children died of the same disease; all had children, but the third generation did not survive the period of the first dentition, all being carried off either by pneumonia supervening on tubercle, or by tubercular meningitis. In another example, a grandfather died of phthisis. One of his daughters also died of it at 30. The other daughter is still living, but three of her children have died either of tubercular pneumonia or meningitis. The general conclusion is, that in proportion as phthisis descends in the genealogical scale, its manifestation takes place at an earlier period of life. A child will therefore run greater chance of falling a victim to the consequences of the numerous accidents of a tubercular affection, in proportion as the phthisical parents who have given birth to it have not attained advanced age. In a diagnostical point of view, then, the existence of tubercular disease in the offspring while yet young, offers a very strong presumption of phthisis. The practical importance of this is especially evident in pneumonia, so common is it to find tubercles of the lungs in the bronchial glands, masked by the signs of this affection.-L'Union Medicale, *No. 5.

On Measles as observed in Idiot Children. By M. DELASIAUVE.

THE remark has been frequently made, that in certain classes of the insane, incidental diseases exhibit a severity which is not usually observed in persons in the possession of their faculties. Exactly the contrary to this has been, it is true, maintained by some, and a supposed immunity asserted. Georget and Esquirol, however, have shown that insanity disposes the subjects of it to be more severely affected than are others by ordinary diseases; and Ferrus especially points out dementia and idiocy as unfavourable conditions in this point of view. M. Thore, also, in a special essay on the subject, adopts the same view. M. Delasiaure deduces the same conclusion from the opportunities he has had of observing epidemics of measles at the Bicêtre. The children of the employes of "the establishment were recently attacked in great numbers, and from these the disease was communicated to the idiot and epileptic children. While among the former the eruption pursued a normal and favourable course, anomalous conditions complicated it among the latter, and very often rendered it fatal. In different epidemics, there has been observed a predominance of some one of these, such as engorgement of the lungs, of the brain, or the portid, œdema, &c. Violent diarrhoea was the especial characteristic of the present one. Besides this, however, in six out of eight cases, occurring in one section, asphyxia from bronchitis occurred, endangering the lives of the whole, and terminating fatally in two.-Annales Med. Psychol. N. S. vol. iii. p. 343.

Epidemic of Lead Colic in Paris from Sophistication of Cider with the Acetate.

MгсH attention has recently been called to the very numerous cases of colic occurring in Paris among persons who drank cider; and on investigation being made, it was discovered, that as this year great difficulty in clarifying the fluid had been experienced, some of the brewers had resorted to the use of acetate of lead for this purpose, the base of which had only become partially precipitated with the dregs. The chemists found nearly a grain of lead per litre of the fluid. No sooner did the Board of Health receive an intimation of the matter, than the most laudable energy was employed in examining the remaining stock of cider in the capital; so that within three days all fear of a repetition of the accidents was rendered groundless. The first cases that were seen, somewhat puzzled those called upon to treat them; but their great simliarity to ordinary lead colic led to the appropriate treatment being soon decided upon. The seat of pain differed, however, somewhat from its ordinary locality, occupying the epigastrium and the right hypochondrium in place of the umbilicus; and stools were producible by much milder purgatives than are usually required in lead colic. In all the patients in whom it was sought for, the blue mark of the gums was dis coverable. This valuable pathognomonic sign should indeed be always sought for, whenever obscure abdominal pains, local paralysis, or even cerebral symptoms of doubtful origin, are present. A remarkable example of this occurred to M. Martin-Solon. During the events of June, 1848, on a hurried transference of some of the patients to other wards, accounts of their cases were lost. One of these patients came under M. Martin-Solon's care, seemingly suffering from marked coma due to cerebral effusion. No account of the case could be obtained; but after an attentive exploration of the whole body, this sagacious observer detected the pathognomonic condition of the gums; and believing the patient to be suffering from saturnine encephalopathy, he ordered purgatives, and soon rescued him from an apparently hopeless condition.— Bull. de Therap., tom. xlii. p. 122.

SURGERY.

