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the symptoms, however. it proved to be more than simpleconcussion. The group of symptoms pointed to injury andinterference of power about the fourth cervical vertebra,this not being so complete as to thoroughly paralyse thebrachial plexus, as evidenced by the involuntary drawingup of the arms, &c. As usual in such cases, this patientgradually sank from impediment in the lungs, dying fromasphyxia. In a medico-legal point of view it is an interestingcase, showing by how simple an accident we may havenot only fracture, but also impaction of the plates of thevertebrae. As there was no evidence of direct violence tothe neck, it is just possible that the man may have fallenon his buttocks with his spine quite erect whilst walking onthe roof, and the stone slate which he was carrying mighthave remained on his head and its weight have thrown thehead violently back, and so fractured the neck at theweakest point of the arch thus formed ; this is supported bythe small contusion found on the forehead. If this sup-position is correct, I think it is an unusual mode of accident.I do not remember another instance of such injuiry being soproduced.

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MEDICAL COLLEGE HOSPITAL, CALCUTTA.CASES OF ANEURYSM.

(Under the care of Mr. O’CONNELL RAYE.)For. the following report we are indebted to Anoda Prosad

Dutt, house-surgeon.CASE 1. Trctqtmatic Aneurysm of the Palmar Arch.-

R. G-, Hindoo male, aged twenty-nine, received a woundtwo years previously in the left hand. The wound healed,but a pulsating tumour soon after formed near the hypo-thenar eminence. On admission the swelling was as large asa half walnut, and pulsated strongly. Pressure on the ulnarartery did not reduce the pulsation, neither did pressure onthe radial; but when both arteries were simultaneouslycompressed the pulsation ceased completely. Accordinglythe radial and ulnar arteries were both ligatured just abovethe wrist ; catgut was employed for ligature. The pulsationat once ceased. On the second day after the operationpulsation returned. It was controlled by compression of thetumour with a pad and bandage lightly applied, and after afew days ceased completely. The swelling gradually sub-sided, and the patient was discharged cured three weeksaftfv DTMrattfm

CASE 2. Axillary Aneurysm,. Ligature of the Subclavian i

in the third part Cttre. -A Hindoo male, aged thirty-eight, 1a clerk, was admitted on October 22nd, 1883. He stated 1that he had suffered from syphilis four years previously, but tthat otherwise he had been invariably healthy. No evi-dence of the existence of constitutional syphilis was dis- <

coverable on a careful examination at the time of admission. aThe man was also wholly unconscious of having received (

any strain or injury which could account for the occurrence 1of the tumour. He first noticed a hard swelling in the axillaabout six aveeks before admission. It was then as large as awalnut, hard, and painless, and so far as he could remember i

did not pulsate. It remained stationary and painless for a ’fortnight after it was first noticed, and then rapidly enlarged. <

Pain commenced with the increase of size, radiating allround the tumour, darting down the arm, and finally be-coming of an intolerable gnawing character in the site ofthe tumour itself. On admission, a tumour the size of a largeorange filled the left axilla. It pulsated visibly, a thrillwas perceptible on palpation, and a loud rasping bruit onauscultation. The pulsation was distinctly distensile, andcould readily be controlled by compressing the subclavianon the first rib. The anterior and posterior walls of theswelling were hard and dense, but inferiorly a sensationof fluctuation was made out. The shoulder was elevated,and the elbow could not be brought to touch the side. Acareful examination failed to elicit evidence of dipease in anyof the organs, and, in fact, but for the presence of theaneurysmand the suffering caused by it the man was in perfect health.Two days after admission digital compression was applied tothe subclavian for thirty minutes, completely controlling thepulsation in the tumour. The pain in the tumour ceasedwith the cessation of pulsation, but the finger compressingthe subclavian caused such suffering that the treatment hadto be given up for the time. A hypodermic injection ofmorphia was then given. On the following morning asecond attempt was made to use digital pressure. Thepatient could not tolerate it, however, for more than a few

minutes. Finding that this treatment could not be bome,and a dark blush appearing on the skin in the axilla wherethe tumour was most thinly covered, it was determinedto tie the artery next day. Accordingly, on the morningfollowing the subclavian was tied in its third part inthe ordinary way. The artery was reached without dim-culty ; but when exposed its pulsation for a few secondswas so feeble as scarcely to be perceptible to the finger.Catgut carbolised ligature was used, and when the liga-ture was tied all pulsation at once ceased in the tumour.Five minutes after the operation the fingers had become cold,while the shoulder felt abnormally hot. Half an hour laterthe whole arm and fingers had regained heat, and through-out the day remained distinctly hotter than on the soundside of the body. The arm and shoulder ’were of course

wrapped in cotton-wool and laid comfortably on a pillow.The patient recovered rapidly without a single bad symptom.The wound healed by the first intention. A catgut drainwas employed. The tumour slowly became smaller andmore dense. Pulsation did not reappear in it at any time.Six weeks after the operation the man was discharged at hisown request. He was then in perfect health, entirely freefrom pain, and could use his arm. The tumour had shrunkto about half its original size and was still contracting.Four months later he reported himself perfectly well.Note.-It may be of interest to note the method adopted

for applying digital pressure in this case. The patient waspropped up with pillows and the operator standing behindhim grasped the shoulder, the thumb resting on the spine ofthe scapula and two fingers pressing deeply behind the innerhalf of the clavicle.

