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seized in bed, while passing urine in the recumbent posture, withextreme oppression, and died in about fifteen minutes. Thechest onlv was examined. The lungs were healthy. The heartwas rather enlarged, and its right cavities dilated. It wascovered with fat, and was empty, and flattened by the pressureof a large clot, weighing half a pound, that completely en-veloped it, and with about four ounces of bloody serum dis-tended the pericardium. This haemorrhage proceeded from afalse aneurism at the root of the aorta, (which was generallydilated,) involving the orifice of the right coronary artery, andopening by a very small aperture into the pericardium. Thesize of the aperture perfectly explains the mode of death bycompression of the heart, and why it did not immediately fol-low the rupture.

____

TUESDAY, JANUARY 20TH, 1857.

Mr. PART presented a specimen ofCANCEROUS ULCERATION OF THE COLON AT ITS

HEPATIC FLEXURE,in which the intestine was narrowed so as scarcely to admitthe end of the little finger. The ascending colon was muchdistended with flatus, and its coats enormously hypertrophied.The peritoneal covering of the intestine had given way in twospots on the anterior surface, where adhesions had been con-tracted with the omentum. The small intestines were alsogreatly enlarged, and the coats hypertrophied and filled withfeculent matter. The patient, a medical man, had been

obliged to relinquish his duties from severe head affliction,which had left him. During the last year, he had frequentattacks of colic, attended by a large, resonant, and very painfultumour on the right side of the abdomen, sometimes in thesituation of the caput coli, and at others higher up. Theattacks supervened upon a constipated condition of the bowels,and upon eating any indigestible substance.Mr. PART likewise exhibited a case of

EXTENSIVE OSSEOUS DEPOSIT WITHIN THE MITRAL VALVE,from a patient aged forty-two, who had died with hydrothoraxon the left side and old adhesions on the right. She had hadacute rheumatism twenty-five years before her death, and fouryears previously to death had had pleurisy.

Mr. PART also showed an interesting specimen ofULCERATION OF THE (ESOPHAGUS, COMMUNICATING WITH THE

RIGHT BRONCHUS.

A gentleman aged sixty-two had had a severe hæmatemesisnine months before his death. About five months and a halfafter this attack, he had, while suffering from dyspepticsymptoms, with dysphagia, a second very severe seizure. Thiswas followed by others, at shorter intervals. He graduallybecame more unable to swallow, until even fluids were, afterfive or six seconds, returned. Six weeks before death, he hadbronchitis, after which blood was sometimes coughed up, andwhat little food he took into his mouth was returned by cough-ing, mixed with frothy mucus and blood. He died on the 3rdof January. Examination after death showed the liver in astate of cirrhosis; the other abdominal viscera healthy. In thechest, a large quantity of offensive, ash coloured pus was foundin the right pleural cavity. At a point corresponding to thebifurcation of the trachea, the anterior wall of the œsophaguspresented a rough, jagged ulcer, about two inches in length,and embracing two thirds of the circumference of the tube.From this, there was a communication with the right bronchus,and with an ulcer as large as a small walnut in the substanceof the lung, at its root. The coats of the aorta were untouchedby the disease, which had spread to close proximity with theleft bronchus.

Mr. JOHN WOOD exhibited IA PORTION OF SMALL INTESTINE PASSED PER ANUM, AFTER

SYMPTOMS OF OBSTRUCTION.

This specimen was sent to Mr. Way, house-surgeon to King’sCollege Hospital, by Mr. Ward, of Bodmin, in whose practicethe case occurred. The patient was a married female, agedtwenty-three, who, six months before, had become subject tosevere pains in the loins and abdomen. The case had beenmistaken, and treated for disease of the womb. When Mr.Ward saw her, she was much emaciated, with a quick, feeble,and occasionally intermittent pulse, dry, furred tongue, andbowels apt to be, but not completely, constipated, with naturalfeces, when acted upon. Micturition frequent and painful;urine slightly albuminous, and containing lithates. She vomited

frequently matters not distinctly feacal, but consisting appa-rently of partially -digested food; the vomiting generally comingon about an hour after eating. She had much griping pain -inthe bowels, with some pain on pressure over the region of theright kidney. No uterine disease, beyond a little thickeningof the os, was detected. In November last the patient passedthe produced portion of small intestine. It is about six orseven inches long, and an inch and a half in diameter, with novalvulae conniventes, or any evident Peyer’s patches, and isprobably from the upper part of the ilium. The mesentery isseparated close to the gut, and one end of the latter consider-ably frayed off. The patient at first went on well, but sincethen has had a return of the symptoms of intestinal strangula-tion, with constant vomiting and scanty fluid dejections, arisingpossibly from contractions of the resulting cicatrix.