On the Operation for Strabismus. By Professor PANCOAST.

PROFESSOR PANCOAST believes that it arises from the ill consequences which have resulted from the nonobservance of the principles which should guide the surgeon in performing this operation, that by many persons it has been considered as abandoned. His own conviction, founded on the result of about 1000 operations performed since 1839, is, that no other operation in surgery yields more gratifying results than this; and in very few would he feel so disposed to promise a perfect cure, on condition of obedience to

rules of after treatment.

First, the nature of the defect to be remedied must be understood. It consists in a spastic or unrelaxed contraction of one of the straight muscles of the eye. Although it usually commences in one eye, the other, sooner or later, more or less regularly assumes the same condition. The causes of the contraction may be various, such as imitation, the pressure of a tumour, &c.; but the most frequent by far is the disturbance of the centric extremities of the nerves of the straight muscles by congestion or inflammation of the brain or its meninges, which so often occur in measles, scarlatina, pertussis, or cerebral disease.

The divergent form appears occasionally to be produced by congestion of the cavernous sinus, through which the nerves to the eyeball run. When seen recently, such cases have always been relieved by repeated alternate cupping and blistering the nape and the temples, thorough purging, and the cold douche. If not seen early, the external rectus has to be divided.

The common internal or convergent strabismus should be submitted to the following preliminary investigation. We have first to determine whether the distortion is double, and whether it is equal in both eyes. To do this accurately is difficult, as the patient can voluntarily direct either eye straight towards an object, and the whole obliquity of both seems accumulated in one eye. "I place myself in front of the patient, and direct him to roll the eyes as far as possible, alternately to the right and left. Now a person of middle age, with healthy eyes, can hide the white completely at the outer canthus, and slightly bury the edge of the cornea at the inner. A young subject, in which the tissues are always more yielding, can do more than this. If I find, after repeated trials of this sort, that the movements of one eye are normal, and that in the other the cornea is buried too deeply in the inner canthus, and that a strip of the adnata, one-sixth or one-eighth of an inch, is left uncovered at the outer, then, I say, the internal rectus of this eye is alone at fault, and its tendon must be divided. We will also frequently observe in the faulty muscle, an involuntary and rapid twitching when the eye is turned strongly in the opposite direction If, at the same time, I find that the eye at fault pretty generally rolls upwards and inwards, or downwards and inwards, I say that a portion of the upper or lower rectus muscle is likewise concerned in the deformity, and may, after the operation on the internal rectus, require to have its tendon cut, and I locate my incision through the conjunctiva to suit. I next observe carefully, when the patient is making no unusual effort with the eyes, whether the lids open equally wide; or, in other words, if there is not a larger disk covered at the upper part of the cornea in one eye than in the other. If so, I am sure that the eye that has the corner most covered, is the one which has the shortened muscle and the squint; for the effect of the strabismic contraction is to sink the ball and leave the lids less widely separated."

When the case is a clear one of single squint, and the internal rectus has been divided, if the eye do not become straight, and remains a little sunken, we may afterwards divide a portion of the superior or inferior rectus. But if, without becoming straight, the eye is equally or rather more prominent than the other, the division must be abstained from, or we shall weaken the stays of the ball, and the eye, though straight, will become too prominent and protruding. This result has too frequently been produced by an attempt to cure a double squint, under the mistaken belief that only one eye was at fault. A squint exists in the other eye, but it cannot be considerable, or it would have been discovered during the preliminary trials. The corres ponding tendon of this eye has, therefore, to be divided completely. The intermuscular fascia should not, however, be divided, nor the sustaining power of the conjunctiva diminished more than is unavoidable-the object being to straighten the direction of the ball without causing protrusion; and Guerin's subcutaneous operation accomplishes this the best.

We frequently have a double squint so decided, that the single tendon may be divided (in the adult) on each eye at a sitting. We then apply our tests to discover which eye requires, in order to bring both parallel and equally prominent, the intermuscular fascia to be divided upwards or downwards, or one of the adjoining straight muscles partially, or in extreme cases, entirely cut.