Medical Societies.ACADEMY OF MEDICINE IN IRELAND.

AT a meeting of the Surgical Section of this Society onApril 4th the following living specimens were shown :-Mr. Hayes : Case of Radical Cure of Hernia. Mr. Croly :(1) Excision of the Knee; (2) Excision of the Elbow;(3) Fracture of the Patella, treated by the expectant method.Mr. Lambert H. Ormsby: (1) Case ot Diseased CervicalVertebra in a Child, treated by spinal support and jury-mast ; (2) Case of large Cervical Tumour. Dr. C. B. Ball :Patient in whom Radical Cure of Hernia had been effectedby torsion of the sac. Mr. A. H. Benson : Cases showingthe result of Dianoux’s Operation for Entropium.The PRESIDENT (Mr. Wheeler) read a paper upon two suc-

cessful cases of Pharyngotomy. The first was that of aman aged forty-five years, who swallowed a threaded needleeye foremost. His efforts to withdraw the needle by pullingthe thread only served to embed the point more deeply. Hewas admitted to the hospital two days after the occurrence.Various attempts at removing the needle having provedunavailing, pharyngotomy was undertaken. An incisionwas made on the left side of the neck from the body of theos hyoides to the superior margin of the cricoid. The partswere caused to bulge by passing a staff into the mouthand pharynx, and upon the point an incision was made,the opening being then enlarged with the fingers.The needle was found embedded in the tissues. Itwas exposed by scraping with the finger nail, and by slighttraction of the thread and grasping the needle with forcepsit was withdrawn. The patient recovered. In the secondcase a lady had suffered some months from what was sup-posed to be ordinary sore-throat. On examination, a tumourabout the size of a small egg was found situated below thelevel of the epiglottis on the right side in the sinus pyriformis.The symptoms of obstruction becoming urgent, it was deter-mined to remove the tumour. An incision was made in theline of the right sterno-mastoid muscle from an inch belowthe angle of the jaw to the level of the upper ring of thetrachea. The pharynx was opened by dividing the tissueson the projecting end of a catheter introduced through themouth, and the wound was enlarged, first by forceps, thenby the fingers. The tumour, which sprang from the styloidligament and process, was removed piecemeal, and was foundto be a spindle-celled sarcoma. The patient made a goodrecovery, but the disease returned in a few months and shesuccumbed. Mr. Wheeler emphasised the necessity of a freeexternal incision.-Mr. TUFNELL, having seen the two cases,

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concurred fully in Mr. Wheeler’s suggestion as to the feasi-bility of a large free external incision, the advantage derivedfrom which was most desirable. Nothing could be moresatisfactory than the mode of performing the operation andthe result. He referred to a case in which Liston extracteda pike-hook from the pharynx of a boy, first by freeing thehook from its attachment, and next by jerking the doubleends with a sponge. A needle might be broken in theextraction. - Mr. STORY said the needle could be cutin two, and then extracted by means of magnetised forceps.He instanced a case of a boy who had swallowed a

needle. The boy was, on his recommendation, kepton slops in the hope that the needle would workdown with the faeces, which it did in a few days.-The PRESIDENT remarked that one case was seldom aguide to another. Early pharyngotomy ought to receiveattention.-Mr. FRANKS considered the great point waswhether foreign bodies in the pharynx should be removedby an internal or an external operation. Opinion justi-fied the necessity of pharyngotomy in certain cases; butwhere there were two natural cavities the need of makingan unnatural opening was doubtful. In England the ques-tion was discussed of opening the thyroid cartilage or thelarynx to get at foreign bodies, and the consensus of opinionwas against external operation until every effort by naturalmeans had failed. The laryngoscope should be employed, andwhere a foreign body was seen in the pharynx it could in themajority of cases be easily got out. Laryngotomy shouldonly be used in extreme cases. In most books pharyngotomywas not mentioned, and the reason was that as a generalrule the operation was unjustifiable.-Dr. M’ARDLE wouldconfine pharyngotomy to such tumours as Mr. Wheeler hadmentioned, but he did not see how a tumour growingfrom the styloid process could be extracted through themouth without injuring some of the large vessels.-Mr.THOMSON asked whether the tumour did not sl)rii3LY fromparts external to the pharynx altogether. If that were so,there was no occasion to perform pharyngotomy, exceptfor the convenience of putting in the finger to push the Itumour upwards.-The PRESIDENT, in reply, said he had ’,attempted to cut the needle in half with forceps, but hadnot succeeded, though he had the aid of Dr. Haughtonand others. Of course he would not perform pharyngotomywhere he could remove the tumour through the mouth.Tumours of the pharynx growing from the base of the skullcould not be removed through the mouth. The laryngoscopewas a great help in diagnosing the exact situation of theneedle and the tumour. The wall of the pharynx was outsidethe tumour.

