It contained many coagula; those next to the aorta were loose and black, in the front of the sac; they were very firm in texture, much laminated, and of a gray colour.

The larger branches of the superior mesenteric artery were distinctly recognized at the projecting end of the sac; they were open, and pervious to the blow-pipe, which passed readily, from them, through the loose coagula of the sac into the aorta.

The cæliac and superior mesenteric arteries were given off as usual from the aorta, and, with it, were healthy in their structure. The lungs were extensively diseased by vomicæ, and by tubercles of the common kind. Dr. Wilson remarks :—

"It may be observed, that the two cases, which I have now described, of aneurism of the trunk of the superior mesenteric artery, do not present many symptoms in common: they were respectively distinguished during life, the one by jaundice, the other by vomiting of blood.

Both cases were remarkable for the severity and constancy of the pain in the middle of the back, referred by both patients to between the shoulders.'

The difference in the leading symptoms of the two cases to which I have alluded, finds its explanation in the difference of the situation of the aneurismal sac in relation to the pancreas, the liver, and the surrounding structures." 230.

XVII.-ON CONGENITAL TUMORS OF THE PELVIS. By Edward Stanley, F.R.S., Surgeon to St. Bartholomew's Hospital.

Mr. Stanley observes that there are various forms of congenital tumor attached to the pelvis, the discrimination of which becomes of much importance with reference to the question of their removal by operation.

In 1836, Mr. Stanley was requested to see a child, four months old, born with a soft pendulous tumor, about the size of an orange, attached to the lower and back part of its body. In every other respect the child appeared to be perfectly formed and healthy. With the growth of the child, the tumor progressively increased, and in proportion to the rest of its body; it continued to thrive well to the age of two years, when it was attacked by measles, with other children of the family, producing much constitutional derangement, under which it gradually sunk. At the time of its death, the following were the dimensions and general characters of the tumor; its circumference measured fourteen inches and a half; a line extending from its base to the most prominent point of its centre measured four inches and a half. The base being very broad, covered the whole of one buttock, aud extended across the sacrum to the opposite side of the pelvis. The skin covering the tumor was natural; some large and tortuous veins were seen ramifying in the subjacent cellular tissue. Upon some parts of the tumor there were shallow grooves, which were supposed by many who examined the case to correspond with depressions between folds of intestine within the tumor. The surface of the tumor was generally soft, but in some situations, portions of a firm substance, resembling isolated pieces of cartilage, were recognized in it, and it was remarked that these points of resistance were not always to be felt in the same situation. Pressure of the tumor did not cause a diminution of its size, so as to justify the belief that any portion of it receded into the body. A finger

passed into the rectum discovered a portion of the tumor extending into the cavity of the pelvis by the side of the intestine. When the child cried loudly, the tumor became tense; this showed its communication with the interior of the body, and it was thought by some to indicate the probability of its communication with the spinal canal, in accordance with the views of Magendie, that there occurs a movement of the contents of the spinal canal in connexion with respiration, and dependant on distention of the vessels of the cord and its membranes.

Many surgeons had seen the case. Mr. Blizard alone thought the removal of the tumor practicable.

A cast of the tumor was first taken, and then its interior was examined. This was found to consist of an assemblage of different tissues. One portion of it was solid throughout, and closely resembling in its characters the ordinary fibrous tumor of the uterus. Another and larger portion consisted of two cysts, one enclosing the other; the sides of these cysts were membranous, and their texture dense and fibrous, each cyst containing a transparent yellow fluid. A narrow and solid portion of the tumor was found to extend through the inferior aperture of the pelvis upwards within its cavity, nearly to the top of the sacrum, chiefly occupying the right side of the pelvis, and in consequence compressing the bladder and rectum, not, however, apparently to the extent of materially interfering with their functions. There was no attachment of the tumor to the sacrum, otherwise than by loose cellular tissue. The sacral canal was completely closed, and accordingly had no communication with the tumor. The information derived from the examination of the extent and connexion of the tumor appeared to confirm the opinion that its removal might have been safely undertaken in an early stage, when, from the smaller extent of the tumor, it might have been practicable to draw downwards the portion of it from within the pelvis, as it had no other connexions with the surrounding organs than by loose cellular tissue.

Mr. Stanley introduces several cases for which we must refer to the Transactions themselves. His inferences from them are deserving of notice. He says that the cases on record admit of being arranged in four classes.

