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symptom, either general or local, of this or any other mischief,, the patient having continued perfectly well in every respectup to the moment when the bleeding took place.During this day-the fourteenth-the pulse fell, and the

skin became cooler. The bowels were relieved by a small doseof castor oil. Ice was applied for some hours over the wound,and subsequently light pressure was substituted. In the even-

ing, bleeding recurred, though to the extent only of a fewdrachms, and readily arrested. He slept quietly for some timeduring the night, and perspired freely. A small quantity ofbrandy was allowed, as he had been addicted to spirit drinking,and lemonade to quench the thirst.

Fifteenth day.-Complained of a dead feeling in the arm,with aching; pulse reduced below 90-wanting in power; theskin above the clavicle somewhat distended, and feeling to thepatient sight and uneasy." Light pressure was kept on thealmost-closed wound with a sand-bag suspended from the frameof the bed. At nine A.M., there was a trifling loss of blood,which was readily arrested. After this he was chilly, and hada slight rigor. Beef-tea and small quantities of brandy wereallowed. In the afternoon, about an ounce of blood was lost,of a distinctly arterial character, readily controlled; the ori-fice by which the blood escaped very small; pressure increased.In the evening, there was a recurrence of the bleeding, a clotbeing forced out, and followed by a flow of fresh blood, thoughnot in large quantity.Through the night of the fifteenth and the following day,

varying quantities of blood were lost, though pressure waskept up by the hand without intermission, the dressers reliev-ing each other in turn.On the afternoon of the sixteenth day, he again had shiver-

ing and more thirst. A fit of coughing induced a recurrenceof haemorrhage, the wound opened further, and the patientbecame violently delirious, losing a larger quantity of blood.A grain of morphia quieted him. Support, in the form ofstrong beef-tea, &c., was constantly supplied.On the seventeenth day, cough and the effort of vomiting

again brought on bleeding. He survived until the morning ofthe eighteenth (rather more than four days from the first lossof blood), and was unconscious during the last few hours of hisexistence. Throughout there was no tenderness nor return ofpulsation in the sac; there was a feeble, but perceptible, pulsein the right radial artery two days before the patient’s death.The poor fellow admitted at last how wilfully he had set at de-fiance all the cautions and injunctions given to him to keepquiet-an admission which was confirmed by the neighbouringpatients, who assert that he repeatedly took advantage of thetemporary absence of the attendants to get up and exert him-self in the most imprudent way. It was also ascertained thathis habits had been very intemperate, and his temper naturallyviolent. The alarm occasioned by the sight of blood, super-vening immediately on his angry fit, may account in part, ifnot altogether, for the severe rigor which directly succeeded theviolent separation of the ligature.On post-mortem examination, the subclavian artery was

found completely divided in the third part of its course, itsproximal and distal ends being half an inch apart. The proxi-mal end was firmly adherent to the external border of the an-terior scalenus, beyond which it projected slightly. It pre-sented an open mouth, perfectly free from clot. The divided

edges of the external and middle coats were somewhat jagged,and projected a little beyond the external cellular coat, andthe latter coat immediately surrounding the orifice was some-what sloughy. About an eighth of an inch internal to thisend the supra-scapular took origin; it was a large vessel, andin calibre half as large again as an ordinary radial. On exami-nation of the distal end, about an inch of artery was foundabove the aneurismal sac; its mouth was open, but the tubebetween it and the sac was occupied by some loose semi-fluidcoagulum. The cellular tissue immediately surrounding themouth was sloughy-looking, and the internal and middle coatsprojected beyond it. The distal and proximal ends were sur-,rounded by a mass of semi-fluid coagulum, which occupied thewhole of the clavicular triangle. The aneurismal sac wassituated immediately behind the smaller pectoral muscle, butprojected a little above and below it; it extended from thehead of the humerus to the external surface of the ribs. Itslong diameter was transverse, so that, whilst it measured inthe latter direction between four and five inches, it measuredonly two inches from above downwards. Looked at externally,it was divided into two halves by a vertical constriction, eachhalf being about the size of a small orange. This constrictionwas caused by the axillary vein, which was displaced inwards,and stretched over the front of the sac. It was intimately ad-

