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favourable results; and this, out of the many peculiarities of iinfancy, shows, as it seems to us, that special notice should be ’,taken of the surgery applicable to children. Mr. Hilton veryjustly observed, in the clinical remarks which he made on thiscase, that fluid in the perinseum may prevent the passage ofthe catheter, and that it is sometimes necessary to removethat fluid by punctures before the instrument can reach thebladder. He further mentioned how difficult it was, withchildren, to discover the causes of such obstructions: in thepresent case, for instance, was the retention caused by a blow,a calculus in the bladder, or phimosis ? The latter is a probablecause, and it will generally act by pressure and ulceration. Asregards calculus, this cause can hardly be entirely rejected,though it may be asked, what had become of the stone if sucha foreign body had caused the obstruction Had it escapedunnoticed when the abscess was opened had it returned intothe bladder? or is it still encased in some of the soft parts in thescrotum ? From this case it will likewise be seen, that withchildren, contrary to what is the practice with adults, the in-strument need not be left in the bladder, for it was found suffi-cient to draw off the water occasionally, and no renewed ex-travasation took place. ____

CHARING-CROSS HOSPITAL.

Lithotomy in a very young Boy.(Under the care of MR. AVERY.)

We have often expressed the opinion, that the cause of thefrequent formation of calculus in the children of the labour-ing classes would be a very interesting subject of inquiry forthe pathologist. No doubt locality, food, and diathesis havea great deal to do with this pathological fact, and it would ap-pear that diathesis is sometimes so strongly marked, that achild may be born either with a strong propensity to renalconcretion, or with a calculus in the bladder.The little patient upon whom Mr. Avery lately operated,

affords an excellent illustration of congenital stone in thebladder. The boy is now only two years and a few months old;he had calculous symptoms from birth, and when first seen byMr. Avery suffered very much from them.The child belongs to agriculturists, living in Wiltshire ; the

mother has had several other children, none of whom wereaffected with any congenital malformation or disease; theyare all tolerably strong and healthy, and the parents, whoenjoy the advantage of a country life, and labour in the openair, are of a good constitution, and exempt from any gouty orlithic diathesis. No particular circumstances accompaniedthe child’s birth, but soon after it, and whilst he was beingsuckled, the mother’s attention was drawn to the colour ofhis urine, which she noticed to be darker than she hadknown it to be with her other children. She was soon struck,likewise, with a peculiar way the child had of putting his handon the hypogastrium, when only a few months old, as if anxiousto relieve pain in that region. The urine, in the meantime,became darker, and soon assumed the appearance of blood,which circumstance naturally very much alarmed the mother.When the child was about one year old, symptoms of a

Still more serious kind occurred; the mother stated thatthe abdomen became suddenly tympanitic, and the scrotum"as black," as she forcibly expressed it, as your hat." Nourine was expelled whilst these symptoms were present; butthe child, to whose aid a medical man had been called, wasrelieved by emollient applications, &c. It may be surmisedthat the irritation caused by the presence of the calculusmust have been great when these congestive phenomena ap-peared, and it is probable that the stone had accidentally beenso placed as to obstruct for a time the flow of the urine.The child was sounded at various times in the country, the

surgeons in attendance were in doubt about the case, and thelittle patient was sent to Mr. Avery, in order that the ques-tion might be solved.On admission, Mr. Avery found the child in tolerable good

health, but its sufferings were very great whenever micturi-tion took place, which function was performed very often.The child, as is generally the case in this affection, was everpulling the prepuce, the mother stating that lie was, while athome, in the constant habit of doing so, and that it grievedher to see him suffer so much every time he evacuated thebladder. Mr. Avery having passed a small sound, ascertainedthe presence of the calculus; the striking of the instrumentagainst the stone gave the impression that the latter wasvery small; and Mr. Avery bearing in mind the advantages oflithotomy over lithotrity in the case of children resolved toperform the first of these operations. .

