ing of two membranous layers or coats, closely adhering together, the external surface being loosely united to the proper substance of the ovarium by soft cellular tissue, blood vessels and nerves.

When impregnation takes place, the coats of the Graafian vesicle and peritoneum covering it burst, the contents escape, and around it a corpus luteum is gradually formed. The author states that the observations of De Graaf, Haller and others, have proved that the corpus luteum is always formed in that ovarium from which the impregnated ovum has escaped; but it has not been positively determined by them whether the corpus luteum is produced by a thickening of the inner layer of the vesicle, as Professor Baer has supposed, or between the coats, as Dr. Montgomery believes, and if corpora lutea are not sometimes formed in the ovaria of women who have never been pregnant.

The author then proceeds to describe the appearances which he observed in the ovarium of a woman who died in St. George's Hospital, at the end of the second month of pregnancy, which have induced him to conclude that the corpus luteum is formed around both layers of the Graafian vesicle, and not between its coats, or by a thickening of the inner membrane. In the preparation of the ovarium the Graafian vesicle, like a small cyst, consisting of two distinct layers separated from one another, was clearly seen. A drawing of the recent corpus luteum, which had a deep orange colour, was likewise exhibited.

In two spécimens of Fallopian tube conception, which were placed upon the table, the Graafian vesicle was likewise seen surrounded by the corpus luteum. The same fact, the author adds, is still more evident in the ovarium of the gravid uterus of ten weeks, described and figured in the 17th volume of the Medico-Chirurgical Transactions.

In several of the preparations in the Hunterian Museum, at the College of Surgeons, which the author has recently examined, with Mr. Owen, he states that the Graafian vesicle is also seen enclosed within the corpus luteum, and forming its central cavity.

The author concludes this part of the paper by recommending additional observations to be made upon the subject, when opportunities, which are not very frequent, present themselves, in order that the correctness of the view which he has given of the structure of the corpus luteum may be rendered perfectly conclusive. All observations upon the subject, to be decisive, he remarks, should be made soon after impregnation and the date of conception, and all other circumstances should be clearly stated.

The author next proceeds to describe the changes which the corpus luteum undergoes in the latter months of pregnancy, and after delivery; and observes, that it is frequently almost wholly absorbed about the end of the third month subsequent to parturition. Various preparations were exhibited to illustrate these appearances.

In the ovaria of women who have never been pregnant, yellow, ovalshaped bodies, he observes, are frequently found, which it is difficult to distinguish from true corpora lutea resulting from impregnation. The greater number of these are produced by blood extravasated within the Graafian vesicles; and he thinks they can generally be distinguished from true corpora lutea by this circumstance, that in the latter the corpus luteum surrounds the Graafian vesicles, but in false corpora lutea the yellow substance is usually contained within the Graafian vesicle. A thickening of the coats of the Graafian vesicle, and the changes it undergoes during menstruation, the author also conceives, might readily be mistaken for true corpora lutea. Various preparations and drawings were also exhibited to illustrate these statements; and Dr. Lee closes the paper with the following remark, that from all the observations hitherto made on the corpus luteum, we may infer that it is never found but as a consequence of impregnation; that the yellow oval-shaped substances found in the ovaria of women who have not been pregnant, may be distinguished from true corpora lutea by the smallness of

their size and irregularity of their shape, the greater depth at which they are situate in the ovarium, the absence of the white membranous appearance of the centre, and by the fawn or yellow-coloured substance being enclosed within the cavity, and not formed around the exterior surface of the Graafian vesicle.

Jefferson Medical College.-Dr. Joseph Pancoast and Dr. Robert M. Huston have been respectively appointed to the chairs of Principles and Practice of Surgery, and of Materia Medica and Pharmacy in this institution.

NECROLOGY.

Dr. Thomas Davies.-We regret to observe the death of an old contemporary in practice-with whom we were on terms of intimacy in London— announced in one of the recent periodicals.' Dr. Davies, about twenty years ago, was threatened with phthisis, and went to reside in the south of France. After this, about fifteen years since, he established himself in practice in London, and was, at the time of his death, assistant physician to the London Hospital, and one of the physicians to an institution in the city for diseases of the lungs. Whilst in France, he attended to the then new doctrine of the physical signs of thoracic diseases, and became celebrated for his diagnosis in such affections. His lectures, on these subjects, have been published.

BOOKS RECEIVED.

From Professor Revere.-Report of the Evidence in the case of John Stephen Bartlett, M. D. versus the Mass. Medical Society, as given before a committee of the Legislature at the session of 1839. (Printed under the direction of the Chairman of the committee, by order of the House). 8vo. pp. 55. Boston, 1839.

From the same.-Annual Report of the Trustees of the New England Institution for the Education of the Blind to the Corporation. 8vo. pp. 28. Boston, 1839.

