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The mental effect of the agitation which has for some timebeen going on in the religious world with regard to dogmatictruth is already obvious to the physician engaged in the treat-ment of disorders of the mind. This is manifested in a greatincrease of disturbed aud abnormal physical conditions, andpalpable deviations from nervous and mental health, clearlytraceable to perturbations of thought on controversial theo-logical questions. The understanding, when directed to thecontemplation of subjects which have an intimate relation toman’s moral obligation to his neighbour and his duty to God,is staggered by the constant discrepancy of opinion propoundedon these important points. If such be the fact when this

polemical contest is restricted to matters which to a degreemay admit of easy solution, how serious must be the result tothe intellect when this violent combat of ideas and strugglefor religious supremacy involves in its issue essential doctrinesof revealed truth, upon which the whole superstructure of theChristian’s faith and hope has from early childhood beenbased.

Is it possible to enter upon a discussion of this nature with-out viewing it in close alliance with the varied physical andmental changes which it may, either for good or evil, giverise to ?The religious element is to the great majority of mankind

part and parcel of their existence. Serious thought withregard, to the present life, and grave contemplation in refe-rence to a future state, are to this class subjects of deep andabiding interest.Need we, then, be surprised at the amount of brain and

mental disturbance which has invariably accompanied all

great religious convulsions? It is impossible to excite acri-monious disputations in regard to what constitutes Divinetruth, or to introduce strange heresies into such controversies,thus unsettling the mind as to the soundness of an accepted,recognised, and orthodox faith, without serious risk to thehealth of the brain. All violent and sudden transitions fromone form of faith to another, unless based upon strong religiousconvictions and scriptural truth, are fraught with great perilto the intellect. Deep-rooted impressions, a firm belief in andearnest adherence to particular theological theories, cannotwith safety be tampered with. Any attempt to insidiouslyand fanatically undermine the foundation upon which reli-

gious hope has for centuries been reared must be associatedwith marked physical changes and consequent intellectual andmoral modifications.

It is a well-established fact that the peculiar characteristicsof insanity are singularly modified by the religious persua-sions, the philosophical opinions, superstitious ideas, or socialprejudices of the age in which the disease develops itself.This was remarkably the case in the fifteenth century, towhich Calmeil directs the especial attention of psychologists.The mental derangement that manifested itself at that epochwas peculiarly significant of the superstitious ideas and thetheological doctrines then in repute. These doctrines had,according to Calmeil, been exhibited, developed, and defendedin the schools, taught in religious houses, explained to every-one from the pulpits, and amply commented upon to all thefaithful at the confessional. Persons who then lost their reasonalmost always erred in ideas or sensations relative to demons,angels, supernatural beings, just because such subjects werefamiliar to them, and had made a deep impression upon theirminds and imaginations. It is certain that the inquisitors,who in many places performed the functions of judges, acceptedas facts the most improbable and atrocious assertions. They,indeed, went much further than this; for they often obligedthe insane to unfold the symptoms of their disease in themidst of torture, and afterwards sent them to finish their livesat the atake.

(To be continued.)

IRIDECTOMY IN FRANCE.—M. Fano has published inL’Union Médicale series of cases of glaucoma (April 11thand May 9th, 18G7), and concludes therefrom:—1. That theexcision of a fragment of the iris C8.nn.ot be looked upon as ameasure calculated to effect a cure of chronic glaucoma. Theoperation is a mere palliative, and does not lead to a radicalcure. 2. That iridectomy retards the progress of the diseasewhen the latter is not far advanced. 3. That favourable re-sults are to be expected when the disease is not of old standing.4. And that, although iridectomy only acts as a palliative, theoperation may be had recourse to, in the absence of any othermeans of restoring or improving sight, when the eye is affectedwith glaucoma.

A MirrorOF THE PRACTICE OF

MEDICINE AND SURGERYIN THE

HOSPITALS OF LONDON.

LONDON HOSPITAL.

OVARIOTOMY; ADHERENT MULTILOCULAR OVARIAN CYST,TWICE TAPPED; RECOVERY.

(Under the care of Mr. CURLING.)

Nulla autem est alia pro certo noscendi via, nisi quamplurimas et morborumat dissectionum historias, tum aliorum, tum proprias collectas habere, et interse compare.—MORGAGNI De Sed. et Caus. Morb., lib. iv. Procamium.

THE patient whose case is here related had been twice

tapped before ovariotomy was performed. Fortunately, how-ever, the adhesions which existed, although extensive, wereeasily broken through. The notes are furnished by Mr. JamesAdams.

