bottom of the larger, so as to come within the mouth of the lesser, and as this is exactly counterpoised by weights suspended from above, its elevation will indicate the quantity of air introduced reduced to the temperature of the water by its passage through it, and sustaining only the pressure of the surrounding atmosphere. In principle the Spirometer exactly resembles a gasometer, the form however is somewhat modified, and the dimensions are vastly reduced in the former.

In using the instrument, the person whose vital capacity is to be ascertained should be in a standing posture, and after inspiring as deeply as possible, should make as long-continued an expiration as he can through the tube, which is furnished with a proper mouth-piece. This process is to be gone through three times consecutively, the instrument being intermediately adjusted, and the greatest of the three results should be recorded as the correct one. The repetition of the trial is necessary in order to exclude the errors which may easily affect the conclusion from a single one. The posture is important, at least it appears from what has gone before, that if a person can only use the instrument while sitting or lying, allowance must be made for that circumstance. The deficiency of vital capacity being ascertained; the inference that disease exists somewhere seems established with a painful certainty. The lungs we conceive will be found in fault in the vast majority of instances; and as there is no one of their diseases which is apt to have so long a period of latency, and afterwards to be so obscure, and doubtful in its progress as phthisis often is, it is especially upon this disease that the Spirometer is calculated to throw light. Subsequent experience, in two or three cases, mentioned in the paper, verified the melancholy anticipations of the author, where consumption had not previously been suspected. Farther experience of the reliance to be placed upon this method of examination will, in all probability, constitute the Spirometer a valuable instrument in the hands of medical men. Our best ground of hope of combatting phthisis successfully is found in our being enabled to recognize it at its commencement with certainty, so that we may attack it early and act against it with earnestness. Now the Spirometer promises to give us this advantage, and we shall watch its future use in diagnosis with much interest, and hopefulness.

No one can read Mr. Hutchinson's Essay without at once perceiving that he has not spared time, study, labour, or expence in his endeavour to give completeness to his researches upon the subject of respiration. He has multiplied experiments to so large an extent as to defy distrust in the general accuracy of his conclusions. He has incidentally, and collaterally to his main object, established many curious and interesting facts in connexion with the powers and mechanism by which the process of breathing is carried on; the influences and derangements to which it is liable. He has made one direct application of the laws which he has discovered to the uses of practical medicine, at the same time that he has improved our knowledge of the mechanical conditions of respiration as a whole. Whether we consider the importance of the function which he has investigated, the probable advantages arising from his discovery, or the manner in which his researches have been carried on, we think him well entitled to the best thanks of his professioual brethren.

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XV. HYDATID CYST, EITHER ORIGINATING IN, OR PRESSING UPON, THE PROSTATE GLAND. By George Lowdell, late House Surgeon to the Sussex County Hospital.

In this case, retention of urine and death were produced by a large hydatid cyst, which pressed upon the prostate and displaced the urethra. There is an appendix to the paper containing the particulars of another fatal case of retention of urine, occasioned by a cyst containing hydatids developed in the pelvis, communicated to the Society by Mr. Curling. In both instances there were hydatids in other parts of the body. The rarity of hydatid cysts in the pelvis, and their serious effects, render these cases well deserving of record.

XVI. CASES OF VARICOCELE TREATED BY PRESSURE, WITH OBSERVATIONS. By T. B. Curling, Lecturer on Surgery, and Assistant-Surgeon at the London Hospital.

Mr. Curling states that, "three years ago, a case of varicocele, cured by the application of pressure to the spermatic veins, came under my notice, and being struck with the peculiar adaptation of this plan of treatment, to counteract the injurious effects of the dilated veins, I determined to give it a trial. In a work on the Diseases of the Testis, which appeared a few weeks afterwards," he stated the object of this method of treatment to be "the maintenance, whilst the patient is in the upright position, of such a degree of pressure on the spermatic veins as may be sufficient to relieve them from the superincumbent weight of the blood, without at the same time endangering the integrity of the testis, by obstructing the spermatic artery, and without causing so much uneasiness as to render the remedy as painful as, or more difficult to be borne than, the disease. This pressure must be continued a sufficient time, to enable the coats of the vessels to return to their natural dimensions, and to acquire strength to carry on the circulation. When this is effected, the patient is cured." He also remarked, "I look forward with no slight interest to the result of further trials of a remedy, which seems to me to be based on sound views of the pathology of the disease," and that this "plan appears to be particularly applicable to cases of varicocele in young persons, whose reparative powers would be sufficient to restore the veins, when relieved of pressure, to a healthy state." Since these observations were written, Mr. Curling informs us that he has treated many cases of varicocele by pressure; and, as a sufficient period has elapsed to enable him to form a just opinion of the value of this plan of treatment, and of its advantages over other methods, he here submits the results of his experience in the management of this complaint to the consideration of the Fellows of the Society. Mr. Curling gives the particulars of three cases, in which firm, steady, and continued pressure on the spermatic veins at the external abdominal ring succeeded in curing the disease. They seem satisfactory examples of permanent benefit derived from the treatment pursued. Mr. Curling observes that, to these cases of cure by pressure, he could add two other cases, if necessary, to establish the value and utility of this plan of

