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BIRMINGHAM WORKHOUSE INFIRMARY.
1276
family. His father and mother were both alive; the father Whilst taking it he had a severe fit. Mr. Pick trephined enjoying good health, the mother suffering from occasional the skull at a spot over the lower and anterior portion of attacks of gout and rheumatism.
He has ten brothers the fissure of Rolando. A portion of bone, about one inch alive-eight perfectly healthy, one deaf with the left ear, and a half in diameter, was removed. Upon its removal and one slightly deaf occasionally ; he has four sisters alive, the dura mater was noticed to bulge very considerably into and all perfectly healthy. One brother died at the age of the trephine hole. Iwas incised through about two-thirds three of whooping-cough. He has had measles and of the circumference of the opening. The brain substance whooping-cough, but no other diseases. When about five now protruded somewhat, and the convolutions looked or six he fell off a chair, causing a scalp wound, of which flattened, but otherwise nothing abnormal was observed. the scar remains visible on the left temple. From eighteen The brain substance was punctured in three different situamonths to two years ago he had a fight with another boy; tions with an exploring syringe, one puncture being made he says they both fell together and that he was underneath. into the lateral ventricle, but no fluid was found. The This rendered him insensible, and he remained in an un- dura mater was now replaced and stitched in position, and conscious state for twenty minutes. The patient’s brother the wound closed and dressed. On the following day he was reported to have slept well, says he was dull afterwards and complained of giddiness, but there was no vomiting. This condition lasted for and to have had no more fits. His temperature was normal. fourteen days, when he had a fit. The brother describes the On April 6th the boy seemed quite bright and happy. He fit as follows: "He clenched his left hand, which was had recovered the complete use of his left arm, hand, and trembling; his head was turned to the left, and remained so fingers. On the 13 ch the wound was dressed ; it was quite during the fit ; there was nothing unusual noticed about the healed. The stitches were removed and a gutta-percha cap - eyes ; the attack did not affect the legs." He recovered fitted, as there was considerable pulsation of the brain at completely after the first fit, but had a second and a third, the seat of the operation. The sense of smell, which was all of the same character, with half an hour’s interval between somewhat defective when he was admitted, now appeared each. He was brought to the hospital and admitted as an to be perfect. On the 22nd he was discharged quite well. Remarks by Dr. PENIROSE,.-This case is involved in in-patient. He remained in the hospital for a week, during which time he had only one fit, on the day of admission. considerable obscurity, both as regards the cause of From this time until four days before readmission he has had the fits and as to the way in which the operation several fits, all of the same character, with long intervals relieved the patient. From the character of the fits it between each. He has always been a bright, intelligent seemed fair to conclude that there was some irritaboy, and there seems to have been no diminution in this tion of a definite area of the cerebral convolutions respect since the advent of the fits. Some time ago he was in the neighbourhood of the fissure of Rolando; and knocked down by a cart and was brought to the hospital from the fact that the symptoms followed within a fortinsensible, with a wound over the right eye, the scar of night after a severe injury to the head, severe enough to which is still visible. On March 27th (four days before produce concmsion, there seemed reason to believe that admission) he played football; afterwards he had a fit, and this injury was the cause of the irritation. It was taking it was then observed that his left leg "shook," as well as this view of the case that induced me to recommend the his arm. His left arm then became useless, and has re- operation of trephining. But on the removal of the bone mained so. On the following day (March 28th) he had six nothing abnormal could be discovered, beyond the bulging fits in rapid succession; and on the day before admission he of the dura mater and the flattening of the convulsions. had four or five fits, which commenced with shaking of the Nevertheless, it can scarcely be doubted that, in some way left hand, which he asked his brother to hold, followed by or other, the operation relieved the patient, since his last fit was on the operating table prior to the commencement .shaking of the left leg. When the boy was admitted he complained of pain in of the operation. After the removal of the bone and the the leftside. The left arm was perfectly flaccid. The incision of the dura mater, without anything having been eyes were normal, and there was no loss of sensa- found to account for the fits, it was thought possible that tion. Abdominal, cremasteric, and plantar reflexes there might be some collection of fluid either in the -good and equal. Knee-jerks equal and normal; no ankle ventricles or in the substance of the brain, as there was clonus. He