Contents generally rice-watery, or gruelly and flocculent, occasionally greenish and viscid. In many, the colon, with the exception of the caput cæcum, was empty. Liver.-Very various in colour; two with Bright's yellow deposit. In some, the vena porta were moderately congested; and, in one, the biliary ducts full of bile. Gall Bladder.-Generally two-thirds full of rather inspissated olive green bile. In the twenty cases, ten were full of this fluid; the others varied from a little bile to twothirds. Pancreas.-Generally healthy. Kidneys.-Commonly healthy; but varying, like the liver, according to the habits of the individuals. Three were slightly congested; one gorged with the dark blood; and another presented a livid appearance. Urinary Bladder.-In all, contracted, and almost empty. When any fluid was present, it was about a drachm of muco-purulent. One, however, was contracted horizontally, and contained five ounces of limpid urine." LXXV. ANEURISM BY ANASTOMOSIS, REQUIRING ANNE EVANS, aged nine months, was &c. that he deferred securing the two lower. Little change, save a diminution of the force of the pulsation, was produced in the tumour. On the following day Mr. Clement secured the two inferior arteries. The pulsation of the tumour ceased entirely; it became more tense and of darker colour, and seemed ready to burst. On the next day it was much softer, less prominent, and not so livid; and, on the second day, it was quite flaccid, and scarcely darker than the integument around. The ligatures separated on the fifth day, the tumour having become flaccid and barely discoloured. On the second day after the separation of the ligatures, the purple colour and pulsation of the tumour had returned, and in nine days, it was as large and discoloured as before the operations; the four large arteries were not perceptible, nor was the tumour so prominent. Mr. C. now excised the tumour. Although he made the incisions at a considerable distance from the base of the tumour, where the integuments did not appear unusually vascular, the hæmorrhage was very alarming. The child was much exhausted, but recovered perfectly in the course of a few days, though the cavity of the wound was so deep, that nearly seven weeks elapsed before it was filled up with healthy granulations. He Mr. Clement makes some remarks with which we do not altogether coincide. observes that "every other method, excepting that of complete extirpation, has generally failed in curing this affection." If by extirpation Mr. Clement implies excision, the observation is incorrect; for the ligature is employed more generally than the knife, and at least with equal success. We have repeatedly seen these nævi and aneurisms by anastomosis cured by the ligature. A small nævus may be tied by simply passing two double ligatures, crossing each other at right angles under the base of the tumour, and either strangulating each half by making two knots, or including four portions of the tumour, by separately tying each end of the two double threads. If the nævus is of large size, or if the case be one of * Mr. Clement's Observations in Surgery, aneurism by anastomosis, which is nævus of a larger growth and affecting the vessels of the cellular tissue, then the employment of the ligature, in the manner recommended by Mr. Brodie, is perhaps the best method. Mr. B. passes two long needles, which cross each other at right angles beneath the base of the tumour, and under these applies a circular ligature so tightly as to strangulate 1. He has operated sucessfully in this manner on several cases. The first case in which he employed it is related in a recent volume of the Medico-Chirurgical Transactions, and was copied into this Journal. The most perplexing cases of aneurism by anastomosis, are those in which a large extent of surface is irregularly affected. A boy, for instance, was recently in St. George's Hospital with an enlargement of the blood-vessels of the left cheek, angle of the mouth, angle of the orbit and probably part of its interior, and temple. The pulsation was indistinct, the disease, according to the mother's account, on the increase. It was not deemed prudent to attempt an operation. LXXVI. LITHOTOMY IN A FEMALE CHILD.* A FEMALE child, five years of age, was brought into the House of Industry, at Shrewsbury, in a state of great debility and emaciation. She complained of constant pain in her belly, cried violently when in the act of making water, and had much excoriation of the external organs of generation, and of the skin between the thighs. This latter was removed by proper applications, and Mr. Clement was induced to examine the child's bladder, which he did with a probe. He discovered a stone, which appeared to be one of such size as to preclude the idea of its being capable of removal by any dilatation of the urethra. Mr. C. however, attempted to dilate it so far as to introduce a pair of forceps, and crush the stone. This was found to be impossible, on account * Mr. Clement's Observations in Surgery, &c. of its extreme hardness, and the child suffered so severely, that Mr. C. determined to perform lithotomy, which he did on the 25th July. "The child being placed in the same position as for lithotomy in the male subject, I first introduced Sir Charles Bell's largest size male staff into the bladder, and placed it upon the stone, giving instructions to my assistant to retain it in that situation. With a large scalpel, I made a long and free incision along the side of the vagina nearly down to the anus: the point of the knife was then passed into the urethra and carried onwards to the neck of the bladder, when the urine gushed out in a full stream. I next introduced the fore-finger of my left hand into the bladder, and felt the calculus; after ascertaining that the incision was sufficiently large to admit of its easy extraction, the forceps were introduced (my finger acting as director for the blades), and a stone larger than a pigeon's egg was immediately extracted. A piece of oiled lint was placed lightly in the wound, and the patient removed to bed. The performance