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more gentle manner, no harm had followed in a single instance. IThere had also been no difliculty in seizing the stone, nor eventhe fragments, except on one or two occasions. He objected tothe mode recommended by Mr. Coulson, of turning the forcepsround, with the view of seizing the stone, as dangerous. He,himself, had never seen the bladder injured by lithotrity; butSir Astley Cooper had mentioned a case to him, in which theforceps had been passed through the walls of the bladder intothe belly. By the plan he had recommended there was nodifficulty in seizing the stone, and he had found no necessity tolower the shoulders of the patient to effect this, except in avery few instances. With respect to the employment of thehammer, as advocated by Mr. Brooke, he (Sir Benjamin Brodie)contended that Weiss’s screw crushed the stone as effectuallyand completely as did the combined screw and hammer ofHeurteloup. Allthe chief French surgeons now used the screw:it was a less formidable operation in appearance, and occupieda smaller space of time. Allusion had been made to the state-ment of Mr. Key respecting lithotomy; but he (Sir BenjaminBrodie) knew that long after that was made, Mr. Key hadrepeatedly confessed the great comfort he had derived fromhaving been able, in many cases, to substitute lithotrity for litho-tomy. Lithotomy was an operation attended with the greatestanxiety to the surgeon, and he was better without it when hispatients were in his private practice, and in affluent circum-stances, for they rarely consented to an operation until thekidneys had become diseased, or some other formidable com-plication had taken place. He mentioned that Cheselden hadperformed 2SO cases of lithotomy, and had only lost twenty. Itwas probable that three-fourths of them were children. Che.selden, in later life, had met with a number of unfavourablecases; and it might be questioned how far his early retirementfrom practice might have been influenced by the niortificatioilattending these failures.

PATHOLOGICAL SOCIETY OF LONDON.

TUESDAY, MARCH 6TH, 1855.MR. PARTRIDGE IN THE CHAIR.

(Continued from p. 293.)

RUPTURE OF THE BLADDER.

MR. PARTRIDGE related the following particulars of a caseadmitted into King’s College Hospital. It was that of a manthirty-six years of age, who was brought to the hospital on aFriday. On the Wednesday previous he got drunk, and foundhe could not pass his urine. On the Thursday he applied tothe surgeon of the Bloomsbury Dispensary, who could notsucceed in drawing off the urine. On the Friday, at six o’clock P.M., he came to King’s College Hospital, when the house-sur-geon tried to pass a catheter, but could not succeed in depressingthe handle or getting the instrument into the bladder. Opiumand the hip-bath were had recourse to, and at eight o’clock he(Mr. Partridge) was sent for, and, on examination, found theabdomen tympanitic; the bladder could not be felt over thepubis, nor could the prostate gland be felt through the rectum.It was tried to pass a catheter through the rectum, but thebladder could not be reached. There was no effusion into theurethra, and no effusion behind the triangular ligament; stillthere was an apparent tumour in the region of the bladder.No blood passed through the catheter to warrant the supposi-tion that there was any tearing of the urethra. The man gave esome history of a former stricture. In withdrawing the cathetereach time there was a spirt of urine. It then occurred to him thatthe bladder got into the abdomen, and probably became dis-tended, and the uvula was bound down so as to obstruct the flowof urine. He waited for a time, and put the man under chloro-form, then introduced a 13-inch catheter, and drew off sixty-three ounces of water. It then appeared evident that a suffi- Iciently large catheter had not been used, so as to push theuvula from its position and get into the bladder. Towards theend the water was coloured with blood. He (Mr. Partridge)did not see the patient on Saturday, but was sent for on Sun-day, in consequence of the house-surgeon not being able topass the catheter, though using the same remedies that suc-ceeded on Friday. The belly was tympanitic. The patientwas depressed and in a state of collapse. He was removedinto the operating theatre, when he (Mr. Partridge) openedthe urethra: he passed the instrument through the urethra,guided by the director; then through the wound; but no urinepassed. The bladder was next cut into through the prostate,

but it was found empty. It now appeared to him evident thatrupture of the bladder took place, and urine got into the cavity

of the peritoneum. The sister of the patient said that on theevening of his being drunk he went home, and fell over atable, and probably rupture then took place. On post-mortemexamination, the bladder was found ruptured through all itscoats at the superior fundus, and the larger portion of theprostate was situated above the bladder, rather than below it.