From Dr. J. R. Coxe, (Presented to him by Dr. Gregory, the Author).— Report of the Physician of the Smallpox and Vaccination Hospital, St. Pancras, presented to the Annual General Court of Governors, held at the hospital, on Friday, Feb. 1, 1839, 8vo. pp. 8. Lond. 1839.

Minutes of the Medical Society of Tennessee, at the tenth annual meeting, held in Nashville, May, 1839. 8vo. pp. 44. Columbia, 1839.

From the Author.-Boylston Prize Dissertations on 1. Inflammation of the Periosteum. 2. Enuresis Irritata. 3. Cutaneous Diseases. 4. Cancer of the Breast. Also, Remarks on Malaria. By Usher Parsons, M. D., late Professor of Anatomy and Surgery, Brown University, &c. &c. Svo. pp. 248. Boston, 1839.

1 Lond. Med. Gazette, June 8, p. 96.

ART. I.-CASES OF EPISIORAPHY' AND TENOTOMY.

BY PROFESSOR GEDDINGS, OF CHARLESTON, S. C.

[The following extract is from a letter to the editor by Professor Geddings. Professor G. has not given us permission to publish it, but he has not forbidden it, and we are satisfied he will pardon the liberty we have taken in placing it before our readers.]

A few days ago I performed an operation for prolapsus uteri, which presents some interest. A female slave, aged about 35, the mother of one child, had been affected with this distressing displacement of the uterus for upwards of fifteen years, to such a degree, that the organ protruded from the vulva in form of a large rough tumour, rendering her incapable of any kind of exertion. As the prolapsus could be reduced, though not retained, I resolved to perform the operation of episioraphy, recommended, and successfully practised, by Fricke, of Hamburgh,—the vagina, however, being very much relaxed, I deemed it advisable to so modify the operative procedure, as to combine with it the advantages of the plans proposed by Marshall Hall and Professor Dieffenbach. By making an incision, commencing on each side, two fingers' breadth below the upper commissure of the vulva, about a finger's breadth of each labium was removed, together with the fourchettethe two incisions being so conducted as to meet at an acute angle in perineo ; the mucous membrane of the vagina was also dissected away, on each side, to the extent of an inch and a half. After the hemorrhage, which was inconsiderable, had ceased, the two raw surfaces were brought in apposition by means of a quilled suture of five stitches. A catheter was left in the bladder, and suitable dressings were secured by means of a T bandage.

On the second day the catheter was removed, on account of the constant escape of the urine by its side. Since then, nothing but light dressings have been applied; but on the fourth day, union having taken place, the sutures were removed. The parts are now healing kindly, and I am pleased to say, that, thus far, my patient seems to have every prospect of being completely relieved of a most loathsome and distressing malady.

Like many of my contemporaries, I, too, have been dividing tendons. In one case, the semi-tendinosus was severed to overcome a contraction at the knee, by which the heel was drawn up to the buttock. The deformity was occasioned by an extensive cicatrix, reaching from the upper third of the thigh to the vicinity of the heel. This was dissected away, when on attempting to extend the limb, it was found necessary to divide the semitendinosus muscle. The member was kept in a permanent state of extension

1 From , the labium pudendi (modern), and 'pan, "suture."-Ed.

by means of a machine somewhat like the fracture apparatus of our friend, Dr. N. R. Smith, until the parts were healed. The limb is now perfectly straight. Another case was one of pes equinus, affecting both feet. The individual was a young lady, aged 14, and the deformity was congenital. The skin on the inner side of the tendo-achillis, in each leg, was punctured by a small knife, (but little larger than the common iris knife,) and the edge of the instrument being turned towards the tendon, it was easily divided. The severance was marked by a loud snap, and the recession of the two ends of the tendon. For the first ten days the only apparatus used was a shoe, having a buckle attached near the toe, from which a strap extended upwards, in front of the leg, to fasten to another strap fixed around the limb, above the knee. After this time, a modification of Stromeyer's apparatus was employed. The small punctures healed in a few days, and gave no trouble; but the patient residing one hundred and fifty miles from town, I have not been able to learn how far the operation was successful. The last intelligence I received was, that there was some contraction of the ham-string muscles, which the writer ascribed to rheumatism.

ART. II.-ON THE DISORDERS OF THE BRAIN, CONNECTED WITH DISEASED KIDNEYS.

BY THOMAS ADdison, m. d.'

The object of this communication is threefold:-First, To point out the general character and individual forms of cerebral disorder connected with interrupted function of the kidneys, from whatever cause such interrupted function may arise. Secondly, To show, that, in recent as well as in chronic disease of the kidney, the cerebral disorder is not unfrequently the most prominent, and occasionally the only obvious symptom present. And, Thirdly, To establish a means of diagnosis, in such obscure or unsuspected cases, upon the peculiar character of the cerebral affection.

