lent to little more than one-half of the benzoic acid expended, so that the remainder must have made its escape by some other emunctory, probably the skin.

The above crystals, when examined by the microscope, display the characteristic form of the hippuric acid, namely, a four-sided prism, with a dihedral summit."

"It may be observed, that no trace whatever of uric acid, or of any of its salts, or of benzoic acid, could be discovered in the above urine.

A nearly analogous result is obtained when benzoate of ammonia or of potash is administered; and, under particular circumstances, the exhibition of one or other will be found preferable to the simple acid; either in the neutral state, or with an excess of base, when there is a disposition to accescence in the primæ viæ ; apportioning the dose, in every instance, to the condition of the urinary secretion, previously ascertained by analysis.

By this singular interchange of elements, capable of being effected only by the aid of vital chemistry, we have an organic acid, containing 8 atoms of azote and 10 of carbon, replaced by one containing no less than 18 of carbon and only 2 of azote, and that even in what various eminent pathologists regard as a highly azotised state of the system.

It is obvious that this new plan of treatment, and which does not interfere with other remedial means, must be steadily persevered in for a considerable length of time, ere any adequate benefit can ensue. How far it may be applicable to various forms of calculous disease, connected with the gouty diathesis, remains for future investigation to decide. Most unequivocal proofs have already been afforded me, of its efficacy in correcting and removing certain disordered states of the urine in individuals prone to attacks of gravel." 35.

V. HISTORY OF A CASE OF PHLEBITIS, WITH OBSERVATIONS. By Thomas H. Silvester, M.D.

This is really a remarkable case. We hardly see the possibility of condensing the excellent account of it furnished by Dr. Silvester.

Case. Mr. P., æt. 59, observed on Friday evening, March 27th, a pimple on his upper lip, which he supposed to have arisen from a scratch in shaving. His friends had noticed him carrying his pen, whilst engaged in accounts, traversely between the lips. He had been using a steel pen, and a new metallic ink, and it appeared to them that this fluid had accidentally come in contact with the wound, and imparted to it the peculiar deep-red irritable aspect which was very observable. On the following Tuesday the patient retired to bed early, complaining of general uneasiness, but neither fever nor head-ache were present, and he slept well. Dr. S. saw him, for the first time, the next day, (Wednesday,) his pulse was 120, small and weak, the skin cool, and he did not complain of thirst. The countenance was inexpressibly anxious, not unlike that of a person who has taken poison, or one who has been stabbed in the abdomen; the lip was greatly swollen, and he suffered more from a feeling of distention than from pain. So much difficulty was experienced in the attempt to open the mouth, that it became next to impossible to ascertain the state of the tongue; another hindrance arose from the tumified overhanging lip, beyond which the tongue could not have been projected had no other impediment existed. The tumefaction extended a little way upwards on each side of

the alæ nasi, but not at all downwards towards the lower lip; it was of a dark red, almost livid, hue, and very firm to the touch. There were no vesicles nor bullæ, nor ædematous appearances on pressure; the pain was of a distending, and not of a burning kind. The affection so resembled the asthenic form of erysipelas, that Dr. Silvester determined upon tonic treatment. The patient was desired to take from four to six ounces of port wine in boiled sago during the twenty-four hours, and three grains of the disulphate of quinine every four hours. This mode of treatment seemed to promise the best effects,-the pulse became fuller and stronger, and the swelling ceased to spread,—the lip itself was cool, but of an immense size,—a glutinous exudation, which now appeared on its surface, thickening gradually from day to day by fresh additions, assumed at length the appearance of a coarse scab, with rocky projections, so perfectly inflexible, that not even the slightest movement of the lip could be effected.

The gums, and the interior of the mouth generally, were seen to be of a dark livid hue, and viscid saliva flowed unceasingly over the neighbouring parts, occasioning soreness and excoriation. On the fourteenth day of the disease, the skin was cool and perspirable, the pulse 80, still rather feeble, the lip was nearly free from uneasiness, although much swollen and thickly encrusted the patient had slept well the previous night, he was enjoying, with a good appetite, his sago, and believed himself to be rapidly recovering. Dr. S. observed on the very next day a large red cord, apparently terminating in a vein extending upwards at the side of the nose as far as the inner angle of the eye, first on the left, and afterwards on the right cheek. These inflamed vessels greatly resembled irritated absorbents, but they were of much larger size than the latter, being as big as a goose-quill, even whilst no fluid could be detected in their interior by the touch. After the lapse of five or six days, fluctuation was distinctly perceptible, and Dr. S. then noticed at several points in the course of these suppurated veins, a slight degree of redness. These red spots became the seat, each of an exudation precisely of the same character and appearance as that which had previously been observed on the upper lip. A viscid liquid at first escaped, and this, either hardening, or being succeeded by a secretion of thicker consistence, a series of projecting masses, somewhat larger than a horse-bean, of a yellowish green hue, not unlike the scabs of rupia, appeared along the course of the vessels. On one of these scabs or exudations being loosened from its seat, at a subsequent period, pus continued to flow for several days from the part which had received the violence. Another, which had escaped injury, and maintained its position up to a period within one week of the patient's death, dislodged itself spontaneously from the depression between the eyebrows, which situation it had occupied, leaving the parts underneath perfectly sound and healthy, but rather redder than natural.