herent to the sac, and could not be dissected from it. It wasflattened, and the effused surfaces of the internal coat had be-come adherent, so as to cause obliteration of the vessel. Belowthe sac, the vein and its tributaries were filled with unadherentclot. The walls of the aneurismal sac were very thin, especiallythe internal half. In its interior was but very little laminatedclot, its contents being for the most part a semi-fluid coagulum.The arterial apertures communicating with the sac were aboutan inch apart, and situated posteriorly. The sac, during itsexpansion, had extended in a direction forwards and inwards,but especially in the latter direction; over its outer wall theexternal cord of the brachial plexus passed, and was intimatelyadherent to it. The thoracic and abdominal viscera were allhealthy. The subclavian artery on each side was much largerthan it ordinarily is, and its walls seemed decidedly thinner.

MIDDLESEX HOSPITAL.PRIMARY SYPHILIS, FOLLOWED BY SUPPURATING

BUBOES AND SECONDARY ERUPTION.

(Under the care of Mr. MITCHELL HENRY. )WE do not intend to enter into the question, whether a

patient who has been inoculated with a primary chancre, fol-lowed by a bubo, will possess a perfect immunity from secondaryeruptions. We merely record a case in which an eruptionfollowed or accompanied the two first; and we may here statethat we know of an undoubted instance of the same kind, inan individual who many years ago contracted primary syphilis,accompanied by a suppurating bubo in the groin, which wasfollowed by an unmistakable secondary papular eruption overthe body and limbs, disappearing only after a course of mer-cury, the patient not having contracted syphilis a second time.This was also the case with the girl whose short history is asfollows :-Mary Ann S-, aged seventeen, was admitted on the 27th

of October, 1858. She has had a superficial granulating sore,the size of a shilling, but of an oval shape, at the entrance ofthe vagina, with purulent discharge of two months’ duration;the glands were enlarged in each groin. Has had a dischargefrom the vagina ever since June last, but no sore. She wasput on quinine, and used a sulphate-of-zinc lotion.Nov. 20th.-The bubo in the right groin has suppurated

completely, and discharged a quantity of pus.30th.-The bubo in the right side still discharging; the left

is increasing in size; copper-coloured spots have appearedwithin the last three days on both shoulders.Dec. 3rd.-The spots are increasing in size, and some are

appearing also under the eyes., After this period the eruption came out stronger, and the

buboes continued to discharge. The sore diminished in sizeunder mercurials, and the girl left the hospital much improved,on Dec. 28th.

____

CLINICAL RECORDS.

VARIOUS STAGES OF ALBUMINURIA.

ON the 1st of February, we were shown a number of cases ofalbuminuria in the medical wards of Guy’s Hospital, both inthe acute and chronic form, and attended by ascites and dropsyof the legs. We will briefly refer to a few of the more important.A man, aged twenty-seven, was admitted, on the 26th of

January, under Dr. Wilks, with symptoms of acute albuminuriaand phthisis, having besides dropsy of the legs, with high-coloured urine. He was improving under the use of a julep ofacetate of ammonia with antimonial wine.A second instance was that of a young man, who was ad-

mitted under Dr. Wilks, on the 22nd of December, with symp-toms of the acute form of the disease, accompanied by high-coloured urine and dropsy of the legs. It is doubtful, however,whether this patient has not long been affected with albu-minuria in a chronic form, on which the present acute attackhas merely supervened. This is a point which still presents

; some difficulty to renal pathologists. However, under treat-ment by infusion of digitalis, nitric ether, and camphor

. mixture, the urine has become pale and watery, and the acute, symptoms have subsided. There were numerous casts of theL uriniferous tubes in the urine when he was admitted.L A third example, in a man aged fifty-seven, is under Dr., Rees, the affection being associated with ascites and dropsy of- the legs, from the same disease of the kidney. He has had an

