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were restrained in their action for a week by the administrationof opium. LTp to the 31st of December, all the urine passedby the rectum; it now commenced to come by the urethra. INo inconvenience was at any time experienced from the pas-sage of fsecal matter through the urethra. The pus and albu-men gradually increased in quantity. The fistula was notinterfered with until the 18th of February, when, as some ofthe urine continued to pass through the rectum, it was exa-mined. It appeared to be in the membranous portion of theurethra, and about a quarter of an inch long. It was touchedonce with nitrate of silver, and subsequently, on two occasions,the electric cautery was applied. He left the hospital on the28th of April, cured; having for the three weeks previouslybeen free from all signs of the fistula, during which time hewas engaged in assisting the nurses in the wards.Mr. Suutham, in his remarks, does not advocate this opera-

tion except in especial cases, considering that the lateral methodis the safest in the majority of instances. He was induced toresort to it in the above-mentioned patient on account of thepresumed large size of the stone, the indurated and contractedstate of the bladder, and the unsatisfactory state of Lhe generalhealth. After referring to the risks which attend the lateralmethod when the calculus is of large dimensions, he alludes tothe objections urged against the recto-vesical operation, theprincipal of which is, its liahility to the formation of a perma-nent fistula. This, he believes, may to a great extent beavoided, if the incision into the urethra be limited to only apart of the prostatic portion. He considers it will be seldom

necessary to extend the incision through the neck of thebladder, experience having convinced him that the obstacle tothe extraction of large calculi by the lateral method existsmore in the surrounding structures than in the prostate, whichreadily yields to steady and cautious dilatation. In the case

now related there was abundant proof of this; indeed, P. cal-culus of much larger dimensions than the one described couldhave been extracted without difficulty by the same incision.He proposes to call the operation the recto-urethral.

Foreign Departement.FORCIBLE EXTENSION OF THE KNEE. JOINT ; APPEARANCES

ON THE POST-MORTEM EXAMINATION.

M. DEMARQUAY mentioned the following case at one of thelate meetings of the Surgical Society of Paris :-A boy, tenyears old, from South America, was sent to him with whiteswelling of the knee. The flexion of the joint was so greatthat the heel touched the posterior aspect of the thigh. Slightmobility of the patella and of the articulation; great emacia-tion ; chest sound. Evacuation of a small quantity of pus bythe trocar, and subsequent injection of iodine, were well borne.Soon afterwards, the joint was forcibly stretched whilst thepatient was insensible with chloroform, and placed in a concavesplint, which was soon replaced by a starch bandage. Somelittle time elapsed, when the boy was suddenly carried off bypneumonia.On examination of the joint, no pus was found in it, but the

femur was considerably bent in its lower portion, and the bone ‘was found fractured along its posterior surface, the anteriorlamella being sound. Lungs studded with tubercles. Thefracture was evidently caused by the forcible extension.M. Chassaignac observed that bones in such operations are

much more frequently broken than surgeons imagine, whichaccident occurs, according to another speaker (M. Broca), fromsoftening of the bones. Such fractures have been known, how-ever, to unite pretty rapidly. We hold that the reduction ofluxations, or forcible extension of joints, carried on whilst thepatient is narcotized, should be performed with great caution,as the guide presented by the sensations of the patient is quiteabsent, and great mischief might follow the reckless employ-ment of force.

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SMOKING, THE EXCITING CAUSE OF CANCER.

