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CUMBERLAND INFIRMARY.
262 24th.-To prevent any displacement of the spine occurring covered with perspiration. This extends three or four inches down his chest, gradually dying away. His neck during a fit, the man was put into a plaster-of-Paris jacket and the upper part of his chest, too, are at the same time extending from the axilla to below the trochanters. Thecovered with a bright red rash, and sometimes, slightly, the jacket was previously prepared, commencing with a manyface. This rarely extends to the arms. To-day the rash not tailed flannel bandage, followed by numerous stiips of only covered the area of sensation, but extended all over the crinoline bandage soaked in a mixture of pl8ster-of-Pari& front and sides of the thorax, dying away over the abdomen. and gum, and internally a thick layer of wool. The gum The pricking sensation passes away very after the was used to prevent the case setting too quickly. The bladder is washed out, rarely lasting more than five or six jacket was placed upon a second bed, to the foot of which the minutes after the operation. The rash remains longer, patient’s bed being brought, he was carried over the head of gradually fading away in from a quarter to half an hour. his bed and laid upon the jacket and enveloped in it. ExtenThe patient states that he sometimes suffers in this way, sion being maintained during the time. There has been great even when he is not dressed, or without any other known pain of a spasmodic character down the course of the great On some days, except after dressing, he is free from sciatic nerve, followed by involuntary expulsion of faeces, cause. it, while on others he has it two or three times during the As the rectum was distended, enemata were administered course of the day, and also at nights. The left heel and foot with marked relief. The urine was drawn off daily and the bladder washed out with a solution of Condy’s fluid and an are still ulcerated. 7th.-Bedsores increasing in size; still occasional vomiting ounce of a solution containing one grain of sulphate of and mucous expectoration. quinine injected and left in. The urine only occasionally 13th.-Patient has incr6asing distress owing to inability had an alkaline reaction, and once or twice contained pus. to expectorate, the cough being extremely feeble. Sores all Fifteen grains of benzoate of ammonia were given three. times a day. healing. 25th. Patient has sensaLion over the anterior crurai’ 23rd.-Fresh bedsore over left buttock; iodoform used. 24th-Patient delirious for twenty-four hours, calling out nerve, but not over the external cutaneous of the left thigh. 27tb.-He can move the ankle joint anu foot, and localise loudly at night. Iodoform discontinued and sores poulticed. Jan. 5th.-Abscess forming in left thigh; sores on right heel sensation better. Dec. 11th. - Plaster jacket removed, and a poroplastic closed, but there is still one on the dorsum of the left foot. 7th.-An abscess of the left thigh burst, about two pints jacket substituted. The extension was removed a few days of rather fetid pus escaping. ago from the right leg, and to day from the left. 24th.-All muscles react to both currents normally, but 17th.-The terminal phalanges of the little and ring fingers of right hand are necrosing. The nails are blackenedL the extension of the foot and the peroneal muscles react and misshapen; beyond and towards the hand the skin is3 rather less easily than in the right leg, and the electrotense, red, and angry as far as the terminal phalanx. The3 sensibility is impaired to a slight degree below the knee. 18th.-The patient got up. He has very little power over abscess in left thigh discharges less and is much less. offensive. All sores doing well. Much difficulty in breath- the left leg, no control over his sphincter ani, and still ing, and occasional twitching of muscles about neck and face. uses a catheter, although several attempts have been made 19th.-Complains of toothache; tooth extracted without to dispense with it. much pain; immediately after an ounce of brandy had beenI Feb. 4th.-Electric reaction of muscles of legs normal; administered the toothache ceased. power returning over the rectum; perineum galvanised 20th.-The tongue is ulcerated and swollen. The whole (+ electrode). of the bed is shaken by the attempts of the patient to 8th.-During an epileptic fit urine was voided spon-
quickly
-
,
