had been taken from the wound. In the course of the following night, another worm was discharged from the urethra. From this time the ulcer in the loins began to discharge less and less, and gradually healed up. The urine, which now recovered a healthy appearance, occasionally contained filaments and membranous shreds, which were perhaps the debris of the cyst in which the worms had been contained. The boy was ultimately restored to perfect health.

Another remarkable case is related, in which an abscess made its appearance in the lumbar region and burst. It did not show any tendency to heal, and the patient gradually became hectic and a length died. It is mentioned in one part of the report that, after taking some brisk purgatives, the woman had passed a dozen of worms-the kind is not stated. On examining the abdomen after death, it was found that the right kidney had become united to the liver; on cutting into it, there was discovered not only a large calculus imbedded in its substance, but also three living worms-each of them about three and a half inches long.

The number of worms, which were passed in the extraordinary case related by Mr. Lawrence, in the second volume of the Medico-Chirurgical Transactions, is estimated at between 800 and 1,000 they were of the sort which has been called spiroptera by Bremser and Rudolphi.

Mr. Curling, assistant-surgeon of the London Hospital, has recently published a case of a girl who voided from the urethra a number of entozootic worms, not hitherto described, with an account of the animals in the 22nd volume of the same work. Mr. C. proposes the name of Dactylius aculeatus for this species

of worm.

Foreign Bodies and Irregularities in the Kidneys.

Besides Calculi, effused blood, and worms, foreign bodies admitted from without have occasionally been found in the substance of these viscera. A ball, or a piece of wadding or of cloth, has been extracted, either during the life or after the death of the patient; and, in a few rare instances, a small irregular mass, formed by one of the latter substances, has actually made its escape from the urethra, several weeks after the receipt of the musket-wound in the loins. On the other hand, an ear of corn, introduced by the urethra, has been known to find its way along the urinary passages and make its exit in the loins; and several cases have been recorded of needles, which had been swallowed, being voided with the urine.

There is sometimes a third or supernumerary kidney present; but a much more common anomaly is the existence of only one kidney. References to an immense number of such cases are given by M. Rayer. Both kidneys are sometimes altogether wanting in certain cases of monstrosity; and, if we could give credit to the accuracy of the examination that was made in the case related by M. Moulon, in the 17th volume of the Archives Generales de Medecine, we must believe that there was a complete absence of these organs in a girl who lived till she was fourteen years of age. There had been, during life, a constant oozing from the umbilicus of a fluid which had a very strong urinous smell. M. Moulon suggests that, in the absence of the urinary apperatus, the principles of this secretion were eliminated by the liver, and conveyed by the umbilical vein to the umbilicus, at which point they were discharged.

If this very extraordinary fact can be credited, we might find less difficulty in accounting for certain cases of anuria of several months' continuance, according to the testimony of several authors. Thus, in the Medical Journal that was edited by MM. Corvisart, Leroux, and Boyer, there is related an instance, in a young girl, of suppression of the urine which lasted for 17 months: the secretion returned after this period.

M. Rayer seems to think that the case narrated by M. Moulon was one of ex

trophia of the bladder, and that the kidneys, from being displaced, perhaps in the pelvis, were probably overlooked.

The two kidneys have often been found fused, so to speak, together, and forming a sort of horse-shoe viscus, situated right across the vertebræ.

We have already alluded to their occasional displacement within, or on the edge of, the cavity of the pelvis; where they might be mistaken for a tumor of the ovarium, uterus or rectum.

Mobility of the Kidneys.

There is a peculiar state of the kidneys in which these organs are capable of moving in different directions, as upwards towards the liver, or forwards and downwards. This state may become the cause of various distressing symptoms; more especially constant pains in the abdomen and the corresponding lower extremity, which are apt to be mistaken for colic or neuralgia. It is now a long time since I, says M. Rayer, first pointed out this peculiar affection to my colleagues at La Charité Hospital, MM. Velpeau and Gerdy, and showed them several instances of it. Two cases occurred in the persons of medical men, who had long been suffering from pains in the right flank where they had felt a moveable tumor, which had greatly perplexed their friends as well as themselves.