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treatment, besides the case mentioned in his work on the Diseases of the Testis, and another case of a gentleman, aged 27, who was affected with a rapidly increasing varicocele, for which he had worn a truss two months with benefit, when he quitted this country for Canada. He returned to England at the expiration of three years with the varicocele quite cured. He had left off the truss after wearing it fifteen months.

Mr. Curling states

"In the above cases, the dilatation of the veins had taken place at a comparatively early period of life, was not excessive, nor in two of them of long duration, but was productive of more or less inconvenience and uneasiness, which could be only partially, or scarcely at all, remedied by the suspender; they were precisely the cases in which it was presumed that pressure, by relieving the veins of the superincumbent weight of the blood, would enable their coats to recover their proper size and tone.

"The same method of treatment has been applied to several other cases of varicocele, of a like character to the above, in some of which, after the patients had derived so much benefit from it, that hope was entertained of a permanent cure being effected, they ceased to remain under my observation; and in others, though the treatment had been hitherto satisfactory, the painful symptoms having been entirely relieved, a sufficient period had not elapsed to enable me to judge of the ultimate result. In two of these cases, the relief afforded by the truss to the distressing symptoms occasionally attendant on the disease, was so immediate and so great, that I am led to give them in detail." P. 263.

We regret that the space we have already devoted to our notice of this volume does not admit of our quoting these two interesting cases. We can only observe that they show, in a forcible manner, the great benefit that may be derived from the application of pressure in painful cases of this disease. Our author remarks

"Patients afflicted with varicocele in early life, often labour under a degree of mental distress very much out of proportion to the actual disease. These hypochondriacal symptoms are partly owing to the dyspepsia so commonly coexisting with this complaint, and partly to an apprehension, by no means unfounded, of the disease impairing the nutrition of one of those organs which exercise a marked influence on the characters of the sex. By appropriate general treatment and encouraging advice, combined with local treatment, the painful feelings alluded to may generally be removed. In other instances, the uneasiness in the testis and spermatic cord, and even in the loins, is so great as to produce much real suffering, and to prevent the person affected from making any kind of exertion. In Case 4, which was an instance of this kind, the patient was prepared to submit to an operation, had I recommended one, but the benefit derived from the truss was sufficient to render so severe an alternative unnecessary. In this case, the distention of the veins was so slight, that I think the relief obtained may be in some measure due to the pressure made on the spermatic nerves." P. 265.

Mr. Curling believes that but little attention is paid to constitutional treatment in varicocele," which is commonly regarded as exclusively a local disease. In the class of cases in which the benefit derived from pressure is most apparent, the subjects of the disease are persons between 18 and 30 years of age, of weak frame and constitution, and subject to dyspepsia, and whose venous system and circulation are feeble, as is evinced by the large size of the superficial veins, particularly in the lower extremities,

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paleness of the countenance, and cold hands and feet. In these cases, the operation of local remedies may be aided materially by general treatment, such as the exhibition of steel and quinine, a nutritious diet, sea-bathing, and similar measures, calculated to improve the tone of the system.' Mr. Curling notices the liability of the complaint to return unless the causes producing it are avoided, and for this reason he advises the use of the truss for some time after all symptoms of the affection are removed. He adverts to another class of cases in which the application of pressure is capable of giving considerable relief though not of curing the disease. They are cases occurring at a somewhat advanced period of life, with which most practitioners are familiar. In these cases the application of pressure "not only removes the slight uneasiness which exists when the veins are pendent, but also counteracts the tendency to further dilatation, though the enlargement is too great to admit of the vessels being reduced to their former size." Our author adds

"From these observations it will appear that I consider the treatment by pressure to be applicable either for the cure or relief of the majority of cases of varicocele occurring in practice. Certainly in all those cases in which tolerably firm pressure, with the fingers, at the abdominal ring, removes the sense of weight and uneasiness along the cord, this plan may be tried with every prospect of a beneficial result; and its simplicity, freedom from all risk, and efficiency, in my opinion, render it superior to every other mode of treatment that has hithero been resorted to." P. 267.

