ployed to a sufficient extent to satisfy any one of its total inefficacy in the disease under consideration. With regard to the pathology of tetanus, Mr. Brodie has never seen any thing the matter with the medulla spinalis, or its membranes. Others are said to have found inflammation, but there is some little reason to suspect that the tortuous vessels, which naturally ramify on the membranes, have been taken, or rather mistaken, for disease. Mr. Brodie, however, has witnessed of the premonitory symptoms of tetanus the morning before the operation. The tetanus was rapidly developed after the limb was removed, and the boy died in less than 24 hours. Many other very interesting observations were made by Mr. Brodie in the course of the lecture, from which we have selected only the more prominent features. In our next we shall detail some cases three cases of opisthotonos following in- of stone in the bladder. From the notes of the dissection it appears that the internal plantar nerve was affected by the inflammation induced by the wound in the cellular structure, and imbedded in the lymph that was effused. A case somewhat similar occurred to the late Mr. Ewbank. A man had a pitchfork run into his leg, which was followed by tetanus, and he died. On dissection it was found that the prong had penetrated to the peroneal nerve, which seemed to have been bruised, and was implicated, as here, in the inflammation set up. . Mr. Brodie, in the next place, adverted to the question of amputation, or excision of the part that has been injured. Either operation may be performed at two periods-before the occurrence of the symptoms, or after. With regard to the first, we should remember that tetanus is a very rare consequence of injuries; and besides the absurdity of operating on so distant a chance, we can never be sure after all that the symptoms of tetanus will not be as likely to follow our wound as the one we are removing. Mr. Brodie has known it occur after amputation of the mamma, and the operation of tying the external iliac artery. If the symptoms have set in, there is neither experience nor analogy to favour the idea that removing the part which is injured will remove the morbid action in the system to which it gives rise. In one case, however, Mr. Brodie unintentionally made the experiment. A boy was admitted with compound fracture of the leg, which was followed by gangrene of the limb. Mr. Brodie performed the operation whilst the gangrene was spreading, but subsequently found that the patient had complained ST. THOMAS'S HOSPITAL. CASE I.-A young woman, aged 20, The appearance of the cavity now is very remarkable, for its sides being elastic, do not lie flat, but are partially erect. Mr. Green once had a similar case. It was in a child which was born with a tumor opposite to the ischiatic notch, containing fluid. This was opened, and the cyst then took on the character of true skin; and the consequence was a permanent unsecreting cavity within one of the nates. Mr. Green thought of destroying the cyst with caustic, but was afraid of doing so on account of the vicinity of the deepest part of it to the pelvic viscera. In such a situation the deformity would be immaterial, but on the forehead it must be very disagreeable; and yet it is difficult to determine how it ought to be removed; for there is so small space between the bottoin of the cavity and the bone, that any attempt to destroy the cyst must almost inevitably lay the cranium bare. CASE II-A boy, aged 16, came to the Hospital July 29th, with a tumor on the forepart of the head, of the form and relative size represented in the annexed sketch. He had had it from the age of three months, and it had attained its greatest magnitude when he was three years old; and from that time had altered very little. It was perfectly soft and compressible, and evidently contained fluid. Mr. Green removed it by making two curved incisions, so as to embrace a portion of the skin covering its upper part, and then dissected the cyst out entire, with its contents. It adhered firmly to the tendon of the occipitofrontalis, and, in other parts, the skin invested it very closely, and the operation was, in consequence, a little tedious. A small artery, which bled rather freely at one of the edges of the divided integuments, was tied, and the flaps of skin were then laid over the wound, and secured by adhesive plaister. G. years of age, was admitted in President ward, under Mr. Vincent, on the evening of the 31st of May last, having received a severe lacerated wound of the scalp, from the kick of a horse. The wound was of a triangular form, with its base situated about an inch and a half above the external meatus, and its apex about as high as the middle of the parietal bone, on the right side; each side of the angle was about three inches in length. The parts were much lacerated, and a large portion of the scalp was pendulous, which afterwards sloughed off. The bone was denuded of its pericranium about the centre of the wound. Although there were no decided symptoms of concussion, the child did not answer questions when put to him for the first three or four days, and there was a great disposition to be drowsy; he did not eat any food, and there was a great flow of blood from the nose. Ordered five grains of jalap and one of Calomel directly, and castor oil in the morning. On the following day the pulse was quick and full, and he was Ordered to have six leeches applied round the wound, and an aperient enema was administered. The effervescing draught every six hours. The bowels were opened by the enema, and the child was better the next day. All through the month of June the wound was endeavouring to throw off the slough, during which time he was very low: he required a large supply of nourishment; he was occasionally feverish, and always appeared languid. He took the Hyd. cum Cretâ, gr. iij. every six hours, and a