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the removal of small portions of its rim, covered with lymph,and of a pretty healthy aspect, and he hoped that a soft sub-stance would be thrown out-between the acetabulum and theshaft, to facilitate the movements of the part after recovery.He had removed some part of the shaft, in order that noobstacle should be offered to such movements. Mr. Hawkinsfurther stated, that diseased action might nevertheless go onin the acetabulum, but the patient had certainly at present abetter chance of recovery than before the operation.

In examining the parts which had been removed, it wasfound that a great portion of the head of the bone had beendestroyed by caries; there was no actual necrosis, but thecancelli of the process had evidently undergone the changesusually effected by a slow ulcerating process. A little beemor-rhage took place after the child’s removal into the ward; butthis was easily arrested, and the progress was pretty favour-able for a couple of days. Still it would appear that the littlepatient’s strength had been so materially diminished by thelong-continued diseased state of the hip, that she could notwithstand the shock of the operation, as she died on the thirdday after it.The post-mortem examination did not reveal any facts of

importance, except as regards the state of the acetabulum.This cavity was filled, as had been stated by Mr. Hawkins,with a fibrinous mass, which occupied almost the whole areaof the acetabulum. As this product was not firmly adheringto the bone, the finger could easily be insinuated under it.By this examination, it was found that the bottom of thecavity was in a carious condition, the centre being completelyperforated, so as to allow the index-finger to impinge on thefascia lining the iliac fossa.

It is thus evident that the reparative process would herehave been of hardly any avail, and it was not without goodreason that Mr. Hawkins stated, after the operation, that thefinal result depended mainly on the state of acetabulum. Onecannot help thinking, in considering all the facts connectedwith the preceding case, that perhaps a time will come whenthis operation will be resorted to somewhat earlier in thecourse of hip-joint disease. Anchylosis is certainly a verydesirable termination, but it must remain clear that instancesmay spring up where this consolidation of parts is not likelyto take place, however long it may be waited for. Thedifficulty would, therefore, seem to lie principally in the dis-crimination of the cases which should be operated early, andthose where anchylosis may be looked forward to with areasonable prospect of favourable results.We have found, in the post-mortem records of St. Thomas’s

Hospital, two examinations, which will illustrate in a very in-structive manner the state in which the hip-joint is sometimesfound after long-continued disease.The first case is that of a girl, aged sixteen, who was ad-

mitted Oct. 22, 1850, under the care of Mr. South, with hip-joint disease of long standing. The autopsy took placeApril 8,1851. The right hip was dislocated on the dorsum ofthe ilium, and a large irregular sore existed on the inner andfront part of the joint, laying bare the body of the rightpubis, and partly that of the left. The exposed bone was in acarious state; the sore communicated with the joint, and thecellular and muscular tissues between them were blackenedand partially disorganized.On examining the joint itself, the capsular ligament was

found to be almost entirely destroyed, a small band onlyremaining at the lower part. The head of the femur wasentire, and covered by cartilage, to which here and there athin layer of false membrane adhered; but on cutting throughthe cartilage it was found to be separated from the bone,which was roughened and softened beneath it. The neck ofthe bone, as well as portions of°the trochanter major, wasdenuded and carious. The dislocated head rested merelyamong the glutsei muscles, and had formed no socket. On ex-amining the acetabulum, its lips were found to be carious, andthe cavity, which was of the natural size, was nearly filledwith an organized substance which had an almost gelatinousappearance. The cartilage was but loosely attached to the

bone, the latter being much more vascular and soft thannatural. There were several abscesses in the lungs.

In the second case the disease had likewise been existingfor a long while in the right hip-joint. On opening theabdomen, it was found that in the right lumbar region,the external surface of the ascending colon was connectedby rather recent adhesions with the peritonaeal lining of theabdominal parietes. In this situation was an irregular abscess,which opened externally, and also into the ascending colon bya small round ulcer, having smooth cicatrized edges; thisabscess communicated directly with the right hip-joint, pass-

ing across the iliac muscle, which was partially destroyed.The matter had escaped from the coxo-femoral articulation,and then passed upwards along the border of the psoas andiliacus tendons, then partly through the iliacus muscle, to alittle above the crest of the ilium.

LONDON HOSPITAL.Amaurosis probably depending on Concussion.

(Under the care of Mr. CURLING.)MR. CURLING has for the last few weeks had under his care

a youth, aged thirteen, who suffers from amaurosis of theright eye, the cause of which is rather obscure. The boy wasadmitted January 19, 1852, and it appears that about twomonths before that date, whilst walking by the side of ahedge, he received in his face a charge of shots, fired, doubtlessinadvertently, by a person on the other side.The patient was not knocked down by the blow, though he

bled much from the face, which was considerably ecchymosed.The parts around the left eye swelled immediately; the globe,however, remained uninjured, for the boy says that by raisingthe oedematous lid he could see very well. The right eyesuffered a little more, some conjunctival inflammation (as itwould seem) occurred, and some shots lodged in the maxillarybone, just below the inferior lid, where they can now be felt.But the inflammation did not run high; by simple means thepatient was pretty well in a week, with good sight on the leftside, but loss of vision on the right.When admitted for this latter symptom, the globe of the

right eye presented no abnormal appearances, except a smallclot under the conjunctiva, which clot was being rapidlyabsorbed. The pupils of both eyes acted pretty equally,and though somewhat sluggish, answered the stimulusof light. When the left eye is closed the patient endea-vours to obtain some vision on the right side by forcingthe globe of the eye towards the inner canthus; but thiseffort, though it gives him a slight perception of light,does not allow him to distinguish any object. When heattempts to walk towards a given part of the ward, with theleft eyelid held down, he takes the proper direction, but slantsgradually away from the place which he is trying to reach.Mr. Curling ordered small doses of mercury with opium, so asto bring the patient under the influence of the metal, but thismeasure had no influence on the amaurosis. Blisters on thetemple were also used, but no improvement took place. Itmay here be asked, Which part of the apparatus of vision wasaffected? Is it likely that one of the shots has found its wayto the retina, without materially injuring the conjunctiva,sclerotic, iris, or lens? This is not probable; and as for injuryto the globe, there was none. It might perhaps be surmisedthat the concussion resulting from the discharge of the gun intothe face, may have either excited inflammation in the retina,and subsequent insensibility of one determined point of thisnervous expansion; or that the same concussion deprived theretina of sensibility in all points except directly inwards,whither the patient directs the pupil, when he makes aneffort at distinguishing objects. This case brings to our recol-lection an instance of sudden amaurosis, the subject of whichwas some time ago under the care of Mr. Lawrence: we shalljust adduce a few particulars.

ST. BARTHOLOMEW’S HOSPITAL.

Sudden Amaurosis preceded by Hœmatemesis.(Under the care of Mr. LAWRENCE.)

JAMES P-, aged forty-nine years, was admitted intoHenry VIII. ward, Oct. 8, 1851, under the care of Mr.Lawrence, with complete amaurosis. The patient is a

strong, healthy-looking man, a cabinet-maker by trade; he ismarried and has several children. His habits were not veryintemperate, but he used to drink pretty large quantities ofmalt liquor up to the time of the present attack. No blow orfall on the head can be remembered, but there was at thescrobiculus cordis, about a fortnight before the loss of vision,a sense of sinking and gnawing; these symptoms did not, how-ever, prevent him from working at his trade.

After this uneasiness at the stomach had lasted about two, weeks, the patient felt, at four o’clock in the morning, when

getting up, a great depression of spirits; at six, after taking. some coffee and an aperient pill, he felt suddenly sick, and

threw up about a quarter of a pint of florid red blood. Up to