577

explored, the patient has been sent away from the operftting-table with the stone unremoved, still free within the viscus, L e.,not encysted. It is. by no means improbable, that many ofthese have had for their cause a condition of things similar tothat described in the case before us. The concretion becomeseither temporarily or permanently lodged in the upper fundus,behind the pubes, and thus eludes the grasp of the forceps.And the origin of this seems indicated in the history givenabove. There had been incontinence for nine months pre-vious to his admission, consequently there was, as far as theretaining of urine is concerned, absolute loss of function, bythe upper portion of the bladder; it may therefore contract,and become fitted to form a kind of pouch, for any concretionwhich may get there. Once lodged, it is not difficult to coii-ceive how its rough external surface may attach it closely tothe mucous membrane in contact. With the stone in such aposition, it is clear that the forceps will at first not discover it;they must pass in a direction almost at right angles with theaxis of the incision, greatly increasing the difficulties ofrnanipulation, and then, probably, will rather force the stoneup behind the pubes than grasp it between their blades. As-certaining this to be the situation of the calculus in thepresent instance, Mr. Erichsen directed pressure to be madeimmediately above the pubes, and succeeded, by thismanceuvre, in accomplishing its extraction, with the aid of acurved scoop.

This, however, is not the first time in which such treatmentof the difficulty has been successfully adopted. Two some-what similar cases are reported in the London Medical Gazettcfor Aug. 15, 1845, as having occurred in the practice of thelate -Mr. Aston Key. It is there said of one of them, thatthe attempt to extract the stone would have been abortive,had not he (Mr. Key) directed pressure to be made above thepubes, so as to bring the calculus within the grasp of the for-ceps. The handles of the forceps, though depressed as muchas the wound would allow, could not carry the bladeshigh enough to reach the stone, and it required very firmpressure on the lower part of the abdomen to depress thestone sufficiently to enable the forceps to seize it. As soonas firm pressure was made, the stone could be felt to descendbetween the blades of the forceps." Again,Ň" It is in the re-treat of the stone before the forceps that the difficulty ofseizing it lies: the stone, instead of retreating in a direct linefrom the opening into the bladder, ascends behind the pubes,where the forceps cannot, without assistance, reach it, much.less grasp it."Of these two cases, the present report forms an excellent

illustration. Taken together, they are most valuable, as

affording a solution to one of the many difficulties which thelithotomist may be called upon at any time to encounter. Theutility of making abdominal pressure under the circumstancesdescribed is not alluded to in any systematic work on the sub-ject ; nor has there been any recommendation or report of it,that I am aware of, excepting the one above quoted, and it ison this account that special attention has been called to it,and its importance referred to in the foregoing remarks.

Reviews and Notices of Books.

..."’lemarks on Insanity: : its Nature and Treatment. By HENRYMoNRo, M.B. Oxon.,* Fellow of the Royal College of Phy-sicians. In Two Parts. Part I. London. 1850.

UNDER this unpretending title, the reader will find some veryinteresting and instructive observations on insanity. He willherein see the impressions conveyed to an earnest and philo-sophic mind, practically engaged in the study of the phenomenaof mental disease. The views which the author adopts as tothe nature of insanity cannot be more clearly expressed thanin the following words:-Without seeking for any more subtle or metaphysical

cause for insanity, we may believe insane phenomena toarise from those states of irritability and defcciency of actionin the sensorium which are the consequences of loss of ner-vous tone ;-that these two degrees, of morbid excess, andsuspension of function, fall coincidently upon different partsof the sensorium; that the first condition affects particularlythe seat of the more elementary phenomena of mind, and

* Dr. Monro here acknowledges himself as the author of the Essay on’Stammering, by M.B. Oxon, which has been already favourablf noticed inTHE LANCET.

that the latter condition, of suspension or partial paralysis ofcerebral power, affects particularly the seats of the higherfaculties :’

