249

In referring to the frequency of aneurisrn of the poplitealartery, Mr. Bellamy said that there were mechanical reasons,apart from pathological ones, which appeared to affect thisvessel in particular. At either extremity of the vessel is amusculo-tendiuous arch, which confines it and exerts pres-sure uponit; moreover, it is pushed backwards slightly by thecontraction of the popliteus muscle during early flexion, andwhich makes the posterior aspect of the knee somewhat con-vex. As a result of these pressures at either extremity ofthe vessel, added to the fact that it is attached to the mus-culo-teudinous rings, there might be a kind of "kinking" " ofthe artery, which, owing to the force of blood-stream, wouldbe exposed to greater pressure than elsewhere. Associatedwith this " kiuking

" is a contraction of the lumen of thevessel, which exposes its lateral aspects over the contractedportion to a still greater pressure. It is noticeable that allvessels which lie in flexures, and which are surrounded byfat and cellular tissue, are more prone to an aneurismal cou-dition than those which are subjected to the pressure of

enveloping muscles. The internal aspect of the poplitealartery has some transverse strise ; whether this is a provisionagainst rupture from pressure or stretching, or a result ofcontinuous flexion, is not quite clear. Some have evenobserved transverse folds of its inner coat.

CENTRAL LONDON SICK ASYLUM.DISLOCATION OF THE HEAD OF THE FEMUR INTO THE

FORAMEN OVALE ; REDUCTION BY MANIPULATIONAFTER FOUR DAYS.

(Under the care of Dr. LEDIARD.)JEMIMA C-, aged fifty, a charwoman, admitted late on

the evening of Nov. 5th, 1878. She stated that at 10 P.M.on the night of Nov. 2nd she was in the street, and was,she thought, pushed by some one. She fell on the left

knee, and on coming to herself she found she could notstand. There was great pain in the left groin, and the leftthigh seemed drawn up. She sought no advice until the4th, though she was in the meantime unable to stand, andsuffering pain in the left groin, hip, and knee.On examination, the leg was half drawn up, and thrown

outwards from the hip ; the foot was directed forwards.There was discoloration over the inner and upper part ofthe left thigh, which was also swelled and deformed. Theback was arched at the loins, and the left knee could not bestraightened. There was Battening over the normal situationof the trochanter on the left side, and there was great widthat the junction of the thigh with the trunk. No crepituscould be felt, and all movements of the thigh were verymuch limited. The left thigh could not be brought into astraight line with the trunk, and there was shortening ofthe limb to perhaps two inches, but it is difficult to measurethis since the limbs could not be put in the same position.When the woman lay on her face the left thigh was stillthrown outwards from the middle line, and the fold of thebuttock was absent on the left side. In the groin no roundedtumour could be felt, and the artery was not raised, butthere were unusual hardness and fulness on the inner aspectand upper part of the thigh, which was not fel on the rightside, and on rotation of the thigh it was evident that thishardness was the head of the thigh resting upon the foramenovale.The patient was put under chloroform at 2 P.M. on the

7th, during the administration of which the right leg wasthrown abllut violently, but the motions of the left were verymuch limited, and the abduction and other sign-i of disloca-tion intensified. As soon as the muscles relaxed the limbwas seized, the thigh flexed to about a right angle andturned outwards with a gentle sweep of half a circle, andimmediately the bone slipped into the acetabulum with anaudible snap ; all deformity at once disappeared. Thepatient was confined to bed for one month with a splint, andon the llth of December she was discharged, being able towalk very well.

Remccr7,;s by Dr. LEDIARD.-There is no doubt that thispatient was intoxicated when she fell, and it is somewhatunusual for a fall of this nature to cause a dislocationof the hip, a joint generally requiring some violence to dis-place it. I have met with one other case similar in this respect, Ithat it occurred from a fall in the street. A boy of about Ifourteen was running quickly and fell and produced a dorsal i

dislocation of the left hip, which was readily reduced bymanipulation under chloroform. This woman, however, washeavy from being rather fat, and no doubt fell with someforce. The early reduction was more probably due to anextensive laceration of the capsule of the joint than to anyother caue ; and the mode of reduction was exactly the re-verse of that recommended by Professor Bigelow, who incases of dislocation into the foramen ovale prefers to flex thethigh and sweep it inwards and downwards.

ST. GEORGE’S (HANOVER-SQUARE)DISPENSARY.

CASE OF REMENSTRUATION AFTER EIGHT YEARS’CESSATION OF THE CATAMENIA.

(Under the care of Dr. SUTHERLAND.)ELIZA G-, aged fifty-nine, began to menstruate when

twelve years old. This then produced such a debilitatingeffect that at each period she was unable to walk. Shemarried at twenty-seven, had seven children born alive, andone miscarriage. She was regular up to the age of fifty-one ; then the catamenia ceased until she was fifty-eight,when they began again. She was unable to account forthis in any way.At the time of attendance at the dispensary she had been

" unwell every three, four, or five weeks for a year; thedischarge being somewhat paler than usual, although at thecommencement of this remenstruation, it was of a normalred colour. She applied for relief of abdominal tension,probably due to flatulence.

It may be added that one daughter commenced men-struating at eleven, and two others not till sixteen.Note by Dr. SUTHERLAND.-In this case the reappearance

of the catamenia could be traced to no distinct cause.

Moral shocks occasionally produce a similar effect, as in acase I recorded, in which a woman commenced menstruatingthree years after cessation, from the shock of seeing herhusband killed by a fall from a ladder. Dr. CrichtonBrowne has recorded another case where the catamenia re-appeared in an old woman from the efforts made to expel asupposed child, under the delusion that she was pregnant.

ROYAL INFIRMARY, EDINBURGH.STRETCHING OF SCIATIC, DIGITAL, AND INFRA-ORBITAL

NERVES.

(Under the care of Professor SPENCE.)FOR the following notes we are indebted to Mr. R. Purdie,

M.B., C. M.CASE 1. St1"eÜ:Jâng of the Scicitic Nerve.-M. F--, a

miner, was admitted in the month of August of last year.He had suffered for several months from sciatica. In con-

sequence of want of rest and exhaustion, caused by theintense paroxysms of pain, the man had become emaciatedand debilitated and quite unfit for his occupation.Before nerve-stretching was used other methods were tried

as well as tonic treatment; local means, such as acupunctureof the great sciatic along diiferent parts of its course, theuse of galvanism, and lastly the use of galvano-puncture ofthe sciatic nerve; but none of these remedies produced morethan temporary relief.On the 3rd of September, the patient having been brought

under the influence of chloroform, an incision one inch andthree-quarters in length was made, from the margin of thegluteus maximusalongtheouter margin of the biceps; the fasciawas opened and the nerve was readily exposed and hookedover the finger. It was then forcibly stretched, while thefoot was held somewhat fixed by an assistant. The stretch-ing was continued until the nerve was loosened and a senseof yielding obtained. The wound was then lightly dressed,and healed by the first intention.

Since leaving the hospital (now more than a year since)occasional slight twitchings have been felt in damp weather,but nothing compared to the intense pain suffered before theoperation.CASE 2. Stretclbing of the Dicqital Nerves.-The patient,

D. H--, suffered from whitlow on the dorsal surface ofterminal phalanx of the forefinger seven years ago, after thepus had been evacuated stiffness of the ioint at the nhalanx