But the symptoms which most attracted attention were, the loud bronchial râles, especially the sibilous, and sonorous; pains, and a sense of stricture around and through the chest, and precordial region; severe fits of coughing, with little or no expectoration; weak, stridulous voice, and great dyspepsia, which, however, became more urgent in the afternoon. The state of the respiration might be readily accounted for, by the narrowing of the air-tubes from previous inflammation, or from the pressure of enlarged glands, or other tumor upon the windpipe, or on the nerves supplying the glottis; but I am not aware that we can depend with certainty upon any physical sign, as indicating the nature of the obstruction; as I have witnessed excessive dyspnoea, where no adequate cause of obstruction of either the circulation or respiration could be discovered post mortem. But it is very probable that the aneurism would have been detected, in the present instance, if there had appeared any inducement to employ auscultation on the chest and back of a patient who was in the last stage of existence. Sectio Cadaveris, 22 hours P.M., presented a healthy aspect of the anterior surface of the lungs, pericardium, &c. but on raising the bronchus to ascertain the cause of the dyspnoea and stridulous voice, a large tumour was discovered behind its bifurcation; which further dissection proved to be an aneurism of the thoracic aorta, occupying the posterior mediastinum, and extending from the second to the ninth dorsal vertebræ-some of which had been rendered carious by its pressure. The dilatation commenced at the posterior part of the aorta, just below the ductus arteriosus, and, as in the case previously alluded to, by a kind of neck, which, expanding to the breadth of eight inches, descended behind the artery, œsophagus, par vagum, and other contents of the mediastinal region, as far as the diaphragm. The coverings of the aneurism, which were farther strengthened by the reflexion of the pleura anteriorly, consisted of the external and middle coats; but the internal terminated by an ill-defined line near the neck of the pouch. The walls, especially of the superior and lateral portion of the cyst, were so thin as to be ruptured by the removal of the left lung; when a large quantity of grumous blood escaped, and concentric layers of nearly colourless fibrine were separated, exposing the interior surface of the sac; which was rough, but so soft as scarcely to be distinguished from the coagulated blood. Posteriorly, where the tumour was attached to the spine, its coats had entirely disappeared by absorption, and the vertebræ (which like the heads of some of the ribs, were partially absorbed) formed the posterior boundary: but the intervertebral substance had, as usual, resisted this destructive process. The circulation was preserved through a channel in the anterior part of the tumor. The lining of the artery, for some distance below the disease, was gathered into longitudinal folds, and the normal ela ticity of its tissues was diminished, although no earthy nor steatomatous deposition was detected. The heart was not diseased. The lungs were congested with frothy serum, and their texture was more friable than natural; they were not tuberculated, but the bronchial mucous membrane was evidently thickened and inflamed. The stomach and other abdominal viscera appeared to be comparatively healthy, and no further arterial disease could be detected in that cavity.

DAVID J. H. DICKSON.

P.S.-Since writing the above, I have returned from witnessing the denouement of a most extraordinary and puzzling case- which dissection proved to be a rupture of the duodenum; the coats of which were so extremely attenuated, that they had given way in four different places near its termination in the jejunum. The man, who had been disrated for fighting, had been seized with violent pain (which he attributed to flatulency) in the right hypochondriac region, on going to the head, at four o'clock in the morning, and which continued excruciating, notwithstanding copious depletion, and every means tried to relieve him-before and after his admission into the hospital, at 3 P.M.-and he died before midnight.

GLEANINGS DURING THREE YEARS SPENT IN THE INDIAN SEAS. By W. B. MARSHALL, R.N.

Medical Establishments of New South Wales and Van Dieman's Land. The territory of New South Wales, at the period of my visits there in 1833-4, contained 34,505 square miles, or 22,083,200 acres of ground; and was divided into nineteen counties.

New South Wales.-According to a census taken on the 2nd September, 1833, there were, scattered over a space of 34,505 square miles, 60,794 inhabitants; of whom 44,643 were males, and only 16,151 females; 5,256 of the former, and 4,931 of the latter being under twelve years of age; while 22,798 male persons were free, and 21,845 bond; and 13,453 free females, with only 2,698 bond— leaving little more than one marriageable woman to three men.

The proportion of the town and rural populations, was calculated to be as one to three, or nearly so.

The Colonial Medical Department consisted of 1st. An Inspector General of Hospitals. 2nd. Four Surgeons, who were located at Sydney, Parramatta, Liverpool and Newcastle. And nine District Assistant-Surgeons, one of whom was resident at each of the following stations-Sydney, Parramatta, Liverpool, Newcastle, Windsor, Port Macquarie, Bathurst, Moreton Bay, and Norfolk Island. At each of these stations there is a Colonial Hospital; those at Sydney, Parramatta, and Liverpool, which I inspected, were more than respectable institutions, while their management was admirable and their efficiency universally acknowledged. Of that at Norfolk Island I have already published an account in the Medico-Chirurgical Review, for January 1838.

