Case of Angina Pectoris. By the Same. This very interesting and well detailed case is remarkable on account of the great power which the imagination of the patient appeared to have over the accession of the fit. Unfortunately, the body was not allowed to be inspected.

Case of Sarcoma or Polypus in the Colon. By Edward Percival, M. B., &c. - The patient was a child of 22 months old, and the case ended fatally.

Two Cases of Inflammation and Enlargement of the Pancreas. By the Same:- With Additional Cases. By J. Crampton, M.D. We have here a very distinct and graphic illustration of an important and interesting disease. Its symptoms are pain and tenderness on pressure in the region of the pancreas, which are succeeded by inflammation of the ducts of the gall-bladder, and liver, and affection of that viscus itself: and the patient at length becomes dropsical. To two cases related by Dr. Percival, two others are added by Dr. Crampton; in one of which the disease seems to have been induced by exposure to cold during the use of mercury. The state of the salivary glands, under the administration of this mineral, renders the occurrence of affection of the pancreas, in such circumstances, very probable. In both of the cases, which were examined after death, the ductus communis choledochus was impervious, the liver much diseased, and the pancreas enlarged and indurated:-in one of them it contained a considerable abscess.

Clinical Report on Dropsies. By J. Crampton, M.D.Dr. C. has performed a most essential service to his professional brethren, by furnishing them with these distinct and candid details. His paper contains an accurate report of the whole of the dropsical cases treated in Steevens's Hospital, during one year. Of 74 in number, 35 were cured, 21 died, 7 were relieved, 8 were not relieved, and 3 left the hospital from different causes. In a great proportion of these instances, the disease had its origin in a more or less acute inflammation of the membrane of the heart, in enlargement of that viscus, in a diseased state of the valves, or in pulmonic inflammation: but in some it had succeeded to fever, in others to diarrhoea, and in one it was dependent on a diseased state of the ovarium. An account of the appearances after death in fifteen cases is given, which fully warrants the statements now made. The treatment pursued was chiefly depletory, and the experience of the author places in a very decided point of view the advantage of a moderate employment of blood-letting in dropsical diseases. It is truly astonishing to those who have been educated in the dread of the lancet, to

know.

know how often traces of sub-acute and sometimes of acute inflammation are detected after death, in such affections: but we ought to beware of carrying this depleting plan of treatment too far, or of adopting it where the dropsy arises from a tuberculated state of any of the abdominal viscera.

'General bleeding,' says Dr. C. in speaking of such cases, 'mostly hastens the doom of the patient; local bleeding is sometimes applicable to such cases, when the peritoneum covering the tuberculated liver, spleen, or pancreas, becomes inflamed. There is no form of dropsy in which detractions of blood are more useful than those where the peritoneum is inflamed, and where ascites follows; local bleedings after general venæsection, repeated according to the strength of the patient, frequently removes the inflammatory state of this membrane, the vital properties of which have been so well appreciated by Bichat; in truth, little is then left after such discipline for the other remedies to accomplish in completing the cure of dropsy.

It is not difficult to distinguish these latter cases from those which attend a tuberculated liver; in dropsy arising from inflamed serous membranes, the pains are superficial, and felt on pressure. Those from scirrhous liver are deeper seated, the general health more broken, the frame more emaciated, the sediment in the urine of a deeper red. The urine occasionally coagulates on the application of heat in both instances, but not with any uniformity. The causes and manner in which the disease has come on, often shew its true nature. When its attacks are sudden after exposure to cold, venæsection is generally advisable; when its approach is more gradual, after abuse in spirituous liquors, there is reason to suspect scirrhus, and the treatment should vary accordingly.'

On the choice of diuretics, Dr. C. has expressed himself to be somewhat indifferent; placing his chief reliance on the previous use of local and general blood-letting, blisters, and a careful adaptation of the doses and forms of those diuretic medicines which are most commonly in use. Mercury does not appear to be approved by him in any case in which a tendency to inflammation or to much irritation exists. He is partial to the use of the tinctures of squills and digitalis. Little attention is paid throughout the body of the report to the coagulability of the urine by heat, on which Dr. Blackall, in his excellent work, has placed so much dependance as a test of the presence of inflammation, and of the propriety of blood-letting in dropsy: but we are informed in an appendix, that the author's trials on this point have led him to disregard this property of the urine. Dr. E. Percival and Dr. Reid, in like manner, found that they could not depend on the coagulation of the urine as an evidence of inflammation, or a guide in practice, In a table appended to the present volume, a brief

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brief view is given of 40 cases of dropsy, subsequently treated; in 34 of which, the urine did not coagulate by heat, while in the remaining six it did: yet, in several of the former, topical inflammation was distinctly present. We regret to observe in this report many errors of the press, and several striking inaccuracies of language.

Cases and Dissections illustrative of Disease of the Brain, By S. Black, M. D. &c. - This is a very excellent paper, and deserves from us a more detailed discussion than our limits will admit. The first case manifested external tumour on the upper part of the os frontis of a young man, which at first yielded to local depletion and other remedies, but afterward recurred:

the disease proceeded slowly, and towards the close was accompanied by convulsive fits, and slight mental derangement. After death, which took place at the end of three years, the pericranium was found discolored, and firmly adhering to the bone in the situation of the small tumour; opposite to this spot, the dura mater was five times as thick as in other parts; and suppuration had taken place, both here and in several other spots in the immediate vicinity.