This view the author supports by, in the first place, con-sidering the general condition of the insane mind, and de-scribing the several modifications which constitute the diffe-rent forms or varieties of insanity; and, secondly, by discuss-ing the nature and causes of several mental phenomena, whichin many points resenible those which exist in insanity. Thesephenomena being admitted to depend on impaired nervoustone, he seeks by analogy to support his views of the natureof insanity by referring both to the same source.The author then advances a second inference, that this state

of nervous depression in the insane is consequent upon aconstitutional and congenital want of vital power in the brain.External agents act as exciting causes of this loss of vigour,but both the predisposing and proximate causes are in theorgan itself. On this frame-work is woven a series of most

interesting and instructive facts, observations, and inferences,Throughout the essay, the author seems careful to regard

nervous matter or material simply as the instrument by whichmental phenomena are manifested, and, though he confineshis attention to showing, in the present part, the probability ofthe view which he adopts, reserving the proof until he comesto consider the actual physical ccndition of the insane, andthe results of treatment, we cordially recommend the worknow before us, to all who take an interest in studying thenature and treatment of insanity.

A Treatise on Diseases of the Larynx and Prachea embracingthe dijferentforms of Laryngitis, Hay Fever, and LaryngismusStridul1ls. By JogN HASTINGS, M.D., &c. 8vo. pp.160.

THiRTT-FouR years ago, Sir Charles Bell first drew the atten-tion of the medical world to the practicability of applying asolution of the nitrate of silver to the interior of the larynx,for the relief of diseases of those organs. The boldness, how-ever, of the measure, which no doubt to many seemed im-

possible, and to others fraught with great danger, operatedagainst its adoption; and the practice sank into oblivion formany years. In 1846, Dr. Horace Green, of New York, re-vived, in America, Sir Charles Bell’s plan, of the direct ap-plication of caustics to the mucous membrane lining thelarynx and trachea, by means of a sponge attached to a curvedwhalebone. The credit is due to Dr. Hastings for having re-vived this method of treatment in England; and he hasfarther developed the resources of this kind of medication onthe mucous surfaces of the windpipe to a greater extent thanhas yet been done. Besides the employment of the nitrateof silver, he has made us acquainted with the use of thebicyanuret of mercury, which appears to possess great efficacyin laryngismus stridulus, a very rebellious disease at all times,and which frequently ends fatally. Speaking of the first casetreated by this method, he thus expresses himself :-

" So gratified was I at the result of the treatment in thiscase, that I have pursued the same plan ever since, and, ex-cepting in one instance, with uniform success. I have treatedin all fifteen cases; the bulk of them have recovered asquickly as the one above mentioned; and in those that wereslower in regaining their health, the severity of the symptomsrapidly diminished, lingering only with a slight amount of thedisease. The case which had a fatal termination was compli-cated with congestion of the brain; and can hardly be said tahave been under my care, as the child died the day after Isaw it, from cerebral convulsions, from which it had re-peatedly suiFered."—p. 157.The author has shown, in a concise manner, that this treat-

. ment is extremely beneficial for all forms of laryngeal disease;and he has availed himself of various modifications, both asregards the caustic to be used, the strength of the solution,

and frequency of application, in the different varieties of

these affections. For the modus operandi, we refer the readerto the book itself, which gives full directions, as well as wood-

578cuts of the instruments that are necessary in the application.Of caustic to the parts.We cannot, however, close our notice of this little work

without observing, that, in the preliminary chapters on the** symptoms, causes, diagnosis," &c., are some valuable obser-

vations, from which the practitioner may gather real informa-tion.

Oratio Harveiana in -,Edibus Collegii Begalis Medicorumhabita, die Junii 29, 1850. A JACOBO ARTURO WILSON,M.D. Londini, 1850.