Dr. COCKLE showed a

SACCULATING ANEURISM OF THE ASCENDING AORTA, FATALBY RUPTURE INTO THE PERICARDIUM.

The subject was a robust man, about forty years of age. Hehad been ill about two years. His early symptoms werecardiac pain, extending up the aorta, and darting through thebreast and down the arms; palpitation, with occasional coughand difficulty of lying upon the left side; gradual loss of weightand sallowness of complexion supervened. The only physicalsign detected at this period was marked intensification of thesecond sound of the heart to the right of the sternum. Somemonths subsequently, in addition to these phenomena, pulsatingtumour, with systolic and diastolic impulse, was detected be-tween the second and third right costal cartilages. Compared.with the cardiac impulse, sensible retardation of the radial

pulse was manifest. No fremitus was felt over the sac, but

percussion yielded a dull note. The systolic sound of theheart, heard over the apex, was dull, as also over the sac; thesecond sound in this latter situation still retaining its unnaturalaccent. The cardiac impulse was slightly heaving. A fewdays before the sac gave way, the first sound over the sacchanged from a dull sound into one accurately imitated by thecrumpling of parchment. Death was instantaneous, in themidst of active duties. A sacculating aneurism of the aortawas found, commencing about one inch and a half above thearterial valves. The sac was bilocular; the common aperturelarge. One loculus ascended upwards and forwards, its outersurface becoming fused with the sternal periosteum, and partiallyeroding this bone at its right inner edge. The other loculusextended downwards and backwards, moulding itself upon thecava, and thus preventing serious pressure upon the vessel.From this lower loculus transverse rupture of three-quarters ofan inch had suddenly occurred midway between the rightauricular appendix and the reflexion of the pericardium, per-mitting the escape of about twenty-eight ounces of blood intothe sac, and thus probably at once arresting the heart’s action.The aorta was greatly dilated at its origin, and had undergoneextensive degeneration of its inner and middle tissues. Thechambers of the heart were in a state of fatty degeneration.Those of the left side were hypertrophied. The right lungwas partially adherent to the sac. Traces of old pericarditisexisted. The apex of the right lung presented tubercle in astate of obsolescence. This case is also interesting from therarity of an aneurism with external pulsating tumour burstinginto the pericardium. From Dr. Sibson’s tables, it has onlyoccurred once in 33 cases.

Reviews and Notices of Books.The Constitution of Women, as illustrated by Abdominal Cel-

lulitis, or Inflammation of the Cellular Membrane of theAbdomen and Pelvis. BY CHARLES BELL, M.D., F.R.C.P.Edin. Edinburgh : Sutherland and Knox. London:

Simpkin, Marshall, and Co. pp. 44.

ANY one who has ever indulged in the sentimental habit ofstar-gazing on summer nights, will doubtless have cogitatedupon the ." whither" and " whence" of shooting stars. Suchan one, too, will have duly admired these beautiful meteors,"Splendidior vitro," and probably cudgelled his cerebral con-volutions to produce fourteen lines of madness upon the afore-said phenomena. Now, Dr. Bell’s essay bears a very strikingresemblance to a shooting star, not in the matter of brilliancy,but in respect of the wonderful obscurity which envelopes its

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"whither" and its "whence." In plain English, we cannot discover the starting point of the argument, nor exactly whatthe argument is, nor to what conclusion the author desires itshall tend. We have, moreover, pondered over the title of theessay, and have failed to discover any real or essential relationbetween "Abdominal Cellulitis" and the "Constitution of

Women," or to see how the latter can be illustrated by theformer. If there were anything sexual in the nature of cellu-litis in the female, we could understand the title; but seeingthat inflammation, exudation, and suppuration, are of thesame nature in one sex as the other, the first part of the titleof the essay is quite irrelevant to the remainder. That womenare more liable to abdominal and pelvic cellulitis than men isnot dependent upon their sex per se, but upon the incidentalviolence and conditions, which their sex and habits subjectthem to. A work on fractured bones might just as well beentitled " The Constitution of Men, as illustrated by Fracturesof the Skeleton"; because, forsooth, men are more liable tobroken bones than women. Dr. Bell may say, "What’s in aaame"? But we beg to assure him that a name is of great im-portance, and that a glaring absurdity upon a title-page is thesurest way to keep a book unread.

