cases with the quicksilver pill and infusion of cascarilla, for every one which they remove by the knife or by caustic. But what is more extraordinary, he will see patients of all ranks afflicted with purely physical diseases, resort to surgeons for advice. Hence it is evident, that the general sense of mankind acknowledges not the artificial divisions which we have made in the profession.

"Nevertheless, the separation of physic from operative surgery, whatever violence it may do to Nature, is probably productive of good to both branches. There are few minds capable of resisting the seductions of the scalpel, where a bold and surgical genius is bestowed by nature. The eclat of operations eclipses the slow, and dull, and too often unsatisfactory march of medical science; and constant application to one line begets, of course, a facility and dexterity that cannot be otherwise attained. The deficit in other branches is not felt in a great city or public institution, where the patient is surrounded by all ranks and degrees of the Faculty. On the other hand, the physician, liberated from the anxieties of the operationroom, brings a calm unruffled mind to the investigation of the infinitely varied phænomena of disease. A close attention to these, generates, without a doubt, a quickness of apprehension, a fertility of resource, and an accuracy of diagnosis, to which but the favoured few of surgeons can pretend. But, except the purely operative part of surgery, medical and surgical practice is completely blended, for the best of all reasons, that medical and surgical diseases are essentially the same. Hence it is incumbent on the young physician to study surgery at least, and to dissect as assiduously as though he were designed for the operation room; while the surgical student may be assured that medicine is his sheet anchor at last; and that whatever degree of accuracy he may attain as an anatomist, or dexterity as a surgeon, yet, without pathology and therapeutics, these brilliant acquisitions will avail him little in his professional journey through life."

We leave it to the public, and to Mr. Lawrence himself, to decide whether all the arguments and illustrations brought forward in this celebrated introductory lecture, have not been anticipated, and even more forcibly urged, in the article which we have here republished. Mr. Lawrence's lecture is characterized in the Lancet as a "brilliant effort," to shew how impossible and foolish is the arbitrary distinction attempted to be drawn between physic and surgery. But we shall soon see that the same arguments, coming from another quarter, will be considered, by the same impartial judge, as ridiculous and imbecile. The learned lecturer has not only trodden the same ground as the writer of the article here republished, but has come to the identical conclusions on all the different points-namely, first, that the distinction between physic and surgery is baseless: secondly, that the education should be the same for both, or as nearly so as possible and, lastly, that the various branches being first studied, the division of labour may afterwards be advantageous to the public, and beneficial to science.*

* "I do not contend that every one should practise all parts; and I am fully aware that the field is far too extensive for one individual to cultivate the whole minutely, with a view to further improvement. No doubt that one, who has received a general medical education, may improve a particular department, if he should have his time fully occupied with it; and that circumstances of taste, convenience, situation, and public opinion, may thus lead to subdivisions in practice with advantage to the public and benefit to science."-Lawrence.

2. ILEUS, FROM CALCULOUS CONCRETIONS.

[From the Spanish.]

A lady of Barcelona, 50 years of age, of very sedentary habits, and subject to hysteria, was seized, on the 8th March, 1822, with acute pain in the epigastric and right hypochondriac region, under the false ribs. The pain was so violent that she was forced to cry out repeatedly, and could not bear the slightest pressure on the parts. There was no tension or swelling of the parts. The tongue was moist and clean-no fever—pulse feeble—no motion for 24 hours previously. Lavements-Hoffman's anodyne liquor. The pain continued unabated during the 9th, notwithstanding various means were used. On the 10th, the pain was less acute, but there were nausea, and even vomiting, on taking some aliment. No stools from the enemata. 11th. Much the same; vomiting continues, accompanied by hiccup―abdomen distended-no passage in the bowels-some fever. 12th. Stercoraceous matters were thrown up-no stool-belly more distended. 13th. Four ounces of quicksilver were swallowed-and tobacco-smoke was injected per anum. The vomiting and other symptoms continued. In the evening, stools and urine passed freely-the vomiting ceased-the belly became soft, and the pain nearly disappeared-good sleep during the night. 14th. The vomiting returned. 15th. Bilious stools came away, and the other symptoms were mitigated. The patient had some tranquil sleep, from which she awoke free from fever, pain, or thirst, and with some appetite. 16th. The abdominal pains returned, and again disappeared, after a copious evacuation of fæcal matters. But, instead of the quicksilver being rendered by stool, the patient passed a calculus, the size of a large chesnut, having a smooth and polished surface. 18th. The patient evacuated another calculus, similar to the former, the size of a pigeon's egg. Next day, a third was passed, of triangular figure, and as large as the second one. In washing this last it broke to pieces, and disclosed a nucleus, around which the concentric layers had formed. The patient was now in full convalescence. On the 20th, the mercury was evacuated, along with much fæcal matter. She was soon quite well. These concretions were analyzed by Professor Ballcells, of Barcelona, and 30 grains gave 20 of cholesterine-5 of inspissated bile-4 of a resinous substance, and one of loss.-Archives.

