gain her strength, suffering occasionally with toothache. All was comparatively well for some two weeks when she noticed a swelling on the left side of the neck below the jaw, accompanied with pain and inflammation. This was about the size of a walnut and the surrounding tissue was considerably indurated. Upon lancing the swelling there was found but a small quantity of bloody pus, but a drainage tube placed in the wound and not removed for two days allowed about twenty drops of thick pus to pass from the opening, and as this contained peculiar sulphur colored granules, they were examined under the microscope and recognized as actinomyces.

An operation being advised, it was performed a few days after by an incision being made from ear to the clavicle parallel to the sternocleido-mastoid. With a sharp spoon and knife there was removed a mass of succulent tissue, interspersed with pus and gold colored granules that penetrated the surrounding tissue. After a carious tooth had been taken out, aprobe was passed down from the alveolus into the wound; a portion of the angle of the jaw chiseled away so as to admit the spoon, and the alveolus and canal thoroughly scraped out. The wound was washed out, a tampon of iodoform gause inserted into the alveolus, a drainage tube put in and the wound closed with silk. The patient made a rapid recovery and was about on the sixth day, good health still continuing.

Ophthalmology.

INTRAOCULAR TUMORS.-Dr. Arthur D. Mansfield. Med. Progress.—Intraocular tumors should engage the early attention of both the specialist and general practitioner, from the fact that it is into the hands of the latter that these cases fall while in their incipiency and when the good can be done. When the tumors are well advanced in growth there remains but a choice between two courses-enucleation, or where enucleation would only hasten matters, to leave it alone, and the patient slowly dies.

Dr. Mansfield only considers in this article those tumors attacking the tunica vasculosa, that tract formed by the iris, ciliary body and the choroid. It is in this tract that the majority of the tumors affecting the eyeball are found. They may be divided into three groups, according to their character, viz.: A. Syphilitic.

B. Miliary tubercles of the choroid.
C.

Sarcomata.

Syphilitic tumors (gummata) occur always in the secondary stage of syphilis when they do occur, and their presence is always diagnostic. Gummata may appear in any portion of the vascular tunic, but are seen most frequently on the iris. They may occur single or may be multiple. The symptoms vary with the position, giving rise to symptoms of locality. A gumma of the iris would show a history of syphilis-the eye would present the ordinary appearance seen in parenchymatous iritis--the cornea hazy and infiltrated with leucocytes; the iris sluggish in its action to light, of a muddy and cloudy appearance, streaked here and there with centers of purulent matter, and localized in one or more foci can be seen the gummata appearing as distinct nodules.

The etiology is the location of a circumscribed collection, not of pus, but of syphilitic matter, which in

the course of time may terminate in pus, and bursting, fall into the anterior chamber, forming hypopyum.

The prognosis depends largely upon the position of these tumors. If, for example, the gumma attack the pupillary margin of the iris, causing more or less adhesion between the two opposing surfaces of the iris and lens, the damage done is of far greater import than if the gumma be located away from the edge and farther toward the periphery.

Again, leaving the subject of irritic gummata, if the gumma locate itself about the fovea centralis and macula lutea, the destruction done the retinal tissues, essential to the proper reception of images, by the syphilitic inflammation is irreparable. The prog

nosis is grave in any case, and the disease needs skillful, careful and immediate attention.

The treatment is very important and should be instituted immediately and carried on boldly. In gummata of the iris the local treatment indicated is mainly the use of atropine (grs. iv-v to the 3j aqua) instillations once every hour or two hours as the severity of the attack demands. If the pain; photophobia or neurotic, in the frontal and temporal region, be very severe, relief will often be found from the use of grs. xx-xxx, salicylate of soda, the application of a "Japanese hot box," or local depletion by means of the artificial leech or the natural leech; if all these fail, then morphia and atropia can be administered.