had a fit at 4.40 P.M., which began by trembling undoubted flattening and bulging of the hemisphere where of the left arm, and then the leg, which was flexed on the it was exposed. No such collection was found, nor probably thigh and rotated outwards. His left arm was drawn did it ever exist, seeing that the boy was entirely relieved towards the median line, and seemed rather stiff; the thumb by the operation. was adducted, the second and third fingers extended, and the ring and little fingers flexed; the hand was flexed BIRMINGHAM WORKHOUSE INFIRMARY. somewhat on the forearm. The shaking at first was not A CASE OF PERITONITIS FOLLOWING PARTURITION; very marked, then became more so and jerky, and finally REMOVAL OF RUPTURED PYO-SALPINX; RECOVERY. became violently jerky. His face was flushed, but not cyanosed. The head was turned to the left, the eyes to the (Under the care of Mr. E. TEICHELMANN, medical officer.) right; the pupils were contracted. He remained perfectly THIS case presents a most unusual and interesting condition, sensible, and complained of pain, but could not tell where the pain was. The pulse was intermittent. There was no and the success which attended the treatment is one on which -involuntary discharge of faeces or urine. The fit lasted two we must congratulate the operator. It is evident that the minutes, and the boy seemed very exhausted afterwards, patient had a chronic pyo-salpinx on the right side, which and sweated profusely. Twenty minutes before each fit the acute peritonitis for which the there was an aura, which he describes as a numbness of the ruptured, causing was performed. It is further probable that operation lefb side, arm, leg, and face, with frontal headache. after the uterus contaminated from the became parturition March 31st he had fits, altogether twenty-four During contents of the dilated the and which lasted on an average about two minutes each, tube, septic condition of the uterus again increasing the acuteness of the tubal mischief, were similar in character to the one described above. On April 1st (the following day) he had altogether and thus leading to its rupture. Although in this case no twenty-three fits, some of them of greater severity and definite history of gonorrhoea could be obtained, it is not more prolonged than those of the previous day. On the unlikely that the pyo-salpinx was of gonorrbceal origin. 2nd up to 4 P.M. he had sixteen fits. He then had Mr. Teichelmann is, however, inclined to believe that a a series of fits in rapid succession, lasting from 4 P.M. till pyo-salpinx is not so frequently of gonorrhceal origin as 4.45, when he was placed under the influence of chloroform; gynaecologists would have us believe. The prolonged and while under the anaesthetic, with pupils contracted, he had tedious recovery was no doubt due (apart from the nature of another fit, affecting the arm only. He had no more fits the case) to the extremely anæmic and collapsed condition after his recovery from the anaesthetic until 3 A.M. on the of the patient previously to the operation. A. R——, aged twenty-two, housekeeper, a widow, was morning of the 3rd, when he had a severe one, lasting four minutes. During this day he had four more fits, but they admitted to the lying-in ward on the night of Dec. 31st, were of unusual severity, and lasted considerably longer 1890, having been in labour for three days. The patient than those of the previous day. was a pale, slight woman, with feeble pulse and hsemic On the morning of the 4th he was reported to have been murmur. Her previous history showed excessive menstrual suffering from a constant succession of fits during the night. pain from the seventeenth year, the lasting from At 9 A.M. he was placed under the influence of chloroform. five to seven days, and being attended by considerable loss. ___________
periods
1277 was there any vaginal discharge between her could any facts pointing to gonorrhceal infection ,periods, be elicited. In August, 1890, she became very ill, and was ’Col3fined to bed for three days. She suffered from severe abdominal pain, which began in the right iliac region, and later on involved both sides. This pain, however, was .always referred by the patient to the site of its commencement, and attained its maximum at the same spot. For the month previously to admission she scarcely left her bed, .and during that time she felt feverish, vomited much, and suffered from the excruciating abdominal pain above described. At the same time her abdomen became distended, and she could feel a tender lump on the right side of the
At no time nor
,pregnant uterus. took
Delivery place a few hours after admission, and was ,followed by considerable haemorrhage. This was continuous Her temperature and the discharges became fetid. .gradually rose, and in spite of antipyretic treatment and frequent vaginal douches of perchloride of mercury, on .Jan. 7th, seven days after delivery, it reached 104:°. On that day Dr. Robertson, the surgeon in charge of the lying-in departmen6,:asked Mr. Teichelmann to see her. On examination, he found the uterus large, reaching nearly to the umbilicus, and tender on palpation, the cervix lacerated .and freely open. Some retained placental tissue was removed by the curette, and the uterus washed out
quite well since leaving the hospital seven months ago.