Grace G-, aged twenty-one, from Cornwall, was admittedon the 12th of March, 1867. About thirteen months beforeadmission the patient, who had previously enjoyed good health,was attacked with an acute pain in the abdomen, which tookplace suddenly on pulling on her boots to go to church, andlasted for a few days. Dr. Head, who examined the patientafter her admission, supposed that this attack of pain arosefrom the enlarged ovary being then pressed upwards into theabdominal cavity. About four months afterwards she per.ceived the abdomen to be increasing in size, and suffered occa-sional pains there, especially on the right side, but was other-wise well, and menstruated regularly for the first three monthsafter the commencement of the swelling. By the end of sixmonths the tumour had attained a large size, and was tappedby Mr. Michell, of Redruth, when about three gallons and ahalf of dark-coloured, viscid fluid were drawn off. The fluid

rapidly reaccumulated, and in about a month after the tumourwas as large as ever. A second tapping was performed a weekbefore her admission, but only two quarts of dark-coloured,viscid fluid could be removed.

On her admission the tumour was very large, pressing upthe thoracic viscera, and causing the apex of the heart to beatabove the left nipple. The whole of the abdomen was dull,and fluctuated from side to side. Slight anasarca.of the lowerlimbs. The patient ate and drank fairly. No albumen in theurine. Cheerful, and anxious to undergo the operation.On March 15th, Mr. Curling performed the operation of

ovariotomy in a by-ward, the temperature of which was keptat 70° Fahr. Besides the medical staff, a limited number ofdressers were present, care being taken to prevent .the admis-sion of anyone who had been in the dissecting or post-mortemrooms. The early steps of the operation were as usual, withthe exception of the incision being somewhat higher, beingcarried about an inch above the umbilicus. It was aboutfive inches in length. This disclosed a large cyst, having ex-tensive though slight adhesions to the abdominal wall in front.These were broken through with the hand ; and the cyst wastapped with Wells’s trocar, and about a pailful of fluid removed,none escaping into the abdomen. The walls of the cyst wereseized with strong forceps, and dragged out, bringing into viewsome smaller cysts and solid growths within; and thus thepedicle of the left ovary was reached. This was secured byChambers’s cautery clamp, and the pedicle was divided byknife-shaped hot irons. As free bleeding occurred from severalvessels, an ordinary clamp was applied; but as the end of thepedicle could not be secured in this way outside the abdomenwithout considerable tension, the pedicle was transfixed by a

I double ligature, which was tied on either side. The ends of, the ligatures were brought out so as to secure the pedicle closeto the abdominal wall. The wound was then accurately closedby deep and superficial sutures. A broad flannel bandage was

placed around the abdomen, and the patient placed in a care-fully warmed spring bed. During the operation the intestines

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were freely exposed, and some blood escaped into the peritoneal Icavity, but was carefully sponged up. Some omentum adherentto the upper part of the cyst had been torn away; and anomental vessel, which bled freely, was at first cauterised, andthen tied, the end of the ligature being left out at the wound.

Shortly after the operation the patient began to vomit, andcontinued to do so frequently until the morning of the 18th.During this time enemata of brandy and beef-tea were ad-ministered, the first one containing also forty minims of tinc-ture of opium. Ice, brandy, milk, and champagne in smallquantities were occasionally taken by the mouth when thevomiting was at all less frequent.

March 18th. -The vomiting has ceased. No pain or tender-ness in the abdomen; tongue red and dry in the centre. (Forstate of pulse, temperature, and respiration, see table.) Takesa fair quantity of fluid nourishment. In the evening she wascomfortable, and slept several times.19th.-About five o’clock this morning she was seized with

violent pain in the epigastrium, with much tenderness; butthis was strictly confined to that region, and was no doubtexplained by the fact of her having taken more than thestomach could digest. She was relieved in a few hours by amustard plaster. After this, one or two more nutritive ene-mata were administered. Later in the day she was muchbetter, the bowels acting twice of their own accord. Tonguerather coated, but moist. Takes fluid nourishment at regularintervals.On the 22nd the deeper sutures were removed. The edges

of the wound had united along the middle, there being oneligature hanging out towards the upper part (from omentum),and the main ones from the bottom. One of the lower onescame away. On the 28th the discharge from the bottom ofthe wound became very copious and slighty tinged with blood;and on the following morning (fourteen days after operation)the main ligature came away, followed by the discharge of alarge quantity of pus. The single ligature towards the upperpart remained firm up to the 3rd of April, when it came awayafter being attached for a few hours to a piece of elastic. Inthe mean time there had been a return of vomiting for twenty-four hours, the matter vomited being tinged with green.On April 5th she appeared to be very well constitutionally,

eating and drinking very fairly, and gaining strength; butabout the centre of the wound, or rather cicatrix, there was acircular hole nearly as large as a shilling and about half an inchdeep, with very pale edges, which discharged unhealthy pus.To this was applied a solution of nitrate of silver (twenty grainsto the ounce) several times, and cotton wool dipped in a solu-tion of the same (two grains to the ounce) was kept appliedto it ; and on the following day all tension was removed fromthe edges by gently approximating them with a piece of strap-ping. In a few days the wound assumed a more healthy cha-racter, and the patient was able to sit up for several hours aday, and continued to gain strength rapidly. She was dis-charged cured on April 26th, exactly six weeks after the opera-tion.

