pulsation ceased; but there came on numbness of the hand, and severe pain, which, however, subsided in a few weeks. In the course of two or three months, the tumour returned, and in September, 1820, he entered St. George's.

On pressing the aneurismal tumour, there was felt, besides the common pulsation, a peculiar thrill like that given by a varicose aneurism. Dec. 7th, Mr. Brodie tied the brachial artery, an inch and a half above the aneurism, when the pulsation ceased, but, in a few minutes, returned. A tourniquet was placed on the arm, the sac cut into, some coagula removed, and its inner polished membrane displayed. On loosening the tourniquet, blood flowed through two orifices, that of the upper and that of the lower portion of the brachial artery; consequently it was tied immediately above and below the sac. But there was yet a third orifice, through which flowed blood, partly venous and partly arterial, marking the communication with both an artery and vein. Into this the blunt end of a probe was passed, so as to mark its situation, and a ligature was then applied close to the sac, thus cutting off the communication of the vessels with it. All went on well, and in a month after the operation, the patient quitted the hospital cured.

This, no doubt, was a case which does occasionally happen, of complication of varicose with common aneurism. We think it might admit of question, whether, in such a case as this, the application of a ligature, above and below the sac, without cutting into it, would not be sufficient. This operation would bring the case into the same circumstances as simple varicose aneurism, which we know does not, in general, require a ligature; and would certainly be attended with less hazard than the opening of the sac. At the same time, we freely confess that the operation performed by Mr. Brodie must be more effectual, and did prove quite unattended with danger, in the above instance.

10. SURGICAL REPORTS OF ROUX, BRESCHET, AND DUPUYTREN.' [Hôpital de la Faculté.]

In No. 10 of this Journal, we noticed the practice of M. Roux, in several cases, as recorded by M. Velpeau. We shall now lay before our readers the sequel of the above reports, drawn up by the same gentleman.

Case 1. This was a boy, two years of age, whose urachus remained open, forming a livid, fungus-like tumour at the umbilicus, which by pressure could be returned into the abdomen, and which discharged a fluid exactly resembling urine. The urinary organs themselves were well formed. Various means were tried to stop the unnatural discharge but without effect, neither catheters in the bladder nor plugging of the umbilical opening proving successful.

Hôpital de la Faculté. Archives Générales, August, 1826.

Stone in the Bladder. Six cases of this fearful disease are detailed; five of them fatal, which is certainly a high ratio of mortality.

Case 1. The patient was a child, æt. 6, of good constitution, who had suffered from stone for two years. M. Blandin operated after the manner of F. Côm, but it is stated in the report, that the incision was so small that the lithotome and forceps were with difficulty introduced. Peritonitis supervened, and the boy died within 48 hours after the operation.

Here the smallness of the incision and consequent violence were no doubt the main cause of the fatal event.

Case 2. A boy, æt. 16, who had laboured under the symptoms of calculus for eleven years. In consequence of the size of the stone, M. Roux decided on performing the operation of Celsus, as modified by Béclard and Dupuytren. A semi-lunar incision was made about an inch anterior to the anus, (cornibus ad coxus spectantibus paululum,) and the neck of the bladder divided on both sides by the lithotome of F. Côm. The calculus, however, was so large that it was necessary to break it into fragments, and the extraction was tedious, and accompanied with a great degree of violence. On the following evening fever and cephalalgia appeared; these symptoms by the next day were much relieved, but they returned, and on the fourth day from the operation the patient sunk.

Dissection. General but slight peritonitis; infiltration of sero-purulent matter into the cellular membrane of the pelvis; parietes of the bladder reddened.

Would not the high operation have been advisable here? We know that in youths the outlet of the pelvis is comparatively more confined than in the adult, and consequently the extraction of a large stone difficult, and proportionably dangerous. This being the case, we think the high operation preferable to the one put in practice here, as the suppuration in the cellular membrane seems to have been principally owing to the force necessarily employed in extracting the masses of calculus from the bladder.

