region. The paroxysms of pain occurred daily, and at the time the epigastrium and hepatic region were very tender, but not at other times. The faces had previously been firm and of brown colour, and suddenly became whitey-grey, but there was no icteric hue. Soon after this change of colour, the distended gall-bladder could be readily felt as a smooth round tumour. Ten days prior to death the patient became intensely jaundiced, the paroxysms of pain continuing, and the liver increasing in hardness and size. Death occurred on the 27th February, consciousness being preserved to the last. We can only make room for the prominent points noted in the autopsy. The liver was partially adherent to the diaphragm, the peritoneal covering thickened, the organ large, soft, friable, and green; the biliary ducts of the liver distended, the branches of the vena portæ filled with fluid blood. The gall-bladder was much enlarged and distended with thick black bile, with numerous plates of cholesterin; the cystic duct was impervious, and the upper half of the hepatic duct distended; its communication with the cystic duct was interrupted by a tough, fibroid plug; the common duct was distended throughout. The stomach was contracted, so as to resemble a portion of intestine; the intestines themselves were collapsed. There was a pound and a half of sanguinolent serum in the pelvis; darkened coagula lay in the region of the transverse colon, in the left hypochondrium, and elsewhere in the abdomen. Between the upper edge of the stomach and the lower margin of the liver there was a tumour nearly as large as a child's head, so as to occupy a large portion of the space belonging to the lesser omentum. At the concave side of the liver, near the left margin, it was intimately adherent to the hepatic coat over a space 1 in. by 2 in. The tumour had an irregularly oval form, and at its lower convex end, close to the transverse colon, was a ragged opening an inch and a quarter long, from which a dark coagulum projected. This sac was filled with concentric layers of blood and fibrine, weighing altogether 14 pounds. The sac consisted of dense walls, from two to three lines thick, consisting of areolar tissue, with rough transverse bands bridging across the interior. The sac rested with a broad basis upon the hepatic artery, with which it communicated by a fissure one centimetre (0-393 inch) long, by four millimetres (0.156 inch) broad, the edges of which were hard and smooth. The hepatic and common ducts were partly inclosed in the walls of the sac. The portal vein was partly adherent to the posterior wall.

The author in his summary observes that the aneurism was probably due to a dilatation of all the arterial coats, which were gradually destroyed by pressure and other processes, because the arterial coats could only be demonstrated at the neck of the arterial tumour; they were not to be found at any other portion of the sac. The paroxysms of pain he accounts for by the irritation of the branches of the hepatic plexus enclosed in the sac, and the pressure exerted upon the solar ganglia and adjoining nerves. For the cause of the aneurism, Dr. Wallmann can offer no explanation.

VIII. Some Facts in Relation to the Nocturnal Incontinence of Urine in Children. By Dr. ADDINELL HEWSON. (The American Journal of the Medical Sciences, Oct., 1858. From Transactions of the College of Physicians of Philadelphia.)

In the House of Refuge (of Philadelphia ?) there are on an average 292 boys, and the habit of wetting the bed had become so prevalent, that Dr. Hewson, in 1857, was requested to suggest a cure. He found that no less than 78 boys were guilty of the practice, or a proportion of about 1: 34. Dr. Hewson consequently subjected the whole establishment to a close critical inquiry, and continued his observations for five months. The results which he gives are