Mr. BLEARY THOMPSON.—Did rupture take place before orafter the admission of the patient into hospital ? Judgingfrom the apparent swelling and tympanitis, it might be thatrupture was not till after admission; the collapsed conditionof the patient, and the great depression on Sunday, wouldwarrant that opinion. It is probable that there was a patentopening, which suddenly gave way, and became enlarged,collapse following.Mr. PARTRIDGE.—The appearance of the tumour was de-

ceptive ; the urine was not a little tinged with blood; and,from the bloody condition of the urine in cases related by Mr.Solly, he was inclined to look on it as ruptured before admission;besides, the urine was found in the peritoneum.

Mr. WARD.—Bloody urine is not diagnostic of rupture ofthe bladder.

Mr. PARTRIDGE. —NO.Mr. WARD.—In all cases of ruptured bladder bloody urine

is not present; and in the most interesting case he ever sawthere was no appearance of blood whatever, but there wascollapse and depression, as noticed by Mr. Henry Thompson,with whom he agreed in opinion regarding this case.

Mr. PARTRIDGE.—The case is one of great interest, and very! much resembles that of the young woman at Portsmouth,. which made great commotion some time ago.

Dr. HANDFIELD JONES exhibited specimens ofTUBERCULOUS DEPOSIT,

taken from a boy who died in St. Mary’s Hospital. He had alarge tumour occupying nearly the whole side of the face,which was supposed to be malignant, but after death wasfound to be scrofulous. On excising the tumour, spots offibrine were found in various parts. Miliary tubercles werefound in the peritoneum and lungs. Dr. Jones was inclined tosuppose that there was some connexion between the depositsin the lungs and peritoneum and the tumour in the jaw. The

microscopical appearances of the deposits in the peritoneumand the lungs were identical.Mr. JAMES SALTER exhibited a specimen and drawings illus-

trative of

A CASE OF DOUBLE CLEFT OF THE INTER-MAXILLARY BONE,ASSOCIATED WITH DOUBLE HARE-LIP,

which were obtained from a little patient, eighteen monthsold, under the care of Mr. Hilton at Guy’s Hospital duringlast autumn. The fissure in the lip passed completely fromthe edge of the alæ nasi to the lower margin of the lip, andwas remarkable for its entire symmetry and the peculiar pro-minence of the central isolated flap. The projection of thisportion separated it for about three-quarters of an inch fromthe lateral portions on either side. The inter-maxillary bonewas cleft on either side in a line coincident with the fissures inthe lip, and the central portion projected forward and tiltedup the central flap. This was necessarily removed as a preli-minary step in the cure of the malformation. The rest of the

operation was simple, and accomplished with a successfulresult. The palate was very deeply vaulted. The mass ofbone removed was very carefully examined by a section afterdecalcification. It contained the germs of the central incisionsof the temporary and permanent set, and not the laterals, as

previously imagined. It therefore constituted only a portionof the incisive bone. The loculi containing the tooth-germswere surrounded by a capsule of osseous tissue, and separatedfrom one another by crucial laminæ—a horizontal and a ver-tical.

Mr. POLLOCK.—How was the section of bone made?Mr. SALTER. —Vertically.Mr. JOHN WOOD suggested that the central mass of bone

might in reality be the incisive bone projecting beyond themaxillary proper, as in some of the lower animals.

Mr. POLLOCK.—To what was the mass of bone attached ?Mr. SALTER.—To the septum of the nose. Be considered

Mr. Wood’s suggestion negatived by the fact that the lateralincisors were not found in the bone removed.