After the acute inflammation has passed away if the iris is bound down to the lens a recurrence of the inflammation in the same eye from time to time is likely to result. Besides the tendency exists to develope sympathetic ophthalmia in the other eye. If the adhesions be extensive an iridectomy is necessary. The local treatment in all of the acute attacks should be supplemented and in fact, a very important factor by the use af the potassium iodide in gradually increasing doses and the use of the bichloride of mercury of 1-12 to 1-16 grain.

The second and least important group is the one designated as "miliary tubercles of the choroid." In this group we find only a means of diagnosing that rapidly forming constitutional disease, which carries the patient off so quickly that proxnosis, treatment and all are swept away as useless by the hand of death before we have hardly made a diagnosis.

The diagnosis, however, is of vast importance in some cases, and the differential diagnosis between a syphilitic gumma of the choroid and a miliary tubercle is not always an easy matter. The diagnosis by the ophthalmoscope may lend a very important aid if the vitreous be clear and transparent; and when clear and transparent tends to differentiate in favor of the tubercle, as the gumma is likely to cloud the vitreous more than the miliary tubercle. Our main reliance is upon the constitutional signs and symptoms and the diagnostic signs of the use of antisyphilitic remedies. The miliary tubercles appear generally about the macula and as small yellow patches, distinguished from the choroidal patches of atrophy by the absence of black pigment about the edges, and the tubercles seem more diffuse and not so clearly defined as the atrophy patches.

It is often a grave question to diagnose typhoid fever from acute miliary tuberculosis, and the presence or absence of the miliary tubercles in the choroid may settle that disputed point, though their absence. does not contraindicate the presence of typhoid fever, though their presence is always pathognomonic

of miliary tuberculosis. These tubercles of the choroid appear mostly in cases of acute miliary tuberculosis and rarely in any other form of tuberculosis. The treatment can easily be stated from an ophthalmological standpoint-leave the eye alone. Constitutional treatment may be instituted, but we all know its value in acute miliary tuberculosis.

Passing now to the third and last group of tumors under consideration in this article, we note that sarcomata are the most insidious and the most destructive to eyesight, occurring, generally, without any pain, no inconvenience, scarcely any proptosis, and such gradual loss of vision that the possessor of the tumor only accidentally discovers that he cannot see in one eye, and immediately, or not, just as he considers it a matter of importance, consults an oculist, who advises the removal of the eye. Such is generally a succinct history of sarcomatous growths of the choroid --they usually grow from the choroid, rarely from the iris primarily and just behind the uvea and the ciliary body, growing into the vitreous chamber and gradually occluding the light and causing blindness. The growth may be accompanied by some pain. This may or may not be present--perhaps oftener absent than present-and may also be accompanied by flashes of light; seen in patient past thirty-five years of age, rarely if ever, seen in younger persons.

The diagnosis is made by the ophthalmoscope and the differential diagnosis from retinal detachment by the same means, using the direct means, often being able to trace distinctly the blood vessels on the tumor and the absence of fluctuation and waving of the retinal detachment. The diagnosis, though not always easy, is yet possible.

. Perimetric examination of the visual field shows a distinct scotoma corresponding to the position of the tumor. In advanced stages the pain may become severe and the tension generally

× (T = +7 T = +1).

Proptosis is marked, the iris becomes sluggish, pain increases, flashes of light become more and more perceptible, vision gradually becomes worse and worse, posterior synechia may occur lacryncation noticeable and the sarcoma may finally cause a rupture and involvement of the periorbital tissues.

Prognosis is good so far as saving life is concerned if the eyeball be removed before the sclerotic or tunica fibrosa is ruptured, but if the orbital tissues be involved, the prognosis is grave, indeed.

