may have committed some imprudences in regimen, and may have suffered from some irregularity of bowels. Constipation, or diarrhoea, or colic pains in the right iliac fossa, may have been remarked for some days or some months, and vomiting may have occurred in connexion with those symptoms. The premonitory symptoms, in short, are vague, and such symptoms occur upon many occasions without any abscess supervening.

Predisposing causes are various and vague. Youth would appear more prone to the disease than advanced or even than mature life; for of sixteen cases carefully collected, eleven were in individuals under thirty years of age. Males are more subject to the malady than females. Autumn and the end of Summer are the seasons in which it is most ripe. The Iwo latter circumstances probably are due to the greater excesses and more violent exertion of men than women. Such is not an unlikely explanation, though it does not occur to M. Dupuytren. That this explanation is consistent with the facts will appear when we state that persons in laborious and unhealthy occupations are those most frequently the subjects of the disease. House-painters, colour-grinders, copper-turners, are the artisans enumerated as especial sufferers by the lecturer. Those occupied with sedentary or with literary pursuits have been affected, after labouring under great derangement of the organs of digestion. Peasants or workmen leaving the country to reside in Paris have, in many instances, laboured under this complaint, a circumstance attributed by M. Dupuytren to the miserable fare of the Parisian ouvrier, especially in the fine season when employment is scarce.

The symptoms of the disease, when actually established, are not very equivocal. A fixed pain is felt in the iliac region, and circumscribed swelling is probably apparent. On tapping or on pressing the affected part, it is found more tense and resistant than natural, and a tumor may be distinguished, of various volume, of considerable hardness, and displaying more tenderness than any other part of the abdomen, and appearing as if it reposed upon the cæcum. The patient complains of constipation, of colic, and of inability to expel the intestinal flatus by the rectum. Sometimes there is fever; usually the general symptoms are slight.

If the case proceeds, as it usually does, to a favourable termination, the tumor slowly disappears; deep hardness remaining for a lengthened period to indicate the seat of the disease. Of sixteen cases collected and compared by M. Meinière, eleven terminated in this successful manner.

Less fortunate cases do, however, occur. Pulsating pain is experienced in the tumor, which increases in dimensions, becomes softer, fluctuates, and bursts. Happily the abscess opens in many instances into the intestine; when a pressing desire is felt to go to stool, and purulent evacuations from the bowels ensue, accompanied with a diminution of the volume of the tumor. Recovery in such cases is generally rapid. Sometimes the abscess bursts in the bladder as well as the intestine-sometimes it is discharged into the vagina-sometimes it opens on the surface of the body. This latter termination is almost always fatal, and chiefly, perhaps, upon this account:-that the bottom of the abscess is the most dependent part in the usual position on the back, and the matter is consequently prevented from obtaining a free and ready exit. The results are of course the formation and extension of

fresh purulent collections, the introduction of air, and confinement of putrid and noxious discharge.

A curious circumstance is noticed. Purulent matter passes from the abscess into the intestine, and fæces escape from the latter to the abscess. The constant pressure of the abdominal parietes is probably the most efficient agent in producing this exchange of contents.

Sometimes inflammation extends to the peritoneum, or cellular tissue seated behind it. This is a danger to be borne in mind, and calculated to inspire uneasiness and caution in cases which wear the most favourable aspect.

The Baron makes some remarks on the affections with which the present might perhaps be confounded. 1. Inflammatory swellings are sometimes developed in the right or the left iliac fossa, dependent upon inflammation of the iliac fascia. 2. It is not unfrequent after confinement to observe a swelling in the iliac fossa, originating in the round or the broad ligaments of the uterus, and extending to the neighbouring cellular tissue and the iliac fossa. Sometimes such abscesses are discharged into the womb; sometimes they burst into the vagina. 3. The iliac fosse may become the seat of collections of matter, arising from caries of the neighbouring bones or disease of the contiguous ligaments. This species of collection is soft and fluctuates as soon as it appears, a sufficiently distinctive feature. M. Dupuytren observes, in concluding his notice of these abscesses resembling the one we are considering, that he frequently has witnessed very gross mistakes in the diag nosis of the latter.

The prognosis is not in general unfavourable. Of sixteen patients affected with abscess in the right iliac fossa, one, and one only died. The supervention of peritonitis is usually fatal. The treatment is simple, obvious, and efficient. Local and general bleeding, fomentations, poultices, baths, lavements, and laxative drinks, are the artillery of M. Dupuytren. The name of calomel, that bug-bear of French physic, is not breathed, and the surgeon of the Hôtel Dieu does not hesitate to use the lancet, but dreads to prescribe the pill. In this country calomel with mild aperients would form an important item in the remedies.

For cases illustrative of the description and remarks we must refer to other papers of this Journal.*

Here we must bring this article to a conclusion. In our next we shall resume the review of the third, and enter upon that of the fourth volume of these lectures, and we trust we shall present in a concise, yet sufficiently ample, form, the substance of what is really a valuable work.

Several are contained in the Number previously alluded to-that for January, 1829.-Eds.

PATHOLOGICAL AND SURGICAL OBSERVATIONS ON THE DISEASES OE THE JOINTS. By B. C. Brodie, V.P.R.S. &c. &c. &c. Third Edition, with Alterations and Additions. Octavo, pp. 344.

London, 1834.

[Second and concluding article.]