The had a red rash abonb and feeble marasmic, very child its nates, and died when seven weeks old. The Fallopian tube on examination showed old fibrous adhesions, as well as recent adherent lymph, and the occlusion of the abdominal end was evidently of old standing, there being The rupno traces of fimbriæ left on its external surface. ture in the wall of the dilated tube appeared to have been of recent origin, the margins of the opening being slightly was
sloughy.
___
___
___
Medical Societies. PATHOLOGICAL SOCIETY OF LONDON.
Dilatation of Sphenoidal Sinus, into which the Left Internal Carotid Artery opened. -Imperforate Rectum ajter Exploratory Operation.-Implantation Cyst from Ox.Pigmentation of Glans in Negro after Circumcision.Nodular Hepatic Cirrhosis.-Cerebral Softening and Hœmorrhage associated 2vith Endocarditis. AN ordinary meeting of this Society took place on Dec. 1st, the President, Sir George Humphry, in the chair. - with hot corrosive sublimate solution, 1 in 2000. From Dr. J. J. CLARKE showed a specimen of Dilated Sphenoidal that time all hæmorrhage ceased, and the temperature Sinus from a boy aged thirteen ; from the anterior part of ’fell to normal by next morning, at which point it it was growing a small polypus, which proved micro. remained for two days. Then it rose again to 103°, and on scopically to be myxoma. The point of chief interest was Jan. 12th she complained of great pain in the right iliac that there was an oval opening, one millimetre in diameter, region, for the relief of which counter- irritation (blister) and communicating with the left internal carotid artery. Some an aperient were ordered. The symptoms increased in well-marked pharyngeal adenoids were also present. Six ;severity, the vaginal discharge again became fetid, and on months before death he came to St. Mary’s Hospital with a the 13th the pain extended over the whole lower abdomen, fracture of the leftfrontal bone. He went out well, but while a distinct fulness could be made out in the right iliac returned two months later, complaining of frequent ’fossa. attacks of epistaxis; there was no history of nose-bleeding On the 14th Mr. Teichelmann again saw her, in consulta- before the accident. A violent attack killed the boy tion with Dr. Robertson. Her temperature was 104: 6°; in a few minutes, and at the necropsy, though two pulse small and rapid; she was excessively pale and ex- lines of fracture could be traced in the frontal bone, hausted, her legs were drawn up, and she was evidently there was none in the direction of the sphenoidal sinus. suffering from general peritonitis. The doughy mass which The sinus itself was occupied by clot, and the carotid prenow filled up the right iliac fossa was thought to be prosented no morbid change other than the perforation already bably intestine adherent around a pyo-salpinx, which subse- described. The mucous membrane lining the sinus was thin, and in some parts the body of the sphenoid had disquently proved to be the case. In view of the urgency of the patient’s condition imme- appeared, the mucous lining and dura mater coming in condiate operation was recommended. Accordingly, in the tact. The cause, he thought, was a minute aneurysm absence of the visiting surgeon, on the same morning Mr. formed on the vessel as a result of a graze, and this slowly Teichelmann opened the abdomen in the middle line by a opened into the sinus. The polypus closed the orifice of two-inch incision midway between the pubis and umbilicus. the sinus in a valve-like manner, and thus explained the Division of the peritoneum was instantly followed by the intermittent epistaxes. No note was made of an intradischarge of thin serous pus. On examination by the cranial noise during life.-Dr. SCANES SPICER said that .fingers, the intestines in the lower part of the abdomen on there was only one recorded case, by Zuckercandl, of both sides were found glued together by recent lymph, myxoma of the sphenoidal sinus. He thought that These adhesions were carefully broken down, and over two aneurysm was the only lesion which would explain the pints of flaky, fetid pus escaped, a considerable collec- occurrence of the haemorrhage two months after the injury. tion being found more or less encysted on the right The sinus had evidently been prematurely expanded by the side. The left uterine appendages were then brought internal pressure to which it had been subjected. Myxomata up to the abdominal wound, and, being found healthy were very uncommon at the age at which this had occurred. except for some congestion of the serous membrane, The haemorrhage into the submucous tissue had probably were allowed to fall back into the abdomen. The right set up irritation, which had led to the myxomatous formaappendages were brought to the surface with more tion.