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the chest, and the dulness at the base of the lungs was found tohave much diminished ; but little crepitation could be heard.On the following morning (5th) the tracheal sound was much

softer, and the inspiration more prolonged; bowels open; theurine plentiful, and containing a normal amount of chlorides ;skin warm and moist. The little patient is cheerful, and wantsto sit up; is reported to have passed a good night. The dulnessover the bases of the lungs has disappeared, and vesicularbreathing is everywhere heard; pulse 112; respiration 28.On the morning of the 6th, the ringing tracheal sound had

almost ceased ; only a roughness in the sounds of inspirationand expiration could be traced, with a slight occasional recur-rence of the ringing tone. The cough had become infrequent,and the chest sounds were nearly normal; respiration 24.On the 7th, the child was able to sit up and play, and ap-

peared convalescent, and from this time forward she progressedquite favourably, being discharged cured on the 12th. Fromthe date of the 7th, the nitric acid was given only every fourhours, and so on, at increasing intervals.CASE 2.-Wm. W. C-, aged two years and five months,

admitted Dec. 29th, 1860, at half-past eleven A.M. The motherstates that the child went to bed the preceding night appa-rently well, but awoke in the morning with great distress ofbreathing; a loud noise in the throat was heard, and there wasfrequent harsh cough.On admission, the following was the patient’s condition :-

Countenance very anxious, and somewhat dusky; cough fre-quent, loud, and brassy; inspiration characteristically " croupy;’chest everywhere resonant on percussion; breath-sounds quitemasked by the noise in the trachea; tonsils of normal size;bowels open; urine scanty; appetite indifferent; thirst onlyslight; skin cool and somewhat moist; respirations 32. Tohave a hot bath immediately, and then to be wrapped inblankets sprinkled with mustard; this measure to be repeatedin the evening. Ordered six minims of dilute nitric acid intwo drachms of water every half hour. Beef-tea and milk (hot)to be given frequently. The bath was followed by a markedincrease of the general temperature of the surface and notableperspiration, and the colour of the face became natural. Atone P.M. the cough was somewhat less frequent, otherwise.there was no great change. Respirations 36 ; food and medi-cine taken with difficulty.During the night the cough and croupal inspiration became

louder, and at five A.M. on Dec. 30th the respirations were 60in the minute; the skin was cold and purple, and the coun-tenance indicated great distress. Repeat the bath, and applya mustard poultice to the throat and chest.-Ten A.M.: Thesymptoms have greatly improved, and there is much less dis-tress. Skin warm; lips red; restlessness much diminished;respirations 40. Repeat the bath. ,

In the course of the afternoon a relapse occurred; the tem-perature of the surface fell, the respirations rose to 46, thetracheal sound became louder, the cough more frequent, andthere was increased restlessness and anxiety of countenance.At nine r.M. the respirations were 60 in the minute, and thebath had failed to produce its usual good effect. At ten P.M.Dr. Radcliffe ordered forty minims of ipecacuanha wine, which,however, failed to excite vomiting or give any relief. At half-past eleven P.M. the respirations were 52, and the child wasin every way much worse; and at twelve P.M. the respirationscould hardly be distinguished, there was no pulse, the skin wascold and clammy, and the lips quite blue. Tracheotomy wasat once performed by Mr. Slaytor, the house-surgeon, and anopening was effected into the trachea, with the loss of scarcelyhalf a drachm of blood. The forceps were introduced, and theopening made patulous, but no signs of returning animationappeared, and accordingly artificial respiration was immediatelyresorted to by Mr. John March, and kept up steadily, thoughfor a long time the case seemed hopeless. At the end of anhour and twenty minutes, however, during which time theartificial respiration had been unceasingly kept up, the pulseand breathing gradually returned, the tube was introduced,the child was laid before the fire, and an enema of wine ad-ministered.At a quarter to two A.M. (31st) the skin was warm and the

