Now, here we have changes of form, and (in the last mentioned instance) even more singular than that which occurs in the fibrin of the blood, and equally inexplicable in the present state of science. As well might we invent some principle to account for the transformations of aldehyde, as for those of fibrine.

It is now well known, that even elementary bodies are capable of presenting very different forms. Those of sulphur and carbon are well known. If this be the case, the susceptibility to change of form in highly compound bodies cannot, or at least ought not, to be a matter of surprise.

I shall conclude this paper by repeating what has been asserted above ; that we must expect from chemistry the solution of these mysteries.

III.—Case of Lithotomy: Fxtraction of a large Stone from the Bladder of a little Girl. By JAMES GUILD, M. D., of Tuscaloosa, Ala. TUSCALOOSA, ALA., February, 1847.

Editors of the New Orleans Medical and Surgical Journal: GENTLEMEN:-Should you think the following described case worthy of notice in your Journal, you will please publish it.

Mr. J Hewit, of this vicinity, consulted me in relation to his little daughter nine years old, who, he informed me was suffering excessively, and had a continuous dripping of urine, and occasional paroxysms, that seemed almost to take life. Said he had consulted several physicians, and had given a great deal of medicine, without any benefit. From his description of the case, I was confident there existed a calculus in the bladder. I accordingly sounded the bladder on the 20th ult., and found the stone without difficulty. The child was much emaciated, adema present, and the healthy functions of the system much impaired ; in consequence of which, I saught the first favorable day to operate. Accordingly, on the 25th of the same month, I performed the new operation of Mr. Ferguson, and removed the largest stone I had ever seen, or described by any surgeon taken from the living subject. The little patient was placed on the table and tied in the usual way for lithotomy. I introduced a deeply grooved straight director into the bladder, the groove pointing downwards and outwards, and to the left side, and with a probe-pointed bistoury, such as is used in operating for fistula in ano, an incision some half an inch in extent, was made towards the tuberosity of the ischium; the incision being limited to the anterior half of the urethra. I then introduced my finger into the wound, and by gentle pressure could dilate the urethra so as to feel the neck of the bladder, the finger coming in contact with a very rough surface and of immense size. Finding it impossible to get the stone through so small an aperture, I made an incision on the opposite side of the urethra, of the same extent that was first made. I could, then, without difficulty feel the neck of the bladder, and found the whole body filled, and its coats firmly attached to the stone. I then by a very tedious process, broke up the attachment with the scoop and fingers. A large lithotomy forceps was

now introduced, when the stone was immediately seized, and though the blades slipped frequently in consequence of its immense size, I succeeded in withdrawing the calculus without crushing. It was about the size of a hen's egg, weighing two ounces, and measuring six inches lengthwise and four inches and five eighths of an inch across its small diameter; it was of an oval form. 27th, visited her, going on well. 29th, much improved, able to retain her water a few hours. 31st, still improving, able to retain her water still longer. Feb. 4th, able to sit up, good appetite, wound almost closed, able to retain her water almost at pleasure. 11th, discharged, able to walk and amuse herself as she thinks proper. Intimation being given that the child had introduced a pin into the bladder some twelve or fifteen months previous, I sawed open the calculus across its small diameter, and to our great astonishment found a brass pin in its center, of an unusually large size, which acted as a nucleus on which the deposit was formed. I am much gratified to find there is no incontinence of urine in the case, and am satisfied there never will be, when the operation is performed in this way.

Sir Astley Cooper states that all his operations with the knife, were attended with incontinence of urine, and recommends a suture upon the edges of the wound. I am well satisfied there is no necessity of cutting the neck of the bladder in the female to extract calculi, for after making the incision as I have described, the parts can be so dilated as to remove any sized stone that may form in the bladder.

My esteemed friend, Professor Brumby, of the university of Ala., has analyzed the stone, and addressed me the following note.

UNIVERSITY OF ALA., January 30th 1847. DEAR SIR. The portion of urinary calculus, which you gave me for the purpose, this morning, has been carefully subjected to chemical examination.