-Dr. CLARKE, in reply, said that he had microscoped difficulty, owing to old adhesions which had to be the mucous membrane at a point not affected with the broken down. The right Fallopian tube was found to be myxomatous growth, and had found the epithelium reduced considerably dilated, occluded at its abdominal extremity, to a single layer of cells, and where the bone was underbut empty, there being a rupture in its wall large enough to going absorption there was a collection of giant-cells. admit the tip of the thumb. The broad ligament was Dr. CLARKE likewise exhibited a specimen of Imperforate ligatured, and the diseased tube and ovary removed. The Rectum, showing an accidental result of exploratory operaabdomen was then thoroughly washed out and the wound tion. The rectum ended as a blind extremity at about two sutured, a glass drainage-tube being inserted at the lower inches from the surface, and there was an anal dimple. A angle of the wound. puncture had been made with a trocar, which went through Next morning the patient expressed herself as feeling the lowest extremity of the rectum, puncturing it in two better than she had been for several days. The temperature places ; the puncture then went on into the peritoneum; a ’sank to normal, but shortly rose to between 101° and 103°; little meconium had escaped into this sac. The peculiarity and for several weeks recovery was very slow. There was of the case was that the child had died of haemorrhage, as no uterine haemorrhage after the operation, and the vaginal the sacra media had probably been wounded by the instrudischarge rapidly lost its fetid character. The glass ment. A large quantity of blood was found in the lower drainage-tube was replaced by an indiarubber one, the use end of the rectum, which had stripped up the mucous memof which was not finally dispensed with for three weeks. brane from the muscular coat, and had bulged the former About the end of that time rapid improvement set in, so upwards in front of it. The rectum not being found by that she left her bed on Feb. 22nd, and was discharged the puncture, an inguinal colotomy was performed, but cured on March 21st. the child died shortly afterwards. He held that this A few days ago (Oct. 15th) she returned to report herself. case showed that there was great danger to be feared She was in excellent health, and stated that she had been from using the trocar in these cases.—Mr. CRiPrs re-
family. His father and mother were both alive; the father Whilst taking it he had a severe fit. Mr. Pick trephined enjoying good health, the mother suffering from occasional the skull at a spot over the lower and anterior portion of attacks of gout and rheumatism.
He has ten brothers the fissure of Rolando. A portion of bone, about one inch alive-eight perfectly healthy, one deaf with the left ear, and a half in diameter, was removed. Upon its removal and one slightly deaf occasionally ; he has four sisters alive, the dura mater was noticed to bulge very considerably into and all perfectly healthy. One brother died at the age of the trephine hole. Iwas incised through about two-thirds three of whooping-cough. He has had measles and of the circumference of the opening. The brain substance whooping-cough, but no other diseases. When about five now protruded somewhat, and the convolutions looked or six he fell off a chair, causing a scalp wound, of which flattened, but otherwise nothing abnormal was observed. the scar remains visible on the left temple. From eighteen The brain substance was punctured in three different situamonths to two years ago he had a fight with another boy; tions with an exploring syringe, one puncture being made he says they both fell together and that he was underneath. into the lateral ventricle, but no fluid was found. The This rendered him insensible, and he remained in an un- dura mater was now replaced and stitched in position, and conscious state for twenty minutes. The patient’s brother the wound closed and dressed. On the following day he was reported to have slept well, says he was dull afterwards and complained of giddiness, but there was no vomiting. This condition lasted for and to have had no more fits. His temperature was normal. fourteen days, when he had a fit. The brother describes the On April 6th the boy seemed quite bright and happy. He fit as follows: "He clenched his left hand, which was had recovered the complete use of his left arm, hand, and trembling; his head was turned to the left, and remained so fingers. On the 13 ch the wound was dressed ; it was quite during the fit ; there was nothing unusual noticed about the healed. The stitches were removed and a gutta-percha cap - eyes ; the attack did not affect the legs." He recovered fitted, as there was considerable pulsation of the brain at completely after the first fit, but had a second and a third, the seat of the operation. The sense of smell, which was all of the same character, with half an hour’s interval between somewhat defective when he was admitted, now appeared each. He was brought to the hospital and admitted as an to be perfect. On the 22nd he was discharged quite well. Remarks by Dr. PENIROSE,.