819

of morphia. Temperature 97 4°; was without pain. Woundredressed; stitches removed; union not good; parts sup-ported by strapping. On the 10th the tongue was stillfurred and rather glazed ; she had vomited again ; therewas a free discharge from the artificial anus, and the patientappeared fairly well. Temperature 9S’S°; pulse 120, stronger.Enemata every three hours ; these were retained fairly.On the 14th, though she had slept fairly well, she wasweaker and unable to retain the nutrient enemata. A littleclaret by the mouth was tried, but it caused vomiting.Small quantities of fæcal matter passed from the wound.Pulse 120, weaker. Temperature 99.2°.—15th: Pulse 120 ;temperature98°. Tongue dryandratherglazed. No vomiting.Slept in snatches, and her mind was not so clear as usual.-17th : Much weaker. Pulse 108, feeble. No pain. Nutrientenemata not retained longer than an hour. Temperature 96.2°.On the 18th the had slept well, and was somewhat better,

though the pulse was 120, and still feeble; had retained oneenema, but only takes a little brandy and soda-water by themouth. Temperature 96’4° to 98°.—19th: During the daythere was increasing weakness, the evening temperaturerose to 102’4°, and she died soon after midnight. Beforethe operation the temperature varied from 97’-1° to 99’2°.The evening temperature after operation was 98’6°. Nextday it reached 100’8°; but did not again exceed 99’6° untilthe evening of the 19th, when, as before mentioned, it was1024°. The morning temperature was usually subnormal,and on one occasion was only 96°.A postmortem examination was made a few hours after

death. There were a few adhesions at the apex of the rightlung; thoracic organs otherwise healthy ; the kidneys andspleen normal; the liver small, friable, and adherent to Theunder surface of the diaphragm ; gall-bladder much distended.The coils of intestine were slightly glued together; there wa-<recent peritonit,s. The artificial anus had been establishedin the small intestine twenty-nine inches from the ileo-csecai valve ; the gut above was quite patent and filled wi’hbilious fluid faeces as far as the orifice made. The lowerpart of the ileurn and the cascam were matted together byglandular and inflammatory infiltration. The rectum wascompressed and adherent to the posterior wall of the uterusand upper part of the vagina. On separating them a smallabscess cavity containing about four ounces of pas wasfound. In Douglas’s pouch were three or four papillarygrowths a’1out the size of hiberts. They were hard, nodular,and seemel to spring from the region of the left ovaryand broad ligament. The position of the left ovary wasoccupied by a firm mass of fibrous cicatricial tissue fromwhich grew one of the papillary growths.

CARDIFF INFIRMARY.VERTICAL DISLOCATION OF PATELLA.

(Under the care of Dr. VACHELL.)FOR the following notes we are indebted to Mr. P. Rhys

Griffiths, M.B., B.S. Lonrl., house-surgeon :&mdash;

Michael E-, aged thirty-one, a labourer of strong build,was admitted into the iufirmary on the night of Feb. 13th,1883. He said that when as-isting some men to push atrolley his legs were jammed between the trolley and a longiron bar called " The David." Tiie pain he experienced wasintense-he described it as "wrenching." After the acci-dent he was unable to move.Ou examination the left leg was found to be fully and

forcibly extended, and the dislocation of the patella was evi-dent. The patella had been rotated on its vertical axis, theconvex anterior surface was directed forwards, inwards, andslightly upwards. The outer slightly concave half of the pos-terior surface of the patella was plainly seen and ea-iiy felt, th-skin being very tense. The right border of the patella restedapparently in the small depression immerliately above themter-condyldr groove. To the inner side of this borderimmediately there was a well-marked depression, in whichthe ridge to the inner side of the articular surface of theinternat condyle of the femur, as well as a part of the smoothcondylar surface, could be felt ; a portion of the externalcondylar surface was also felt. The tendon of the quadricepsextensor was very tense, and could be plainly seen as twostrong bands. The patella was slightly movable on theright border as axis. Attempted flexion of the limb wasaccompanied by acute pain. The patient complained of painnly over tde inner side uf the linee-joint.