It is insoluble in alcohol and very partially soluble in boiling water. In solution of potassa or soda, it is insoluble, but emits a faint odor of ammonia, and deposits, after cooling, small flakes of animal matter. It is readily dissolved by diluted nitric, hydrochloric, sulphuric and acetic acids. From any of these solutions, it is precipitated by alkalies. The solution in nitric acid placed in a small retort, was slowly evaporated to dryness. The saline mass was white. This was then heated to near redness, over a small spirit lamp, when the retort was filled with dense white fumes, evidently of undecomposed nitrate of ammonia, and a white saline residue was left. This was insoluble in water, but dissolved readily when a drop of pure nitric acid was added. This solution rendered neutral by ammonia, was tested and found to contain phosphoric acid, magnesia and a trace of lime.

A portion in fine powder was then heated gradually to redness in a small platinum spoon, over the flame of a spirit lamp. It became black, yielded the odor of ammonia, but did not melt. In the blow pipe flame it was fused with difficulty into a white enamel.

These chemical characters combined with color, form, size, structure, powder and other physical properties, prove this calculus to be of the species denominated ammoniaco-magnesian phosphate, mixed probably with a small quantity of phosphate of lime. Its aspect shows that it is

not the fibrinous, a rare species of calculus; it is not the xanthic oxide, for its color is neither reddish nor yellow; it is insoluble in potassa, and its solution in nitric acid, deposits on evaporation, a white, instead of a bright lemon residue. It is neither cystic oxide, nor the uric acid calculus; for it is insoluble in alkalies, and soluble in acetic acid. It is not the fusible calculus, for to convert it into an enamel, requires the highest heat of the blow pipe flame. Finally, it is not the phosphate of lime (bone earth) calculus, since it contains very little lime, is soluble in cold acetate acid, and consists chiefly of ammoina, magnesia and phosphoric acid. Yours truly,

Dr. James Guild.

R. T. BRUMBY.

IV.-Accounts of a New and Fatal Epidemic that Prevailed Recently in Mississippi and Tennessee. By B. J. HICKS, M. D., of Vicksburg, Miss., and B. F. TAYLOR, M. D., of Whiteville, Hardeman County, Tennessee.

(It is a remarkable coincidence that we should have received about the same time the following communications, evidently describing the same curious disease, as it prevailed at localities nearly 300 miles apart. It will be seen that Dr. White gives no name to the strange affection; whilst Dr. Hicks calls it myelitis petechialis. We are satisfied it is the cerebro-spinal meningitis, which prevailed during the last year in Ireland and some parts of Europe-an interesting account of which may be found among our Foreign extracts in the present number, taken from Ranking's Half-Yearly Abstract, vol. 2, No. 2, p. 192. Upon enquiry, we learn that several cases of a similar nature were seen in this city in the early part of the spring; and on reflection, we are inclined to think it was the same disease that killed so many of the 2nd regiment of Mississippi Volunteers as they passed through this place in January last.We think it evident that neuralgic and spasmodic affections have increased greatly in the south within a few years past. EDS.)

Editors of the New Orleans Medical and Surgical Journal.

GENTLEMEN: In the neighborhood of this village we have had an epidemic that has proven to be one of the most formidable, probably, in the records of medicine. It appears to have been more prevalent near Hatchie river, than in any other section of the country. The disease has been confined principally to children between the age of six and fifteen years. The attack is ushered in with cold chilly sensations, after which moderate heat of surface, pain commencing between the shoulders, extending to the occipital region, rigidity of the posterior cervical muscles, retracting the head considerably backward, as in tetanus. Delirium supervenes in an hour or two, contraction of the pupils of the eye, dilitation of the one eye sometimes, with contraction of the other, ptosis of the eyelids, ecchymoses under the eye and on the body, rigidity of the abdominal muscles, spasmodic twitchings of the flexors of the extremities, and a disposition to keep the legs in motion

from side to side alternately. A difficulty in expanding the lungs, breathing through the nostrils principally, constipation of the bowels, and sometimes retention of urine. Stertorous breathing comes on, and death soon closes the scene-such are the general symptoms of the disease. It terminates its course in from fifteen to seventy-two hours.— I have known one case to terminate as late as the twelfth day.

Almost every method of treatment has been devised and carried into effect; bleeding, emetics, cathartics, cold douche, cupping, mercurials, blisters; after which, opium, quinine, and stimulants. The system appears to be so excessively shocked that the recuperative powers are not sufficient to sustain the tottering fabric. The necessary chemical change is not carried on in the lungs; the blood is not decarbonized; consequently, from the phenomena manifested, we are led to the conclusion that death is produced principally by asphyxia.

I will simply detail one case, the particulars of which will be found highly interesting, illustrating clearly and conclusively the pathology of the disease.

