others. The year following, I held the appointment of house surgeon at St. Bartholomew's, London, were I had an opportunity of verifying many of my conclusions; but I was still anxious to have the opinions of some of those, whose candour, industry, and discrimination, I thought I might rely on. One of these gentlemen was Mr. Arnott, at that time engaged in collecting cases on erysipelas; and it is but justice to myself to affirm, that I spared neither time nor trouble, as far as my then extensive opportunities afforded me, of assisting him in his researches. In those frequent meetings, I drew his attention to the subject, which I had been studying with much care. I shewed him the cases I dissected, my drawings, and placed in his hands the result of my labours on the pathology of the vascular system. I did this, of course, with the idea that he would not make any unfair use of them, nor do I suppose that either of the other two gentlemen,* to whom I was equally candid, ever heard him hint that he had an idea of publishing them as his own opinions-cases to which I first directed his attention, in confirmation of conclusions I had formed from former experience.

However, a few months after I had bid adieu to my country and friends, amongst whom I unsuspectingly included him, he read his 'Pathological Inquiry into the secondary Effects of Inflammation of the Veins' before the Medico-Chirurgical Society; to which, he says, his 'his attention was particularly directed, by some Occurrences which marked the course and termination of the fatal cases of inflammation of the veins, after venesection, which he had an opportunity of observing (vide London Med. and Phys. Journal, No. 38, page 138, new Series). Then follows the account of three cases, two of the first, and I believe the third, will be found related in the follow

* "For obvious reasons I do not mention these gentlemen's names; but I am sure both of them will be happy to substantiate the facts, should that be considered necessary."

ing Essay, and were those that I particularly shewed him as proofs of my opinions. In some parts, perhaps, there may be a slight difference of opinion: but I believe they are few, and on points of little importance. Mr. Arnott was evidently necessitated either to mention my name, or content himself with appearing first before the public under a peculiar designation, although he was well aware that my Essay had been ready for publication before he had even thought on the subject.

More I could say in corroboration of those opinions; but I am disgusted with the ungrateful subject, and leave my essay to the candour and discriminaation of an impartial public."

We have not space to give any thing like an account of the paper in this part of the Journal, but probably we may be enabled to notice it more fully in our next number.

LXX.

CASES OF ABSCESS PRESSING ON OR OPENING INTO THE VAGINA.

DR. DAVIS relates two cases of this description in Part VII of his Principles of Obstetric Medicine lately published. The first case occurred to himself. An intense inflammation of the left ovary terminated in an abscess so extensive as ultimately to involve the peritoneal flooring of the left lateral portion of the posterior chamber of the pelvis. The pain being chiefly referred to the hypogastrium and small of the back, an examination was made to ascertain the condition of the uterus. The orifice and neck were very tender to the touch, and a large fluctuating tumour was felt to occupy the left and posterior portion of the pelvic cavity, causing an extensive projection or convexity of the corresponding portion of the vaginal parietes towards the interior of the passage. The abscess, for such it was, was the result of a severe and much mismanaged labour. On examination of the body after death, the matter of the abscess

was found to have made its way through the peritoneum of the posterior chamber of the pelvis into the cellular structure connecting the vagina and rectum with the inferior portion of the pelvis on the same side. For the particulars of the second case Dr. D. is indebted to Dr. Stroud.