breathe. 22nd.-A fresh attack of erysipelas broke out in the right leg, and he died on the 26th. At the post-mortem examination, held twenty-five hours3 after death, the articular processes of the seventh cervical and first dorsal vertebrae were found to have been fractured, and the cervical vertebrae had been displaced forwards. Opposite the seat of displacement the spinal cord had been crushed within the dura mater. CASE 2.-J. H-, aged twenty-eight, a ship’s steward, was admitted on Nov. 22nd, 1886, under the care of Mr. Morrant Baker, suffering from a fracture and dislocation of the spine. The patient, from the age of fifteen, has been subject to epileptic fits. and whilst about to enter a train at a railway station he was seized with a fit, and fell between the train and the platform. On regaining consciousness he found he had lost power in the left leg, and was brought to the hospital. His condition on admission was as follows. At the junction of the twelfth dorsal and first lumbar vertebrae there was an obvious displacement the lumbar vertebrae being depressed, leaving the dorsal prominent. There was entire loss of motion and impairment of sensation in the left leg. There was byperaesthesia in the right leg, with acute pain over an area corresponding to the distribution of the twelfth dorsal nerve. There was no bruising over the seat of injury. The patient was put under the influence of ether, and, under the superintendence of Mr. Bruce Clarke, extension was made from the arms above the head and the ankles, the patient lying on his left side. The bones were seen to go back into position, but the displacement returned when the tension was discontinued. Extension was again applied, and maintained while the patient was placed upon his back, the vertebrae this time remaining in position. While making the extension, crepitus was distinctly felt by the hand placed over the seat of fracture. An extension of 51b. was applied to each leg, counter-extension being obtained by raising the foot of the bed. There was no hyperaesthesia in the right leg when the patient had recovered from the anassthetic, and there was less pain at the seat of fracture. Nov. 23rd.-No urine has been voided since admission. A catheter was passed and twelve ounces of urine drawn off ; sp. gr. 1020; acid; no albumen; bowels acting normally. -
taneously.
15tb.-The patient left the hospital. He had control over his rectum, but still used a catheter; could walk easily and without pain. The bladder had not been washed out for & month, the urine remaining acid. He complains of pain on pressure over the seat of fracture, and the last dorsa vertebrae are slightly more prominent than natural. Temperature, pulse, and respiration remained normal throughout
CUMBERLAND INFIRMARY. PERITONEAL ABSCESS DISCHARGING THROUGH THE. UMBILICUS.
of Mr. H. A. LEDIARD.) THIS case seems to merit a little attention, on account of the doubt that was reasonably felt in satisfactorily tracing the suppuration to its origin, and the necessity there is of reading it in connexion with others where purulent discharge from the umbilicus has existed, in order to arrive at a. correct conclusion as to the pathology. The child’s age was ten, and she was first seen on Feb. 3rd, 1886, having been brought to the out-patient room, a long distance, by her mother. For six weeks there had been swelling and tenderness of the abdomen. Her appearance was suggestive of the end of an exhaustive fever, which had rendered her exceedingly thin, weak, and haggard, for she lay in her mother’s lap like a rag. On admission the child’s temperature was 100°, but for the next six days it was subnormal. In addition to a swollen abdomen with distended veins, the umbilicus was converted into a red, tender protuberance the size of a walnut, which burst a week after admission, the temperature rising to 103° ; the discharge was very foul, but entirely purulent. and continued for a very long while, so long that it was thought that it might be needful to explore the abdomen. On Feb. 18th a drainage tube was put into the peritoneum through the umbilicus, and although the temperature rose to 1020 or 103° each night, the child began to improve. Examination of the abdomen suggested tubercular peritonitis to some who saw her in the ward, and this seemed confirmed by the fact that there were some moist sounds
(Under
the
care
263 heard in the chest. Mr. Lediard did not share this view, for when the child was admitted he could not help thinking of typhoid fever, and was somewhat supported in his first impression of the fact that whenever a long probe was passed through the sinus it always found its way to the An hatroduction to the Study of Embryology. By AzFRED region of the esecum or towards the right iliac fossa. C. HADDON, M.A. Cantab., Professor of Zoology in the occasionally it was thought that fluctuation was present, College of Science, Dublin. WiGh 190 Illustrations. Royal and a certain amount of thickening within the abdomen ; London: Charles Griffin. 1887. Pp. 336. but there was never any definite tumour to be felt. PusI is a condensation of our present knowledge of work THIS could generally be forced, on pressure, from the umbilicus, than whilst the smell was something more simply foul. embryology intelligently arranged and well adapted for selfIn spite of a night temperature constantly more or less: study, as the Germans express it. It is divided into eight high, and profuse discharge from the sinus, the child picked chapters, which are thus occupied-1. The Maturation and up; in spite, also, of an always loose condition of the bowels, there being frequently three motions a day. The Fertilisation of the Ovum. 2. Segmentation and Gastruladrainage tube inserted was about four inches in length in tion. 3. Formation of the Mesoblast. 