lips red; there was no cough; the respirations were 72 in theminute. An enema consisting of half an ounce of port wine,a drachm and a half of brandy, and two ounces of beef-tea wasordered to be given at once, and repeated every three hours.The tube was frequently cleaned out with a feather, and atfirst much flaky mucus was brought away; but this soon

ceased, and during the next twenty-four hours but little mattercould be removed, although every care was taken to clear thetube. The child was wrapped in blankets, and kept near the

fire. It lay very quiet all day, but could not bear to have itsarms covered up by the clothes. Gradually the temperatureof the surface fell, the face became livid, and at half pasttwelve A.M. (Jan. 1st) death took place, after two or threesevere struggles for breath, twenty-four hours after .the per-formance of tracheotomy. The respirations, three - quarters ofan hour before death, were 36 in the minute.

Necropsy.—A thin, tenacious, pseudo-membrane lined thetrachea from the site of the operation downwards to the bifur-cation of the tube, and extended slightly beyond it into eachbronchus. The bronchial tubes generally were very red, andfilled with a thin, red serum. The lungs were much engorged,but everywhere crepitant; and there were no adhesions of thepleurae. The larynx itself was free from any remains of theexudation, which were only discovered below the site of theoperation. The heart was healthy, and its cavities nearlyempty.

ST. MARY’S HOSPITAL.FOUR CASES OF CYNANCHE TRACHEALIS ; TRACHEOTOMY

PERFORMED IN TWO, WITH RECOVERY IN ONE.

(Under the care of Dr. HANDFIELD JONES.)’CASE 1. -A-, aged four years,*-female- ’-seen June 26th,

1860, with bronchitis. In the afternoon of the same day symp-toms of croup appeared, and became very. grave by the eveningof the 27th. Two leeshes were applied to the top.of the ster-num, and the bites bled freely. Antimony was given in fulldoses for twenty-four hours, to-produce,emesis, without any goodeffect. The child had a hot bath up to the neck twice,: and theneck was well fomented. On the evening of the 27th, the pulsewas 128; respirations. 40. Tracheotomy was seriously con-sidered, but postponed for twelve hours, and calomel .and.

antimony given. - Death occurred, however, in four or- fivehours.CASE 2. - S. C-, aged sixteen months; attacked with

croup on July 10th, 1860, treated with antimony and calomel;vomited once from the effects of antimony; took altogetherthree grains of calomel. On the night of the 12th, dyspnoeawas very urgent; lips livid; backs resonant, but air not heardentering. Tracheotomy performed with immediate relief.July 13th, 1860.-The general state was pretty satisfactory ;

the air entered well into the lungs, but the pulse was rapidand excited, and the breathing quick. There was some diar-rhoea. Medicine had been left off, and wine given.

14th. -Breathing very bad in the night; now 63 in aminute; pulse 124. Some rfiles in the backs; diarrhœa quiet.

16th.-Breathing very frequent; evident signs of pneumonicconsolidation going on in the right lung.17th.-The patient died at five P.M.CASE 3.-B. D-, aged two years and three months,

female; seen on July 7th, 1859, about five P.M. She washoarse yesterday; symptoms of croup set in this morning,and are now very grave, the face and lips becoming livid.Antimony has been given in full doses all day without advan-tage. Tracheotomy was performed with immediate relief, andacetate of ammonia and nitrate of potass given as medicine.The tube (a single one) was frequently sponged out, withoutremoving it. She went on very well; but it was a long whilebefore she could bear to have the oritice of=the tube at all ob-structed-more than s;x weeks. Altogether the tube was keptin about ten weeks, at the end of which time she removed.,itherself, and the opening closed immediately. She had beenperfectly well in health for some time. Very shortly after, theremoval of the tube she got a slight attack of bronchitis, whichyielded easily to remedies. The following year, about t4esame time, she had another severe and perilous attack of croup,for which tracheotomy had almost become necessary; but underthorough nauseant and emetic antimonial action the -stress ofthe disorder was checked, and recovery ensued. The case wasunder the care of Dr. Palmer, of South wick-street, with whom,on the first occasion, Dr. Jones saw the patient in consultation.CASE 4.—A boy, about ten years of age, after ailing for some

days, became seriously ill with croup. He was treated withfull doses of antimony with some relief, and with calomel tothe extent of producing green stools. On the morning of thethird day, however, the difficulty of breathing was so con.siderable that Dr. Jones recommended tracheotomy to be per.formed. The surgeon who was attending with him, however,declined to operate, and senega and ammonia were then given

