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chiefly at the expense of the latter. Under the microscope notrue pus-cells were seen, but there were many nuclei and, blood-corpuscles. It was believed that the apparent abscess was theresult of the dissolution of a fibrinous block in the spleen. Thevagina and cavity of the uterus contained pus.

GUY’S HOSPITAL.

CARCINOMA OF PLEURA, COMPLETELY SURROUNDING ABRANCH OF THE PULMONARY ARTERY IN

TWO SITUATIONS.

(Under the care of Dr. BARLOW.)RICHARD S-, aged sixty, was admitted into Philip ward,

Dec. 22nd, 1862, in a very feeble and worn-out condition. Hewas very fat and flabby, and the whole of his tissues were evi-dently degenerating. He had also the atheromatous expressionwell marked. His principal complaint was due to an omentalumbilical hernia, which caused him much uneasiness. He diedon the 23rd February, 1863.

Autopsy, ten. hours after death -Body very fat, flabby, andold-looking; brain healthy. The whole of the pleura wascovered with nodules of cancer, which were white, firm, andsmall; these growths also covered the spine. On careful exa-mination, no disease could be found in the more solid texturesaround ; and thus it seemed as if the cancer was confined tothe pleura alone, and had originated there. The lungs werecomparatively healthy; only in one or two spots near the rootof the lung was any cancer found in the tissue, and here it ap-peared to have proceeded inwards in the course of the tubesand vessels-the cellular tissues around the bronchus beinginfiltrated, and thus the disease carried for a short distance in-wards. In two places the cancer had completely surrounded abranch of the pulmonary artery. The bronchial and otherglands were unaffected. Some clear serum was present in bothsides of the chest. The heart was larger than natural, andfatty; the surface covered with fat. This encroached on thewall of the ventricle, which was streaked throughout with fat.The left ventricle was pale and very soft, streaks of yellowindicating fatty tissue in various parts. The valves and liningmembrane were healthy. There was much fat in the peritoneumand liver. The sac of the omental hernia contained adherentomentum, and, dragging the colon to the back of the sac, this(the sac) had formed above the umbilicus.

KING’S COLLEGE HOSPITAL.

STONE IN THE BLADDER OF A MAN ON WHOM THE

OPERATION OF LITHOTOMY HAD BEEN TWICE

PREVIOUSLY PRACTISED; LITHOTRITY.

(Under the care of Mr. HENRY SMITH.)W. H-, a very stout man, of florid aspect, residing in

Kent, was admitted July 29th. Seven years previously he hadsymptoms of stone, and placed himself under the care of Mr.P. C. Price, who performed lithotomy and extracted a largecalculus ; he recovered rapidly. Twelve months after this he

began to suffer from his old symptoms, and six months subse-quently he was again lithotomized by Mr. Price, who ex-tracted five stones. The patient recovered as rapidly as before;but on convalescence it was found that the bladder was para-lysed, and it has remained in this condition ever since, hebeing obliged to use a catheter on all occasions. With this

exception he continued well until six months ago, when hebegan to suffer again with his old symptoms; and on beingsounded lately by Dr. Wm. Price, of Margate, a stone was dis-covered.On admission, it was found that the man was suffering from

well-marked symptoms of stone, there being great irritabilityof the bladder, pain, and thick mucous urine. In other re-spects his health was very good. On examining him very ’icarefully with a sound on two separate occasions, Mr. Smithcould not detect the presence of stone, but the bladder wasfound to be exceedingly thickened and sacculated. Mr. Fer-gusson also examined the bladder on two occasions, but failedto detect any stone. On Aug. 12th Mr. Henry Smith made athird very careful examination with a lithotrite, and imme-

diately struck a stone lying on the right side of the bladder.He at once seized it and broke it up.Aug. 17th.-The patient has suffered a great deal; but, of

course, as the power of passing the urine is lost, nothing hasbeen got away except a few very small fragments in the eye ofthe catheter. But to-day Mr. Smith washed the bladder well;out with a large-eyed catheter, and removed numerous frag.ments of considerable size.21st.-Mr. Smith again washed the bladder well out, re

moving several fragments. He also introduced the lithotrityscoop, and got away two or three entire calculi. These werecomposed of lithic acid, coated with phosphates.

’

27th.-Although there is reason to suspect that the bladderis not quite cleared, the patient has been allowed to go home.

This man returned to the hospital on the 18th of November,stating that for a month after he left he was very well, butafterwards he began to suffer from irritability of the bladder.He got away several small fragments of stone by the aid of hiscatheter ; nevertheless, the symptoms have continued. Oncareful sounding, no stone or fragment could be discovered;, but the urine was very much loaded, and he was orderedpareira brava and opium. This medicine had the effect of re-lieving the symptoms very much; but Mr. Smith still felt con.vinced that there was some stone or fragment remaining in thebladder, and therefore carefully sounded him again, both bythe sound and the lithotrite. This was done on two occasions,and it was determined to dismiss the patient as he was so much-better ; but prior to this the bladder was very carefully searched,one of the instruments used being a large catheter with a veryabrupt curve. As this was being very slowly passed, a stonewas distinctly felt, apparently just behind the pubis. Apower-ful stream of warm water was now injected through a catheterwith very large eyes, and an entire stone, of about the size of asmall bean, was brought away. From this time the symptomsdisappeared, and the man was discharged in a few days.

METROPOLITAN FREE HOSPITAL.

DISEASE OF TARSAL BONES; SYME’S OPERATION; SUCCESSFULRESULT.

(Under the care of Mr. G. B. CHILDS.)J. A. P-, aged ten years, a strumous-looking boy, ad-

mitted Aug. 17th, 1863. About six months previously he hadtwisted his left foot, and some inflammation of a more or lessacute character had followed the accident.On admission the left ankle was considerably swelled, uni-

formly rounded, and club-shaped. The integument was glazed,tense, and semi-elastic. There were three sinuses (two on theouter side and one on the inner) discharging pus, and sur-rounded by granulations; these apparently led to the astra-galus and calcaneum, and through them softened and cariousbone could be distinctly felt. There was some tenderness overthe astragalo-scaphoid and calcaneo-cuboid articulations; butno great pain, except when the foot was moved. The limb waswasted from disuse, but the boy was in fair general health.An attempt was made by constitutional treatment and local

rest to obtain spontaneous cure, but without avail; so on

November 2nd, the patient being under chloroform, Mr. Childsattempted Pirogoff’s operation, but finding the os calcis toomuch diseased, he took it all away; the malleoli were thensawn off, and the flap brought up as usual and fixed by sutures.An examination of the removed parts showed the astragalus,

and os calcis very much diseased; the latter especially so at its-outer side and at its articulation with the cuboid. The sca-phoid was perfectly sound. The cuboid had a small speck onits posterior aspect, as had also the middle cuneiform.For a short time after the operation the patient had a small

quick pulse, furred tongue, and copious night-sweats ; butthese symptoms quickly disappeared on the administration ofquinine and sulphuric acid. The greater part of the woundunited by the first intention.On Dec. llth the patient was discharged; he had got fat,

and the wound had quite closed, except at the outer side,where there were two small granulations discharging saniousmatter (not pus).

ST. BARTHOLOMEW’S HOSPITAL.-It is intended to placein the Great Hall of this institution a portrait of the highly-esteemed treasurer, Joseph Foster White, Esq. A subscriptiaalist has been opened, to which the governors and officers of theestablishment have readily contributed.