The subject of treatment is an important one, as it deals with the question of recurrence. We may have metastatic glandular sarcomata in various parts of the body, and when we do, then extirpation is the only means of cure. We may have to deal with ophthalmic sarcomata in two ways, viz.: either the orbital tissues may be affected, or secondly, the sarcoma may be confined entirely within the fibrous tunic of the globe. When the sarcoma is within the bounds of the eyeball, then simple enucleation suffices to eradicate the disease and stamp it out forever. It is always safer to resect as much of the optic nerve as possible for the safeguard against possible sympathetic recurrent sarcoma in the other eye. Secondly, if the orbital tissues be effected, enucleation is essential, and the eradication of all infected tissues by means of the knife, as far as possible, and then by means of the Paguelin thermo-cautery, followed up by strong zinc chloride paste or sulphuric acid and

charcoal pulverized, a soft unguent applied on cotton to protect the lids, and followed up by such constitutional treatment as may be indicated.

REMOVAL OF LENS IN HIGH DEGREES OF MYOPIA. Dr. Arthur D. Mansfield in the Medical and Surgical Reporter offers the following reasons for the removal of the crystalline lens in high degrees of myopia: Distinct vision for the eye is obtained.

1.

2.

Retinal images are very much enlarged, which in itself is a marked advance and benefit. 3. Visual acuity is improved.

4. When using the eyes normally for the distance the myope uses his accommodation, thus the relaxation of the accommodation is marked and complete in many cases, the accommodation being impaired, which latter condition cannot be called strictly an improvement, yet it is an advantage when compared with the previous condition present in the eye prior to the operation.

5. Often in high degrees of myopia the binocular vision is at fault, especially when the degree of myopia in the two eyes is far apart as to quantity and degree, binocular vision for near work is restored by this removal of the lens.

6. The work at the punctum proximum is held at proper distance from the eyes and not at the myopic distance which varies with the degree of refractive

error.

7. Spasms of the accommodation and all disturbing elements disappear in this method of treatment; this is of a necessity so, as the accommodation is greatly impaired.

8. The myope is converted into an hyperope which is not progressive and ceases to be a form of annoyance as soon as the eyes are properly adjusted with glasses.

EYE TROUBLES IN PREGNANCY.-As the conclusion from a very interesting paper on the "Induction of Premature Labor, in Amaurosis and Amblyopia in Pregnancy" (Jour. Am. Med. Assoc.) Dr. Pooley

says:

1. In all cases of pregnancy, not only should examinations of the urine be systematically made, but the eyes should be examined with the ophthalmoscope; since, in a large proportion of cases where eye troubles exist, the patients make no complaint of disorders of vision. Frequently such troubles can be detected with the ophthalmoscope long before any disease of the kidney is shown in the urine.

2. In uremic amaurosis, without changes in the eye visible to the ophthalmoscope, even should the usual accompanying symptoms, such as dizziness, nausea and threatened convulsions be absent, their supervention is soon to be anticipated, and the immediate induction of premature labor is indicated, without waiting until the life as well as the sight of the patient is in danger.

3. In neuro-retinitis the induction of premature labor is not only justifiable but urgently demanded. In some instances it is called for even in the earlier months of pregnancy.

4. It is required in cases of eye trouble recurring in successive pregnancies.

5. A woman having once suffered in this way during pregnancy, the relationship of cause and effect should be fully explained, both to herself and her husband.-Medical Times.

NOTES ON HIRSCHBERG'S METHODS. - Dr. T. M. McIntosh, writing from Berlin to the Southern Medical Journal, says the oculist, Hirschberg, even goes so far as to require that those who witness his cataract and other internal eye operations shall not have been in the dissecting or pathological room for ten days. He takes all precautions that the gynæcologist does with his laparotomies, and his operating room has the glass and metal table, tiled floor and stone walls of the laparotomist.