"Elizabeth Hunt, a married woman, fiftythree years of age, was admitted a patient of the Northern Dispensary, under the care of Dr. Stroud, about two months before her death. During the previous four or five months, she had suffered severe pains, first in her feet, afterwards a little above the right knee, and ultimately in the neighbour hood of the right hip joint. Her health was already much broken, and she was very feeble and emaciated. She was lame from the state, as supposed, of the hip joint. Her appetite was greatly diminished. Her sleep was disturbed, and she was the subject of a slight hectic fever. During the patient's first visit to the Dispensary, she assigned no cause for her complaint except cold, and fatigue from laborious occupations. But during her second visit it was ascertained that, some months before, there had been a discharge of blood from the vagina, accompanied by a fainting fit, and that, subsequently to that period, blood had occasionally issued either from the vagina, or from the rectum. The alvine dejections were said to be contracted and of a flattened form. Under these circumstances an examination per vaginam was proposed, and with some reluctance permitted. Two fingers introduced into that passage, although with the greatest caution, gave much pain, and were withdrawn covered with blood. A hard round substance, supposed to be the uterus diseased and displaced, was found near the orifice of the vagina, projecting backwards in the direction of the rectum. On account of the tenderness of the parts, and the great weakness of the patient, a more accurate examination was deferred to a future opportunity. In the mean time, the suspicion of a malignant disease of the uterus, which had been previously entertained, was now considered to be confirmed."

The patient died, and a very minute and unnecessarily prolix account of the dissection is appended. We may as well take this opportunity of protesting against the long list of nothingnesses which it seems the present fashion t cam into re ions of cadaveric alterations. If disease of the uterus is to be described, the writer begins with the crown of the head, and tells of every thing healthy or unhealthy, natural or unnatural, that presents itself from that starting point till his arrival at the Ultima Thule, the sole of the foot. With laudable liberality all receives the same degree of attention, and whether we are told of the condition of the soundest organ, or of that which was chiefly diseased, the same amount of labour, and nearly the same amount of words is expended, and the weary reader wonders to which the author attaches most importance. It is really abominable that in order to learn the nature of a disease in a single organ or apparatus, one must wade through a dissertation on every other to be met with in the body. The case before us will be shewn to be one of psoas abscess, ulcerating into the vagina. Then what in the world can such information as the following be worth, or why should it be here unless to exhaust the reader's patience, and make him exclaim against morbid anatomists as absolute nuisances. "The cartilages of the ribs were very short, and the ensiform cartilage was extremely narrow. The heart was quite sound, and contained recent coagula on both sides. The left auricle was rather large and the right ventricle small. The venous trunks were full, and the arterial ones empty. The coronary vessels, particularly the veins, were beautifully injected, embossing as it were the surface of the heart with abruptly serpentine lines," and so on. What interest or utility can possibly attach to this? We might as well be amused with a geographical and statistical account of Peru, before entering on the description of a psoas abscess. We do protest most earnestly against such a system of case making and case taking, and when samples come before us we shall not fail to visit them with heavier censure than

we deem it necessary to resort to at present. To pass to the principal pathologic features of the case-the right psoas muscle was found excavated by a very large abscess which extended outwards to the groin, and downward to the bottom of the pelvis, where it had formed one considerable opening into the vagina and another into the rectum. The cyst was filled with greenish pus and flakes of lymph, which had found their way into the vagina and rectum and prevented the escape of the pus. Some of these flakes were found quite putrid in the vagina. There was a small distinct abscess on the left side of the rectum and rather behind it. The cavity of the large abscess was traversed from above downward by the anterior crural nerve, which was entirely

The

denuded, and at one time seemed contracted and almost reduced to a membrane, and above and below became suddenly large and dense. The bone at the sacro-iliac synchondrosis was denuded. The cellular tissue at the posterior part of the vagina, contiguous to the peritoneum was infiltrated with lymph and pus, the peritoneum presenting some adventitious bands. posterior half of the vagina, immediately below the neck of the uterus was destroyed by an ulcer an inch in breadth, by which it communicated laterally with the cellular tissue alluded to, and inferiorly with the rectum by an opening large enough to admit the thumb. The posterior lip of the orifice of the uterus was to a certain extent destroyed by ulceration. The rectum at the perforated part was thickened, and the mucous membrane in front of it red and

swollen. These are the essential particulars. The case was one of psoas abscess, and the changes about and in the parietes of the vagina and rectum were consecutive.

LXXI.