On the 17th of June, the child was brought into the theatre,and having been rendered insensible by a piece of lint,sprinkled with chloroform, being lightly held over the face,Mr. Avery made the usual incisions, and cautiously extractedfrom the bladder a round stone about the size of a horse-bean.On examining it at first, it appeared strange that the symp-toms should have been so distressing at the very onset ofthe affection, when the stone, as it fairly may be snpposed, wasconsiderably smaller. Still foreign bodies, however small,will cause disturbance according to the susceptibility of theorgan where they happen to be placed, and the age of thepatient.The child lost very little blood, and was removed, while still

under the influence of chloroform. The progress of the littlepatient was extremely favourable; three days after the opera-tion, the urine passed almost entirely per urethram; but in afew days it again flowed almost wholly through the wound,with considerable pain and irritation about the part. Thischange was, however, of short duration; and six days afterthe extraction of the stone, the urine again passed throughthe urethra, and gradually was entirely evacuated by thenatural passage, the wound being quite cicatrised. On thenineteenth day the part was perfectly closed, and the boy leftthe hospital quite restored, about five weeks after admission.The stone was examined by Mr. John Quekett, and foundcomposed of a necleus of oxalate lime, invested by a layer ofphosphates.

This case affords some confirmation to the opinion thatchildren may be visited by any disease in utero, as it wouldappear that in this instance the patient was affected withstone, either in the kidney or bladder, before he saw the light.Such cases likewise show the necessity of giving proper atten-tion to apparently trifling symptoms in children: frequencyof micturition, occasional pain in evacuating the bladder, thehabitual pressure of the hand on the hypogastrium, shouldnot be overlooked, especially in boys, and suspicions be ex-excited, that these symptoms may be owing to a congenitally-formed calculus. It may likewise be observed that if theearly symptoms had suggested the employment of an instru-ment, and a slight dilatation of the urethra at an earlyperiod, it is more than probable that the calculus, in its thensmall state, would have been evacuated.

WESTMINSTER HOSPITAL.

Excision of a Portion of the Os Calcis.(Under the care of MR. HOLT.)

AFFECTIONS of bone are not only very tedious, both in pro-gress and treatment, but they very often undermine the pa-tient’s health, to such an extent, that amputation, when alimb is concerned, is imperatively called for; and though ex-foliation and the casting off of sequestra are processes whichbeautifully exemplify the wonderful resources of nature, it isoften the duty of the surgeon to step in, and endeavour tosave the sufferer from the exhaustion which may follow theefforts at repair. Surgical interference, in such cases, must,of course, vary according to the indications to be fulfilled; butamong the most effective means which may be employed, theexcision of portions of diseased bone holds a prominent place.We have already had the pleasure of recording several

cases, under the care of hospital surgeons, where this practicewas successfully carried out; the next in the series we noticedamong Mr. Holt’s patients, and we proceed to give an outlineof the case, aided by the notes which Mr. Moore, the dresser,has kindly put at our disposal.The patient is a youth of eighteen, of a scrofulous constitu-

tion, who was admitted under Mr. Holt’s care, in Februarylast. It would appear that the patient had suffered muchfrom rheumatism, which had successively attacked all thejoints of the body, but it had latterly been more particularlyconfined to the left ankle. Inflammation had subsequentlyattacked the os calcis, and given rise to the usual train of phenomena which attend diseased bone - viz., abscess andfistulse.On the boy’s admission, the cellular membrane around the

above-named joint was considerably thickened and infiltrated,so much so, that the articulation had entirely lost its usual ap-pearance ; fistulous openings were observed a little below eachmalleolus, a third was situated a little more anteriorly on theexternal side, and a fourth, of considerable size, was seen overthe tuberosity of the os calcis, where the integument hadformerly sloughed. The probe, being passed along thesevarious tracts, came in contact with diseased bone, but, as itappeared that the joint was not implicated, and that its mo-