The day before a cataract operation, the patient has a complete bath and is clothed in a suit thoroughly cleansed. The morning of the operation the entire face is thoroughly washed and then bathed with a 1-5000 solution bichloride mercury, but the conjunctiva is washed only with sterilized water. No bichloride solution ever comes on the conjunctiva. His instruments, sterilized after each operation, are again boiled before the next one, and cotton and gauze also are resterilized (I mean in a straw sterilizer). All of this preparation takes place under his own eye and much is done by himself. He operates with the narrow knife, makes the upward incision, and usually in corneo-sclerotic juncture, and without iridectomy, as most of the leading operators do. His last 180 extractions gave only a loss of one case, which is phenomenally good. He uses silk in his muscle and conjunctival operations. For sympathetic ophthalmia he yet makes, sometimes, a neurectomy, and for pain ful bulb, exsection of the optic nerve. In detachment of the retina he obtains, in many cases, a normal visual field by the use of pilocarpine injections, pressure, and in some cases a puncture of the sclerotic. As interesting only from its novelty, and also from a diagnostic view, he showed in his clinics a case of vaccine of the eyelid which had been conveyed to the mother by the hand of her child, which had a typical pustule on its arm. He used instillations of eserine and atropine indefinitely without conjunctival irritation, and claims that when it does irritate the solutions are not properly sterilized.

Distilled water is the solvent for every eye lotion, and before used is resterilized, which is repeated every few days against infection which may occur after use.

THE EXTRACTION OF INCIPIENT CATARACT.-Under this head Dr. J. Dickson Barr pleads, in the Medical Record, for the early extraction of cataract. He finds early operation followed by more satisfactory results both to patient and surgeon. The percentage of cases in which secondary cataract occurs is smaller and vision is better than when maturity of the cataract has occurred. In one of the cases vision was 20 before operation and in three others it was Vision with glasses after operation was as good as 20 in all of these cases. Instead of forcing out the lens by pressure he introduces a Critchell's spoon, anterior to, and a curved spatula posterior to the lens and lifts it

out.

20

70

40

TRANSPLANTATION OF THE CORNEA.-Von Hippel reports in the Berliner klin. Wochenschrift, xxviii. Jahrg., No. 19, his seventh case subjected to this operation. The patient had a dark-brown opacity which covered the pupil, and which had been produced by repeated cauterizations of the cornea with nitrate of silver. He also had cataract. After extraction of the opaque lens, with iridectomy, he had vision equal one-fifth,

but he insisted on the removal of the spot on the cornea. The corneal tissue, down to Descemet's membrane, was removed from a circle four millimeters in diameter, and replaced by the full thickness of the cornea from a young rabbit. The eye was afterward dressed with iodoform and both eyes bandaged. Although there was temporary clouding of the thin layer of original tissue behind it, the transplanted flap remained clear. In two weeks the epithelium was continuous from the cornea to the flap. After discission for a secondary cataract, the patient obtained vision equal one-third. It does not appear from the report that the transplantation caused any improvement in vision. But the operation deserves to be called successful in that it secured the continued life and health of the graft, and removed an unsightly scar.--. --Med. and Surg. Reporter.

Therapeutics.

EUGENOL.-Dr. D. C. Pettit, writing in the Medical Record, says that the chemical, physical, and therapeutic properties of eugenol having recently been given some attention by the profession, I may be permitted to recall some investigations made by myself some years ago, and to add some more recent observations on the subject.

The volatile oils from cloves, pimento, and the leaves of myrcia acris were found to contain respectively seventy-two, sixty-one, and forty-one per cent of rectified eugenol.

Throughout the entire experiments the acid prepared from the three oils gave similar reactions under the same treatment, and their physical properties were alike. The acid was obtained most easily from the oil of pimento, but most economically from the oil of cloves.

The original investigations of Ettling and Bonastre (Genelin's "Handbook of Chemistry") almost exhaust the chemical and physical properties of the acid, but a few practical points on its preparation may be of some value.

The oil of cloves should first be neutralized with a strong solution of potassic hydrate; the fragrant odor of the hydrocarbon will manifest itself when the point of saturation has been reached. The hydrocarbon can be freed from the mixture by distillation and the remaining solution of eugénate of potassium decomposed by the addition of sulphuric acid, when the eugénol will separate and float in brownish colored oily like globules and may be drawn off with a pipette, washed, and dried over sulphuric acid. The resulting crude eugenol rectified by distillation from a glass retort on a sand bath, gives a clear oily liquid, having when fresh a pungent odor similar to that of cloves, distilling at a temperature of 470° F., and having a specific gravity of 1.0785 (sp. gr. taken from the acid. prepared from the oil of bay).