CASES OF CONTRACTION OF THE VAGINA.*

IN that portion of his work which treats of imperforate, obstructed, and contracted vaginæ, several interesting cases are related by Dr. Davis. From these we shall select two which occurred to himself, and are not uninstructive. The first is an instance of general, the second of partial contraction of the vagina. The first is so brief that we give it in the author's words.

Case 1. "Its subject was a lady of thirtynine years of age, whose spine was considerably distorted by an injury which she accidentally sustained during her infancy. When she had been in labour only for two or three hours, she was advised by her monthly nurse, who probably anticipated more than ordinary difficulty, to send for her medical attendant. On the author's arrival, he found the orifice of the uterus very amply dilated, NEARLY OBLITERATED, and the foetal head presenting favourably. In ascertaining these facts, however, he encountered some difficulty in carrying his finger through the middle of the vagina, where he found it contracted into a very narrow diameter, and presenting such a feel as it might have been expected to present, if it had been bound by a ligature coiled round it on the outside. It moreover felt firm, thick, and rigid. The mother of the patient, being in attendance, reported that her daughter had always menstruated regularly and well, and that she had never been the subject of any known disorder of her genital organs. The affected part gave no evidence of its ever having been the subject of cicatrization. Time and patience, therefore, presented themselves as the principal remedies. The cavity of the pelvis was sufficiently ample. The labour-pains became very active in the course even of a few hours, and ultimately exceedingly urgent, accompanied by a tempestuous excite

* Dr. Davis's "Obstetric Medicine." Part VI.

ment of the heart and arteries. The patient was bled freely and repeatedly, and the hand was as much used to promote dilata tion as was deemed consistent with the soundness and safety of the part to be dilated. She was delivered of a still-born child in about FIFTY HOURS after the commencement of the labour. She recovered slowly but perfectly. She sustained no retention of urine, nor purulent discharges during her convalescence. The loss of an heir to a good property, as it might well be supposed, was not a little regretted. But the disappointment was forgotten, and the loss doubly repaired by the subsequent birth of two living children, both sons."

In some cases of contracted vagina a considerable, and we may say, sudden dilatation occurs during labour, of which the following is not a bad example.

Case 2. The wife of a corn-chandler had a first labour of long duration, and attended with great excitement of the heart and arteries, and during her recovery she was subject to severe purulent discharge. In the next labour another medical practitioner was employed. On making the usual examination, he found the vagina, about an inch and a half from its orifice, so contracted that he could not pass his finger through the narrowed portion. He ordered the patient a dose of castor oil: and, as it was early in the labour and late in the evening, be left her till the following morning. He then found that the pains had been neither frequent nor urgent; the contracted part of the vagina was somewhat less rigid, and, on one side of the ring, it was distinctly soft and relaxed. Nothing further was done till the following evening, when the labour became more active and the circulation began to be excited. The morbid ring was dilated to the size of about half a crown, continuing rigid, tuberculated, and thick on one side-soft on the other. The medical practitioner employed a full bleeding, exhibited forty drops of Battley's sedative, and remained with the patient during the night, Early next morning he sent for Dr. Davis,

who did not arrive till 3, p.m. The orifice of the uterus was now dilated to the diameter of two inches and a half, the head of the child had descended nearly half way into the pelvis, the membranes were unruptured, the left side of the vagina felt hard and greatly thickened, but the other was soft and disposed to dilatation, when the child's head was propelled by the uterine contractions against it. The excitement of the heart and arteries was considerable, the skin moist. A pound of blood was abstracted. At nine, p.m. the symptoms were more formidable; the arterial action was very great, the countenance expressive of great suffering, the patient extremely restless. The liquor amnii had escaped for several hours; but the descent of the fœtal head had made great progress, one-third of it being in the act of clearing the impediment of the left side of the vagina. There was doubt as to what should be done; but, abandoning a resort to the forceps or the knife it was determined to try the effect of another bleeding. The patient was accordingly bled to faintness (thirty-two ozs.) and with success. The excitement was allayed, and the patient, after sustaining some fifteen or twenty more powerful pains, was delivered of a living and well-grown child. Her recovery was speedy and perfect, and her family now consists of four children, of which the three younger have been borne at the eighth month of gestation, in consequence of premature labour having been purposely induced in the pregnancies subsequent to the one we have described. All the labours have been extremely slow, and the last two rather alarmingly severe. The child whose birth forms the subject of the present case came into the world like Tristram Shandy, with his head rather the worse for its voyage. It was considerably disfigured by the pressure it sustained in its passage through the narrow part of the vagina, and presented on its left side a furrow, long, broad, and deep, with some abrasion of the cuticle. We know not whether the father took the matter so much to heart, as did Mr. Shandy the flattening