-This case is involved in in-patient. He remained in the hospital for a week, during which time he had only one fit, on the day of admission. considerable obscurity, both as regards the cause of From this time until four days before readmission he has had the fits and as to the way in which the operation several fits, all of the same character, with long intervals relieved the patient. From the character of the fits it between each. He has always been a bright, intelligent seemed fair to conclude that there was some irritaboy, and there seems to have been no diminution in this tion of a definite area of the cerebral convolutions respect since the advent of the fits. Some time ago he was in the neighbourhood of the fissure of Rolando; and knocked down by a cart and was brought to the hospital from the fact that the symptoms followed within a fortinsensible, with a wound over the right eye, the scar of night after a severe injury to the head, severe enough to which is still visible. On March 27th (four days before produce concmsion, there seemed reason to believe that admission) he played football; afterwards he had a fit, and this injury was the cause of the irritation. It was taking it was then observed that his left leg "shook," as well as this view of the case that induced me to recommend the his arm. His left arm then became useless, and has re- operation of trephining. But on the removal of the bone mained so. On the following day (March 28th) he had six nothing abnormal could be discovered, beyond the bulging fits in rapid succession; and on the day before admission he of the dura mater and the flattening of the convulsions. had four or five fits, which commenced with shaking of the Nevertheless, it can scarcely be doubted that, in some way left hand, which he asked his brother to hold, followed by or other, the operation relieved the patient, since his last fit was on the operating table prior to the commencement .shaking of the left leg. When the boy was admitted he complained of pain in of the operation. After the removal of the bone and the the leftside. The left arm was perfectly flaccid. The incision of the dura mater, without anything having been eyes were normal, and there was no loss of sensa- found to account for the fits, it was thought possible that tion. Abdominal, cremasteric, and plantar reflexes there might be some collection of fluid either in the -good and equal. Knee-jerks equal and normal; no ankle ventricles or in the substance of the brain, as there was clonus. He had a fit at 4.40 P.M., which began by trembling undoubted flattening and bulging of the hemisphere where of the left arm, and then the leg, which was flexed on the it was exposed. No such collection was found, nor probably thigh and rotated outwards. His left arm was drawn did it ever exist, seeing that the boy was entirely relieved towards the median line, and seemed rather stiff; the thumb by the operation. was adducted, the second and third fingers extended, and the ring and little fingers flexed; the hand was flexed BIRMINGHAM WORKHOUSE INFIRMARY. somewhat on the forearm. The shaking at first was not A CASE OF PERITONITIS FOLLOWING PARTURITION; very marked, then became more so and jerky, and finally REMOVAL OF RUPTURED PYO-SALPINX; RECOVERY. became violently jerky. His face was flushed, but not cyanosed. The head was turned to the left, the eyes to the (Under the care of Mr. E. TEICHELMANN, medical officer.) right; the pupils were contracted. He remained perfectly THIS case presents a most unusual and interesting condition, sensible, and complained of pain, but could not tell where the pain was. The pulse was intermittent. There was no and the success which attended the treatment is one on which -involuntary discharge of faeces or urine. The fit lasted two we must congratulate the operator. It is evident that the minutes, and the boy seemed very exhausted afterwards, patient had a chronic pyo-salpinx on the right side, which and sweated profusely. Twenty minutes before each fit the acute peritonitis for which the there was an aura, which he describes as a numbness of the ruptured, causing was performed. It is further probable that operation lefb side, arm, leg, and face, with frontal headache. after the uterus contaminated from the became parturition March 31st he had fits, altogether twenty-four During contents of the dilated the and which lasted on an average about two minutes each, tube, septic condition of the uterus again increasing the acuteness of the tubal mischief, were similar in character to the one described above. On April 1st (the following day) he had altogether and thus leading to its rupture. Although in this case no twenty-three fits, some of them of greater severity and definite history of gonorrhoea could be obtained, it is not more prolonged than those of the previous day. On the unlikely that the pyo-salpinx was of gonorrbceal origin. 