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and which may have rendered them peculiarly susceptibleto the poisonous blood. As the patient’s speech was firstaffected, it might be that Broca’s region was primarilyattacked, and then, from their proximity, the motor centresof the face and arm became involved. The aphasia, was notaccompanied by any marked symptom of paralysis, but theclonic spasms at the time of the fits indicated, I think, theintimate relations which seem to exist between aphasia andparalysis of the right side, and especially of the right arm.From the transient character of the symptoms, the patho-logical lesion of the affection was in all probability a conges-tion of the cortex of the brain, which congestion graduallysubsided as the alcohol was being eliminated from thesystem.In connexion with the preceding case of temporary

aphasia, I will mention a curious instance of still moretransient loss of speech, which might be called the " aphasiaof anger," that came under my observation a few years ago.Many people, when under the influence of anger, stutterand stammer so much that their language is hardly intelli-gible. The case I briefly give was an exaggerated exampleof this kind. A gentleman, about sixty years of age, a veryexcitable and irritable man, and most intolerant of contra-diction, one day entered into an argument with a very self-opinionated man on the policy of the disestablishment of theIrish Church, and both became so warm on the subject that"from words they almost came to blows," when suddenlytheir argnment was brought to a close by my patient losinghis speech. Those about him became alarmed, and thoughthe had a stroke of apoplexy. I found him sitting in a chair,hot and perspiring, in a towering passion, gesticulatingtowards his former, but now much frightened, opponent,and making fntile efforts to speak, but quite unable to ar-ticulate a word that could be understood. A person present,thinking that he wished to communicate something par-ticular, handed him a pencil and slate, which he took, but,after making a few vain attempts to write, threw them fromhim impatiently. In about an hour the speech began to re-turn, and in two or three hours it was quite restored, andnothing remained of the attack but a little exhaustion.This gentleman, who has since died, had no apparentdisease of the heart or brain. I have learned that on severaloccasions he had similar attacks when under violent ex-citement.The prime factors and the exact pathology of many cases

of aphasia and convulsions are still, I think, clouded in con-siderable obscurity, notwithstanding the recent great ad-vances towards the elucidation of cerebral disease.Lincoln.

A MirrorOF

HOSPITAL PRACTICE,BRITISH AND FOREIGN.

SEAMEN’S HOSPITAL, GREENWICH.LARGE PRE-RECTAL ABSCESS SIMULATING EXTREME

DISTENSION OF THE BLADDER.

(Under the care of Mr. JOHNSON SMITH.)

Nulla autem est alia pro certo noscendi via, nisi quamplurimas et morborumet dissectionum historias, turn aliorum, tum proprias collectas habere, etinter se cotnpar&re.—MoRaAGNt De Sed. et Caus. Morb., lib. iv. Proaemium.

WILLIAM P-, aged twenty-one, a waterman, wasadmitted into the hospital on Nov. 26th, 1878. Accordingto the report of Dr. T. Creed, of Greenwich, who had hadprevious charge of the case, this patient, fifteen days beforeadmission, and soon after prolonged exposure on the river tocold and wet, had been attacked with severe pain over theabdomen, and with vomiting of biliary fluid. During thefollowing ten days he had suffered from frequently repeatedattacks of this kind, and alternately from obstinate con-

stipation and profuse diarrhoea. At the end of the first weeka fulness had been noticed on the lower part of the abdomen,which had subsequently increased in size so as to haveformed a prominent swelling.The patient, when seen shortly after admission, was found

to be anaemic and very feeble. The skin was hot and dry,and the face expressive of anxiety. He complained of severepain across the lower part of the abdomen. He was lyingon his left side, and could not sit up in his bed withoutdifficulty. The urine was passed frequently, in smallquantity at a time, and had a very deep-red colour. In thelower portion of the abdomen was a very prominent ovalswelling, extending from the pubis almost as high as theumbilicus, and involving an equal extent of each lateralregion. This swelling, the front surface of which was quitesmooth, was extremely tender. It could be moved to a

slight extent from side to side, gave a distinct feeling offluctuation, and was dull on percussion. The integumentof the hypogastric region, though much stretched over theswelling, was pale and-free from congestion. No cedemawas observed in either groin, or in any portion of the anteriorwall of the abdomen. No complaint was made by thepatient on pressure over those regions of the abdomen thatwere not occupied by the swelling.

After the patient had been in the hospital for about anhour a No. 8 silver catheter was passed without difficultyalong the urethra, but though introduced to almost its wholelength it gave exit to but a few drops of urine, and could notbe freely rotated. On subsequent digital exploration of therectum there was felt, just above the prostate, a large elastictumour, in which fluctuation could be distinctly made outon pressure over the front of the abdominal swelling. Thistumour having been punctured with Cock’s instrument usedfor paracentesis vesicle, the removal of the trocar was atonce followed by the discharge through the cannula of athick greenish-yellow pus, of a very offensive and distinctlyfaecal odonr. During the flow of this purulent fluid, of whichseventy-six ounces were collected, the abdominal swellinggradually collapsed. The cannula was left in situ, and along piece of elastic tubing fixed to its outer extremity inorder to conduct any subsequent discharge into a vesselplaced below the bed.

Sixteen ounces of pus mixed with blood was passed duringthe night after the operation, and ten ounces of similar fluidduring the following day. The discharge afterwards rapidlyceased, and the general health of the patient continued toimprove until December 2nd, when, in the course of a fewhours after the removal of the cannula, he suffered muchfrom short and frequently repeated attacks of acute painover the left side of the abdomen. On the following day hewas quite well. On Dec. 14th he was allowed to walk about,and on the 19th he was discharged as cured.

MONTGOMERYSHIRE INFIRMARY.TWO CASES OF DISEASE OF TARSUS ; AMPUTATION ;

SECONDARY HÆMORRHAGE ; ANTISEPTIC

TREATMENT; RECOVERY.

(Under the care of Dr. PRATT.)CASE I.-T. H--, aged twenty-five, a miner, had a year

previous to admission, according to his own account, some-how sprained his right foot by treading upon a stone, andhad suffered since principally from want of power in thelimb.On admission, Oct. 15th, 1878, the foot was not much

swollen, and the ankle-joint was mobile ; but there weretwo openings discharging slightly, one on each side of thefoot, about the middle, and these two openings were foundto communicate. No bare bone could be detected. Astrumous enlargement of the left ulna and of the right radiuswas found at the wrists, otherwise the health was good, asalso was the family history. Chronic synovitis of thecommon synovial sac of the foot was diagnosed, and a verydoubtful prognosis with regard to the safety of the foot wasgiven.For two months after admission various means of cure

were tried: counter-irritation by tincture of iodine, completeimmobility secured by a plaster-of-Paris bandage, cod-liveroil, and full diet. Nothing availed. The foot got graduallyworse, and at the end of the two months dead bone could befound extensively. On Dec. 20th, 1878, Dr. Pratt resolvedto remove the foot by " a Syme." The patient took chloro-form well but slowly, and " a Syme " was performed withall antiseptic precautions. In order to secure a bloodlessoperation an Esma,rch’s elastic bandage was used, on theremoval of which it was found difficult to control the hsemoir-