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colour is that of pale golden sherry; the odour i sweet; whenrecently passed, it has barely any action on litmus paper. -Bdistinct alkaline reaction upon reddened litmus has not, how-ever, been observed. When poured into a test-tube, a veryslight cloud may be seen floating near the bottom; if allowedto stand for an hour or so, a small opaline deposit, easily dis-persible, will form. The recent urine is unaffected by heat,or NO5 HO ; but if allowed to stand after their action, a smallflocculent precipitate sometimes forms; occasionally, however,no precipitate is visible to the naked eye. Of that portionwhich is allowed to stand, the supernatant liquid is ilnaffectedby heat and NO5 HO; the deposit, however, is dissolved bythe latter, indicating the presence of phosphates; and whenheat is applied to the mixed fluid, as in the recent urine, aprecipitate may or may not be the result. Upon submitting adrop of the recent urine to the field of the microscope, blood-discs, turgid or collapsed, single and not aggregated, togetherwith epithelial cells and occasional casts of the uriniferoustubes, are seen; no pus-globules have been detected. Suchare the usual characteristics of the urine; but the action ofconcurrent causes, as exposure to cold and the imbibition ofdiuretic fluids, renders the urine acid for a time, when crystalsof uric acid and of the lithates, together with blood-discs, areseen.

It will be observed that the symptoms, general and local,are those of that form of renal disease termed by Payer" Chronic Nephritis," but that there is an important differencein the character of the urine. In treating of this " chronicnephritis," Dr. Christison states (" Lib. of Med.," vol. iv.p. 270) " that the urine very seldom contains blood or albumen,unless other renal diseases concur." " However, of that form ofrenal disease now under notice, blood-globules have been in-variably contained in the urine, but could only be detectedwith certainty by the microscope. Liability to passive renalhmmorrhage appears to be either constitutional or acquired.Persons constitutionally predisposed are those of lax fibre, faircomplexion, with skin soft and supple, easily excited to action,but as readily depressed: persons of a tuberculous tendency,prone to affections of the mucous membranes, as catarrh,bronchitis, diarrhoea, &c., whose arterial system is in thatstate which may be termed irritable. Such a constitutionappears, as it were, acquired by two other classes, who arespecially prone to this hæmaturia—viz., those who are in thehabit of consuming large quantities of diluent fluids, as hay-makers, reapers, engineers, stokers, bleachers, tenters, dressers,and spinners in cotton-mills-persons who, after exciting greatcutaneous action by severe manual labour, or by working in ahigh artificial temperature, check the same by exposure to amuch cooler atmosphere after the cessation of their dailyemployment. The habitual dram-drinker is most prone to theacute form of Bright’s disease, or to that stage which probablysupervenes upon this-viz., that in which the urine is of lowspecific gravity, and contains free albumen. May not thefrequent use of spirits, from their direct action upon the

kidneys, by over-stimulating the organs, produce this hæma-turias which may ultimately pass on to " chronic albuminousnephritis" ? It may be observed, that of several cases of

"passive renal haemorrhage’’ which have occurred in the

practice of the writer, not one could, as far as the patient’srecollection served, be traced to any dropsical affection,proximate or remote.The average age of the persons affected was above thirty-

five years; they were chiefly of the male sex, probably onaccount of the greater exposure of males to the predisposingand exciting causes, which latter appeared, as far as they weretraceable, to be exposure to cold, damp air when in a state ofperspiration, frequent use of diuretic spirituous liquors-infact, any circumstances which, depressing the heat of the body,produced congestion of the viscera.