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attack of pleurisy of the right side since his admission, but isnow getting better. He is taking infusion of digitalis, withnitrous ether, &c.A fourth example (in a man aged forty-eight) of chronic

albuminuria, under Dr. Wilks, was admitted with pain in hisloins and head. He has had Bright’s disease for five years,having been treated at intervals during that time. He is now

passing large quantities of pale urine, of low specific gravity,and is taking with benefit ten-grain doses of gallic acid, withten minims of dilute acetic acid in camphor mixture three timesa day.The gravity of this disease may be understood by the question

often asked, of how long a patient may survive who is affiicted

Iwith it. We frequently meet with cases where it has extendedfrom four to five or six years, and we have heard Dr. Wilks istate that he has known a patient to have the disease for evenfifteen years.A point worth ascertaining in this affection is, whether one

kidney alone may be affected, and the other remain compara-tively healthy and useful.

CHRONIC GLUTEAL ABSCESS. IA GIRL, eleven years of age, was admitted into St. Bartho-

lomew’s Hospital, on the 3rd ult., under the care of Mr. Skey,with a chronic abscess situated in the right gluteal region. Shewas in a very low state of health in consequence. About threemonths ago, she fell and hurt herself in that region. Six weeksafterwards, she complained of pain in her limbs, limped inwalking, and, in three weeks more, the abscess appeared.When we saw it, on the 8th of January, it had assumed con-siderable prominence, and as it was threatening to point, Mr.Skey thought it advisable to open it, which he did by meansof a fine bistoury. This was effected without pain to the girl, I,and a tolerable quantity of pus was withdrawn. The bistoury ’,,was gently, not quickly, thrust into the abscess, and as gently ’’,was a proper-sized opening made. By opening an abscess in ’,this way, Mr. Skey remarked, there is not nearly so much pain ’’,suffered by the patient a,s when the instrument is plunged into I

it, and the abscess rapidly opened. Patients often complain of ’a long continuance of severe burning pain when the latter pro-ceeding is adopted. Of the truth of this remark, we thinkmost surgeons are well convinced. The abscess has becomediminished in extent, although matter is still secreted, anda cure will probably result without any mischief to the bones.

LARGE EXTERNAL THORACIC ABSCESS.

A FISHERMAN, forty-eight years of age, residing at Deptford,was admitted into the Royal Free Hospital, under Mr. Alex.Marsden’s care, on the llth of January, with a very large ab-scess on the right side of the chest. For five weeks beforeadmission, he had had swelling of that part, which was attri-buted to cold caught whilst followirg his vocation. The abscesswas opened the same night by Mr. M’Gregor, the house-sur-geon, and a very large quantity of matter was evacuated, withgreat relief to the patient. It appears he had enjoyed unin-terrupted good health before his present illness. The pus hadburrowed behind the great pectoral muscle, which seems tohave been almost completely dissected by it, as a probe passesinto an opening near the sternum, behind the muscle, and outagain at another and very large opening fronting towards thearm and axilla. At the time of the evacuation of the matter,there was some hoemorrhage, which was found to proceed fromthe inferior thoracic artery. His general health is being sup-ported by generous diet and tonics, his chest is bandaged, andthe now ulcerated openings carefully dressed.

SUSPICIOUS TUMOUR OF THE THIGH.THERE is a case of some interest at the present time in the

Charing-cross Hospital, in the person of a man forty-sevenyears of age, who has been the subject of a tumour in the leftthigh, slowly forming for two years, but which had taken on amore rapid growth within the latter six months. It was re-moved by Mr. Canton on the 7th of October last, and wasfound to have sprung from the fascia lata behind the saphenousopening, through which it emerged and spread out upon thethigh. In character, the tumour possessed the fibrous ele-ments, but it had a very suspicious look, not unlike medullarycancer. It is doubtful, indeed, whether the disease will notreturn, as a very deep sinus remains at the seat of the opera-tion, through which a probe passes some two or three inches,almost down to the bone, and in dangerous proximity to the

great femoral vessels. When the tumour was taken away,much care was necessary in dissection, from the fact of the

saphena vein passing right through it. The patient’s urine isalbuminous. The sinus is being dressed from the bottom witha styptic solution.

