faculties became disturbed-the oedema reached the upper extremities, and in this state he was received into the Clinique Interne de la Faculté, where he died in a few days.

Dissection. Besides the general edema of the extremities, there was sanguineous infiltration into the substance of the brain, and water in the ventricles. There was a large collection of yellow serum in the right side of the chest, and the lung of that side almost entirely hepatised. There was no water in the pericardium ;-the heart was covered with much fat, and was nearly double its natural size. The chambers were dilated, and the parietes of the left ventricle were "visibly thickened." There was a red tinge (which could not be washed off) in the lining membrane of the left ventricle, and on the internal surface of most of the large vessels. The liver was enlarged, and there were unequivocal marks of phlogosis in the mucous membrane of the stomach.

Remarks. We do not see any cogent reason for supposing that the sanguineous infiltration of the brain, in this case, was solely owing to the hypertrophy of the heart. Doubtless the cardiac disease, and the hepatised state of the right lung, were the causes of the general serous effusions; and it is probable that what was called sanguineous infiltration in the cerebral substance, was merely sero-sanguineous effusion, and not hæmorrhage. The symptoms of apoplexy are no where stated as having occurred before the death of the patient.

Case 3. M. G. aged 54 years, had enjoyed good health till June 1821, when he had an attack of hepatitis occasioned by distress of mind. This gave way to proper treatment, and two months afterwards he was seized with an intermittent, (quartan) which resisted every kind of treatment till the end of December of the same year. In the beginning of January 1822, M. G. on getting out of bed, became suddenly deprived of sense, and on reviving a little, was found hemiplegiac and unable to speak. He was bled largely and repeatedly, and in two days speech and muscular power were restored. He complained of pain in the head, vertigo, and tinnitus aurium. Leeches, pediluvia, antimonials, &c. apparently restored the patient, in a few days, to health. More than two years elapsed, after this, without any accident, except that he had occasionally frightful dreams, and his breathing was short, on going up an ascent. He was now destined to experience a fresh attack, which ended in paralysis of the right side. This hemiplegia had continued four months, when our author was consulted. The patient complained of violent palpitation, difficulty of breathing, acute head-aches, vertigo, and an irresistible propensity to sleep after meals. The face was injected, the eyes prominent, pulse strong, quick, and irregular. After examining the heart attentively by auscultation, our author diagnosticated an hypertrophy of the left ventricle. Bleeding, general and local, rigid abstinence, digitalis, counter-irritants were prescribed. At this interview the sudden decease of a near relation by apoplexy, was imprudently announced to the patient, the effect of which was, instantaneous death by the same disease!

Dissection. The membranes of the brain were very much injected, and of a red colour. The right hemisphere presented no appearance of disease. In the centre of the anterior lobe of the left hemisphere was a small cavern, the size of a pigeon's egg, filled with black and coagulated blood. The cerebral substance surrounding this apoplectic cyst was changed into a kind of bouillie of a yellowish colour. In the same hemisphere was found, near the fissura magna sylvii, a large quantity of blood, apparently of recent

extravasation, and which had partly made its way into the lateral ventricle of that side. This extravasation was evideftly the immediate cause of death. There was no alteration of the cerebral structure in the vicinity of this effusion.

The lungs were sound-the heart very much enlarged-the parietes of the left ventricle more than an inch and a half in thickness-auricles dilated, and their coats very thin-nothing remarkable in the abdominal viscera.

This case exemplifies the fact, that a large effusion of blood in the brain, as well as universal congestion, may occasion sudden death. The cyst in the left hemisphere of the brain corresponded with the previous hemiplegia of the right side.

One of the three cases above detailed shews that we are not always to expect a corresponding cyst for each preceding attack of apoplexy. If there be an extravasation of blood, and a succeeding paralysis of any duration, we may be pretty certain of finding the said cysts. Where the apoplectic attack is not followed by distinct paralysis, we may generally conclude, that the pathology of the disease was congestion merely, without rupture of vessels.

How far the foregoing cases corroborate the opinion of hypertrophy of the heart being a cause of apoplexy, we leave to the judgment of our readers. For ourselves, we have no doubt of the truth of this etiological doctrine generally speaking; but we think that one or two of the cases, here detailed, are of equivocal validity on this point, though interesting in other respects.

11. REGENERATION OF THE URETHRA.

In our last Number, page 220, we gave the particulars of a case of “ regeneration of sphacelated urethra," by Dr. Brown of Sunderland, as published in the Ed. Journ. Med. Science, No. 4. We request that our readers will turn to that case, and re-peruse it, as it is very short. It will be seen, that we doubted not the veracity of Dr. Brown's statements, but the conclusions which he drew from what appeared to him as facts. We have received a long letter from Dr. B. vindicating himself from the imputation of being deceived, or of wishing to deceive others. The latter was never imputed to him, and therefore we shall pass it by unnoticed. That he was deceived, is no great imputation; for we believe that there is not a medical man in existence, who has been ten years in extensive practice, and who has not been a thousand times deceived. Dr. B. hopes we will "cast off, or rather cast out, the slough of scepticism," in our next number. Dr. B. who is a man of great literary acquirements, and deep philosophy, ought to know that it is not in a man's power to alter either his creed of his scepticism by a voluntary effort. Both are the result of conviction; and there is nothing in Dr. Brown's letter which has shaken our scepticism. It is true Dr. B. has taken the advice and opinion of several eminent practitioners on the case, and they all give it in his favour. This must be very gratifying to him and we can assure him it is not in the least mortifying to us. The case is fairly before the public, and let that public decide.