First. The cases wherein the tumor is composed wholly of morbid structures, which, although formed during foetal life, have no peculiar character, the solid tissues mostly resembling the ordinary fibrous tumors of the uterus, and the membranous cysts being analogous in their nature and contents to the corresponding anormal structures formed at other periods of life.

Secondly. The cases wherein the tumor is composed of morbid structures in conjunction with isolated portions of perfectly-formed animal organs, having no other relation to the living being with which they are connected, than as they are dependent upon it for the means of nutrition and growth. These cases must be considered to belong to the class of parasitic monsters, constituting intra-fœtation, the inclusion of one fœtus within another, and, in accordance with the present theories on this subject, supposed to result from the cohesion or intus-susception of germs, when more than one ovulum is contained in the same vesicle, under which circumstances there will arise either the union of two perfect fœtuses, as in the instance of the Siamese twins, or the growth of one fetus to its perfect form, with but the portion of another fœtus attached to it, as in the remarkable case recorded by Velpeau, where a tumor which was reNo. 87.

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moved from the scrotum of an adult was found to consist of several bones, with other distinct parts of a fœtus.

Thirdly. The cases wherein the tumor, being of the nature of spina bifida, consists of a membranous cyst, communicating with the interior of the theca vertebralis.

Fourthly. The cases wherein the tumor is composed either wholly, or in part, of membranous cysts, communicating with the spinal canal, but exteriorly to the theca; thus in one of the cases related, a probe passed from the cyst, of which the tumor in part consisted, through one of the anterior sacral holes into the cellular tissue between the theca of the cord and the bony walls of the canal.

It will be observed, that in all the cases noticed in this paper, the congenital tumor projected from the posterior and inferior part of the pelvis; its situation, consequently, was such as to allow of removal by operation, but from the apprehension that there might be some deeper portion of it extending to the interior of the pelvis, and more especially from the apprehension that the tumor might be of the nature of spina bifida, and accordingly that its interior would be found to be continuous with the membranes of the spinal cord.

We learn from the foregoing histories that the general character of these congenital tumors, whatever may be their nature, is to increase progressively, and in proportion to the rest of the body; hence arises the important question of their removal and it must be added, that this question will in general be extremely difficult of decision, for the reason that no outward mark or symptom can be referred to as distinguishing the tumor composed wholly of morbid products, and having no other connexion with the body of the child than by cellular tissue, from the tumor which, by the continuity of its interior with the membranes of the spinal cord, is of the nature of spina bifida; yet the operation of removal, in one case accomplished with a fair prospect of success, would, in the other, be certainly fatal. And, accordingly, it has happened in one of these cases, that an operation commenced with the expectation of a successful result, has been stopped in its progress by the discovery of a pedicle extending from the tumor to the interior of the spinal canal. Mobility of the congenital tumor does but indicate the probability of its having no connexion with the vertebral canal, as the means of this connexion may be a narrow pedicle, permitting free movement of the tumor upon the walls of the pelvis. Also to the existence of a narrow pedicle and a small opening of communication with the vertebral canal, we may refer for explanation of the frequently observed fact of pressure of the tumor causing no portion of its contents to recede into the canal, and thus occasioning symptoms of compression of the spinal cord or brain. Any derangement of the nervous functions in the lower limbs would of course be evidence of the probability of the connexion of the tumor with the spinal cord; but it must be recollected that the instances are not infrequent of spina bifida co-existing with a perfect integrity of function in the spinal cord and its nerves.

A circumstance of physiological interest will be noticed in two of the foregoing cases, namely, the existence of a fluid in the isolated portion of intestine within the parasitic monster, which in colour and other obvious characters closely resembled meconium, although there existed no liver or other distinct hepatic apparatus which could have furnished the colouring matter of this fluid, and there was certainly no communication between this portion of intestine and the intestinal canal of the child to which the parasitic monster was attached. An analogous fact occurred to my observation, many years ago, in the examination of an acephalous lamb, in which, with perfectly-formed stomach, intestines, spleen and kidneys, the liver was wholly wanting, and yet within the intestines, especially, the large, there was found a considerable quantity of a dark yellow and thick fluid, not to be distinguished by its appearance from meco

nium. When diluted, the colour of this fluid was exactly that of healthy bile, but it was not bitter to the taste, and in this respect it differed from the perfect meconium of the human foetus, which imparts to the tip of the tongue the peculiar bitter flavour of bile." 244.

An instructive communication.

This completes our account, itself complete, of the volume before us. A volume fraught with practical information, and reflecting honour on the Society and the Profession.

TRAITE DES MALADIES DES REINS, &c. Par P. Rayer. 3 tomes. Paris, 1839-40-41.

