to satisfy us that the recto-vesical operation is decidedly objectionable. The occurrence of fistula after its employment is not only likely to happen, but in at least five cases out of ten, actually does happen. There are six or seven cases adduced here, to show that these fistula will often, after a certain time, take on the healing process. But, granting that the fistulous communication remain open only for a year or so, the case is still bad enough in all conscience; and there is a chance of the disease continuing for a much longer period. The recto-vesical operation will never come into general use.

We shall now return to the Clinical Report of M. Roux, at the Faculté.

Two cases of strangulated hernia are related, the first an inguinal, and successfully operated on: the second, crural, and fatal, in consequence of the laceration of the intestine by the upper pillar of the ring, in the endeavour to draw it out. On examination after death, the knuckle of intestine was found not gangrenous, but so soft as to be very easily torn through. This should teach a surgeon caution in handling a strangulated gut. The operator was Mr. Wessely, an English student.

Tumours. Larochette, æt. 27, blind and deaf, had a large steatomatous tumour removed from the region of the right parotid gland on the 16th April. All went on well-the wound was nearly cicatrized, when the patient grew weaker, and died, without any symptoms of internal disease. On dissection, all were surprised to see the marks of a most intense peritonitis.

Case 2. Durand, æt. 44, robust, but of a highly irritable constitution, entered the hospital on the 4th May, with an encysted tumour, the size of a turkey's egg, on the forepart of the right knee. This was removed by M. Velpeau on the 5th, under the direction of M. Roux. Tumefaction of the limb, fever, great excitement, irritability, and even delirium succeeded, and in spite of bleedings and anodynes the patient expired on the 10th.

Dissection, 36 Hours after Death. Putrefaction had made remarkably rapid progress. The veins of the limb operated on were inflamed to a very trifling extent, and the cellular tissue infiltrated with serum. The veins of the dura mater were rather congested, but no other morbid appearance was to be seen. On dissecting the tumour, it was found to be a bursa mucosa, its structure altered, and containing partly its proper synovia, and partly a fluid more pultaceous, and seemingly the product of inflammation.

Remarks. This case exemplifies the mischievous consequences which will occasionally, though rarely, attend operations on the bursa mucosa. The degree of irritation produced in patients of nervous habits by the removal of these bodies is sometimes astonishing, whilst in others they may be treated very roughly, without the slightest ill effects. The patient in this case evidently died of the high degree of constitutional exVOL. VI. No. 12.

20

citement produced by the operation, for there is nothing in the postmortem appearances to account for the fatal result.

Bleeding Polypus. Massenet, æt. 13, entered the hospital, Nov. 25th, with a polypus of eight months' standing in the left nostril. It had been tied once and extirpated twice, and each time a considerable hæmorrhage occurred. M. Roux decided on extirpating it, and seized it with the forceps, but such was the toughness of the tumour that the forceps broke. The pedicle was then cut across by a straight probe-pointed bistoury, when such a hæmorrhage occurred, that it was necessary to suspend the operation and plug the nostril. Fever appeared, sore throat succeeded, the patient became comatose, and died on the 6th day from the operation.

Dissection. The tumour was attached to the back part of the roof of the nose-it was fibrous-of a reddish-gray colour-little vascular, but so tough as not to be torn through with the fingers. The bony palate was necrosed, and its mucous membrane, with the gum, detached; pharynx inflamed; pus between it and the spine, and the upper vertebral articulations themselves much altered.

Seven operations for cataract took place, only four of them successful. M. Velpeau apologises for this, by saying that the majority of the subjects were in a condition by no means favourable for extraction, the method which M. Roux generally adopts.

Inflammation of the Muscular Coat of the Bladder.-Case. Maurican, æt. 44, was suddenly seized, on the 5th February, with violent pains in the hypogastrium and difficulty of making water. He was admitted on the 8th. Nausea, small pulse, hypogastric pain, but no swelling. Twelve ounces of limpid water were drawn off by the catheter; the symptoms, however, increased, and on the 10th he died.

Necropsy. The bladder was found contracted, thickened in its parietes to the extent of an inch, and in the midst of its muscular fibres purulent matter was effused. There was also infiltration of pus in the cellular membrane around, and the peritoneum in the pelvis was inflamed.