One fact, however, which Dr. B. has now brought forward, in proof of the correctness of his opinion, that it was the urethra itself which was extruded from the wound in the left side of the abdomen, deserves to be recorded. It is this:that the man has since lost all venereal appetite. He accounts for this phenomenon, by supposing that the apertures seen in the preparation are the openings of the prostatic ducts. Now, without referring to musty

volumes on this subject, we shall appeal to the experience and observations of surgeons. When the prostatic ducts are cut, or obliterated by inflammation, after lithotomy, the accident does not destroy, or even impair, the venereal appetite. It prevents the emission of the seminal fluid, and occasions great distress, of which we have recently seen a remarkable instance, but we maintain that it does not destroy the sexual appetite. These facts before our eyes, no statements in books can make us "cast off the slough of septicism." Dr. B. no doubt considers us as quite solitary in our scepticism. We beg him, therefore, to peruse the REVUE MEDICALE for November last, pages 280-3, where he will find that the "slough of scepticism" will require his caustic on both sides of the channel. The French reviewer observes, that "tout doit etre merveilleux dans cette observation;” and concludes with the following sentence: "Toutefois, nous devons dire ici que l'auteur n'a pas donné assez de details, ni sur la maladie, ni sur la piéce pathologique, pour lever tous les doutes que se fait laissera dans l'esprit des lecteurs."

It is but fair to state, that Dr. Brown means to send the preparation to Lor don, in which case we promise to submit it to two or three of the first anatomists of this capital, and publish the result of their examination. Unquestionably those who have seen the preparation have better means of forming a judgment, than we who have only seen the plate. Dr, B. will perceive, that the French journalist is not convinced, any more than ourselves, by the drawing, and therefore we recommend him to send the original to town.

12. REMARKABLE DISEASE OF THE STOMACH.

The following extraordinary case is related by M. Nacquart, secretarygeneral to the Medical Society of Paris, in the January number of the JOURNAL GENERAL DE MEDICINE.

Case. Madame S. aged 50 years, had been subject to derangement of the digestive functions all her life, accompanied sometimes by pains in the epigastrium, at others, by nausea or vomitings. These symptoms were mitigated by warm baths, abstemiousness, and amusements, and she had occasionally long intervals of tolerable health. In 1822, the catamenia ceased, and then there came out an herpetic, furfuraceous, and even erysipelatous eruption on the face, which continued more than three months. Some time after this, Madame S. remarked, that the left hypochondrium was somewhat enlarged, as well as all that side of the abdomen. She also felt darting or dragging pains in her stomach. The intumescence was attributed to enlargement of the spleen; meanwhile the epigastrium became tender on pressure, and the stomach refused to digest the lightest aliment. In 1825, she had occasional vomitings of black matters, like coffee grounds, with copious ptyalism of mucous matters from the mouth. The tongue was denuded and painful-constipation obstinate. On the 27th March, 1826, M. Nacquart was called to the patient, and found her excessively emaciated, with an indolent tumour communicating the sensation of a gellatinous fluid, occupying the left hypochondriac fossa, stretching over to the epigastrium, and downwards below the umbilicus. Pressure on this tumour caused borborygmi, and percussion elicited a hollow sound. There was nothing particular in the constitutional symptoms. By a strict regimen, the use of a bandage, and taking the waters of Vichy, the patient mended greatly, the gastric irritability subsiding, and the tumour decreasing in size. But the amendment was of short duration, and the vomitings returned, with general malaise, and sense of burning pain in the stomach. These symptoms

again subsided-again the appetite returned—and what remained of the tumour was soft, but still sonorous. The case was so mysterious, that Dupuytren was called in consultation (5th of June), but he could not decide on the nature of the tumour. He was of opinion, however, that the tympanitic character must be owing to some convolutions of intestine placed over it. During the next month, the appetite continued pretty good, but at the expiration of that period, the black vomitings again returned, preceded, as before, by ptyalism, and thus blasting the hopes which the patient had entertained of a recovery. The tumour, in the centre of the epigastrium, now became more apparent, more tender, and the emaciation increased, with oedema of the lower extremities, and diarrhoea. 27th July. The tumour, for some days past, had become so enlarged, as to dip into the left side of the pelvis. At this time the patient discharged from her stomach more than three pints of a black fluid, mixed with the debris of food formerly taken. Her condition was now very distressing, and she could keep no aliment on her stomach. On the 7th of August, while sitting down in her chair, she uttered a cry, bent herself forwards, and with a faint voice averred, that something had given way internally, and produced a burning sensation in the abdomen. She died in 12 hours from this period.

