an inch, others an inch and a half; no trace of the lobules being discernable. The gall bladder was of a paler colcur than the other structures, full of glairy mucus, like ordinary mucilage, and its duct quite permeable.

The spleen did not appear to have undergone any change; perhaps it might be said to be darker than natural, but the pancreas was nearly double the natural size, presenting, however, no other appreciable change. The kidneys were more congested than natural, and the supra-renal capsules were also very much enlarged.

The urinary bladder was tense, and contained quite a quantity of dark coloured urine.

The heart and lungs appeared unchanged, with the exception of the colour with which they were also stained; the pericardium contained no fluid.

The brain was not examined.

A microscopical section of the olive-coloured substance presented the following appearances: quite a number of compressed cells were crowded together, which seemed loaded with fat and a quantity of oily matter; there was an absence of blood cells-the entire specimen seemed to be of a dark yellow colour.

On evaporating some of the urine preserved from the autopsy, I obtained quite a number of crystals of Tyrosine and Leucine, and a few crystals of Cystine. There were also a few circular bodies present with which I was unacquainted. In the case which I have just read, and which I have regarded as one of acute atrophy of the liver, there was much in the early history of the disease both to puzzle and render the diagnosis difficult. Occurring at so early an age, too, as in acute atrophy it is more generally confined to persons between the ages of seventeen and thirty-five. It is not mentioned at all as a disease of infancy, nor could I find any case recorded where it was the result of an injury, and it is generally fatal. While on the subject I should wish to draw attention to two cases, apparently very similar; one of which occurred in my own practice, and the other I watched while house surgeon at the Meath Hospital, Dublin. In the first instance the case of a woman six months pregnant, who at this period became partially jaundiced, which increased so much within a period of ten days that any one might be led from the colour to diagnose it as a case of malignant disease. There was continued vomiting, loss of appetite, irregular action, and partial dilatation of the pupils, and drowsiness. Cholamia might be said to be nearly complete when the woman was prematurely confiued of a dead child; recovery then took place, but not speedily.

The second case might be said to be a fac simile of the above, with one exception, that she died. I made the post-mortem and was struck then with the greenish-yellow patches on the liver. There was no name given to the disease, nor was there any microscopical examination made. She was seen at the time by Dr. Fleetwood Churchill.

We are all well acquainted with infantile jaundice (Icterus Neonatorum,) which we occasionally meet, and which is generally easy of management, indeed, requiring none at all, and is, as a rule, of short duration. Also with that form of transient jaundice which is occasionally met with during pregnancy, and which a few gentle aperients only are necessary to but neither of these cases have any real resemblance (unless the colour) to the examples I have just read.

recovery,

The following is a brief synopsis of the discussion which ensued: Dr. FRASER enquired whether the liver of the child was smaller than usual?

Dr. REDDY said it was smaller, and was dotted over very peculiarly. Dr. DAVID asked if Dr. Reddy considered the disease to have been the result of the fall, and whether the child was fat?

Dr. REDDY said the disease was certainly due to the accident, and that the child, although not fat, was a well nourished one.

Dr. GODFREY mentioned a case which occurred in his practice a few days previous, of jaundice from obstruction. A large gall stone was passed and the patient rapidly got well. He exhibited to the Society the gall stone which his patient had passed. It was discovered floating upon the surface of the evacuations,

Dr.FRASER remarked that the case just detailed by Dr. Reddy naturally brought up the interesting subject of the manner in which jaundice is produced and proves fatal. Not long ago it was taught by Dr. Budd and others that jaundice was produced in two ways: that is by suppression and retention of the secretion. But since it has been experimentally proved, that all the elements of bile, with the exception of cholesterine, are formed by the liver, the formation of jaundice by suppression is not now thought possible. Dr. Murchison recognized two forms of jaundice, one in which there was a mechanical impediment to the flow of bile into the duodenum, and the other in which no such impediment existed. His theory of the production of jaundice was as follows:-He believes that in health a portion of the bile is absorbed into the blood, and then transformed into products which are eliminated by the lungs and kidneys. But in certain morbid states and when there was an excess of bile, this normal metamorphosis does not take place, and the absorbed bile circulates with the blood and stains the skin and other tissues. Considering