lotion of the chlorate of soda was applied to the wound every day previous to the poultice. On the 5th of July, being now very much reduced, he was ordered an ounce of wine daily. The pulse was very small, and the wound had made very little effort to granulate. On the evening of the 6th he was taken with a convulsive fit, which lasted three hours; his feet were put into warm water, and he had a tea-spoonful of syrup of poppies, which was ordered to be repeated if necessary. On the following day his mouth was drawn towards the left side, the eye-lids hung more than half-way over the globe of the eye, and the countenance looked depressed and anxious; pulse very small and frequent. Ordered Hyd. Sub. gr. j. Pulv. Jalapæ gr. v. statim. Also Hyd. c. Cretâ gr. iij. 6tis horis. From this day up to the 12th he had no more convulsions, although his limbs were twitched occasionally. The pulse was languid, and the countenance remained anxious; there was a disposition to sleep, and the eye-lids continued to hang over the eyes; the pupil was not dilated, and the mouth remained drawn towards the left side. For the last day or two he had refused to take his food, and had been evidently sinking. The wound had suppurated, and some pus was pressed out from between the scalp and the bone; matter had been evidently formed somewhere, and there was a question whether this was situated immediately beneath the bone or between the membranes, or even in the substance of the brain itself. The chances were not very favourable to the first question; but as the child must have died had he been left alone, though the chance was small, it was determined (with the united consent of Messrs. Vincent, Earle, and Stanley-Mr. Lawrence at that time not being in the Hospital) to perforate the bone with a trephine. This was accordingly done by Mr. Vincent on the 12th. Upon raising the ring of bone which the instrument had made, nearly a tea-spoonful of matter made its escape. There was a deposition of lymph upon the inner surface of the bone, which appeared to have been connected with the surrounding parts. The dura mater did not look healthy, but was puckered, and with some deposition upon its surface. The child bore the operation well, though it did not effect any alteration in the symptoms, the mouth still continuing drawn towards the left side of the face, and the eye-lids being still drooping. The pulse was not at all accelerated. In the evening, eight hours after the operation, he was still in the same lethargic state as he had been in during the preceding six days. The pulse had not risen or altered from its previous character: he had refused to take food since the operation. The bowels had not been open. Ordered to continue his medicine. He continued to sink till the 15th, when he was seized with another convulsion fit, in which he died. Sectio Cadaveris.-Upon removing the skull cap the dura mater was found to be more adherent than natural every where over its surface, but more particularly around the seat of the injury, where there was a very considerable alteration in its structure, and increase in its thickness, with a deposition of lymph upon that surface which was next the skull. About an inch and a half posterior to the perforation made by the trephine, there was a small hole, which admitted the blunt end of a probe. This hole communicated with an extensive abscess beneath, in the substance of the posterior lobe of the cerebrum, containing thin flaky pus. This cavity extended down towards the base of the brain, and communicated with the lateral ventricles. Carcinomatous Ulcerations of the In guinal Glands and Penis. Thomas Carnie was admitted in Henry's ward, under the care of Mr. Lawrence, July 9th, having a couple of schirrus of the penis. He gave the folindurated buboes in the groins, and a lowing history of his case. He had had gonorrhoea five or six times in the course of his life. Two years ago he caught a clap, which was severe, and attended with considerable inflammation and fent as to require the operation for diphymosis. The phymosis was so vioviding the prepuce: after the prepuce was divided, the glans penis was found to be much ulcerated, and these ulcers never healed from that time. The gonorrhoea was not stopped. Subsequently he had two buboes appear in his groins, which continued swelled and indurated around were much swelled. He preup to the present time. The parts sented the following appearances. The penis, in its whole extent, was very much indurated, and spread over with several ill-conditioned sores, which had been there about nine months. The penis began to become hardened just salivated for two months, and got well after the prepuce was divided. He was of the salivation; after which he took pills, which did not make his mouth sore. mercurial ointment for some time. The penis had been covered with Of the buboes in the groins, that on the left side came first. It was a sore more irregular in shape than that on the right side, and not so much raised; the edges were indurated and thickened, and the centre of the sore contained a curdlike matter. On the right side there was a large dark-red indurated swelling, not very tender, having an irregular knotty surface, and being broken in its centre. Where it had given way the sore had a peculiar appearance, being round and hollow, and of the size of a shilling; at the bottom of the sore was more of the curdy substance. When he applied to a surgeon, he refused to open the buboes, they having this peculiar character, and being so hard about their bases. They soon after burst spontaneously. Has had no rest for some nights past. Ordered Catap. Panis c. 11.-In much less pain. Has rested the last two nights. Sores not so tender; not altered in character. Ordered, Ext. Colocyn. Co. gr. v. o. n. and Lotio Chloruret Calcis to the sore. Appetite not very good; pulse frequent, and rather full; feels feverish. 15.