Former and more recent investigations have convinced me that eugenol has very decided and active therapeutic properties. Applied locally to the skin it first produces a burning sensation, this being followed by some local anesthesia; applied to carious teeth it relieves pain when due to exposure of the nerve.

The eugénate of potassium when taken internally in a dose of five gr. produced active purgation and causd griping pains.

It is highly probable that the rectified acid has antiseptic and local anesthetic properties.

SPERMINE IN SURGICAL DISEASES.-Brown-Sequard's discovery last year, of what was jocosely termed the elixir of life, excited amusement rather than scientific interest, and after a short period of notoriety the remedy was allowed to lapse into oblivion. In Russia however, a number of distinguished chemists and medical men have been engaged during the past year in investigating the therapeutic possibilities of this remedy, and the results of their labors are published in the Berliner Klinische Wochenschrift. Professor Poehl, of St. Petersburg, has extracted from the testicular fluid of the sheep an alkaloid named spermine, the physiological effects of which are the same in kind as those of Brown-Sequard's elixir, but less powerful. The experiments of Schreiner, Poehl and Tarchanoff showed that spermine has no direct effect upon the genital organs, but that it acts as a general tonic and stimulant. Unlike the testical fluid, it may be injected without producing irritation or dangerous effects. Shicharew successfully employed this alkaloid in the treatment of neurasthenia, anæmia and paresis. Of surgical interest are the investigations of Dr. Weljaminoff. Having found that subcutaneous injections of spermine are devoid of danger, he concluded to avail himself of its stimulant and tonic properties in cases where he was obliged to administer chloroform to anæmic and weak persons, and also before the performance of protracted and severe operations. In order to judge the more distinctly of its effects, he used it only on greatly debilitated persons. One of the cases reported was that of a woman twenty-nine years of age, who suffered from a fibroma of the fundus and a cancer of the cervix uteri. The patient was markedly anæmic from the frequent profuse hæmorrhages, but after several subcutaneous injections of spermine, her condition was so much improved that a vaginal hysterectomy could be performed with success, convalescence taking place promptly.

To judge from the author's experience this alkaloid seems to possess marked restorative properties, and if his investigations are confirmed by other observers, Brown-Sequard's discovery will have served to add another valuable remedy to our therapeutic resources. --International Journal of Surgery.

SALICYLATE OF LITHIA.-Dr. Vulpian states that salicylate of lithia is more efficacious than salicylate of soda in cases of acute and progressive subacute articular rheumatism. It also has some effect in chronic cases when a certain number of the joints are still deformed, swollen and painful.

A pre

HYDROBROMATE OF HYOSCIN FOR ANTERO-LATERAL SCLEROSIS. For a case of antero-lateral sclerosis, the following was ordered by Prof. Da Costa : scription containing iodide of potassium, thirty grains three times a day. Counterirritation and dry cups to spine. Sitz bath. Also ro gr. hydrobromate of hyoscin at night.

HYOSCYAMINE IN CHOREA.-Prof. Da Costa continues to derive good results by the administration of hyoscyamine in cases of chorea which have resisted other treatment. In a recent case, a child aged five years, it was given in grain doses, ter die, to be increased.

ATROPINE FOR SINGULTUS. For singultus of seven months' standing which had resisted other means of treatment, Prof. Da Costa ordered the hypoder

matic injection of gr. of atropine every day or second day; also ice bags to spine at intervals of two or three hours.

Parzevski puts

BENZOATE OF SODIUM IN URÆMIA. forth some remarkable claims regarding the curative power of sodium benzoate in uræmic intoxication (quoted in Bull. Gén. de Thérap., December 15, Under the action of this remedy the paroxysms lessen in severity, the intervals grow longer and the convulsions after a time cease entirely. Profound sleep is induced by it, and during this the cerebral functions are restored. When albuminuria exists, a marked diminution occurs in the quantity present, or the albumen disappears entirely. --Amer. Jour. of Med. Science.

