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to the irritation of ligatures which were placed on the stumpof omentum; the latter, moreover, was drawn up so as toclose the abdominal ring. If I had left the omentum inthe wound, and not cut it off, as in Dr. Tibbits’ cases, therewould not have been sufficient skin to cover the mass, whichwas very large. Absence of peritonitis after the operationproves that the ligature had no irritating effect upon theomentum.

Staveley, Chesterfield, July, 1870.

A MirrorOF THE PRACTICE OF

MEDICINE AND SURGERYIN THE

HOSPITALS OF LONDON.

GUY’S HOSPITAL.CASE OF APHASIA CONSEQUENT ON FRICHT.

(Under the care of Dr. HABERSHON.)

Nalla autern est alia pro certonoseendi via, nisi quamplurimas et morborumet dissectionum historias, turn aliorum, tum proprias collectas habere, etinter se comparare.-MORGAGNI De Sed. et Caus. Morb., lib. iv. Proœmium.

,THREE weeks before admission, the patient, seeing one ofher children scald herself, ran and caught her in her arms;and then, having handed her to another person, imme-diately lay down, and from that time remained for threedays motionless, unconscious, and without food. She mut-tered occasionally; and her general appearance is describedas being "dreamy:’ The first thing she remembered wasa doctor being called in on the fourth day, when she re-covered sufficiently to walk about, and to understand whatwas said to her. From that time she is said to have verygradually improved. On admission she could say two orthree words very imperfectly, her pupils were equal, andher physical powers unimpaired. On being questioned, sheindicated that she had great pain at the vertex of the head;when put to bed she lay quite passive. Three days after-wards she appeared perfectly intelligent, but replied toalmost everything, sometimes with a little hesitation,Yes ’m"; sometimes, however, to a question requiring anegative reply, two or three times repeated, she succeededin answering "No m’m"; and once or twice she, with greateffort, and after some failures, expressed one of the first twoor three numerals, but days, weeks, months, and years werequite beyond her utterance, and, after several despairingshakes of the head, a great effort would end in the almostinvariable" Yes’m." She remained quite unable either toread or write. In five days more the pain in the head wasless severe; she could make almost any reply requiring nomore than two or three short words, but the interrogatorwas still addressed as " Mum." She also read one or twoshort words correctly, and was able to write her name dis-tinctly. When again seen four da,ys later, she was walkingabout the ward apparently in perfect health. She still com-

plained of pain at the top of the head ; and though hervocabulary was limited, and her speech sometimes hesitat-ing, she was in a fairly convalescent condition.

Dr. Habershon remarked that this case, in which therewas no evidence of anything more than some disturbanceat the vertex, did not, so far as appearances went, confirmthe theory of the localisation of the lesion producing aphasia.He also added, that the account which they had been ableto obtain left it a,n open question whether the seizure whichushered in the affection had been epileptic.

ILL EFFECTS OF CHLORAL ; CLINICAL REMARKS.

(Under the care of Dr. HABERSHON.)

A patient of Dr. Habershon, affected with aneurism ofthe thoracic aorta, suffering great pain and occasionalattacks of dyspnœa, was ordered hulf a drachm of chloralat night, with a view to giving relief and procuring sleep.He became unconscious immediately after swallowing thedraught; the face and hands turned livid and cold, and he

breathed only at long intervals; indeed, for about fivehours, death seemed to be impending. In the course of thenext day, however, he had so far recovered as to be to allappearance none the worse for the dose. Dr. Habershon saidthat this was the first time he had administered chloral toa patient suffering from aneurism, and that the result con.firmed the opinion ha had formed from observation of itseffects in cases of pneumonia and bronchitis, that, throughthe means of the pneumogastric nerve, it had a tendency toproduce congestion of the bronchial tubes and the lunggenerally, and is not a suitable medicine in cases where tharespiration is liable to embarrassment.

A CASE OF CONTRACTED MITRAL ORIFICE ; PLUGGING OFTHE LEFT FEMORAL ARTERY ; DEATH.

(Under the care of Dr. HILTON FAGGE.)The following account is gathered from notes by Mr.

William Greaves.The patient was twenty-six years of age; her father died

of phthisis, her mother died suddenly from some unascer-tained cause ; her four brothers and four sisters were allsaid to be healthy. She herself had always enjoyed goodhealth until she had a severe attack of " brain fever" two

years previously, since which she had led a laborious lifeas servant, and had had frequent attacks of "biliousness,"accompanied by headache and vomiting. During the sixweeks immediately preceding admission, the attacks ofheadache and sickness had become much more frequent;she lost strength and flesh, though her food was sufficient,and her legs swelled and became painful at night. Four

days before admission, while out walking, she was seizedwith cramping pain down the whole of the left leg, and wastaken home in a cab. The leg, ankle, and foot becamepainful, numb, and cold; loss of appetite, feverishness, andwandering followed, and finally she was brought in an ex-hausted condition to the hospital. She then complained ofcoldness and numbness of the left leg, which was found tobe osdematous from below the knee, and very tender onpressure. No arterial pulsation could be detected belowPoupart’s ligament. There was no paralysis. The heart’s

apex was a little lower than natural, and a presystolic bruit,not increased towards the left side and axilla, was audibleat the apex. The leg was wrapped in cotton wool and ablanket, and raised on a pillow. Although after admissionthe limb resumed its natural temperature, it remainedso acutely painful that, in spite of opiates administeredby the mouth, and hypodermic injections of morphia,the patient could get no sleep. During the night of thesecond day she had a severe attack of dyspnœa. On thethird day the face wss observed to be slightly drawn to theright side; the tongue could not be protruded beyond thelips, and there was complete loss of power of the left armand hand; the pupils were closely contracted. She passedher water and motions in bed, and was rambling, restless,and irritable, but recognised her friends.On the following day the mental confusion had passed

off, and there was a partial return of power in the affectedarm and hand. On the night of the fifth day the deliriumreturned, and on the sixth morning, though the thigh waswarm, the temperature of the leg from the knee downwardswas lower than natural. Along the outer side of the lowerthird of the leg ran a line of bluish cuticle, from one to twoinches in breadth; with the exception of a similar bluishpatch on its outer side, the foot was white and waxy, thetoes, also, were discoloured, and the power of sensation inthem so far impaired that the patient was unable to decidewhich of them was touched. The limb was wrapped in lintsoaked in carbolic oil (of the strength of 1 in 20), and incotton-wool and blankets. The condition of the affectedhand and arm continued to improve. After this the pain inthe leg very much abated, and she passed a good night the seventh morning found her much ralieved as to the pain,but flushed, and breathing forty times to the minute.On the ninth day there was a sensation of pins and

needles in the f.ot, and the heel was found to have becomelivid. During the night she was once more seized with dis-tressing dyspnœa, and on the following day the paiu in thelimb was increased, and she became anxious and irritable.Throughout the eleventh day the dyspnoa was very

urgent, and the patient was drowsy ; an examination of thechest revealed, no lung mischief. The dyspnœa increased