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back in the opening of the ureter at the moment they are passinginto the bladder, may sometimes have led the operators them-selves to suppose that they had formed an incorrect diagnosis.The principal facts of Mr. Fergusson’s cases are as follows :-

Edward B-, aged six years, was admitted March 20, 1852,under the care of Mr. Fergusson, with several of the symptomsof vesical calculus. About two years and a half ago, the patient’smother noticed that he experienced pain every time he passed hiswater, and that he was frequently pulling his prepuce; blood wasoften seen in the boy’s urine, and the flow of the latter usedto stop suddenly. These symptoms had continued with more orless intensity ever since, and had caused the patient much dis-tress. Mr. Fergusson readily detected the stone on sounding thechild, and proceeded to perform the lateral operation a weekafter admission.Mr. Fergusson is in the habit of making a free external inci-

sion, and the parts are in such close proximity with youngpatients, that very few strokes of the knife are sufficient after-wards to reach the neck of the bladder and lay it open. Wesuspect that the aperture into this viscus is made at first verysmall, as Mr Fergusson generally appears to dilate it with theleft forefinger before introducing the forceps. This instrument,as stated above, was not used in this instance, as Mr. Fergusson,knowing the calculus to be small, preferred using the scoop, withwhich he succeeded in removing the stone in a very short time.The patient progressed satisfactorily; in about a week the wholeof the urine passed through the urethra, and the boy was dischargedwith a firm perlnseal cicatrix one month after the operation.CASE 2.-John V-, six years of age, was admitted March

14, 1852, under the care of Mr. Fergusson, labouring under thesymptoms of stone in the bladder. The child suffers veryseverely each time he attempts to pass water; micturition iseffected with much straining, the urine being then voided in butvery small quantities, mixed with blood, and containing pus andmucus. The stone was easily detected by sounding, andlithotomy performed immediately after the first patient was re-moved. After the usual incisions, the stone, which was of anoblong shape, and rounded at one end, was removed by the scoop,as in the former case, this instrument being preferred to theforceps for the reasons above stated. From the peculiar figure ofthe calculus, Mr. Fergusson was inclined to think that it hadbeen grasped by the opening of the ureter. The progress of thispatient was marked by a feature which is seldom observed withyoung people: he had, namely, several pretty severe attacks ofhaemorrhage, but the loss of blood was easily controlled byplugging. All went on well with the exception of this, and aboutfive weeks after the operation the patient was discharged in verygood condition.

Being on the subject of haemorrhage after lithotomy, we woulddirect the attention of our readers for a few moments to a methodof operating proposed and performed by Professor Rizzoli, oneof the advantages of which is said to be the non-division of thegreat perinaeal arteries and the prostatic venous plexuses. Theoperation is described in the August number (1851) of theMedico-Chirurgical Review, and is not, as far as we have seen,often performed in this country. The proceedings are describedas followsThe perinseal urethra being well projected out by a very convex

sound, the operator commences his incision of the superficialcoverings, a few lines behind the base of the scrotum, and carriesit to the margin of the anus. Passing the nail of his left thumbor fore-finger under the bulb of the urethra, in order to protectit, he feels for the groove of the sound, and penetrates the anteriorpart of the membranous portion of the urethra with his lithotome,the ligature or torsion being applied to any of the arterialbranches proceeding towards the bulb which, owing to theirabnormal development, may bleed too freely. Having implantedhis bistoury within the origin of the membranous portion, inorder to prevent any injury to the rectum, the surgeon now takesthe sound from the assistant, and, raising the handle to a rightangle with the pubis, enables the instrument to slide under thearch, rendering the membranous portion prominent, and its divi-sion easier, without injuring the rectum. The incision should becarried far enough to scarify the edge of the prostate, as urinaryeffusions into the cellular tissue of the anterior walls of the pelvisare much more likely to occur when it (the incision) is limited tothe membranous portion, and the dilatation of the part by thepassage of large calculi is then more difficult.The incision completed, the operator passes his index finger

into the wound, with the palm or surface upwards, guiding italong the groove of the sound into the bladder, and makingit serve as a conductor for the passage of the forceps. If thesurgeon discover for the first time during the operation thathe has to do with a large calculus, it is better to break itprior to the removal; for which purpose Professor Rizzoli has

contrived an instrument. He believes the advantages of thismethod to be, that neither the bladder, rectum, bulb, vasa

deferentia, the great perinaeat arteries, nor the prostatic venousplexus, are wounded. He has operated upon eight cases

with success; in one of these there were two calculi, oneof which was discharged by an aperture which occurred spon-taneouslv in the nerinseutn.