M. Bouissox has published a valuable article in the Mont-pellier Médical, wherein lie endeaaours to prove that smokingis often a very active exciting cause of epithelial cancer aboutthe tongue, lips, sides of the cheeks, or soft palate.M. Bouisson has collected sixty-eight cases of cancer and

cancroid of the lips, in which the habit of smoking was eithercarried to excess or was verv inveterate. He considers that such

morbid products have more frequently been seen since the cus.tom of smoking has become general; but concedes that, for thedevelopment of cancer, there must be the proper diathesis.The author maintains, however, that this tendency would oftenhave remained latent without the local exciting cause to whichwe have alluded. He further states, in support of this opinion,that labial cancer mostly attacks the lower lip, where the cigaror pipe rests; and that such cancer is rare with women andchildren. One young lady is mentioned who suffered from theaffection; but she used by stealth to smoke immoderately.The more inveterate the habit, the more frequent the cancer,

especially with those who smoke short pipes and strong to.bacco. Cleanliness, long pipes, and mild tobacco, may keepoff the complaint.M. Bouisson operated upon a medical man of Barcelona who,

in the Spanish fashion, allowed the smoke of cigarettes toescape through the nose. The nostrils were filled with epithe-

lial vegetations.No doubt M. Bouisson’s paper is extremely valuable; but itmight be asked whether the disease in persons labouring underthe diathesis would not have broken out elsewhere. It is,besides, well known that labial cancer has been found in pa-tients who never smoked in their lives. That smoking mayact as an exciting cause is, however, both rational and inaccordance with fact.

DIPHTHERIA AFFECTING WOUNDS MADE BY SURGICAL

OPERATIONS.

M. GUERSANT. in speaking of diphtheria at a meeting of theSociety of Practical Medicine of Paris, said that between 150and 160 cases of the malady had occurred at the Children’sHospital during the first half of the present year. He addedthat, in private practice, and at short intervals, he had ope-rated in three cases of phymosis in children, living in differentdistricts, and whose parents are in good circumstances. Three

days after the operations, a diphtheritic coating covered thewounds, and the malady from thence attacked the tonsils.Chlorate of potash was given, and the children recovered.The mother of one of the patients took the disease, and got

well. In the family of another of the children, the father, abrother, and two servants sickened of diphtheria. They allrecovered, except the brother, who, being struck with greatterror at the complaint, died, as if poisoned, in a slow asphyxia.

LUXATION INTO THE OBTURATOR NOTCH MISTAKEN FOR

DISLOCATION ON THE DORSUM OF THE ILIUM.

A MAN was violently flung against a wall by machinery.Besides slighter injuries, the thigh was found dislocated. Thesymptoms were-inversion of the limb, the leg half bent uponthe thigh, and the latter upon the pelvis. Extension painful;a slight shortening observed; prominence in the glutæal region;trochanter thrown backwards; adduction easy; abduction androtation outwards painful; on strong pressure a little belowthe anterior superior spinous process of the ilium, the cotyloidcavity seems empty. Reduction under chloroform. The pa-tient died of internal injuries soon afterwards, and the luxationwas found to have been into the thyroid notch !

HEALTH OF LONDON DURING THE WEEK ENDINGSATURDAY, AUGUST 27TH.-The health of Londou is now inan average state. The deaths in the week ending on Saturdaylast amounted to 1217, whereas the corrected average deathsin the corresponcling weeks of ten previous years were 1120, ifthe two weeks of 1849 and 18;4 are excluded, when cholerawas epidemic, and 2456 and 2039 persons died. 474 deaths

occurred from zymotic diseases, including 22 from small-pox,12 from measles, 78 from scarlatina, 13 from diphtheria and 6from croup, 16 from whooping-cough, 46 from typhus, 215 fromdiarrhoea, and 10 from cholera. Of those from diarrhœa, 174occurred under two years of age. The diarrhoea is most pre-valent in the East districts (60 deaths,) and in the South dis-tricts (69 deaths). The deaths from this disease in the Metro-polis in six weeks have progressively fallen from 415 to 382,312, 296, 240, and 215. 253 persons died of constitutionaldiseases, including 31 by cancer, and 148 by consumption. Of307 deaths by local diseases, 100 attacked the nervous system,

, 71 the breathing organs, and 64 the digestive organs. 25 per-sons died by accidents or negligence—namely, 7 by mechanicalinjuries, 3 by burns, 1 by poison, 10 by drowning, and 4 bysuffocation. 3 deaths are referred to murder or manslaughter,

and 5 to suicide.