Harley, saying that some alarming symptoms had suddenly made their appearance. On going to the hospital, I learnt that during the afternoon he had had a severe attack of shivering, after which he complained of giddiness, and his countenance assumed a look of anxiety. It was not, however, till the evening, about nine o'clock, that any alarming symptoms made their appearance. He then suddenly became pale, his features contracted, his pulse very rapid, and scarcely perceptible at the wrist. When I saw him at ten o'clock, he had all the appearance of a patient suffering from the shock of a severe injury; he was quite sensible; the surface of the body was cold and clammy; his features shrunk; the pulse was scarcely perceptible at the wrist; he complained of a choking sensation, and had all the aspect of a dying man. He had passed water freely in the afternoon; there was no distension of the bladder; both the wounds had a perfectly healthy appearance; there was no swelling in their neighbourhood; no swelling or induration of the perineum, or in the prostate, when examined by the rectum. The sheets were stained by a few drops of blood from the wound in the perineum. Warm bottles had been placed around him, and brandy had been freely administered. I desired that this treatment should be continued, and that he should take in addition some camphor mixture with carbonate of ammonia.

In a few hours he had rallied somewhat; his pulse became more perceptible, and he felt better.

At visit the following day he was better; his pulse very rapid, but quite perceptible at the wrist. He had passed water freely, but in small quantity, both by the wounds and the natural outlet. Mr Syme saw him with me, and, with myself, was satisfied that nothing could be detected in the perineum to account for the constitutional symptoms. The wounds had the same healthy appearance as on the previous day. The same treatment was continued, and he improved a little during the afternoon, till about four o'clock, when he again suddenly sank into the same state of collapse as on the previous evening; and, in addition to his previous symptoms, the stomach now rejected all fluids as soon as they were swallowed. Sinapisms were applied to the epigastrium and to the calves of the legs. On visiting him about eight in the evening, I found that the vomiting had continued constantly since the afternoon, and had not been in the least degree checked by creosote and some other remedies which had been given. He was now evidently dying. The whole surface of the body was perfectly cold; the pulse was not perceptible at the wrist, and scarcely so at the axilla; his breathing was laboured and very rapid, and his breath cold; he had constant hiccough, and vomiting of a dark greenish-coloured fluid; his countenance was sunk, and he had very much the appearance of a patient in the last stage

of cholera.

Being at a loss to account in any way for the presence of these symptoms, it occurred to me that, if it were possible to maintain his

strength for a time, he might still rally from the state of prostration in which he now was, and the only means by which it appeared to me that this object could be attained was transfusion. In this opinion Dr Graham Weir, who was with me, concurred; and, with his assistance, from ten to twelve ounces of blood were safely transferred from one of the porters of the hospital into the veins of my patient. The effects of the transfusion on the patient were immediate, though not strongly marked. He said immediately that he felt "warmer and stronger," and in a short time his pulse was felt at the wrist, regular, and about 126 in the minute. The vomiting became less urgent, but again returned towards morning, and continued till the following afternoon.

On the following day (the 5th), at the hour of visit, his extremities were still cold, and his pulse of the same frequency, and weak. He had passed a small quantity of urine by the wound voluntarily, and without difficulty.

On the 6th, his appearance was decidedly improved. His pulse was 100, regular, and much stronger. He had still, however, a good deal of hiccough, and his countenance had an increased look of anxiety.

In the evening his pulse had fallen to 88; his tongue was clean and moist; he had taken some nourishment with relish, and had passed a larger quantity of urine freely by the natural outlet. The healthy appearance of the wounds continued, and the perineum and prostate were free from swelling or induration.

His

On the following day (the 7th), I found him much worse. pulse was rapid and irregular; his tongue brown and dry; the surface of the skin over the whole body was of a bright scarlet hue; there was suppression of urine, with muttering delirium, and subsultus tendinum. He gradually sank, and died at 8 P.M. on the 7th (the eighth day from the performance of the operation, and three days after the transfusion).

A post-mortem examination of the body was made by Dr Gairdner on the following day.

The abdominal organs, including the kidneys and ureters, were healthy without exception.

The skin being reflected from the genital organs, the penis was divided about two inches from its orifice, the pubes sawn across on each side, and the whole urinary organs removed. The surface of each wound in the urethra had a gray sloughing appearance, which, however, was confined to the immediate neighbourhood of each wound, there being no suppuration or sloughing of the texture of the corpus spongiosum or bulb, or in the cellular tissue immediately surrounding these parts. The deep perineal fascia, and the textures around the levator ani, were free from any morbid appearance. The anterior incision of the urethra was from an inch and a quarter to an inch and a half in length-the posterior about half an inch. These

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incisions were found, on laying open the urethra, to correspond in length to the extent of the constricted portions of the urethra,-the anterior stricture being an inch and a quarter in length, and much narrower at one point at its anterior extremity than in the remaining part of the stricture-the posterior stricture occupying the situation of the bulb, and about half an inch in length. A considerable degree of induration still existed in the sub-mucous tissues around each divided stricture.