M. Rayer candidly acknowledges, that references to this peculiar state of the kidneys are to be found in the writings of some of the older authors, and quotes a passage from the work of Riolan, published in 1682, in which there is a very accurate description of it.

He (M. Rayer) relates four cases.

In the first, the right kidney could be distinctly felt; it was so moveable that it could easily be pushed on near to the umbilicus, and then back under the edge of the liver. The woman complained of an uneasy dragging feeling in the loins and round the abdomen. She experienced considerable relief from a bandage applied firmly round the stomach.

In the second case, a tumor was felt under about the middle of the anterior edge of the liver. A variety of applications, including a moxa, had been tried, in hopes of dispersing it. M. Rayer attentively examined her, and, as the abdominal parietes were very lax, he could easily distinguish the size and shape of the tumor; it descended as low as nearly to the level of the umbilicus, but with gentle pressure it could be pushed upwards and backwards under the edge of the liver. He was convinced that it was in truth the right kidney.

An interesting case, which had occasioned great discrepancy of diagnosis among several medical men, is recorded by Professor Aberle of Saltzburg. A middle-aged man had long suffered much from dyspepsia and hypochondriasis. What, however, distressed him most, was a firm tumor, rather larger than a hen's egg, situated in the epigastric region; by firm pressure on the flanks, it became much more prominent and distinct.

He died from an attack of apoplexy; and, on dissection, it was found that the tumor was formed by the right kidney, which was so moveable that it could be readily pushed forwards almost as far as the umbilicus. There was no other abnormal character of the urinary organs.

M. Rayer assures us that mobility of the kidneys, usually the right one, is far from being uncommon, although hitherto the circumstance is not even known to almost any medical men.

It is much more frequently observed in women than in men; and is very often co-existent with an enlargement of the liver, or with some displacement either of some portion of intestine, or of the uterus. Repeated gestation, the lifting of heavy weights, &c. seem to have given rise to it in some instances.Traité des Maladies des Reins.

Clinical Review.

GUY'S HOSPITAL.

Gur's HOSPITAL REPORTS. No. XIII., October, 1841. Edited by GEORGE H. BARLOW, M.A. & M.D., Trinity College, Cambridge; and JAMES P. BABINGTON, M.A., Trinity College, Cambridge.

The present number contains fewer papers than some of its predecessors have done. The contents are as follows:

Observations on certain Diseases originating in Early Youth; illustrated by Cases of defective Expansion of the Lungs; by George H. Barlow, M.A. & M.D. -Medico-Legal Report of the Evidence given on a recent Trial for Murder by Poisoning with Arsenic; by Alfred S. Taylor :-A remarkable Case of Abdominal Effusion, resulting from Mesenteric Tumor; by H. Marshall Hughes, M.D. With Observations on the Effused Fluid, by G. Owen Rees, M.D. -On Acute Aortitis; a Portion of an Essay read before the Physical Society at Guy's Hospital, Jan. 13, 1838; by Norman Chevers, M.D. :—Cases of Malignant Disease of the Lung; by H. Marshall Hughes, M,D. :-Reports of Cases requiring Capital Operations, which have been performed since Oct. 1, 1840, by Bransby B. Cooper, Esq., F.R.S. :—On the Structure of the Blood Corpuscle; by G. Owen Rees, M.D., and by Samuel Lane :-Account of a Patella broken transversely, and re-united by Bone. With Remarks on the Na

ture and Treatment of similar Injuries; by T. Wilkinson King. (With plate): -A Case of Intestino-Vesicle Fistula; by Mr. Hingeston. Communicated by Mr. C. Aston Key. (With plates) :-On Chorea; by B. G. Babington, M.D., F.R.S.