ST. BARTHOLOMEW’S HOSPITAL.A CASE OF SUN-STROKE; DEATH IN FORTY HOURS.

(Under the care of Mr. HOLMES COOTE.)

WELL-ATTESTED cases of insolation are sufficiently rare in

England to make the following worth recording. On the same

day (May 6th) there were other cases of sudden or rapid deathin the streets of London which were attributed to a similarcause. Mr. Cuddeford, house-surgeon, has obliged us withthe following notes.

’ W. R--, aged twenty-six years, was admitted April 20th,suffering from a fistulous opening, leading down to bare bone,on the ilium. He had been ill for fourteen months. Hishealth was very little affected, and he was in the habit ofwalking daily in the hospital square.On the morning of May 7th Mr. Cuddeford was sent for to

see him, and found him lying in bed apparently asleep. Onbeing spoken to, he opened his eyes, but did not answer anyquestion. He put out his tongue when requested. His facewas flushed ; skin perspiring ; pupils had no unusual appear-ance ; tongue clean; pulse 140, rather feeble ; respiration shal.low, 40 per minute ; head very hot. Ice was ordered to beapplied to the head, and six grains of powdered jalap and threegrains of calomel to be taken immediately.

It seemed that on the previous day (Monday, May 6th),which was excessively hot, the temperature being at 84° in theshade, he had walked in the hospital square between threeand four o’clock in the afternoon. After returning to theward. he remarked to one of the nurses that all the seats wereoccupied, and he had been obliged to walk about in the sun,and had felt a slight headache. He went to bed a little earlierthan usual, and seemed to sleep quietly. He asked for anddrank some water twice during the night; and about tenminutes after taking the second draught, he vomited whatseemed to be nothing more than the water he had taken; thenurse, however, did not notice that he was ill. In the morn.ing, the sister of the ward, not being able to arouse him ormake him speak, sent for the house-surgeon. He had had noshivering.

In the middle of the day he was seen by Mr. Coote, andafterwards by Mr. Wood, the resident apothecary, and hadan enema of ordinary house physic, which had the effect ofbringing away a large quantity of dark, unhealthy-lookingfaeces. He also had a blister applied to the back of the neck.The patient, however, got no better. At five P.M. he wasrestless, moving his arms continually about. He opened hiseyes occasionally when addressed, but made no attempt tospeak. He would not now put out his tongue. The conjune-tivæ were slightly suffused; pupils of ordinary size; face muchflushed; skin perspiring; pulse 135, feeble, somewhat irre-

gular ; respiration 50 ; base of right side of the chest dull onpercussion, with moist crepitation. He had not been sick, anda. fair amount of pourishment had been given him- At twelveP.M. his condition was nearly the same as just described,except that he had been convulsed three or four times, not,however, in a very violent manner. He gradually becameworse, the convulsions becoming stronger, and he died at eightA.M. on the 8th of May.

Autopsy, fourteen hours after death.—The longitudinal sinuswas full of blood, the vessels of the dura mater much con-gested, and the whole surface of the brain more or less injected,especially at the base. There was what seemed to be serouseffusion underneath the pia mater, and at the base was a con-siderable effusion of recent lymph. There were some pointsof congestion in the substance of the brain ; but there was noeffusion into the ventricles. The chest was not opened ; butthere was evidently congestion of the lungs from the physicalsigns.

Provincial Hospital Reports.HUDDERSFIELD AND UPPER AGBRIGG

INFIRMARY.MUTILOCULAR OVARIAN CYST ; TWO TAPPINGS ; OVA-

RIOTOMY ; RECOVERY.

(Under the care of Mr. KNAGGS.)As in Mr. Curling’s case, the patient in this instance had

been twice tapped before the ovary was removed. For noteswe are indebted to Mr. Thomas Brewer, house-surgeon.M. M— -ways admitted in August. 1865. She had been

previously tapped in another infirmary, but no large quantityof fluid escaped. On the 20th of August Mr. Knaggs tappedher with Mr. Spencer Wells’s trocar, and drew off from threedifferent cysts about five gallens of tizich gelatinous fluid. She