[Reported by Mr. W. C. WORTHINGTON.] FRANCES BAKER, æt. 14, of a precocious appearance, was admitted a patient of the Lowestoft Dispensary on the 7th July, complaining of violent paroxysms of pain in the abdomen and loins, shooting down the thighs, and with occasional difficulty in passing her urine. In the hypogastric region was discovered a circumscribed elastic swelling, rising above the brim of the pelvis, which she described as having progressively increased for the last three months. From the situation and feel of the tumour Mr. W. was led to suspect some uterine disease existed, and upon endeavouring to make an examination per vaginam, to satisfy himself upon that point, he was surprised at an irresistible impediment to the introduction of the finger. On a more accurate investigation, the orifice of the vagina was found to be preternaturally and effectually closed by a firm adhesion of the parts. Medical treatment having failed to afford her any relief, it became apparent that the swelling and pain were owing to the uterus being distended by the retained menstrual fluid. This opinion was further confirmed by an examination per rectum, through which a tumour was perceptible, possessing a distinct fluctuation, and descending towards the perinæum. The operation consisted in carefully dividing with a scalpel a dense cellular structure, of about half an inch in thickness, situated at the orifice of the vagina. A thin membranous expansion being left was then punctured with a lancet, which gave exit to about a pound of dark-coloured fluid. The swelling immediately disappeared and the girl expressed herself relieved. A spongetent, well oiled, was inserted, and retained between the divided parts. The third day after the operation, severe pain in the abdomen, with exquisite tenderness supervened, together with excessive gastric irritation. Notwithstanding a strict antiphlogistic plan of treatment was adopted, the patient died the following morning. On examination after death, the peritoneum was found to have been generally affected with inflammation; various gangrenous spots were presented to view, also a considerable quantity of lymph was effused, causing adhesion of the convolutions of the bowels. The uterus was nearly of its ordinary size, but the vagina was dilated into a pouch, contracted towards its orifice, capable of holding a pint and a half of fluid. Its parietes were much thickened, and of a semi-cartilaginous structure. Professor Langenbec* relates a similar case, in which death took place the fifth day after the operation, and attributes the tendency to inflammation to the long retention of the menses. He, therefore, very judiciously advises the operation never to be delayed when the true nature of the complaint is discovered; an opinion worthy of attention, inasmuch as some surgeons have considered all interference as improper, until such time as the tumour shall have attained a large size, grounding their opinions upon the principle, that it may then be punctured with more facility. If the professor's views on the subject be correct, the practice of an early operation in cases of imperforate vaginæ cannot be too strongly enforced, and the reporter cannot but be inclined to believe that the unfortunate issue of this case has contributed to verify the truth of them. XII. LA PITIE. SOME CASES SHEWING THE EFFECTS OF THE SUPPRESSION OF HABITUAL EVA CUATIONS. Three or four cases are reported from the practice of M. Louis, in La Pitié, illustrative of the subject under consideration, which is by no means an uninteresting one. Case 1. A voiturier, aged 25 years, had had an ulcer of long standing on each of his legs, of which he was cured in La Pitié in the space of six weeks, and was discharged. In about three weeks afterwards, he returned to the same hospital, complaining that, in two days after his discharge, without any ostensible cause, he became affected with acute pain in the left flank, and also in the left side of the chest, attended with some fever, loss of appetite, and diarrhoea, but without cough or expectoration. Veresection did not relieve these symptoms, and when examined at the hospital, on the 28th of April, the following were the symptoms: the heat of surface was increased-pulse rather accelerated-thirst--white tongue-ten motions in the 24 hours-acute pain in the left flank, increased on pressure, and extending to the groin of that side-a tumour developed in the left hypogastric region, protruding several inches beyond the level of the false ribs. The inferior part of the left side of the chest sounded dull, and no respiration was there heard but was clear in every other direction. The tumour appeared to M. Louis to be an enlarged spleen; and he thought this enlargement, as well as the diarrhoea, was owing to the suppression of the long-established drain from the ulcers on the legs. With this impression, M. Louis endeavoured