In our last number we submitted to our readers' attention a lengthened review of M. Rayer's Researches on that form of Renal Disease, which has of late years excited so much interest among medical men, and is known under the names of Albuminuria, Albuminous Nephritis, or Morbus Brightii. On the present occasion we shall complete our notice of these important volumes, by briefly analysing the chapters on the simple, the gouty, and the rheumatic forms of inflammation of the kidneys, on Pyelitis or inflammation of their pelves and calices, and on Hæmaturia, occasional and endemic.

Under the generic term of Nephritis have been comprehended all the inflammations of the various tissues which enter into the organization of the kidneys, not only of the renal substance, properly so called, but also of its membranes, its vessels, and of the excretory ducts of the urine. It is unnecessary to say how faulty such a classification must be. As well might we groupe under one term the different kinds of pneumonia, and pleurisy and bronchitis at the same time.

M. Rayer has endeavoured to disentangle this confused web; and, basing his conclusions on a most elaborate examination of facts drawn partly from his own experience and partly from the writings of others, he has been led to propose the following catalogue of the inflammatory diseases of the renal organs.

1st groupe.-NEPHRITIS, or inflammation of the cortical, or of the tubular substance of the kidneys.

This groupe comprises-1, simple nephritis; 2, nephritis from morbid poisons; 3, arthritic nephritis (gouty and rheumatic, &c.); 4, albuminous nephritis.

2d groupe.-PYELITIS, or inflammation of the pelves and calices of the kidneys.

The principal species of this groupe are-1, simple pyelitis; 2, blenorrhagic, or gonorrheal pyelitis; 3, calculous pyelitis; and, 4, verminous pyelitis.

3d groupe. -PERINEPHRITIS, or inflammation of the cellular and fibrous coverings of the kidneys,or of the fatty cellular tissue which surrounds them. The different inflammations arranged under these three heads differ from

each other not only in their seat or the tissue which is mainly affected, but also in the symptoms they produce during life, and the anatomical appearances which they present upon dissection.

But as we find in certain cases of pulmonic inflammation that the parenchyma of the lungs, as well as the bronchi and the pleuræ, are all involved at the same time, so we observe that all the different tissues of the kidneys may be simultaneously affected: to such a case we should give the appellation of Pyelo-nephritis.

We shall begin our comments with a short notice of

Simple Nephritis,-as this must be considered the standard with which the other forms of renal inflammation are to be compared and contrasted. Under this term M. Rayer comprehends all the inflammations of the cortical and tubular portions of the kidneys, which are induced by any mechanical or accidental cause, and which are not dependent upon a constitutional disposition or diathesis, or upon the action of a morbific poison.

The kidney may become inflamed in consequence of a blow or wound in the loins, or of a violent muscular effort, which has strained the lumbar muscles and powerfully contracted the abdominal parietes. The presence of a calculus or any other foreign substance; the retention of the urine in the pelvis of the organ, from an obstruction of the ureter, bladder, or urethra, or from a paralytic weakness of these organs; the action of such stimulants as cantharides, turpentine, nitre, &c.; the sudden impression of cold and moisture on the body when heated and perspiring, more especially if the patient be affected at the same time with any complaint of the excretory urinary organs :--these are the most frequent causes of simple renal inflammation. M. Rayer is of opinion, that nephritis from the action of cold and moisture is of much more frequent occurrence than is generally imagined. The disease is more common in the advanced than in the more youthful periods of life: this is what we might expect, considering the greater frequency of urinary complaints, as well as of cerebro-spinal affections in mature and old age.

If the diseases of the urethra, prostate gland, and bladder are frequent causes of nephritis in men, the diseases of the uterus and ovaria, the existence of abdominal tumors, not to mention gestation and delivery, are no less powerful agencies to the same effect in women. The urinary secretion in simple nephritis is usually scanty, sometimes almost completely suppressed generally it is is only slightly acid, or it may be neutral or even alkaline. In the early period of the disease it often contains a portion of blood loaded with it; and in the latter stage it occasionally contains an admixture of pus. Whenever either of these ingredients are present in the urine, this fluid may be found to exhibit signs of albumen on the application of heat or the addition of nitric acid. The temporary presence of a certain portion of albumen in the urine is by no means in itself a sign of the existence of the disease, which has been called albuminuria or albuminous nephritis; but, as we have discussed the history of this form of the disease at considerable length in the last number of this Review, it is unnecessary to revert to the subject at present. In the simple, as well as in the albuminous, form of nephritis, the proportion of the uric