Case. I was called in consultation with my friend Dr. Durham, an old practitioner, in the night of the 30th March, to see a servant girl, aged 11 years, the property of John H., Esq. She was taken on Sunday evening the 28th, and was seen the following morning by Dr. Durham. She was then delirious, conjunctivæ injected, pupils contracted, retraction of the posterior cervical muscles, twitchings of the flexors, rigidity of the abdominal muscles, hurried respiration, pulse full, but compressible, constipation of the bowels. A mercurial cathartic was ordered, and a blister to the nape of the neck, extending over the occipital region.

29th. Delirium ceased; there is still retraction of the muscles; medicine produced two evacuations; has passed a small quantity of urine; says she feels better. Ordered calomel and pulv. doveri.

30th. This evening I saw her the first time. Intellect clear, complains of pain in the hypochondriac region, retraction of posterior muscles, pupils contracted, the eye looks rather dull, tenderness on percussing the 2nd and 3rd dorsal vertebræ, restlessness, pulse quick and compressible, no fever, tongue of a dull red or purple color around the borders, coated with a thin yellow fur and fissured, respiration quicker than natural, performed principally by the abdominal muscles, dullness on percussion over the right hypochondriac region, auscultation detected slight engorgement of the lungs, no purgative since yesterday. I advised that she should be cupped over the spine pretty extensively, and to have an active mercurial cathartic.

31st. The cupping relived the muscular retraction; skin feels pliant, though there is increased heat of the scalp. In the course of the night it was thought proper by Dr. Durham to administer 3 i. tinct. opii. camph. to relieve excessive abdominal pain. Bowels not moved; the anodyne had the desired effect. She says that she is better. Ordered ol. ricini. and ol. terebinth., to be repeated in four hours, should it not operate.

When we were in the act of leaving, the mother came out from the cabin and desired us to come back and see her, as she was much worse.

She stated that the patient had asked for a drink of water a few minutes previously, complaining on lying down of pain in the abdomen, and evacuated her bowels in bed. The pupils were contracted, pulse depressed, breathing stertorous. Death closed the scene in a few

minutes.

I examined the body in presence of Dr. Durham, and the following were the appearances.

Sectio. Cadaveris, 18 hours after death.-The body was not thin, and there was a quarter to half an inch of fat covering the abdominal muscles.

Head.-The posterior integuments were swollen, both pupils were dilated. On removing the calvarium, a considerable amount of blood flowed from the sinuses of the dura mater. The arachnoid membrane adhered with moderate firmness to the surface of the convolutions.

While the brain was being removed, some two or three ounces of serum escaped from the ventricles, being a clear and transparent color. The weight of the brain was not ascertained, but it appeared heavier than usual. The surface of the convolutions was much flattened. The base of the brain bore evident marks of inflammation. The membranes covering the medulla oblongata and the cerebellum, the right lobe more especially, were thickened and opaque, adhering likewise pretty firmly to the fissures of Sylvius. The membranes at the base were unusually vascular, but the substance of the brain itself was not altered very much in color or consistence. The membranes, more particularly, around the third nerve of the right side, were thickened and more vascular than natural. On examining the superior surface of the brain and separating the two hemispheres slightly, they gave way inferiorly. This was ascertained to arise from softening of the lower part of the middle lobe of both hemispheres, as also a considerable portion of the corpus callosum. The corpora striata were very slightly injected and softened, particularly that of the right side; the lining membrane of the ventricles was not altered in color. The brain, taken as a whole, excepting the parts mentioned, was natural.

Spinal Marrow.-On sawing the vertebræ, a considerable quantity of fluid blood gushed out the moment the interior of the canal was reached. It appeared to be perfectly flooded and engorged. The membranes were evidently thickened and highly vascular. The spinal marrow was not altered in appearance, but if any thing, softer than natural. The substance itself was not injected.

Thorax.-On inflating the lungs, the cells were permeate throughout. There was no appearance of hyperemia or inflammation of the substance, or of the lining membrane.

The Heart contained within the ventricles a thick coagulum of blood. The pericardium being cut through, about two ounces of serum escaped. The valves were healthy and the artery was free from deposits.'

Abdomen.—The liver was perfectly engorged with blood; an incision being made through its structure, the blood could be squeezed from it as from a sponge. The gall bladder was distended and contained a quantity of thick black bilious matter. The weight of the liver was 5 pounds.

The Kidnies were congested, but otherwise healthy.