of the operation occupied only a few seconds, and the child apparently suffered less from the incisions than from the previous attempts which were made to seize and break the calculus. It would be useless to follow up and to describe minutely the details of this case; I shall, therefore, only observe, that in the course of sixteen days the wound was perfectly healed, and the child able to run about, suffering no inconvenience from the operation excepting the want of power to retain the urine. She was taken from the House shortly afterwards, by her parents, and I lost all sight of her until last year, when I was happy to find that the stillicidium urinæ no longer continued to trouble her. The bladder, however, continues irritable, for the patient cannot allow any large quantity of urine to accumulate in it. In every other respect, she is perfectly well." LXXVII. EXCERPTA CHOLERALOG ICA. I. IMPORTATION OF CHOLERA. IT is not a little remarkable that the introduction of this mysterious disease into each city and place can be clearly traced-when at a great distance-but never, when under our own sight. Thus if we ask the advocates of importation, how cholera was imported into Sunderland? They answer, we cannot tell; but we can shew you how it was traced from Jessore into Calcutta. How did it travel, man from man, to Newcastle? We know not; but we know how it travelled, by means of personal communication from Bengal to Bombay. Can you trace it from Newcastle to Haddington? No. But we can trace it from Bombay to Bagdad. From Haddington to Musselburgh? No. But from Bagdad to Ispahan. From Musselburgh to Kerkintilloch? No. From Ispahan to Moscow. Can you tell us how it was introduced into London? Oh no. But we can tell how it radiated from the barques into St. Petersburgh. Such are the facts upon which the doctrine of importation rests. Our Hibernian brethren seem to be amazingly puzzled about the introduction of cholera into Dublin, as will appear by the following document, which deserves record, as it will prove of some importance hereafter. CENTRAL BOARD OF HEALTH FOR IRELAND. March 30. "The Board were engaged on that day and yesterday in examining the different reports of the medical gentlemen who at tended the cases, and hearing viva voce evidence on the subject, from all which it appeared that the symptoms of these cases very much resembled those described as attending the epidemic cholera in England, but the Board were not able to trace the disease to any communication by which it might have been introduced into the neighbourhood of Dublin." The central Board ought to have provided themselves with some keen-scented cholera hunters from this side of the water, who would soon have found them a ship-scraper, a pedler, or a mendicant who came from some "infected district" of England, and carried the dire contagion with him in his wallet or knapsack. The Irish Board has shewn a lamentable lack of foresight on this occasion! P.S. As we expected they have here committed themselves. The disease has spread, and they themselves proved that it was not traceable to any contagion! II. So too, cholera has taken the Gallic capital by surprise. Instead of landing at a sea port, as it is said always to do, and "travelling" by the great roads and channels of human intercouse, it has thought proper to step at once into the heart of Franceaye, and into the heart of its capital, without paying the least respect to the documentary line of march chalked out for it "by authority"--and by the various historians who have traced its progress on the contagious route, from Jessore to Sunderland! This, certainly, is not as it ought to be! But so it is:-and it may give us some insight into the authenticity of those documents which have emanated "from authority," among the slaves of Persia, the hordes of Russia, the tongue-tied vassals of Prussia, Austria, and other countries. The unfortunate bias which was given to the investigation in England, "by authority," has, for very obvious but humiliating reasons, cast a stigma on the medical profession of this country, which will require half a century to efface. True it is, that a few independent and resolute minds have stood in the breach, and defended the ramparts of truth and science, when the battalions of contagionists and importers poured like a torrent upon the devoted citadel. They flinched not. They resisted the fearful preponderance of their countless adversaries, till reason dawned, and gave them powerful auxiliaries, from the very ranks of their opponents. The delegates of the "grand nation," and the quarantine restrictions of our Gallic, Spanish and Lusitanian neigh bours were cited as proofs that all nations regarded cholera as an indubitably contagious malady, to be stemmed and bounded by cordons and files of bristling bayonets! Let us hear then, what the first physicians of the "most civilized country" in Europe, say, when epidemic is pouring into their hospitals. "The undersigned physicians and surgeons of the Hotel Dieu think it their duty to declare, in the interest of truth, that although up to the present time this hospital has received the greatest number of persons affected with the cholera, they have not observed any circumstance which authorises them to suspect that the disorder is contagious. (Signed) leans, the Archbishop of Paris, and many distinguished personages were in the habit of daily visiting the hospitals and conversing with the cholera patients, without catching the malady; while Casimir Perrier, busily employed in his cabinet, together with many others took the disease. This does not look like contagion. And when we find more than a thousand men stricken down in one day, and upwards of 400 of them perishing, in various parts of a great metropolis, can we possibly connect this with personal contact or contagion? But then some of the medical officers have died of cholera. Have they a special protection against an epidemic influence? Why should not they be affected as well as Cassimir Perrier, and several of the nobility of Paris? Were not the faculty, by their avocations, compelled