The operation for external or divergent strabismus, cases of which occur in the proportion of four to five per cent., is easier, as the tendon is uncovered for a larger space, and we have no plica semilunaris to avoid. Still the cure of this is neither so easily nor so promptly accomplished as is that of the internal-a circumstance in some cases due to a paralytic condition of the internal rectus.

When treating the young (and operations under 10 years of age should be exceptional) the extent of our sections must be more guarded. Here the over-stretched muscles have much recuperative energy, a gradual increase of their power seeming to extend over several days. The evil to be feared is, that the antagonistic muscle will pull the ball so far over, as to let the divided tendon become reattached too far back on the globe. In few cases, even of double squint, then, should both eyes be operated on at a sitting, under pu berty. The tendon on the worst side should be divided, and then we may wait several days, or even in some cases months, to observe the effect. In children we must always allow for this recuperative power of the muscle, and not seek to make the eyes immediately straight. The proper degree of allowance to make, is one of the difficulties of this operation, which has to be guided by the judgment of the operator, according to the age of the patient and the degree of the deformity. It is true, in case an external squint should fol low an operation for one of an opposite kind, you have it in your power to correct it by a subsequent divigion of the external tendons; yet it is a most unpleasant result, which you ought, and may most usually, avoid. One mode to which, when I particularly fear such a result, I have recourse, is, to stop considerably short of making the eyes straight, to reintroduce subsequently my blunt hook, so as to loose the reattaching tendon, and to nick the fascia above or below very cautiously with the scissors without enlarging the wound of the conjunctiva, until the balls begin again to assume their proper position."

The division of the oblique muscles is in all ordinary cases unnecessary, as they are never directly concerned In the production of strabismus. In his earlier operations, Professor Pancoast several times divided them, without ever inducing the slightest change in the ordinary movements of the ball.-Phil. Med. Exam. vol. vii. p. 509.

On the Treatment of Paronychia. By PROFESSOR PANCOAST.

Ir is important to know the modus agendi by which a trifling puncture may giver ise to the alarming, or even fatal symptoms sometimes met with. If the puncture be not deep, there is merely inflammation beneath the skin, giving rise, however, to great suffering, from the free nervous distribution to the finger. The cuticle does not give way readily, and a poultice by softening it may afford relief. If this is not obtained, the Inflammation sooner or later extends beneath the vaginal ligament, involving the sheaths of the tendons The ligaments not yielding to the increased bulk of the inflamed tissue, strangulation is produced, and sloughing of the tendinous sheath and periosteal lining, and subsequent death of the phalanges, may occur, producing what is called in America a "felon." The disease, compressed laterally, extends readily upwards towards the palm, following along the sheath of one finger, into the sero-cellular covering of all the tendons of the hand and wrist. It may now extend itself down the thecal bursa of the other fingers, or along the tendons of the flexor muscles, high up in the arm. The first indication is to relieve the strangulation. A sharp-pointed, curved bistoury is passed vertically through the skin and vaginal ligaments, to the flexor tendons, and brought down with its back towards the palm, so that the point may slide under the ligament, In the direction of the finger, and so pass out. The incision should extend the length of one phalanx only; If this is not enough, it is better to make a separate incision over another phalanx, than to divide the whole length of the finger, when the tendons would start from their sheath. The palm is not to be laid open as we do the fingers, although this would relieve the strangulation; but a deforming and troublesome cicatrix

would be left, and a troublesome hæmorrhage might arise. When the middle palmar fascia becomes involved at one of its sides, so as to let a soft fluctuating tumour form in the palm, this may be opened, as the preliminary inflammation will have blocked up the vessels. When the palmar fascia has not yielded, Dr. Pancoast has several times afforded complete relief, without any ill-consequences following, by passing a somewhat blunt-pointed, curved, and rather dull bistoury, under the opened sheath of the tendon, from the first phalanx into the centre of the palm, and sweeping it gently round, so as to break down the inflamed synovial and cellular tissues, and furnish an outlet for the fluids with which they are distended. Little force is given to the sweep, so that the tendons need not be cut. No hæmorrhage follows, for the swollen state of the parts separates the two palmar arches-the radial arch being fixed by its perforating vessels near the face of the metacarpal bones, and the ulnar being pushed off with the palmar fascia, lying as it does in front of the superficial flexor tendons.-Philad. Med. Exam., vii. p. 505. [In the American Journal of Medical Sciences,' Jan. 1852, Dr. Morgan states that paronychia, during last summer, prevailed in an epidemic form at Washington. The constitutional symptoms were in some cases very severe.]