Mr. POLLOCK asked if there was cleft in the soft palate, andwhether the uvula was present?

! Mr. SALTER.—There certainly was no cleft palate ; there was

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no communication between the oral and nasal cavities. As to Asylum at Maidstone, for an opinion as to the perforation beingthe presence or absence of the uvula he could not say.* * congenital or the result of disease. It was taken from a manMr. MiTCHELL HENRY.—What was the precise extent of the aged forty, many years an inmate of the asylum, and suffering

transverse fissure behind the teeth? from general paralysis of the insane. He had no cardiac symp-Mr. SALTER.—It was not a fissure, but a mere groove. tom during life. There was no history of the case given, orDr. WILKS exhibited a specimen of whether he had rheumatism or endocarditis. Immediately be-

CANCER OF THE HEART, tween the attachments of two of the aortic valves was a perfo-taken from a man, aged thirty-three, who was a patient at the ration admitting the point of the finger, and passing into theSurrey Dispensary under Dr. Wilks, who had only seen him a right ventricle. The edges of the hole were jagged, the endo-week before his death. The symptoms were said to have ex- cardium in the neighbourhood was much thickened, and theisted for six weeks previously, but no medical advice was adjacent valves puckered. Dr. Wilks said he could not expectsought. When first seen by Dr. Wilks, the patient was sitting members to assent to his opinion as to its being a perforationon the side of the bed, presenting a most extraordinary appear- from disease, as there was no history, but wishecl to know whata.nce; the face bloated and livid; the eyes starting almost from objections there were to the possibility of such a morbid pro-their sockets, and great dyspnoea ; suffocation threatening every cess occasionally occurring. Many specimens had been broughtmoment; the voice could only be heard in a whisper. The to the Society, of endocarditis associated witb myocarditis, inarms were enormously anasarcous; the superficial veins of the which the so-called false aneurism had formed in the ventri-chest and abdomen were large. The right side of the chest cular walls, and although these were generally fatal diseaseswas universally dull on percussion. It was certain there was he did not know why, in such a doubtful specimen as the pre-some growth in the chest, involving the superior vena cava. sent, the possibility of its being the result of such a morbidDeath took place in a few days. On post-mortem inspection, ht:ocess should not be discussed. He believed it to ue the result

the right lung was wholly converted into cancer; the disease of disease.extended to the pericardium and the cavities of the heart. The Dr. QUAIN believed it to be congenital malformation. He

superior cava appeared entirely closed, but in a few days, from brought a case before the Society on a former occasion, inimmersion in water, a small aperture was found to exist in its which the malformation was at the base of the ventricle, a

course; the walls of the vessel were nearly destroyed by the very common place for such perforations. The specimen pre-cancerous mass attacking them. The right division of the pul- selits no character of disease to warrant the supposition that itmonary artery was so compressed, that it resembled a slit in IS other than congenital malformation.. , . ,the midst of the cancer when cut into; a small fungoid growth Dr. WILKS.—May it not oe false anettrism associated withalso protruded into the right auricle. On the left side the dis- endocarditis or my ocarditis? ’? ..

ease appeared to have entered the heart by the pulmonary Dr. QuAlx thought not; false anenrism is very rare.veins, which could not be found, but in their proper situation Dr. HARE had already exhibited before the Society threethere projected into the auricle, and, half filling it, a mass of specimens of deficiency of the septum ventricnlorum, andcancer the size of a small ccm though the present specimen appears to be original deformity,Mr. HUTCHINSON asked if Dr. Wilks was aware of the history still there is some induration at the edges, and an appearance

of the case before it came under his care, and whether it bore of gritty matter.the general marks of cancer ? ?’ Dr. S-No-Bv BECK had a specimen bearing some resemblance

Dr. WiLKS could only learn that the patient had been suffer- to the one now before the Society; the septum is dilated into ing for six months before he saw him. pouch, as if one ventricle was running into the other, appear-

Mr. PARTRIDGE.—IS the cancerous growth in the heart, or tng as if the septum was giving way, and disease originatingis its appearance there the result of pressure ? the same as exists in that now before the Society, which, in

Dr. WILKS was disposed to view its appearance in a great his opinion, is the result of diseased action.measure as the result of pressure.