Some cases are here detailed, where injuries about the hand were followed by excessive inflammation of the synovial membrane and sheaths of the tendons, ending in sloughing, death of the bones, and a fatal issue, in spite of amputation of the limb. These cases it would be needless to particularize, especially as M. Velpeau promises a memoir on the subject.

We have now concluded our analysis of this paper, and have little to add to what we have remarked on some of the individual cases. We may observe, however, that this report is drawn up in a very ingenuous and candid manner, that the practice is detailed as it really was, and that even where errors or oversights have been committed, they are stated fairly and manfully. This is as it should be.

P.S. In the second number of the Répertoire, appears the continuation of the series of experiments on lithotomy, instituted by M.M. Bres

chet, Dupuytren, and Sanson, at the Hôtel Dieu. During the three months which have elapsed since the last report, M. Breschet and M. Dupuytren have each performed their respective operations twice, and with success. There is nothing particular in these cases, and it would be useless to detail them here. The fifth case, however, which occurred to M. Sanson, and in which he performed the recto-vesical operation, we think worthy of notice.

Case. Duplessis, æt. 65, entered the Hôtel Dieu, March 31st, 1826, with strong symptoms of stone. He was decrepid beyond his years, bis respiration was hurried, his voice feeble, the least muscular effort occasioned dyspnoea, and the pulse was feeble and irregular. The suffering on making water was excessive. On sounding, a calculus was distinctly felt in the bladder. On the 8th or 10th of April, the lithontriptic process was attempted by M. Meirien, in the presence of M.M. Breschet, Dupuytren, Sanson, and the éléves of the hospital; but, after five and twenty minutes spent in fruitless endeavours to seize the stone, the attempt was given over. Some fever, with incontinence of urine, ensued, and these symptoms were followed, on the 13th, by a swelling of the left testicle. Leeches, lotions, &c. were applied, and by the 1st of May the organ had regained its natural size. On the 13th of this month the recto-vesical operation was peformed by M. Sanson in the manner we have described above. The stone was extracted with little difficulty; its long diameter was about 16 lines, its short about 10, and its surface was very rough. Some degree of depression of the system took place after the operation, but on the next day a slight re-action followed, which, however, was checked before night. Pain in the hypogastrium, irregularity and intermissions of the pulse, cephalalgia, and torpidity of the bowels now shewed themselves, the urine flowing almost entirely by the wound. From the 20th to the 25th the patient was better, complaining of little else than the irritation of the skin produced by the dribbling of urine from the wound. Obstinate torpidity of the bowels again appeared, the skin around the anus became excoriated, and, finally, tilcerated; extreme prostration of body and mind supervened; solid fæces collected in the rectum and were obliged to be eked out by a spatula— the tongue became dry-the abdomen exquisitely tender, and on the 13th June the unfortunate patient expired.

Dissection. The peritoneal cavity contained between two and three pints of an opaque, flocculent fluid-the convolutions of the intestines were agglutinated by inflammation, and the large intestine was distended with solid fæces. The bladder itself was natural, except that its mucous membrane was a little coloured. The lips of the wound in the urethra, prostate and bladder were wide apart, in fact no attempt at adhesion had taken place. The prostate itself was so altered by suppuration that it was impossible to distinguish the ejaculatory ducts. All the cellular membrane of the pelvis was one vast abscess. The right kidney was soft and much altered, the left nearly as much so. Cavities of the heart dilated, and their walls ; aorta at its origin covered

with numerous patches of ossification; about an ounce of serum in the cavity of each pleura.

Remarks. It would be hardly fair to cite this as a case which proves against the recto-vesical operation, for we much question whether any operation would have succeeded here. A man of 65, with symptoms of disease of the heart or large vessels, and a highly irritable habit, is no very good subject for lithotomy in whatever way performed. But still, the more we see, or rather read of M. Sanson's method, the more we are convinced that it neither will, nor deserves to, become general. The recoveries are uniformly tedious, fistula not an uncommon consequence, and this case has shewn, that it may produce extensive suppuration in the cellular membrane of the pelvis.

11. CANCER OF THE PENIS.

[Clinique de La Pitié.]