The Patlaology of the Disease.-The presence of blood in theurine affords ample proof of the existence of haemorrhage fromsome part of the genito-urinary passages, the state in whichthe blood-discs are found, the inadequacy of chemical re-agentsto detect them, the occasional c3,sts of uriniferous tubes, andthe natural colour of the urine, indicate that the haemorrhageis renal, yet not of an active kind. But the comparative epaucity of the globules discharged would lead to the conclusionthat the kidneys are not suffering from any organic lesions, ’,but from an unbalanced state of their circulation. This stateof venous engorgement may probably exist for some time with-out any structural change in the glands themselves, but unlessrelieved, it is apparent that exudation will ultimately occur,and derange the whole action of these excernant organs. Theactual progress of this haematuria into chronic albuminous

nephritis has not been traced, the remedies used in the cases,of which this paper is a general history, having had the effectof checking, if not of curing the hæmorrhage.The therapeutical indications are three in number. First,

to check the haemorrhage by reheving the congestion ; secondly,to restore the general health; thirdly, to guard against relapse,and this is an important point, as there is a great tendencythereto upon the application of any exciting cause. The firstindication may be effected by rest, daily use of the warm bath,with friction to the bodily surface, local depletion, abstinencefrom diuretic drinks, bland farinaceous diet, and the use ofastringent remedies. To relieve the gastro-hepatic derange-ment, a small quantity of blue-pill, with a sedative salinedraught, will be found useful at intervals during the exhibitionof astringent remedies, the best of which is gallic acid. It hasbeen given in the following form:—Gallic acid, a drachm;dilute hydrochloric acid, two drachms; solution of hydro-chlorate of morphia, (E. P.,) one drachm; distilled water,five ounces and a half, as a mixture; a tablespoonful to betaken every fourth hour. The therapeutical effects of gallic acidare well described by Dr. Golding Bird:—" Gallic acid acts asa direct astringent, reaching the renal capillaries, and findingits way into the urine, which becomes strongly charged withit, &c." To relieve the irritability of the bladder, tive grainsof soap-and-opium pill should be used every night as a supposi-tory. These medicines should be continued until the hæmor-

rhage ceases, and the vesical irritability which remains for sometime after the cessation of the haemorrhage, is relieved bytincture of cantharides, in doses of from ten to twenty drops,combined with an anodyne. When the urine is free from blood-discs, the general hygienic rules for restoring tone to the systemshould be enforced; animal diet, with a few glasses of sherrydaily, may be allowed, and quinine with iron prescribed. As

preventive measures, the warm bath with friction should bedaily persisted in; flannel should be worn next the skin, and allexposure to exciting causes studiously avoided.

Park-road, Chorley, January, 1854.

REPORT OF

A CASE OF PARTIAL OVARIOTOMY, INWHICH THE PATIENT SURVIVED THEOPERATION FOUR MONTHS.

BY JOHN CROUCH, F.R.C.S., Bruton, Somerset.

MRs. B-, a widow, aged fifty-seven, of sallow complexionand unhealthy appearance, had conducted for several years thebusiness of a confectioner. She was the mother of threechildren, and her habits were those of an active and industrioustradeswoman. Very early rising, long continuance in theerect posture, and considerable exertion in her occupation, atthe time of the cessation of the menses, were the predisposingcauses of her disease.

Five years since, she first consulted me respecting a swellingin the left groin. The tumour was the size of a large cocoa-nut, of a tirm, unyielding character, and was considered to bean enlargement of the left ovary. She underwent a longcourse of diuretics, iodine, and mercury, and "pressure’’ was

applied, without any sensible effect. About two years afterthe above treatment, this swelling suddenly disappeared, whichthe patient attributed to drinking acid cider.

In the autumn of 1851 she discovered another enlargement,which commenced in the right groin. I was not consulted onthis occasion till the abdomen had become as large as that of awoman in the last stage of pregnancy. The circumference ofthe bowels was nearly forty inches, and fluctuation was per-ceptible over their whole surface. After taking a short courseof alteratives and diuretics, she was tapped on the 13th ofJune, 1852. Two gallons of a coffee-coloured fluid. whichyielded a large proportion of albumen, were drawn off. On

examining the bowels after the operation, a hard, immovablesubstance was found in the right iliac region.Although great temporary benefit was experienced from the

tapping, the fluid soon collected again, and at the end of five eweeks she was so distressed by the accumulation as to earnestlyrequest that something further should be done for her relief.As she had been informed that a patient on whom I had

successfully operated in lb49 had suffered from a similar disease,it was necessary to explain that, in the first instance, thetumour was completely extirpated, but with regard to her owncase, so favourable a result was not to be expected.

