cumspectione, invenimus hepar mole sua naturalem quantitatem non excedere, ut nec ventriculum nec lienem. ***** Nam venis

magnis per superficiem sparsis preditus erat tumor, et in ejus parte superiore, aliquid rubicundi instar placentæ uterinæ apparebat. **** Aperto tumore invenimus eum repletum fuisse copia seri ingenti; tandemque deprehendimus renem dextrum in ejusmodi molem excrevisse, et tumorem illum efformasse, qui tamen ren et a figura sua naturali, et a substantia plurimum discrepabat, cum crassissimæ membranæ erat admodum similis, ureter quoque dexter plane erat impervius.'

Here then we have a case of congenital renal distention, with an impervious ureter on the same side:-and that these stood in the relation of cause and effect to each other, there can be no reasonable doubt. We think that the same explanation may be extended to those cases that are recorded by the gentlemen abovementioned. We cannot, therefore, agree with Dr. Howison in his pathology of the case detailed by him. He never seems to suspect obstruction of the ureter as the cause of the disease; and, strangely enough, supposes, that the inflammation which "existed in the interior of the kidney arose from the ulceration there going on." On the contrary, we believe that the inflammation arose from the distention caused by the obstructed ureter, and that the ulceration was the consequence, not the cause, of the inflammation.

From this view of the etiology and pathology, it is obvious, that puncturing the tumours would not have afforded any effectual relief, as it would not have removed the cause of the disease.

"M., aged

8. Singular Disease of the Nervous System. thirty-six years, of an agreeable figure, cultivated mind, but of great nervous susceptibility, led a gay life prior to his marriage, which took place about six years ago. At that time he experienced some crosses in business, and was afterwards severely afflicted, in consequence of a mental derangement which attacked his wife, at the time of her first accouchement. He never left her during the whole of the disease, but accompanied her in a journey, and was thus witness, for nearly a year, of the incoherencies and convulsive affections of a being for whom he had the most tender attachment. The complete cure of Madame put an end to the moral torture which her husband experienced; but, instead of giving way to joy, which such a fortunate event might naturally occasion, he remained dull and silent, and gradually shewed every symptom of real melancholybelieving himself inevitably ruined, and feeling persuaded that he was the object of animadversion by the laws, of the searches of the police,

* De Hypochondriorum Tumore, Lib. III. Sect. XVII. Obs. XXII. + M. Magendie. Journal de Physiologie, April, 1822.

and of public raillery. His mind was perfectly correct upon every other subject. He was recommended to travel, to take the waters, and to undergo different modes of treatment, but without success.

"Things were in this condition, when, in the month of September last, he was seized with a degree of stiffness in the right leg and thigh, to such an extent as to cause him to limp. A few days afterwards, a similar stiffness attacked the opposite thigh and leg; and he subsequently lost all power of volition over his movements. The limba were, however, far from being paralyzed, but they were, in some measure, isolated for whole hours: he was then obliged to execute the most irregular movements, to assume the most whimsical attitudes, and to make the most extraordinary contortions. It is impossible for language to paint the multiplicity and the strangeness of his movements and positions. If he had lived in times of ignorance, he would, doubtless, have passed for one possessed of a devil; for his contortions were so far removed from the movements proper to man, that they might easily have been regarded as diabolic. It was worthy of remark, that, in the midst of these contortions into which his thin, supple body was thrown, sometimes forwards, sometimes behind, or to one side, like certain vaulters, he never lost his equilibrium, and that, in the great number of attitudes and singular movements which he executed during several months, he never happened so fall. In certain cases, his movements re-entered into the class of ordinary movements; thus, without his will participating in the least in the world, he would get up and walk rapidly, until he met some solid body which obstructed his passage; sometimes he started backwards with the same promptitude, and was only stopped by a similar cause. He was often observed to resume the use of certain movements, without being able in any manner to direct the others: thus, his arms and hands frequently obeyed his will; and, more frequently still, the muscles of the face and of speech. It was sometimes possible for him to recoil, when his progress in advance was interdicted, and he then made use of this retrograde movement, for the purpose of directing himself towards the objects which he was anxious to reach.