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tions were impeded principally by the cedematous state ofthe soft parts, Mr. Holt was induced to believe that theosseous affection was confined to the os calcis. This diagnosiswas, however, not fully relied on, as it was rather difficult toexamine the parts accurately, owing to the considerable swel-ling of the posterior part of the foot, and, as the patient’shealth was, besides, in a very weak state, Mr. Holt preferreddelaying any active interference until some improvement inthe general condition of the boy had taken place. He wastherefore put upon good diet, the limb placed in the situationbest calculated to favour the return of the venous blood, andthe part kept warm and moist by bread poultice.These measures were attended with considerable benefit;

in about two months, both the appearance of the foot, and thegeneral health, had materially improved. A consultation wasnow held, and it was decided, the disease being ascertainedto be principally seated in the os calcis, that that bone shouldbe cut down upon, and either wholly or partially removed.The patient was put under the influence of chloroform, and

the bone brought into view by a T incision, and a little dis-section. The soft parts were still considerably thickened, but,the flaps being dissected back, Mr. Holt removed, with thebone forceps and gouge, as much of the calcaneum as hadsuffered caries. The wound was kept open by a piece of lint,as it was expected that some portions of bone might still comeaway when suppuration was fairly established.The further progress of the case was very satisfactory; the

limb was kept at rest; the patient had a nutritious diet; hisbowels were duly regulated, and in about two months afterthe operation, he was so well that he began to use his foot.The wound had been allowed to cicatrize, as, contrary to pre-vision, no more necrosed bone was thrown off. The boy wasdischarged, with the advice not to bear his weight upon thefoot yet, but to use a crutch for a little time. The influenceof the open air will no doubt still more invigorate his health;and it is extremely likely that the patient will eventually beenabled to walk tolerably well with the affected foot, as thethick tissues about the heel will gain more and more in hard-ness, and eventually supply the place of the portion of the os-calcis which has been removed.

It will, of course, strike every surgeon that in excisionof bones the ultimate result will be obtained in a compa-ratively short time, when only a small wound is made, and aninconsiderable portion of bone removed; but that cicatrizationand consolidation will be the longer in being established as thewound has been larger, and a greater amount of bone takenaway. The chances of success are likewise greatest when theablation of bone, as in Mr. Holt’s case, does not interfere with ajoint; for when only a part of the bone is taken off, granula-tions will spring up on the divided osseous surface, and therewill be an active tendency to the reproduction of the removedportion of bone, which may be so vigorous as almost to restoreit to its original size. It must, however, be confessed, thatone of the causes of the tardiness of cure in operations of theabove kind, is the fact, that most of those who require it(traumatic cases excepted) are of a strumous habit, and theirtissues slow in the work of repair.

EPIDEMIOLOGICAL SOCIETY.A PUBLIC meeting was held at the Hanover-square Rooms onTuesday evening last, for the establishment of this Society,the formation of which has been in progress for the last sixmonths, under the management of Mr. Tucker, (with whom itoriginated,) together with other zealous promoters of theScheme.

Lord Ashley occupied the chair, vacating it in an advancedstage of the proceedings, after which it was occupied by Dr.Babington, the president-elect of the Society. The meetingwas most respectably and numerously attended, nearly 200gentlemen being present, among whom we observed many ofthe most distinguished members of the profession. The in-terest excited in the objects of the Society appeared to beunusually great, and the meeting would doubtless have beenmuch larger, but that there happened to be a dinner of theApothecaries’ Society the same evening. The speeches deli-vered on the occasion were eloquent and appropriate, andwere listened to with mute and undivided attention on thepart of the audience. The whole of the proceedings wereconducted with the utmost propriety, and a spirit of harmonyand cordiality prevailed, not less gratifying to the promotersof the Society than honourable to the profession. The meet-ing was, in fact, an appeal from the profession to the publicfor help and encouragement in ejecting a mighty effort for

F the public weal. The necessity for further investigation intothe nature of epidemic visitations, together with the imper-fection of our present knowledge of the subject, was candidly

> admitted by the professional speakers, and even forced upon- the attention of the laity, who, on their part, received the

appeal with sympathy, and responded to it in a most gratefultone of encouragement and generosity.The CHAIRMAN opened the business of the meeting in an

> eloquent oration, which he commenced by alluding to theappalling fact, that upwards of 12,000 persons died annually

l in the metropolis of epidemic diseases, and that they appearedto be depending upon causes always more or less in operation,

; and probably, to a great extent, preventible, provided theconditions of their prevalence were better understood and

