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and partly because a very slender elastic catheter is liable to beblocked up so that the urine cannot flow through it, and thepatient is thereby prevented from micturating. Thirdly: thatin no case should an instrument be permitted to remain in theurethra which fits very tightly in the stricture. More successwill be gained by always using a catheter which lies loosely inthe canal, than one which, although a size or two larger, isgrasped by the contracted portion. In the latter case the pro-cess is painful, since, frequently, distressing spasm continuesuntil the instrument becomes loose; and if, as soon as thisoccurs, another tight instrument is introduced, the irritation isperpetuated, and inflammation may be set up; or at all eventsthe patient is liable to be worn out by pain and loss of rest,which evils may be wholly avoided by adopting the plan ofusing an instrument which lies rather loosely in the canal.Such an one effects by its continued presence as much dilatationof the stricture as one which fills it completely. During theperiod of remaining in bed, the patient takes fifteen or twentygrains of citrate of potash four or five times daily in as muchwater, or barley-water, as he pleases, for common drink ; and alittle hyoscyamus or opium, if any pain or irritation render itnecessary. The latter is advantageously employed also in theform of suppository; but this is rarely necessary if proper careis taken in the management of the catheter, which is the essen-tially important part of the treatment.

CLINICAL RECORDS.

TONICS AND IRON IN ERYSIPELAS OF THE FACEAND SCALP.

WE very frequently see the value of the treatment of erysi-pelas of the scalp and face by the exhibition of the muriatedtincture of iron conjoined with tonics, and dusting the inflamedskin with flour, not neglecting proper attention to the chylo-poietic viscera. We might refer to several recent instances inwhich the efficacy of iron has been marked, but shall contentourselves with noticing that of a woman in Guy’s Hospital,under the care of Dr. Wilks. She is fifty-seven years of age,and was admitted on the 6th inst., but the erysipelatous in-flammation had set in a few days before that period, andextended all over the face and the scalp. Its intensity wasnot so great as to cause closure of the eyes, nor were thefeatures altogether obliterated. The scalp was remarkablyswollen, puffy, and extremely tender. When placed in bed,on her admission, the inflammation had apparently subsided,and evidences of desquamation were already manifest. Never-theless, she was in a precarious condition, being very weakand low, and evidently requiring generous and supportingtreatment. Twenty minims of the muriated tincture of ironwere ordered every four hours, with eight ounces of wine,porter, and light nourishment. She now began to improve,and when we last saw her (on the 12th instant) she was sittingup in bed, with still some disfigurement of the features, andpuffiness and unusual tenderness of the scalp. Her improve-ment was uninterruptedly steady under the use of the steel,and she is making a good recovery. We have seen cases thustreated from the beginning with equal advantage.

EXCISION OF THE KNEE-JOINT FOR OLD-STANDING DISEASE.

ON the 7th of this month we were present, at the GreatNorthern Hospital, when the knee-joint of a man, twenty-sixyears of age, was removed by Mr. Price. It was one of thosecases of disease which he believes to be well adapted for theoperation. It was surmised that the mischief was confined tothe synovial membrane and the cartilages of articulation. On

opening the joint, purulent fluid escaped. The ends of the

articulating bones were found in the condition expected: thesynovial tissue had almost disappeared; the cartilages wereentirely removed, except at a few spots; while the exposedbone was healthy in appearance, vascular, but not ulcerated toany great extent. The patella was deprived of its cartilage,and was removed. We noticed that the operator, in openingthe articulation, first reflected only the skin and sufficient ofits cellular connexions, so that the infiltrated fat and loosetissue which generally abound about the joint when it hasbeen long diseased, formed no part of the flap. Should anyunhealthy inflammatory action set in, this altered structure isliable to slough and greatly complicate the treatment of thewound. The haemorrhage was more copious than usual, the

soft parts and periosteum being extra vascular. The limb was

adjusted in the manner recommended by the operator, and, upto the present time, the patient has expressed himself greatlybenefited by the operation, his appetite and sleep having re-turned.We shall take care to notice the termination of this case,

and probably may report the details at greater length. Therecent case of Mr. Fergusson’s, at King’s College Hospital,already referred to, is doing remarkably well.

