severe pain and straining. Since that period he had never been free from pain about the bladder, and in passing water; and the consciousness of the foolish cause of his suffering, of which he was no doubt himself the author, made him shy and uncommunicative in regard to it. He confessed also that he had been in the habit of self abuse, both before the accident detailed above, and also to a much greater degree since; in fact, of late years he seems to have been unable to keep his hands away from his genital organs.

After admission into the Hospital, he was found to have a calculus of considerable size in his bladder, which was readily felt by the sound, and he presented all the usual symptoms of the disease. His bladder was in a very good condition. His general health was good, with the exception of a very slight cough, and slight flatness under the left clavicle. Pulse regular, and appetite good.

On consultation, it was determined to give him the chance of the removal of his calculus; and accordingly on the 6th August, he was operated upon by Dr. Van Buren, by the lateral method, with the knife. There was no difficulty in withdrawing the calculus, although its dimension exceeded the average size of urinary calculi.

A section was made of the stone whilst still wet, by M. Luer, and in its centre was found the slate-pencil passed into the bladder five years before, thus proving the patient's statement. The adjoining woodcut will give an idea of its dimensions. Its weight (Apoth.) is 3 oz. 5 dr. 11 grs.; length, 23 in.; breadth, 2; thickness, 14.

The bladder was syringed out with tepid water; a bandage passed around the patient's leg; and by the time he was well recovered from the influence of the ether, which was employed during the operation, he was removed to his bed, and an anodyne administered. No perceptible shock was caused by the operation.

The patient did perfectly well until the eighth day after the operation, when he had an attack of pneumonia in the left lung. This limited itself on the eleventh day, and he did well again for a week; but he continued to have unpleasant symptoms, recurring from time to time on the left side of the chest, which rendered his recovery exceedingly slow; and, at the end of a month, urine was still passing through the wound, although the latter had contracted down to a mere fistulous tract. He was now also annoyed by a bed-sore over the sacrum, which rendered it necessary to place him upon a water-bed.

Unfortunately, during the fifth week, the patient was attacked by diarrhoea, which soon rendered his situation exceedingly critical. From this time he continued to run down, in spite of our efforts, and finally died on the 16th September.

On examination of the body, the wound through which the stone had been extracted was with difficulty traversed by a slender probe, the bladder and contents of the pelvis being all healthy. The left lung was very much compressed by a very large collection of pus which had accumulated in the middle or posterior mediastinum; there was also a limited abscess in the pleura of the left side. Right side of chest healthy.

The case just detailed is not the only one which I have encountered in which a urinary calculus has been formed upon a foreign body introduced into the bladder from without. In one of the present series of cases it will be recollected that the broken end of a catheter became encrusted with urinary salts so as to form a calculus, which was subsequently removed by the lithotrite (Med. Times, Vol. II., No. 8, May, 1853).

About six years ago, I operated upon an aged man, in Bellevue Hospital, by lithotomy, for the extraction of a calculus of large size, which was found to have been formed upon a nucleus which, from its unusual and grotesque character, I suspect to be an unique specimen in the history of urinary calculi. The case was made public at the time in the proceedings of the N. Y. Pathological Society, published in the N. Y. Journal of Medicine; but in consequence of its rare and curious character, I subjoin a wood engraving of the nucleus in the present connec

tion.

It is a head of wheaten straw, complete in its proportions, and faithfully represented by the artist, with fragments of the urinary salts (triple phosphates) still encrusted upon it. The calculus, which was of a very friable consistence, was crushed by the forceps whilst it was being withdrawn from the bladder, and the nucleus alone is represented in the engraving. Its extremity was evidently folded upon itself; and, thus bent, it is more than two inches in length. From the partial confessions of the patient, I surmise that this strange substance found its way into his bladder in the following manner: he was a pauper, in the habit of sleeping upon a straw bed, and a very old man. As is not unfrequently the habit of old men of this class, he was in the habit of provoking what remained of his capacity for sexual excitement by such odd means as his fancy suggested; and, with this object no doubt, he one night drew out a straw from his bed-sack, and introduced the end to which the stalk had been attached into his urethra. The beard and husks upon the straw gave him pain in attempting to withdraw it, and he probably dropped asleep without removing it. The motions of his body during sleep forced the straw onwards into the urethra beyond his reach; and ultimately, in consequence of the arrangement of its husks and barbs, it reached his bladder, where, of course, it soon became encrusted with the salts of the urine.