2nd up to 4 P.M. he had sixteen fits. He then had Mr. Teichelmann is, however, inclined to believe that a a series of fits in rapid succession, lasting from 4 P.M. till pyo-salpinx is not so frequently of gonorrhceal origin as 4.45, when he was placed under the influence of chloroform; gynaecologists would have us believe. The prolonged and while under the anaesthetic, with pupils contracted, he had tedious recovery was no doubt due (apart from the nature of another fit, affecting the arm only. He had no more fits the case) to the extremely anæmic and collapsed condition after his recovery from the anaesthetic until 3 A.M. on the of the patient previously to the operation. A. R——, aged twenty-two, housekeeper, a widow, was morning of the 3rd, when he had a severe one, lasting four minutes. During this day he had four more fits, but they admitted to the lying-in ward on the night of Dec. 31st, were of unusual severity, and lasted considerably longer 1890, having been in labour for three days. The patient than those of the previous day. was a pale, slight woman, with feeble pulse and hsemic On the morning of the 4th he was reported to have been murmur. Her previous history showed excessive menstrual suffering from a constant succession of fits during the night. pain from the seventeenth year, the lasting from At 9 A.M. he was placed under the influence of chloroform. five to seven days, and being attended by considerable loss. ___________
periods
1277 was there any vaginal discharge between her could any facts pointing to gonorrhceal infection ,periods, be elicited. In August, 1890, she became very ill, and was ’Col3fined to bed for three days. She suffered from severe abdominal pain, which began in the right iliac region, and later on involved both sides. This pain, however, was .always referred by the patient to the site of its commencement, and attained its maximum at the same spot. For the month previously to admission she scarcely left her bed, .and during that time she felt feverish, vomited much, and suffered from the excruciating abdominal pain above described. At the same time her abdomen became distended, and she could feel a tender lump on the right side of the
At no time nor
,pregnant uterus. took
Delivery place a few hours after admission, and was ,followed by considerable haemorrhage. This was continuous Her temperature and the discharges became fetid. .gradually rose, and in spite of antipyretic treatment and frequent vaginal douches of perchloride of mercury, on .Jan. 7th, seven days after delivery, it reached 104:°. On that day Dr. Robertson, the surgeon in charge of the lying-in departmen6,:asked Mr. Teichelmann to see her. On examination, he found the uterus large, reaching nearly to the umbilicus, and tender on palpation, the cervix lacerated .and freely open. Some retained placental tissue was removed by the curette, and the uterus washed out
quite well since leaving the hospital seven months ago.
The had a red rash abonb and feeble marasmic, very child its nates, and died when seven weeks old. The Fallopian tube on examination showed old fibrous adhesions, as well as recent adherent lymph, and the occlusion of the abdominal end was evidently of old standing, there being The rupno traces of fimbriæ left on its external surface. ture in the wall of the dilated tube appeared to have been of recent origin, the margins of the opening being slightly was
sloughy.
___
___
___
Medical Societies. PATHOLOGICAL SOCIETY OF LONDON.
Dilatation of Sphenoidal Sinus, into which the Left Internal Carotid Artery opened. -Imperforate Rectum ajter Exploratory Operation.-Implantation Cyst from Ox.Pigmentation of Glans in Negro after Circumcision.Nodular Hepatic Cirrhosis.-Cerebral Softening and Hœmorrhage associated 2vith Endocarditis. AN ordinary meeting of this Society took place on Dec. 1st, the President, Sir George Humphry, in the chair. - with hot corrosive sublimate solution, 1 in 2000. From Dr. J. J. CLARKE showed a specimen of Dilated Sphenoidal that time all hæmorrhage ceased, and the temperature Sinus from a boy aged thirteen ; from the anterior part of ’fell to normal by next morning, at which point it it was growing a small polypus, which proved micro. remained for two days. Then it rose again to 103°, and on scopically to be myxoma. The point of chief interest was Jan. 12th she complained of great pain in the right iliac that there was an oval opening, one millimetre in diameter, region, for the relief of which counter- irritation (blister) and communicating with the left internal carotid artery. Some an aperient were ordered. The symptoms increased in well-marked pharyngeal adenoids were also present. Six ;severity, the vaginal discharge again became fetid, and on months before death he came to St. Mary’s Hospital with a the 13th the pain extended over the whole lower abdomen, fracture of the leftfrontal bone. He went out well, but while a distinct fulness could be made out in the right iliac returned two months later, complaining of frequent ’fossa. attacks of epistaxis; there was no history of nose-bleeding On the 14th Mr. Teichelmann again saw her, in consulta- before the accident. A violent