December 5th.-On tolerably firm pressure, half-way between the umbilicus and anterior superior spine of ilium, a not very well defined lump was felt extending through to the lumbar region. Pain was felt at the anterior end of the lump and in the lumbar region. The Inmp could be moved between the fingers placed in front and in the loin. The urine was abundantly loaded with pus, the proportion of which had been increasing. The amount of urine had been decreasing in quantity. 9th. A glass of urine was, on being left to settle, opaque with pus to within about half an inch of the top.

7th.-Swelling scarcely so apparent. The patient had ether administered, and Mr. Bryant made an oblique incision in the lumbar region, about three inches long, above the posterior part of the crest of the ilium, at the juncture of the lower third with the middle third of the distance between it and the last rib. The subperitoneal fat was cut down upon, and a directer passed into the kidney, when about two ounces and a half of pus were evacuated. Afterwards the finger was passed into the wound, and Mr. Bryant considered the finger penetrated into the pelvis of the kidney. The cavity was then washed out with a lotion composed of three drachms of the compound tincture of iodine to a pint of water, a drainage tube introduced and fixed by means of a silk ligature, and the wound strapped and dressed.

8th. She vomited a little in the night, but did not sleep. She thought the pain was less since the operation. The pus in the urine had greatly decreased. The wound looked well, and there was very little discharge.

10th.-Pus had disappeared from the urine; there was slight discharge of pus from wound.

12th. She felt pretty well; no bad symptoms except that her temperature was a litttle high.

13th.-Temperature 104°. She had great retching, without vomiting; bowels very much relaxed; one pint and two ounces of urine were excreted, specific gravity 1026.

14th.-Patient complained of burning heat over the abdominal parities, which could be distinguished easily with the hand. Temperature 102.8°. She was ordered pil, opii in one-grain doses. Urine ten ounces, specific gravity 1026.

15th.-Temperature 102.8°.

16th. She was much worse during the night, breathing with difficulty; complained of great pain in side. She died about

noon.

Post-mortem by Dr. Goodhart.--The ascending colon and cæcum were intimately adherent over the kidney and psoas muscle. The bowel was rather contracted. The supra-renal capsules were healthy, but the right was somewhat tough, embedded in fibrous tissue. The left kidney was large and weighed about nine ounces, white, mottled, and contained many cysts. The other was small and embedded in a tough mass of tissue; capsule firmly adherent and dense. The pelvis opened into the abscess described. There was a still unopened cyst in its lower part. The ureter was evidently dilated, so also the renal cavity as far as the brim of the pelvis, where it became matted up in a thick mass of fibrous tissue connected with the right ovary; it was traced along and found pervious to this part; then for an inch it was lost, being damaged in extraction; below the missing part it was again pervious, but not dilated. There was no broad ligament on this side nor yet on the other. All the parts were matted up together, and the ovaries were not found without difficulty. The uterus was healthy, rather large, and transeverse. The bladder was small, its mucous membrane red and velvety, and in a state of subacute cystitis. All the mischief looked like some old inflammation in both broad ligaments, leading to puckering of the ureters, and so to renal hydro- and then to pyo-nephrosis.-Medical Times and Gazette.

Acute Ascending Paralysis.-M. DEGERINE has announced to the Académie des Sciences the observation of changes in the anterior roots of the spinal nerves in cases in which a careful, naked eye, and microscopic examination revealed no lesion of the spinal chord. The method of examination employed was the hardening in osmic acid, and examination by means of picrocarmin. In each preparation a number of nerve-tubules presented the appearance of parenchymatous neuritis, fragmentation of the myelin in drops and

In

droplets, an increase in the protoplasm of each inter-annular segment, and multiplication of the nuclei of the sheath. some of the tubules so changed the axis-cylinder had entirely disappeared. Most of the nerve-tubules presented no appreciable alteration. The same appearances were observed in each part of the chord. A similar alteration of some of the nervetubules was found also in the intra-muscular nerves of the paralyzed limbs. Attention is drawn to the point without much. weight being laid upon it, and its relation to the disease may admit of some doubt when we consider how small a proportion the few degenerated tubules bear to the great amount of paralysis. Lancet.