-Much improved in health; sores not painful, and changing their charac ter. Ordered, Essen. Sarsæ, 3ss. ter die. 17.-Health and appetite very much improved by the sarsaparilla. The character of the sore is completely changed: it looks healthy compared to what it did. It begins to have a healing edge. The curdy matter at the bottom of the sore has disappeared. The parts have not lost their hardness. He rests very well at night. The penis is not so hard. This man left the hospital a few days after this, thinking he was well enough to return home. GUY'S HOSPITAL. Fracture of Seven Ribs-Emphysema. Death. MOSES CARTER, aged about 60, at ten on the morning of July 29th, was thrown down by a heavy coal-waggon, the wheel of which passed over the right side of thorax and right clavicle.When he was brought to the hospital several ribs were found to be broken and depressed, and he had extreme pain on the injured side, increased by inspiration, with laborious breathing, a mucous rattle in the bronchial tubes, and great irritation in the fauces, producing a desire to cough, which he was prevented from doing by the great pain thereby caused. The matter expectorated was small in quantity, and consisted of mucus mixed with blood. The pulse was more than 100, and rather hard. A flannel roller was applied. Mr. Key saw him at one, and ordered V. S. ad x. which diminished a little the dyspnoea. A solution of supertartrate of potass was ordered as a beverage, to be taken ad libitum. At 9 P.M. emphysema, which had been apparent at noon, had traversed the upper part of the chest and neck, and had now extended to the cheeks. The breathing, and the mucous rattle attending it, were little altered. The pulse was 92, and the skin was warm and moist. Examination post mortem. Seven ribs-viz. from the second to the eighth-were broken, and the pointed extremities of two, the third and fourth, were driven into the substance of the lung. The results of inflammation in increased vascularity, and the formation of adhesions, appeared in the parts surrounding the wound. The lung itself was unusually vascular, and there was a considerable quantity of mucus mixed with blood in the bronchial tubes, but not so much as was expected from the symptoms. The patient had laboured under chronic bronchitis for some time previously to the accident. Aneurism of the Thoracic Aorta. The following case is interesting, because although there was an external pulsating tumor, yet from situation, great doubt was entertained before death as to the nature of the disease. The following account of the symptoms is abstracted from Dr. Bright's ward-book May 16th, C. Norton, aged 30.-Two years since he fell and struck his breast against some hard substance. Severe pain was felt for ten minutes, but no inconvenience followed. Was perfectly well two months before his admission, except that he had a slight cough. He then began to feel a pain in the right side on running fast, or walking up stairs. About ten days after his admission it was discovered that there was undue pulsation in the right side of the thorax. There was a small tumor, which swelled out and became harder every time the ventricles contracted. This discovery would have decided the nature of the case but that the tumor was too low for the aorta, being between the fifth and sixth ribs. There was then no cough, but slight expecto ration. During the month of June a pain, which he first began to feel on making a deep inspiration, increased so much, and was so much aggravated by lying down, that he could only lie in a semirecumbent posture on the right side. The pulsation in the tumor became less distinct. During the whole of this month the pulse was quiet, regular, and of good strength, and never above 60. Early in July he complained of con stant pain shooting from the right breast to the scapula, which he thought was relieved by a tight bandage applied round the thorax. July 11th-He complained of pain in the right side of the head, with giddiness. 15th. At 8 A.M. after a restless night, he suddenly discharged from the mouth a quantity of blood, estimated to amount to six pints. 16th.-Pulse 120. He continued to spit a little blood at intervals on the two or three following days, and after that at longer periods, but after the first bleeding the quantity brought up in 24 hours never exceeded 6 ounces. From this time until his death, which occurred on August 2d, the pain and other uneasy feelings were much less than they had been previously. The pulse was strong almost to the last. On Examination post mortem. — The right lung and pericardiuin, which was adherent to the heart, were united into one mass by adhesive matter thrown out on their surface. tracing the aorta from the upper part of the arch towards its origin, an opening was found behind one of the semilunar valves somewhat larger than the ventricular orifice, which led into a most extensive cavity contained between the heart itself and the right lung. This was the aneurismal sac; and as almost every part of it was below its mouth, the low situation of the pulsating tumor was explained. This last was found to be a part of the cavity which extended forward, entering a little way the substance of the lung, but mainly pushing it aside. The parietes of the sac were thinnest at that part, consisting of a very thin layer of lung, behind which some coagula were deposited. It appeared as if the aneurism had commenced in the expansion of one of the sinuses situated behind the semilunar valves of the aorta. This having given way, the pericardium must have become the boundary of the disease; but as it had become united to the surface of the heart, either previously, or as a consequence of the affection, the cavity must still have been small. But the blood being continually impelled into it with all the force of the left ventricle, it must soon have become dilated, and then the pericardium giving |