IT has rarely been our lot to read anything so spirited as thisOration, whether in its subject matter or its latinity. Wewill adduce a few examples.And first we quote the account of the late invasion of the

cholera, and the contumelious conduct of the governmenttowards our profession on that occasion :-

" Respicite, igitur, in annum vix prseteritum, vos, Prmses etSocii! qui mecum huic solenni orationi inserviatis! In triviis- per vicos-per aperta rura-apud ipsas Baias, qui pavor!quantus luctus! quae frequentia funerum! Q,ua? haec estimmanis morbi species! haec mortis imago nova—Annusnefastus!-Collegio nostro, prae cseteris, heu! sine gloriamemorabilis. Annus, in quo, huic urbi insolita et saevisslma.peste diu ingruente, tum postea universum Angliae regnumvastante, Collegium hoc Regium Medicorum Londinensium,neqne a senatu, neque a consiliariis reginm intimis, neque aprastore regio ad res domesticas administrandas designato, neunå quidem vice vel voce, in auxilium salutis publiem vocatumest! Neque in curia, neque in foro, prmvalento morbo, voxnostra audita est. A nullis nostri penculum factum est consilii!"Per cor et sanguinem Harveii! Quid est, si hoc non contu-

melia est! Nec satis erat hanc aciem nostram medicorum in-structam, in morbo insolito oppugnando, ne ad succursumquidem adhibere,-nos sic negligere, et sic negligendo pronullis efficere; quinetiam ex adverso, nobis, Apolline duce, inpestem dimicantibus, ad Mercurii fabri officinas in vico prox-imo Aulae Candidae constitutas, signa, si operosa et sanitaria,certe non medica, consiliarii regii, ad hoc delecti, sustulerunt., Diversae voluntates civium fuerunt, distractaeque sententise.’Non enim consiliis solum et studiis, sed armis etiam et castrisdissidebamus. Erat autem obscuritas quaedam, erat certameninter clarissimos duces, multi dubitabant quid optimum esset,multi quid sibi expediret, multi quid deceret, nonnulli etiam. quid Iiceret/ Post hanc tam turpem immeritamque repulsam,post hanc quasi ignominiae notam parietibus nostris auctoritatepublica affixam,nunc iterum ad Harveii festum inhac concionedomesticâ congregati, nos invicem et ex corde gratulemur,qu6d, dum pesti oppugnandum erat, domus nostra ab ipsis suis-nuham interiorem maculam suscepit."

And next, what a tribute is paid to the general practitionerof these realms. After having stated the conduct of thepresident and fellows of the Royal College of Physicians, theorator proceeds:" Neque id solum de medicis hujusce nostri ordinis affirmo,

- Sed etiam de omnibus in omni genere per universum Angliseregnum medicinam exercentibus. Profectb de nobis ipsis inBiedicina doctoribus vel omnino tacendum est, dum fratresnostros,quamvis sine doctoratu, medicos respicimus, in nosoco-miis, in carceribus, in ergasteriis, in vicis et angiportibus omniilluvie inquinatis, nocte dieque, per menses sestivas et autum-nales, decies vel centies pro una vice nostra in peste oppu-gnandaoccupatos. Quse fortitudo! Constantia, fiducia, quamadmirandse! Quas vigiliae! Quanta dispendia et rei et virium!Quae incuria sui!"In the month of Oct, 1849, the late Dr. Burton announcedthe

fact of the invasion of this dire disease at St. Thomas’s. Thisamiable and lamented physician was amongst the first to becarried off by it! Of Dr. Burton our orator thus speaks:-

" Et vltaa et mortis exemplo sit nobis ille frater noster de-lectus,—cum in omni tempore, virtutibus, industria, ingenio,a. nemine obliviscendus, turn, hoc praecipuè die, merito atqueoptimo jure suo, in pathologiâ sanguinis exquirendå, cumHarveio ipso celebrandus. Nam sanguinis cursum, auctore etduce Harveio, duplici via insecutus, attigit, et ratione et oculis,lineam istam caeruleam margine gingivarum circumscriptam,qua teste, venenum Saturninum in venis et visceribus penitusreceptum quasi in conspectum medici proponitur. Profectb,

ex hue tam simplici ratione rei, Henricus noster monumentumsibi exegit, quhmvis e plumbo, sere perennius."We next come to the orator’s notice of the late Dr.