to re-establish the said discharge by means of a large blister to the leg and twenty leeches to the left flank and left side of the chest. In two days the pains had nearly ceased, and the diarrhoea was much diminished. The size of the spleen also decreased rapidly, and, by the 19th of May, there was no vestige of tumour in the left side, and the chest on that side was sonorous throughout. He was discharged cured. We forgot to mention that an issue had been established in the flank. Case 2. This was a deaf person, but very intelligent, aged about 55 years, who came to the Hospital La Pitié in the beginning of last Winter, with a large ulcer, of several years' standing, on the malleolus internus. It was dressed regularly every day, and soon healed. In two or three days after the complete cicatrization, the patient, who had previously been in good health, lost his appetite, had nausea, malaise, lassitude, without any other symptom that could indicate any particular disease. The above continued to increase for eight days, when M. Recamier applied a large blister to the site of the healed ulcer. As soon as a suppurative discharge was established, the foregoing phenomena diminished, and, in the course of a week, they entirely disappeared. The patient remained three months in hospital, and had no return of complaint. The blister was then allowed to heal, and health continued. Case 3. A female, aged 40 years, had a vaginal discharge for several years, which was suddenly and totally suppressed by a severe moral affliction. From that time the appetite and strength diminished-the patient complained of pains in the epigastrium-wasted in flesh-and, after three months, was obliged to enter the hospital. M. Louis endeavoured to re-establish the vaginal discharge by means of the vapour-bath sinapisms, &c. In about eight days these remedies reproduced the vaginal discharge, from which period all the symptoms above mentioned gradually diminished, and at length disappeared. Case 4. A female, aged 62 years, was received into hospital on the 23d of May of this year. The catamenia had ceased about 12 years previously, since which she was subject to palpitations of the heart and pains in her head. For these she had been bled eight times. Her legs swelled occasionally in the evenings. During the last six months she had leucorrhoea of inodorous character. Having been severely frightened by some ruffians one evening, and beaten by them, the discharge suddenly stopped, and soon after this she felt depressed, with head-ache, giddiness, some obscurity of vision, constant drowsiness, cramps in her limbs, with some dyspnoea and dema of the feet. Nevertheless she was free from the palpitation; but her appetite disappeared. These symptoms continued unabated for eight days, and were in the same state when she entered the hospital on the 23d of May. She appeared to have a good constitutionpulse 84, regular, as were the motions of the heart, which did not appear enlarged-lungs sound. A large blister was applied to the inside of the right leg-vapour-bath to the lower half of the body-sinapisms to the feet. 24th. Pulse 96-the other symptoms the same. 20 leeches were applied to the lower extremities. 25th. During the bleeding of the leeches, some of the leucorrhoeal discharge returned, but did not continue. The symptoms however, were all mitigated, and when the blister came to discharge freely, they disappeared, with the exception of considerable debility, which required tonics and nourishing diet. Some threatenings of her former symptoms, however, required the formation of an issue in the the thigh, which entirely removed them. XIII. THE LATE KING. MISCELLANIES. Now that the marble tomb has closed over the cold remains of His late Majesty, and the columns of our contemporaries, medical and popular, have ceased to pour forth their daily and hebdomadal lucubrations on the nature, cause, treatment, and probable event of a disease, the subject of which they had not seen, and the symptoms of which they were not permitted to know, we may be pardoned for making a few observations on this tragical scene of suffering and of death. The life of irregularity-medically speaking, we might, perhaps, call it INTEMPERANCE-which the vigorous PRINCE and indulgent MONARCH is well known to have led, could scarcely fail to impair the functions, and, ultimately, derange the structure, of some of the vital organs. Gout was the first manifestation of this constitutional disturbance, and doubtless warded off, for a long time, more dangerous consequences-partly by the reduction of an overloaded system, through the medium of pain, depletion, and abstinencepartly by determining plethora and irritation to structures not essential to the existence of life. Pain is seldom borne with patience, even by philosophers-and still less by princes. That his late Majesty had, for some years, been in the habit of