The portion of the urethra between the posterior stricture and the bladder was very much dilated; and the muscular fibres around the membranous portion of the urethra were strongly developed, giving this portion of the urethra somewhat of the fasciculated appearance presented by the inner surface of the bladder in this as well as other cases of old-standing stricture of the urethra. The prostate and tissues surrounding it were perfectly healthy. The plexus of veins between the levator ani and prostate were carefully examined, as well as the veins in the neighbourhood of the incisions in the urethra, but were not found to present any signs of inflammation. The bladder was contracted and empty. Its mucous coat was here and there slightly congested, and especially at one point at its fundus, apparently from its having been in contact at this part with the point of the catheter. The muscular coat of the bladder was strongly developed, being uniformly about half an inch in thickness. In the substance of the muscular wall, above the peritoneal reflexion, on the posterior surface of the bladder, and a little to the right side of the mesial line, an abscess existed, containing fully a drachm of healthy pus. The posterior wall of this abscess was formed by the peritoneal covering of the bladder. On examining the pelvic viscera before they had been removed from the body, some slender and soft bands of lymph were observed uniting the most prominent part of the wall of this purulent collection to the peritoneal covering of the rectum. Lymph was also exuded on a small spot of the mucous membrane of the bladder, as well as in the sub-mucous texture forming the anterior wall of the abscess. A similar, but still smaller, exudation of lymph existed on the mucous membrane, a little below the opening of the ureter.

On opening the chest, about a quart of purulent fluid was found in the cavity of the right pleura, both surfaces of which were coated, to the thickness of about quarter of an inch, with soft yellow lymph. The right lung was mostly flaccid and partially compressed, but presented several condensed nodules and points of congestion, which yielded a sero-purulent fluid on pressure. The largest of these condensed nodules was about an inch and a half in diameter, very deep purple externally, but presenting at its centre the grayish colour usually seen in the first stage of the secondary deposits, which take place as a consequence of purulent infection. On sections being made of the left lung, it showed a few small points congested and partially solidified, yielding on section a frothy purplish gray fluid.

I have been further informed by Dr Gairdner, that the blood in the ascending vena cava, when examined under the microscope, was found to contain structures similar in appearance to true pus corpuscles, and that a loose decolorised clot, found in the left auricle, and having an unusually granular opaque appearance, was found to contain similar corpuscles in large quantity. In both these situations, these bodies very much exceeded in numbers the ordinary proportions of white corpuscles in the blood.

On examining the wound at the bend of the arm, the edges appeared everted and slightly callous,-having, likewise, a grayish discoloured appearance. All the tissues around the immediate edges were perfectly healthy. The whole of the superficial veins throughout the arm were carefully examined, but neither their internal membrane, nor the blood within them, presented the slightest appearance of disease.

I need not apologise for having entered somewhat minutely into the details of this case, which I have considered it my duty to lay before the Society.

Its bearing upon the value of the operation proposed and advocated by Mr Syme, must be judged of by those who have watched its progress, and who have now heard its details. I can only say for myself, that it will not deter me from repeating the operation in similar cases.

It must be said of this, I think, as well as of all other operations, however trifling, that it is not free from dangerous consequences. It is well known that small operations, such as the removal of a finger or toe, the excision of small tumours, and incisions of all kinds, have repeatedly proved fatal, and this most commonly from the complication, which proved fatal in this case, the absorption of pus into the circulation.

The disease for which the operation is performed (confirmed stricture of the urethra), is one of a most distressing kind—one, which itself frequently proves fatal, and which, under the ordinary means of cure, is a tedious and frequently unsatisfactory subject of surgical treatment.

The operation, in the case I have related, has, it is impossible to deny, been directly productive of fatal consequences. It was performed at a time when the urinary irritation, produced by the disease, had been overcome by the partial dilatation of the urethra, and when the patient, as far as I could judge, was in a most favourable state for the performance of an operation. The operation was performed, and the after-treatment conducted, on the principles laid down by Mr Syme, and which have been followed, in his hands, with so much success.

With regard to the transfusion, I must state that, had I known that the symptoms which existed were the consequence of pyæmia, I should not have thought of adopting such a measure. I resorted

to transfusion when at a loss to assign any distinct cause for the state of extreme prostration which was present; and I think no one, who had seen the condition of the patient on the night of the 4th, could doubt that the effects of the transfusion were to prolong his life during the three following days.

ARTICLE III.-Case of Tumour in the Middle and Anterior Lobes of the Brain. By WILLIAM TRAILL, Esq., Surgeon, Arbroath. MR A. B., a farmer, aged 31, tall and robust, with an unusually small head, of active and temperate habits, but nervous and excitable, subject in boyhood to obstinate chronic ophthalmia, and since manhood to frequent attacks of dyspepsia, one of these terminating in jaundice,—in March 1846 had an attack of inflammation of the hepatic peritoneum, probably involving the duodenum, which yielded to general bleeding and other antiphlogistic measures, but left ever after a considerable degree of torpor of the bowels, requiring the habitual use of aperients.

On the 10th May of the same year, without any premonitory signs, he fell down insensible; on which I was sent for. When I arrived he had recovered, but was still torpid and confused, and had that peculiar expression of countenance which is commonly found after an attack of epilepsy; but I could not ascertain that there had been convulsions or foaming at the mouth, or the peculiar epileptic cry. A similar attack, I was informed next day, had occurred some hours after; but of this one I could not obtain any more particular account than of the first, his friends having been too much agitated to be capable of observing correctly.

In a few days he was able to be out and attend to his ordinary employment; and in the course of a few months he recovered his usual health and energy, except that ever after he was subject to frequent slight attacks of confusion or stupor, lasting only for a few minutes, and attended with the appearance of sparks of fire before the eyes. With this exception, and a torpid state of the bowels, he continued in good health, and took a great deal of active exercise, both on foot, and, after the spring of 1848, on horseback, and had no real fits of epilepsy till 26th May of that year, having been thus more than two years exempt from them.

On the day previous to that date he had been transacting some business at a distance from home, and, after staying over the night, left the place on horseback, with the intention of being in Arbroath by a certain hour. But on the journey his horse unfortunately lost a shoe, which accident mistimed and excited him a good deal, and induced him to ride very fast. When within four or five miles of Arbroath, he had taken a fit on horseback, and was found lying on the road, but not hurt. He afterwards mounted his horse, and rode into town,