The first page of Dr. Bell’s broc7ture informs us that-" The phlegmonous inflammation which affects the inter-

stitial or cellular substance of the abdomen has been entirelyoverlooked as a distinct disease by all our systematic authorson midwifery and the diseases of females; and almost the onlyinformation we have regarding it in this country, previous toDr. Doherty’s valuable paper On Chronic Inflammation ofthe Uterine Appendages,’ is contained in some isolated cases,widely scattered through our periodical publications, and workson midwifery, in which it is described under as many denomi-nations nearly as there are authors."

In illustration of this sweeping assertion, our author quotesno less than twenty-seven persons who have written on the.subject, eleven of whom, being. countrymen of our own, re-

ported between them fifteen cases, besides several by Dr.Seymour, and several by Sir Charles Clarke ; while " Astrue," says Dr. Bell, " entered fully into the consideration of abscessesconnected with the womb, and described their symptomsminutely." This want of harmony between the exordium andthe next fourteen pages of the pamphlet is very singular. It

certainly is very difficult for some persons to begin a composi-tion; but however terrific may be the throes of a labouringauthor, we humbly conceive that it is hardly excusable tomake a sweeping assertion in limine, and then studiously en-deavour to confute it in the following third of the work. It

appears to us, too, that Dr. Bell has betrayed an unnecessaryamount of grief that authors should have bestowed such avariety of names upon the disease in question; a little con-sideration will show, that various as have been the exactnames given, they have, in the main, only been variations of acorrect generic conception of the pathology of the affection.That the disease was an inflammation, or an abscess, or a

" depot laiteux," or an " engorgement laiteux," is a*matter ofvery little moment, for the nomenclature would naturally bedetermined by the prevailing theories of the day. The im-

portant point is, did former authorities know the.-disease, havethey describedjjit with as much accuracy as could be expected,and did they know how to treat it? Our answer is, Yes.They knew far more about the matter than Dr. Bell imagines.Let anyone read the first fourteen pages of his pamphlet, andwe will guarantee him a very tolerable knowledge of the

’pathology and history of the disease. And yet we are toldthat it had been " entirely overlooked" until Dr. Doherty’stime.

After having depreciated the ante-Dohertian writers by hisexordium, and subsequently confuted himself most successfully,Dr. Bell proceeds to notice later authorities. After Dr.

Doherty, Dr. Churchill is the first whom he honours with a

remark. Then Professor Simpson is accused of having "added

nothing to our information with regard to the symptoms andcharacter of the disease, while he seems desirous to claim themerit of having first pointed out that this disease is liable toform several species of deep pelvic nstulse," and is broadlyhinted to have cribbed his ideas from Puzos and Levret. Dr.Lever is next disposed of as follows :-" He"-i. e., Dr. Lever-" advocates the opinion of its being a chronic disease, whichoccurs sufficiently often to attract the attention of the ac-coucheur ; but it is very remarkable that the cases which he

reports, and on which this opinion seems founded, do notjustify such a conclusion, as they are neither chronic in theirsymptoms nor duration. But of this subject we shall say morein a subsequent part of this paper." In spite of this flourish,however, Dr. Bell preserves a most judicious silence about theduration of the cases, and tries to pin his readers down to adefinition of what a chronic abscess is, winding up his obser-vations thereanent by a melancholy platitude about carefuldiagnostics. We have taken the trouble to tabulate Dr. Lever’scases and Dr. Bell’s also.

Average duration, from first symptoms of inflammation orapplication of presumed exciting cause of inflammation,to suppuration or inflammation-

So much for Dr. Bell’s deductions as to acuteness in point ofduration, and his attack upon Dr. Lever’s accuracy. Ourauthor goes on to say again that cellulitis generally does notoccur in the kind of subjects who would be likely to havechronic or cold abscess. Let us look at his own cases :-1. Isnot spoken of as regards constitution. 2. Had been exhausted

by her confinement, and a mammary abscess. 3. Was " verypale and emaciated." 4. Had a " painful and tedious labour."5. Was " of delicate and strumous constitution;" and, 6, wasa pauper, who had been delivered of an illegitimate child by abungling midwife. Thus in every case where the general con-dition of the patient is referred to, the statement of the authoris diametrically opposed to the conclusion he draws. Heascends to a general law by the curious method of ignoringhis particular instances. On referring to Dr. Lever’s cases, wefind that No. 1 occurred after puerperal fever. No. 4 was a

