Fall of 1837, and again called my attention to his condition. He was now much reduced in flesh and strength, his complexion very sallow and the whole skin unnaturally dry and harsh, while the cuticle on the palms of the hands and the soles of the feet was exceedingly thickened and marked by fissures or cracks. But the most striking feature of the case in its present aspect was a large abdominal tumour occupying the right iliac and right hypochondriac regions and extending laterally in the opposite direction to a short space beyond the umbilicus. The tumour was in shape an irregular oblong of uniform surface, exceedingly tense and rather unyielding but slightly elastic under pressure. In reference to the further treatment of the case it was of the first importance that the nature and origin of this tumour should be satisfactorily ascertained. The difficulty of this task, however, was not a little increased by the various and discrepant opinions which had been passed upon it by the several medical gentlemen whom the patient had consulted at different points. Looking to the situation of the tumour, and its apparent connection with the symptoms of renal inflammation which had so long and so constantly preceded it, I felt myself justified in the decision that it resulted from and consisted in some morbid growth or structural change in the kidney itself.

After repeated examinations of the tumour, in which I was accompanied and aided by Dr. Flint, professor of Surgery in the Louisville Medical Institute, we thought that fluctuation was perceptible, and that the case in its present stage might be considered and treated as Abscess of the Kidney.

We accordingly made an incision into the tumour, when purulent matter of ordinary consistence and of greenish yellow color issued from the orifice, and continued to flow until full half a gallon had been collected in the vessel which re

ceived it. A few days after the orifice having closed was again opened, when an additional quantity of pus was discharged, amounting perhaps to about one quart. From this time the orifice remained open, and the matter continued to be sponta neously discharged from day to day, in various quantity. For several weeks the case wore a most favorable aspect; no constitutional disturbance succeeded to the operation: the patient became cheerful in the hope of recovery, slept soundly, ate and digested a fair allowance of food, and enjoyed a regular state of the bowels, and an improved condition of the surface. At about four weeks from the date of the operation upon the tumour, and after an anxious and sleepless night, consequent upon an important transaction of business in which he had been involved, he was seized with a strong rigor, to which ensued in regular succession, and by daily paroxysms, a well defined hectic fever, bringing in its train cough, night-sweats, colliquative diarrhea, which terminated his life about ninety days from the opening of the abscess.

A post mortem examination exhibited the following circumstances:-The abdominal points were divided by an incision over the tumour extending from the sternum to the pubis, by which the tumour, consisting now of the half empty sack of the abscess, was brought into view, extending from the natural situation of the kidney below, to the concave surface of the liver above, and united by old and strong adhesions, to all the contiguous parts and organs, to the walls of the abdomen, the folds of the intestines, and the concave face of the liver-where the union was so extensive and intimate as to be inseparable by the knife, seeming to constitute, with the liver, a continuous and identical structure of morbid condition and aspect. On enlarging the opening in the sac, and sponging out the matter which it contained, no trace of the

natural structure of the kidney remained; the substance of that organ seemed to have been utterly disorganized and destroyed, leaving only its original tunic now converted by inflammation and pressure into the diseased, thick walls of the abscess.

On exploring the cavity of the abscess, it was discovered to be divided into several compartments or pockets, in each of which was contained a quantity of urinary calculi of various sizes, from a millet-seed to the largest garden pea, and so lodged and compacted in these pouches, that they could not find their way into the general cavity of the abscess, while on the other hand, they could not be carried forward to the bladder the renal orifice of the ureter having been completely obliterated by inflammation. The kidney of the opposite side was of normal structure, but rather paler than natural, and enlarged considerably beyond its usual size, and containing in its pelvis a single calculus of a soft and firiable texture, marking the incipient stage of a similar disease in the left kidney, to that which had already destroyed the right. The dissection was not extended to the lungs or other organs, in consequence of the intention of the friends of the deceased to convey his body for interment to a distant county. Enough, however, had been revealed to furnish to me the satisfactory assurance, that I had not erred in the diagnosis of the case, and to convey to his friends, the melancholy conviction that no course of treatment could have conducted it to a different issue.

ART. III. Remarks on Secale Cornutum in Pseudocyesis

Molaris. By DR, JOSIAH HIGGASON, of Somerville, Tenn.

In the latter part of December 1838, I was called to see Mrs. G., laboring under excessive uterine hemorrhage. So alarming was her exhaustion from loss of blood, that, together with other means, it was necessary to have recourse to the tampon. She was then directed to lie in bed, use light diet, keep her bowels open by rhubarb and magnesia, with occasionally a small dose of calomel, and when threatened with a return of hemorrhage, to use pills composed of opium, ipecacuanha and acetate of lead. For about a week she had frequent returns of flooding, generally light, but of sufficient severity to require the pill. She had also rigors, without the sensation of coldness, which I have often found to be indicative of the existence of some extraneous body within the uterus. In the intervals of hemorrhage, she had a discharge of a sanguineo-mucous character from the vagina, which had contin ued with greater or less profuseness for twelve months.

The

The patient indulged the belief that the solid parts of a fœtus were retained within the uterus, and that this was the source of all her suffering, which led to an examination. uterus was found to be of the size which it attains about the third month of gestation, with the cervix elongated and the os tincæ rigid. The examination satisfied me that I had taken a wrong view of the case-I had regarded it as one of a disordered state of the menstrual function, and had prescribed for it as such. I was now at a great loss to determine its precise character. Did the uterus contain a dead fœtus? If so, it must have been retained for twelve months, since, during that period, her health had been too bad to admit of conception. About a year previously she was supposed to have aborted, and the retained substance, she believed, had existed

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within the uterus from that time. She recovered but imperfectly from the effects of the abortion, and continued to be pale and nervous, and to suffer with the discharge above referred to, which was occasionally so free, as to demand the use of astringent remedies, purgatives, &c. An alarming hemorrhage at the time specified, made it necessary to render her prompt and regular attention. She was found free from labor pains the uterus had been quiescent for months-the cervix was firm, and the os uteri unyielding, but as the danger of the patient was imminent, it was determined, on consultation with Dr. Gray, a relative of the lady, to put her upon ten grain doses of ergot, every two or three hours, with a view to the production of light, but continued action in the uterus, thereby soliciting the relaxation of the parts. The remedy was commenced about 10 o'clock, A. M., and persevered in for four-and-thirty hours, when an organized, firm substance, about four inches long and two in diameter, was expelled. It was enveloped in a smooth, white, membranous coat, which had no appearance of having ever been attached to the uterus:-it was pear-shaped, corresponding to the cavity in which it had reposed, and in its structure spongy, or cellular, with tough, ligamentous bands, passing through it in different directions.

During the operation of the ergot, the following effects were observed with interest:—at first the hemorrhage was increased, but subsided when the tonic contractions of the uterus were established. After the first three doses, the patient complained of pain and uneasiness in the back, which gradually increased until the contractions became general, and occasionally severe. The remedy was then intermitted for a time, lest injury should result from too much pressure upon the still unyielding parts. Gradually, however, this rigidity