general. A course of lectures represents the prevailing practice of the day. But we want also the practice of the individual. Eminent physician rises after eminent physician, runs a beneficial course, and dies without leaving a memorial of his habitual methods of practice, except in the decaying recollections of his cotemporaries. We may justly lay claim to a very improved state of pathology in the present age. But how gladly

should we receive information, if such could be given us, how a David Pitcairne, a Warren, or a Baillie, treated certain combinations of symptoms, and with what event. The agents suggested to the medical mind by a survey of disease from different sides, and on different hypotheses, will have interesting differences, which such records of practice alone could adequately elicit, independently of the absolute value of the practice recorded.

In the enumeration of benefits that may result from published cases, we must not leave out one, implying indeed very little merit in the publisher, but of considerable value to one class of perusers. Every student must have been aware of the value of a hospital casebook. The publication of such a record of pathology and practice would be of great value, and not the least so in presenting to him ordinary cases. For the cases usually recorded in print are so recorded, because they are remarkable, and therefore of unfrequent occurrence. So far, then, as this source of information is concerned, his daily wants-such wants as every one must have felt at the commencement of practice-are left unsupplied.

The following publication may contribute something to the supply of these wants, since cases of ordinary occurrence plainly fall within its scope. I may add, that with the most ordinary cases he may really gratify an appetite for novelty, if he rightly appreciate the fact, that in nature no two cases are alike.

CASES OF PERITONITIS, &c.

Ann Chesworth, aged eight years, a thin pale girl, with anxious eye, and distressed look, was admitted into the Infirmary of St. Marylebone, the 24th September, 1842, having been ill two days. She was constantly crying and fretting, but made no definite complaint. There was a quick small pulse, a hot head, restlessness, some distension of the abdomen, and some tenderness, not easily recognised indeed, because she complained wherever she was touched. I saw her on the 25th; she had been much relieved the day before by leeches applied to the temples. Hydrarg. Chlorid. gr. iij. had been given her every sixth hour. She was passing by the bowels green shreddy fæces, and had been doing so before the calomel was given. Vomiting, which had before existed, is relieved.

26th. Continues free from sickness; fretfulness abated; fæces continue green.

Sumat Hydrarg. Chlorid. gr. j.; Hyd. c. Cretâ, gr. ij. bis quotidie.

Oct. 1st. Other symptoms remaining the same, I observed that the respiration was quickened, and was

informed that she had coughed during the night. Examining the thorax, I found extensive small crepitus, and deficient vesicular penetration in both lungs, principally the right; conceiving this to be intercurrent pneumonia, I applied a large blister interscapulas, and continued the mercurials. But for the quickened respiration, her general appearance was that of simple fever. Without delirium, there was constant fretfulness, and an aspect expressive of distress. The mercurial treatment was continued, with similar but less copious motions; no effect on the gums. She died on the 4th of October, somewhat suddenly.

AUTOPSY.-Pia mater congested; brain normal, except that it was firmer and drier than usual.

Extensive engorgement of both lungs; first stage of pneumonia. Heart normal.

The external coat of the peritoneum, the muscles being dissected from it, was red, and covered with apparent granulations secreting pus. Much pus in the cavity of the abdomen. The peritoneal coat of the intestines was normal, except that slight and very delicate membranes partially connected some of the convolutions. Other organs healthy.

The extent to which inflammation of thoracic and abdominal viscera had proceeded in this case, compared with the symptoms furnished during life, is remarkable. The mental, and some of the physical symptoms, resemble those of another case, which I will relate.

Eliza Guyon, aged 11, was admitted into my female

ward at the Infirmary, Oct. 29, 1842. She had been previously in the surgeon's wards for strumous ophthalmia. She was then taken with the ordinary symptoms of fever, and transferred to the medical side. She made no complaint of pain, nor did she seem to suffer any; lay straight in bed on her side or back, and, except some heat of skin and the inflammatory state of her eyes, exhibited no physical symptoms. I understood that she had been perverse in the surgeon's ward, and of this she manifested proofs in the highest degree, refusing to give any information, or to do any thing that she was desired to do, except eating and drinking. She repeatedly beat a little girl, who for a short time. had been placed in the same bed with her; when not scolding was apparently inattentive and sulky. After a few days, the heat of the skin increased, and her mouth became much encroutée, as in fever, For the last four days of her life her visage had also the character of severe febrile illness, but her fulness of person did not diminish. The bowels were regular, motions loose. Throughout this illness she took Hydrarg. Chlorid. gr. ij. 6tis., which was disguised in her food.

AUTOPSY.-The brain and thoracic viscera healthy; some congestion posteriorly of the lungs, probably cadaveric.

On opening the abdomen, though only twentyeight hours after death, we noticed putrefaction of the peritoneum, both intestinal and abdominal. The pelvis contained six ounces of pus. False membrane covered a portion of the intestines. There was an ulcer in the

ileum, near the cæcum, of the size of a halfpenny, perforating both internal coats; another in the colon, of the size of a sixpence.

Now on making inquiry at the school of the workhouse respecting this girl, I found that, although rather dull and stupid, she was considered peculiarly goodtempered. In her, therefore, the peevishness and illtemper, so strongly expressed during illness, were undoubtedly indicant of disease. The question is not yet sufficiently explained, what precise changes of moral character and intellect belong to different states and forms of physical disease. A new supply of diagnostic symptoms might probably be obtained from this

source.

In both the above cases the insidious march of peritonitis is worthy of notice. The following case illustrates an equally insidious coming on of peritonitis under other circumstances, and has an important bearing on the subject of paracentesis.

John Strutt, aged 41, admitted into the Infirmary, May 26, formerly a man of intemperate habits, had laboured under ascites for three weeks. Tall, thin, dark, apparently he has been of a good constitution. There is evident fluctuation in the abdomen, oedema of legs and thighs. He lies straight. Pulse strong, 80; occasional sputa, mucous, somewhat reddened; urine very deep coloured, clear on being heated, acid, not albuminous with heat; sound on percussion clearest under right clavicle; breathing generally vesicular, but with a loud snore, very rough and muco-crepitous under left