strumous-looking woman who had had a lingering labour; 7was a strumous subject; 8, died of phthisis a few months afterdelivery; and, 9, had been debilitated by diarrhoea and twoprevious miscarriages. Thus five outof nine were eminently pre-disposed to chronic or subacute abscess. On the whole we areinclined to think that Dr. Bell did not read Dr. Lever’s casesat all, and that he forgot all about his own before writing thefirst part of his own paper. Dr. Priestley’s elaborate descrip-tion of the pelvic fasciæ is dismissed as if it were beside the

question.We are constrained to ask one or two questions:-Who was

M. Recamie ! ? Is he the same person as M. Recamier ? Whatdoes our author mean by the word "incidently?" Is it a vari-ation upon inddentally? What kind of a worm is a lumbrici?Is " for which she got an astringent mixture" an approvedstyle at modern Athens? And was it necessary to report thevirginity of Miss M. ?Again: here is a passage at p. 24, which defies our most

strenuous efforts to understand it :-" Cellulitis, in place of always being a primary disease, the

result of cold or fright, is frequently, in reality, secondary dis-

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ease called into action by some mechanical exciting cause; andthat, from its deep-seated situation, and the peculiar delicacyand excitable nature of the surrounding parts, is often obscurein its origin, and virulent in its character."

This is what we call writing round a corner; and as we arepersons of ordinary mental vision, we do not profess to be ableto accomplish the feat of looking round it.The cases reported are in themselves very interesting, and

they are not badly described; but there is a great want ofcohesion in the essay itself. The style is meagre, and the

punctuation is inexcusably defective. The most redeemingfeatures about the pamphlet are the evident interest theauthor takes in the subject, and the careful industry with whichhe has collated his authorities.

THE EXMOUTH SANATORIUM TO THE DEVONCOUNTY LUNATIC ASYLUM.

To the Editor of THE LANCET.SIR,-You are doubtless aware that the experience of the past

ten years points to a steady increasing accumulation of chroniccases in our county lunatic asylums-cases which, however quietand orderly under the healing discipline of an asylum, are yettotally unfit and unsafe to be entrusted either to their friends,or to the authorities of the parochial union-house. All attemptsthus to clear the asylum invariably fail, and the patients sodisposed of are generally within three months returned to theasylum as dangerous either to themselves or others, and with agreat aggravation of the symptoms they presented on their dis-charge.And yet to retain all such cases in the County Asylum is

necessarily to close by degrees the door against the recentcurable patient, and to convert the expensive building, with itsvaried appliances for the curative treatment of mental diseaseinto a mere house of detention and safe-keeping for chroniclunatics-the very state indeed into which the great metro-politan asylums of Hanwell and Colney Hatch are passing.

This serious and increasing evil has not failed to attract theattention of the Commissioners in Lunacy, who, in their lastAnnual Report, recommend economically-constructed buildings,separate from the main structure of the asylum, for the use ofthe more quiet, orderly chronic and convalescing patients.

It is to a fuller development of this idea, as carried out byDr. Bucknill, at Exmouth, that I wish to direct attention.The over-crowding of the Asylum by chronic cases is an evilwhich, at the Devon Asylum, particularly in the female depart-ment, has been much felt. Now, Dr. Bucknill, to meet thedifficulty, adopted the bold and novel expedient of hiring alarge house at Exmouth, on the sea-side, capable of accommo-dating forty patients. To this house he has transferred thirty-eight of his quiet, harmless, and convalescing patients, placingthe establishment under the charge of an assistant medicalofficer, Mr. Symes, to whose kindly and judicious treatment ofhis patients I here gladly bear testimony. The fittings andfurnishings were sent from the stores of the Devon Asylum,about six miles distant. The diet scale is the same as at theAsylum, and the contracts are taken in the town of Exmouth,as near as may be at the same figure as in Exeter. The rentalof the house, with rates and taxes, is £130, or Is. 3d. per headper week for each of the forty patients accommodated, whilethe expense of rental per head in the County Asylum stands at3s. 6d. a week, as fixed in the contracts entered into by theDevon magistrates with the boroughs of Exeter, Plymouth,Bideford, &c. On this head, therefore, is a saving of seventyper cent. of rental. The rent charge of 3s. 6d. a week iscalculated on the actual cost of the Devon Asylum, and thiswas by no means an expensive building of the kind. At ColneyHatch the rental calculated at only six per cent. interest onthe cost of the building, would exceed 5s. a week for eachpatient.At a recent visit which I paid Dr. Bucknill, at Exminster,

I thrice visited with him the Sanatorium at Exmouth. ThEdrive from Exminster to Starcross (five miles), with the viewall the road, of the estuary lying like some quiet island lake.with its watching hills around, was a glad contrast with th(dismal London pavement. And, then, the sail over the noblEestuary, and the glorious view from the windows of the Sanatorium, of ocean and clouds, as the sun sunk behind those brighlred lights which are so lonely in our winter sunsets, right overthe hollow of the bay, whence the distant smoke of Tor

quay rose, added to the beauty of the scene. Surely, it struckme, here must even the troubled and weary mind find quietand so(,thing peace.