allaying the suf ferings and curtailing the paroxysms of gout by full doses of WILSON'S TINC TURE, we have some reason to believe, and we need scarcely say that such byeways, or, as we might here call them, royal roads to temporary health, seldom fail to entail on the experimenters a train of disorders more dangerous, if not more dolorous, than those which were set up by the wise hand of Nature, but interrupted in their course by the interferences of art. Three powerful classes of causes contributed to augment and exasperate the effects of this reiterated, but perhaps unavoidable applica tion to colchicum, for the abbreviation of the arthritic attack-full and stimulating regimen-inactivity and a humid, or rather malarious atmosphere. The existence of the first two classes of morbific agencies in His Majesty's case, is too well known to require proof in this place. Those who have examined the medical topography of the cottage, Virginia Water, and all those routes where the King spent so much of his time in inactive repose, or, at the most, in passive exercise, can only wonder that His Majesty's constitution so long resisted the usual and almost inevitable effects of an atmosphere for ever loaded with moisture, or impreg nated with vegeto-animal exhalations. We have no means of judging of the actual phenomena which the King's ordinary health may have presented, previously to the issue of the first and ce lebrated bulletin, respecting the "bilious attack," and " embarrassment in breathing," on the 15th of April last. It was not likely that the somewhat vague phraseology made use of, on this occasion, should escape the censure of those who, having neither responsibility nor practical knowledge themselves, delight in affixing the stigma of ignorance on others. Thus a great outcry has been raised against the King's physicians, because they did not state, in the public bulletins, the precise NAME and NATURE of a disease, which, perhaps, not one physician in Europe would have been able to have stated, with any thing like certainty -no, not even Laennec, had he been alive, and admitted to examination of the royal chest! And by whom has this weighty accusation against His Majesty's physicians been raised? By men so ignorant of practical medicine -and more especially of auscultation, that they could not tell which end of the stethoscope was proper to be applied to the ear or the body-men so ignorant of morbid anatomy, that they did not know either the name or the nature of the disease, when the minutes of the dissection were lying on the critical table before them!! This will scarcely be believed; but we pledge ourselves to prove it. Before proceeding to this task, however, we shall make a remark or two on the moral or ethical part of the question. It is the bounden duty of the medical attendant, when he cannot arrest the progress of a mortal malady, not to accelerate the fatal event. No political interest-no state policy can or should bend this maxim from the direct and inflexible line of uncompromising punctuality. The prince and the peasant are on terms of rigid equality in this respect. What practical physician, then, we would ask, could be so cruel, so unfeeling so unprofessional, as to allow a patient, labouring under organic disease of the heart, to be made acquainted with the astounding fact and fiat, that for him HOPE ΝΟ LONGER EXISTED! The genius of a NERO, a CALIGULA, a HELIOGABALUS, never invented a torture so truly diabolical as this announcement, so advocated and lauded by the self-elected HERO OF HUMANITY, and a narrowing JUNTO of disappointed de mocrats! Every medical man, excepting those who know nothing of diseases of the heart, and those who have no hearts in their own bosoms, are well aware that such an announcement as is above alluded to would, in all probability, be attended with most imminent danger-perhaps death, to their patient. Such is the cold-blooded policy of scribbling tyrants, who, from a conscious sense of their own ignorance, would shrink from the responsibility of a diagnosis or hesitate not to assert the most wilful falsehoods in the event of a detection of their blunders ! It is unnecessary to tell the wellinformed of the profession, that no extent of experience-no amount of pathological knowledge, can enable a medical practitioner to give any thing like an accurate prognosis as to the duration of an organic disease of the heart, even when he is convinced of the existence of that terrible malady and of its final result. Many who labour under the most formidable symptoms linger out for months and years-while others, whose symptoms are by no means alarming, drop off suddenly, when no apprehension of death is entertained by physician, patient, or friends. Who, then, would be so ungenerous or unjust as to blame the physicians of His late Majesty, for not at once proclaiming to the nation that which no human sagacity could