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enough. There were two spots on the left Sylvian arteryshowing the same remarkable inflammation in an earlierstage. The substance of the pons Varolii was swollen, andits parts indistinct as though running into each other, yetno breaking down had actually occurred; section throughit showed, when submitted to a very feeble stream of waterfor a moment, a noticeable degree of softening on the leftside more than on the right. The portion of brain corre-sponding to the left Sylvian artery was rather soft. Theother organs of the body did not yield any point worthy ofnotice.

Dr. Moxon considered the occurrence of so acute a form ofarteritis as in itself very interesting and very important.The disposition at present, he thought, is too much to re-gard all changes in the arteries as of a chronic and dege-nerative kind. When the inside of an artery is found de-faced by atheroma and cartilaginous thickening, this is setdown as the result of senile atrophic changes. Such chronicand degenerative changes are even commonly held to bethe cause of aneurisms. He believed that this view ofarterial pathology is very far from being correct. As toaneurisms, they often occur in young people, and the soft-ened and thickened tracts of the arterial wall that accom-

pany the aneurisms are found, on microscopic examination,to be infiltrated with inflammation corpuscles; so that, inshort, many aneurisms, if not all, are accidents of arteritis.So, too, he believed that the deformed senile arteries, thatwere viewed as degenerate, may be in many cases at leastnot degenerative and progressive, but rather remains of by-gone inflammation of the arterial coats, corresponding toold thickenings of the pleura, periosteal nodes, &c. Thisis not a new view, at least as regards the inflammatorynature of arterial diseases. The presence of inflammatorycorpuscles in the walls of these arteries has been assertedby numerous observers, especially in Germany, and Dr.Moxon has verified the presence of these corpuscles in manyexamples. But the arteritis in the present case differedfrom the ordinary forms of thickening of the arteries. Itaffected all the coats, and the amount of the lymph forma-tion was very unusual. The occurrence of this remarkablearterial disease along with periosteal nodes in a syphiliticpatient is another important instance establishing thepower of syphilis to cause acute disease of the arteries.

WEST LONDON HOSPITAL.

RETENTION OF URINE FROM CALCULUS ; LITHOTOMY;RECOVERY.

(Under the care of Mr. TEEVAN.)IT would seem from Mr. Teevan’s remarks, that the size,

roughness, and peculiar hour-glass shape of the stone inthis case accounted for its only advancing a certain distancein the urethra.

We are indebted to Mr. Adams, the house-surgeon, forthe following notes.

S. H-, an emaciated, strumous-looking lad, seven yearsold, was admitted into the hospital at 11 A.M., April 10th,for retention of urine. On admission, he was in excessivepain; legs drawn up; great fulness in the hypogastricregion, extending rather above the umbilicus, accompaniedwith much tenderness. Has not passed urine for forty-eight hours. Tongue coated; pulse 132. The mother statedthat he had not had a similar attack, and that he had nevercomplained before. No history of stone in the family. Mr.Adams introduced a No. 4 silver catheter; but as it was in-terrupted near the neck of the bladder by a calculus, itwas withdrawn. Chloroform was then administered to thepatient, and with some difficulty the catheter was passedinto the bladder, and upwards of a pint of urine drawn off.At 7 P.M. the same evening, the catheter had to be againused to relieve the distended bladder.

April 11th.—Urine had to be drawn off night and morning.12th.-The catheter had to be again used to-day. Ivlr.

Teevan attempted to seize the stone with an urethra]forceps, but did not succeed.

13th.—6 P.M.: The boy was put under the influence ofchloroform, and placed in the position for lithotomy, Mr.Bird holding the staff. Some little difficulty was experi-enced in introducing it, as the calculus was for some timefirmly fixed near the neck. As the bladder was distended

to about two inches above the umbilicus, Mr. Teevan allowedhalf the urine to flow away, and then extracted by the lateralincision a small oxalate-of-lime calculus, of the size andshape of two united peas.May 1st.—To-day the boy passed, per urethram, a small

oxalate-of-lime stone, weighing 6 gr.23rd.-The boy left the hospital quite well, and not suf-

fering from any incontinence of urine.The difficulty experienced in introducing the rectangular

staff, Mr. Teevan thought, was not owing to the peculiarityof shape of that instrument, but simply to the fact that itsprogress was for some time interrupted by the calculus,which was rather firmly fixed in the ’prostatic urethra. Inaccordance with his usual practice, he extracted the stonewith his finger only, through a lateral incision, as therewere no facts to show that there was any better incision forthe removal of a calculus. After the operation, Mr. Teevanwas unable to feel the second stone, although he was ofopinion that it was in all probability concealed in the folds.of a very large collapsing bladder.

EVELINA HOSPITAL FOR SICK CHILDREN.

CASE OF MEASLES FOLLOWED BY DIPHTHERIA; DEATH.