On the Consequences of Congenital Phimosis. By M. FLEURY.

M. FLEURY terminates his paper upon this subject with the following conclusions:-1. Congenital phimosis possesses a pathogenetic importance that has been almost entirely overlooked.-2. This is exhibited in three orders of phenomena to which it gives rise. These are (a.) Accidents relating to the genital organs. The penis and testes are frequently small, and the mucous membrane of the glands delicate, red, and morbidly sensitive. Coition is painful and ejaculation incomplete, difficult, and often attended with severe perineal pain. Exhausting erections and nocturnal pollutions are of frequent occurrence, as are urethral discharges even after the purest connexion. The genital sense is sometimes so excited as to give rise to almost continual erection, immoderate venereal desire, masturbation, and involuntary emission; while in other cases it is, so to say, extinct, a more or less complete anaphrodisia prevailing. (b.) Phenomena referrible to the urinary organs. These are, frequent desire to pass urine, pain at the orifice of the urethra, and other symp toms which are usually attributed to a vesical neuralgia, disease of the prostate, stone, or some other disease of these organs (c) Various disturbances of the nervous system, presenting a great analogy to those observed in women suffering from uterine disease, or displacement of the uterus, such as gastralgia, hypochondriasis, and hysteriform attacks-the true cause of which symptoms is always overlooked.-3. The excision of the prepuce is the only remedial means-In 23 out of 27 cases in which this was resorted to, success was complete, the four others being lost sight of soon after the operation.-4. Whatever form of treatment may be had recourse to, these cases cannot be relieved until the vicious conformation has been remedied. After the operation, tonics, anti-spasmodics, and especially hydro-therapeutic means, are often of great service.-5. Ricord's operation, aided by the serre-fines of Vidal, constitutes the best surgical procedure.-Bull. de l'Acad., tom. xvii. p. 79.

On the Treatment of Hospital Gangrene. By Professor PORTA.

In treating this disease, two principal indications are to be observed; the removal of the causes, and the arrest of the gangrenous process. By fulfilling the first of these we may often cut short an epidemic, and cure the individual case without resorting to special means for accomplishing the second; the gangrenous process, no longer fed by the influences which induced it, ceasing, the eschar becoming detached, and the wound returning to its simple condition. The success obtained in such cases has seduced many observers into the erroneous belief that the cure of hospital gangrene consisted entirely in removing the causes, without the necessity of attending to the local process at all. It is true that at first this will suffice; but when the gangrene has struck deep roots into the part, it can maintain itself there in spite of the removal of the primary causes.

From whatever causes it may proceed, hospital gangrene is, at least at first, of an inflammatory character, and calls for general and local antiphlogistics. But frequently these become useless in consequence of the fugacious or illusory character of the inflammation; and then the stimulant, tonic, and antiseptic remedies, formerly so much abused, are of avail. Notwithstanding, however, the eulogia passed on caustics and the cautery, Dr. Porta was accustomed to find them usually disappoint expectation in his own and other hands, the gangrene continuing to advance, or reappearing, and the patient dying or undergoing amputation. Examining these cases after death or amputation, he found that the gangrenous substance below the eschar was untouched, and that at the periphery of the ulcer it sent prolongations below the integument into the areolar membrane and fleshy substance. The supposed relapse was in fact but an extension of the disease. As even repeated cauterizations failed to reach the ultimate roots of the gangrene, the author believed that the knife might advantageously precede or replace them. At a distance of some lines from the gangrenous margin, he carried an incision quite round this, through the skin, adipose substance, and aponeuroses, opening a passage into healthy parts. When the bleeding had ceased he applied some caustic substance, or oftener the cautery, freely along the track of the incision, so as to surround the gangrenous mass by an artificial eschar. In other cases, in place of following the incision by caustic, he removed by means of the knife all the corrupted mass which covered the part, leaving a clean wound behind. This practice has proved highly successful; for although in some exceptional cases, under the influence of the causes which first produced it, the gangrene has appeared in the recent wound, in the majority of cases the complete removal proved final. In some cases the effect has seemed almost marvellous; the patient, who was exhibiting all the symptoms of typhus, recovering as if by enchantment, after the removal of this source of sanious resorption and reflected irritation.-Annali Omedei, vol. cxxxv. pp 549–57.