-

---The house, which is situated at some distance from the town,

is well adapted for its present purpose. It is surrounded by awalled garden, and it affords easy access to the sands. Thepatients were cheerful, happy, and busily employed in a roomlarge enough to dine forty people in comfort. All the con-valescing patients are sent for a time to this place before theirfinal discharge; and it has been found that their removal fromthe asylum wards, together with the agreeable change of airand scene, has had a marked influence in promoting recoveryand establishing convalescence. Many patients in feeble bodily.health, whose mental disease is chronic and inevitable, havegained strength and derived much benefit from the same in-fluences.

This success, pecuniary as well as medical, leads me to direct,attention to the advantage which Dr. Bucknill’s plan affordsof alike relieving the surplus population of an asylum, and ofproviding a sanatorium or house of trial for convalescents.And specially does the suggestion apply to counties distantfrom London, where large empty country houses are often tobe had at a nominal rental.

I would just add, that it is only in connexion with a largerasylum, from the wards of which suitable inmates for such asanatorium can be selected, that I recommend the plan. It isas an adjunct to the county asylum, not as a substitute, that itmerits attention and trial.The benefits which the Commissioners in Lunacy state to

result from the adoption of their suggestion of apartments de-tached from the main building of asylums, must trebly followthe influences of the sanatorium-the distinct house, the change,of air and scene, of Dr. Bucknill’s plan :-

" As a means of treatment, we consider this species of sepa-rate residence of the utmost importance, constituting, in fact,a probationary system for patients who are convalescing; givingthem greater liberty of action, extended exercise, with faci-lities for occupation; and thus generating self-confidence, andbecoming not only excellent tests of the sanity of the patient,but operating powerfully to promote a satisfactory cure. Thewant of such an intermediate place of residence is always muchfelt; and it often happens, that a patient just recovered froman attack of insanity, and sent into the world direct from alarge asylum, is found so unprepared to meet the trials he hasto undergo, by any previous use of his mental faculties, thathe soon relapses, and is under the necessity of being again Ie-turned within its walls."

I am, Sir, your most obedient servant,C. LOCKHART ROBERTSON, M.B., Cantab.,.

Berkeley-square, Hon. See. to the Association of Medical Officers, January, 1857. of Asylums and Hospitals for the Insane.

C. LOCKHART ROBERTSON, M.B., Cantab.Hon. Sec. to the Association of Medical Officers

of Asylums and Hospitals for the Insane.

POOR-LAW MEDICAL REFORM ASSOCIATION.AT a meeting of the Committee, which was most numerously

attended by members from various parts of the country, (R.Griffin, Esq., in the chair,) held at No. 37, Soho-square, onTuesday, the 10th inst., several letters were read from noble-men and other members of Parliament, expressive of theirsympathy and willingness to co-operate with the Committeefor an improved system of Poor-law medical relief. The presentposition of the question having been considered, it was resolvedto convene a general meeting of the Union Medical Officers andother members of the profession, to petition the Legislaturefor a redress of the grievances complained of. A sub-committeewas appointed to frame a petition for presentation to theHouse of Commons ; also one to be signed by the magistrates,

clergy, and other ratepayers, who feel that the present system

is unjust both to the poor and to the medical officers.

THE STUDENTS OF ST. GEORGE’S.A MEETING of the students of St. George’s Hospital was

held on Tuesday last-Charles Roberts, Esq., in the chair-forthe purpose of supporting Mr. Griffin’s movement, when, con-sidering that each hospital making a different set of resolutionsonly tended to complication, it was resolved to adopt thosepassed at the London Hospital (a report of which will be foundin THE LANCET of Jan. 17th, p. 75), as they were consideredthe best to answer the end in view.A committee was then formed to represent the hospital, con-

sisting of Mr. Charles Roberts, Mr. Wintle, and Mr. Clifton,and Mr. Hooper, hon. secretary. The thanks of the meetingwere then given to the chairman for the able manner in which

) he had conducted the proceedings.