"Finally these movements, which might be called automatical, never continued a whole day: he had tolerably long, quiet intervals between the paroxysms, and his nights were always tranquil.

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Although the contractions were very violent, so as to produce copious perspiration, when they had ceased, he experienced no feeling of fatigue, proportionate to the intenseness of the efforts which he had made as if the intellectual exertion which we make use of, in order to excite our movements, is that which becomes the most fatigued in us.

Reckoning from the day on which the movements showed themselves, there was a slight amelioration in his moral condition.

"The physicians of the province in which he dwelt made use of several means against this singular disease. Amongst others, baths, leeches, antispasmodics, &c. were useless. They then decided upon sending him to Paris, where he arrived in the month of December last, and put himself under my care.

"I employed the first days in studying his condition, which I could not class under any known disease. It was not a catalepsy, for the movements were frequently rapid and multiplied; there were no convulsions, for the contractions had a certain ensemble, and a sort of regularity in the disorder of the movements; and it was not the dance of St. Guy, for in that there is an agitation, a friskiness, and a versatility in the contractions, which were not perceptible in this patient.

"What was to be done in such a case? and how much the emptiness of medical theories is felt upon such occasions!

"Many remedies had been already employed, and it was necessary to try others.

"Having no particular motive, and seeing, moreover, no inconve nience from it, I decided upon administering the sulphate of quinine, which was given in the dose of two grains a-day, in a small potion.

"From the second day an appearance of amendment was perceptible; on the third it was evident, and, on the sixth, all the automatical phenomena had disappeared; and M., to his great satisfaction, regained the supreme direction of his locomotive system.

"From this moment (about four months from the present time) he has had several slight relapses, always produced by strong moral emotions, such as the death of his sister and father-in-law. At the first time, I considered it proper to have recourse to the curative means, which I had employed with so much success, and I obtained from it a speedy cessation of the symptoms.

"In the last month, there have been some involuntary movements, which continued for some hours, and disappeared of themselves.

"A final remark, which I should not forget, is, that the influence of volition over the movements was gradually restored: for example, during several weeks he was unable to run, and, consequently, felt obliged to be contented with walking, and even with this to a certain limit, both as regarded the extent of his steps and their speed."

9. Stethoscope.t M. Kergaradec has lately published a small memoir upon the Application of Auscultation to the Study of Pregnancy. By means of the stethoscope or pectoriloque of Laennec, he is of opinion, that the pulsations of the heart of the foetus may be distinguished from those of the arteries of the mother; and that, by an attention to the different sounds communicated to the ear, we may determine, in doubtful cases, whether the foetus in utero is alive or dead. MM. Kergaradec and Laennec are both of opinion, that the

Both the phenomena and the treatment convince us, that the disease was nothing else than chorea, of which there are many instances on record, where the movements were quite as singular as in the present case.-Ed.

†M. Kergaradec. Magendie's Journal.

stethoscope and the immediate application of the ear, are attended with the same advantages; but M. Fodera considers, that although, for the purposes of delicacy, the stethoscope may be sometimes preferred, yet that we may frequently be able to detect diseases by the immediate application of the ear, which we are not able to do with the stethoscope; and he consequently gives the preference to auscultation performed in that manner, in all cases where the stethoscope may be considered necessary.

*

10. Uterine Hæmorrhage. Although it be a general truth, that uterine contraction secures from uterine hæmorrhage-and that the uterus is contracted when it feels small, round, and firm; yet the attentive practitioner is occasionally struck by the disproportion that exists between the want of contraction and the degree of hæmorrhage -a bulky uterus being often free from discharge-and there being, sometimes, a profuse flow when the uterus is small and contracted.

