mation in the left side of the chest, for which he was copiously bled, and had proper medicines administered. When questioned by Dr. Guerard, he informed the physician that, 22 years previously, he had been affected with pneumonia, which terminated in an abscess, and for which an operation was performed. As the inflammation still continued, Dr. G. ordered farther depletion, blisters, &c. On the fith day, there was oppression on the chest, and the stethoscope gave indications of a fluid in the left cavity of the pleura. On the 9th day, the symptoms were so unequivocal, that the operation was performed, when a large quantity of fetid pus was evacuated, with relief of all the symptoms. The discharge gradually decreased, and, on the fifth day from the operation, the patient was able to leave his bed. He was seen a year after this period, in perfect health.

38. PERFORATION OF THE INTESTINUM ILEUM.

[M. Martinet. Hôtel Dieu.] It was reserved for modern pathology to discover the true cause and the terrible consequences of this fatal accident. A knowledge of the causes of a disease, is the first and most certain step towards prevention. In former times, when dissections were less common, many sudden and violent deaths were caused by perforations of the stomach and bowels, which were not suspected-and when these perforations were discovered, their cause was not ascertained. This cause is preceding inflammation and ulceration of the mucous membrane in general-sometimes, though very rarely, of the peritoneal coat first, and the other coats afterwards. When we reflect on the frequency of these intestinal ulcerations, we might wonder that perforations are so rare; but we must remember, that the peritoneal covering of the intestinal canal presents a most powerful and obstinate barrier to the escape of fæcal matters, even when the mucous and muscular coats are completely destroyed. Nevertheless, the perforation does sometimes occur, and that at all periods of muco-enteritis, and even during convalescence from that disease, and from fevers, when patients are thought VOL. VIII. No. 15.

to be out of danger, and when practitioners are off their guard. Excesses of the table, at this period, bring the danger into view when it is too late. On this account, the convalescence of a patient from any disease in which inflammation of the internal surface of the intestinal canal had previously existed, should be most rigidly watched, and all imprudences in food forbidden.

When this rupture of the external tunic takes place, there is, in general, a pain, more or less acute, felt in some particular point of the abdomen, commonly about the umbilicus, or towards the caput coli. This pain is suddenly developed, and sometimes consists, at the very beginning, of a sense of burning heat, spreading in all directions from a centre. The pain, however, rapidly augments, and soon occupies the whole of the abdomen, rendering the least pressure insupportable. Then come on nausea, vomitings, hiccup, profound alteration of the features, extreme smallness and quickness of the pulse; all showing the existence of acute peritonitis. Two, three, or four days of intense suffering bring the solace of death.

The diagnosis of this terrible calamity is rendered very difficult, when the patient happens, at the time, to labour under cerebral disease, especially arachnitis; for then, the delirium which obtains prevents the patient from feeling, or, at least, expressing, the abdominal sufferings. In a few instances, the inflammation resulting from perforation and extravasation, has been sub-acute, and patients have lived ten or twelve days. This, however, is rare. If the pain continues confined to a circumscribed spot, we may hope that the intestine has been ruptured into a kind of cyst, of which there are several examples on record. We shall now introduce the particulars of a case in illustration.

Case. Brisson, aged 25, had fever and diarrhoea for three days prior to his entrance into the Hôtel Dieu, when he complained of abdominal pains, head-ache, and febrile attacks, every evening. Second day. The belly was rather painful on pressure, especially about the navel diarrhoea-cephalalgia-tongue very white-pulse strong and full. Injection, containing tartar emetic and sulphas magnesia, which provoked some vomiting, 30

with relief of the cephalalgia and abdominal pain. During the next few days, he was kept on farinaceous food, and he was on the point of full convalescence, when, on the eleventh after his entrance, he was suddenly seized with severe pain above the pubes, which quickly spread over the abdomen, attended with dysury, vomitings, bloody diarrhoea, &c. Leeches, warm-bath-but no relief followed. He lingered out for three days after this, and then died.

Dissection. The cavity of the pelvis was filled with flocculent pus and a milky fluid-intestines covered with false membranes, of very recent formation-a small perforation, perfectly circular in the ileum, a few inches from the ileo-coecal valve-the mucous membrane around the perforation was red, but not thickened, or otherwise altered-no other ulceration in the ileum; but there were two or three small ulcers in the large intestine, with inflammation of some of the mucous follicles.-Revue Med.

Happily, perforations, where there are so few ulcerations as in the above case, are very rare; and we find that Nature is more disposed to heal numerous and extensive ulcers in the mucous membrane, than to permit a perforation of the serous coat. Still we ought to be on our guard, and keep patients on mild nutriment, till all danger is completely over.