; more carefully anticipated. The object of this institution wasl to remove this opprobrium, an object which commends itselfL to all minds in all nations; for it was not a mere question of

theory or taste, but the discovery of truth, and the applicationof that truth to the great benefit of mankind. He regarded

. it, not only in its medical, but also in its moral and social, bearing. Epidemics and their existing causes, bad drainage,, deficient, supplies of water and ventilation, and the over-

crowding of habitations, tended to produce widows, orphans,, pauperism, licentiousness, and intemperance. His lordship! alluded to the tendency of the day to the aggregation of large

masses of the people to carry out the application of the! advancing science of the times to useful arts and commerce,

thus, in the present state of things, augmenting the influence’ of epidemic diseases. One object of the Society would be, to. inquire how this aggregation of masses might be rendered in-nocuous. His lordship concluded by urging the Society toproceed in a right spirit, not for the sake of eulogy, but

! desiring, with one heart and mind, to effect a true and lastingbenefit upon mankind. [We are sorry our limits will not

; allow a more detailed report of this interesting speech.]The following resolutions were then proposed, and carried

’ unanimously-viz.,1. That a Society be forthwith established for the investi-

gation of epidemic diseases, to be called the" EpidemiologicalSociety," and that all gentlemen interested in its objects shallbe eligible as members.

2. That the Society shall be governed by a president, vice-president, council, and other officers.

3. That Dr. Babington be requested to accept the office ofPresident of the Society.

4. That the following gentlemen be requested to act as vice-presidents-viz., Thomas Addison, M.D.; Richard Bright,M.D., F.R.S.; Sir B. C. Brodie, Bart., F.R.S.; Sir W. Burnett;Knt., K.C.H., F.R.S.; Sir C. M. Clarke, Bart., M.D., F.R.S.;Rev. Thomas Dale, M.A., Canon-Res. of St. Paul’s; R. D.Grainger, Esq., F.R.S.; Sir Charles Hastings, M.D., Worcester;J. Haviland, M.D., Regius-Professor of Physic, Cambridge;Sir James M’Grigor, Bart., K.C.T.S.; John Nussey, Esq.;John Propert, Esq.; G. L. Roupell, M.D., F.R.S.; ThomasSouthwood Smith, M.D.; Colonel Sykes, F.R.S.; ThomasWatson, M.D.

5. That the following gentlemen do constitute the council-viz., Jacob Bell, Esq.;’James Bird, M.D.; Golding Bird, M.D.,F.R.S.; A. Bryson, M.D., R.N.; G. Busk, Esq., F.R.S.; W. B.Carpenter, M.D., F.R.S.; R. Greenhalgh, Esq.; W. W. Gull,M.D.; E. Headland, Esq.; A. Helsham, M.D.; T. Hunt, Esq.;W. Jenner, M.D.; R. Gordon Latham, M.D., F.R.S.; H. B.Leeson, M.D., F.R.S.; J. 0. M’William, M.D., F.R.S.; J.Marson, Esq.; E. Parkes, M.D.; W. Percivall, Esq.; E. C.Seaton, M.D.; F. Sibson, M.D., F.R.S.; E. Sieveking, M.D.;J. Simon, Esq., F.R.S.; J. Snow, M.D.; C. R. Walsh, Esq.The following are some of the more interesting points al.

luded to by the several speakers.Dr. BABINGTON wished to correct an error which had ap-

peared in a portion of the periodical press, to the effect thathe was the founder of the Society. He must disclaim thishonour. The merit of originating the Society was exclusivelydue to Mr. Tucker. He (Dr. Babington) had only, in commonwith others, cheerfully given a helping hand, when solicited todo so by Mr. Tucker, and he felt it incumbent upon him thuspublicly to state the fact. The subject was not new; from thetime of Hippocrates to the present, epidemics had engaged muchof medical attention. They were rife in the middle ages, butstill more so of late. There were, however, new circumstancesconnected with them. The physical sciences had made greatadvances of late. Animal chemistry, human and comparativephysiology, meteorology, and microscopic anatomy, might beconsidered as new sciences, all bearing an application to thetheory of epidemic diseases. And it must be impossible forone man, or for a number of men, separately engaged, to work