J. Sellwood, of Oregon says hydrochlorate of coCOCAINE AS, A REMEDY FOR SEA-SICKNESS. -Dr. J. caine, properly administered, is a remedy of great value in seasickness. Not that it will cure all cases, but it will cure a good percentage of cases, and relieve nearly all of them. In severe cases, where symptoms of collapse are presenting, 4 of a grain of cocaine should be given by the stomach every hour until the emesis is relieved. Then the dose should be decreased by one-half for twelve hours afterward, and gradually decreased from that on, until the patient is able to take and retain nourishment. Cocaine is easily retained by the stomach and never fails to give relief, many cases being cured by its use. If taken in %-grain doses three times a day for one week before going to sea, it would be equally beneficial as a preventive.

PILOCARPINE IN ERYSIPELAS.-For erysipelas, Prof. Da Costa continues to strongly advocate and recommend the use of pilocarpine in robust plethoric subjects. It is of striking value, and better results can be obtained than from any other mode of treatment. The proper dose is gr. %-/ of pilocarpine, or M.xx of fluid extract of Jaborandi. Local means are not of much avail.

PILOCARPINE IN ECLAMPSIA.-Pilocarpine may be said to be on trial as a remedy in the dreaded convulsions of puerperal eclampsia, and it is important to note the results which are from time to time reported by competent observers. On the whole, the reports are decidedly favorable, and a case recently published in a French contemporary shows clearly enough that in certain cases the drug may be relied upon to cut short the attack. In this particular case the attack had come on during labor, and was not relieved on the evacuation of the contents of the uterus; indeed, the condition of the patient on the following day was simply desperate. The injection of a third of a grain of pilocarpine at the critical moment is reported to have produced a most remarkable effect. After an abundant diaphoresis lasting over half an hour, the pulse returned in the radial arteries and the surface temperature was restored. No further convulsions occurred, and in the course of a day or two the injections continued night and morning, albumen disappeared from the urine, the patient becoming convalescent. effects were too clear and too prompt for the results to be attributed to any other influence, and the remedy is one which should always form part of the armamentarium of the obstetric physician. -Med. Press and Circular.

The

SALICYLATE OF SODA IN ORCHITIS-(Dr. Pigornet). --In gonorrhoeal orchitis salicylate of soda causes in a few hours at first diminution, and finally complete cessation of pain. Its action is especially constant in acute cases of epididymitis with vaginalite. When inflammation of the cord predominates the medication is often without effect. In cases thus treated revolution of the swelling begins sooner than in cases treated antiphlogistically. It follows a regular course, and it may be completed in less than eight to ten days, leaving only slight induration of the epididymis. Bulletin General de Therap.

MONOBROMIDE of Camphor FOR SPERMATORRHOEA.

The Med. Summary says: The monobromide of camphor has been successfully used in the treatment of spermatorrhoea, where a host of the usual remedies had been administered with no satisfactory results; finally the monobromide of camphor was given with prompt effect and perfect cures.

THE BROMIDES AND INCREASED SUSCEPTIBILITY TO INFECTION.--In the Mercredi Médical, October 21, 1891, Dr. Féré takes up the assertion that patients undergoing bromide treatment are more susceptible to infection than others, particularly to the influence of Koch's bacillus. Upon this latter point there are no positive clinical evidences within the author's personal observation, yet during epidemics of pneumonia at the Bicetre those persons under the influence of bromides proved most vulnerable. Animals inoculated with tuberculine virus after large doses of bromide began to lose ground immediately and soon died.-Medical Record.

Medicine.