Dissection. The peritoneum was inflamed in several places, and contained two or three pints of turbid fluid, mixed with flocculi and pus. The abdomen being completely opened, the stomach appeared to be divided into two portions the one on the left forming an immense pouch, descending into the hollow of the ilium, and concealing the whole mass of small intestines on that side-the other portion, or pyloric, not larger in volume than the duodenum. These two portions were connected by a contracted portion, in front of the vertebral column, and in this portion was a circular perforation, about four lines in diameter. The stomach having been entirely isolated, the left division was found to contain about two pints of a brownish fetid matter, mixed with streaks of pus, its mucous lining being softened, discoloured, and presenting extensive arborisations. The peritoneal coat was pale and healthy-the right, or pyloric portion, three or four inches in length, was about the size of the duodenum, and might have been mistaken for it, if the pylorus had not remained intact. The mucous membrane of this division was somewhat thickened, but otherwise sound. The middle, or intervening portion, presented an irregular mass, three or four inches in length, and of unequal diameter, varying from one to two inches. Its parietes were indurated, and there was a canal through its centre of only some lines in calibre. When this portion was slit open, it shewed an irregular ulcer, of cancerous aspect, with ragged edges, and with several softened tubercles in its substance, some containing encephaloid matters, some a black and diffluent substance. In one of the sinuosities of this ulceration there was a circular perforation, as above-mentioned. The matters contained in the abdomen resembled those found in the stomach. Some convolutions of the intestines were phlogosed and adherent, but the mucous membrane of the duodenum, and all the intestines, were perfectly healthy, The liver and other organs were sound.

It would be useless to speculate on the origin and progress of this terrible disease. The case shews the difficulty of exactly ascertaining the nature of abdominal tumours.

13. CEPHALO-SPINAL FLUID.

Two things often puzzled us when examining the bodies of the dead-the disproportion of size between the spinal marrow, and the canal in which it is contained-and the fact that, in almost all cases, there was more or less serous effusion (as it is called) at the base of the skull, and in the vertebral canal. In a late sitting of the Royal Institute of Paris, M. Magendie read a memoir on the fluid found in the cranial and spinal cavities of man and mammiferous animals, to which fluid he has given the epithet "Cephalorachidien." This eminent physiologist commences with an estimate of the total amount of this fluid, which he found to vary, in the adult and healthy subject, from two to five ounces. Among other uses, M. Magendie considers the cephalo-spinal fluid to serve the purpose of keeping, in a proper degree of plenitude, the cavities of the cranium and spine. In old age, the shrinking up of the brain and spinal marrow (not sufficiently observed by physiologists) causes a greater space for the accumulation of this fluid, and is thus inimical to the sustenance of life. In corroboration of this opinion, M. Magendie has observed, that, in the old and emaciated females who die at the Salpetriere, the quantity of this cephalo-spinal fluid is very considerable. Numerous experiments on animals have demonstrated, that this same liquid, when drained off artificially, is very quickly reproduced, like the humours of the eye. The effect which this artificial evacuation produces in animals, is a state of numbness and hebetude, which continues till the reproduction of the liquor. In two instances, he found the evacuation induce a state of agitation and violence in the animals, which resembled hydrophobia, and lasted for three or four days. An artificial augmentation of the cephalo-rachidien liquor causes pressure on the brain and spinal marrow, and determines paralysis. The disease, known by the name of spina bifida, consists, according to M. Magendie, of a kind of hernia of the membranes which contain the said fluid. By pressure of the spina bifida, in children, he has produced the same phenomena which were exhibited by animals, where injections had been used to augment the quantum of this fluid. The temperature of the cerebro-spinal liquid was found to be under that of the blood, by some degrees. M. Magendie has produced in animals a tremor and a momentary paralysis, by drawing off this liquor, suffering it to cool, and then injecting again the same fluid. These symptoms appeared to last till the fluid had regained its natural temperature. If, after the evacuation of the fluid, the same was injected again, of the natural temperature, no such symptoms occurred. The motion of the head on the trunk of the animal, produced a waye or agitation of the fluid in the spine. M. Magendie is of opinion, that the contact of this fluid plays an important part in the development of electricity, and has undertaken a series of experiments, with the view of determining this point. All physiologists now agree in believing, that a certain quantity of halitus, or watery vapour in the ventricles of the brain, is consistent with health. M. Magendie has proved, to his own satisfaction at least, that a communication exists naturally between the lateral and the other two ventricles of the brain, and between the fourth ventricle and sub-arachnoid cavity of the spine. This communication, he says, is established by an aperture between the two posterior cerebellic arteries, and is, at least, three lines in diameter. M. Magendie proposes to call this aperture "entreé des cavitiés du cerveau," or " entrée des ventricules cerebraux."

The communication being thus established between the ventricles of the