121 BLEECKER ST., March 20th, 1854.

DR. BULKLEY :

NEW YORK, March 20, 1854.

DEAR SIR, AS on a recent occasion, when I related the following case, you expressed the opinion that there were points of interest in it which should not be lost, I have hastily drawn up an outline report of the same, which is at your disposal.

For the description of the postmortem appearances, I am indebted to the kindness of Dr. Lidell, who conducted the examination for me.

Case of Hemiplegia, without apoplectic symptoms, five days after Parturition, terminating fatally in sixteen days, with extensive extravasation of blood in the left cerebrum.

Mrs. T- —, aged 37 years, of highly nervous temperament, pregnant for the third time, after having suffered somewhat severely for some days from symptoms of hepatic and gastric derangement, was on the 15th of January, prematurely delivered of a small child, after a natural and unusually easy labor. From this time the symptoms of restlessness, slight fever, nausea, and torpor of the bowels from which she had suffered, became day by day less troublesome, till on the 20th she was so far recovered as to express herself as feeling much better, and had some desire for food. On the afternoon of the same day, she said she feared, from her sensations, that she was about being attacked with palsy; and almost immediately afterwards it was found that she was unable to speak; I saw her in fifteen or twenty minutes after, and found her pale, cool, the pulse frequent and feeble, perfectly hemiplegic on the right side, unable to turn her head or move her position, entirely conscious, and manifesting great mental distress at her situation. There was not any distortion of the features; she was able to protrude the tongue without lateral deviation. In a few hours the system re-acted; the skin became natural in temperature, the pulse less frequent and increased in volume, and deglutition, before difficult, comparatively easy.

For eleven days the changes in the condition of the patient were not material, but apparently for the better. She was more comfortable, passed some good nights, and was able to rotate the head, showed some signs of sensation in the paralyzed side, and took her nourishment with more relish. An extensive miliary eruption now occurred, with free perspiration, and other evidence of debility; the deglutition began to be more

difficult, and the respiration more frequent and less full. These symptoms continued to increase till the power of swallowing was entirely lost, and the respiration became rapid and imperfectly performed, and on the 5th of February, sixteen days from the occurrence of the palsy, she died, exhausted.

From the invasion of the disease up to a few moments previous to death, the intellect appeared unimpaired; she signified her wants, showed by expressions of her face likes or dislikes, and responded by signs to questions when asked.

AUTOPSY, thirty hours after death. Cadaver pale and emaciated. Head. Skull thick; dura mater normal; on removing dura mater, so as to bring the convexity of the cerebrum into view, the surface of the right hemisphere presented a pale, jelly-like appearance from extravasation of limpid serum beneath the visceral arachnoid; the surface of the left cerebral hemisphere presented the same pale, jelly-like appearance, except a space about four inches in length, by nearly two inches in breadth (average), which had a reddish-brown color, as if blood were effused beneath the visceral arachnoid; this dark-colored space commenced at the external and upper extremity of the fissure of Silvius, and extended upward, backward and inward, over the surface of the left cerebral hemisphere, so as to terminate at the longitudinal fissure, about an inch behind the vertex. On slicing down the cerebrum, the middle lobe of the left hemisphere was found to be the seat of a firm, dark-colored clot of blood, of an irregularly rounded form, and of great size-so great, indeed, as to extend from the roof (corpus callosum) of the left lateral ventricle upwards to the convex surface of the hemisphere, and to lie in contact with the arachnoid, thus producing a great part of the superficial discoloration already mentioned. This clot exceeded a large goose-egg in size, and had an uniform color and consistence. No other clot was discovered, after careful search. The ventricles were either entirely empty, or contained only a small quantity of pale serum. The substance of the whole brain was somewhat firmer than natural. The little vessels traversing the interior of the organ were also somewhat dilated, which was evidenced by their open mouths on the cut surface of the slices.

Thorax. The right lung was highly edematous; its posterior third also had a dark-brown color, and was pretty firm in feel, presenting considerable resemblance to hepatization. On incision, fine bubbles of air could still be expressed, so that this partial solidification seemed to be