Cartilaginous Degeneration of the Capsule of the Spleen.-By W. F. MURRAY, M.B., Officiating Civil Surgeon, Gya.-On the 26th April last the body of a Hindoo, age about 60 years, was brought to Gya for examination. He was said to have fallen into a well. In making the P. M. I found a tendency to ossification all over the body. The cartilages of the ribs had become ossified; there was commencing ossification of the coronary arteries; there was atheromatous disease of the mitral valves, with thickening of the walls of the left ventricle of the heart. But the peculiar phenomenon which I met with was on examining the spleen, when I found the whole external surface to consist of a cartilaginous plate about inch in thickness. The remaining surface of the spleen was normal, and the substance of the spleen, except for some slight congestion. Signs which I need not enumerate showed drowning to be the immediate cause of death, but I thought this case worth sending to your journal, as I do not remember having ever heard of an exactly similar one.-Indian Medical Gazette.

.

Cessation of Epileptic Fits with Ultimate Cure.-Dr. SCHULTZ (Berlin Klin. Woch.) reports a case of epilepsy occurring in a sailor, 18 years old, formerly healthy, who for a month had suffered from epilepsy. He had a fit regularly every mid-day. The usual remedies were

employed without the least benefit. The fit was preceded by weariness and a feeling of pressure on the chest, and was followed by several hours sleep. By the administration of a teaspoonful of common salt before the time for the fit, it was warded off for a week. By the continuation of this treatment (a teaspoonful of common salt every mid-day) the case was cured, at least, the patient at the time of publication of the case had had no fit for seven weeks. [Quoted in Centrallblatt f Med. Wissensch.]

Report of a Case of Malignant Cholera -in which thirty-two grains of Chloral-Hydrate were hypodermically injected: recovery.-Augustus R. Hall, M. R. C. S., Eng., reports the following case in the British Medical Journal:

M. M., the wife of a soldier, a very spare woman, aged 30, the mother of four children, was carried to the Female Hospital, Fortress Gwalior, about three o'clock in the afternoon of October 27th, 1877, suffering from Cholera. From a statement subsequently made by herself, it appears that on that same morning she was feeling well till after breakfast. About 11 o'clock she felt uncomfortable and oppressed, and laid herself on her bed. She went to sleep, and, about 1 o'clock, woke up, and found that copious watery evacuations were literally flowing from her, and saturating her bedding. Vomiting and cramp soon set in, and her hushand then sent for a dooly, and had her conveyed to the hospital. On admission she had the usual symptoms of well-marked collapse. The skin was cold, lips blue, eyes sunk, tongue and breath cold, finger-ends shrivelled, voice sepulchral; the pulse could not be felt at the wrist, nor even in the brachial artery. As she was a very thin woman, it could have been easily felt there if it had been present. There were cramps in the hands and feet, and a good deal of vomiting, but not very much purging. The temperature in the axilla was 95.2 degs. Fahr. On examining the thorax by percussion, it was found that the usual area of cardiac dulness emitted a resonant sound. On application of the stethoscope, the beating of the heart could be scarcely heard, and at times seemed lost; but respiration was detected over the part of the chest where the heart-sounds are usually perceptible.

Shortly after admission, one scruple of chloral-hydrate, dissolved in three ounces of water, was given by the mouth, but was rejected; it was therefore determined to administer that drug subcutaneously at once. At 4 o'clock p.m., six grains of chloral, dissolved in sixty minims of water, were injected into the substance of the left deltoid muscle in the following manner : As the hypodermic syringe employed held only twenty minims, containing two grains of chloral, the point of the cannula was passed through the skin and into the muscle perpendicularly for about the depth of one inch; the syringe was then emptied, and the cannula was withdrawn until its point reached the areolar tissue, but was not withdrawn through the skin. It was then thrust in a slanting direction at about an angle of forty-five degrees into another portion of the muscle. The cylinder of the cyringe was then unscrewed, filled with twenty minims of the solution, screwed on to the cannula, and again emptied. The point was then plunged into the muscle in an opposite direction, and twenty more minims injected. By these means sixty drops of the solution were injected into three different portions of the muscle with only one puncture through the skin, thus lessening the chance of irritation of the cutaneous nerves. These details are given thus minutely, as a strict attention to them is considered a very essential part of the method of treatment recommended.

Observations were taken with the clinical thermometer in the axilla every twenty minutes. Half an hour after the first operation, sixty more minims of the solution were put into the deltoid muscle of the right arm in the manner described above. The temperature in the axilla now began to rise steadily.-By 6 o'clock, eighteen grains of chloral in 180 minims of water had been injected through three cutaneous punctures, and the thermometer registered 97.8 degs. Fahr. The cramps had ceased by this time, and the vomiting was much less. Some serous evacuations had been passed.—At 7 o'clock, she passed a small quantity of urine. Four grains more chloral were injected into a muscle, the left pectoral.—At 8 o'clock, the temperature was 98 degs. Fahr.-Soon after 9 o'clock, she had a motion of serum