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July 2nd.-Mr. Erichsen removed the stone by the lateraloperation, under the influence of chloroform. The stone-a

mulberry calculus-was two inches long by one inch and three-eighths wide, very hard, and covered by nodules, which renderedits extraction extremely difficult; the interstices of the noduleswere partly filled with lithic acid. It weighed nearly an ounceand three-quarters. The opening into the bladder through theprostate being much lacerated, some blood was lost, but not agreat quantity.-Six P.III.: Going on very well, with the ex-ception of a little sickness; pulse 100; skin hot, but moist;tongue clean; no tenderness in abdomen and no pain; urinepasses freely through a gum-elastic tube, with a little blood;no haemorrhage from wound.-Nine P.M.: Sickness and vomit-ing frequent; ordered effervescing draughts with some hydro-cyanic acid. Pulse 100, regular and full, but not bounding.-Eleven pm Sickness arrested; patient feels sleepy, and dozescontinually. From five to six ounces of urine have passedthrough the tube.3rd.-Three A.M.: Patient easy; pulse 96, regular, strong,

and full; skin moist; tongue soft and clean. The urine comes

freely through the tube; no haemorrhage.—Six A.M.: Pulse 80,less full, slightly irregular; skin moist and cooler; tongueclean; no haemorrhage; urine passes freely through the tube,of dark colour and ammoniacal odour; no blush; no pain any-where.—Seven P. M. : Slight attack of hiccough, which producedsome nausea; patient otherwise easy; no pain. Vv ound healthy.Urine passes freely through the tube. Has slept a good dealduring the day. Pulse 96, soft, and slightly irregular.4th.-Nine A.M.: Pulse 116, full, and hard. Has had a

slight attack of hiccough during the night, but it did not lastlong; it has just returned with some violence, and has beenfollowed by an attack of vomiting.-Two P.M.: Hiccough stillviolent and frequent; some slight pain on pressure over theabdomen. Mr. Erichsen removed the tube, as it caused someirritation. Ordered two grains of calomel and half a grainof opium at once, and four hours afterwards a draught ofhalf a drachm of powdered rhubarb, one drachm of Rochellesalts, half a drachm of aromatic spirits of ammonia, in anounce and a half of cinnamon water; and linseed poultices toabdomen.-Four P.M.: Hiccough recommenced, for which hewas ordered forty minims of chloric ether, which relieved itslightly. Pulse 120, irregular, and small; skin dry. -Six p.M. : ,Patient better; has slept some time. The hiccough has ceased.- midnight : Still sleeps. Has taken a little brandy andarrowroot; an effervescing mixture to be taken.5th.-Nine A.M.: Pulse 112, small, soft, and irregular; skin

cooler and moist. Has taken some more brandy and arrowroot;has slept much through the night; tenderness less, and nopain when not touched; slight feeling of swelling and oppressionin the abdomen. The bowels have not been moved bv themedicine, and castor oil has been given; he takes a littlearrowroot and brandy occasionally, but has no appetite.-Six P.M.: Hiccough has recurred for a few minutes, but a doseof chloric ether relieved it; pulse 130, small.—Midnight:Pulse 132, small; no urine passes through either urethra orwound; great tenseness and tenderness over the whole of theabdominal surface, more especially above the plibes. Hotflannels moistened with tincture of opium applied to theabdomen. Patient’s strength sinking; suffers much fromshortness of breath.6th.-Eleven A.M.: The patient has just died in great ex-

haustion, but not in pain.

Autopsy.-The body was that of a stout, healthy man.Abdomen somewhat tympanitic. On opening the peritonealcavity, a small quantity of turbid serum, of dirty puriformappearance, escaped. The intestines were slightly injected inpatches, but not adherent to one another. The capsule of theleft kidney was easily detached, but a part of its substance wastorn away with it; the surface was rather lobulated, and itsstructure completely disorganized; the medullary portion wasgreatly atrophied, and three calculous masses were foundwithin it, one of the size of a hazel-nut. The right kidney waspale and flabby, loaded with fat, and in a state of fatty de-generation ; one small calculus, the size of an ordinary shot,was found imbedded in it. The liver was large, soft in struc-ture, and moderately congested. The interior of the bladderwas smooth, tolerably free from loculi, pale in its upper part,slightly congested below, and the mucous .membrane abradedin parts. The prostate gland was considerably enlarged; theline of incision was sloughy and rather ragged. There wereno signs of purulent infiltration or inflammation in the pelvicpassage, nor any signs of inflammation or infiltration of urinein the pelvic fascia.