DISEASE OF THE STERNUM SIMULATINGANEURISM.

! THE following case is one of great interest, and is still undertreatment at the Hospital for Consumption, Brompton, underthe care of Dr. Edward Smith.An athletic man, aged thirty-two, engaged in a gunpowder

factory, had felt palpitation of the heart, after moderate exer-tion, for twenty years. Fourteen years ago he had rheumaticfever during six weeks. He has at various times been muchalarmed by explosions. Has been accustomed to make greatmuscular efforts, particularly in turning a crank or a mill, inwhich he had to use great effort in dragging towards himself.Whilst engaged in this violent labour about sixteen monthsago he felt a sudden giving-way within the chest, and soonafterwards first perceived a bulging at the middle of thesternum.

July 7th, 1858.-There is now a bony projection, beginningabout two inches from the top of the sternum, extendingdownwards four inches, and transversely three inches, andhaving its highest part opposite the third rib. There is notenderness on pressure, but the surface is red and covered withhair. He has scarcely any internal pain, but there is a senseof stretching about the sternum, and at night he feels a littlethrobbing, chiefly on the left side. There is no purr, nor anypulsation perceptible to the touch. There is a musical blowingwith the second sound over and to the left of the sternum, anda non-musical and soft murmur about the apex of the heart.The bruit is not loud anywhere, but it extends to the top ofthe sternum and to a wide extent below. There is a roughsystolic and a feeble diastolic bruit at the apex, and there ispulsation ardent and natural at the apex of the heart and itsvicinity. The pulse is 76, full, even, and regular in bothwrists when sitting, and the respirations are 23 per minute.No unusual pulsation in the carotid or subclavian arteries, norany turgidity of the veins.The case was thus obscure, but it wore a serious aspect, and

a fear was entertained lest it should be proved to be one ofaneurism of the ascending aorta.

Sept. 1st.—Again examined, and presents the same symp-toms.15th.—He has had a little pain in the right breast, and a

sense of pressure on each side of the chest when lying down.Oct. 6th.--There is more pain, and it is of a darting charac-

ter ; the tumour is a little larger; there is no’ dysphagia; hisappetite is not good; and a careful examination of the lungsshows that there is lessened vesicular action. There is still ablowing diastolic sound, and it is sharper on the right of thesternum; arterial pulsation still regular. He is beginning tostoop somewhat, and there is insufficient respiration.20th.-He has suffered somewhut more pain at night, but

pain has never been a prominent symptom. There is nowfluctuation perceptible at the lower part of the tumour and inthe space on the left of the sternum, but there is no thrill nor

pulsation there. He has experienced one or two attacks ofshivering.

At this period the case became less obscure, for it was almostcertain that the pulsation was due to the presence of a littlefluid in the anterior mediastinum. The case was now examinedby a number of Dr. Smith’s medical friends, and the generalopinion arrived at was, that it was not a case of aneurism.Nov. 3rd.-Still in the same state.1-th.-Dr. Smith showed the case to Mr. Fergusson, the

consulting surgeon to the hospital, who regarded it as one ofdisease of the bones of the sternum. The patient would notpermit an exploring needle to be used, as his club surgeon hadinformed him that he was suffering from an aneurism.24th.-No change.27th.—A small bladder of the size of half a hazel-nut has

formed where the fluctuation was perceptible, but no dischargehas taken place.

