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plains bitterly of pain in the head. Omit the opium, continuingthe quinine.

llth.-Sliaht improvement; she is more composed; head-ache is less; the eye presents a more favourable appearance;it is syringed with a weak solution of nitrate of silver (half agrain to the ounce). A purgative of castor oil and turpentinegiven.14th.-Chemosis increased. There is still ground for fearing

that the cornea will slough. To syringe the eye with thebefore-mentioned solution of nitrate of silver every morning.20th.-The swelling prevents an accurate inspection of the

globe, but the inflammation has decreased, and there is muchless pain; it is feared that the cornea has sloughed; cold-waterpads are kept to the eye.22nd.-Inflammation much less.23rd.-Does not complain of pain. Mixture of extract of

belladonna and mercurial ointment, equal parts, smeared abovethe eyebrow.25th.-Improving; the cornea is cloudy, but all tendency to

sloughing has passed away.27th.-Much improved; conjunctival congestion much less;

she begins to distinguish objects, and to assign to them theirproper colours.30th.-All the good signs have increased; vision is daily

increasing.July 6th.-Continued improvement up to the present time;

congestion much less, but there is a haziness of the cornea;pain and lachrymation have ceased; the gonorrhae3.1 dischargecontinues, and a mixture containing copaiba is ordered.

8th.-Scarcely any congestion of the conjunctiva; toleranceof light much increased. The sight, she says, is as good asbefore the occurrence of the disease.18th.-The only evidence of disease is mottling of the cir-

cumferential part of the cornea; sight is perfect; opium wineis dropped into the eye daily. _

28th. -Discharged, cured; the only remaining corneal opacitybeing below the axis of vision.

CASE 2.-John R-, aged twenty-one, a tall, healthy-looking lawyer’s clerk, applied as an out-patient on the 17thof August, 1859. He complained of pain, great heat, andwatering of the left eye. The lids were seen to be muchswollen, and of a purplish colour. On raising the upper lid,purulent fluid escaped. The conjunctiva was excessively che-mosed ; the cornea pretty clear.

His previous history was as follows:-He had had gonorrhoea.four months before the outbreak of this attack, but more latelyno symptom of it. A fellow-clerk with whom he lived, how-ever, had, at the time his disease began, a gonorrhoea; and itis to having used his companion’s towel that he attributes thepresent inflammation. The eye affection commenced on the5th of August with watering and pain; it continued increasingin severity until the present application.He was imniediately admitted into the hospital, and ordered

two grains of disulphate of quinine three times a day; fulldiet, with eggs, a beef-steak or meat for supper, and two pints Iof porter daily; to bathe the eye frequently with decoction of ’’,,poppy-heads.

Aug. 18th.-Does not complain of much pain in the eye, andsleeps well at night.

20th.-Expresses himself as better. Tired of hospital re-straint, he begged to be allowed to become an out-patient. Thesame treatment was enjoined and continued.30th.-Chemosis had quite disappeared; the cornea looked

slightly soft. A solution of nitrate of silver (one grain to theounce) was dropped into the eye.

‘

Sept. 2nd.-Still much better; no pain; lachrymation hasceased; says he can see as well with the affected as with thesound eye, except that he is unable to keep it long fixed uponan object; the conjunctival congestion is fast disappearing;there remains a very slight softened appearance of the marginof the cornea. He still remains under treatment, but the onlynotable sign the eye presents is a slight congestion of the con-junctiva.

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CLINICAL RECORDS.

EPITHELIAL CANCER OF THE LIPS.

ISOLATED examples of this form of cancer of the lip are occa-sionally presented to the notice of the pupils at the differentgeneral hospitals in London, and, when the disease has not ex-tended too far, it is removed by operation. On the occasion

of a single visit to the Cancer Hospital, we observed the follow-ing cases :-A man, sixty-eight years of age, had the left side of his

lower lip affected for a year with a distinct epithelial cancerousulceration, slowly enlarging. It had now almost entirelyhealed by the application, three times a day, of eqnal parts ofalmond oil and solution of diacetate of lead (two drachms ofeach). This has a soothing and drying-up effect, and absorbsthe surrounding induration.Another man, sixty-one years of age, had been the subject of

cancer of the middle of the lower lip for fourteen years. Ithad been removed ten years ago, at St. George’s Hospital, butrecurred some time afterwards. From being very large it haddiminished to the size of a shilling, and was drying up or scab-bing over by the simple application of distilled vinegar andGoulard’s lotion.A third example was that of a man, fifty-eight years of age,

with the same disease affecting the left side of the lower lip forfour years. He had never been operated upon, and was beingtreated with apparent advantage by the local application ofspirits of turpentine three times a day.A man, aged forty-five, had his lip and submaxillary glands

affected. The diseased part of the lip was excised by Mr.Stanley, at St. Bartholomew’s Hospital, about eighteen monthsbefore, the whole duration of his disease having been now threeyears. The lip remained well after the operation, but theglands in the submaxillary space of the same side of the neckbegan to enlarge and suppurate shortly afterwards. This isnot a favourable case to treat, from the deep extension of thedisease; but, under the use of an embrocation of lead, withtonics, the man was greatly improving.A Chelsea pensioner, aged seventy-one, had a cancer re-

moved from the right side of his lower lip two years ago, byDr. Marsden, at the Cancer Hospital, Brompton. The diseasereturned, but has dwindled to a mere scale or superficial scabby the use of the soothing lead lotion.