4. General Formanrder to assist drainage. The child was made to lie on the tion of the Body and Development of the Embryonic stomach, but the change in position was not attended by 5. Organs derived from the Epiblast. 6. Organs any marked improvement. Tedious as the closure of the Appendages. sinus was, yet the child’s returning colour and ravenous derived from the Hypoblast. 7. Organs derived from the appetite afforded a satisfactory sign that she was on the Mesoblast. 8. General Considerations. It is difficult, of course, right track. It was not, however, until July 23rd that she rigidly to limit the description of the parts derived from the was discharged well, with a good covering of flesh and in several layers of the blastoderm in compound organs-as, for excellent spirits. No good account of the child prior to admission was ever example, in the case of the eye and ear; but upon the whole obtained, but what there was is consistent with typhoid there is little overlapping, and these sense organs in partifever. The record is epitomised as much as possible, but the cular are wholly given under the head of " Organs derived temperature chart tells a great deal. Thus, on Feb. 27th from the Epiblast." Mr. Haddon’s qualifications for underand 28th the evening rise was 104° ; on March llth, 12th, and 13th it was 102° ; on March 24th and 25th and April 5th it taking so important a work as the present are that he was 104°; the morning temperature being invariably subwas engaged for a considerable period in working at developnormal or normal. In June lower variations were present, ment, especially of invertebrata, in Dohrn’s Marine Bioloand towards the end of July the feverish symptoms had gone. Station at Naples, and has published one or two good Remarks by Mr. LEDiABD.—Although the sequence of gical events cannot be considered as proved, I am of opinion that memoirs on the subject. He has thrown himself thoroughly the child had typhoid fever, with ulceration of the bowel, into his work, and seems to have exhausted all the literature perforation, and an intra-peritoneal abscess, which discharged of embryology since the date of Balfour’s unfortunate death. itself through the umbilicus. The chest symptoms passed away very early, so that tubercular disease was eliminated Much interest is added to the details of development by from consideration. I heard during June of this year-that suggestions as to the cause of the first appearance of the is, about a year since the child was last seen-that she was different organs. The reader will find remarkably good well and attending school. In looking for references to umbilical fistulae, I find that Mr. Erichsen (8th ed., vol. ii., accounts of the different forms of placenta, of the developp. 857) states that they arise from perforation of the small ment of the heart, and of the genito-urinary system, in which intestine by chronic ulceration, usually tubercular, with the all recent work is included. We venture to give a short formation of a circumscribed abscess amongst the coils of extract from the section on the placenta which will serve to the intestine, finally discharging at the umbilicus; but he makes no allusion to typhoid fever. West (5th ed., show the mode in which Professor Haddon deals with his p. 117) mentions a case where from a quarter to half a pint subject. After having described the allantois in the bird and of sero-purulent fluid escaped daily from the umbilicus the peculiarities of the chorion in thelower mammals, he goes of a child eight months old, the cause being peritonitis; on to say that the nature and position of the villi of the also another case of acute peritonitis, where a puncture of a prominent umbilicus was followed by the discharge chorion vary considerably. ef forty-eight ounces of pus. Hilton Fagge (vol. ii., p. 248) "The villi fit into depressions of crypts of the uterine says: "In some of those rare cases of strumous peritonitis wall, the conjoint structure being known as the placenta. in which the abdomen becomes distended with pus, the The placenta of the Rodentia, lnsectivora, and Chiroptera umbilicus gives way and allows the fluid to escape." is dorsally situated and discoidal, as in the rabbit, Amongst the complications of typhoid mentioned by Fagge andusually is with the area of contact between coextensive is peritonitis, which generally depends on a perforation of the bowel or sloughing of a swollen mesenteric gland, and he the allantois and the subzonal membrane. In these forms further quotes cases going to show