Dec. Sth.-The health has improved, and the bladder is alittle shrunken at the top.21st.-On the 18th there was a very small Quantity of clear

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fluid discharged, which formed a small crust; and the bladder is a little shrunken. ’

Jan. 5th, 1859.-The bladder is slightly enlarged, but thereis no change in the condition of the tumour.May 20fh.—Still in the same state, and able to do light

work.This case is very interesting from its obscurity in its earlier

stages, and shows well how guarded the practitioner should bein forming an opinion as to the nature of such diseases, andmore particularly in expressing any opinion to the patient.Its march has been very slow, and unmarked by any promi-nent symptom, and seems to be very much independent of anycontrol on the part of the physician or surgeon. Dr. Smith’saim in treatment was to prevent local irritation and to main-tain and improve the general health, but particularly to re-move the habit of feeble respirztion and to cause the diminutionof the vesicular murmur, which constitutes the first stage ofphthisis, and tends so frequently to the deposition of tubercle.This has been in great part effected.

TOBACCO-PIPE STEM IN THE THROAT.

THE recent case of wound of the throat by a tobacco-pipe, inwhich the carotid artery was tied by Mr. Ure, at St. Mary’sHospital, will be in the recollection of our readers. (See thelast volume of this journal, p. 559.) The ligature came awayon the eighteenth day, and the poor man was progressing veryfavourably, but with the inconvenience of almost completeclosure of the mouth, which had remained since the day of theaccident. He was put upon a grain of sulphate of iron threetimes a day, with evident advantage. On the 22nd of June,he felt something in his month, and on introducing his twofingers withdrew the stem of the tobacco-pipe from beneaththe left side of the tongue, where it had remained unsuspectedand unobserved for several weeks. It measured two inchesand three-quarters in length. The removal of this body per-mitted the mouth to open wider, and the rigidity of the musclesof the jaw to relax. No bad consequences have ensued, and aswe had already predicted, a good recovery has taken place.

ENCEPHALOID DISEASE OF THE EPIDIDYIMIS.

A LAD sixteen years of age was admitted, on the 22nd ult.,into University College Hospital, with encephaloid disease ofhis left testicle, which had grown within seven months to thesize of a cocoa-nut. By the end of the next few days, it hadincreased nearly three inches, so no time was lost in its removal,which was performed by Mr. Erichsen on the 27th. The an-terior part of the scrotum was red; the tumour was soft infront, but indurated posteriorly; and although the disease wasextensive, the spermatic cord was unaffected. A section ofthe tumour showed the body of the testicle to be quite healthy,situated in the centre of the diseased mass which had originatedin the epididymis. The wound was attacked with erysipelasthe next day, which is prevalent just now, and temporarilyretarded the healing action, but the boy is otherwise doingwell.We were present at the Middlesex Hospital on the 25th of

May, when the right testicle was removed from an elderlyman for the same disease. It originated in a blow ten monthsbefore, and had latterly much increased in size, until it was aslarge as a fcetal head. For three months after the blow nogreat inconvenience was experienced. From the general ap-pearance of the man, there was no doubt that he had seriousinternal organic disease, which would endanger his life at alater period. He has recovered from the effects of the opera-tion. A section of the tumour showed it to be the well-knownform of the disease, with the development of several smallcysts. Metallic sutures were used to bring the edges of thewound together.

NASAL CARCINOMA.

WE were lately shown a patient under Mr. Coulson’s careat St. Mary’s Hospital, who had a carcinomatous tumour inrather an unusual situation. It occupied the left side of thenose, was oval in shape, of the size of an almond, and waspartly hollowed out by ulceration. He was admitted on the24th of June, and stated that the disease commenced about ayear ago, in the form of a small pimple over the left nasalbone, which slowly increased in size, became inflamed, andthen ulcerated. Various caustics were employed-amongstothers strong nitric acid—for destroving the Surface. followed

by the application of the concentrated chloride of zinc. It is

quite possible, with perseverance and attention on the part ofthe house-surgeon or dresser of the patient, in applying thecaustics, that the ulcer may be got to heal. When we lastsaw it, it had a very angry and irritable look, which has beensomewhat increased during the prevalence of the great heat ofthe last few days.