The next case we shall notice is more remarkable for the candid manner in which it is related than for any great éclât which attaches to the operator himself.

Case 3. This was a child, æt. 2, who for a year had suffered from uneasiness in the penis, and pain on making water. On sounding, M. Roux thought he felt a stone, but on the operating table, on sounding again, the results were less satisfactory. M. Velpeau and others introduced the instrument, and could not satisfy themselves of the presence of a calculus. M. Roux, however, thought he felt one, and the recollection of a former case where he alone had discovered a small calculus in the bladder, determined him to operate. The operation was performed with Hawkins' gorgeret, but no stone could be found. Peri

tonitis succeeded, and in 60 hours the child was dead. No examination of the body was permitted.

When such candour is shewn as in the report of the present case, one feels reluctant to employ the pen of criticism. We must say, however, that placed as M. Roux was, himself not satisfied of the existence of a stone, and those around him still less so, the performance of the operation was imprudent, to say the least of it. He is a confident man who sounds with a gorget. M. Velpeau remarks, that such instances are not so rare as, from the little mention made of them, one would be inclined to believe. Candour, no doubt, would be beneficial to the interests of science; but we much doubt whether in England at any rate, where public opinion is so free, we might almost say censorious, men will be found to publish to the world what may be any thing but advantageous to the interests of themselves.

Case 4. This was a diminutive lad of 15, and by no means a good subject for the operation, as he had a most unconquerable dread of it. The gorget was used; the stone found to be very large, and after having been broken to pieces, extracted with difficulty. The lad died on the second day.

. Dissection. Purulent infiltration of the cellular membrane of the pelvis-fragments of stone still left in the bladder, and indeed in the wound; the surface of which was coated with coagulable lymph.

In lithotomy, more perhaps than in any other surgical operation, as much depends upon the constitution of the patient, his habits of life, and other fortuitous circumstances, as upon the skill and dexterity of the surgeon. At the same time, there are very many instances where the fatality is attributable to obvious causes, and we conscientiously think that in several of the above cases such is the fact. In the first case particularly, the smallness of the incision, and consequent violence necessary, as we observed before, left few well-grounded hopes of success. Upon the whole, we do not think these favourable specimens of lithotomy.

As we are upon the subject of calculus, we shall amalgamate with this report of M. Roux's the report on the same subject published by Messrs. Breschet, Dupuytren, and Sanson, in the Répertoire. These Gentlemen determined on making experiments at the Hotel Dieu, on the comparative merits of the transverse or bilateral operation, performed by M. Dupuytren; the lateral operation of F. Côm, performed by M. Breschet; and the recto-vesical operation, by M. Sanson. The different methods were put in practice alternately, and consequently without selection of cases.

Transverse Operation. The instruments M. Dupuytren uses are-a common staff, a lithotome somewhat like that of F. Côm, but consisting of two curved blades, which open in opposite directions by means of two levers, (bascules,) which are pressed against the handle of the instrument. The handle is moveable upon a screw, and so contrived

that the separation of the blades can be regulated at will to the extent of eighteen lines. The mode of operating will be shewn in the following

case.

Case 1. Rouzet, æt. 38, of lymphatico-sanguineous temperament, who had suffered pain in making water for thirty-two years, entered the Hotel Dieu, on the 14th June, 1825, for incontinence of urine. On sounding, M. Dupuytren discovered a stone apparently large and rough. It appeared that he had been in the habit of introducing the fingers of his left hand into the anus, in order to relieve the pain which he experienced. The patient was prepared by baths, light purges, and regimen, for the operation, which took place on the 1st July.