that pus in the abdominal the yelk sac is in contact with the larger portion of cavity is known as a sequel of the peritonitis of typhoid, due the subzonal membrane. In Edentata the placenta may to perforation, which pus makes its way externally or be discoidal (Loricata), or dome-shaped (Pilosa), or zonary into the bowel; he does not allude to the umbilicus as a. is, (Tubuli-dentata)-that occupying a broad band round mode of exit. In vol. xvii. of the Transactions of the Clinical the free from villi, or diffuse the ends chorion, leaving Society of London, three cases of peritoneal abscess in (Squamata.) In the the dog large vascular yelk sac does not children are recorded by Dr. Goodhart. The first case was a fuse with the The allantois first grows subzonal membrane. girl of eleven, and the symptoms and progress of the case are very similar to mine. The discharge had, however, no out on the dorsal side of the embryo, where, coalescing with ecial fetor. The origin of the discharge was due to the subzonal membrane, it forms (at first) a discoidal platyphoid fever. The other two cases were treated by in- centa. The villi soon extend, so as to form a zonary cision. From these few references it is clear that discharge The zonary placenta is found in the carnivora, of pus from the umbilicus may be tubercular, but is not placenta. and elephant. The extension of the placenta over hyrax, necessarily so, and that, in the absence of the evidence of the whole of the chorion results in what is termed a diff used tubercle, a typhoid lesion will account for some of the other is characteristic of the Perissodactyla, the This cases where purulent peritonitis, in the form of a localised placenta. the Tylopoda, the Sirenia, the Cetacea, the Simia, the umbilicus or elseeither Tragulina, abscess, discharges through where. Where a clear history of typhoid is obtained there and the Lemuroidea. The collaction of the villi into groups cannot be much doubt, or, again, where a child makes so constitutes what is known as a cotyledonary placenta. This excellent a recovery from a discharge which lasted for about is confined to the Pecora." five months, a recovery unlikely to be met with in tuber- variety The mode of formation of the decidual and non-decidual cular disease. The dressing of the abdomen usually consisted of moistened moss pads, whilst the tube was retained placenta is then given, and finally an excellent ?’6SM)Me’of until so short as to be thrust out of the sinus. the recent researches of Kupffer, Selenka, Hensen, Spee,
Reviews
i
and
Notices
of
Books.
quickly
-
,
breathe. 22nd.-A fresh attack of erysipelas broke out in the right leg, and he died on the 26th. At the post-mortem examination, held twenty-five hours3 after death, the articular processes of the seventh cervical and first dorsal vertebrae were found to have been fractured, and the cervical vertebrae had been displaced forwards. Opposite the seat of displacement the spinal cord had been crushed within the dura mater. CASE 2.-J. H-, aged twenty-eight, a ship’s steward, was admitted on Nov. 22nd, 1886, under the care of Mr. Morrant Baker, suffering from a fracture and dislocation of the spine. The patient, from the age of fifteen, has been subject to epileptic fits. and whilst about to enter a train at a railway station he was seized with a fit, and fell between the train and the platform. On regaining consciousness he found he had lost power in the left leg, and was brought to the hospital. His condition on admission was as follows. At the junction of the twelfth dorsal and first lumbar vertebrae there was an obvious displacement the lumbar vertebrae being depressed, leaving the dorsal prominent. There was entire loss of motion and impairment of sensation in the left leg. There was byperaesthesia in the right leg, with acute pain over an area corresponding to the distribution of the twelfth dorsal nerve. There was no bruising over the seat of injury. The patient was put under the influence of ether, and, under the superintendence of Mr. Bruce Clarke, extension was made from the arms above the head and the ankles, the patient lying on his left side. The bones were seen to go back into position, but the displacement returned when the tension was discontinued. Extension was again applied, and maintained while the patient was placed upon his back, the vertebrae this time remaining in position. While making the extension, crepitus was distinctly felt by the hand placed over the seat of fracture. An extension of 51b. was applied to each leg, counter-extension being obtained by raising the foot of the bed. There was no hyperaesthesia in the right leg when the patient had recovered from the anassthetic, and there was less pain at the seat of fracture. Nov. 23rd.-No urine has been voided since admission. A catheter was passed and twelve ounces of urine drawn off ; sp. gr. 1020; acid; no albumen; bowels acting normally. -
taneously.