Statistical Account of the Fractures occurring in the New York Hospital. By Dr. Lente. In this paper Dr. LENTE furnishes a statistical account of the 1722 cases of fracture which were treated in the New York Hospital during twelve years (1839-51): and he compares some of the results with those furnished by the cases reported by Malgaigne, from the Hotel Dieu (1939), by Londsdale, from the Middle.

sex (1392), and by Norris, from Pennsylvania (840). The following table exhibits the percentage of the principal fractures :

In respect to age, Dr. Lente observes that the greatest number of fractures of the thigh, arm, forearm, clavicle, and lower jaw, occurred between 20 and 30; of the leg and patella, between 30 and 40. Of fracture of the leg, 65 80 per cent. occurred between 20 and 40; while of the thigh, only 33 04 per cent. occurred at this age. In the earlier years of life, fracture of the thigh is more common than that of the leg-viz., prior to 10 years of age, as 17 75 per cent. compared to 171, and between 10 and 20 as 20 65 to 8.11. No case of fracture of the cervix femoris, either within or without the capsule, occurred prior to 23. Above the age of 50 the per-centage of fractures of the os brachii (11·25) is greater than that of any other bone, that of the forearm being only 3:12. Only 1 case of fractured clavicle under 10 years of age, and 21 cases under 20 years, occurred in a total of 158! In regard to the sex of the patients, the female varied from 10 to 11 per cent. of the males, except for the clavicle, when they were 17 per cent.

Dr. Lente regards the question of shortening as an unnecessary refinement in respect to any other bone than the femur; inasmuch as an inch or so of shortening in the upper extremity does not interfere with its uses. In the leg, if there be no considerable deformity from loss of bone, there will be no appreciable shortening; and even when the deformity is great, the shortening is usually inconsiderable. In a great number of cases that Dr. Lente has measured, he has never found any shortening that could give rise to a limp, where there was no loss of bone, even when the fracture was comminuted. For several days after the acci dent, there is considerable shortening; but the fractured surfaces gradually adjust themselves so as to render this imperceptible, even on measurement. It is this same self-adjusting power which, in fracture of the femur of young children, corrects the obstinate early bowing-out at the seat of fracture. In fracture of the femur it is of great consequence to prevent shortening, as this will produce lameness; and this is the only fracture in which, for that reason, extension is required. Dr. Lente agrees with Malgaigne that a certain amount of shortening must take place in almost all cases; and he believes that surgeons who declare they can treat cases without any occurring, are either disingenuous, or are incompetent to the somewhat difficult task of comparing the limbs by measure. In nine cases out of ten there will be no limp, though a shortening of 1-2 or 3-4 of an inch occur; and a shortening of 1 1-4 inch may be overlooked in the ordinary mode of measuring by placing the limbs side by side. To measure properly, requires tact and practice; and a limb should be examined several times before coming to a conclusion. At the New York Hospital, the average shortening amounts to 3-4 of an inch; and sometimes, in spite of every care, it reaches an inch or more.New York Journal of Medicine, vol. vii. p. 154.