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Nay, further, I have witnessed a profuse hæmorrhage though the uterus had contracted in the degree which commonly indicates security; and I have ventured to do what is seldom justifiable, separate the placenta before the uterus had contracted, without more hæmorrhage than after a common labour, What is this circumstance which has so great an influence that its presence can cause a moderately contracted uterus to bleed profusely, and its absence can cause an uncontracted uterus to bleed scarcely at all?"

Experience has taught our author that, there are two circumstances in which a hæmorrhage may prove alarming, though the uterus be contracted.

1st. The effects of uterine hæmorrhage are comparative in different constitutions. If some people, who are prone to syncope, lose rather more blood than usual, it will affect the constitution as much as a profuse hæmorrhage will others-this trifling excess not being indicated by any thing unusual in the size of the uterus. 2dly. After delivery, in general, uterine contraction prevents hæmorrhage, by closing the mouths of the vessels so as to resist the ordinary momentum of the circulation. But if this momentum be extraordinarily great, it is reasonable to suppose, that it might overcome the common occlusion of the vessels even in a contracted uterus. The two positions above stated, are elucidated by cases. The following is illustrative of the first position. Dr. G. delivered a lady of her first child, the labour being short and easy. About ten minutes, post partum, the uterus felt round, firm, and of the usual size. In this state of things, she suddenly exclaimed that she was going to

* An Account of some Circumstances in which a Uterine Hæmorrhage may occur sufficient to produce alarming Symptoms, though the Uterus feels contracted in the ordinary Degree. By ROBERT GOOCH, M. D.Med.-Chir. Transactions, Vol. XII. Part 1.

faint, (being accustomed to it,) and, in a minute afterwards, she did faint. For a long time, she continued alternately reviving and sinking "a state which the most experienced cannot watch without painful anxiety." Dr. G. does not give the sequel, but we conclude, of course, that recovery took place.

In some constitutions the syncope is the accidental effect of an exhausting labour, and is accompanied by that powerless and agitated state of the vital functions, termed "nervous irritation"-cases in which the best cordial is an opiate. We shall insert the following case in the words of our author.

"I was attending a lady, thirty-six years old, in her first labour. Of her mother and three daughters, all but one, have, in their first labours, been delivered with the forceps. She had a severe and protracted labour, and no longer feeling justified in postponing the delivery, I applied the forceps. The external discharge was not greater than usual; the uterus, after the removal of the placenta, felt rather, but not very, large. She had not been tranquil since the extraction of the child, but about twenty minutes afterwards her appearance alarmed me greatly. Her heart beat with indescribable rapidity, her pulse was countless, she breathed so quick and short that, to use her own expression, if it became quicker and shorter she should not breathe at all, and she felt as if she was dying.

"I had two duties to perform; one, to take care that the symptoms were not kept up, nor caused by internal hæmorrhage; the other, to administer what I thought most likely to tranquillize these alarming symptoms. I passed my hand into the uterus; it contained a good deal, I guess a pound and a half, of coagulated blood; I scooped it out with the hollow of my hand. There was no occasion to irritate the uterus to contract; the instant it was empty it shut like a spring, and when I put my hand on the outside I found it not more than half its previous size, but the symptoms continued as alarming as ever. I now gave her a dessert spoonful of Hoffman's æther, and fifty drops of laudanum, and then sent off for the family physician. When he arrived the symptoms had abated so much, as to relieve me from my anxiety; the pulse was slower, the breathing more tranquil, and she felt disposed to sleep. She continued to sleep nearly two hours while we remained in the house, then awoke for a few minutes, slept well through the night, and awoke the next morning without any vestige of her symptoms, sensible to herself; but her pulse continued frequent for many days." 156.

In illustration of the 2d position, (extraordinary momentum,) the following case is related. On the 10th of April, 1816, Dr. Gooch delivered Mrs. S. of her second child. For many hours before the accession of labour, she was flushed, and had a quick pulse. This state was diminished, but not removed, by proper means. It continued for some time post partum. After the removal of the placenta, the uterus felt, in the hypogastrium, contracted in the ordinary degree; yet, in twenty minutes afterwards, there came on one of the