The case

the large amount of bile (50 oz) poured daily into the duodenum as compared with what passes through the alimentary canal, there can be no question, that a large portion of it was in health absorbed into the circulation and eliminated from the system through other channels as pointed out by Murchison. When the amount was excessive, as might be the case from mechanical impediment or excessive secretion, its complete transformation into products fit for elimination by the lungs and kidneys does not take place, and hence jaundice. Jaundice produced in either of the ways referred to was characterized by the presence of the biliary acids and bile pigment in the urine. These elements are not met with in the urine of animals whose livers have been cut out by way of experiment, thus showing that they are not preformed in the blood. The only constituent of bile performed in the blood, according to Dr. Austin Flint, jun., who has largely experimented on this subject, is cholesterine. His experiments appear to show, that this was the only fatal element of bile; that when it accumulated in the blood, owing to failure of the secreting action of the liver, it acts, like urea, as a blood poison, which Dr. Flint characterizes as cholesteræmia. described by Dr. Reddy appears to have been due to an acute traumatic affection of the liver, characterized by the absorption of much of the bile formed and terminating in atrophy. No doubt the urine must have contained the biliary acids and pigment. Dr. Fraser also spoke of the late experiments of Dr. Bennett of Edinburgh, upon the chologogue action of mercury, saying that this high authority was now of opinion that this drug possesses no specific action upon the secretion of the liver. On the other hand Dr. Murchison believes that mercury produces bilious stools by irritating the upper part of the bowel and sweeping on the bile before there is time for its absorption. Dr. Fraser stated that while calomel was unquestionably useful in congestion of the liver he did not believe it acted, as was usually urged, by stimulating that organ to increased secretion, which might be expected to increase the congestion rather than diminish it. Besides the mode of its action pointed out by Dr. Murchison, he thought it quite possible that the irritation of the duodenum by calomel and other purgatives might be reflected on the gall bladder and cause it to contract and thus evacuate an increased quantity of bile. But whatever the mode of action of the so called chologogues might be, he was satisfied from personal observation, that in the human subject, they increase the amount of bile passed through the alimentary canal and diminish bilious stains on the skin and conjunctivæ,

Dr. HOWARD spoke of the late experiments of Dr. Bennett, of Edin

burgh, upon the cholcgogue action of mercury, saying that this high authority was now of opinion that this drug possesses no specific action upon the secretion of the liver.

Dr. G. W. CAMPBELL (President) would say that although such an observer as Dr. Bennett had declared this doctrine, still, it was an undoubted fact that small doses of mercurials, more especially in children, had a marked effect in those cases in which it is generally recognized that the liver is at fault, connected commonly with loaded tongue, acid-smelling breath, and constipated bowels, with greyish stools. After small doses of calomel or grey powder, they rapidly change to dark brown, or socalled bilious stools. The green colour of the evacuations also after the exhibition of mercury to children is generally looked upon as showing the presence of bile, but Bennett denies that this is the case. Whether or not these newly impressed views be correct, certain it is that we should be foolish to discard our calomel on that account, for many years' experience has proved to him its great value in these hepatic derange

ments.

Dr. GIRDWOOD said that some believed that purgative doses of a mereurial acted in relieving congestion of the liver simply by the purgation produced, and without any specific action on the organ itself.

Dr. CAMPBELL would object to this view being taken, as saline purgatives are not followed by nearly the same amount of benefit.

The President thanked Dr. Reddy for his interesting paper. Some general business was transacted after which the Society adjourned,

REVIEWS AND NOTICES OF BOOKS.

Lectures upon Diseases of the Rectum. Delivered at the Bellevue Hospital, Medical College, session 1869-70, by W. H. VAN BUREN, A.M., M.D., Professor of the Principles of Surgery. New York: D. Appleton & Co. Montreal: Dawson Brothers.

The class of diseases treated of in the eight lectures comprised in this volume, are among the most common as well as the most troublesome and painful which the surgeon will be called upon to treat. As a rule, however, they can nearly all be relieved, and the experience of a careful observer, drawn from an extensive practice, among such cases, must be of great value. A false delicacy, upon the part of both patient and surgeon often prevents a correct understanding of rectal diseases and entails upon the sufferer a vast additional amount of pain. A perusal of this little volume of about 194 pages, will do much to impress upon the surgeon the

vast importance of an early attention to this class of diseases. The style in which they are written is pleasing, and a very large amount of thoroughly practical information is given. We believe the experience of Dr. Van Buren has been very large, and we hope yet to see something more exhaustive from his pen upon this subject.

PERISCOPIC DEPARTMENT.

Surgery.

EXOPHTHALMIC GOITRE.

By J. J. CHISOLM, M.D., Professor of Operative Surgery and Clinical of Eye and Ear Surgery in the University of Maryland.

Whilst general attention is being drawn to a disease the pathology and causes of which are unknown, cases which differ from an assumed type should be carefully noted. When these become sufficiently numerous, their symptoms can be analyzed and useful deductions obtained. Exophthalmic goitre is one of these obscure diseases now under investigation, its curiously combined symptoms of heart disturbance, thyroid enlargement, and protrusion of the eyeball remaining, up to the present, unexplained. The disease is an insidious one, usually of slow approach, and of very chronic tendency,-the unsightly and annoying protrusion of the eye being a very persistent symptom.

The first prominent symptom-often the precursor of all the others, and said to be always present-is rapid and forcible cardiac action, with tumultuous palpitation from the least excitement. The frequency of the pulse is rarely below one hundred beats per minute; and the great nervous excitability of those affected, with the accompanying irritability of temper, nearly doubles the heart beats upon trivial provocation. Organic disease of the heart is found only exceptionally. In some cases there may be hypertrophy of the organ, with atheromatous deposit in the vessels, but most frequently the cardiac disturbance is purely functional, and the persons afflicted are young chlorotic women with irregular or suppressed menstruation. The implication of the heart is so very constant that it is called the invariable symptom, and to many observers is a sufficient explanation of the enlarged thyroid gland and the undue prominence of the eye,-being, in fact, the point of departure of all the accompanying symptoms, and the key to the phenomena.

The goitrous affection involves, ordinarily, the entire thyroid gland, but either lateral lobe may alone undergo enlargement: and, although