I. OBSERVATIONS ON CERTAIN DISEASES ORIGINATING IN EARLY YOUTH; ILLUSTRATED BY CASES OF DEFECTIVE EXPANSION OF THE LUNGS. By GEORGE H. BARLOW, M.D.

Dr. Barlow remarks .

"There is, I think, one consideration connected with the etiology and treatment of a large class of chronic and organic diseases, which, although it can not have escaped the notice of any practitioner of experience and observation, does not appear to have received that attention which its importance seems to demand;— I mean, the occurrence of disease arising from a want of proportional development in some of the organs of the body; by which, either, other organs are excited to undue activity, leading to their excessive development and ultimate disorganization; or, serious, and sometimes fatal, disturbances are produced in the current of the circulation.

The deviation from the normal proportion, to which I more particularly allude, exists in the lungs, the liver, and the two sides of the heart; and its first commencement, or, at all events, its first manifestations, may generally be traced to the period of early youth; when, owing to the increasing proportion of those parts whose blood is returned to the heart directly by the vena cavæ, to those which return it through the medium of the portal system, a corresponding change takes place in the relative volume and functions of the liver and the lungs; the latter being developed, as it were, at the expense of the former. When the lungs and heart are sound, the air-passages unobstructed, and the capacity of the chest

sufficiently ample, this change is effected with safety; and that full expansion of the chest is the result, which the artist, as well as the physiologist, has always regarded as indicative of health and vigour. But if, on the other hand, the expansion of the lungs be impeded, either by a want of capacity in the chest, or narrowing or obstruction of the principal air-passages-or if the lungs be unsound-or if the circulation be disturbed by disease in the heart, or a want of due proportion between its different cavities and its different orifices-or if the extremities be too rapidly developed-the consequence must be, either, that the change which should now take place is prevented, and the liver retains its original proportion to the rest of the body, the result being a tumid abdomen and contracted chest, with imperfect respiration, and stunted and often oedematous extremities-or, that the lungs suffer, either from undue accumulation of blood, or from the excess of function which they may be called upon to perform-or the heart becomes embarrassed, and ultimately diseased, by obstruction to the current of the circulation."

Dr. Barlow, however, confines his present paper to those cases in which the expansion of the lungs is impeded either by contraction of the chest or defect in the principal air-passages.

The first case is given at great length. Its nature may be guessed from the following summary of its particulars-dyspnœa first becoming urgent about the age of 11-palpitation, ascites, and anasarca-checked growth-partial recovery -occasional relapses-severe return of symptoms at the age of 15-no signs of puberty-death at the age of 16-distention and hypertrophy of the right side of the heart.

In some observations on the case, which is much too long for insertion, Dr. Barlow develops his ideas upon its nature. He says that the prominence of the heart symptoms during life and its enlargement discovered after death, must not be regarded as the source of the mischief.

"It appears," he remarks, "that up to the age of 10 or 11 years, this patient had enjoyed good health, so that there could not have existed any abnormal condition of the heart before that time; whereas the healthy state of the valves, and the absence of all traces of any inflammatory affection of either surface of the heart, leave us without any assignable cause, referrible to that organ, for the hypertrophy which was afterwards found to exist; the change being, in fact, just such as might be expected to result from obstruction to the passage of the blood from the heart. And further, the hypertrophy and distention existing in so much greater a degree on the right side, shows that this obstruction must have existed, for the most part, between the right and left heart; namely, in the pulmonary circulation. If, moreover, we refer to the history of the case, we shall find abundant evidence of the existence of such obstruction, in the dyspnoea, the lividity of the countenance, the narrowness of the chest, and the dropsical effusion observed during life; as well as in the compressed state of the lungs, the congestion of the liver, the narrowness of the pulmonary artery, and the enormous distention of the right auricle and ventricle, which were found after death.