- -

ROYAL SOCIETY.SIR BENJAMIN BRODIE, BART., PRESIDENT.

ON THE STRUCTURE OF THE ULTIMATE AIR-TUBES, AND THEDISTRIBUTION OF THE BLOODVESSELS, OF THE

HUMAN LUNG.

BY A. T. H. WATERS, ESQ.,LECTURER ON ANATOMY AND PHYSIOLOGY, LIVERPOOL.

THE bronchial tubes terminate in a dilatation, into whichopen a number of cavities, to which various names have beengiven, but -which the author proposes to call " air-s acs." Theair-sacs connected with a terminal bronchial twig, with theirvessels, &c., constitute a "lobulette." The lobulette consistsof from six to twelve air-sacs; the latter are somewhat elon-gated cavities, lying side by side in the lobulette, and separatedfrom each other by thin walls; in shape they are polygonal,from mutual pressure of their parietes. They all communicatewith the dilated extremity of the bronchial tube, which formsthe common mouth or centre of all the sacs. They have nolateral orifices of communication with each other. They oftendivide, or give off other sacs. The air-sacs of one lobulette do-not communicate with those of another. The walls of the air-sacs are covered with a number of small, shallow, cup-likedepressions, separated from each other by partial septa: thesedepressions, or alveoli, are very numerous, their number vary-ing in different air-sacs from 8 to 20. The lobulettes are sup-ported externally by the pleura; but within the lung, in partby the bronchial tubes and bloodvessels. The membrane form-ing the walls of the air-sacs in a lung inflated and dried is verytransparent, and constitutes, by its projection towards thecentre of the sacs, the septa of the alveoli. Each lobulette isdistinct and separate from those which surround it. The sepa-ration may be sometimes seen in the inflated infant’s lung, butthe observation of the fœtal lung affords the best proof of it.The author alluded to investigations he had made on the lungsof foetuses, which confirmed the view he had taken of thearrangement of the ultimate pulmonary tissue, and of the sepa-ration between the lobulettes. The air-sacs are fully formedbefore birth, and each lobulette is seen as a little red bodyattached to an air-tube. By a partial or complete inflation of-the fcetal lung, the arrangement of the air-sacs may be dis-tinctly made out. The bronchial tubes at their terminationhave a special character: a number of alveoli like those of theair-sacs are found in their walls. They are best seen in thelungs of some of the lower animals, as the cat. The authorhas found them in the infant, in the last divisions of the bron-chial tubes and their dilated extremity; in the adult, only inthe dilated extremity: they seem to become obliterated with

advancing age. Their existence was first pointed out byRossignol.

The bloodvessels of the lungs.—The pulmonary plexus issituated in the walls of the air-sacs ; when formed it maintainsa tolerably uniform diameter throughout; the spaces betweenthe vessels, in an injected and inflated preparation, are some-what larger than the vessels themselves. The branches of thepulmonary artery do not anastomose till they reach the termi-nation of the bronchial tubes; they anastomose freely in theair-sacs. The author believes that the vessels of one lobulettedo not anastomose with those of another; that consequently inthe adjoining walls of two lobulettes two layers of capillarieslie side by side, and therefore in such situations the blood in asingle capillary is not fully exposed to the air on both sides.The radicals of the pulmonary veins issue from the peripheryof the lobulettes, and, forming larger vessels, run in the inter-lobular spaces to the root of the lung. After briefly alludingto the general opinion of the distribution &c. of the bronchialvessels, the author described the results of his own injections.Injection of the pulmonary artery, so as to fill the plexus butnot the veins, does not inject the vessels of the bronchial tubes;but if the veins are filled, the bronchial tubes become partiallyinjected. Injection of the pulmonary veins, whether the plexusbe well filled or not, always injects the bronchial tubes. In-

jection of a bronchial artery, when fairly within the lung, pro-duces injection of the bronchial tubes, and the fluid returns by