Dr. QUAIN.—All congenital malformations are the result ofDr. MARKHAM differed in opinion with Dr. Wilks, for it was disease in utero, and in that light may be looked on as the

not shown how far pressure on the heart was known to exist, result of aiseased action. ..

or on what part it was exercised. Dr. MARKHAM was inclined to look on the specimen as aDr. WILKS next exhibited a specimen of normal abnormal condition.

OSSIFICATION- OF THE CORONARY ARTERIES AND FATTY DE- Dr. SANDERSON exhibited specimens ofGENERATION OF THE HEART IN A CASE OF ANGINA PECTORIS, MELANOTIC CANCEROUS GROWTHS IN THE CEREBELLUM, SUB-

removed from a man aged sixty-one years-a patient at the PERITONEAL CELLULAR TISSUE, LIVER, AND HEART,Surrey Dispensary, under Dr. Wilks. He was by trade a removed from a woman, aged forty-three years, admitted intocoal-dealer, of temperate habits, strong, muscular, and always St. Mary’s Hospital, under Dr. Alderson, January 8th, 1855.healthy. Six or eight months previous to death he first com- Besides the above situations, similar growths were found inplained of pain in the prsecordia.1 region on any unusual exer- the cellular tissue around the mammary gland, the subcu-tion ; shortly it became more severe, and extended to the right taneous cellular tissue, right lung, left pleura, and pancreas. Oneshoulder and arm, occurring in paroxysms, and lasting several of the specimens consisted of a chain of tumours which hadminutes. The sounds of the heart were muffled; there was extended from the lower margin of the spleen to the brim ofno bruit. Subsequently the attacks became more frequent and the pelvis on the left side of the vertebral column. In theviolent from the slightest exertion. He lived in constant earliest stage of formation in which it could be observed, whendread of pain and instant death. On one occasion the agony about as large as a pin’s head, a single tumour consisted of a,was so intense that he attempted to cut his throat, the wound delicate cyst of condensed fibrous tissue, enclosing differentfrom which was superficial, and shortly healed. A few hours brownish-black contents. These exhibited under the micro-before death he had a fit of convulsions, from which he re- scope—1st, oval nucleated cells, about of an inch in theircovered consciousness in about ten minutes. On post-mortem long diameter, and remarkably uniform in size and shape;inspection by Mr. Isce, the house-surgeon, the body was found 2nd, black pigment molecules, endowed with active Brownianvery fat internally and externally, including the liver. The motion. In addition to these were found in the larger tumoursheart was covered with fat, and the muscular tissue was fatty, numerous conglomerates, containing reddish-brown granularboth by encroachment of that outside and by the degeneration pigments. Each of the melanotic masses in the liver consistedof the muscular fibre itself. The coronary arteries were exten- of an aggregation of distinctly encysted granular masses, differ-’sively ossiiied; they were rigid, and could be felt before dis- ing both in colour and consistence from each other. The cell-section tlu-oughout the whole of their course. There was no forms whicl2 they exhibited were longer and more irregularvalvular disease, than those found in the peritoneal tumours. Attached by a,

Dr. QUAIN.—What state was the muscular fibre of the heart fibrous pedicle to one of the fleshy columns near the apex ofin?-Was it fatty ? the cavity of the left ventricle, was a body about the size of aDr. WILK.—Yes, very much so. pea, consisting of a greyish pulp, enclosed in a membraneousDr. QUAIN.—What was the condition of the cavity of the cyst, agreeing in structure with those already described. Theleft ventricle ? left lobe of the cerebellum was displaced by an encysted massDr. WILKS.—it was dilated. larger than a walnut, and was perfectly separable from theDr. WILKs also exhibited a specimen of cerebral tissue, which presented in its neighbourhood its natu-