But, although the obstruction to the passage of the blood through the lungs must act immediately, and therefore with the greatest effect, upon the right side of the heart, yet the obstruction thus afforded to the return of the blood through the systematic and portal veins must increase the difficulty with which the blood passes into the veins from the arteries, and in this manner call upon the left ventricle for an additional effort; and consequently give rise to distention there, though in a much less degree than on the right side of the heart. It appears, then, that we have a cause adequate to the production of the abnormal state of the heart; and, moreover, have satisfactory proof of the existence of that cause."

We find in the account of the dissection of the case, that the left auricle was dilated and hypertrophied, but in a much less degree than the right. When the

auricle was laid open, the auriculo-ventricular opening was seen, of the size of a shilling. The curtains of the mitral valve were very slightly thickened, and contracted. The cavity of the left ventricle was large, and its walls rather thickened. It appears to us, if we rightly apprehend Dr. Barlow's statement, that there was narrowing of the left auriculo-ventricular opening. If this were so, it would go to explain much of the case and rather militate against Dr. Barlow's observations.

THE SECOND CASE was one of Dyspnea first becoming urgent about the age of 15-Bronchitis-Lividity-Palpitation-Severe aggravation at the age of 18 -Anasarca-Ascites-No signs of Puberty-Death.-Like the former, it is reported too much at length for insertion. But the observations of Dr. Barlow upon it will convey his ideas to our readers.

"In this case, as in the last, there can, I think, be little difficulty in accounting for the more urgent symptoms, by the obstruction to the return of the venous blood; of which sufficient evidence is afforded by the distended state of the right auricle.

The action of this obstruction, in producing venous congestion as well in the system generally as in the portal circulation, and thereby giving rise to lividity, anasarca, and ascites, is too obvious, and too generally acknowledged, to be here insisted upon. The next point, then, is the cause of the distention found to exist in the right auricle. This was obviously the effect of the opposition offered to the passage of the blood from the auricle to the ventricle, and to the regurgitation which no doubt took place through the tricuspid valve; and here also, as in the former case, the condition of the right ventricle is to be accounted for by the distention arising from the obstruction to the passage of the blood from the right side of the heart; for which we have a cause, in the smallness and diseased condition of the pulmonary arteries. Was then the defect, primarily, in the pulmonary arteries? or must we still seek for some anterior cause? Now, upon a reference to the first case, we find a small trachea and bronchi: small chest ; tough and fleshy lungs; with enormous dilatation of the right ventricle and auricle, and patulous tricuspid valve: in the second, we have a similar state of things, as regards the lungs and walls of the chest; with the addition of the disease of the pulmonary artery, and the dilatation of the bronchial tubes; the condition of the walls of the right side of the heart was nearly the same in both cases, though the dilatation and hypertrophy existed in a greater degree in the first than in the second. On the left side there was considerable disease of the mitral valve, in the second case, though but little, if any, in the first. The identity of the lesion, therefore, as regards the right heart, (the difference in the two cases being only in degree.) naturally suggests the idea of an identity of cause; and in seeking for that cause, we are, I think, justified in rejecting as adventitious what was found only in the second case, namely, the disease in the coats of the pulmonary arteries and mitral valve; and retaining, as essential, what was common to both, namely, the obstruction offered by the compressed state of the lungs, and narrowness of the pulmonary arteries.

The next question which arises is: are these conditions of the lungs and pulmonary artery to be regarded in the light of cause and effect; or as the collateral effects of some anterior cause, to be sought for hereafter? Now, reasoning from analogy, we should, I think, be led to the conclusion, that the diminished calibre of the artery was the result of the diminished capacity for blood of the part supplied by that artery, as is seen in the case of the contraction of an artery above a ligature in the variation in size of the spermatic and uterine vessels; and in other instances, which it would be superfluous to enumerate.

We come next to the inquiry, Whether the ill-developed condition of the lungs was the primary disease? or, Whether either of the two other circumstances observed in both cases, namely, the diminished capacity of the chest, and the