After fully explaining its dangers, I obtained her consent to

42

the following operation, which is nearly similar to that firstpractised by Mr. Wilson, of Bristol. It took place on the 13thof August, 1852. Having marked with the tincture of iodine- one perpendicular and three transverse lines as guides to theoperation, I made an incision of two inches through the skinand cellular tissue about an inch below the navel, and to theright side of the mesial line. The rectus muscle and perito-næum were then divided, and the ovarian sac carefully securedby ligature to the upper angle of the wound. Nine quarts offluid, which had accumulated in eight weeks, were then drawnoff with the trocar. The cyst was very thick and vascular,and adherent to the surrounding structures in every direction.I extracted a portion three inches in length, and after applyingMr. Wilson’s ingenious tourniquet, excised with a large pairof scissors a part the size of a crown-piece. No fewer thanseventeen small arteries required the application of a fineligature silk. In this part of the operation I was very ablyassisted by Mr. T. G. Stockwell and Mr. C. J. Morris. Bothends of the seventeen ligatures having been cut off, the re-maining portion of the cyst was returned into the abdomen,and the outer incision closed with three sutures and adhesiveplaster. The patient was then placed in bed, and forty dropsof laudanum were administered.

She passed the first four days after the operation without asingle untoward symptom, having been free from fever,haemorrhage, and peritonitis.On the fifth the wound was dressed, and the external liga-

tures removed. The outer incision had nearly healed, and thebowels acted on this day without the aid of medicine.I On the seventh, a tympanitic state of the abdomen was first

observed. This arose from the formation of gas in the ovariansac, and was unattended by any symptom of peritonitis.On the fourteenth the cyst became fully distended, and the

upper angle of the wound giving way, a large quantity of fostidair and matter escaped.From this time it was necessary to treat the case as one of

chronic abscess. The sides of the sac were now drawn togetherwith compress and bandage, and nourishment in every formfreely given. For the first few days after, the discharge was s !very considerable and offed-sive, but by the end of August itbegan to diminish, and the appetite to improve. The cyst wasnow daily syringed with a pint of warm water, to which wasfrequently added a drachm of the tincture of iodine, or thesame quantity of the sulphate of zinc.By the end of October the matter became more healthy, and

the quantity, instead of amounting to ten or twelve ounces, wasreduced to three or four, night and morning. She continuedslowly to improve, and the cyst had so far contracted that itscavity, which at the operation contained nine quarts, was nowonly capable of holding a few ounces. A bed-sore, which atfirst was troublesome, had now completely healed, thus provingthe increased vitality of the system.Her death, however, took place suddenly on the 13th of

December, sixteen weeks after the operation, and when shewas about to partake of a substantial meal.The post-mortem examination proved that matter had

escaped from the cyst into the peritoneal cavity, and the solidpart of the tumour showed evident traces of cancerous deposit.The left ovary appeared healthv, aud only slightly enlarged.The uterus had a small fibrous tumour imbedded in its sub-stance. The other viscera were not examined. The portionof cyst that was excised at the operation, and which has beenpreservecl in strong acetic acid, measures more than a quarterof an inch in thickness.

Remarks.—Notwithstanding the fatal termination of thecase, the above operation was so far successful that there isevery reason to believe the result would have been favourablehad the patient’s general health been good, and free from

specific disease. There can, I think, be little doubt that herlife was prolonged by the means employed.

It is most desirable that, in addition to the dangerous andformidable operation of complete extirpation, we should pos-sess, in the treatment of ovarian disease, some remedy moreefficient than those usually adopted. I allude to diuretics,iodine, pressnre by tight bandaging, issues, setons; subcutaneoussections, and tapping. Dr. Tanner’s proposal of tying the

pedicle of the cyst is not included in the above list, becauseexperience is required to test its value.