drawn from the consideration of 63 of the 78 cases which remained in the house during the whole period; of these, 29 were whites and 34 negroes, and as the total number of whites and blacks was respectively 201 and 91, the affection was more than twice as prevalent among the blacks than the whites. The worst cases also occurred among the blacks. The average age of all was thirteen years, the extremes being seven and eighteen years; the greatest number affected at any given age was 9, the age being fourteen. The appetite was excellent in 53, poor in 10, though only 34 had the appearance of good health; 24 suffered from ascarides, including 5 of the 6 most inveterate cases. Herpes circinatus occurred in 7 white boys, and 1 had itch; 27 had clean, healthy tongues, 13 being white, 14 coloured; 19 had pale, putty-looking tongues, 8 being white, 11 coloured; 17 had a furred tongue, 8 being white, 9 black; 26 had 1 evacuation per diem, 16 from 2 to 4, blacks and whites being equal in both instances. One black boy had no control over his sphincter ani; 20 suffered from constipation, including 3 of the 6 worst cases, but the worst case of all was regular in his bowels. Twenty-seven of the cases urinated two or three times a day, besides morning and evening discharge; 28 passed water more frequently; 3 could give no account; 4 had no control over the bladder at all. The urine was normal in colour in 46, very pale in 17, acid in all. Average specific gravity among whites, 1016, among the blacks, 1020. Uric acid was deposited in 31 specimens, urate of ammonia in 8, urate of soda in 1, triple phosphate in 1. It does not appear that the urine of each boy was examined more than once. The prepuce and penis were discoloured, and the former elongated, either from frequently pulling or scratching or from mastur bation, in no less than 46 cases, 21 being whites, 25 blacks. Eighteen boys confessed to masturbation; in 12 there was no suspicion of it, but the remaining 63 were strongly suspected, in spite of their denial. The greatest number were always reported as having wetted their beds on Wednesday and Saturday nights, the smallest always on Sunday nights; 2 did it every night without intermission, only 12 did it once a week, 3 not as often, and the remainder varied from 6 or 7 to once or twice a week. The diet on Wednesday and Saturday was salt pork, or fish and hominy for dinner for the coloured boys; the white boys had the same on Saturday only, and fresh boiled beef, soup, potatoes, rice, cabbage, and bread on the other days; and for the evening meal they had mush and molasses regularly every evening except Saturday and Sunday evening. On the former evening they had soup, on the latter bread and molasses. A sudden fall of the barometer or thermometer, or of both, always appeared to increase the number. Other influences at work were the better treatment of the white than the black boys, in regard to ventilation, exercise, and work.

The various remedies employed were first bromide of potassium in 2 to 3 grain doses thrice daily, with which 9 were cured; 2nd, tincture of sesquichloride of iron, from three to five drops thrice daily for six weeks (this failed entirely); 3rd, cantharides externally and internally (equally ineffectual); 4th, each boy suffering from constipation received a dose of magnesia, those who had worms one drachm of turpentine and five grains of bicarbonate of soda, three times a day, and all received five drops of Squire's juice of belladonna, prepared by Bentley's process; they also had all a dry supper of bread alone, as previously ordered, and the cold douche. Each boy was made to rise and micturate an hour after retiring at night. A sudden diminution followed, and two weeks after commencement of this plan, only four cases besides those who wetted their clothes in the day were reported, and on their supper being reduced (as a punishment), the former four also lost the bad habit, and those only remained uncured who had diurnal incontinence, though they were improved.

IX. On the Presence of Inosit in the Urine in Renal Diseases. By Dr. H. VOHL in Bonn. (Archiv für Physiologische Heilkunde. Jahrgang 1858, Drittes Heft.)

12

Inosit, a saccharine matter, stated by Lehmann to be incapable of vinous fermentation, has hitherto chiefly been found in the muscular tissue of the heart. In the present paper the author shows that grape-sugar may in diabetes mellitus be replaced by inosit, the formula for grape-sugar being C12 H12 O12 + 2 HO, for inosit C12 H12 O12+4 HO. Cloetta has recently shown that inosit occurs in the urine of persons affected with albuminuria--a circumstance that suggested the inquiry to Dr. Vohl which has led to his discovery. In a case of diabetes mellitus, in which the test for grape-sugar ceased to yield the usual result, Dr. Vohl subjected the urine to the following examination:-The residue obtained by evaporation of the urine in a water-bath was precipitated with caustic baryta, and the filtrate mixed with equal parts of weak spirits of wine (50 per cent.), again filtered, and the clear fluid mixed with strong alcohol, (90 per cent.) Chloride of sodium crystals were deposited on the walls of the glass cylinder, and also shining crystals resembling sulphate of lime, which on being dissolved in water and decolorized by animal charcoal, yielded on evaporation fine large tabular and columnar crystals. The crystals effloresced readily, and at a temperature of 100° C., yielded a residue of 16 to 17 per cent. Evaporated to dryness with nitric acid on platinum foil, and then treated with chloride of lime and ammonia, the reaction for inosit was obtained.