SOME FORMS OF THROMBOSIS AND EMBOLISM ILLUSTRATED BY CASES.-H. B. Lowry, M. A., M. D. The Omaha Clinic.-A young German man, well built and weighing 200 pounds, had an acute attack of endocarditis and about two weeks after coming under observation, he stated that one year before he had experienced a slight seizure of rheumatism, but it had been so slight as to raise a doubt as to its causal relationship to the existing heart disease.

An examination of the urine gave negative results; there was præcordial oppression complained of; the carotid pulsations were exaggerated, but no noises in the ears and no headache. A physical examination of the heart revealed only a bruit, nothing definite being made out, as the pulse was 180 per minute and temperature 100° F.

Digitalis was given and two days after temperature was normal and pulse 70. An examination of the heart revealed a pre-systolic and a systolic apex murmur, showing the existence of both stenosis and insufficiency of the mitral valves. Perfect rest and quiet was ordered, but the patient feeling so much better got out of bed and fainted. The pulse showed but 53 beats per mintue, and there was intense pain in both lower extremities, with impaired sensation. The cause was at once supposed to be an embolus probably occluding the abdominal aorta at its bifurcation. Morphia carbonate of ammonia was administered with whisky. The pain continued in spite of the large doses of morphine, and the legs were swollen, cold to the knees, and the capillary circulation much impaired. Two days afterward the temper

ature was 99, pulse 72 and the capillary circulation was somewhat improved, especially in the left leg, but the toes of the right foot were discolored and gangrenous bulla appeared on the dorsal surface of this foot. This discoloration gradually extended over the entire right foot, and in about a week the pain had increased greatly in the region of profundus femorus of right side. The gangrene had so extended that on the outer aspect of the leg it had reached to within three inches of the knee joint, the toes being shriveled and presented the appearance of dry gangrene. Sorder had appeared upon the teeth and lips and this condition continued for some days when the patient became restless, and for the first timo since attacked his mind wandered. The urine was scanty and the specific gravity was 1024. There was no albumen or tubecasts or other evidences of derangement of kidneys.

In about a little over a month the patient died, the pulse before death rising to 200 and temperature to 106. The legs were much swollen, did not pit on pressure, and the gangrene had extended over an ill defined line of demarcation on the inner aspect of the leg, spreading over the lower and inner portions of the thigh.

At autopsy, upon opening the abdomen and exposing the abdominal aorta it was found to be filled with a firm, buffy, fibrinous clot which had lodged at its bifurcation. Secondary thrombi had formed, extending up the abdominal aorta as high as the inferior mesenteric artery, and down the left common iliac to ts bifurcation. On the right side the common iliah, the external iliac, the femoral and the popliteal down to the gangrenous mass, was shrunken to one-half or two-thirds its normal size and its lumen completely filled by a clot with pigmentary deposits in the greater portion of it.

A CASE OF INTUSSUSCEPTION. W. E. Martin, M. D. Nashville Journal of Medicine and Surgery.-A colored man, aged 60 years, was attacked with what was suppased to be bilious colic and treated for same for over two months without much relief, as he still continued to suffer with paroxp.ms daily, experiencing intense pain in the region of the liver and stomach.

The patient having taken thirty ffrains of calomel through a mistake, and being called to see him, found that this dose had failed to produce a fæcal discharge from the bowels; although he had been having mucous discharges previously, thts continuing with the exception of one night when he had several hæmorrhages from the bowels. It had been some days since he had had any fæcal discharge, and the bowels were greatly distended and tympanitic, but there was no tenderness or tumor noticeable.

The contents of the stomach were continually vomited, and this was absolutely void of fæcal matter. The tongue was coated with a moist, white fur; kidneys acted well all the time; urine was of normal color, and there was no fever or acceleration of pulse. He was given enemas of hot water and glycerine, with hypodermic injection of morphia, with liquid. food diet.

For four weeks the man continued under this treatment and at the end of that time he had a copious discharge of fœcal matter from the bowels, after which all distention and tympanitis had disappeared, but he sank rapidly and died three days afterward.

An autopsy showed twelve inches of the ileum in