340

every three hours. About nine r.M., he had become muchworse, and tracheotomy was performed with immediate reliefto the dyspncea; but his strength was exhausted, and he diedby asthenia in about twenty minutes after the operation.The instruction derivable from the foregoing cases seems to

be briefly this: not to delay tracheotomy as soon as it appearsthat the disease is not likely to yield to a full exhibition ofantimony or ipecacuan.

GUY’S HOSPITAL.CYNANCHE TRACHEALIS, SUBSEQUENTLY RELAPSING INTO

BRONCHITIS ; RECOVERY.

(Under the care of Dr. OWEN REES.)

THE notes of the following case were taken by Mr. A. N.Cookson, one of the pupils :-

Daniel J-, aged three years and nine months, admittedinto Lydia ward on the 15th of November, 1860. When first

brought into the hospital he had been suffering from croup foreight days; and so severe were the symptoms prior to admis-sion, that the surgeon who had been treating the case hadgiven up all hope of his recovery.He appeared tolerably well during the intervals of the cough,

though very irritable, desiring not to be touched, and refusingto put out his tongue when requested. His breath was of awheezing character, and when the fits of coughing came on hebecame livid and blue in the face from retarded circulation to-wards the right side of the heart. His mother, who was her-self a patient in the hospital, could not give any history of thecase besides what she herself had heard, as the child had beenunder the care of her friends. Mr. Stocker was sent for on thenight after admission, and prescribed twelve minims of anti-mony wine in two drachms of water, every two hours.

Nov. 16th.—He was seen by Dr. Rees, and appeared greatlyexhausted. His mother said that he coughed up much phlegm,but was unable to spit it out, and consequently it was alwaysswallowed. The mixture to be repeated, and two grains ofcalomel were ordered to be taken at bed-time.17th.-The bowels had not been acted upon by the calomel,

which was accordingly repeated, strict orders being given tosee that it was not spit out after taking it into the mouth.

19th.-Breathing is improved a little, but the cough seemsas serious as heretofore, and he is still very weak. Orderedeight grains of sulphate of zinc.22nd.-The emetic had no effect, and the calomel-and-anti-

mony mixture was ordered to be repeated.24th.-Breathing is still wheezing, and he gets no continued

rest from the constant cough, during the paroxysms of whichthe veins in the head become congested and he appears blue inthe face.26th.-Ordered a drachm of antimony wine every hour for

five hours, till vomiting is produced.27th.-Medicine produced no effect, but the bowels were

purged freely.29th.-The cough now resembles that of pertussis, and a

" whoop " was heard.Dec. 1st.—The child is much emaciated, having eaten no

food for three weeks. Dr. Wilks saw him, and prescribed fiveminims of ipecacuanha wine, three of paregoric, and three ofdilute nitric acid, every four hours, in a drachm of water.3rd.-Cough relieved by the medicine.4th.-He now begins to show a desire for food, and with the

return of his appetite he appears less restless and irritable thanheretofore; but he is still much emaciated. The cough seemsto have extended from the trachea to some of the bronchialtubes; having changed, in fact, from croup to bronchitis.20th.-Cough still troublesome; the appetite is, however,

good, but he frequently vomits what is taken in the way offood.He subsequently left the hospital, very much better and free

from all danger.

ROYAL FREE HOSPITAL.URINARY CALCULUS IN A FEMALE INFANT, IMPACTED IN

THE URETHRA, CAUSING RETENTION OF URINE.