Dr. Vohl found that the increase of inosit was in the exact ratio of the diminution of the grape-sugar. At last, when the grape-sugar had altogether disappeared, he was able to obtain as much as 18 to 20 grammes of pure inosit from the urine passed in the course of a day. Dr. Vohl tried to convert grapesugar directly into inosit, but this he failed in achieving.*

QUARTERLY REPORT ON SURGERY.

By JOHN CHATTO, Esq., M.R.C.S.E., London.

I. On a New Elastic Bandage in Fracture of the Jaw. By Prof. BOUISSON. (Bulletin Général de Thérapeutique, tome lv., 13 and 62.)

pp.

IN this paper, Professor Bouisson, of Montpellier, describes a new form of bandage, which he has found very useful in the treatment of fracture of the lower jaw, and which being constructed of elastic material, allows of the combination of solidity with the amount of mobility requisite for carrying on mastication, insalivation, deglutition, and speaking. The point of support is derived from the cranium, by means of an open skull-cap, constructed of broad strips of leather or jean. One of these bands passing in front of the forehead, encircles the cranium below, and another passes along its antero-posterior diameter above, being joined to the first at its two extremities, and by two transverse bands. Next, a sling, composed partly of leather and partly of caoutchouc, is nicely padded and adapted to the chin, and is then attached on each side by means of two leather straps and buckles, to the band of the skull-cap, a horizontal strap being attached behind, opposite the mastoid process, and a vertical strap in front, opposite the coronoid process. The amount of support may be easily regulated by means of the buckles, and its lightness, suppleness, and ease of application render the apparatus not only an effectual, but a comfortable means of adjustment. It secures effectual adaptation of parts, and with modifications may serve also in compound and comminuted fracture, as also in a variety of other accidents and diseases of the jaw.

* Want of space compels us to postpone several interesting articles.-ED.

II. On Intra-Ocular Hæmorrhage after Extraction of Cataract. By Dr. RIVAUD LANDRAU. (Annales d'Oculistique, tome xl., pp. 129-137.)

In relation to a clinical lecture upon this accident, by Mr. White Cooper, Dr. Rivaud Landrau observes that in more than 2000 operations for extraction, performed during seventeen years' special practice at Lyons, he has only met with this complication in four instances, the particulars of which he furnishes in the present communication. He rejects Mr. Cooper's hypothetical explanation that the occurrence is produced by reason of the complication of the case by the existence of deep-seated disease of the eye. In his own cases he has found, notwithstanding their differences in other respects, there has always been an evacuation of vitreous humour, either taking place during the operation itself, or resulting afterwards as the consequence of a contusion. The portion of the humour which remains, being propelled forwards during the spasmodic contraction of the ocular muscles which ensues, becomes detached from the choroid, and the hæmorrhage is the consequence of the rupture of the minute vessels meandering in the hyaloid and between it and the choroid. It is impossible that the central artery of the retina should furnish the blood, as supposed by some authors, so considerable is the quantity sometimes. Mr. Cooper believes that the detachment of the vitreous humour is a consequence, not the cause of the hæmorrhage; but this gives no explanation of the rupture of the small blood vessels, to which the haemorrhage is due. This hæmorrhage is to be found whenever there is a considerable escape of the vitreous humour; and as the hæmorrhage is in the author's view but a consequence of such escape, its prevention is only to be sought in the measures which prevent the loss of this substance.

III. On Mercurial Disease and Syphilis. By Prof. LORINSER. (Wien Med. Wochenschrift, Nos. 19-21.)

Professor Lorinser observes, that ever since mercury has been employed in the treatment of syphilis, practitioners have never been wanting who protested against its use as something worse than the disease itself. Still, whatever its opponents might advance, mercury has always emerged anew after the contest, this arising, on the one hand, from the arguments opposed to its employment not being clear and incontradictable, and on the other, from its supporters being able to point to the apparent success of their mode of treatment. Two important discoveries, however, of the present time may assist in the scientific solution of the problem. The first is that of Melsens, who has shown that iodide of potassium is a means by the agency of which lead or mercury that may have lain concealed in the system for even years becomes excreted; and the other is, that the minutest traces of quicksilver may be detected in the urine, sweat, or saliva by means of the electrolytic test, so ably handled by Professor Kletzinsky. The author's attention had been already attracted by the fact of the extremely rapid influence exerted by the iodide in certain cases of pains in the bones, and optic and serpiginous cutaneous ulcers; and while certain experiments in treating syphilis were being carried on in 1856 at the Wieden Hospital, he had the opportunity of investigating the subject closely, and has continued so to do, the conviction becoming forced on his mind that the benefit derivable from the iodide is really due to its expelling mercury previously given, perhaps years since. The following are the conclusions he