39. GANGRENE OF THE LUNGS.

This is a rare disease, and has never been accurately described before Lænnec's time. Since the work of this talented physician appeared, M. Andral, M. Bouillaud, and others, have brought forward examples of the disease in question. The following case is deserving of record, though we shall greatly abridge the original.

Case. A gendarme, 38 years of age, received, on the 10th March, a violent blow of the fist on the right side of the chest, which was followed by severe pain for some days, but not such as to prevent him from pursuing his usual avocations. Towards the end of March, he began to lose his appetite, and decline in health. On the 16th April, he was forced to give up work, and consulted Dr. Pichot, who

found the skin dry and hot, pulse quick and hard, tongue red at the point and edges, epigastrium tender on pressure, nausea, sometimes sickness after food, bowels irregular. The patient did not now complain of the side that had been injured; but only observed, that he felt some uneasiness there one or two hours after eating. Considering the disease as inflammation of the mucous membrane of the stomach and bowels, Dr. P. ordered leeches to the epigastrium, and mucilaginous and farinaceous drinks. The patient was speedily relieved, and, in ten days, he was able to take food without inconvenience. Returning, however, to irregularity and intemperance, he fell back, in three weeks, to the same condition as before. The original treatment was again prescribed, and in three or four weeks he again recovered. Once more he got into his usual habits of intemperance, and again he relapsed. He now entered the Charenton Hospital, whence he was discharged uncured. He next tried the VAL DE GRACE, and had no better success. He returned home, and consulted a Parisian physician, who promised to set him up in a fortnight. Emetics and drastic purgatives were now energetically administered, and the patient daily got worse! On the 15th of September, Dr. P. was again consulted, and found the poor man in a desperate condition, being emaciated to a skeleton, and harrassed with constant expuition from the mouth, without cough, or difficulty of breathing. The patient complained of burning pain between the shoulders and in the right side of the chest— pulse soft and regular-urine high-coloured-sleep greatly interrupted-abdomen swelled and painful in several places. Our author suspected chronic gastro-enteritis, converted into acute or sub-acute; but did not suppose there was any very material disease of the lungs. He prescribed some soothing medicine, and, for a few days, the patient seemed a little better. At the end of a week, he was suddenly seized with a sense of suffocation, extreme pain in his back, and through the chest, violent cough, attended with fetid expectoration. These symptoms were sometimes exasperated-sometimes moderated; and, in this condition, the miserable patient dragged out a wretched existence for fifteen days, when he expired.

Dissection. In the right side of the thorax, there was found a vast depôt of purulent matter, enclosed in a kind of cyst, formed by false membranes organized. The greater part of the lung of that side was in a state of complete gangrene, being black, putrid, soft, and exhaling a most fetid odour. The left lung was the seat of a considerable degree of inflammation, as was the internal surface of the pericardium, which was covered with a soft false membrane. The heart itself was sound. The liver was greatly enlarged, and somewhat indurated. The stomach and intestines were opened throughout their whole extent, and various marks of chronic inflammation were evident on their internal surface.-Bibliotheque Medicale.

We conclude, from the particulars of the above case, that chronic inflammation and disorganization had been going on in the right lung ever since the time the man had received the injury there, and that acute inflammation having supervened about the 20th September, it ran into gangrene, aud thus produced this rare specimen of disease in the pulmonary structure. The case affords an instructive lesson respecting the insidious nature of pulmonic inflammation sometimes, and may serve as a caution against looking too much to the abdominal organs, while mischief is going forward in the chest. This oversight is daily committed in this country.

suddenly abandoned, and the founder of the system turned his LANCET against the more conspicuous bodies of his own brethren, and bled at so furious a rate, that a universal atrophy was apprehended by the heads of the profession! Sir Astley Cooper, from the stamina of his constitution, and the plenitude of his vascular system, was selected as the first medical patient of the phlebotomist. He was bled daily-not by ounces, but by pounds

and this extraordinary depletion was carried on for more than a year! To the surprise of every one, the vigorous baronet bore this daily and hebdomadal venesection and sanguisuction (for leeches were also employed in great numbers) without apparent exhaustion. But every thing has its limits, and a period at last arrived, when even Sir ASTLEY COOPER would bleed no more!

Mr. ABERNETHY was known to be very far gone in a certain derangement of the stomach and bowels, which blue pill and black draught entirely failed to remove. Indeed, his disorder was said to be on the increase, and the PHLEBOTOMIST thought him an excellent patient for a trial of the new remedy. Without the formality of a consultation-indeed, without leave or licence, he thrust his LANCET into the body of the lecturer, and abstracted the vital fluid at a tremendous rate, affirming that he would soon correct, not only the morbid secretions of Mr. A.'s chylopoietic viscera,but that he would condense certain gazeous exhalations from his pineal gland, for the sole good of the public-and not with any view to his own private emolument. The eccentric patient did not prove

OF THE DAY.