In all the cases of varicocele which Mr. Curling has treated by pressure, he has employed the moc-main lever truss, which seems better adapted to make the necessary pressure on the spermatic veins at the external abdominal ring than any other instrument that he knows of. It is not liable to shift, and, what is very important, the degree of pressure can easily be regulated by the patient. He has used it with success in cases where the

patient has tried other trusses without obtaining relief.

"The truss should be applied so as to make rather firm pressure: it often happens that, though worn with comfort after being adjusted in the morning, towards the after part of the day it begins to produce uneasiness. When this is the case, the pressure may be diminished. In general, the truss need be worn only during the day, though in some instances I have thought it advisable to recommend its use during the night also. Thus in one case the patient suffered uneasiness in lying on the side affected, and was able to pass a better night on wearing the truss. When the scrotum is unusually pendulous, or when the veins are very long, and form a plexus of any size, I advise the addition of the silk net suspender, which may be readily adjusted to the truss." P. 268.

There are few practitioners who have not been frequently disappointed with the methods of treatment ordinarily resorted to in cases of varicocele. In early life, support often fails in giving relief and preventing the progress of the disease and wasting of the testicle; and operations on the veins cannot be performed without risk to the patient. If, therefore, pressure on the veins be capable of affording all the benefit represented in this paper, the practice must be regarded as a valuable improvement in surgery. At first sight it appears opposed to the received notions of the indications to be fulfilled in the treatment of varicocele, but the modus operandi has been satisfactorily explained by Mr. Curling, and our preconceived theories must yield to the fruits of experience.

XVII. ON A PARTICULAR DERANGEMENT OF THE STRUCTURE OF THE SPLEEN. By J. B. S. Jackson, M.D., Boston, U.S.A. Communicated (with some Remarks and Comments) by Thomas Hodgkin, M.D.

In this paper, Dr. Hodgkin calls attention to a partial, well-defined alteration in the texture of the spleen, described by him in the 17th volume of the Transactions, which he was induced to attribute to the extravasation of blood caused by local injury, but which Rokitanski regards as one of the effects of endocarditis, and as produced by the poisoned condition of the blood. He there gives the substance of some communications from Dr. Jackson of Boston, containing his observations on this derangement. As neither Dr. Hodgkin nor Dr. Jackson seem to have arrived at any satisfactory conclusion on the subject, we shall not dwell further on this paper, and we think that one containing views as yet crude and imperfect might have been omitted without impairing the value of the Transactions.

XVIII. ON A LUMINOUS APPEARANCE OF THE HUMAN EYE, AND ITS APPLICATION TO THE DETECTION OF DISEASE OF THE RETINA AND PosTERIOR PART OF THE EYE. By William Cumming, late House-Surgeon to the London Hospital.

Mr. Cumming, after giving some extracts from the works of Beer and Tyrrel, pointing out the cases in which reflection from the posterior part of the human eye has been observed, states that he has not found or heard of any author who has described a reflection from the posterior part of the perfectly-formed and healthy eye of the human subject. The object of this paper is to shew "that the healthy human eye is equally, or nearly equally, luminous as the eye of the cat, dog, &c., when observed under favourable circumstances, and the application of the abnormal appearance, or want of, this luminosity, to the detection of changes in the retina and posterior part of the eye.'

Mr. Cumming states that the reflection may be seen in the following

manner :

"Let the person whose eye is to be examined be placed at the distance of ten or twelve feet from a gas or other bright light; the rays of light must fall directly on his face; all rays passing laterally of his head must be intercepted by a screen, placed half way between the light and the eye examined. If the reflection be bright, it will be at once seen from any spot between the light and the

screen.

"The following observations were made in two rooms; in one of which was a gas-light, the other completely darkened. The person whose eye was to be viewed was placed in the dark room, five feet from a half-closed door opening into this room; he directly faced the light, also at the distance of four or five feet from the door.

"The appearance of the reflection was in most cases extremely brilliant when seen from a position between the door and light. In some it was at once ob vious with the door wide open; in others it was seen with great difficulty, and not till every ray of light passing to the side of the iris was carefully intercepted by the door on one side and the hand or a book on the other. The reflection