CHARING-CROSS HOSPITAL.

LACERATED WOUND OF THE RING-FINGER FROM BROKEN GLASS,FOLLOWED BY SWELLING AND SUPPURATION OF THE HAND;EXTENSION OF ERYSIPELATOUS INFLAMMATION UP THE ARM ;DISEASE OF THE RIGHT EYE, WITH PROTRUSION OF THEGLOBE; ARACHNITIS ; GENERAL CONTAMINATION OF THE

SYSTEM; DEATH; POST-MORTEM CEREBRAL APPEARANCES.

(Under the care of Mr. CANTON. )WE have noticed lately, in several of our large hospitals,

during the existence of the very warm weather, a tendency tofatal pyaemia and sloughing in cases of recently-occurring wounds,and of ulcers already formed; this has appeared to be a resultmore especially in such cases possessing a peculiar low type ofconstitution, in which the vital powers were much below par,and a general sluggishness in the performance of the variousfunctions essential to the preservation of life. Not a few werecharacterized by an attack of erysipelas, as in the interestingexample we record to-day; and so fearful of this scourge havemost of our hospital surgeons been, that a disinclination was,evinced to perform almost any operation until the temperatureof the atmosphere had become somewhat reduced. Meteoro-logical influences most assuredly greatly influence the result ofoperations, when the reading of the thermometer is high, asso-ciated with certain conditions of the atmosphere; it is to thesewe must attribute, in some measure, the invasion of lowerysipelatous inflammation in the slightest breach of surface.

In the subjoined case, which presents a remarkable series ofsymptoms, the patient entered hospital with erysipelatous in-flammation running up the arm, with large vesications, whichhad supervened on a comparatively trifling wound of the finger

from broken glass. The extension of the inflammation wasarrested by the application of nitrate of silver, but the consti-L tutional symptoms were very severe. Free incisions, followedF by evacuation of offensive matter, gave great relief, the swellingJ and inflammation subsided, the girl’s health began to improve,L when, owing to an unhealthy state of the blood, as shown by) bleeding from the nose on simply raising her up-the bloodbeing of a light colour and thin consistence-and from othert symptoms, she was attacked with severe pain in the head and: excessive vomiting, followed by delirium. The right eye. became paralysed, with cedema of the lids and chemosis-an

event occurring in typhus and other exhausting diseases, butmostly ending in total destruction of the eye-and some puscame from the orbit. Muttering delirium set in, and a fatalresult ensued. Now, most of these symptoms were whatmight be anticipated in an unhealthy constitution, affectedwith a trifling wound of a finger, which was especially predis-posed to take on an unhealthy action during the existence ofsuch conditions of the atmosphere as lately have been prevail-ing. In such subjects as these, when a slow form of sloughing.phagedsena exists, we meet with a peculiar beef-steak tongue,with moisb and elevated papillae. The alvine discharges werein keeping with this low state, depending not upon a want of,but a vitiated state of the bile. Mr. Canton, in many similarinstances, has been in the habit of employing with benefityeast, combined with chlorate of potass, although the first of £these was not given in this case. He has found that chlorateof potass may be given up to a certain point, but when its goodeffects are obtained, if persisted in, it produces results whichare likely to prove injurious, manifested by debility and fever,the consequences of an excess of fibrine in the blood, of itself acondition which predisposes to the invasion of many exhaustingdiseases. The most striking appearance found after death waspurulent exudation beneath the arachnoid, incompatible withthe mildness of the symptoms during life, but in characterwith the other phenomena throughout the case.