to visit those localities where the primary causes of the epidemic were in greatest activity? Were they not obliged to spend great part of their time in the vitiated atmos "Done at the Hôtel Dieu, Paris, March 31, phere of crowded hospitals, and the wretched 1832. Most of the other hospitals have followed the example of the Hôtel Dieu. We shall not revert to the humiliating picture of our own professional magnates on a similar occasion. The large and black or red letters that were to be painted on the tenements of cholera patients, fortunately could not find painters-and London, that was confidently prognosticated to be a "Charnel-house" by the first of May, 1832, is now, (10th May) almost free from the pestilence! We will not be so uncharitable as to suspect that the PROGNOSTICATORS Would have gloried in the accomplishment of their horrible anticipations; but, from what we have seen and experienced during the last three months, we have not the smallest doubt that, had the prediction been verified, the contagionists would have presented a petition to parliament, praying that the anticontagionist might be burnt, en masse, in Smithfield, "fire and ashes" being first sprinkled on their heads! The proofs of cholera being a local epidemic, rather than a contagious disease, are daily multiplying. Thus the Duke of Or apartments of the sick? Did a single physician or surgeon of a cholera hospital in London catch the disease, a time when the talented and lamented Dr. Dill, of the London Fever Hospital caught the typhus and died of it?-That distinguished and gifted individual was busily employed in the investigation of cholera, visiting the sick, and dissecting their bodies-yet he caught-not cholera, but typhus, and fell a victim on the fifteenth day of the fever! Had he belonged to a cholera hospital; or had he caught this highly contagious epidemic, we should never have heard the last of this incontrovertible proof of contagion of cholera. III. ELY BOARD OF HEALTH. This hopeful scion of a celebrated stock in London and Edinburgh, has come to a most logical conclusion that cholera is contagious, "under certain circumstances," in the malarious locality of Ely. What are these certain, or rather uncertain circumstances adduced by the sapient Board of Cambridgeshire? First, some two or more individuals of the same house have taken the disease in succession-and secondly, individuals who came from a distance to attend the funerals of their friends in Ely, caught the disease there. Ergo, cholera is contagious. Let us compare this with some other similar circumstances and events. Several soldiers, in the same barrack, at Fort St. George, have become affected with hepatitis, in succession:-Secondly, some Europeans, who had just landed, and went to occupy the same barracks, became ill with hepatitisergo hepatitis is contagious. Now facts of the latter description are every day presenting themselves at Madras and other places, yet no one thinks of drawing the conclusion which the Ely Board of Health has drawn. IV. PROGNOSTICATIONS. It is well known that the Editor of this Journal hazarded a prophecy some eight or ten months ago, that, should the Asiatic pestilence reach our shores, it would be shorn of its terrors, and produce much less destructive ravages than in any other countries through which it has travelled-or where rather, it had originated. The prophecy has, like many other phophecies, been partly fulfilled-partly falsified. The epidemic did not come shorn of its terrors-for the panic was universal. But the more important part of the prognostication was verified. The impression of the malady on the soil of Britain was extremely slight. It is sufficient to say that, during the first fourteen days of the epidemic in Paris, there died double the number that died in all England (including London, Edinburgh, and Glasgow) in seven months! We need say no more on this point at present. V. BARON HEURTELOUP ON THE PARIS WE quote the following passage from the "I cannot close this leter without saying a few words upon the important question of contagion; and I must here take occasion to affirm, contrary to the opinion of contagionists, that notwithstanding the frequent contact betwen those suffering under the attack of cholera, with numerous individuals who have visited them in all parts of the city, not one single example of contagion could be cited. And if some persons, after contact with cholera patients, have been attacked by the malady, that must be attributed to the influence of general infection, and by no means to the communications which may have taken place between the healthy and the sick. Besides, the noncontagion doctrine, supported as it is by an infinity of proofs, has been proclaimed by all the physicians of the Hôtel Dieu, and by nearly all those attached to the other hos pitals. The only question now is, to determine whether one or more cases of presumed contagion will prevail over an immensity of facts which prove the contrary, and whether there be not ground for this reflectionnamely, that though the existence of contagion should be proved with respect to some individuals, it is necessary to take into consideration the frequency of its occurrence and the quantity of evil which may result from it,-in a word, to ascertain whether this quantity of evil is not inferior to that which is necessarily produced by sanatory measures. It would be a foolish attempt of the people of Paris to endeavour to escape (and the infection of Paris proves that such escape is impossible) from a less evil by submitting themselves to a much greater. Finally, it is bad logic that would lead to the conclusion, that to save 10,000 individuals from the risk of taking the cholera, 50,000 should be starved to death in consequence of the restraints imposed on commerce by sanatory measures. The whole question of contagion depends, I think, upon striking this balance.-I am, &c. Baron HEURTEloup. VI. MODIFICATIONS OF OPINION. IT is well known that our contemporary, the LANCET, laboured most indefatigably in the cause of contagion: and, from the |