necessarily with sloughing, filled up; broken bones are reunited, and necrosed bones replaced; the diffusion of pus restrained; tubercular cavities occasionally walled; the fatal effects of intestinal mortification and sloughing averted; aneurismal arteries obliterated; great surgical operations rendered admissible, and the stumps of amputated limbs speedily healed! On the well-known but absurd aversion of French surgery to the last, our author has the following merited criticism:

"Much good has also resulted in respect to the treatment of incised wounds, whether produced by accident, by the removal of a tumor, or the amputation of a limb. In all these instances it is customary, in every part of the civilized world, with the exception, perhaps, of France, to endeaver, if possible, to bring about union by the first intention; the surgeon well knowing that if this can be effected he will save himself much trouble, and the patient no little suffering and inconvenience. When we reflect upon this subject, it is extremely difficult to account for the great apathy and silly hesitancy which the Parisian practitioners exhibit, with regard to this plan of treatment, about the propriety of which there ought to be but one opinion. In this respect they certainly are fifty years behind the present state of the science, a circumstance which is so much the more surprising, when it is recollected that they have decidedly the best schools of pathology in the world."

But good and evil are associated, and while lymphization brings us so much of the former, it imposes not a little of the latter. The adhesive and plastic character of lymph, and its long continued contraction or shrinking up, are the sources of these difficulties. Thus, after an extensive loss of skin by sloughing from fire, the new textures often produce deformity, and sometimes an inconvenience which no surgical operation can obviate; again in inflammations of the cheek, adhesions and indurations compress the jaws against each other; from the same cause, the eye-lid becomes agglutinated to the ball; the larynx fatally obstructed with false membrane; the urethra nearly closed up; the intestines combined into a

great bundle; the lungs and pleura cemented to each other; and the solid viscera compressed till they fall into atrophy.

What then can be of deeper interest to the physician and surgeon, than the study of lymphization! How important to know the means of promoting it when necessary, and of averting it when and where it would be mischievous!

Our author next treats of suppuration. He adopts and enforces the sound doctrine that the formation of pus in whatever part of the body occurring, is the result of inflammatory action, either acute or chronic, simple or specific. Some of the large and cold abscesses are the offspring of very chronic inflammation-others no doubt are but collections of pus secreted in an inflamed part, absorbed and subsequently deposited in another. Pus may be formed without any solution of continuity. This happens especially in the lungs and their investing membranes. Purulent expectoration without ulceration is not very uncommon, and empyema is a collection of pus in the cavity of the pleura, not, we presume, the consequence of ulceration. We have met with two cases in which the quantity was so great, as to indicate secretion from an extensive surface, and the recovery after paracentisis so rapid and perfect, as almost to demonstrate, that the pleura could not have been the seat of ulcerative absorption, or the subserous tissue the bed of an abscess.

"Pus, when first effused, generally appears in the form of distinct globules, which are dispersed through the affected structure, and can be easily recognized by their pale yellowish color. As the purulent particles increase in number, they gradually become confluent by the absorption of the part concerned, and in this way the matter is at length collected into an abscess."

The account here given varies somewhat from the reports of several other observers. Autenrieth affirms, that if some of the watery moisture, which exudes from the surface of an

inflamed part after the pus has been removed, is collected between two transparent thin plates of tale and allowed to lie in the wound, globules are seen to form gradually in it, to enlarge and become opaqe, while if the fluid is removed altogether from the atmosphere of the living textures, no such change takes place in it. Brugman, also, states that if a supurating surface has been washed clean, the pus is seen to be secreted as a clean fluid, which afterwards become thick and opaque.-Muller Elem. Phys. 469.

The experiments of Gendrin have shown, that pus is formed out of all the elements of the blood. He has seen that fluid when extravasated gradually transformed into pus. To this end, however, it must be lodged in the midst of an inflamed tissue.

An attentive study of the characters of pus is essential to the surgeon. These characters will sometimes indicate to him the tissue affected, and very commonly the state of the secreting surface-sometimes even that of the constitution.

Pus is very often imbued with a specific quality-syphilitic, variolous, gonorrhœal, &c., which does not seem to modify its sensible properties. It would be interesting to ascertain, whether the pus which might be secreted under an accidental solution of continuity, in the vicinity of a chancre, or in the midst of variolous pustules would possess a specific character.

But we must turn aside, and bring this extended, perhaps tedious review to a close. There remain many other subjects to be discussed, which we shall make the topics of other articles. Having completed the division of general pathological anatomy, we shall from time to time indulge ourselves in the presentation of some of the leading facts touching the morbid anatomy of particular organs, connecting them with pathological speculations, and occasional therapeutic remarks.

The high estimate we place on Professor Gross' work may be inferred from the copious presentation we have made of a part of its contents in this article, not less than the intimation we have just given in regard to what remains. If we are not greatly mistaken, its publication will give to the study of pathological anatomy in the United States, and especially in the west and south, where the author is extensively and advantageously known, a decided impulse. The work bears intrinsic evidence of varied and patient research; and while the author has availed himself of nearly all the standard works of Europe, he has not neglected to bring forward the rich results of his own experience. For some time called upon by a large proportion of his brethren in the city where he lives, to make post mortem inspections for them, we know his opportunities to have been greatly multiplied; and have often had occasion to mark his accuracy and minuteness. For our surgeons and physicians, we regard his work as decidedly superior to that of Andral. That distinguished pathologist, it is well known, reserved his practical remarks for his Clinique Medicale, scarcely ever met with in this country; but Professor Gross has sought to connect his with the different pathological appearances which it has been his duty to describe. Moreover, he has given us the morbid anatomy produced by our own diseases; and an unusually large proportion of his cases have been in private instead of hospital practice, all of which is calculated to give his facts a special application to western practice.

D.

THE WESTERN JOURNAL.

No. VIII.

LOUISVILLE, AUGUST 1, 1840.

DR. BALLARD'S CASE OF EXTIRPATED UTERUS.

We published in the June number of this Journal a brief notice of a remarkable case of forcible removal of the uterus by a midwife, which fell under the observation and treatment of Dr. Ballard, then of Westport, Kentucky, now of Indiana. Our notice has elicited from the Dr. a more circumstantial and authentic account of the case, which we take pleasure in laying before our readers, believing that it will be highly gratifying to them, as it was to us. The promptitude and vigour with which the inflammatory symptoms were met, and the rescue of the unfortunate sufferer from death after so serious a lesion, reflect great credit upon the skill of Dr. Ballard.

H. M.

Sır-I have just perused, in the June number of the Western Journal of Medicine and Surgery, a notice of a case of forcible removal of the uterus and its appendages after the expulsion of the fœtus, which occurred in Oldham county, Kentucky, communicated