Susan S-, aged eighteen, had only been twelve months inLondon, kitchenmaid at a public-house, was admitted Julyllth, 1856. On the 28th of June, while rinsing an ale-glass,it fell from her hand, and, on trying to catch it, she dashed herhand against the broken pieces, severely lacerating the ring-finger of the left hand. On being brought to the hospital,some pieces of glass were extracted with some little difficulty.She was ordered to keep the hand in a sling, and apply cold-

water dressing. The next day the finger became swollen andpainful, and subsequently it extended to the hand, the back of ,

which was rather puffy. Shivering occurred, with increased: swelling and pain, and an opening was made on the 5th ofJuly, extending from the seat of injury to the palm, givingexit to a quantity of offensive matter, with very great relief.: The swelling subsided, and the wound discharged freely. Threedays before admission, the hand and palm became again

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swollen, the wound assuming an angry appearance, with red-ness along the course of the absorbents, attended by shiveringand symptoms of fever. She became worse after this, theback of the hand being tense and shiny, and broad patches ofa dusky-red inflammation extended up the arm, with largevesications, and’ excessive pain. She was, therefore, admittedon the llth of July, when the symptoms were found to beseriously aggravated. The arm, as far as the shoulder-joint,was excessively swollen, the inflammation of a dark colour,and an increased number of vesications; a probe could bepassed from the wound in the palm to the back of the hand,and on making pressure in that situation, a quantity of mattercould be forced out; there were also subcuticular collections ofdark-coloured and foetid serum at the tips of the fingers, whichwere opened by dissecting off the skin around them, and thewound was enlarged across the palm of the hand. The consti-tutional symptoms were very severe: countenance flushed andextremely anxious; great thirst; pulse very rapid; great pain iin the head; sickness; tongue brown and dry; skin parched;

I

bowels confined. Ordered, nitrate of silver to be applied roundthe shoulder to prevent the inflammation spreading; full diet,a pint of beer, and four ounces of wine. To take five grains ofcarbonate of ammonia, twenty minims of chloric ether, in anounce of decoction of cinchona, three times a day.

July 12th.-The patient is very much better; has slept alittle; skin cooler and a little moist; bowels have been freelyopened. The back of the hand, however, continues as muchswollen as before. The inflammation has not extended beyondthe line of the nitrate of silver. Mr. Canton now made twofree incisions over the back of the hand, so as to completf’lyliberate the pent-up matter. To apply a poultice; and to takein addition two grains of camphor, and a quarter of a grainof opium, every night and morning.

13th.-The alteration is now very marked; the swelling ofthe arm has greatly subsided, and the inflammation is not ofso dark a colour; skin on the back of the hand wrinkled;swelling reduced, and the wounds made yesterday gape open;discharge escapes freely; the wound looks healthy, and thepatient expresses herself perfectly free from pain. The con-stitutional irritation is now slight; no anxiety of countenance;pulse slower; tongue moist and coated, but clear round the.edges; not so thirsty; appetite good; has slept well, and feelsperfectly easy.I4th. —Continues to improve. The skin of the palm andback of the hand has now a white shrivelled appearance. Aportion round the edges of the wounds was removed thismorning. The flexor tendon looks sloughy.16th.-Tongue clean and unnaturally red ; papillas very

prominent; pulse small; countenance pale, and flushes on theleast excitement. The wounds look healthy, and the swellingof the arm is materially reduced. Some more dead skin re-moved.

18th.-Has benefited by a change of wards. The swellingin the arm and hand has completely subsided; discharge fromwounds healthy; wounds filling up with healthy granulations.slight febrile symptoms towards evening.19th.-Attacked with rigors during the night; pulse very

rapid; face flushed; tongue furred; nausea, headache, &c.20th.-Wounds continue to look healthy; no pain or swelling

of either hand or arm. She has had but little sleep, in conse-quence of the pain in the head, which is very severe. The righteyelid droops a little; bowels confined; tongue dry; skin hotand perspiring. To take an ounce and a half of the compounddecoction of aloes immediately; a grain of powdered opiumand two grains of camphor night and morning; and ten grainsof chlorate of potass, in an ounce of decoction of cinchona,three times a day.