Talipes Equinus; Tenotomy, Rectification of the Deformity.(Under the care of Mr. PARTRIDGE.)

Mr. Partridge has lately operated upon two brothers whowere each affected with congenital talipes equinus. We need notsay that this variety of club-foot is rarely met with, for it is wellknown thatout of perhaps twenty operations for talipes varus, thereis hardly one for talipes equinus. As to the two brothers present-ing the same congenital defect, may we not suppose that theuterine malposition was owing to some peculiarity of the uterusitself, which has a tendency to produce the same effect atevery gestation? No doubt but that a smaller quantity thanusual of amniotic fluid may have much influence on congenitaldefects of this kind.

C)

I It is no small triumph of modern surgery that talipes shouldnow be so easily remedied; we should, however, mention that itis worth while paying the strictest attention to the manner ofdividing the tendon (which should be delicate and regular), andthe application of the apparatus after tenotomy; for we haveknown cases where the non-observance of these rules caused verytroublesome sloughing, and inflammation of the whole limb.

Seth Y-, aged twelve, was admitted Feb. 3, 1852, underthe care of Mr. Partridge. He is a healthy lad, though thin,and has been much annoyed by the deformity of congenitaltalipes equinus of the left side; he has walked upon the affectedfoot from an early age without assistance. The boy treads onall the toes except the great one, the heel being drawn up so faras to bring the instep almost on a straight line with the leg. Infront the extensor proprius is so contracted that the great toe isdrawn up, and does not come in contact with the ground.Mr. Partridge divided the tendo-Achillis, four days after ad-

mission, and an apparatus, intended to bring the heel downwardsand flatten the foot, was put on a few days afterwards. Pressureon the instep caused a little ulceration in that region, but aboutfive weeks after the operation the patient could put his foot flaton the ground. The improvement kept pace for the next fewweeks, and about three months after the division of the tendon,the boy could walk with comparative ease, very faint traces ofthe deformity being left.The second case refers to a brother of the former patient,

Lewis Y-, aged ten years. The defect was here likewisecongenital, but affecting the right foot, and pretty analogous towhat has been described above, except as to the contracted ex-

tensor, which was not quite so much drawn up. Both patientswere operated on the same day, they progressed pretty well in ananalogous manner, and are now both free from their congenitaldefect.

Reviews and Notices of Books.

On Diseases of the Liver. By GEORGE BUDD, M.D., F.R.S.,Professor of Medicine in King’s College, London, and Fellowof Caius College, Cambridge, pp. 486. London.

IN writing a book on Diseases of the Liver," says Dr. Budd," I shall hardly be accused of having undertaken a needless task.There are no other diseases of such frequent occurrence, whichit is so difficult to discriminate, and for the treatment of whichthe practitioner has so few trustworthy guides. There is, again,no class of diseases at all equal to this in importance, on whichso few treatises have lately been written." Now all this is verytrue, if we make allowance for the small spice of exaggerationwhich will creep into the language of any one who makes hisown estimate of a subject in the investigation of which his facul-ties have been long and successfully absorbed; and even if thesediseases were less important, less obscure, and less difficult totreat than they are, we should be glad to re-welcome in anotheredition, a work, which, by teaching us what is true, will help torid us from the everlasting wearisomeness of hearing that "theliver is out of order," when the poor liver is altogether exemptfrom blame.

Dr. Budd begins with a full analysis of those anatomical andphysiological prinoiples, without the knowledge of which any