Prout, of whom, even now, not enough has been said. Hehas passed from amongst us in the same quiet manner inwhich he lived amongst us. But he has left a great andenduring name. To him we owe all that has been done

during the last quarter of a century in promoting our know-ledge of urinary diseases, and not a little of what has given agreat name to Liebig. The Harveian orator thus speaks of himimmediately after his notice of Dr. Burton.-

" Prout hie, sic ille alter, quem e nostro numero amissumhodie lugemus, per vires ingenii et industria? insitas, materiemnaturse, ab aliis rejectam vel minim6 expetitam, sibi et surefamae inservire coegit. Praeclarus hic plumbo, prout ille urina’Ad scientiam excolendam, tanta est ex rebus omnibus laborisoccasio et copia. In materia morbi indaganda, lex nostra phi-losophiae recens hand minus quam avide de minimis curat.De philosopho illo sexagenario, menses abhinc tres adhuc vivo,sedulo, operoso, quomodo, nisi ut de philosophia ipsa, licetloqui? In foro et triviis hujusce nostrse Romae, dum ad clien-telam suam incedebat, quis et qualis, si non philosophus, anteora hominum exstare visus est ?-gressu properante, sedtacito,—vultu demisso,—habitu humili,—vestitu quam modesto - etiam in fumo, pallore candidus,-ad strepitum surdus,-adopes non magis quam modice attentus. Me semper pigebat,-et, inter colloquia nostra, annos abhinc viginti, saepe eumsic alloquehar,—quod, in succis animaliblls a sanguine ex-cretis tam assidue et tam feliciter versatus, a sanguine ipso,vivo, universo, omnia omnibus ministrante,-a sanguine nonsolum passim recipiente, sed etiam passim agente, quasi animoaversus foret." Grata et constans sit Proutii nostri apud nos memoria, non

solum quod in pathologia chemica fere primus viam medicaminstituerit, sed qu6d alios ad se ipsum aemulandum viribusingenii sui suscitaverit."Do not we all remember the original of this picture so true

to nature*—"gressu properante, sed tacito, vultu demisso,.pallore candidus,"-and, remembering, lament that we shallsee that face no more ?

.

But here we must conclude our quotations; we cannot doso without again thanking Dr. Wilson for the gratification:hehas anbrded us.

______

A mirrorOF THE PRACTICE OF

MEDICINE AND SURGERYIN THE

HOSPITALS OF LONDON.

KING’S COLLEGE HOSPITAL.Occlusion of the Vulva after Measles.

(Under the care of Mr. FERGUSSON.)THE exanthemata, when severe, are followed by sequelae of sucha description as sometimes to interfere materially with variousfunctions; thus we have discharges from the ear after scarla-tina, and more or less deafness, cicatrices on the cornea aftersmall-pox, and partial blindness, &c. In a case which we

published last week, lupus, of a very destructive kind, followedupon an ulcerated throat accompanying scarlatina, and wehave now to record a rather unusual effect of an ulcerationconnected with measles-namely, a complete occlusion of thevulva. It will at once be apparent how inconvenient must besuch an occurrence, and how earnestly we should strive, whenulceration has attacked an inlet or outlet of the body, to fore-stal its occlusion.The patient is a little girl, six years of age, who was ad--

mitted some months ago into Victoria ward, under the careof Mr. Fergusson. The labia majora had quite united, andpresented, instead of the opening of the vulva,alinear cicatrix,the escape of the urine taking place through a fistulous openingin front of the anus, of which latter there was some prolapse.The mother stated, that at the beginning of this year, the! child had been attacked by the measles; towards the fifth