(Under the care of Dr. FAGGE.)THE occurrence of a diphtheritic attack after measles, or

before it, is not so very uncommon, and is mentioned bothin Hebra on Diseases of the Skin and in Reynolds’s Systemof Medicine. But taking these two cases together, the childand its nurse, as probably affected by a common poison,they are interesting, illustrating as they seem to do a largeclass, more commonly seen perhaps in general than in hos-pital practice. Numerous instances like the present compelone to consider whether the existing strict classification offevers is correct; whether, in searching for specific germs,we may not have overlooked the varieties of soil, or thevigour of the seedling ; whether, in other words, anyone-poison in different degrees of intensity, acting on the bodyin its varying conditions, may not be capable of producingother varieties of fever than that which is considered now-adays to be peculiarly its own; whether, indeed, differentstates of the recipients may not determine that a certainpoison shall produce measles in one, diphtheria in another,pneumonia or pleurisy in a third, while in a fourth thefactor from without, finding no corresponding internalfactor, shall produce no appreciable result, or at most aresult which may only be evidenced in after-years by anapparent insusceptibility to some poison. Whether this beso or not, a large number of so-called "fevers" in generalpractice cannot be classified, and the question is begged bycalling them " febricula."We are indebted to Mr. Goodhart for these notes.Sarah C-, aged two, was admitted on July 1st for

ecthymatous sores over the body and legs.July 29th.—After the occurrence of two cases of measles.

in the ward, the child became hot and feverish, and wastransferred to the fever ward, under the care of Dr. Fagge.30th.-Trunk covered to-day with eruption of measles. It

is neither so raised nor so livid as usual. She has a harsh

dry cough, but no other catarrhal symptoms. She pro-gressed well for four days, the temperature being at the

outset 101°, with an evening rise of about 2°.Aug. 2nd.-Morning temperature 1000; evening 1006‘.3rd.-Tongue is again dry and glazed. She clrinks fluids

. greedily, but refuses all solids. There is a firm, tough! diphtheritic membrane covering the right conjunutiva,. somewhat adherent.

4th.-Morning temperature 1013°; pulse 12S. Membrane. on conjunctiva has re-formed; the cornea is yellow, as if

suppurating. She still takes fluid well. No throat symp-toms. Respiration fair all over chest. Urine is passed underher. -

5th.-Morning temperature 102° ; very restless, -,nd -willnot take any nourishment; evening temperature 104.6°.

’

6th.-Morning temperature 102° ; evening 102°.7th.-Had a very restless night, and died this morning at

10.30 A.M.! At the inspection, five hours after death, the posteriorpart of the tongue and the soft palate and tonsils were

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covered with a uniform layer of yellowish membrane. Thisextended to the epiglottis, and lined the anterior surface upto its very edge; it did not extend over the margin to thelaryngeal surface. The larynx was healthy. Glands beneathjaw were much enlarged, more on right side than left. Thelungs contained a few patches of broncho-pneumonia, andthere was some capillary bronchitis, but not to any extent.There was also some old disease in a small portion of onelung, consisting of cavities lined by a smooth membrane,and containing pus. The spleen was large, weighing twoounces and a quarter. Instead of the usual pulpy feverspleen on section, it was very firm, with no diffluent pulp.Appended to the above is the following case :-Anne M—,aged forty-four, nurse to Sarah C-, felt

very ill on Aug. 8th, but, being subject to bilious attacks,she did not say anything about it. Towards evening shebecame so ill that she was unable to rise from her bed.Aug.9th.-Looks ill; tongue is thickly coated, and the

breath very offensive; much pain and aching in all thelimbs ; bowels confined. Ordered an aperient mixture im-mediately, to be repeated four hours afterwards.—Evening:Temperature 104°; pulse 102. Much frontal headache andsore-throat. Is slightly delirious.

10th. —Morning: Temperature 102° ; pulse 120. Muchdelirium during the night.The patient was now transferred to Guy’s Hospital, under

the care of Dr. Moxon. Dr. Hilliard, the house-physician,has furnished the notes of the continuation of the case.On admission: There is much headache; throat is sore,

but better than it was; there is no injection of the faucesor membrane; temperature 101°; pulse 108; some pain inthe right side, with a questionable pleuritic rub on auscul-’tation; no dulness.

Aug. llth. - Some cough, with expectoration of viscidmucus ; decided pleuritic rub to-day beneath the rightnipple, and now and then a little crepitation over the lowerlobe of the right lung. No other physical signs. To takeSeidlitz powder every four hours, and a saline aperient inthe morning.

12th.-Crepitation is now fine, with rusty, viscid sputum;rub still audible. From this time the crepitation graduallyextended up the front of the lung, and she began to im-prove.

HOSPITAL PRACTICE.

THE TREATMENT OF ACUTE GOUT.