(Under the care of Mr. THOMAS WAKLEY.)ONE of the causes of the rarity of stone in the bladder of

females is the shortness of the urethra, and the facility withwhich small calculi pass from the bladder along this canalwithout impediment. This circumstance explains the great

difference observed in the statistics of the frequency of stonein the two sexes, published by Civiale, Coulson, Crosse (ofNorwich), and other standard authorities. Impaction of acalculus in the urethra of a male child is by no means infre-quent ; on the other hand, it is a rare and exceptional circum-stance in the female. Most surgical writers dwell upon thefact of impaction in the male urethra of the young, its conse-quences, and the means of removing it. The same peculiarityin the female is not even referred to. We are glad, therefore,to have an opportunity of placing upon record the followingvery rare case of a female infant, only six weeks old, whohad a stone lodged in the urethra, causing actual retentionof urine. Its removal completely obviated this inconvenience.The case is also interesting as showing the commencement ofthe formation of a stone some time prior to birth.For the notes of the case we are indebted to Mr. John D.

Hill, house-surgeon to the hospital :-Mary F-, the mother of the child, applied for an out-

patient’s letter on March 1st, 1861, making the followingstatement :-" Three weeks after birth she first noticed thatthe child cried after passing urine, and since that time appearedto suffer more or less after micturition. On one or two occa-sions the linen was stained with blood, and the urine dark-coloured at the same time. During the last week nothingwould pacify the child ; she was incessantly screaming; theappetite had fallen off, and she could get no sleep." She ap’plied more particularly for relief for the child, because no urinehad been passed for eighteen hours.On examination, the distended bladder could be seen and felb

above the pubis. The meatus urinarius was swollen and tender.On introducing a probe, the presence of a foreign body was de-tected by Mr. Hill, in Mr. Wakley’s absence. A small pair offorceps were inserted into the urethra, and a calculus removed,of nearly oval shape, and flattened on each side. Its composi-tion, as seen by the microscope, was found to be lithate ofammonia, with phosphatic deposit filling up the depressionsupon its surface.

The bladder was immediately relieved, and the child’s healthimproved without a bad symptom.

CALCULUS IN THE BLADDER OF A MALE CHILD ; LITHO-

TOMY ; RAPID RECOVERY.

(Under the care of Mr. THOMAS WAKLEY.)IF corroborative evidence were required to support the well-

known statement of Mr. Coulson, that " in estimating the risksof lithotomy age is an essential element in the reckoning, theoperation previous to puberty being a very different affair fromwhat it is after that period," the accompanying case wouldform a very happy illustration. During our visits to theLondon hospitals we frequently witness the considerable suc.cess which attends lithotomy in children. The almost im-mediate relief to the little sufferer, and the rapid recovery afterso important and serious an operation, are highly interesting.Mr. J. D. Hill has kindly furnished us with the following

short notes of the case :- .

Frederick C-, aged three years and a half, was admittedon the llth ult., with the usual symptoms of stone in thebladder, which had existed about six weeks according to the-mother’s statement, although the stone, from its size, must-have been present for some time, without producing any incon--venience. Latterly he had become much wasted and ex-hausted, and on examining his bladder Mr. Wakley readilydetected a calculus.March 14th.-The little patient having been carefully pre-

pared for the operation, chloroform was administered by Mr.Irvin, house-physician, a No. 5 sound introduced, and the stoneeasily found. Mr. Alexander Marsden having inserted andheld the staff, Mr. Wakley performed the usual lateral opera-tion with the loss of scarcely more than a teaspoonful of blood.The operation was of the ordinary character; the stone wascaught in the first gush of urine and instantly extracted. Theknees were tied together, and the patient was removed to his

bed..

15th.-The wound is very healthy, and urine flows freely-

through it; and, excepting the pain caused by the urine pass-ing over the incised surface, the child appears quite comfortable,

i and takes his food with a relish.