freely. Pulsation could be felt in the vessel above the clot, but not below. The sheath was opened, the artery ligatured above and below the aperture, and the intervening piece cut out. The muscles and deep fascia were then brought together with catgut sutures, and finally, the external wound closed with horse-hair sutures. Dry dressing was then applied, and the limb put on a back splint. May 3.-Patient is very comfortable, sleeping all day; no hæmorrhage; no pain. May 5.-Wound dressed and leg re-adjusted; some redness about the incision; temp. 99°. Mouth is clean; some tenderness about the angle of the jaw. May 8.-A little pus obtained from the central portion of the incision, but not from any deep-seated trouble. Since then the patient has rapidly improved, and was discharged on May 25 quite well. Clinical Records. SILENT OPTIC NEURITIS, PROBABLY DUE TO A J. D., æt. 39, a carpenter, came for advice in October, complaining of pain, itchiug, and noise in the right ear of a fortnight's duration. His hearing was reduced in both ears to one-eighth of the normal, but beyond an eczema of the right meatus, and a little depression of the membrane, there were no objective signs of ear disease. He was treated for the eczema and for chronic catarrh of the middle ear, and was seen three or four times. His hearing improved, and the itching ceased, but the tinnitus continued; he then left off coming, and was not seen for more than a month. On January 10th, he again presented himself, and his hearing had improved to nearly half the normal; and bone conduction, which had been deficient before, was now normal, but the tinnitus was still present. On January 20th, he mentioned casually that he had pain on the right side of his head, and a strange feeling in the head. An ophthalmoscopic examination was made, and led to the discovery of a pronounced double optic neuritis. A careful inquiry was then made into his history, and the following facts ascertained :-He had had "gastric fever" some years ago, but otherwise had always been well, and he very positively denied any venereal complaint, sore throat, or eruption. He married at 32; his wife was not very strong, and her first conception resulted in a premature offspring, subsequently she had two healthy children and no miscarriages. The two children, aged three and four respectively, present no signs of constitutional disease. In July, he had an epileptic fit, and was unconscious for about twenty minutes, after which he returned to his work, and beyond feeling rather weak, was much as usual. He has not had another fit, but from this date has suffered almost continuously from a pain in the right side of the head; at times of considerable severity, at other times not much to complain of. On previous visits he had not mentioned this pain, probably because he was already taking medicine for it prescribed for him elsewhere, and at first referred to it lightly as a "worrying of his nerves." The pain was principally felt over the parietal eminence, but extended downwards behind the ear, backwards to the occiput, and forwards over the brow as far as the left eye. He found that he was, to some extent, able to relieve it by pressing his hand to his head. He has had no vomiting. One day in December, whilst at dinner, his fork dropped from his hand and the arm fell powerless, and became cold; he put it in a bucket of hot water, and the power and warmth returned in a few minutes. Precisely the same thing happened the next day at dinner, but has not recurred since. On examination, a tender area to firm pressure was found over the centre of the right parietal bone. Both optic papilla were swollen to the extent of three to four dioptres; most of the arteries were buried, and the veins large, tortuous, and partly concealed by exudation. The rest of each fundus was healthy. Refraction emmetropic. Examination of vision revealed central vision normal, being, and Cowell 1 in each eye. Fields greatly contracted, without scotomata. The pupils and tension were normal, and there was no ocular paralysis. Examination of his nervous system revealed no loss of muscular power, no tremor, and no twitching. The knee-jerks were normal, and his gait firm and steady. Mentally, he was a little dull, and complained of his memory being bad. The fit, the pain, and the neuritis suggested a cerebral tumour, and the temporary paralysis of the left hand and arm pointed to the right Rolandic area as its probable seat. The man was ordered thirty grains of iodide of potash per day, which was increased rapidly to eighty. He at once began to improve, and in a month had lost all his pain, and felt and looked quite well. The optic neuritis subsided rapidly, the central vision was perfect, and in addition, we have ascertained that his light minimum, light difference, and colour sense are normal. The concentric contraction of the fields still remain. The tinnitus, too, for which he first sought advice, has disappeared. To confirm the diagnosis that the iodide had made, there is abundant evidence of syphilis in the right leg, which presents a host of pigmented scars, the result, probably, of tertiary serpiginous ulceration, which the patient states broke out some six years ago, and has been healed for a year. Perhaps the most interesting features of the case are the rapidity with which the pain yielded to large doses of iodide; the retaining of normal visual acuity, light minimum, and difference and colour sense, with pronounced neuritis. The long interval, five months, between the epileptic fit and the temporary paralysis of the hand, and the absence of more marked motor symptoms, and lastly, the positive denial of syphilis. The fortunate, though almost accidental discovery of the neuritis, confirms once again the importance of the ophthalmoscope in general diagnosis. Cases of unsuspected optic neuritis are far from