Partial ovariotomy, by quickly and effectually destroyingthe entirety of the cyst, offers the best substitute for the ma-jor operation" in all proper cases, where the total extraction ofthe tumour cannot be effected. Of three cases treated in this

way by Mr. Wilson, one was restored to health in three weeks,after the formation of a gmall abscesg near the incision, and an-

other recovered without a single adverse symptom. No dis-charge ever took place from the wound, although a large por-tion of cyst had been removed, and ten arteries secured. Mrs.B-’s case was a most unpromising one, and the operationwas only resorted to as a last resource.No minor operation, however, can supersede that more per-

fect one, by which the total eradication of the disease is in-sured. Dr. Clay has kindly informed me that he has now per-formed " ovariotomy by the large incision" fifty-eight times,out of which number only eighteen cases proved fatal-a mor-tality not exceeding that attendant on hernia, amputation,and lithotomy.

It is satisfactory to find that the leading men of the profes-sion have not all set their faces against the performance ofovariotomy. Mr. Fergusson, in the last edition of his excel-lent " System of Practical Surgery," says, " Ovariotomy is notonly justiJhble, but, in reality, in happily selected cases, anadmirable proceeding." The late Mr. Aston Key, in the

" Guy’s Hospital Reports" for October, 1843, writes as fol-lows :-" If the constitution of the ovarian patient be unaf-fected by the disease, her nervous system tranquil, and thearterial action free from inflammatory tendency, I cannot seeany objection to submitting such to the operation." Mr.Druitt, whose ’’ Manual of Modern Surgery" stands pre-emi-nent as a work of talent and research, makes the following ob-servations in his sixth edition :-" In favour of ovariotomy, it

may be argued—1st, that the mortality arising from this is notgreater than that from many other surgical operations ; 2ndly,.that no other plan of treatment can effect a radical cure, butthat by this, women relieved of a burden which made life mi-serable, have married and borne children ; 3rdly, that iffavourable cases only were submitted to the operation, themortality would be very small, and that increase of experiencewill lead to the selection and discrimination of favourable cases ;.

4thly, that if the surgeon, in order to complete his diagnosis.makes a small incision, to ascertain the existence of adhesions,and closes it again with suture, if he find this to be the case,no great harm is likely to result; in fact, this, which is some-times raked up as an opprobrium against operators, is a pru-dent and legitimate measure. Lastly, that it is by far themost merciful plan of treatment, if adopted early, in patientsotherwise healthy, with a still growing but non-adherenttumour.

In conclusion I would remark, that as Mr. Wilson’s threecases, and one published by Mr. Brown, are the only otherinstances of "partial ovariotomy" yet on record, it is de-sirable that the profession should communicate the results oftheir experience in this important operation.

Bruton, December, 1853.

IODIDE OF POTASSIUM IN LEAD POISONING.BY J. R. NICHOLSON, M.D.

j IN the Britist, and Foreiya Medical Review for Januaryappears a translation, by Dr. Budd, of M. Melsens’paper on the

" Employment of Iodide of Potassium as a,

Remedy for Diseases caused by Lead and Mercury." A sup-position had occurred to me, previous to reading that paper,that the effects of these poisonous agents were caused bychemical combination with the tissues of the human body, orby being present in intimate union with those tissues in someanalogous manner. The views so ably stated in the above-mentioned paper show that there has been given to a similarsupposition the form of a definite theory, on the grounds ofwhich M. Melsens has conducted some successful experiments.If the theory be correct,—and it is borne out by the fact thatlead and mercury have been obtained from the body afterdeath,-the conclusion is self-evident that the action of thecurative agent must be directed to the conversion of thepoisonous agent into a compound having less affinity for thosetissues, and therefore readily eliminated from the body.M. Melsens has shown that iodide of potassium possesses therequisite conditions to become a curative agcnt in these dis-eases according to this theory, and several examples are givenin Dr. Budd’s paper of its effect in mercurial poisoning. The

following case shows it is not less efficacious in cases of leadpoisoning. It is not only the successful result, but the com-parative rarity of such cases which has determined us to forwardthis case for insertion:—

P. R--, a house-painter, aged thirty-nve, presented him-self to me March 6th, 1853. He was then suffering frompartial paralysis of the left forearm, and occasional fits ofcolic of a very distressing nature. He stated that he keel