Pseudo-membranous Thickening of the Tunica Vaginalis, in Hydrocele and Hæmatocele. By M. GOSSELIN. In this essay M. Gosselin endeavours to demonstrate that the condition described by authors as thicken. ing of the tunica vaginalis, is really due to the production of a firm, thick, imperfectly organized pseudomembrane, which lines the tunica vaginalis, and produces the thickness and inflexibility observed in these cases. It can be completely detached from the tunica, except near the testis, leaving it in its normal state of suppleness and flexibility, though slightly thickened. To the naked eye it looks like dense fibrous tissue, and has been often described as fibro-cartilaginous transformation, but its minute structure resembles no normal tissue. Short, narrow fibres are observed, lost amidst amorphous matter, nucleated fibres being found here and there in small numbers. Sometimes calcareous matter is deposited amidst the stratified layers, which has been supposed to arise from incipient ossification; but the microscope detects no vascular canaliculi, or bone-corpuscles. The membrane contains vessels which are continuous with those of the tunica. The fluid in such a hydrocele is usually of a chocolate-brown or deeper colour, from the mingling of blood, and it contains a notable quantity of cholesterine. The inner surface of the pseudo-membrane is rugous, and sometimes covered with plastic exudations. The testis, usually placed as in ordinary hydrocele, is sometimes situated in front, and sometimes it remains below the tumour, which then simulates encysted hydrocele of the cord. It is often pressed back and flattened, so as not to be felt from the interior of the sac; but the author has never known it atrophied. The body of the epididymis is sometimes separated two to five centimetres from the testis, becoming elongated and flattened in proportion to the degree of separation, and assuming a curved form, with an external superior convexity. It is now even difficult of recognition, and has been often divided or cut away in operations. This change in the position and form of the epididymis, is, however, also a result of the distention of the sac, and may, as shown, by Curling, be present in ordinary hydrocele. M. Gosselin has met with spermatozoa only in one case, but this may arise from the suspension rather than from the destruction of the function of secretion; and he has as yet seen no such disorganization of the seminiferous substance, as would justify the belief that secretion could not be reproduced. Excretion may in some cases be prevented by the obliterations which occur at the globus minor, and which may be a consequence of all chronic inflammations of the testis and its coverings. In some of the cases, injection proved that no such obstruction was present.

In their mode of formation, these pseudo-membranes resemble those more delicate and completely organized ones, which are found uniting the two surfaces of the serous membrane after the cure of hydrocele; and which, indeed, are seldom found absent (to a partial extent) in the adult and aged. From these the present differ, by not establishing adhesions between the two surfaces (almost exclusively belonging to the parietal one), and by becoming very much more thick and inflexible. Their cause is found in whatever may produce a chronic and often unperceived vaginitis, this arising sometimes spontaneously, sometimes from traumatic causes, and at others following orchitis or epididymitis.

The diagnosis of the affection is often obscure, and especially in its early stages. It may be suspected when the transparency of the hydrocele is imperfect, when its formation has been attended with pain, or

when injections have already once or twice proved unavailing. At a later period it may be confounded with sarcocele, from which it is distinguished by its loss weight, and by the fluctuation, though indistinct. The greatest difficulty is presented when calcareous deposits have been formed. An exploratory puncture is usually required to assure the diagnosis, and to ascertain the degree of thickness of the envelopes, and the power of contracting upon themselves they may possess. Left to itself, the diseased mass may reach the size of a double fist, but rarely gets larger. A sudden increase sometimes supervenes on external injury; and there is a great proneness to suppurative action, as a consequence of even slight wounds or injuries. The general symptoms attendant upon this traumatic inflammation, are often very serious; so that the exploratory puncture should not be made until we are prepared to follow it by the definitive operation it may show to be necessary. The prognosis of this pseudo-membranous hydrocele is much more serious than that of the common one, in consequence of the more severe operations required for its removal, and the greater liability to consecutive dangerous accidents. These last arise from the difficulty with which the adhesive inflammation is set up, and the tardiness of the formation of granulations after suppuration-tedious fistula being common, while the false membrane may be eliminated through gangrenous inflammation, giving rise to great constitutional irritation.