15tb.-The patient left the hospital. He had control over his rectum, but still used a catheter; could walk easily and without pain. The bladder had not been washed out for & month, the urine remaining acid. He complains of pain on pressure over the seat of fracture, and the last dorsa vertebrae are slightly more prominent than natural. Temperature, pulse, and respiration remained normal throughout
CUMBERLAND INFIRMARY. PERITONEAL ABSCESS DISCHARGING THROUGH THE. UMBILICUS.
of Mr. H. A. LEDIARD.) THIS case seems to merit a little attention, on account of the doubt that was reasonably felt in satisfactorily tracing the suppuration to its origin, and the necessity there is of reading it in connexion with others where purulent discharge from the umbilicus has existed, in order to arrive at a. correct conclusion as to the pathology. The child’s age was ten, and she was first seen on Feb. 3rd, 1886, having been brought to the out-patient room, a long distance, by her mother. For six weeks there had been swelling and tenderness of the abdomen. Her appearance was suggestive of the end of an exhaustive fever, which had rendered her exceedingly thin, weak, and haggard, for she lay in her mother’s lap like a rag. On admission the child’s temperature was 100°, but for the next six days it was subnormal. In addition to a swollen abdomen with distended veins, the umbilicus was converted into a red, tender protuberance the size of a walnut, which burst a week after admission, the temperature rising to 103° ; the discharge was very foul, but entirely purulent. and continued for a very long while, so long that it was thought that it might be needful to explore the abdomen. On Feb. 18th a drainage tube was put into the peritoneum through the umbilicus, and although the temperature rose to 1020 or 103° each night, the child began to improve. Examination of the abdomen suggested tubercular peritonitis to some who saw her in the ward, and this seemed confirmed by the fact that there were some moist sounds
(Under
the
care
263 heard in the chest. Mr. Lediard did not share this view, for when the child was admitted he could not help thinking of typhoid fever, and was somewhat supported in his first impression of the fact that whenever a long probe was passed through the sinus it always found its way to the An hatroduction to the Study of Embryology. By AzFRED region of the esecum or towards the right iliac fossa. C. HADDON, M.A. Cantab., Professor of Zoology in the occasionally it was thought that fluctuation was present, College of Science, Dublin. WiGh 190 Illustrations. Royal and a certain amount of thickening within the abdomen ; London: Charles Griffin. 1887. Pp. 336. but there was never any definite tumour to be felt. PusI is a condensation of our present knowledge of work THIS could generally be forced, on pressure, from the umbilicus, than whilst the smell was something more simply foul. embryology intelligently arranged and well adapted for selfIn spite of a night temperature constantly more or less: study, as the Germans express it. It is divided into eight high, and profuse discharge from the sinus, the child picked chapters, which are thus occupied-1. The Maturation and up; in spite, also, of an always loose condition of the bowels, there being frequently three motions a day. The Fertilisation of the Ovum. 2. Segmentation and Gastruladrainage tube inserted was about four inches in length in tion. 3. Formation of the Mesoblast. 4. General Formanrder to assist drainage. The child was made to lie on the tion of the Body and Development of the Embryonic stomach, but the change in position was not attended by 5. Organs derived from the Epiblast. 6. Organs any marked improvement. Tedious as the closure of the Appendages. sinus was, yet the child’s returning colour and ravenous derived from the Hypoblast. 7. Organs derived from the appetite afforded a satisfactory sign that she was on the Mesoblast. 8. General Considerations. It is difficult, of course, right track. It was not, however, until July 23rd that she rigidly to limit the description of the parts derived from the was discharged well, with a good covering of flesh and in several layers of the blastoderm in compound organs-as, for excellent spirits. No good account of the child prior to admission was ever example, in the case of the eye and ear; but upon the whole obtained, but what there was is consistent with typhoid there is little overlapping, and these sense organs in partifever. The record is epitomised as much as possible, but the cular are wholly given under the head of " Organs derived temperature chart tells a great deal. Thus, on Feb. 27th from the Epiblast." Mr. Haddon’s qualifications for underand 28th the evening rise was 104° ; on March llth, 12th, and 13th it was 102° ; on March 24th and 25th and April 5th it taking so important a work as the present are that he was 104°; the morning temperature being invariably subwas engaged for a considerable period in working at developnormal or normal. In June lower variations were present, ment, especially of invertebrata, in Dohrn’s Marine Bioloand towards the end of July the feverish symptoms had gone. Station at Naples, and has published one or two good Remarks by Mr. LEDiABD.