The patient being placed in the usual position, a slightly curved. transverse incision, the concavity of which looked backwards, was made through the skin and cellular membrane, with the point of a straight bistoury, about seven or eight lines from the anus. M. Dupuytren fearing that the great dilatation of the lower part of the rectum (caused by the repeated introduction of the fingers) would expose the gut to injury from the blades of the lithotome, introduced two fingers of the left hand into the intestine, stretching it transversely, and pressing it towards the coccyx. A second and deeper incision was now made down to the urethra; this was followed by a good deal of bleeding. The urethra was next divided in the direction of its axis by the bistoury passed on the nail of the fore-finger. The double lithotome was opened to No. 15, and divided from right to left, and from behind forwards, the neck of the bladder and internal parts of the prostate. This was followed by much struggling of the patient; the gorgeret and forceps were introduced; the stone broke and was extracted piece-meal; it was as large, when whole, as a hen's egg, and appeared to consist of uric acid. Hæmorrhage to the extent of eight ounces occurred; three injections were thrown up, and a canula and plug of linen around it introduced into the wound; the whole was then covered with a T bandage. It is needless to go into the details of this case; suffice it to say that all went on well. By the 7th suppuration was established in the wound; for some time the urine continued to flow through it, but at last it was voided wholly by the urethra, and on the 10th August the patient was discharged perfectly cured.

Case 2. Scache, æt. 46, of sanguineous temperament, entered the Hotel Dieu, Sept. 5th, for calculus, to which he had been subject, more or less, since the age of seven years. For some time before admission he had been in the habit of passing, at intervals, urethral calculi, and about a month before this period he had passed a lumbricus eleven inches and a half long, giving rise to the suspicion that there existed a communication between the bladder and rectum.

On sounding the bladder, M. Dupuytren discovered a stone, which, on the 14th, was removed in fragments by the operation, as described above, without any hæmorrhage. In the evening cephalalgia came on,

which was removed by bleeding. Next day colicky pains-bleeding to eight ounces, emollient cataplasm. From this time he continued slowly to improve, under the use of pills composed of Venice turpentine, gr. xl. acetate of lead, gr. iv. extract of white henbane, gr. vj. At the latter end of October he was discharged cured; the urine, however, still being slightly catarrhal.

There is nothing particular in the operation of M. Breschet. Both cases did well.

Recto-vesical Operation.-Case 1. Varnet, æt. 19, of melancholic temperament, entered the Hotel Dieu on the 4th October, 1823, with symptoms of stone of three years' standing. On sounding, calculus was easily discovered. Oct. 10th. The operation was performed by M. Sanson in the following manner. The staff being passed into the urethra, the membranous portion of this canal was divided by a longitudinal incision, carried from behind forwards on the median line of the perineum. Into this incision, a probe-pointed bistoury was introduced, and the prostate, neck of the bladder and its lower wall divided to the extent of about fifteen lines above the anus. A large stone was then extracted. No accident whatever happened, except that, in spite of cauterization, the wound in the rectum remained open, and loss of power to retain the urine was the consequence. M. Sanson has learnt that, since his discharge, the wound is contracting, and in a fair way to cicatrization.

The next case did well-the wound healed perfectly, and the patient was discharged cured in a month from his admission.

Remarks. M. Royer Collard, the reporter, observes, on the subject of hæmorrhage, that when internal, it may be recognized by these symptonis: the patient feels weight and uneasiness in the region of the bladder, arising from its distension; frequent desire to make water, which, however, he cannot pass; the cheek becomes blanched, at times even fits of syncope succeed, from which the patient recovers only on the accession of fresh pain. On examining the hypogastrium, a tumour will be felt, formed by the distended bladder. To stop this hæmorrhage, plugging, as was employed in the first case, is had recourse to. A silver or platina canula, three inches long, and five lines in diameter, terminating at one end in a cul-de-sac, pierced by numerous holes, is to be procured. At some distance from this extremity, a covering (chemise) of fine linen is attached, the canula introduced through the wound into the bladder, and between it and the chemise lint is to be stuffed, sufficient by its pressure to stop the hæmorrhage. The canula is to be secured by tapes and a bandage. If the bladder be already full, it is necessary to clear it out by injection, before introducing the canula.

From the small number of cases here detailed, and from their being all fortunate ones, no very accurate inferences can, of course, be drawn, as to the comparative merits of the several operations. Sufficient, however, has been brought forward on former occasions, as well as on this,