In describing the treatment suitable for this affection, M. Gosselin passes in review the different operations that have been recommended, observing that the French surgeons have rejected that of incision, still performed in England, as highly dangerous, and prefer to it that of excision, or even, on account of the dangers attendant upon both of these, castration. He now proposes for adoption, one which he terms decortication or ablation of the pseudo-membrane-an operation not more dangerous than castration, and one which leaves the testis uninjured. He thus describes it. Having left-in some fluid after the exploratory puncture, and ascertained that the testis is situated posteriorly, he carries a vertical incision along the whole length of the anterior side of the tumour, dividing the tissues layer by layer. When little more of these remain, he plunges the bistoury into the lower part, and enlarges the incision upwards. The detachment of the membrane is effected by the handle of the scalpel or the fingers, just as one would peel an orange, drawing it inwards at the same time by means of a forceps held in the other hand. If there is much resistance, a few strokes of the bistoury or scissors may be required. When the lowest portion near the testis is reached, he stops, and proceeds to separate the other half in the same manner. When both portions are thus brought down, they may be divided by the scalpel or scissors; or one side may be excised before proceeding to the other. The bottom of the wound being now, after the removal of this abnormal membrane, composed of healthy tissue, takes on a good form of inflammation, and easily fills up with granulations.

In the only case in which he has tried this procedure, the author has met with complete success. This is related, as are several others illustrative of the different points adverted to in the memoir.-Arch. Generales, xxvii. § 5, 295 and 385.

Statistics of Hernia. By M. HUTIN.

Ar a recent examination of the pensioners at the Hotel des Invalides, M. Hutin found that among the entire population of 3177 pensioners, there were 670 who had hernia. These were distributed as follow: 631 Inguinal (213 double, 418 single).

6 Femoral (5 left, 1 right).

18 Umbilical.

11 Superumbilical.

2 Subumbilical.

2 Near spine of ilium.

670.-Rev. Med. Chir. vol. xi. p. 182.

Cases of Atresia Ani in the Adult, with Preternatural Anus. By DR. DEUTSCH.

DR. DEUTSCH has met with two of these rare cases. The first occurred in an unmarried woman, æt. 29, whose corporeal development seemed, however, rather that of a girl of 15. She, however, enjoyed good health until seized with a nervous fever. While she was in an unconscious state, it was discovered, on attempting to give an enema, that there was no anal aperture. At its usual seat a cartilage-like substance, the size of a pea, could be felt; and at the entrance of the vagina,fimmediately below the hymen, which was complete, a pretty regular round opening, half an inch in diameter, was observed, surrounded by a firm, almost cartilaginous edge. The finger, passed through this into the rectum, caused fæcal matter to flow out. Around the cartilaginous border, radiated folds of membrane were observed, resembling those surrounding the orifice of the urethra. The opening contracted slightly upon the finger, but could not be completely closed. The patient, on recovering her senses, was surprised to learn that she was the subject of an abnormal formation. She said she had only inclination for stool once or twice in a fortnight, the fæces then passing either in a fluid state or in small hard pieces. She refused to submit to any attempt to remedy an inconvenience from which she suffered so little.

On examining the other case, occurring in a well-developed girl of 16, a completely flat surface, with neither depression nor elevation, was observed at the seat of the anus. About the middle of the perinæum, and rather towards the right side, an aperture existed about the size of a pea, surrounded by almost cartilaginous edges, and capable of completely opening and shutting. Towards the interior it was lined by a circular fold of mucous inembrane; and the completeness of the power of expansion and contraction which existed, left little doubt of the existence of a muscular apparatus.

Doepp states, in the Transactions of the Petersburgh Physicians,' that among five cases of atresia ani in the adult, two occurred in girls. The hymen extended to a membrane closing the anus, and an aperture existed in the vagina. In both cases he sought, by an incision in the interval between the hymen and reetum, to enlarge the aperture of the artificial anus; but both cases died in consequence of his interference.— Neue Zeitsch. fur Geburts, Band xxx. pp. 281-285.

On the Cause and Diagnostic Value of Musca Volitantes. By M. TAVIGNOT.

M. TAVIGNOT assigns as the cause of this phenomenon, the passage of the luminous rays through a very