The Spanish author and M. Julia-Fontanelle, who translates the case, seem to consider these calculi as intestinal concretions. We have not the smallest doubt that they were biliary. It is highly probable that they had passed from the gall-bladder into one of the small intestines-or, perhaps, into the colon, by ulceration. Such an event has happened in this country, as was proved by dissection afterwards—the patient having died of another disease.

3. SYNCOPE ANGINOSA.

In one of the sittings of the Academy of Medicine, M. Chantourelle read the case of a French nobleman, which deserves some commemoration, although the precise nature of the disease was not verified, as it usually is in France, by dissection.

Case. M. le Duc had enjoyed good health till the age of 58 years. In the month of March, 1826, he began to experience some inconvenience when he walked fast, and on the 12th of the same month he fell down in a state of syncope, which lasted nine or ten minutes, and then he revived, but the action of the heart, and the pulse at the wrist, continued

imperceptible for some time, the breathing being very short. By baths, sinapisms, leeches to the anus, and cordials, the circulation was restored, in some degree, by the third day. On the fifth day he was bled from the arm, when the pulse became still more developed, and the action of the heart could be felt all over the left side of the chest. During the following days the patient was able to get up, take some light food, and even go out in his carriage. At this time, some moral emotion caused a great tumult in the circulating system, and he was again bled. He complained that he could not sleep-the intellectual faculties were quite free. On the 24th of March, the Duke went to church, and in kneeling down, fell into another fit of syncope, from which he never recovered.—Archives, Dec.

M. Chantourelle saw the corpse four hours after death. The face was pale, but along the whole left side of the thorax there was an enormous sanguineous infiltration. The body was not allowed to be opened. M. Chantourelle informs us that the disease with which the Duke was afflicted, was considered successively to be aneurism of the heart, apoplexy, angina pectoris. We were rather surprized to find that some members of the Academy maintained that the Duke died of pulmonary apoplexy. There cannot be a doubt that the disease was dilatation of the heart, most probably of the passive kind. Rupture of the organ, we should suppose, took place, and gave origin to the appearances of bloody infiltration in the chest.

4. TRANSFUSION IN UTERINE HÆMORRHAGE.

Mr. Brown, a very able practitioner in the Borough, has communicated an interesting case of this kind, in the eighth Number (New Series) of the Medical and Physical Journal. The particulars are as follow:-A female, 30 years of age, was delivered of her tenth child at a quarter before one o'clock, P. M. of the 31st of December. She had always suffered from uterine hæmorrhage on these occasions, and an alarming flooding soon succeeded the present delivery. Mr. B. introduced his hand, and the uterus soon contracted and stopped the hæmorrhage; but the mischief was produced. An alarming collapse ensued, which required brandy, æther, and camphor. These gave only temporary relief. Convulsions and vomiting took place, and again the collapse threatened the life of the patient. Dr. Blundell, Mr. Doubleday, and Mr. Waller were summoned. The latter only could be found. He arrived at half past two o'clock, an hour and three quarters post partum. The following was the state of the case :-Lies on her back, with a death-like expression of countenance—extremities of marble coldness -little animal heat in the chest or abdomen-laborious and stertorous respiration-eyelids closed, and eyes insensible to light-pupils fully dilated— jaw fallen-pulse imperceptible at the wrist, and even in the carotids. It was Mr. Brown's firm conviction that the woman was dying; but it was properly determined to give her the chance of transfusion. Thirteen drachms of blood were injected, in the usual manner, at twenty-five minutes to three o'clock. No particular effect seemed to be produced by this operation. In five minutes another injection, of thirteen drachms, was effected; and now the action of the radial artery was felt-the breathing became more freebut the pupils remained dilated, and the eye evinced no sensibility to light. In ten minutes more a third injection was made, the aggregate quantity amounting to about five ounces of blood. The improvement was now more evident. She moved her extremities and uttered a faint ejaculation. Deglutition (before extinct) now enabled her to take three tea-spoonfuls of brandy. It was not, however, till after the fourth injection, that the amelioration was most conspicuous. The pupil now readily contracted on the

admission of light-the chest was fully expanded at each inspiration-the pulse was 120, and equable. She seemed in pain about the left hypogastric region. She recognized her husband and others—and, in short, the urgent danger was evidently over. We need not pursue the details of the case. As is usual after such extreme states of collapse, a pretty violent re-action succeeded, and required even detractions of blood from the head; but the patient completely recovered.

We think that every unbiassed person must here recognize, not merely the safety, but the utility of transfusion. There are some, however, whe cannot be convinced. If the patient recovers after transfusion, it was owing to the efforts of Nature, or the effects of other means :-If she dies, the inutility of transfusion is, of course, manifest. There is no species of evidence which can carry conviction to the minds of these people, and, therefore, we shall not waste our own time, or the time of our readers, in argumentation. We advocated the propriety of transfusion, ever since we became acquainted with the first attempts which were made, and we have no cause to withdraw or change our opinions on this subject. Much praise is due to the gentlemen engaged in this transaction, which we consider as one of the most unequivocal proofs of the safety and efficacy of transfusion, which have yet come before the public.

