tion on different parts of it in succession, in order to guard against inflammation in the mucous membrane of the trachea.

The deformity succeeding the cure has been found to disappear in great measure in a few months.

It has been asserted by Mr. Nerman, a student from Sweden, that in Denmark it is a common practice to make incisions into the substance of the diseased gland, and that bronchocele is thus frequently cured; but we are not informed whether the suppurative process is afterward established or not. This disease has also been successfully treated by Dr. Coindet of Geneva, with solution or tincture of iodine; and Dr. Straub, of Howfyl, asserts, that this medicine may be advantageously used in all cases in which burnt sponge has been employed.

To the above case, in which the seton was employed, Mr. Hutchison adds one by Mr. Gunning, surgeon to St. George's Hos pital, three by Mr. A. T. Thompson, and one by Mr James, of the Devon and Exeter Hospital. In Mr. Gunning's case, eight days after the operation, the ston was removed, the parts contiguous to it being in a sloughing state; and in a few days after the separation of the sloughs, the patient's health having gradually declined, she died after one of the severe attacks of tracheal irritation, to which she had been su'ject. The remaining portion of the thyroid gland was in a sloughing condition, and some slight streaks of inflammation were discovered in the lining membrane of the trachea after death.

In the first of Mr. Thompson's cases the operation was successful. A considerable discharge of blood followed immediately, and a slight one continued during two or three days. The seton was removed at the end of two months The result of the practice in the second experiment was not known. The third case occurred in a man, aged sixty-one. The swelling was of the soft kind. The seton was withdrawn in three weeks, the tumour being greatly reduced.

Mr. Thompson was partly induced to try the effects of the seton, having witnessed the cure of a very large bronchocele by the application of a caustic, which occasioned the whole of the diseased gland to separate at the end of five months.

Mr. James's case was a most interesting one. The patient, a man aged 35, had received the best assistance which could be afforded him, without experiencing any benefit. The tumour was firm and elastic, and of the size of a flattened orange. The progressive increase of it and the accompanying symptoms threatened his destruction. The seton was introduced through the centre of the swelling from the upper to the lower part. The next day, the obstruction returning and the face being flushed, he was bled and purged. The dyspnoea increasing, attended with distressing cough, suppression of the voice as in laryngitis, copious expectoration, haggard countenance, and a frequent, small, and weak pulse, the seton was taken out about ten days after the operation. At this time the patient expectorated transparent firm lymph, having the appear

ance of membrane; and the same substance could be extracted from the ulcerated orifices. An expectoration of puriform mucus was present, attended with orthopnoea. In less than two months

the tumour entirely disappeared.

The practice of curing bronchocele by the seton, which was introduced by Foderé and others nearly halt a century ago, appears tuntil lately to have fallen into disuse. The attempts to revive it, which we have just detailed, have been sufficiently fortunate to justify us in recommending its adoption in all cases, in which the tumour is soft, and in others, where the symptoms portend a speedy dissolution, and the usual means have been found ineffecual. In young persons the operation will seldom be found requisite, because the sponge will in them usually effect a cure, and we have frequently observed the disease to disappear spontaneously before puberty. After this period, medicine is seldom of any avail, and our chief hope must rest upon local measures.

II. Observations on the Scrofulous Inflammation of the Peritoneum occurring in Children, and frequently denominated Marasmus. By GEORGE GREGORY, M. D. Senior Physician of the St. George's and St. James's Dispensary.

DR. GREGORY thinks he has been able to distinguish three different states of abdominal disease in children, which have, as a common character, fever of a slow remitting kind, and emaciation.

"The first of these consists in simple disturbance of the functions of the intestinal canal without organic derangement." P. 261. This, according to Dr. Pemberton, may prove fatal without inducing inflammation or ulceration within the abdomen, and constitutes the most common form of infantile remittent fever.

"The second form of marasmus is that in which the mucous membrane of the bowels is extensively implicated. After death ulcerations both of the great and small intestines are observed, with more or less enlargement of the mesenteric glands, and sometimes, though rarely, ulceration of them." 262.

In many instances Dr. Gregory presumes that this species is secondary, having been preceded by the one, which is found only to disturb the functions of the bowels.

The third form of marasnius is that to which Dr. G. wishes most particularly to attract our notice. He is induced to believe that it is primarily a disease of the peritonæum, and calls it the scrofulous inflammation of that membrane; on account of its being usually met with in scrofulous children. Disease of the mesenteric glands has not escaped his observation; but, having always seen it complicated with, or probably resulting from, a morbid state of the mucous or serous membrane of the abdomen, he views it in a subordinate light.

Symptoms. Gradually increasing tenderness of the abdomen, soon followed by paroxysms of acute pain, which grows more frequent and violent, and spreads from one part over the whole of the abdomen. The belly is at first enlarged and tense, and we have seen it completely tympanitic; but, as the disease advances, the swelling abates or subsides altogether, and is seldom perceptible after death. The pulse about 100; tongue generally clean; appetite irregular; thirst; intestinal discharges frequent, at first slimy and afterward consisting of a whitish brown matter, and greatly exceeding in quantity the medicine and other ingesta. Emaciation, and in four or five months diarrhoea and petechiæ, which in three or four days destroys the patient. Strangury is a common symptom, and in several instances we have satisfactorily ascertained that there have existed a periodical increase of pain and a febrile exacerbation, for the most part after midnight.

Necrotomy. Dr. G's. description of the morbid appearances on dissection exactly correspond with those, which we have ourselves witnessed.