22nd. -Pain in the head very severe; excessive vomiting, sothat she cannot keep anything on her stomach; right side ofthe face swollen and red; cannot raise the eyelid, which isodematous.23rd.-Has been delirious during the night. All her com-

plaints are referred to the head. The right eye is protruded,and the pupil dilated and insensible to light; great cedema ofthe conjunctiva, so that the cornea appears sunk. She haserysipelas in the back.24th.-Has passed a very bad night. The pain in the head

continues, but is not of so acute a character; it is more a senseof weight than actual pain. The conjunctiva now protrudesbetween the eyelids, looking like the vesication of a blister;she complains of a burning, throbbing pain in the orbit, fromwhich, according to the statement of the nurse, there was dis-charged during the night about two teaspoonfuls of pus. Shehad been attacked previously with rigors. A cautious ex-

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ploratory incision was made in the outer side of the orbit byMr. Canton, with a tenotomy knife, but without discoveringany collection. Mr. Canton did not think it advisable to intro-duce it at the inner side, at any rate to-day. The tongue isnow very dry; pulse full, rapid, and strong; vomiting stillcontinues; bowels relaxed; great anxiety of countenance; facemuch flnshed, and thirst excessive.25th.-Has been delirious all night-not violent, the delirium

being more of a muttering character.-Ten A.M.: Urgentdyspnoea,; sphincters relaxed; surface of body becoming cold;pulse very feeble.She continued to sink from this time, and died at eleven A.M.Autopsy.-Brain substance generally very firm to the touch,

convolutions appearing rather closely pressed together. Menin-geal vascularity more extensive over the posterior than theanterior lobes of the cerebrum. Over the lateral surfaces ofeach hemisphere was a moderate amount of purulent exudationbeneath the arachnoid, and following the course of the vessels.On section of the hemispheres, the small relative amount ofgrey matter was striking, and also the pale hue of the greymatter. The brain matter was very firm indeed, and more in-jected than normal. Ventricular fluid normal in amount; nosoftening of any of the central portions. Some purulent exuda-tion on the velum interpositum, on the cerebellum, and appa-rently at the base of the brain, but now too changed to besatisfactorily determined. Medulla oblongata firmer thannatural. No pus was found in the orbital cavity, but its gene-ral contents, exclusive of the eye, were redder than natural.The contents of the other great cavities were normal. Theblood appeared to be more fluid than is usually seen afterdeath.

Medical Societies.PATHOLOGICAL SOCIETY OF LONDON.

MR. ARNOTT, PRESIDENT, IN THE CHAIR.

DR. GRAILY HEWITT exhibited

THE LUNGS OF FOUR CHILDREN WHO DIED OF HOOPING-COUGH.

The specimens now presented consist of the lungs of fourchildren, who have recently died in the St. Marylebone In-firmary and Workhouse, from hooping-cough, under the careof Mr. Filliter. They are illustrative of the lesions which willin almost all cases be found to be associated with the disease,and all exhibit one peculiar lesion in a greater or less degree.In these cases certain portions of the lungs will be found, onexamination, to present that condition formerly known aslobular pneumonia, but which now is ascertained to be inreality collapse of the lung substance, without necessarily in-flammation of the parenchyma of the lung itself..Particularsof four fatal cases of hooping-cough were then read, togetherwith an account of the post-mortem appearances in each case,of which the following is an abstract :-

In Case 1, that of a child aged sixteen months, there wascollapse of portions of both lungs, with emphysema and sub-pleural ecchymosis, some of the collapsed portions presentingminute bronchial abscesses.

In Case 2, a child aged twelve months, there was collapse of-the lungs, the right middle lobe being quite collapsed, togetherwith the catarrhal or vesicular pneumonia of Legendre andBailly, and slight depositions of tubercle in one lobe.

In Case 3, a child aged eleven months, there was partialcollapse of the lungs, together with double pleurisy andcatarrhal pneumonia. Ulceration and inflammation of thePeyerian and solitary glands of the ileum were also noticed.

In Case 4, a child aged fourteen months, collapse of thelungs was also present, with a few bronchial abscesses. Thiscase presented a pathological condition in other respects inte-resting. The gastric fluid had, after death, perforated thecesophagus one inch above the cardiac orifice of the stomach,and escaping into the left pleura, had eroded the posterior andupper part of the left lung.

In all the cases, slight enlargement of the bronchial glandswas observed. The bronchial tubes, especially the smallerdivisions, were always filled with a thickish muco-purulentfluid. Emphysema of the lungs always co- existed with collapseof the lung tissue.I Remarks.-The points of interest in these cases may be nowbriefly recapitulated. The subjects were all infants of tenderage-from ten to sixteen months old. The collapse of the