'On the inner surface of the membrane, to a considerable extent, and surrounding that condensed portion of it where these little abscesses were situated, was a distinct layer of coagulable lymph, as thick as a wafer. — The suppuration did not extend into the brain, but that organ, to the size perhaps of an orange, immediately beneath the diseased membrane, had become a soft and pulpy mass, in which scarcely any trace of organic structure was discoverable; in colour it resembled a custard; in consistence, it was thicker. There was an effusion of serum into the ventricles, which we calculated to exceed four ounces.'

The four concluding dissections are cases of typhus fever, and they all indicate a greater or less degree of previous congestion, or inflammatory action in the brain or its membranes.

Case of Inflammation and Abscess of the Brain attended with Disease of the Ear. By Dr. John O'Brien. In this very interesting case, the fatal disease appears to have been produced by suppression of discharge from the internal ear.

The subsequent paper also reports a Case of Inflammation of the Ear, attended with Symptoms of Compression of the Brain. By R. Grattan, M. D., &c.

Observations on Varix and Venous Inflammation, with Instructions for operating with safety to the Femoral Vein in Pop liteal Aneurism. By R. Carmichael, M. R.I.A., &c. The observations of Mr. C. on the subject of venous inflammation are interesting and instructive: but we must express our dissent from his remarks on the most eligible mode of avoiding

the

the wounding of the femoral vein in operating for popliteal aneurism, since we think that the best of all instruments for carefully separating the vein from the artery is the nail of the forefinger. In answer to his strictures on the directions of Scarpa for this operation, we have to say that we have often seen the two vessels separated by the finger, and the artery raised on the handle of a scalpel, without the slightest bad consequence: whereas by employing the aneurysmal needle, whether introduced on the mesial side of the artery or not, we still hazard the wounding of the vein. Mr. Hennen's observation, that in fatal cases of amputation the veins of the stump are often inflamed, is corroborated by the experience of Mr. Carmichael. Five cases are also given in the paper before us, of the successful adoption of Mr. Brodie's ingenious plan of treating varicose veins by dividing their enlarged branches. We cannot conclude our remarks on this subject without stating our conviction, that much of the failure which has attended operations for aneurysm, and varicose veins, has arisen from the total neglect or the unskilful application of the roller to the affected limb.

Case of incurable Disease of the Arm, &c. By the Same. This is an instance of disease resembling Phlegmasia dolens, produced by the voluntary introduction of needles into the palm of the hand. Amputation close to the shoulder-joint became necessary, and the patient recovered.

On the Origin of Intestinal Worms, particularly the Ascaris Vermicularis. By Dr. J. M. Barry. By Dr. J. M. Barry. A gentleman and his family, residing near Macromp in the south of Ireland, were afflicted with Ascarides Vermiculares; and insects similar every respect, except the darkness of their color, were found in abundance in the water of the spring from which the house was supplied. The local origin of this disease was farther proved by the appearance of the complaint in strangers after a short residence at the place, and by the relief experienced by the family in question when they removed to a distance from it.

Medical Report of the Fever-Hospital and House of Recovery, Cork Street, for 1816, with some Account of the succeeding Epidemic. By Dr. W. Stoker. We have to regret that Dr. Stoker was not allowed sufficient time to digest his materials for this report, or space to detail his observations; and that he has added to the difficulties thus occasioned, by entering into general discussions on the origin of epidemic fever, and on the merits of particular modes of treatment. He is still hostile to the use of the lancet in fever: but we see plainly that his opinions on this subject have already under- ́

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gone a manifest revolution, although they are not yet so ma tured in their new form as to allow him to express himself on this point in clear and decided language. In illustration of his practice in the late epidemic, he has given a tabular view of the state of the Cork-Street Fever-Hospital, during the months of July and August, 1818; and of 471 patients, he lost during that period only four by fever, one by dropsy, and one by hydrocephalus, making in all only six. The average number of days during which the persons remained in the hospital was 93. The treatment seems to have consisted chiefly in purgatives and antimonials: wine or spirits were given only to 86: not more than 21 were bled generally; and 36 had blood drawn by leeches or cupping. These results are most highly creditable to Dr. S.; though the period, which his return embraces, is very much too short to warrant us in drawing any general conclusions. The paper throughout shews evident marks of hurry in its composition, and is altogether an unfavorable specimen of the labors of this able and zealous physician.

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Medical Report of the Sick Poor Institution for the Year 1817. By Dr. J. O'Brien. We have in this report a very striking and melancholy picture of the wretched condition of a large portion of the numerous population within the district of the Sick Poor institution. The usefulness of this humane establishment has been still farther extended by ingrafting on it another, not less benevolent in its purpose: viz. the Dorset Nourishment Dispensary, for distributing Food, Cordials, and Fuel to the Sick Poor. Ireland affords indeed a vast field for the exercise of charity: but the sufferings of her poor are so intense, and the cry of misery which ascends

piercing, that the philanthropist must possess no common firmness and courage to be enabled to proceed undauntedly in his benevolent exertions. Some excellent remarks are given by Dr. O'B. on the judicious and enlightened adoption of blood-letting in fever; and a succinct and satisfactory account is furnished by him, of the other diseases prevalent within the bounds of the institution during the year 1817.

Medical Report of the Fever-Hospital, Cork-Street, Dublin, containing an Account of the Progress of the present Epidemic. By Dr. F. Barker. Here again we are presented with the same deplorable details of the sufferings of the poor of Dublin. The heart sickens at such recitals: but we would console ourselves with reflecting on the good which may flow from evil, -on the benefits which are likely to arise from the devastation of the late epidemic in Ireland:

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