In the last number of this Journal we brought down our analysis of Mr. Brodie's admirable work to the subject of caries of the spine, on which we did not actually enter. It remains for us to place before our readers a digest of the remaining portion of the volume, consisting of about one hundred pages. Mr. Brodie treats consecutively of caries of the spine-tumors and loose cartilages in the cavities of the joints-malignant diseases of the joints-some other diseases of the joints-and, of inflammation of the bursæ mucosa.

ON CARIES OF THE SPINE.

It is scarcely necessary to observe that Mr. Brodie commences his account of a disease, with an enumeration of the pathological changes of which it is made up. He remarks, with reference to the present subject, that opportunities of examining the morbid appearances in a very early stage of disease in the spine are of very rare occurrence, It is evident, however, when the structure of the joints between the bodies of the vertebræ is considered, that they cannot be liable to any diseases, that bear a resemblance to the affections of the synovial membrane which occur in other articulations. But analogy might lead us to expect, what Mr. Brodie's observations have proved to be really the fact, that as two important elements of all joints-cartilage and bone-are present in the spinal column, disease might commence in the one or in the other.

Mr. Brodie has found, in some instances, the intervertebral cartilages in a state of ulceration, while the bones were either in a perfectly healthy state, or merely affected with chronic inflammation, without having lost their natural texture and hardness; but in others it has been manifest that the original disease has been that peculiar scrofulous condition of the bones, the effects of which in the bones and joints of the extremities have been described at length in the chapter with which our notice was concluded in the last number.

Mr. Brodie relates six cases, displaying the morbid alterations, of which the sum gives the history of the disease. He then presents a summary recapitulation of the facts, to which we shall direct our attention first.

In some cases caries of the spine has its origin in that peculiar alteration of the bone, described by Mr. Brodie under the term of scrofulous disease of the joint. Ulceration, in these circumstances, may begin on any part of the surface, or even in the centre of the bone, but in general the first effects of it are perceptible where the intervertebral cartilage is connected with it, and in the intervertebral cartilage itself.

In other cases the vertebræ retain their natural texture and hardness, and the first indication of the disease is ulceration of one or more of the intervertebral cartilages, and of the surfaces of bone with which they are connected.

fresh purulent collections, the introd and noxious discharge.

A curious circumstance is noti scess into the intestine, and fa The constant pressure of the a ent agent in producing this exc

Sometimes inflammation e seated behind it. This is a inspire uneasiness and caut aspect.

The Baron makes some might perhaps be confou developed in the right o of the iliac fascia. 2. I swelling in the iliac for of the uterus, and exte fossa. Sometimes su they burst into the va lections of matter, a of the contiguous li as soon as it appe serves, in concludi considering, that he nosis of the latter. The prognosis ed with abscess pervention of per and efficient. lavements, and name of calome surgeon of the I prescribe the pi an important ite For cases il other papers of

Here we mi resume the rev these lectures ample, form, t

I

forming a preternatural projection posteriorly. Abscesses : in the groin.

ation of the body, there was found at the posterior part of the onfused mass of soft substance, which proved to be the parietes >s communicating with the orifices in the groin. The bodies of dorsal and three superior lumbar vertebræ were found at the part of the abscess, nearly consumed by caries. There were no of the intervertebral cartilages between the tenth and eleventh nor of those between the third and fourth lumbar vertebræ. These rtebral spaces were filled with pus, and the opposite surfaces of the ræ were carious, but only to a small extent. The central part of the rvertebral cartilage between the ninth and tenth dorsal vertebræ had en completely absorbed, and pus was found in its place. Externally to is, the concentric layers of elastic cartilage were entire, though somewhat altered from their natural appearance.

In the next case, (Case LXIII.) besides extensive caries of the dorsal vertebræ and ulceration of the inter-vertebral cartilages, the latter intervening between the third and fourth, fifth and sixth, seventh and eighth, tenth and eleventh dorsal vertebræ, and also that between the eleventh dorsal and first lumbar vertebræ were found in a perfectly natural state towards their circumference, but of a dark colour in the centre. On the surfaces towards the bones they, as well as the bones themselves, were in a state of incipient ulceration, but without any appearance of pus having been secreted. The bones of the vertebræ had everywhere their natural texture and hardness.

Case 3. (XLV.) A girl, aged 19, was admitted into St. George's Hospital, on the 30th May, 1821, with violent pain in the left leg, from the knee to the foot. Previously to her admission she had suffered from pain in the loins, which was relieved by cupping. Soon after her admission this symptom returned, accompanied with a tumor in the loins on the right side. Sixteen ounces of matter were discharged from this by puncture, hectic symptoms were established, and on the 3d of August she died.

On dissection, the bodies of the three or four inferior lumbar vertebræ were found preternaturally vascular, and of a dark, and almost black colour; but they retained their natural texture and hardness, and had undergone none of those changes which mark the existence of the scrofulous affection of the bones. The intervertebral cartilages were in a natural state; but the body of one of the vertebræ was superficially ulcerated for about the extent of a sixpence on one side, towards the posterior part. A large abscess communicated with this ulceration, and occupied the situation of the psoas muscle of the left side, extending downwards to the groin.

Case 4. (LXVI.) A man, aged 45, was admitted into the hospital with an abscess in the left groin. On being confined to the horizontal posture this disappeared, and then presented itself over the left os innominatum. Forty ounces of pus were discharged from this by puncture. The patient died exhausted by hectic.

On dissection, it was found that the cancellous structure of all the dorsal and lumbar vertebræ was of a dark red colour, and softer than natural, so