On the twentieth day of the disease the veins of the forehead had begun to swell, and in a very short period they were to be seen, in great numbers, ramifying all over the fore part of the head, and extending beyond the vertex, presenting a most extraordinary appearance, difficult for the pencil to portray. The skin and cellular membrane occupying the spaces between the several inflamed vessels seemed at this stage of the complaint

to be almost wholly unaffected, and owing to this circumstance, the veins themselves were highly prominent and easy to be distinguished from any other order of vessels. A process similar to that which had taken place in the veins of the lip and face, occurred in those of the scalp, namely, exudation of a glutinous fluid, and incrustation in some instances-resolution and suppuration in others.

The incrustations became loose invariably on the application of a poultice, and quickly fell off. The interior of the vein was thus exposed, and a long, irregular, ulcerated cavity formed.

The vessels which were opened with a lancet emptied themselves gradually of their contents-pure laudable pus for the most part-and neither exudation of the thin gelatinous fluid nor ulceration took place.

On the 21st of April, skin cool, pulse 82, feeble but regular. 24th— the pulse had suddenly risen to 100, extremely feeble.

On the 6th of May the patient seemed to have had a shivering; it was however very slight: he had likewise vomited after his usual night dose of Syr. Papav. 8th-greatly excited after a dose of morph. hydrochloras gr. ss. 26th-the patient expired, perfectly rational to the last

moment.

Autopsy. The body greatly emaciated; on turning back the scalp, which was so fragile and perforated by ulceration that it tore, and yielded to the slightest touch, the diseased veins were seen, meandering over the internal surface, filled in some part of their course with a yellowish crumbling, fibrinous mass, the smaller branches containing fluid blood of a pale colour, in minute quantity, and a single trunk of the temporal on the left side terminated in a foyer filled with laudable pus. On slitting open those veins which, during life, appeared restored, or nearly so, to their natural condition, they were found perfectly empty, rough and irregular in their interior, apparently deprived of their smooth lining, and their calibre greatly increased. The shrunken attenuated muscles were cut into and examined in several parts of the body, but no deposits of pus could be detected. The lungs, liver, kidney, and brain were in a healthy condition, but bloodless. The heart and larger vessels entirely empty. The joints were not examined internally, but they evidently contained no fluid. The patient had not complained of pain or uneasiness in the limbs, and had even walked across the room a few days before his death.

Dr. Silvester makes some judicious reflections on the case, which presents many features of singularity. Unfortunately, there seems to be no opportunity of drawing from it any great practical lesson.

VI.-CASES OF CANCEROUS OR MALIGNANT DISEASE OF THE SPINAL COLUMN, WITH REMARKS. By Cæsar Hawkins, Esq.

Mr. Hawkins observes that there are so few well-described examples of malignant disease of the spinal column, that he is induced to relate four cases which have come under his observation. We shall endeavour to abbreviate them.

Case 1.-Sophia Green, aged 39, admitted into St. George's Hospital,

May 7, 1834, with ulcerated cancer of one breast, thickened skin, and enlarged absorbent glands. She complained however quite as much of pain in the neck, which had begun about two months previously, the pain being in the cervical vertebræ chiefly, whence it extended round the neck and over the scalp, and all these parts were very tender to the touch. She had also a little difficulty and pain in swallowing, and was unable to move her head in any manner without great exertion, and the effort gave her considerable pain. Supporting her head and neck on the right side, as she lay in bed, was very painful, but she could not lie on the left side at all; probably some stretching of the parts being occasioned by the weight of her head on the pillow. If she tried to change her position, it was done by first putting both her hands to her head to support it; and pressing the head downwards by the hand occasioned much suffering. The centre of the neck appeared a little sunk forwards, as if the upper vertebræ had been depressed in that position. In the early part of June an immense number of cancerous tubercles formed in the skin around the breast, covering much of the abdomen, and thorax, and shoulder; and in the latter situation many of them had coalesced, so as to form a hard mass of considerable size. About the same time she began to suffer from obstinate constipation, with frequent vomiting-the breast sloughed extensively and she died on the 16th of July.