PEEFORATION OF THE SEPTUM VENTRICULORUM, ral appearance and consistence. The mammary glands werewhich was sent to him by Mr. Hill, of the County Lunatic contracted and atrophied; around their margins were numerousMr. Sfi,ter has since found that the uvula was present, and the posterior black masses, corresponding in structure to the peritonealregions of the mouth normal. tumours, perfectly separable from the tissue of the gland. The

320

tumours in the other organs did not present any peculiaritiesworthy of notice. The lymphatic glands in the axillae, andsubjacent to the peritoneum, were apparently healthy. Themelanotic molecular pigment was most abundant in the sub-cutaneous tumours. One of the peritoneal tumours, on chemicalexamination by Dr. A. J. Bernays, was found to contain, in 100parts, 82’16 water, 17’84 solid material; from it was separated’005 per cent. of cholesterine, which was exhibited to theSociety. Another tumour was found to contain, in 100 parts,1 °321 of ash yielding 1’052 of iron. The symptoms observedin the case were—1st, intense pain in the occipital region, re-ferred principally to the left of the middle line, the side

opposite the tumour. This symptom, which lasted for sevenweeks, ceased altogether three weeks before death; 2nd, con-stantly recurring vomiting; 3rd, rapid emaciation and loss ofmuscular power. During the last three weeks, there wasgreat difficulty in swallowing; deglutition was naturally per-formed, but was directly followed by violent cough, with feel-ing of suffocation. The intellect was perfect to the last.

In answer to a question,Dr. SANDERSON said that only the left eye was affected.

Reviews and Notices of Books.On some of the Developmental and Functional Relations of

Certcain Po?-tioi2s of the Cranium. Selected by Dr. PAVYfrom Lectures on Anatomy delivered by JOHN HILTON,F.R.S. 8vo. London : J. Churchill.

IT is well known to the profession that the author of thisvolume has long held peculiar views in regard to the modewhereby " cranial vibrations" affect the encephalic mass whenviolence, applied through the spine or directed more imme-diately against the skull, results in functional disturbance ofthe contained organ; and though we cannot entirely agreewith him in all his propositions, there is, nevertheless, muchin his ingenious manner of investigating, and able method ofcommenting upon, the subject, which is not only highly attrac-tive, but at the same time may be looked upon as a step in theright direction-as an effort towards the elucidation of manyof those phenomena associated with fractured skull and cerebrallesion which hitherto have been a series of enigmas to themost scientific surgeons.Not alone, however, does Mr. Hilton here enlarge upon a

favourite topic, but he discusses likewise many other pointsconnected with the development and functional intention ofthe cranial and facial bones, and his observations upon thefrontal sinuses in health and disease, the cerebro-spinal fluid,the presumed accordance of the convolutions of the brain withthe " make" of the skull, the uses of the parietal, mastoid, andother foramina, &c., are highly interesting, and prove theauthor to have studied his subjects not only as an anatomicaltopographer, but to have passed over the ground and masteredits geography in that true philosophic spirit which, whilst itcontemplates the " means," inquires thoughtfully into the

" ends;" and in the acknowledgment of that sublime truthwhich finds no part of the "house we live in" fashioned butto subserve some particular object,-nay, not a projection,depression, or foramen existing but the Almighty fiat hasordained its presence with care, and adapted its form withconsideration,—the author has adduced numerous examples toprove a position which, whilst it is admitted by all in its grandtotality, so often astonishes and puzzles in its more intricatedetails.The remarks upon the uses of the several cranial bones, in

connexion with their particular configuration in the fœtal

skull, are happily rendered, and in their description admirablyaccord with the account of these parts in their further develop-ment and ultimate perfection; whilst the observations uponthe harmonious arrangement of the whole, both in the young andadult, constitute a masterly display of physiological acumen.In stating that this work is composed of selections from Mr.