"On cutting through the parietes of the abdomen, all trace of abdominal cavity will be wanting. The mesentery, bowels, and peritonæum lining the parietes, will be found united together into one mass. The peritonæum, in all its duplicatures, appears thickened; and, on cutting through the diseased mass, very large quantities of scrofulous matter will be found. The mucous membrane of the bowels, particularly (of) the small intestines, appears ulcerated in various places, and at these points of ulceration the conyolutions of the intestines communicate, so that, instead of forming one line of canal, as they will continue to do even in advanced stages of common chronic peritonitis, they constitute a mass of tubes communicating freely with each other, and with the thickened and ulcerated peritoneal membrane by innumerable openings. The matter, which will be found both within and without the mucous membrane, will be observed to correspond exactly with that which was passing during life by stool. 266.

Treatment. Little impression having been produced on the disease by any medical treatment, Dr. G. has enumerated only a few remedies, and on these he appears to place no reliance. When laudanum becomes necessary in the latter period of the malady, he has not found it to produce constipation.

Diagnosis. Abdominal tenderness and paroxysms of pain, followed by the discharge of large quantities of thick white matter by stool, are considered by Dr. G. sufficient peculiarities to distinguish the scrofulous peritoneal inflammation from the other species of marasmus.

Dr. Gregory proposes to offer to the Society, on some future occasion, observations respecting hydrocephalus, when he will add his farther experience in the different species of marasmus. We shall be happy to give extended publicity to Dr. Gregory's remarks at all times.

III. Case of Fractured Os Pubis successfully treated. By HENRY COATES, Esq. Surgeon to the Salisbury Infirmary.

THE accident was occasioned by three persons falling with great force upon a woman from a coach, which was overturned. The fracture was readily discovered at the juncture of the ramus of the pubis with the ischium. The bladder, rectum, and the extremities retained their sensibility.

Mr. Coates procured a bandage of wide, woollen girth-web. This was drawn under the pelvis, and, by means of buckles and straps placed near together, was secured as tightly as the patient could bear. Two straps were attached to the back part of this belt, brought between the thighs and fastened in front; and pads were placed on each side the pubis. Bleedings, aperient and saline medicines were had recourse to, and at the end of five or six weeks the patient was able to walk without assistance, and recovered.

IV. Case of Sudden Death, in which a Hydatid was found in the Substance of the Heart. By DAVID PRICE, Esq. London.

THE boy, who was the subject of this case, was ten years old. He fell down suddenly and unexpectedly, and in a few minutes expired.

The contents of the cranium and of the abdomen were found perfectly healthy. A portion of the pericardium adhered to the heart, and in the muscular substance of the latter was discovered a large hydatid. Two ounces of dark coloured fluid were floating in the pericardium.

V. A Case of Aneurism of the Carotid Artery. By HENRY COATES, Esq. Surgeon to the Salisbury Infirmary.

THE aneurismal tumour was seated in the left carotid, and measured five inches and a half in length, and four in depth. The patient, aged 41, was first a sawyer, afterward a dragoon, and, lastly, a labourer in husbandry. This disease extended beyond the mastoid process, in part concealing the ear, and covering the edge of the inferior maxilla almost to the chin, where it became conical. The pulsation was strong, and ulceration had begun. The man complained of headach, had a slight cough, was confined to bed, had dyspnoea and dysphagia, and expectorated daily nearly three pints of mucus. The pupil of the left eye was contracted, and vision imperfect. He spoke indistinctly. The pulse 90.

Digitalis and venesection having been tried in vain, the operation of applying a ligature on the artery was deemed expedient. Only one ligature was employed, and the wound was drawn together with adhesive plaster. The patient became faint, and continued so for some minutes.

The next day the pulse having become hard and quick, he was bled from a large orifice, and other symptoms were relieved by aperients and sudorifics, and by opiates at bed-time; and about the eighth day the aneurismal mass had subsided to half its pristine size, and the contracted pupil had nearly recovered its natural dilatation and sensibility. On the 33d day the tumour was much enlarged and tender, and a blush of inflammation appeared on both sides of the neck, attended with much pain in the throat. The 34th day, the pulse being hard, venesection both local and general was had recourse to, and a fluctuation being evident, an opening was made, which gave vent to seven ounces of offensive blood and pus. On the 55th day six ounces of florid blood were suddenly discharged from the aneurismal sac, after which the hæmorrhage spontaneously ceased; and the pulse remaining hard, bleeding from the arm was again repeated. The tonsils were then inflamed. From this to the 63d day hæmorrhage repeatedly appeared; and about the 67th day the patient fell into a state of collapse with dysphagia, singultus, and anxiety, and in the evening expired.

Necrotomy. The ligature had been applied to the artery at the distance of an inch and a half from its origin. The vessel itself was impervious for the space of an inch. An artery, which admitted a probe, was discovered extending from the lower jaw into the sac. The back part of the aneurismal bag adhered to the bodies of four of the vertebræ.

Mr. Coates is inclined to believe that the event of this case might have been more fortunate, had the contents of the tumour been evacuated by art, before the inflammation had made its appearance.

VI. Case of Malformation of the Heart. By GEORGE GREGORY, M. D. Senior Physician to the St. George's and St. James's Dispensary.

THE patient was from birth of a blue colour, thin, and subject to constant dyspnoea; and at the age of eighteen years he died of pulmonary consumption.

The preternatural appearances in the heart were the following: the aorta and pulmonary artery arose from the right ventricle; the septum ventriculorum was deficient at its base; the opening in the septum corresponded exactly with the situation of the aorta at its orign, and effected a communication between the ventricles; the pulmonary artery was but little smaller than usual.

VII. A Case of Chorea successfully treated by Arsenic. By GEORGE GREGORY, M. D. Senior Physician to the St. George's and St. James's Dispensary.

THE Species of Chorea, for which arsenic has been successfully exhibited, is said to be unaccompanied with disorder in the stomach and bowels.