That suppression of urine has the effect of inducing disorder of the brain, has long been familiar to the profession; and was recently illustrated, in a valuable communication made by Sir H. Halford to the Royal College of Physicians. It is also well known to surgeons, that mechanical obstruction to the discharge of urine, when long continued, is occasionally followed by a similar result; and Dr. Bright has not failed to demonstrate, that there exists, in many instances, a corresponding connection between disorder of the brain and the peculiar change of kidney he has so well described, and so fully illustrated, in his recently published works.

I am not, however, aware that any attempt has hitherto been made to specify with precision, and in detail, the several forms of cerebral disorder arising in connection with disease of the kidney; or that any one has sought to found, upon the character of these cerebral affections, a means of diagnosis available in cases in which, from the absence of the ordinary symptoms of nephritis, of every form of dropsical effusion, and of an albuminous state of the urine, the diseased condition of the kidneys is liable to be altogether overlooked. Experience and observation having led me to the belief that such obscure cases are by no means of very rare occurrence, and that, in the absence of other indications, the renal disease may occasionally be recognised with tolerable certainty by the character of the cerebral disorder alone. I venture to offer what follows as embracing an outline-although a very imperfect outline, I confess of the general character and individual forms of cerebral disorder arising in connection with interrupted function of the kidneys.

According to my experience, the general character of cerebral affections

Guy's Hospital Reports, No. viii. April, 1839, p. 1.

connected with renal disease is marked by a pale face, a quiet pulse, a contracted or undilated and obedient pupil, and the absence of paralysis:

this general character, however, being somewhat modified in certain cases, by circumstances attending the individual attack.

So far as I have yet been able to observe, the individual forms of cerebral disorder connected with renal disease are the five following:

1. A more or less sudden attack of quiet stupor; which may be temporary and repeated; or permanent, ending in death."

2. A sudden attack of a peculiar modification of coma and stertor; which may be temporary, or end in death.

3. A sudden attack of convulsions; which may be temporary, or terminate in death.

4. A combination of the two latter; consisting of a sudden attack of conia and stertor, accompanied by constant or intermitting convulsions.

5. A state of dulness of intellect, sluggishness of manner, and drowsiness, often preceded by giddiness, dimness of sight, and pain in the head; proceeding either to coma alone, or to coma accompanied by convulsions; the coma presenting the peculiar character already alluded to.

With respect to the first mentioned form of eerebral disorder connected with renal disease, that of quiet stupor, it is, in its most exquisite form, probably the least frequently met with; the face is pale, the pulse quiet, the pupil natural, or at least obedient to light; and although the patient may lie almost completely motionless, there is no paralysis; for, on attentively watching him for some time, he will be observed slightly to move all the extremities. By agitating him, and speaking loudly, he may sometimes be partially roused for a moment, but quickly relapses into stupor, as before; or it may not be possible to rouse him at all. There is little or no labour of respiration, no stertor, and no convulsions. Slight degrees of it occasionally precede and pass into the next or second form.

This second form of cerebral affection is that of a sudden attack of coma with stertor, or in other words, apoplexy: it is, nevertheless, different from ordinary apoplexy: it is the serous apoplexy of authors, and presents the usual general characters of cerebral affection depending upon renal disease; for the face, instead of being flushed, is, in almost every instance, remarkably pale; the pulse, though sometimes small, and more rarely full, is remarkably quiet, or almost natural; the pupil, also, although occasionally dilated or contracted, is often remarkably natural in size, and obedient to light; and there is no paralysis. When the labour of respiration is very great, the general character is apt to be modified by an accelerated pulse, and occasionally by a slight flush of the countenance. The coma is for the most part complete, so that the patient cannot be roused to intelligence for a single moment. The stertor is very peculiar, and in a great measure characteristic of this form of cerebral affection, connected with renal disease: it has not, by any means, in general, the deep, rough, guttural, or nasal sound of ordinary apoplexy: it is sometimes slightly of this kind; but much more commonly the stertor presents more of a hissing character, as if produced by the air, both in inspiration and in exspiration, striking against the hard palate or even against the lips of the patient, rather than against the velum and throat, as in ordinary apoplectic stertor: the act of respiration, too, is usually, from the first, much more hurried than is observed in the coma of ordinary apoplexy. The peculiar stertor coupled with the pale face has, in more instances than one, enabled me to pronounce with confidence the disease to be renal, without asking a single question, and in cases, too, in which no renal disease whatever had for a moment been suspected.

The third form of cerebral disorder connected with renal disease is that of a sudden attack of convulsions. In this case, also, the countenance is, for the most part, remarkably pale, although, occasionally, slightly flushed at intervals: the pupil is often but little affected: in slight attacks of the kind, the pulse is sometimes singularly quiet; but when the convulsions are