The patient was put under the iniluence of ether, and assoon as the quadriceps muscle relaxed, with a very littlelateral pressure on the margins of the bone the dislocationwas easily reduced by Dr. Vachell.

Itemccrhs.-This is about the twentieth case which hasbeen placed on record. As a rule, these dislocations arecaused by muscular spasm; in this case there can be nodoubt that it was caused by the pressure of the iron bardirectly upon the patella itself, the spasm of the quadricepsretaining it in its abnormal position. The redaction, whichin many cases has been most difficult, was in this very easilyeffected. After the reduction a back splint was put on, andthis on the following morning was replaced by a plaster case.

EYE INFIRMARY, GLASGOW.REMOVAL OF EYELASH FROM ANTERIOR CHAMBER FOUR

WEEKS AFTER INJURY, RESULTING IN GOOD VISION.

(Under the care of Dr. CRAWFORD RENTON.)J. D-, aged thirty, gamekeeper, was admitted on

Oct. 18th, 1881. He was suffering from an injury to hisright eye, caused by the splintering of a percussion-cap twoweeks previously. On examination, a slight abrasion of thecornea was observed ; the iris was irregular, and across thelower and inner side of the pupil a minute foreign bodyseemed to be lying, but owing to the presence of iritis, itwas difficult to be certain that it was not pigment or lymph.Fomentations and atropine solutions were recommended tosoothe the pain and subdue the iriti?. On Oct. 28th the eyewas quiet, the pupil had yielded, and it was now moreapparent that a fOleigu body was present, and that it wasenher a very fine splinter of the cap, or, as the residentsurgeon, Dr. Hunter, suggested, an eyelash.On Nov. 2nd Dr. Renton made an incision through the

lower and outer aspect of the cornea, and removed with afine pair of forceps the foreign body, which proved to be aneyelash &mdash;18th: Pupil did not yield freely after the opera-tion, but it gradually improved, and the patieat was dis-missed with good vision.

Jan. 6th, 1883.&mdash;The patient is reported as having foundhis eye as useful as formerly during the whole shootingseason, and no trace is left of the inflammatory attack or illeffects from the injury.

ABERDEEN GENERAL DISPENSARY.EXTERNAL H&AElig;MORRHOIDS IN A NEW-BORN CHILD.

(Under the care of Dr. FRANCIS OGSTON, junior, and Mr.GEORGE VINCENT.)

AT the beginning of February a child three days old wastaken to the dispensary by its mother, who stated that shehad noticed the child cried very much when its bowels weremoved, and that it had a red projecting tumour at the anus.Oa examination a btight-scarlet tongue-shaped tumour

was seen to spring from the point of union of the mucousmembrane of the anus with the skin. It was situated atthe left side. At the front part of the anal border a secondflatter tumour of the size of a split pea was also found.After a few days’ treatment with boracic acid ointmentthe inflammatory redness had in a great measure sub-

sided, and the larger tongae-like tumour had nnw changedinto a club-shaped unmistakable hemorrhoid with a narrowpedicle ; and the second flatter projection had greatlydiminished. A day or two afrerwarda the larger tumourwas removed by surrounding the pedicle with a loop ofthread.Note by Dr. OGSTON.&mdash;The earliest case of haemorrhoids

which I can find record of occurred in a child of four monthsof age, but this seems to have been existent at birth or afew hours after it. It is difficult to account, for such a

phenomenon thus early in life, for the bowels had all alongbeen moved freely and the stools were of normal colour andconsistence, a fact which was verified by the howels beingmoved while I was examining the child. The icterus neona-torum had never been present. The liver seemed on pal-pation of normal size ; and the umbilicus cicatrised in ahealthy manner. Thus none of the usually given predisposingcauses of h&aelig;morrhoids&mdash;portal congestion, liver disease, andoverloading the rectum with bard f&aelig;ces,&mdash;were present.The labour, the sixth, had been a perfectly normal one, withhead presentation.