I. NOTE ON THE COMPARATIVE PREVALENCE OF CALCULOUS DISEASES, &c. By Mr. COPLAND HUTCHISON, F.R.S. L. & E.

Our readers are probably aware that Mr. Copland Hutchison has endeavoured to establish two statistical facts of some interest and importanceone, that calculous diseases are comparatively unfrequent among sea-faring people; the other, that they are comparatively frequent in Scotland.

The former statement has met with some opposition. To this Mr. Hutchison alludes, and endeavours to meet the argument employed against him in the following manner.

"It has been stated, in opposition to my opinions, that although calculous diseases have been proved to be exceedingly rare among sea-faring people,-to amount, indeed, almost to a total exemption,-that such exemption arises more from the circumstance of this class of people having embraced their insular employment after the calculous diathesis is supposed to have been passed by— namely, the period of youth, than from any immunity they may possess from their particular situation and mode of life, according to my previous

statements.

Those who have advanced this doctrine should, however, recollect that I have elsewhere distinctly observed, that boys, at the early ages of nine and ten years, were admitted into ships of war as midshipmen, officers' servants, or in the merchants' service as cabin boys; and it can be shewn, from data not to be disputed, that more than twice the number of operations for stone are performed on persons after the age of fourteen even, than before that period of life." 21.

Since Mr. Hutchison wrote his former paper, Dr. Henry Lee, of Charlotte Street, Bloomsbury, has pointed out to him a passage of Aretæus, which appears to lend some gentle confirmation to his views. Speaking of the cure of calculous diseases, Aretæus says:-" but diet and anointing, and sailing and passing one's life at sea-all these are remedial in diseases of the kidneys."

Mr. Hutchison adds ;—

"I have applied to Sir William Burnett, the Physician-General to the Navy, for an account of such cases of stone and gravel as may have been admitted into the naval hospitals at home and abroad, from April 1830, the period of my last communication on this subject to the Society, up to the present date, and the answer returned is as follows. I have caused the returns of the naval hospitals at home and abroad to be carefully examined from April 1830 to the present time, with reference to the prevalence of calculous disorders, and the only instance of the kind is one case of renal calculi, in Malta hospital, in Michaelmas quarter, 1833; the patient was purser of the Pelican sloop of war.' P.S. 'He was discharged, cured, in the same quarter.'

'Signed, WILLIAM BURNETT, 26th Nov. 1836.' The average number of seaman and marines annually voted by parliament from 1830 to the present date, including 2,000 boys, has been 30,000. The latter are particularly specified, in the navy estimates, as boys." 23.

Such is the amount of confirmation, afforded to his former statements, in Mr. Hutchison's present paper. We would merely suggest for Mr. Hutchison's consideration, and as reasonble elements in his calculations, that stone is, on the whole, the disease of early and advanced life—that a delicate boy

would not go to sea, this stormy element being usually selected by the hardy and the wild-and that the old sailor will frequently have quitted the navy and its institutions, when calculous disease has overtaken him. We do not say that these considerations explain all the immunity from stone on the part of sailors, contended for by Mr. Hutchison. But we think he will admit that they deserve to be taken into the account.

II. HISTORY OF A FEMALE WHO HAS FOUR MAMME AND NIPPLES. By ROBERT LEE, M.D. F.R.S., Physician to the British Lying-In Hospital, and Lecturer on Midwifery at St. George's Hospital.

Our friend Dr. Lee is never idle. Ever on the watch for some interesting fact, or some broad generalization in the field of science, his own department of it is continually receiving some accessions at his hands. The following fact is curious

Mrs. æt. 35, was delivered prematurely of a still-born child on the 21st July, 1835. Soon afterwards, the mammæ became excessively painful and distended, and she had a severe attack of fever with delirium. Though the symptoms became daily more aggravated, a week elapsed before she would permit the condition of the breasts to be ascertained. On inquiring into the cause of this unwillingness to allow the necessary examination of the mammæ to be made, Dr. Lee was informed by her sister-in-law, that she had two mammæ and two nipples on each side, and that this peculiarity, which she was anxious to conceal, had been observed ten years before, when her first confinement took place.