uncommon; this case is typical. Had it only been allowed to develop into atrophy, an oculist would have first been consulted, when all symptoms of neuritis had disappeared. The causation in this case is fairly clear. In many cases of double optic neuritis it is not so definite. As double optic neuritis is very common, and as the bulk of the cases which are seen by oculists do not end fatally, even in the absence of treatment, it is certain that if they are caused by cerebral affections, the cerebral lesion usually undergoes spontaneous recovery. A CASE OF MYXEDEMA, WITH SYMPTOMS SIMULATING OVARIAN TUMOUR. By E. H. EMBLEY, M.B., B.S. The patient, a lady, 53 years of age, who had had six children, and had enjoyed good health until she reached 38 years age, when on lifting a heavy weight, she felt a severe pain in of the left side, and she attributes the illness to that injury. From that time her whole body has always been fuller and stouter than it should be, and she always felt ill and weak. She noticed that the fulness in face and extremities increased on exercise, and with worry or excitement; that pleasure and change caused improvement. There was no other indication of disease to account for weakness and ill-health than the swollen condition of the whole body. Her family physician could not account for it. At times there were periods of improvement, followed by relapse rather worse than before. Change of residence considerably improved her, so she took periodical visits to New South Wales, and three years after the onset of the disease, she went to Europe and consulted medical men there without benefit, and although much improved by the trip, she lapsed into the old state on returning home. She still continued to take changes into the country with benefit, relapsing on returning. A few years later she again took a trip to Europe, and during her stay there, tried the effects of mountain residence in Switzerland, and though much distressed by the rarefied air, she felt improved on returning to lower levels, being able to walk quite nimbly afterwards for a little while. The normal condition of body and health were never reached. Though improvement was again considerable, she returned home to Victoria without prospect of permanent relief. After being at home a while and coming to live in Melbourne, she found that the abdomen was rapidly increasing in size, and with it a reduction in size of the rest of the body, and it appeared as though the swelling was all being concentrated in the abdomen, which became very large. She was now tapped, and nineteen pints of fluid were removed, great pain following the operation. The diagnosis was then made of ovarian tumour, and after consultation it was decided to operate, with, however, some degree of indecision on the part of the consultants. On removal of the patient to a private hospital, a laparotomy was performed; no ovarian tumour was found, but a condition that looked like malignant disease, on discovering which the wound was closed and she went home hopeless. This occurred five years ago, and no appreciable alteration had occurred in her condition up to the time of coming to me on the 20th of August, 1894. She then presented the characteristics of myxedema; the face was puffed; the brick-red flush was marked; the lips thick, prominent, rounded, soft, bluish, and almost trans lucent; eyelids puffed, and their movements much restricted; skin harsh and dry; arms rounded and full, with a jelly-like feel on rolling the skin between the fingers; hands large, but not spade-like; hair coarse and scanty; tongue large, flabby, feeling too large for mouth; fauces congested. Speech very slow and hesitating; memory very imperfect. Extremities always cold; feels the cold very much. Temperature in mouth 97° F. Urine almost thick with mucus, and slightly albuminous; specific gravity 1013. Radial pulse 70, soft, and easily compressible. No thyroid gland to be felt. On examining the abdomen, it was found to be considerably enlarged and quite uniformly, with the exception of a large ventral hernia at the site of the laparotomy incision. The measurement at the greatest circumference of the abdomen was 44 inches. On percussing the abdomen, an area of absolute dulness was found occupying a large portion of the left side, bounded by a line drawn from about the end of the tenth rib to the symphysis pubis. The rest of the abdomen was more or less resonant, and the hernia contained a nodular reducible mass about a pound in weight, firm, but tender to the touch. No appreciable fluctuation could be obtained on palpation. I put her under treatment with thyroid extract, using only one and a half grains three times daily, along with citrate of caffein. A week later the urine was again examined, and its specific gravity was 1018, with an increase in urates and diminution of mucus. Even this amount of thyroid extract had to be limited to twice or even once daily in consequence of slight syncopal attacks. Headaches at this period were frequent and distressing, and care was needed in moving about in consequence of weakness and faintness. Her appetite was very poor. Treatment was, however, persevered in, the density of urine rising to 1020 and over, temperature slowly improving, and reaching normal, with increased feeling of warmth, and slow but regular improvement in general health, appearance, and speech; and after six weeks of treatment, the greatest circumference of abdomen had diminished six inches in measurement; exfoliation in skin, changes in the hair and nails, and marked alteration in the general appearance occurring. The diminution in the size of abdomen from this time, however, being slower but continuous. With care, little outings could be taken, and now the appetite began to improve, strength to increase, and with it the doses of extract were increased to three grains three |