toms, and being combined with those alluded to, as also its evening exacerbations, are the diagnostic marks of this disease. Eight cases are related; we can find room for one or two.

Case. A gentleman had a hydrocele with enlarged testis, and a surgeon, in attempting to tap the former, wounded the latter; he concluded there was a solid enlargement of the testis, and proposed extirpation. Sir Astley being called in found enlargement of the tibia with nocturnal pains, and a venereal eruption on the fore-part of the chest and abdomen. He ordered a course of mercury, when the syphilitic symptoms vanished, and the enlargement of the testis disappeared. The hydrocele was injected, the patient got well, has since been married, and had children.

Case. A gentleman, aged 32, had four years ago a chancre, for which he took mercury until it was healed. A few months afterwards he had pains in his limbs and his head, succeeded by enlargement of the tibia. He used mercury at various times, in sufficient quantity to subdue the symptoms, but not to cure the disease. Fourteen months ago a swelling began in the right testicle and gradually increased; then he suffered from pain in the left, in which a hardness remained. Sir Astley affected his mouth with calomel and opium, and continued it for six weeks. He made him observe the recumbent posture, apply leeches and a lotion of the liq. ammon. acet. and sp. vini. The swelling testis was entirely reduced, but when he left town the pain in his leg was not completely subdued.

Sir Astley is not inclined to dispute with those who doubt the syphilitic nature of such cases, but he is sure that he has seen enlargements of the testis combined with syphilis, and that the best mode of treating them consists in putting the system fairly under the influence of mercury, exhibiting afterwards a lengthened course of the compound decoction of sarsaparilla. He feels assured, in fact, that the testicle becomes affected during the progress and influence of the syphilitic poison upon the body in some persons, and that mercury is the only cure. At the same time we must employ the recumbent posture, local depletion, and evaporating lotions, although without mercury they will inevitably fail.

X. OSSIFIC INFLAMMATION OF THE TESTIcle.

The deposit of earthy matter not unfrequently takes place in structures not originally containing it. It is most commonly seen in the cartilages of the larynx, trachea, and ribs. It is found in ligamentous structures, as the symphysis pubis, sacro-iliac synchondrosis, and ligaments of the spine; in serous membranes, as the arteries, the pleura, pericardium, and peritoneum ; and in most instances it is the concomitant of old age.

In dissecting enlarged and much hardened testicles, our author has sometimes met with deposits of earth, variously situated. The tunica vaginalis occasionally undergoes this change, a beautiful specimen of which may be seen in the museum at Guy's Hospital. The tunica albuginea is still more frequently affected, little patches of earth being often seen between it and the tunica vaginalis testis; the albuginea is also sometimes entirely covered, as well as interstitially loaded with earthy matter. When a hardness is left by chronic inflammation at each extremity of the epididymis, earthy matter is sometimes found in the globus major or minor. The testis is less

frequently affected, but when very enlarged, portions of cartilage containing earth are found amidst the recently effused solid matter. A simple chronic disease will occasionally, under a length of time and changes of the constitution, undergo such alterations that various appearances will be found in it-pulpy substance, cysts, cartilaginous and ossific matter.

Case. James Verroil, aged 26, a musician at one of the theatres, was admitted into St. Thomas's Hospital, on the 8th April, 1824, under the care of Mr. Tyrrell. His aspect was sallow, his secretions irregular, and there was much constitutional derangement. One testicle was about the size of a large orange, rather uneven on its surface, hard in some parts, soft and fluctuating in others. There was at times severe pain in the affected part, extending to the loins. In the Spring of 1823, he had contracted a gonorrhoea for the fourth time, which in three or four weeks gave rise to inflammation and enlargement of the testis. By rest and evaporating lotions the inflammatory symptoms were reduced, but the testicle still remained hard and much larger than natural. He returned to his former irregular mode of living, and in the following October, the testis enlarged still more, particularly at the posterior part. From that time till his admission the enlargement had continued progressively increasing.

The remedies for chronic inflammation being tried without success, Mr. Tyrrell removed the disease. On examination of the testis, its substance, was converted into a soft pulpy or medullary matter, in the centre of which was a small abscess. The epididymis presented a hard mass like scirrhus, had numerous portions of cartilage deposited in it, and at its upper part was a bunch of hydatids. An attack of peritonitis followed the operation, but the patient recovered, and left the hospital cured.

These cartilaginous and ossific deposits, whether in the membranes or in the substance of the testis, admit of no relief from medical or surgical treatment. The operation of castration is not generally required, as they remain for many years in an indolent state, and urgent measures are unnecessary, unless the complaint assume a malignant disposition, or be very inconvenient from its bulk. Sir Astley believes that such deposits are more frequently the effect of long-continued simple chronic inflammation, and of change of structure from age, than the consequence of malignant action in the part.