A few years ago, there arose, all at once, an epidemic rage for PHLEBOTOMY. An experiment was made on a plethoric member of the church, who was bled by the founder of this epidemic system, usque ad deliquium, for several weeks in succession and that for the cure of a disease not to be found in the Nosologies of Cullen or Mason Good-but which has been termed by the phrenologists a PROPENSITY. This experiment excited a great sensation, both in the medical and clerical professions; but, for some reason or other, the church, which could have so well afforded to be bled profusely, was

He winced and kicked most lustily, and protested that neither his stomach nor his head required or desired any such phlebotomising measures. Blood-letting did not suit his constitution-and he would take nothing but his own favourite pill. These remonstrances made no impression on the phlebotomist. On the contrary, he very deliberately proceeded to the opera-tion of the TREPAN, boring the cranium day after day, and extracting a portion of his patient's brains, which he exposed for sale, in the Strand, with as much sang froid, as a butcher would sell the brains of a sheep in Leadenhall Market!!

This was "too bad," as Lord Liverpool once said; and, therefore, Mr. Abernethy

applied to the Lord Chancellor (who has the especial care of men's cerebral property) for an injunction against the skull boring and brain-sucking operations of a surgeon, whose professional advice or assistance he never solicited. Here was a puzzling question for Lord Eldon! Mercy on us! what a world of consideration was necessary to determine so knotty a point! What important rights and privileges might be invaded or compromised, if one surgeon were restrained from perforating the skull and extracting the brains of another, whether invited to operate, or doing so by way of experiment! Long did the Chancellor weigh these mighty matters in his deepest thoughts but, by the time he had "made up his mind" on the subject, the poor patient's head was as full of holes as a sieve, and his cranium as empty as that of Yorick! It has been said of some animals, that, after tasting human flesh, they could never relish any thing else. it was so with the PHLEBOTOMIST. The brains of Abernethy were so delicious and so fattening withal, that the brains of Clutterbuck, Bell, Lawrence, Armstrong, HasJam, Blundell, Brande, &c. were hashed up, and so well cooked by a cOMPANY of PHLEBOTOMISTS, which was now established by charter, that public entertainments were weekly given (at 2, P. M. every Friday) to all who chose to partake of the intellectual banquet, at the very ordinary price of eight-pence a head.

Now we do not find fault with the company for these their public treats. On the contrary, we believe that the individuals above enumerated, had each a great deal more brains than were necessary-and that, as a certain number of the profession are by no means overburthened with these articles, so a kind of public distribution, for the preservation of an equilibrium, was very charitable, and had all the good effects of the largesses which used to be accasionally scattered among the hungry Romans, when it was thought politic to put them in good humour with their masters.

But men will, in time, get tired of the most delicate viands; and a faint murmur of "toujours perdrix," was a strong hint for varying the bill of fare. The PHLEBOTOMISTS had excellent noses for smelling out savoury matters; and the hospi

tals, the dissecting rooms, the dispensaries, and even the colleges of the land, furnished a most odoriferous variety of garbage for garnishing out the dishes of brains at the head of the table. All this, too, had its use, and we are far from censuring the diligence of the Worshipful Company of Phlebotomists, in thus uniting the salutary trade of public scavenger with that of public cook. The rooks are always respected as useful birds, on account of their propensities to pick up worms and insects. Even the unsightly ADJUTANT is permitted to strut through the streets of Calcutta unmolested, because he devours every putrefying and deleterious substance that comes in his way. But there is no unmixed good in this world. Whether it was that a dearth of "morbid parts" did sometimes occur, or that the company's sense of smell did sometimes deceive them, but so it was, that living, healthy, and useful limbs of the profession came to be "served out," and served up, at almost every banquet― till, at length, a general dread of mutilation began to pervade the more corpulent and portly members of medical societywhile the stomachs of the guests, and even of the by-standers, showed symptoms of turning at sight of the horrible spectacle of human sacrifices before them. The offences of this COMPANY were at last rank, and "smelled to Heaven;" for, like Diana of old, in the Island of Taurica, theyhad their INSTRUMENT--a very sharp one, too-as an Iphigenia, ready to immolate every one who did not belong to their association!

A strong re-action was at last visible in the public mind; and a sense of common danger, prompted to measures of common defence. A lucky thought occurred to some one, that an ANATOMICAL COMPANY might be formed, whose office it would be, to dissect the "morbid parts" of the old or PHLEBOTOMIST COMPANY, and form a museum of these precious specimens, to be exhibited in conspicuous parts of town and country.

It has been currently reported, but for the accuracy of the report we will not vouch, that this lucky thought of an Anatomical Company, occurred at a festive meeting of the committee of manslaughter; and that, while the juice of the Tuscan grape was flowing round in