attack killed the boy tion with Dr. Robertson. Her temperature was 104: 6°; in a few minutes, and at the necropsy, though two pulse small and rapid; she was excessively pale and ex- lines of fracture could be traced in the frontal bone, hausted, her legs were drawn up, and she was evidently there was none in the direction of the sphenoidal sinus. suffering from general peritonitis. The doughy mass which The sinus itself was occupied by clot, and the carotid prenow filled up the right iliac fossa was thought to be prosented no morbid change other than the perforation already bably intestine adherent around a pyo-salpinx, which subse- described. The mucous membrane lining the sinus was thin, and in some parts the body of the sphenoid had disquently proved to be the case. In view of the urgency of the patient’s condition imme- appeared, the mucous lining and dura mater coming in condiate operation was recommended. Accordingly, in the tact. The cause, he thought, was a minute aneurysm absence of the visiting surgeon, on the same morning Mr. formed on the vessel as a result of a graze, and this slowly Teichelmann opened the abdomen in the middle line by a opened into the sinus. The polypus closed the orifice of two-inch incision midway between the pubis and umbilicus. the sinus in a valve-like manner, and thus explained the Division of the peritoneum was instantly followed by the intermittent epistaxes. No note was made of an intradischarge of thin serous pus. On examination by the cranial noise during life.-Dr. SCANES SPICER said that .fingers, the intestines in the lower part of the abdomen on there was only one recorded case, by Zuckercandl, of both sides were found glued together by recent lymph, myxoma of the sphenoidal sinus. He thought that These adhesions were carefully broken down, and over two aneurysm was the only lesion which would explain the pints of flaky, fetid pus escaped, a considerable collec- occurrence of the haemorrhage two months after the injury. tion being found more or less encysted on the right The sinus had evidently been prematurely expanded by the side. The left uterine appendages were then brought internal pressure to which it had been subjected. Myxomata up to the abdominal wound, and, being found healthy were very uncommon at the age at which this had occurred. except for some congestion of the serous membrane, The haemorrhage into the submucous tissue had probably were allowed to fall back into the abdomen. The right set up irritation, which had led to the myxomatous formaappendages were brought to the surface with more tion.-Dr. CLARKE, in reply, said that he had microscoped difficulty, owing to old adhesions which had to be the mucous membrane at a point not affected with the broken down. The right Fallopian tube was found to be myxomatous growth, and had found the epithelium reduced considerably dilated, occluded at its abdominal extremity, to a single layer of cells, and where the bone was underbut empty, there being a rupture in its wall large enough to going absorption there was a collection of giant-cells. admit the tip of the thumb. The broad ligament was Dr. CLARKE likewise exhibited a specimen of Imperforate ligatured, and the diseased tube and ovary removed. The Rectum, showing an accidental result of exploratory operaabdomen was then thoroughly washed out and the wound tion. The rectum ended as a blind extremity at about two sutured, a glass drainage-tube being inserted at the lower inches from the surface, and there was an anal dimple. A angle of the wound. puncture had been made with a trocar, which went through Next morning the patient expressed herself as feeling the lowest extremity of the rectum, puncturing it in two better than she had been for several days. The temperature places ; the puncture then went on into the peritoneum; a ’sank to normal, but shortly rose to between 101° and 103°; little meconium had escaped into this sac. The peculiarity and for several weeks recovery was very slow. There was of the case was that the child had died of haemorrhage, as no uterine haemorrhage after the operation, and the vaginal the sacra media had probably been wounded by the instrudischarge rapidly lost its fetid character. The glass ment. A large quantity of blood was found in the lower drainage-tube was replaced by an indiarubber one, the use end of the rectum, which had stripped up the mucous memof which was not finally dispensed with for three weeks. brane from the muscular coat, and had bulged the former About the end of that time rapid improvement set in, so upwards in front of it. The rectum not being found by that she left her bed on Feb. 22nd, and was discharged the puncture, an inguinal colotomy was performed, but cured on March 21st. the child died shortly afterwards. He held that this A few days ago (Oct. 15th) she returned to report herself. case showed that there was great danger to be feared She was in excellent health, and stated that she had been from using the trocar in these cases.—Mr. CRiPrs re-