This concludes the portion of Sir Astley Cooper's magnificent work, which treats of the simple diseases of the testicle, a portion comprising 115 pages. We have placed within the compass of a little more than twenty, almost every individual observation and precept of the observant, experienced, and able Baronet. It has required no talent to do this, it merely needed dense and unwearied analysis. We have added few remarks of our own, for although the cases we have witnessed might justly enable us to say more, we thought that the most useful boon to our readers, would be placing before them the sentiments of Sir Astley Cooper, without the alloy of trite observations or specious criticism. Little summing up is required, for, in the present case, any censure would be absurd, and praise superfluous. We are not presented with flimsy theories, which would probably be upset by the visionary of to-morrow, but with solid precepts deduced from long and careful observations of the book of Nature. The malignant diseases of

the testicle, and the diseases of the tunics remain to be considered; they will occupy an article. Another will be devoted to the anatomical portion of the volume, and then all that is susceptible of, review, will have been consumed. The plates of course we cannot analyse; and here we must be contented to express our admiration. They are executed in the best style, without exaggeration, without caricature; portraying with fidelity the diseases they represent, and adding force, truth, and vivid illustration to the descriptive department of the work.

XI.

MEDICAL REPORT OF THE FEVER HOSPITAL, DUBLIN. By Dr. J. O'Brien.

In the annual report of the above hospital for 1826, the author had occasion to describe the formidable epidemic of that period-an epidemic the most extensive as to numbers, which had ever previously visited that city. It was computed that 50,000 persons, that is, about a sixth part of the population, had been involved in the calamity on that occasion, of whom, from three to four thousand died.

"Since that period a revolution not unusual in Epidemic maladies, and similar to those which mark the vicissitudes of other great natural phenomena in which extremes often follow each other in rapid succession, has occurred with respect to Fever in this metropolis. Not only has this disease fallen below its ordinary numerical standard, but at particular moments, it appeared to be altogether evanescent and extinct. On several occasions the number of cases of Typhoid Fever in this hospital, did not exceed half a dozen, and I have reason to believe, that a few occasions occurred, on which not a single case of Typhoid Fever was to be found in our wards."

In respect to the etiology of fever, our author completely overturns the medico-political doctrines of Dr. Corrigan, which have been bruited about in the Lancet and the newspapers-namely, that want is the cause of the Irish epidemics.

"There is one fact, however, which he thinks it important to notice, and which, he conceives to be a decisive refutation of that opinion, which would attribute the generation of Epidemic Fever to the sole and exclusive agency of public distress and famine;—namely, that during the period of Epidemic intermission, if we may be allowed the phrase, just now described, when this disease had nearly disappeared from amongst us, public distress and suffering had never previously, perhaps, attained to so great a height in Dublin. This unhappy state of things is so well authenticated by repeated public meetings, and repeated claims on public charity, that it would be quite superfluous to offer further proofs of its existence.

It is well known that the great mass of the humbler population in the district immediately contiguous to this hospital, and from which its wards are principally supplied, have, after suffering the most afflicting distress, been fed for months back from the scanty gleanings of public charity. The Author, however, is far from denying the powerful agency of want and misery in generating Epidemic

Fevers; he has ever regarded those evils, in conjunction with certain moral habits, which he looks upon as their natural and inevitable consequences, to be the chief, the great, he would say it emphatically, predisposing causes of Fever in this country; but he holds the opinion that these evils alone are incapable of generating Continued Fever in any individual instance, much less in its epidemic form, and that to produce this effect, the combined agency of another set of causes, which, in medical language, we call exciting causes, is indispensably necessary. This latter class of causes will operate with tenfold effect upon an impoverished and enfeebled multitude, when present, but when they are absent, we are instructed by the events of the past year, distinguished at once for an extraordinary immunity from Fever, and extraordinary public distress, that want and misery are incapable of themselves, of producing Epidemic Fever.” 7.

Dr. O'Brien next introduces a series of cases from the journals of the hospital, amounting to sixteen, exhibiting, as he expresses it, "a lively portrait of the different types of fever which prevail in Dublin." The first four patients present examples of primary gastro-enteritis, " or that disease which has proved a false light to M. Broussais." The fifth case exhibits an example of complication of gastro-enteritis with typhoid fever and the remaining cases afford illustrations of various types of typhoid fever, "from the mildest to the most intense and malignant form of the disease." We shall give the following general conclusions in the author's own words, as they cannot be abbreviated without injury.