Dissection. The breast and pectoral muscles, and cellular texture, formed a large mass of scirrhous tumor, which at one part reached to the intercostal muscles, and a central slough had contaminated the ribs also, two of which were softened by absorption of their earthy substance, and filling of the cells with bloody pulp, so as easily to allow of their being bent or cut. The cutaneous tubercles, and absorbent glands, and the fat surrounding them, were evidently of cancerous structure, and one of the glands contained some bloody purulent fluid. The body of the fifth cervical vertebra was very irregular on its surface, and was softened throughout with much enlargement of the cells of the cancelli, which were filled with a sanguineous pulpy fluid; the two adjoining vertebræ showed a lesser degree of the same morbid structure. The uterus was healthy, but both Fallopian tubes were much dilated, and contained a thick brownish fluid; the ovaria formed two tumors of the size of an orange, and contained several cysts, the larger of which were filled by transparent fluid, the others by an opake semi-fluid substance. These ovarian tumors were the immediate cause of death, as they filled the pelvis in such a manner as to obstruct the rectum, which lay in the angle between them, upon the sacrum; and their nature was probably malignant, as several of the lumber glands were enlarged and pulpy.

In this case the cancerous change of structure was in an early stage, affecting only the cancellous texture, or nearly so, and influencing slightly the adjacent nerves; but not forming any tumor, and causing no alteration in the functions of the spinal marrow. The next case illustrates the further progress of the disease.

Case 2.-Jane Hall, aged 55, admitted for paraplegia under Dr. Wilson, transferred to Mr. Hawkins, in November, 1839. The right breast had been removed six years previously for cancer, and the part had remained

well till May of the present year, at which time some cancerous tubercles were formed in and around the cicatrix, and one or two glands became enlarged and hard in the axilla.

About March she had begun to suffer much pain in the back, chiefly in the dorsal region, and in May she experienced some pricking sensations in the feet, soon followed by numbness and loss of sensation, and in a short time by loss of power over the muscles of the lower limbs, which nearly at the same time became affected by involuntary contractions; in July the bladder and rectum also became paralysed.

In November, one spinous process in the back was just enough promi nent to be fixed upon as the seat of the disease, but by degrees it projected so as to form an acute angle, with a considerable curve above and below it, the vertebræ being bowed forward somewhat in a semicircular form. · She complained of constant and acute pain along nearly the whole spine, but especially at the angle formed by the sixth dorsal vertebra, and the pain was much increased by pressure about this part, or any where below it, and for a little way above that bone. The angle appeared to arise from loss of substance in the body of the vertebræ, without any apparent swelling around it. Below the affected part of the spine all the functions of the spinal marrow were materially impaired. And Mr. Hawkins gives a very interesting account of experiments, showing the absence of voluntary motion with the persistence of the excito-motory power, &c. Sloughs formed on the trochanters and sacrum, and on June 17, 1839, the patient died.

Dissection. All the vertebræ were found to be unusually soft and vascular, and there were seen in the section of several of the dorsal vertebræ spots or tubercles of yellowish white substance, similar to that found in larger quantities in their bodies. On opening the sheath of the spinal marrow, a little clear water was seen below the arachnoid membrane, but the whole medulla was of its natural colour and consistence, and presented no appearance whatever of inflammation. Opposite to the sixth dorsal vertebra it had been pressed upon by a tumor projecting from the body of the bone, so that a deep sulcus of the entire circle was formed, in which so little medullary matter was left that the central part was almost transparent: the part thus pressed upon was full half an inch in length. Even in this point, however, there appeared to have been no inflammation

whatever.

Opposite to this part some firm structure without bone projected from the body of the sixth dorsal vertebra in the form of four oval prominences, so as to encroach considerably on the canal; three of these were covered by the dura mater in firm union with the morbid growth, but over the other an opening was formed in the membrane with smooth edges, through which the new growth appeared, the opening being the result of simple absorption without any ulceration. On making the section of the vertebræ seen in the preparation, the morbid growth was found to proceed from these vertebræ, the sixth or central one being most altered in shape, though all three of their bodies were almost entirely converted into a cancerous substance; the sixth having spread out posteriorly, while it was much compressed in front, the fifth and seventh vertebræ almost coming in contact, an acute angle was thus produced, which made the spinous