5. RETENTION OF URINE, FALSE PASSAGE.

There is a case of this kind reported lately from Guy's Hospital, and, if the report be correct, there is a lesson contained therein, which surgeons would do well to bear in mind. We know that some surgeons of high repute have great confidence in the powers of nature, when retention of urine is to be treated. A man may be two or three days unable to make water, or, at all events, unable to discharge it as fast as it is secreted-he may be suffering great pain-the bladder may be felt above the pubes—there may be an impossibility of introducing a catheter, and yet the surgeon will say "Oh! let him alone, the water will dribble through." It will often do so, we are aware; but it will sometimes dribble through the urethra, behind the stricture, into the cellular membrane-or inflammation and suppuration may take place in the neighbourhood of the urinary passage, and when the matter makes its way into the urethra, urine will make its way into the cavity of the abscess, and the consequences may be fatal. The following case, which we shall greatly abridge, appears to have been an instance of this

kind.

Case. A middle-aged man was admitted into Guy's, on November 15, 1826, having laboured for some days, under partial retention of urine, and passed none during the preceding 18 hours. Catheterism was attempted (by Mr. B. Cooper) in vain. The patient was bled in a warm bath till faintness was induced; but still the catheter could not be passed into the bladder. Some urine dribbled through, however, after the bath. Still the bladder was felt distended above the pubes, where much tenderness is evinced on pressure. The pulse is small, tongue furred-hiccup. Calomel and opium at bed-time. More attempts were unsuccessfully made with the catheter on the 16th. Leeches to the pubic region. In the evening, Mr. Callaway (who happened to be going round) succeeded in introducing the catheter, and drew off four pints of high-coloured urine. Much relief was now, of course, experienced, and the catheter was mostly kept in the bladder. On the 20th, there were two shivering fits; on the 26th, there was great irritability and restlessness, with irritative fever, and much pain about the membranous part of the urethra, to which leeches were applied.

27th. Pus was discharged with the urine. Irritative fever continues. 28th. A fluctuating swelling, the size of a walnut, was perceived, immediately anterior to the scrotum, which might be made to disappear by pressure. Swelling and tenderness in the perineum. 29th. Swelling in front of the scrotum increased-urine constantly dribbling away. On the 4th Dec. we find that "the abscess has greatly enlarged-it is harder to the touch-and the integuments, to some extent around, have a dark red colour; whilst, in the centre of the swelling, there is a gangrenous spot, nearly the size of a shilling." The constitutional symptoms were in unison with the local affection. An opening was made, and some ill-conditioned pus, mixed with urine, came away. We need not pursue the details any farther. The event may be easily anticipated. The patient died on the evening of the 7th December.

On dissection, a stricture, of considerable firmness, was found in the bulbous portion of the urethra. An abscess had formed externally to the urethra, partly anterior, partly posterior to the seat of stricture. There was a false passage in the urethra, large enough to admit of the point of a catheter, and it was of about two inches in length; this false passage commenced anteriorly to the stricture, and terminated at a short distance behind it, so that, in all probability, the catheter had taken this course behind, or rather beneath the natural channel, and had thus, as it were, evaded the stricture." The nates were found to be in a sloughy state to some depth; but not apparently from infiltration of urine.-LANCET, No. 179.

This is a very remarkable case; at least in one point of view. It is not often that the point of the catheter, having once ruptured the urethra, and got into the cellular substance, finds its way back into the urethra, beyond the obstruction. We know, indeed, that a stricture may be bored through, as it were; but this curvetting of the catheter out and in of the passage is a phenomenon to which we never heard of any thing," simile aut secundum,' before. It is abundantly evident that this new or circumambulant passage, if it really existed as such, must lie at the door of Mr. Callaway, who succeeded in reaching the bladder after Mr. Cooper had failed. Mr. Callaway will doubtless give the public some information on this curious point.

At all events, we think it will be allowed that the danger of puncturing the bladder above the pubes-or of taking the chance of the water "dribbling through," without any assistance, was much less than that of using such force with a catheter as was sufficient to rupture the urethra. This last accident should not happen. The choice will then be between paracentesis vesica and the dribbling process. For our own parts, we should much prefer the knife, since there is scarcely any danger in puncturing the bladder above the pubes, but great danger in temporising, as the foregoing case sufficiently shews. It is more than hinted by the reporter, that the swelling under the urethra was not opened in due time. We should have been glad to know what other morbid phenomena presented themselves among the vital viscera. The local disease was inadequate to destroy life, without other sympathetic lesions in one or more of the great organs of the body.

6. SCIATICA CURED BY TURPENTINE.

The ol. terebinth. is one of the heroic medicines which our Continental neighbours have ventured to import from this land of specifics. Venesection is evidently performed with a boider hand since their intercourse with the English and even calomel is kept in their boutiques, if not actually prescribed, on some rare occasions.

In the November RÉVUE MEDICALE, M. Piorry has stated a case of severe femoro-popliteal neuralgia, cured by the medicine at the head of this article.