After long entreaty, Dr. Lee obtained leave to inspect the breasts, and was surprised to find that there were two on each side, as had been represented; the two of the same side being separated by a deep oblique depression. The inferior or pectoral mammæ, as they were afterwards termed by Sir Astley Cooper, were fully developed and in their natural situation, and their nipples, areola and glands, presented nothing unusual in their appearance. Near the anterior margin of the axilla, a little higher up on each side, was situated another mamma, about one-sixth the size of the others. The nipples of these were small and flat, but when gently pressed, a milky fluid, which had all the external characters of the milk secreted by the other breasts, flowed copiously and readily from several ducts which opened on their extremities. When milk was drawn from the lower breasts, a small quantity usually escaped from the nipples of the superior breasts, and when the draught came into the former, the latter invariably became hard and distended.

Mrs. had previously borne several living children, and five years before this period had twins, when she had a severe attack of uterine inflammation, and suffered much from painful distention of the two upper breasts. In consequence of the flatness of their nipples, she has never been able to suckle any of her children with these. The vagina, orifice of the uterus, and all the other organs, besides the mammæ, in this female, are well formed.

"I mentioned," continues our excellent friend, "this case to Sir Astley Cooper at the time it first came under my observation, but he did not see it with

me until the 28th February, 1836, several months after the secretion of milk had entirely ceased. When Sir Astley saw the mammæ, he said there could be no doubt that there were two on each side, an axillary and pectoral breast, and that nature had separated them completely from each other. He considered it proper that some record should be given of a case, which he thought to be without a parallel in this country.

Mrs. again became pregnant, and was safely delivered on the 19th July, 1837, of a living child, which she now suckles with the pectoral breasts, and the axillary breasts again present the same appearances as those which have now been described.

The preceding case furnishes one of the best examples of quadruple mammæ in the human subject which has yet occurred." 268.

Dr. Lee has collected the particulars of five other cases from foreign authors. The knowledge of the occasional occurrence of the fact may possibly be useful. At all events, the fact itself is one of the "curiosities" of Nature. Dr. Lee adds in conclusion :

In some women only one breast has been developed, others have had two nipples placed on one mamma, and a few individuals have had three breasts, two in the natural situation, and a third situated in the middle of the two others. Only one case has been recorded of five mammæ in the human subject.*

III. RESULTS OF POISONING BY SULPHURIC ACID. By JOHN WILSON, M.D. Physician to the Middlesex Hospital.

Two cases are detailed.

1. In one, the patient lived for six months after swallowing a part of two-pennyworth of oil of vitriol. She ejected, in a violent fit of coughing, a cylindrical tube, about eight or nine inches in length. On the morning of the 14th of November, she had a shivering fit, preceded by vomiting, and succeeded by great pain in the region of the stomach, &c. and fatal collapse. She died on the 17th.

Examination, eighteen hours after death.-Body extremely emaciated; the lower two-thirds of the œsophagus thickened and narrowed, internally very vascular, irregular, and softened; the upper third shining like an old cicatrix. In the stomach, opposite to the spleen, was an opening of the size of a half-crown piece with softened edges; there was great softening of the mucous membrane of the stomach; the abdomen contained a quantity of dark-coloured fluid, but no peritoneal inflammation.

In the interval between her swallowing the acid, and her fatal seizure, she had suffered, amongst other symptoms, considerable difficulty in swallowing. Some thought it would be advisable to pass a bougie down the œsophagus. But Sir Charles Bell and Dr. Wilson thought otherwise, and the disssection shewed that they were right.

2. In the second case, death occurred twenty-two hours after swallowing from two to three ounces of strong sulphuric acid, which remained on the stomach for a quarter of an hour.

Inspection, fourteen hours after death.-Lining membrane of the mouth,

Dict. des Scien. Med. Tom. XXXIV. p. 529.

pharynx, and œsophagus, of a silvery grey speckled appearance, like a snake's skin, from some of the carbonized matter adhering to the deeper parts of the rugæ, the more prominent being of a lighter appearance; the membrane of the tongue easily peeled off.

The stomach was very much distended, but contained only air, and when opened, its mucous coat was nowhere visible, from its entire surface being covered with a black pitch-like substance, which did not wash off with ease, and when scraped it shewed the mucous coat of a pink colour, much swollen, but entire: the commencement of the duodenum had a similar appearance, which soon became less marked, and nearly disappeared at the beginning of the jejunum, when it gradually assumed the greyish appearance, somewhat like that of the œsophagus, but of a much more dull colour, all of which seemed to terminate with the ileum.

The peritoneaal coat of the small intestines, and particularly that of the stomach, was much inflamed, but no albuminous deposits were seen.

IV. HISTORY OF A CASE OF POPLITEAL ANEURYSM. With Observations. By SAMUEL HADWEN, House-Surgeon to the Lincoln Hospital.

This case is interesting on several accounts, though it does not seem to us to support altogether the observations appended to it.