Medical Societies.OBSTETRICAL SOCIETY OF LONDON.

WEDNESDAY, FEB. 2ND, 1859.DR. RIGBY, PRESIDENT, IN THE CHAIR.

NOTES OF A CASE OF CANCER OF THE UTERUS AND RECTUMIN WHICH ABORTION WAS PRODUCED.

BY F. W. MACKENZIE, M.D., ETC.

I THE author was first consulted by the patient on the 26th ofNovember, 1858, when she had reached the fourteenth weekI of pregnancy. On examination, there was found a scirrhouscontraction of the rectum about four inches from the sphincter,a hard, scirrhous deposit in the recto-vaginal septum, and asimilar deposit in the anterior segment of the cervix uteri,projecting somewhat into the cervical canal. Thinking it un-advisable that the course of pregnancy should be allowed mproceed, attempts were made to bring on uterine contractionsby means of the uterine douche. Very little effect was, how-ever, produced, until the terminal pipe of the injecting appa-ratus was introduced into the os, so that the water could bethrown directly into the uterus. This proceeding was repeatedon three successive days, its action being aided by the use ofelectricity; and the entire ovum was then expelled, withouthaemorrhage. The patient made a good recovery from theeffects of the abortion.

ON THE ABOLITION OF CRANIOTOMY FROM OBSTETRICPRACTICE.

BY W. TYLER SMITH, M.D.,PHYSICIAN-ACCOUCHEUR TO ST. MARY’S HOSPITAL.

In this paper the author shows that craniotomy is resortedto in British practice about once in every 340 labours. Thewhole number of births in England and Wales exceeds 600,000per annum ; and if we apply the proportion of 1 in 340 to thesefigures, we get a total of about 1800 cases of craniotomy perannum. This is as though every year all the children born inLondon during rather more than one week were sacrificed ; oras though all the children produced during the year in such acounty as Westmoreland were born dead. The mortality tothe mother from this operation is nearly 1 in 5, in Britishpractice, which would give in England and Wales a maternalmortality of between 300 and 400 per annum. Craniotomy isperformed about twice as often in British as in French practice,and four times as often in this country as it is in Germany. It isan obvious fact that every improvement which has ever been madein obstetrics has tended to restrict and diminish the cases andconditions in which the performance of craniotomy has beenresorted to. It is the author’s object to show that, with theproper and scientific use of all the means at our command, itmay be laid down as a general rule, that craniotomy should notbe performed in the case of a living fcetus after the period ofviability has been reached. It is certain that, up to the presenttime, the measures which are the alternatives of craniotomyhave never been carried out in practice to their full and legiti-mate extent.-Z’2crninc was the first great obstetric operationwhich checked the voluntary destruction of the fcetus duringlabour. The objections to turning which some obstetrists en-tertain depend on an almost superstitious fear of the uterus-a fear mainly owing to ignorance of the nature of the organ,

! and of the laws under which it acts. The dread of introducingthe hand into the uterus has prevailed almost universally. But,, apart from the danger of infection, the hand of the accoucheur,, properly guided, can do no more harm in the uterus than any

portion of the fcetus of equal bulk. Restrictions of the mostI absurd kind have been laid upon the operation, and it has cometo be almost limited to arm presentations and cases of placenta

prævia. On the continent, turning is the recognised practice’ in cases of difficulty, where the head is above the brim, beyondthe reach of the forceps, when the os uteri is in such a state as to

admit the hand, and when no serious distortion of the pelvis. exists. The operation of turning in cases of moderate pelvic

deformity was practised by Denman and others, but it was dealtwith rather as an exception than a rule of practice until the