of Tristram's nose, by the newly-invented and all-but-perfect forceps of Dr. Slop. But this by the way.

"A case, bearing something of analogy to the one just narrated, may be found recorded in the first volume, p. 461, of the London Medical Repository. But as the practice which was described by its contributor as having been resorted to for its relief, has always appeared to the author much too hasty, as well as prematurely vigorous, he cannot give it a place in the present work without introducing it to his reader by an expression of regret, that a case so peculiarly important on many accounts, so supremely easy apparently as to its management, and so strikingly felicitous in its results, should have been given to the public, without the benefit of the most ample authentication. A woman fell into labour of her second child. The vagina seemed to be imperforate. But on more attentive examination, an opening was found very near the perineum, which appeared not to lead directly to the vagina, but to pass at first sideway downwards towards the rectum. It would not admit the point of the little finger. On dilating this with the first finger, the child's head was felt, high up, pressing against the obstruction, which extended a considerable distance along the vagina in the form of general contraction of the canal, rather than obliteration from adhesions. It became necessary to DIVIDE MUCH OF THE SKIN LINING THE VAGINA, and AT LAST TO DELIVER with the forceps. After delivery, a mould of wax, in the shape of a long pear, was worn, and has prevented the accident from occurring again. In her labour preceding this, she had been delivered with the forceps after three days pain, of a dead swollen child, and for a fortnight afterwards the catheter was used for retention of urine. The contraction was discovered within five weeks after delivery.'"

Dr. Davis concludes the subject by the mention of a case, illustrative of what certainly appears to have been infamously bad management on the part of some surgeon in the country. The patient was a young

woman who became pregnant soon after her marriage, and, while on a visit to her friends in the country had a premature labour a few weeks prior to the natural period. She represented her medical attendant as having used instruments, and experienced great difficulty in effecting her delivery. On her return to town, after a tedious and painful recovery, the vagina was found to present a perfect cul-de-sac, at the distance of an inch and a quarter from its orifice, the whole being perfectly smooth, lined with mucous membrane, and free from ruga. Sir Astley Cooper declined an operation, and the case is irremediable. From all that he could learn, Dr. D. thinks that the employment of instruments must either have been totally unnecessary, or, if required, that they were used most unskilfully. Can any thing be more reprehensible than such culpable ignorance on the part of a medical man.

LXXII.

CASE OF ABDOMINAL WOUND. By JOHN JAMES HALLETT, Surgeon, &c.

I was sent for, on the 16th ult., to visit E. Brereton, a young man residing with his father, at about a mile from this place, and found him labouring under symptoms of mental derangement, which, however, were not so apparent at the time of my seeing him, as, from the account given me by his friends, who represented him as having used violent and unjustifiable threats to his parents, although naturally of an inoffensive disposition. His appetite also had fluctuated; for at some times he would refuse food for many hours, although a labouring man-at others, a moderate allowance for three or four men would not suffice to answer his cravings. He complained to me of a sense of deep-seated heat in his abdomen, about the epigastric region, with slight tenderness. He was very shy of being questioned, and refused any and every medicine; yet said that, if he could make up his mind in a day or two to take any, I should be sent for again, On the Monday