"First. That there exists a primary Gastro-enterite, attended by a Fever of a peculiar kind, approximating in some respects to the Typhoid character, like all intense phlegmasia of the Gastro-intestinal canal, yet differing from Typhus by some obvious and striking properties.-The following is the train of symptoms peculiar to this disease, viz.-Pain, uneasiness, and generally fulness of the epigastrium, or abdomen, or both aggravated by pressure, and accompanied by headache, nausea, or retching, and, in many instances, by frequent vomiting, particularly after the introduction, even of the smallest quantity of fluid or solid aliment, into the stomach. The appearance of the tongue is peculiar and characteristic; it is either of a vivid or dark red colour, over its entire surface, or it is red at the edges and point, but covered with a dark white fur in the centre, through which specks of red are occasionally visible; the centre, however, is also frequently brown, or even of a yellowish hue, whilst the edges are dark red, as above described, and the papillæ all over the surface unusually prominent; and this organ, on the whole, presents a more striking appearance of irritation and sub-inflammation in this disease than in any other type of Fever-The pulse is usually deficient in fulness; it is small, frequent, and compressible, and approximates more to the Typhoid than the Synochoid character. It is also accompanied by a lower temperature of the skin; and, in a word, displays none of the signs of that strong re-action, which marks the early stage of Synochus. It is distinguished, however, from Typhus by the comparative mildness of the cerebral affection; the author has, indeed, been frequently surprised at the clearness and integrity of the intellectual faculties, in the midst of that extreme depression of the muscular powers which characterises this type of Fever. This disease is slow and gradual in its access as well as its progress; the patient feels himself ill for some time, affected with loss of appetite, costive bowels, uneasiness, and occasional twitches of pain at the epigastrium and in the abdomen, which continue until the febrile movement is developed, when the train of symptoms before described, sets in with all its violence. The progress is also remarkably slow, the disease being frequently protracted to the sixth or seventh week before convalescence takes place. It is further distinguished from Typhus by the absence of petechiæ, a black crust on the tongue, or black sordes of the teeth and gums, which the author has never observed in any of the clearly

marked cases of this disease he has witnessed. The bowels are either constipated, or too relaxed, and occasionally these two states alternately succeed each other. The abdomen is tumid, resisting and tender to the touch, when pressure is employed externally ;—the sleep is uneasy, interrupted, and delirious; but when awake, the patient seems to suffer little diminution of his intellectual powers.

As a further proof of the real nature of this affection, it may be stated, that the author has invariably observed that, in proportion as the abdominal symptoms were mitigated or subdued, the affection of the head and the febrile symptoms suffered a simultaneous mitigation or removal. The colour of the skin in this disease is commonly one of the shades of yellow; occasionally the tint is deep and dark, as in the case of Kitts (No. 1), where it approached to one of the lighter shades of mahogany.-The intense bright yellow colour of the skin, peculiar to jaundice, and, we presume, to yellow Fever, has not occurred in this Hospital since the Epidemic Fever of 1826; but, from the author's recollection of the cases which then occurred, he is inclined to consider them as modifications of the disease we have been considering.

"Secondly. The disease now described may be secondary, that is, may supervene on Typhoid Fever, a predisposition being probably formed by previous disorder of the stomach and alimentary canal, functional or organic, or by the prevalence of that epidemic constitution or Malaria which disposes to diseases of the stomach and bowels, as Cholera, Dysentery, &c. This adjunct to Typhoid Fever may occur at an early period of the disease, but it is more frequently observed to accompany the advanced stages.

In those cases, we are taught by numerous dissections made by modern pathologists, that the principal, in many instances, the sole seat of disease, is the lower part of the ileum, near its junction with the cœcum, which is probably to be attributed to the densely glandular structure of this part of the intestine, and partly, as we believe, also to its inferior situation, which favours the accumulation of acrid secretions in this part. In a disease like Typhus, where the sensibility is greatly impaired, or even destroyed altogether, this affection may exist, without being felt or complained of by the patient; but it will very seldom, indeed, fail to be detected by careful examination externally, or by diarrhea, or a tympanitic state of the abdomen-which latter are its appropriate signs, when the patient is in a state of coma or insensibility. Another of its symptoms, more rare than those above-mentioned, is hæmorrhage from the bowels, which, if superadded to a tympanitic state, presents the most intense and hopeless form of this affection. With respect to the colour of the alvine discharges in this affection, it is stated by Dr. Bright that they are generally ochre-coloured; but the author has more frequently seen them of a dark or mud colour-yet he has also frequently observed them as described by Dr. Bright.

Thirdly. The author is of opinion that there are good grounds in nature for dividing Idiopathic continued Fever into two great classes, which become the foundation of important practical indications, viz.: Inflammatory Fevers (Sy. nocha), and Typhoid Fevers (Synochus and Typhus); between the first and second of which, as formerly observed of the second and third, various intermediate shades of type occur, the allocation of which to this or that genus or class, it will be difficult to determine. Again, he infers that in the first class (Synocha), the Morbific cause of Fever exercises its agency principally over the heart and arterial system, whilst the sensorium and nervous system enjoy a comparative exemption from its influence. Further, that the operation of the Morbific cause in Typhoid Fever is directed primarily and essentially against the brain and nervous system (including the spinal chord), and through that system against the heart and arteries, and their capillary extremities. That the various modifications of class and species, arising out of the two great divisions above-mentioned, may depend on specific modifications in the Morbific cause itself, or in the original conformation or constitution of the individual who is