Case. John Asman, aged 23, a muscular man who had been accustomed to violent exertions, was seized with pain in the right leg and knee, succeeded by swelling. The complaint was thought to be rheumatic.

Three months afterwards, July 16th, 1837, he came under the care of Mr. Hewson, surgeon to the Lincoln Hospital. He had then an aneurysmal tumor in the popliteal space, about as large as an orange, with diffused tumefaction around it. There was distinct pulsation, synchronous with the heart, and clear bruit in the swelling, especially at the inner side of the calf. Pressure upon the femoral artery suspended the pulsation, rendered the tumor soft, and diminished its size. The heart and arterial system, examined with the stethoscope, appeared perfectly healthy.

On the 18th, Mr. Hewson placed a ligature upon the superficial femoral artery at the margin of the sartorius muscle. Before the patient was removed from the table, it was observed that the aneurysmal tumor was as large as ever, and the tension greater than it was before the application of the ligature; there was, however, no return of pulsation. He suffered very severe pain, for a few seconds after the ligature was tightened, down the leg, and a slight irregularity of the pulse, not amounting to an intermission, could be occasionally but unfrequently perceived.

An hour after the operation, no pulsation could be perceived in the tumor; but after three hours more it had returned with some force. Twelve hours after the operation the tumor did not appear quite so large as it had been, and was of the natural temperature; it was, however, deemed expedient to envelop it in flannel. There was a regular, but indistinct pulsation in the tumor, which was not synchronous with the pulse.

19th. Integument over the tumor yellow, tense, and resistant. A feeble pulsation could be felt, and an obseure murmur heard.

27th. Pulsation not perceptible in femoral artery below the ligature, but distinct in the tumor at the ham, which was still hard and resisting. Leg, from knee to toes, beginning to assume an oedematous character, and of great size. Wound healed, save where the ligature projected through it. Heat of leg great. Occasional paroxysms of severe pain, extending from the ham down the leg.

29th. Temperature between the toes of each foot 101° Fahr.; at the external surface of the calf, which was in contact with the bed, 102°; the same part of the unaffected leg, 98°. On applying the fingers to the middle of the thigh there was felt a pulsation, and, with the stethoscope, there could be traced a distinct arterial bruit along the inner side of the thigh in the course of the artery, from about three inches above the knee to the groin, least audible at the lower part, and gradually becoming more loud to a little above the ligature, where it was very strong and distinctly heard. Next day it was found that pressure on the artery at the groin completely suspended the pulsation in the sac, which was not the effect of pressure about the middle of the thigh, where the bruit was heard.

About 10, p.m. of that day (30th) about eight ounces of florid blood issued from the wound. There was some puffiness around the cicatrix, and about an inch and a half to the outer side, a distinct pulsation. A little pressure and cold were applied.

"31st. At five o'clock this morning there was a slight escape of blood, not more than an ounce. About twelve at noon the hemorrhage returned with such violence that an arterial jet was forced out between the dressings to some distance. It was decided that the femoral artery should be tied again immediately below Poupart's ligament, which was accordingly done by Mr. Hewson.

The ligature was firmly tied, and the beating previously observable at the seat of the former ligature, and in the surrounding tumefaction of effused blood, im mediately ceased. It was also thought the aneurismal sac and calf were less distended; the pulsation in the former, and the bruit along the course of the femoral artery, were stopped.

In the evening it was found that there had been a slight oozing of blood from the situation of the first ligature, and in the surrounding tumefaction, which was reduced in size, a decided pulsation could be felt, and, with the stethoscope, a faint bruit." 323.

The tumor was softer; temperature between the toes 90°, gradually rising as the instrument advanced up the leg, and at the calf the mercury stood at 102°.

On the 1st August, a bruit was no longer perceptible with the stethoscope. At 8, p. m. of the 2nd, the bleeding suddenly recurred from the wound in the thigh where the first ligature had been applied. Pressure immediately above the wound controlled it, but, as soon as it was removed, the blood, in a stream as large as a quill, was projected upwards a foot and a half. The cicatrix was laid open, and an ineffectual attempt having been made to find the mouth of the bleeding vessel, amputation of the limb was immediately performed. The upper part of the artery was found to be quite separated from the lower, upon which the ligature still remained, and to present an open mouth.

Great collapse was the immediate effect of the operation, but he rallied from this, and went on well enough until the 21st. At 4, a. m. of that day No. LIX.

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