr. Anstie is an accurate physician,thoroughly familiar with the latest investigations of science,and in constant clinical contact with disease; he has, more-over, the strong human interest in great sanitary problemswhich has always characterised our best physicians. In additionto all this, he is a good honest writer; so that his Notes on Epi-demics are most valuable reading, and most properly publishedin a cheap form.

The Early History of Anatomy. An Address delivered tothe Hunterian Medical Society, in the University of Edinburgh,at the Commencement of the Session 1867-68. By J. WARBUR-TON BEGBIE, M.D., F.R.C.P. Edin. Edinburgh : Oliver andBoyd.-A learned and interesting address. It is difficult to

say whether the history of the knowledge of anatomy or ofthe ignorance of it is the more interesting. The history ofboth, however, is given in Dr. Begbie’s address in just as

much detail as is of use to medical men generally. Hippo-crates’ ignorance of myology, Aristotle’s notions that the brainwas destitute of blood, and that the back of the skull wasempty, and Galen’s inaccuracy about the number of ribs, arefine specimens of the ignorance of men whose authority forages was greater than the facts of nature. If a busy physiciancan find time to write such an address as this, busy prac-titioners should find time to read it.

A Manual of the Pathology and Treatment of Ulcers andCutaneous Diseases of the Lower Limbs. By JOHN KENTSPENDER, M.B.Lond., Surgeon to the Mineral Water Hos-pital, and the Eastern Dispensary, Bath. London: JohnChurchill and Sons. pp. 90. 1868. - The author discussesthe production of ulceration of the lower extremities, describ.

ing the varicose, the syphilitic, the scrofulous, and traumaticulcers, and adding a sketch of the more common forms of skinaffections seen on the lower limbs.

Principles of Organic Life. London: Robert Hardwicke.1868.-This is a well-bound and nicely got-up book, with anenticing title, and we opened it with an anticipation of in-terest. We have come to the conclusion, however, that thebest part of the work is its outside. It is an anonymouspublication, wordy and ungrammatical in style, and as a

quasi-scientific production, we are bound to say, not worthyof serious criticism.A Compendium of Practical Medicine and Morbid Anatomy.

By WM. DALE, M.D. Lond., M.R.C.P., &c. London: JohnChurchill. 1868.-The author has not aimed at producing avery comprehensive book on an original pattern. He has

brought together and condensed, as he says, the gleanings ofmany years. It is practical, clearly written, and fairly levelwith the knowledge of the day. It scarcely comes up to our

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