There are also hospitals attached to the two excellent Asylums for Male and Female Orphans, the former near Liverpool, the latter a little way out of Parramatta. These are attended by the district surgeons of those places, who receive extra payment for the extra duty.

There is also an hospital in the female factory of Parramatta, with a ward for midwifery cases. And an asylum for lunatics, of which also a notice will be found in the last October number of this Review.

Nosological returns from all the districts are sent in to Sydney, monthly and quarterly.

The dietary of the patients is according to a prescribed scale, varied, however, at the pleasure of the medical officer.

The allowances of the medical officers are, what the allowances of our parochial medical officers ought to be, the same as officers of corresponding ranks in the army. The apparently increased expence of this just remuneration for professional labour, is, in reality, only an enlarged economy-the health of the population being maintained by it-and the restoration to health and usefulness of a single individual being rightly considered a benefit conferred upon the community, where the population is small and the territory large-not, as in this country, looked upon as of very doubtful advantage either to the party concerned or to the public, in consequence of the received dogmas of modern political

economy.

The following is an extract from a "Government Order," bearing date "Colonial Secretary's Office, Sydney, June 29, 1831;" and headed: "Assigned Servants." "The great expence to which the Government is subjected by the maintenance and treatment of the assigned servants of settlers, when sent into Colonial Hospitals, having been brought under its notice, and the attention of the Government having also been called to the expence to which his Majesty's Treasury has been subjected in keeping up an extensive constabulary, a great portion of whose time has been employed in conducting the servants of settlers from Sydney to their masters in the interior; and taking others back, who, from

misconduct, or, from other circumstances are returned to the Government, the following regulations have been laid down in these cases respectively, viz. :—

1. That the master shall pay at the rate of one shilling a day for the time his servant shall be in the hospital, to the extent of 30 days. Should the servant continue under treatment for any longer period, the master will not be required to make any further payment.

2. That the persons who send their servants into any of the hospitals, shall appoint an agent on the spot to take them away, as soon as they are recovered, and unless they be so taken away, they shall be considered as immediately assignable to other parties, in order to prevent the hospital from being improperly burthened with men who do not require treatment."

Van Dieman's Land extends from 42° to 45° south latitude, and from 145° to 148° east longitude. Its length is 210 miles, and its breadth 150, but the undulating surface of the whole island must materially increase the extent of both, taken superficially. The entire area contains 23,437 square miles. It was supposed, at the close of the year 1833, to embrace a population of 32,000 inhabitants.

For the convict portion of this population, there are, one Surgeon, who resides at Hobart Town, and has charge of the crowded colonial hospital in that place; six Assistant Surgeons; and eleven District Assistant Surgeons; thus making a medical corps equal in number to that of the larger and older colony of New South Wales, the population not being more than half the number of that in the latter. This numerous body being one of the many benefits flowing to the island from the philosophical and benevolent government of Colonel, now Sir George Arthur, to whose paternal anxiety for the welfare of every portion of the community, I am happy to bear testimony, from the personal knowledge I had of that truly good and great man, during my short sojourn in the island.

The 11th of his "Regulations," for prisoners of the crown, provides for the medical attendance of assigned servants in private service, on a plan, which, I should think, ensured efficient aid to every such individual throughout the colony, and ample remuneration to the medical attendant, at a cost altogether disproportioned, apparently, to the service and professional skill contracted for.

According to it, no free person can be received into any of the colonial hospitals, without an obligation being entered into by a respectable householder, making himself liable for the sum of 2s. per diem while the patient remains in the hospital, and for the expences of his funeral in case of death. The masters of assigned servants become liable for the sum of 1s. daily for one month.

The District Assistant Surgeons in the interior receive for attendance on each convict servant, five shillings per annum, payable whether sick or in health: and exclusive of medicines. Free persons in the towns, can only receive medicines gratuitously on the certificate of a clergyman or magistrate, of their inability to pay for them. And for convicts their masters must pay, as in the country, 5s. annually.

The expence to government of the entire Colonial Medical Department, including two large hospitals, was, by the above wise, humane, and just regula. tions, for a whole year, only £798.

I shall only remark upon those regulations, that, by them, a very necessary distinction is established between the medical skill and attendance rendered, and the medicines required to give effect to that skill and attention.

The contract of 5s. per annum on behalf of each assigned servant, sick or well, was for medical advice and assistance, Colonel Arthur rightly considering that still, they were obtained" at a very cheap rate." Medicines were to be paid for extra-except in the neighbourhood of the principal hospitals, in cases where the sick attended for relief as out-patients.

26. Cataract, &c. By JOHN STEVENSON. This work came too late for notice în Fourth Edition, improved. Highley, 1838. this number of the Journal.