Hilton’s anatomical lectures, we may add that we shall gladlyhail a similar exposition upon other regions from the sameauthority.

_____ ___

The Cyclopædia of Anatomy and Physiology. Edited byROBERT B. TODD, M.D., F.R.S., &c. &c. Part XLV.London. 1855.

THE forty-fifth part of this well-known work amply sustainsthe character of its predecessors. The subject of " The Pelvis"is concluded; an elaborate article on "Reproduction, Vece-table," by Dr. Sanderson, is given entire; and a disquisitionon the " Organs of Respiration" is commenced by Dr. ThomasWilliams.

Edinburgh New Philosophical Jo?t?,nal; exhibiting a View ofthe Progressive Discoveries and Improvements in theSciences and the Arts. New Series. Editors—THOMASANDERSON, M.D., F.R.S.E., Regius Professor of Chemistryin the University of Glasgow; Sir WILLIAM JARDINE, Bart.,F.R.S.E.; and JOHN HUTTON BALFOUR, M.D., F.R.S.E.,Professor of Medicine and Botany in the University ofEdinburgh. No. I., January, 1855. To be continuedquarterly. Edinburgh. pp. 411.WE draw attention to the commencement of a new series of

the above scientific journal. Good as hitherto has been its

repute, we doubt not but that the highly accomplished editorswill strive to increase (as it well deserves) yet further its circu-lation amongst prosecutors of the physical and natural sciences.

LUNACY-THE CASE OF MR. GREENWOOD.To the Editor of THE LANCET.

Sir.,-Pe.rmit me to correct an error into which you havefallen, in noticing the letter from me, published in THE LANCETof March 17th. Towards the end of your editorial article onthe case of Mr. Greenwood, you say, " Mr. Morley is incorrectin asserting that Dr. Winslow and Sir A. Morison allege intheir report that the delusion’ with respect to the poison stillexercised an influence over Mr. Greenwood’s mind."Now, as I asserted the very contrary, you will be pleased, I

hope, to acknowledge that I am quite correct, and that you areincorrect.When I first wrote to you, I did not think it fell within my

province to do more than prove that I had discharged a painfulduty with care and integrity, leaving my statement as to theinsanity for what it was worth. I wish at present just to add(for I perceive no one else has alluded to this part of the sub-ject) that I am strongly inclined to believe that when Mr.Eastwood brought Mr. Greenwood from Todmorden to Billing-ton, he did not at all know that any medical certificates werenecessary.

I know that this has frequently occurred, and I have oftensigned certificates under circumstances similar to those of Mr.Greenwood.-I remain, Sir, very respectfully yours,Blackburn, March 20th, 1855. JONATHAN MORLEY.

THE FRENCH GOVERNMENT AND THE METROPOLITANCOMMISSION OF SEWERS.—At the iVIarylebone Vestry, held lastSaturday, in the Court House, Marylebone-lane, ClementGeorge, Esq., in the chair, Dr. Sayer, the representative of theBorough at the Metropolitan Commission of Sewers, asked theassistance of the Vestry under the following circumstances :-The French Government had applied to the Commissioners forplans and sketches of the metropolitan sewerage, to be exhi-bited at the Paris Exhibition this year; but the Commissionersnot having any authority to order an outlay for the completionof such plans and sketches, they referred the subject to theBoard of Works, &c., when that Board replied that they alsohad not any authority to order such an outlay. Therefore,finding that they (the Commissioners of Sewers) would be un-able to comply with the very courteous wishes of the FrenchGovernment, he (Dr. Sayer) was induced to bring the matterbefore his constituents to crave their assistance. Dr. Sayerwas about to enter fully into the subject matter of his commu-nication, when the Vestry one and all decided that they hadnothing to do whatever with the application, which was there-fore dismissed.