the pavement. The blow was on the temple and quite severe because of the suddenness of his fall, as the wagon wheel plunged into a deep hole, which in the evening he did not notice. He did not lose consciousness, but had violent pain in the head. On examination I found some swelling of the lids, but no apparent injury of the eye-ball. The ophthalmoscope showed the media of the eye clear, and the retina and optic nerve healthy, except slight haziness and redness. The patient persistently declared that he was totally blind in that eye. This being the first case of the kind coming under my observation, I advised him to go to the New York Eye Infirmary for treatment. About a week afterwards he made his appearance at the above mentioned institution, and was examined by Dr. Noyes. He says in a report of the case, "I examined the patient, and for the most part could confirm the statement of Dr. Bacon. The optic nerve was not in a perfectly normal state, but showed some capillary hyperæmia, and haziness of substance, but the large vessels were natural." Careful examination as to the truth of the patient's statements concerning his blindness were made by prisms, etc., but his answers were always consistent. He also complained of trouble in the opposite, the left ear. On inspection a small laceration was found in the membrana tympani. The patient was treated in the Infirmary for about two weeks, when there occurred some loss of sight in the other eye. The cause was found to be neuritis. Shortly after he left the institution, and I have not seen him since. There was no improvement at all in the eye injured, and before leaving the Infirmary atrophy of the optic nerve had commenced. The second case was that of a German gentleman of fifty-three years of age, with the following history: On the first of June while going down stairs with his arms full of spindles he fell, injuring his head and left leg; the fall caused loss of consciousness for a short time, and then followed vomiting. On becoming quiet he complained that he couldn't see anything, not even light. A few days after the accident I saw the gentleman with Drs. Mayer and Chamberlain, and found him in bed in a dark room with his eyes closed, but perfectly rational and able to answer questions. On examination the right eye showed slight ptosis, but moved readily in all directions. He could at this time see a light with this eye everywhere except on the nasal side, and movements of the hand at two feet. The pupil was dilated by atropine previous to my visit. The patient at that time stated that half an hour before he could not see light with that eye. With the ophthalmoscope the media of the eye was found to be clear. The fundus showed the retina and papillæ very slightly hazy, blood vessels normal. Left eye showed marked ptosis, movements of the eye normal; vision nothing, slight perception of light in the tempero superior, and inferior quadrants. No light could be seen on the nasal side. The pupil was dilated with atropine. With the ophthalmoscope, media clear, fundus hazy, especially about the papille, vessels about

normal. There were no extravasations of blood in either eye. Improvement in vision went on from the time I saw him until after several weeks he recovered good sight, which he retains to-day. He describes the return of vision as being like looking through the meshes of a net, at first very fine, then growing larger and larger, and finally they entirely disappeared. After the return of vision I examined the eyes and found them healthy in appearance. These cases are interesting for two reasons, namely, on account of their infrequency, and secondly, as to the causes of sudden blindness with no particular lesion of the eye. Stelwag says, in speaking of this class of cases: "Unfortunately only a small portion of these cases have been sufficiently examined, and it is quite probable that very different kinds of affections are classed together, that correspond in the chief symptom, which is the sudden or very rapid diminution or complete destruction of the sensitiveness to light." We come now to the consideration of the cause of blindness in the two cases reported, both having nearly the same history and the same appearance opthalmoscopically, but in the last reported, recovery, while the first remained blind. Of course the diagnosis is somewhat hypothetical, and must be made rather by exclusion, than by the appearance of the eyes. The fact of finding no hemorrhages in the eye or on the retina, throws out the supposition of a ruptured blood vessel, while the almost healthy look of the nerve militates against the supposition of any extravasation into the nerve sheath, for in this case there would have been swelling of the papillæ. There remains nothing but the direct effect of the blow on the nerve tissues; this is sometimes called concussion of the retina. The first case was considered not to be one of that kind chiefly because only one eye was affected, as no reason could be given why the two should not suffer for an injury inflicting about the same degree of violence on both. Dr. Noyes explained the case to be due to damage of the nerve at the foramen-opticum where it passes from the cavity of the skull to the orbit. "The mechanism is the transmission of

force along the dense outer wall of the orbit, so as to concuss the nerve trunk against the sharp edges of the foramen, just as if it were struck with the back of a heavy knife." The fact of there being a rent in the drum of the ear on the opposite side rather strengthens the hypothesis as the petrous portion of the temporal bone is in the same line of direct osseous contact. The action of the blow supposed is obliquely across the base of the skull from the right temporo frontal region to the left ear, while the parts about the left orbit may be protected by hollows in the bone. At first I was disposed to explain the second case in the same way, that is, direct injury to the nerves, but was obliged to abandon the hypothesis on account of recovery. Making a diagnosis by exclusion we are compelled to call it one of concussion of the retina until further investigation in the cases of traumatic amaurosis give us more facts on the subject.

PERITYPHLITIC ABSCESS.

C. W. CHAMBERLAIN, M.D., HARTFORD.

The patient, æ. 37, an inventor and machinist, was seized with severe pain in the right side just above Poupart's ligament, accompanied with a chill, followed by high fever and tympanites. I found, on examination, extreme tenderness on right side of abdomen, less marked generally over abdomen, pulse 130, temperature 105°, and patient complaining of intense pain. I gave 15 m. of Magendie's sol. hypodermically, warm fomentations, and as the bowels had been constipated, 10 gr. calomel, to be followed by an injection of sweet oil. This was about midnight; in the morning I found that the oil had passed away clear, and there had been no movement of the bowels. The tenderness was more localized, tympanites marked. Suspecting either intestinal obstruction or inflammation, I examined the bowels carefully, and found that there was a hard, doughy feeling just above Poupart's ligament, and the tenderness more decidedly localized.