—Although the sequence of gical events cannot be considered as proved, I am of opinion that memoirs on the subject. He has thrown himself thoroughly the child had typhoid fever, with ulceration of the bowel, into his work, and seems to have exhausted all the literature perforation, and an intra-peritoneal abscess, which discharged of embryology since the date of Balfour’s unfortunate death. itself through the umbilicus. The chest symptoms passed away very early, so that tubercular disease was eliminated Much interest is added to the details of development by from consideration. I heard during June of this year-that suggestions as to the cause of the first appearance of the is, about a year since the child was last seen-that she was different organs. The reader will find remarkably good well and attending school. In looking for references to umbilical fistulae, I find that Mr. Erichsen (8th ed., vol. ii., accounts of the different forms of placenta, of the developp. 857) states that they arise from perforation of the small ment of the heart, and of the genito-urinary system, in which intestine by chronic ulceration, usually tubercular, with the all recent work is included. We venture to give a short formation of a circumscribed abscess amongst the coils of extract from the section on the placenta which will serve to the intestine, finally discharging at the umbilicus; but he makes no allusion to typhoid fever. West (5th ed., show the mode in which Professor Haddon deals with his p. 117) mentions a case where from a quarter to half a pint subject. After having described the allantois in the bird and of sero-purulent fluid escaped daily from the umbilicus the peculiarities of the chorion in thelower mammals, he goes of a child eight months old, the cause being peritonitis; on to say that the nature and position of the villi of the also another case of acute peritonitis, where a puncture of a prominent umbilicus was followed by the discharge chorion vary considerably. ef forty-eight ounces of pus. Hilton Fagge (vol. ii., p. 248) "The villi fit into depressions of crypts of the uterine says: "In some of those rare cases of strumous peritonitis wall, the conjoint structure being known as the placenta. in which the abdomen becomes distended with pus, the The placenta of the Rodentia, lnsectivora, and Chiroptera umbilicus gives way and allows the fluid to escape." is dorsally situated and discoidal, as in the rabbit, Amongst the complications of typhoid mentioned by Fagge andusually is with the area of contact between coextensive is peritonitis, which generally depends on a perforation of the bowel or sloughing of a swollen mesenteric gland, and he the allantois and the subzonal membrane. In these forms further quotes cases going to show that pus in the abdominal the yelk sac is in contact with the larger portion of cavity is known as a sequel of the peritonitis of typhoid, due the subzonal membrane. In Edentata the placenta may to perforation, which pus makes its way externally or be discoidal (Loricata), or dome-shaped (Pilosa), or zonary into the bowel; he does not allude to the umbilicus as a. is, (Tubuli-dentata)-that occupying a broad band round mode of exit. In vol. xvii. of the Transactions of the Clinical the free from villi, or diffuse the ends chorion, leaving Society of London, three cases of peritoneal abscess in (Squamata.) In the the dog large vascular yelk sac does not children are recorded by Dr. Goodhart. The first case was a fuse with the The allantois first grows subzonal membrane. girl of eleven, and the symptoms and progress of the case are very similar to mine. The discharge had, however, no out on the dorsal side of the embryo, where, coalescing with ecial fetor. The origin of the discharge was due to the subzonal membrane, it forms (at first) a discoidal platyphoid fever. The other two cases were treated by in- centa. The villi soon extend, so as to form a zonary cision. From these few references it is clear that discharge The zonary placenta is found in the carnivora, of pus from the umbilicus may be tubercular, but is not placenta. and elephant. The extension of the placenta over hyrax, necessarily so, and that, in the absence of the evidence of the whole of the chorion results in what is termed a diff used tubercle, a typhoid lesion will account for some of the other is characteristic of the Perissodactyla, the This cases where purulent peritonitis, in the form of a localised placenta. the Tylopoda, the Sirenia, the Cetacea, the Simia, the umbilicus or elseeither Tragulina, abscess, discharges through where. Where a clear history of typhoid is obtained there and the Lemuroidea. The collaction of the villi into groups cannot be much doubt, or, again, where a child makes so constitutes what is known as a cotyledonary placenta. This excellent a recovery from a discharge which lasted for about is confined to the Pecora." five months, a recovery unlikely to be met with in tuber- variety The mode of formation of the decidual and non-decidual cular disease. The dressing of the abdomen usually consisted of moistened moss pads, whilst the tube was retained placenta is then given, and finally an excellent ?’6SM)Me’of until so short as to be thrust out of the sinus. the recent researches of Kupffer, Selenka, Hensen, Spee,
Reviews
i
and
Notices
of
Books.