arrives at:

1. That mercury, whether administered internally or externally, may remain for years within the body, without a trace (under ordinary circumstances) being detectible in the urine. Numerous trials made upon patients to whom mercury had been given amply proved this; but it is not meant to be

stated that where large quantities of mercury have been thrown in, that this may not be sometimes detected in the urine or sweat, as it is also in the saliva during salivation. 2. By the employment of the iodide of potassium the mercury contained in the body is expelled in the urine, so as to become detectible by means of the electrolytic chemical analysis. The expulsion does not always take place immediately, several days sometimes first elapsing. 3. All those forms of disease which exhibit a rapid decrease proportionately to the excretion of the mercury, and which disappear when this is entirely expelled, can only be regarded as mercurial disease, which can only be said to be completely cured when no more mercury appears in the urine under the continued use of the iodide. All the symptoms which thus can be referred to hydrargyrosis disappear with remarkable rapidity under the use of the iodide; while in other cases, when no mercury can be detected, the iodide exerts no effect. 4. The symptoms gradually produced by the long sojourn of mercury in the system differ essentially from those which immediately result from recent mercurialization. The symptoms of this chronic hydrargyrosis are indeed far less known than those of the acute form; one very remarkable thing is, that the symptoms of a chronic hydrargyrosis may be thrown in the background, and seem for a length of time to have undergone improvement through the occurrence of a new and acute mercurialization. 5. The symptoms of chronic hydrargy rosis have hitherto for the most part been mistaken for those of syphilis, and sometimes for those of gout, or the ordinary nervous and abdominal affections; and only very rarely has their true nature been apprehended. 6. As hitherto chronic hydrargyrosis has not been clearly distinguished from syphilis, both conditions having been usually treated alike, all the cases of secondary syphilis on record are only of doubtful value; and new observations, founded upon a physico-chemical diagnosis, so as accurately to distinguish between hydrargyrosis and syphilis, are required.

IV. Observations on the Treatment of some of the Symptoms of Syphilis. By M. HERVIEUX. (Bulletin de Thérapeutique, tome liv. pp. 441 & 529.)

1. Phagedanic Chancre. M. Hervieux observes that it is very natural that a disease which produces such rapid local destruction should have been met by means rivalling it in energy and celerity of action, such as the butter of antimony, the various forms of caustic, the actual cautery, &c. But although all those means have been successful in some cases, it is certain that they have still oftener failed, or they would not have been so generally abandoned. There is one means, however, which, in the hands of M. Ricord, has proved of indubitable advantage-viz., the carbo-sulphuric paste, prepared by mixing sulphuric acid with powdered vegetable charcoal, in sufficient proportions to form a semi-solid paste. When applied to the chancre this soon dries, forming a black crust, which intimately adheres to the tissues, and only falls off after several days, leaving a clean sore, or even, in some cases, a cicatrized surface. In the author's practice, pure tincture of iodine, applied at the commencement, has proved to be the best means of arresting the progress of the disease. It induces generally a burning pain, the intensity and duration of which are in proportion to the extent and depth of the chancre, as also to the sensibility of the individual and of the parts affected. Very well borne by some patients, the pain induces in others the most horrible torment. Chloroform would in such nervous and irritable subjects save this suffering. The pain, upon an average, lasts half an hour. In simple, uncomplicated cases, two applications, made by means of a pencil after an interval of twenty-four hours, generally arrests the progress of the blood. If, however, the chancre be complicated with gangrene, hospital gangrene, or diphtheria, four, five, or even six applications may be required. But when two or three of these seem to be without