The patient was kept decidedly under the influence of morphia, and poultices applied. Suspecting the nature of the case, I proposed to explore with a hypodermic needle, and to have an operation if pus was found. The exploration was made in the presence of Dr. Jarvis, and pus found. This was on Thursday, the patient first seen Sunday morning. Thursday afternoon the operation for perityphlitic abscess was performed by Dr. Geo. C. Jarvis, in presence of several physicians of this city, and a little over a teacupful of matter discharged. The wound was syringed freely with a weak solution of carbolic acid three times a day, free drainage secured, and carbolic dressings used. The day after the operation the bowels moved three times, and for a time diarrhoea threatened to be a serious complication. The abscess walls were discharged completely in about three weeks, a portion apparently of the vermiform appendix, also, with what appeared to be a concretion. Patient made a good recovery.

COMMUNICATION.

S. W. ROCKWELL, M.D., EAST WINDSOR.

6th. In regard to this question I cannot assert, with confidence, that I have ever known a case of one of the diseases embraced in the inquiry, to arise spontaneously. I was once well assured that I had. I was called to attend on a young girl seven years of age, who I found laboring under a very severe attack of scarlet fever, of the anginous form, from which she died on the seventh day. There were no other cases of the disease in town, and there had been none during the year, and no

case followed it. It appeared to be perfectly isolated, but the truth respecting it came to light many months afterwards on this wise: A woman from a neighboring State came on a visit to the mother of the child and remained with her some weeks. On her return home she borrowed a cloak of the mother of the child, and before she returned she assisted in nursing a family of children sick of scarlet fever. A few days after the return of the cloak the child sickened and died of the disease as above stated. It was a long time before we were able to assign the death of this lovely child to the true cause. Such causes cannot always be traced, but may always exist. I think they do.

COMMUNICATION.

W. H. MATHER, M.D., SUFFIELD.

March 3d, Sunday, at 11 A. M., I was called to see a woman about 45 years of age; Dr. Burnap was also present. We found the patient prostrate, cold, with a clammy feel, yet complaining of heat, and begging for cold water; said she drank three quarts in the night; got up and helped herself at the pump. Her intellect was as clear as ever. made her will, and gave directions for her funeral, etc.

She

We administered hot whiskey, carb. ammonia, and hot capsicum tea, applied sinapisms and baths and friction, but we could get no reaction; she died at 5 P. M. She did her own baking on Saturday; said she had a slight chill in the night; complained of a feeling of suffocation and heat, with some restlessness. We have never seen patients die with these symptoms in this latitude. Her appearance was very much like the collapse of cholera. There were no bowel symptoms; no cough to speak of; she vomited once.

Can you give a name to her disease? Should we not have expected the brain would work imperfectly or obscurely? Shall we call it congestion and let it go? I believe Dr. B. reports two similar cases occurring in same locality within four days of this one; one died with only fifteen minutes' warning; the other three or four hours.

I had one interesting case of aphasia in a young mother who got up too quick after confinement; was delirious a month, and very feeble. As strength returned, found she could not give the names of her nearest neighbors, nor the names of the groceries on the table. She would say I want - blank. So it continued ten months; she forgets name of her children; is exceedingly irritable and melancholy.

A second case of aphasia in a man 62, caused by a blow on the head. He would call his boots a looking-glass; nearly everything wrong, and at times in whole sentences would utter not one English word or any other known word; syllables of different words intermixed like a basket of chips; confusion worse confounded. He died of hemiplegia.

A CASE OF URETHRAL HEMORRHAGE.

E. P. SWASEY, M.D., NEW BRITAIN.

On the 18th inst., a man, aged 35, presented himself at my office with the following history: About four weeks previous to this visit he had contracted gonorrhoea, which afterwards subsided into a gleety discharge; said he had been treated for stricture recently. At 3 o'clock in the afternoon of the above date, he indulged in sexual intercourse, and during the act hemorrhage began, which had continued, uninterruptedly, up to 6 P. M., at which hour he consulted me. He had been drinking during the afternoon, and was considerably under the influence of liquor. On examination I found that the inner parts of the trowsers were saturated with blood down to the knees, and it was dripping on the floor. When he had unbuttoned the garment I found a clot protruding from the urethra, and a steady flow issuing from the same. I administered 3 ii of flu. ext. ergot by the mouth, and compressed the glans to favor the formation of a clot, but without success. I next applied ice to the penis for ten or fifteen minutes with a like result. I then requested him to lie down on his back, and I introduced a No. 12 steel sound, preparatory to bandaging the penis. It passed in so easily, meeting with no obstruction, that I at once withdrew it for the purpose of substituting a larger one, when I noticed that the hemorrhage had entirely ceased. An hour later I applied a bandage to insure him against a return, and gave him another dose of ergot. The first had been vomited shortly after its administration. I have not seen him since, but am aware that up to noon the next day there was no return of the bleeding.

Judging from the appearance of his clothes, and considering the amount lost while in the office, I should say that he lost all of fourteen ounces of blood.

Up to the moment I used the sound the hemorrhage was unabated, but did not recur after its removal, so that I am inclined to believe that it was checked simply by the irritation which the passage of the sound produced.

COUGH FROM RECURRENT LARYNGEAL CONGESTION.

C. W. CHAMBERLAIN, M.D., HARTFORD.

The peculiar climate of New England with its frequent alternations, renders affections of the upper respiratory passages so common that oftentimes they do not receive the attention they deserve from the profession, and the traveling empiric reaps a rich harvest in consequence. There is also, perhaps, a too great reluctance on the part of those who have been long in active work to adopt new