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The cases seen by ophthalmic surgeons are different.They see patients whose sight has failed more or less, andinferentia,lly cases in which the neuritis is in a later stage,when treatment is likely to be less efficacious. It is pro-bable that in most cases of amaurosis from optic neuritisthere is a pre-amaurctio stage. and one in which the

ophthalmoscopic appearances differ from those found whensight is defective. The ophthalmoscopic appeara,nces fromfirst to last in cases of neuritis vary very much indeed, somuch that those who have not often traced cases from the

very beginning might think there were many varieties ofneuritis.The important fact to be insisted on is that optic neuritis

will come on and pass off without there being any defect ofsight from first to last.

MIDDLESEX HOSPITAL.WOUND OF ABDOMEN; PROTRUSION OF INTESTINE ;

HÆMORRHAGE ; PERITONITIS; DEATH.(Under the care of Mr. HULKE.)

THOMAS W -, aged forty-three, a thick-set, stout,sallow-complexioned man, was admitted on March 5th, at1.15 A M., with a wound of the abdominal walls, producedtwenty minutes previously by falling on a quart bottlewhich he had in his pocket. A portion of the colon andomentum, nearly as large as a foatal head, protrudedthrough the wound, which was on the right side of theabdomen in a line with the umbilicus, jagged, and aboutthree and a half inches in length. The clothes were satu-rated with blood. At the time of admission the patient wascold and unconscious, partly from drink. The peritoneumcould be felt constricting the hernial mass, and as thiscould not be reduced, the patient was put under chloro-form, and the peritoneum nicked in three places, when,after a little difficulty, the whole mass was returned. Asthe haemorrhage, which was considerable, could not be

stopped, the external wound was enlarged towards themedian line, and the bleeding points tied. The peritonealcavity appeared to contain a large quantity of fluid blood,but as no other bleeding points could he found, the deeppaJts of the wound were brought together by a quilledsuture, the external wound being closed by the ordinarysuture covered with lint saturated with carbolised oil, andsupported witla a pad of cotton wool fixed with broad stripsof plaster. Ater the chloroform the patient Ftill remainedin a collapsed state; surface cold and clammy; pulse quickand almost imperceptible. Ordered one tablespoonful ofbrandy every hour by the rectum, if patient cannot swallow;to have a subcutaneous injection of half a grain of morphiaat once, and to t ke a half-grain opium pill every hour.8.10 A.M. : Patient conscious, and has been for two hours.Surface of bodv warm ; considerable oozing from the wound.- 9.30 A.M.: Temperature normal. Patient complains ofgreat thirst. Brandy to be given every two hours.-2 r.M.:Complains of feeling hot; is perspiring freely. Brandy tobe discontinued. To have ice to suck.March 6t h.-Had a good night up to 4 A.M., when he

vomited, and then vomited everything he took. Had a

rigor at 5 A.M., and another about 6 A.M. He died at 9 A.M.On March 5th the patient took eighteen pills, and on the

6th five.Post-mortem appearances.-The omentum looked like a

mass of clotted blood; a large quantity of coagulum wasfound in peritoneal cavity. No wound of the intestine, andno open aitery could be detected. There were signs ofcommencing peritonitis.

OMENTAL HERNIA; NECK OF SAC OBLITERATED;EFFUSION OF SERUM.

(Under the care of Mr. HULKE.)The following seems to be a case of spontaneous cure oi

omental hernia which had lasted considerably over twentyyears.A married woman, aged forty-eight, was admitted intc

hospital July llth, 1871. She has had a rupture for twenty-three years, and has worn a truss for twenty-two years,The present swelling appeared on July 9th. Previously thE

hernia bad been perfectly reducible. The swelling camedown underneath the truss. On admission there was asoftfluctuating swelling in the position of a right femoralhernia measuring three inches in length and two inches inbreadth ; the swelling was painless on pressure, had slightimpulse on coughing. Complained of pain in lower part ofabdomen; bowels were opened on the 10th; felt sick onMonday (the 9th), but did not vomit; appetite good;tongue clean and moist; pulse 64; temperature 98°.July 13th.-No notable change in swelling; is free from

pain ; bowels have not been opened since admission; pulse64; temperature 98°.14th.-Swelling in groin slightly smaller; bowels were

freely opened yesterday; has rheumatic pains in limbs;pulse 80; temperature 1008°.

17th.-Swelling is gradually diminishing ; bowels openedyesterday ; a coarse granular mass, evidently omentum, cannow be felt; swelling dull on percussion.The patient went on much the same till her discharge on

July 31st; the swelling not at all tense. What remainedcould not be reduced, and appeared to have no communi-cation with the abdomen.

CHARING-CROSS HOSPITAL.

CASE OF MITRAL DISEASE ; EMBOLISM ; DRY GANGRENE ;HEMIPLEGIA ; DEATH.

(Under the care of Dr. HEADLAND)THE notes of the following case were communicated by Mr.

P. W. Delamotte.C. W-, aged thirty-three, chandelier maker, a thin,

pale man, fair complexion, was admitted into Charing-crossHospital, June 12th, 1872, suffering from a continuous painin the bowels and lower extremities, which were flabby,hyperaesthetio, attenuated, and slightly cedematous at theankles, and the left knee was a little swelled. The actionof the heart was weak, at the apex was a double bruit, anda thrill could be detected by the hand. Round the marginsof the gums was an indistinct blue line; the bowels, more-over, were constipated. Ordered to take half-drachm dosesof the sulphate of magnesia with twenty minims of dilutesulphuric acid three times a day. The patient improvedconsiderably, and lost the pain in the abdomen, and theconstipation was relieved.June 24th.-Legs free from pain, but still tender.28th.-Ordered to take iron and quinine. Tenderness of

the muscles persisted. The pal,ient could walk, but withmuch pain. Ilis general health did not improve.July 15th.-Ordered five-grain doses of the iodide of

potassium and cod-liver oil. The tenderness and pain inthe legs much about the same as before the 24th ult.Aug. 10th.-Intense pain attacked the right leg and foot,

which lasted some hours, when he lost sensation and mo-tion in both. The limb was cold, swollen, and of a whitish-blue colour. Pressure in the popliteal space caused severepain. No pulsation in the anterior or posterior tibial ar-teries. The temperature of the limb was maintained byartificial heat. The thermometer in the mouth on theevening of the llth stood at 104° Fabr.l3th.-Two or three small pinkish-red spots appeared on

the dorsum of the foot, and on the plantar surface was alarge dark patch, resembling the smaller spots, immediatelybehind the toes, and extending to the middle of the foot onthe inner side. At the base of the left lung were roughcrepita.nt rales. The temperature ranged from 100° to104° Fahr. The treatment consisted of two-grain doses ofthe disulphate of quinine every four hours, stimulants, andspoon diet.14th.-Temperature in the morning, 1022°; in the

evening, 103 8°. Ordered to increase the quinine to four-grain doses.15th.-The urine of a smoky-red colour. It did not con-

tain more albumen than the blood ’would naturally furnish.The foot looked better, but still gangrenous.From this date up to September 9th the leg and foot

gradually regained motion and sensation ; the temperatureof the body varied from 100° to 103° Fahr., being usuallylower in the morning and higher in the evening. Thespots on the dorsal surface of the foot disappeared, but thesole of the foot remained the same. The double mitral