M. Lisfranc was often surprised, on amputating the penis, to find that the disease had not extended nearly so far as it appeared to do previously to the operation; and consequently he was led to the idea of making, in future, a kind of exploratory operation, before he ventured to remove the organ in toto. This exploration consists in making, on the dorsal face of the penis, an incision, parallel with the aris of this organ, commencing at the anterior part of the carcinomatous portion, and carried backwards to its posterior. The knife should be directed slowly along the parts, cutting by light strokes through the degenerated mass. By carefully sponging, the surgeon will thus come down (as if cutting on a hernial sac) to the fibrous envelope of the corpus cavernosum penis. If this be found sound, a careful dissection of the diseased parts may be effected, and the necessity of amputation avoided. If, on the contrary, the disease is ascertained to have spread its roots too deeply, the organ must be sacrificed. M. Lisfranc thinks that the addition of pain which this exploration occasions should not be put in competition with the chance thus afforded of preserving the We shall now proceed to the statement of two cases in illus

organ. tration.

Case 1. John Roussel, 27 years of age, was admitted into La PITIÉ, on the 6th of June, 1826. Some months previously he had had a paraphymosis succeeding a gonorrhoea, and which required an operation to set it free. The part had continued painful ever since, notwithstanding the use of antiphlogistic and antisyphilitic medicines. The pain afterwards became lancinating and insupportable. When received into hospital, the prepuce was observed to be retracted behind the gland, forming a dense, red ring, the thickness of a person's thumb,

Sur le Diagnostic des Divers Degrés de Profundeur des Cancers de la Verge, &c. Par M. E. Margot. [La Pitié.] Revue Medicale, Decembre, 1826.

and apparently making part with the body of the penis. There were two points in a state of ulceration, discharging a thin fetid pus. The pain was very distressing, the pulse hard and quick. Twelve ounces of blood were taken from the arm-emollient poultices were appliedand the patient put upon low diet. These means were continued till the 10th, when an operation was practised. Every thing was prepared for amputation of the penis, in case the malady was found to amalgamate with the corpus cavernosum. A longitudinal incision was made, in the manner before-mentioned, from the posterior to the anterior portion of the tumour, penetrating slowly down to the fibrous envelop of the corpus cavernosum, carefully sponging away the blood as they proceeded. It was clearly ascertained that the said fibrous envelop was sound. It was therefore determined to dissect away the whole of the disease, which was no easy operation. The patient was intractable, and it was necessary to be careful in removing the whole of the disorganized mass, without injuring the body of the penis. Opposite to the two ulcerated points it was found that the fibrous envelop was partially diseased. The diseased portion was removed, and the whole mass finally dissected away, without injuring the urethra. Some vessels were next secured, and the operation completed. Simple dressings were applied, and the patient carried to his bed. Considerable inflammation and sympathetic fever followed, and were met by blood-letting, antiphlogistics, and poultices. On the 13th, suppuration commenced, and the symptoms were mitigated. Every thing went on favourably; but as it was feared that there was a syphilitic taint in the constitution, the proper remedies to correct this were administered. In order to effect a good cicatrization, the dressings were carefully attended to, and the chloruret of soda was used, in weak solution. By the end of July, the wound was completely healed. The patient has since been seen, and was found perfectly well.

Case 2. J. Chevalier, aged 46 years, entered LA PITIÉ, on the 25th July, 1826, for an old-standing cancer of the penis, occupying the whole of the anterior part of the scrotum, the skin covering the pubes, and half of the penis. The right testicle was indurated and enlarged, and the spermatic cord in the same state. The disease had continued long; but the man was so deaf, that little information could be obtained as to the exact history of the case. The patient experienced almost constant lancinating pains, and ulceration prevailed far and wide over the diseased parts. The ulcers had raised and everted edges, with foul yellow sloughs at bottom. The pulse was hard and quick; but the appetite had not failed. He was bled from the arm-his diet reducedand diluent drinks ordered. The ulcers were poulticed. These means were continued till the 5th of August, when the following operation was performed.

A semi-elliptic incision was made, beginning at the crural arch of the right side, an inch from the spine of the os pubis, and ending at the lower part of the scrotum; then carried upwards to the summit of the left testicle. Another incision, commencing from the same origin as