VPE subjoin a note of the treatment of acute gout asfollowed by physicians at some of the metropolitan hos-pitals. It is especially as regards the use of colchicum- -a most ancient remedy for gout-that we have thoughtit interesting and important to glean these particulars. Thespecial power of this drug in controlling the inflammatoryphenomena of the disease is generally recognised, but itsmodus operandi cannot be explained. The researches ofGarrod go to show that colchicum does not increase theamount of uric acid excreted by the kidneys, nor does it in.all cases increase the quantity of urine. Yet the relief ob-tained by the use of this drug is in the experience of mostpractising members of the profession.

ST. GEORGE’S HOSPITAL.

For the purposes of clinical instruction, Dr. Fuller dividescases of acute gout into two classes: namely, (1) cases inwhich the excretory organs are organically sound and func-tionally active-cases in which the attack of gout is dueprincipally to excess and indiscretions of diet; and (2) casesin which the excretory organs are in some way disordered,and fail in performing their eliminative functions-cases inwhich the patient is not necessarily guilty of indiscretionsof diet, but in which the liver and kidneys fail in theiraction, either as the result of functional disorder or oforganic change in their structure.The first class of cases correspond with those which pass

under the name of sthenic gout: the tongue is usuallyfurred, the urine loaded, and the bowels are commonly tor-pid. In these cases, until the acute symptoms have sub-sided, Dr. Fuller restricts the diet to liquids, administers a

saline draught containing sulphate and carbonate of mag-nesia and a few drops of colchicum wine, occasionally givesan aperient pill containing calomel, aconite, and opium,and wraps the joints in finely carded wool or in flannelssteeped in a solution of soda and laudanum. As the acutesymptoms subside, a more generous diet is permitted, andsome light bitter tonic, such as tincture of gentian orcalumba, is added to the mixture.The second class of cases have more affinity with what

has been termed atonic gout: the tongue is often clean, theurine clear-sometimes of low specific gravity, and thebowels are regular. In these cases Dr. Fuller does not re-strict the diet to the same degree; he allows a little meatwithout vegetables, and also, if desired, a glass of sherry ora little spirits and water. He acts freely on the skin bymeans of the hot-air bath; administers an aperient in themorning containing taraxacum and sulphate of magnesia,and during the day he gives a warm stomachic draught con-taining ammonia, and a few grains of soda in a light bitterinfusion. Occasionally a dinner pill is prescribed containingrhubarb and a grain of colchicum; and in some instances,characterised by pale clear urine, a draught containingquinine, the mineral acids, and taraxacum, is substitutedfor the mixture just referred to. In these cases, as soon asthe acute symptoms have subsided, a drachm of the syrupof phosphate of iron is given each morning before break-fast.

MIDDLESEX HOSPITAL.

In the treatment of acute gout, Dr. Murchison commence?by clearing out the bowels with colocynth, blue-pill, andhenbane, and then he relies mainly on alkalies and col-chicum, the bicarbonate of potash and colchicum wine.With these he usually combines the nitrate of potash, andin private practice the patient is also instructed to drinklithia water. In rare cases, where there is irritability ofthe stomach, it may be necessary to subdue this by bismuth,magnesia, lime-water, and ice, with sinapisms to the epi-gastrium, before giving colchicum. The inflamed joints arecovered with pledgets of lint moistened with laudanum, orwith belladonna liniment and oil-silk, and the whole en-veloped in cotton-wool. Opiates are not given, except inrare cases where the pain is protracted and severe, and noteven then unless the bowels be well open, and the urinefree from albumen. The patient’s diet is restricted for themost part to milk and farinaceous articles.

WESTMINSTER HOSPITAL.

Dr. Radcliffe thinks that, during the last twenty years,there has been a great change in the character of the casesof gout which fall under the physician’s notice. The acute

gout of old, he believes, is now rarely met with. It is muchmore common to meet with the subacute form-the form,that is, which is more nearly allied to rheumatic gout. Dr.Radcliffe does not employ colchicum. In a case of goutwhere some part of the foot is involved, he raises the limbto a height above that of the pelvis, gives diluents, iodideof potassium, alkalies, and no colchicum. Nor does he givepurgatives. He diminishes the allowance of port wine andbeer.

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CHARING-CROSS HOSPITAL.

Dr. Salter’s treatment of cases of acute gout does notdiffer, in any essential particulars, from the general man-agement of such cases; and the results are such as, in hisopinion, to entitle the treatment to be considered success-ful. It consists of the administration of certain remedies,the prescription of certain dietetic and other management,and the application to the part affected of a certain localtreatment. What he generally orders is a mixture con-

taining iodide of potassium, bicarbonate of potash, col-chicum wine, and decoction of bark. He regards as ground-less, in the great majority of cases, the fears that are sooften expressed of the peculiarly lowering tendency of col-chicum ; at the same time recognising the fact that casesare sometimes met with which appear to be almost abso-lutely intolerant of it, and others that bear it very ill. Hethinks that it should always be commenced very cautiouslyand tentatively with those who have never taken it before.He is equally incredulous of the opinion that has been ex-