tell or foretel-the precise nature, duration, or degree of danger of an organic disease? None, but the ignorant or the unprincipled! Sorry are we to say, that the latter class is almost exclusively to be found, in this instance, among the ranks of our own profession! The medical advisers of His late Majesty were denounced for their ignorance, in not knowing the name of the disease, and only calling it by one of its symptoms-THE EMBARRASSMENT OF BREATHING." Yet more than half of the long black catalogue of human afflictions, with all their hard and unCouth nomenclature, are only the names of SYMPTOMS-and certain we are that the very best practitioners prescribe, in nine cases out of ten, for symptoms alone. When they prescribe for names of diseases, they are generally wrong! Then there is no such disease as 64 em barrassment of breathing," according to these wise-acres. What is DYSPNEA -the third GENUS in Dr. Good's order pneumonia? What is dysphagia, but a symptom? What is Bex, (cough,) the first genus of the order pneumonia? Why a symptom; and yet it is laid down in our best nosologies as a distinct disease. Suppose the physicians had considered (and they would not have been very far wrong) the Royal Patient to be labouring under ANGINA PECTORIS. The classical name of this disease is STERNALGIA, according to Good. Sternalgia!" Suffocating breast-pang." What is this but a symptom?—and not a whit more indicative of the nature of the disease which it is designed to represent, than "embarrassment of breathing" was of His Majesty's disorder. But the ignorance and dishonesty of these scurrilous hyper-critics are truly disgusting, as we shall now proceed to demonstrate. OFFICIAL ACCOUNT OF THE POST-MORTEM EXAMINATION OF HIS LATE MAJESTY. The body exhibited but little sign of putrefaction; and the anasarca had disappeared, excepting some slight remains of it in the thighs. Notwithstanding the apparent emaciation of His Majesty's person, a very large quantity of fat was found between the skin and the abdominal muscles. Abdomen. The omentum, and all those parts in which fat is usually deposited, were excessively loaded with it. The abdomen did not contain more than an ounce of water. The stomach and intestines were somewhat contracted; they were of a darker colour than natural, in consequence of their containing mucus tinged with blood; and in the stomach was found a clot of pure blood, weighing about six ounces. The liver was pale, and had an unhealthy granulated appearance. The spleen, although larger than usual, was not otherwise diseased, and the pancreas was in a sound state. The sigmoid flexure of the large intestine (the colon) had formed unnatural adhesions to the bladder, accompanied by a solid inflammatory deposit of the size of an orange. Upon a careful examination of this tumor, a sac or cavity was found in its centre, which contained an urinary calculus of the size of a filbert, and this cavity communicated by means of a small aperture with the interior of the bladder at its fundus. In other respects the bladder was healthy, and the prostate gland did not appear to be enlarged. The kidneys were also free from disease. Thorax. Two pints of water were found in the cavity of the right side, and three pints and three quarters in the left side of the chest. The left lung was considerably diminished. The lower edge of each lobe of the lungs had a remarkable fringe, which, upon examination, was found to be formed by a deposit of fat. The substance of the lungs had undergone no change of structure, but the mucous membrane lining the air-tubes was of a dark colour, in consequence of its vessels being turgid with blood. The pericardium (or heart-purse) contained about half an ounce of fluid, but its opposite surfaces in several parts adhered to each other, from inflammation at some remote period. Upon the surface of the heart and pericardium there was a large quantity of fat, and the muscular substance of the heart was so tender as to be lacerated by the slightest force it was much larger than natural. Its cavities upon the right side presented no unusual appearance, but those on the left side were much dilated, more especially the auricle. The three semilunar valves at the beginning of the great artery (the aorta) were ossified throughout their substance, and the inner coat of that blood-vessel presented an irregular surface, and was in many parts ossified. The original disease of His Majesty consisted in the ossification of the valves of the aorta, which must have existed for many years, and which, by impeding the passage of the current of blood flowing from the heart to the other parts of the body, occasioned effusion of water into the cavities of the chest and in other situations. This mechanical impediment to the circulation of the blood also sufficiently explains those other changes in the condition of the body which were connected with His Ma |