Dr. M’ARDLE brought forward a case of Stricture of theRectum, in which linear rectotomy had injured the patient,and dilatation by bougies was ineffective. Having reviewedthe various methods of treating intractable stricture, andshown that the mortality after colotomy was as great asthat after excision of the rectum, he invited opinion on themethod of excision by a musculo-cutaneous perineal flap andretention of the external sphincter, as advocated by Busch ofBerlin.-Mr. HAMILTON regarded one operation only asabsolutely radical for cancer of the rectum. Linear recto-tomy was only a palliative operation, not curative. But hecould hardly say the same of colotomy. It was of coursepalliative, and gave a great deal of comfort. The only radicalcure was extirpation of the bowel; but the cases in whichthat operation could be performed with satisfaction werevery few. Where the limit of the disease could be reachedwith the finger, the rectum might be removed with a fairchance of success.The SECRETARY, for Surgeon-Major TOBIN, read the

particulars of a case of Ununited Fracture of the Femur,which was under treatment in Netley Hospital in February,1883. The injury was sustained whilst the patient was onactive service in Egypt. He was in the mounted infantry,and on Aug. 6th his horse ran away and dashed him againsta tree. The injury was first treated by a long Liston’s splint.Whilst in hospital he had an attack of enteric fever, whichlasted five weeks. About six weeks after the receiptof the injury the splint was removed, but no union wasfound to have taken place. A MacIntyre’s splint was now sub-stituted, and after six weeks a gypsum bandage was appliedand left for several weeks. Still no union took place. Onthe patient’s admission into Netley Hospital the shorteningwas two inches and three-quarters. On May 18th, 1883,the situation of the injury was exposed, and the fracture wasfound to be a comminuted one. The ligamentous union

between the fragments having been divided, the lower frag-ment was made to protrude, and its upper extremity excised.The lower extremity of the upper fragment was removed bya chain saw, and the two fragments were then wired to-gether. To counteract the tendency to tilting forwards ofthe upper fragment it was decided to put the leg up atnearly right angles to the body. In carrying out this plan,an ingenious apparatus devised by the author was em-

ployed, by which all the necessary requirements were fnl-filled. The patient’s recovery was uninterrupted, and whenthe apparatus was removed firm osseous union was found tohave taken place. The shortening was two inches andthree-quarters. When this shortening was compensated forby a suitable boot, the patient soon learned to walk aboutwith freedom.

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Reviews and Notices of Books.Clinical Lectures on Mental Diseases. By T. S. CLOUSTON,M.D. 8vo, pp. 624. London : J. and A. Churchill. 1883.

Influence of the Mind upon the Body. By Dr. HACK TUKE.Second Edition. Two vols., pp. 335 and 309. London :J. and A. Churchill. 1884.

Insanity considered in its Medico-Legal Relations. ByT. R. BUCKHAM, A.M., M.D. 8vo, pp. 250. Phila-delphia : Lippincott and Co.DR. CLOUSTON’S work is without doubt the best clinical

book on insanity yet published, and should be of great useto the general practitioner in dealing with insane cases.

The author has clearly and interestingly described a largenumber of varieties of insanity, especially from the point ofview of "progress" rather than from that of "state"; andalthough these varieties have not been exhaustively treated,the consideration of them has been carried far enough forpractical purposes ; the practical character of the book,indeed, is evidenced in every page. Regret must be

expressed, however, that the author should have stillfurther burdened a subject already overloaded with terms.Psychalgia, psychlampica, psycho coma, &c., give rise to amental feeling which can best be described by the first ofthe terms quoted. Dr. Clouston follows the rule of writerson mental diseases by inaugurating a new classification.This is founded on symptoms and is divided into, states ofmental depression, exaltation, regular alternation, fixed

delusion, enfeeblement, stupor, defective inhibition, and,lastly, the insane diathesis. He also treats of some nine-teen major and fourteen minor varieties of insanity, thesevarying in value from general paralysis to post-connubialinsanity. The relative importance of each of these varietieswould probably vary with the experience and attention ofeach writer; but Dr. Clouston certainly seems to havetreated some of these cursorily, as the traumatic, syphilitic,and gouty forms. In a work of so much clinical detailthere is difficulty in criticising the special divisions of thesubject, but the concluding lecture on medico-legal andmedico-social duties calls for especial commendation for

clearness, conciseness, and systematic arrangement. Thebook is embellished by eight plates, of which several arecoloured. One of these represents a section of brain in astate of acute mania, showing a degree of irregular vascu-larity which Dr. Clouston appears to think is more commonthan the majority of his contemporaries will admit. Asecond represents the vertex of the brain in general paralysis,and is too pretty to be satisfactorily pathological. Thatthe book is well written is guaranteed by the name of theauthor, who in furnishing so useful a work to the professionhas added to his well-deserved reputation.

Dr. Tuke, in the preface to the first edition, states the: object of his work to have been the collecting together and.

arranging in physiological order the authentic illustrationsI of the influence of the mind upon the body. In his secondL preface he further aspires "to lay down and illustrate certain