In these five cases, which we had the opportunity of thusseeing together, there was an absence of the offensive secretionusually observed. The sores had a healthy appearance, andthe patients felt that they were getting better. Without ex-

ception, all had been 01d smokers, and the disease was evidentlytraceable to the unglazed stem of a tobacco pipe. In none didit appear to be specially inherited.On the 19th July, two cases of cancer of the lower lip were

submitted to operation at Guy’s Hospital. The first presentedthe usual characters of the epithelial form of the disease, occu-pying the right half of the lip, involving the mucous membrane.It was removed by Mr. Hilton by a V incision, and the edges ofthe wound were brought together by needles. The second wasa case of greater interest, in a middle-aged man, in whom therewas no breach in the continuity of the mucous membrane, buta distinct tumour occupied the middle of the lower lip, pro-jecting forwards. It was excised, in a manner similar to theprevious case, by Mr. Birkett. On making a section of thetumour, it was found to be a distinct nodule of true carcinoma,of the size of a marble, and with none of the characteristics ofepithelioma about it. Both of these patients were old smokers,but it was only in the first that the disease could clearly betraced to the effects of the stem of the clay pipe. Union byfirst intention ensued in each case.

THE NUMBER OF CHILDREN A WOMAN CAN BEAR.

THE question of how many children a healthy woman can bear,during the child-bearing period of her existence, is one of someinterest. If a couple live harmoniously together during a longlife, and marriage has taken place very early, it is quite pos-sible that as many as 24 children may have been born to thestate, at intervals reasonably short, and without their comingas twins or triplets. Amongst the poorer classes this regularityis not met with, although even amongst them a pretty largenumber of children are born. On looking over the Register ofthe St. Pancras Roynl Dispensary since the year 18<>3, six in-stances occur in which over 16 children were born: thus, twopatients, aged 4 and 46 years respectively, were each confinedof their 17th child ; one, aged 39, of her ISth; whilst three, agedrespectively 39, 40, and 50, were confined of their 19th. Thelast patient, 50 years of age, besides her 19 children, had 4 mis-carriages. In most of these cases the births were single, althoughoccasionally twins were horn. The greatest age was 50. Dr.Gibb states that, on a careful examination of the Register formany years back, the age of 50 is the highest at which anypatient was admitted, and as the same patient did not presentherself again, it is probable she ceased to bear children.

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If the cessation of the catamenia determines the time at E

which gestation ceases, then it must occur in some instances as <

late as 55 or even 60 years; for M. Brierre de Boismont, who 1determined the critical period of life in 181 females, found that xit occurred in 21 between 51 and 55 years, and in 5 between I

55 and 60 years. c

In considering the number of children a woman can bear, we lof course here exclude those cases of multiple births, whereinfrom 2 to 6 children are born at one time, and which thus willswell the number of children brought into the world by onewoman t3 as many as from 25 to 69.

CONGENITAL PHYMOSIS IN A MAN AG1:DTHIRTY-FIVE.

A PATIENT of the above age, of healthy and ruddy aspect,submitted himself to Mr. Fergusson’s notice, at King’s CollegeHospital, with complete phymosis, there being an extremelysmall orifice through the end of the foreskin to permit the urineto pass. From his history it appears that he had a congenitalphymosis, with a moderate-sized orifice; six years ago, he con-tracted syphilis, and the treatment of a chancre by the appli-cation of nitrate of silver caused the contraction of the openingto the smallest degree. On the 13th ult., the anterior part ofthe foreskin was simply slit up, which at once relieved theglans, the edges being kept together by sutures. No other

operation was admissible, as there was not a redundancy ofskin, but it completely answered the desired purpose.One of the risks to which an adult is liable who has had phy-

mosis for years is the occurrence of epithelioma. It is a re-markable fact, that in the majority of instances of thin form ofcancer of the prepuce, the patient has been the subject of anunrelieved congenital phymosis.

EFFUSION INTO THE JOINTS AND SHEATHS OFTENDONS FROM RHEUMATISM.

WE were shown a case of articular rheumatism under thecare of Dr. Wilks, at Guy’s Hospital, in a girl nineteen yearsof age, in joints there is a moderate amount of effusionof fluid, that in the wrist extending into the sheaths of theneighbouring tendons. The other articulations involved arethe shoulders, ankles, and knees. Her illness has been offive months’ duration, and this is her first attack of rheuma-tism, which does not appear to have been at any time veryacute in its character. Her general health previous to herpresent attack seems to have been very good. Since her ad-

mission, she has been taking, amongst other medicines, twofluid ounces of lemon juice three times a day, and, so far as wecould see, with benefit. The features of interest in her caseare-the effusion of fluid into the joints without any acute esymptoms or much suffering, and the extension of it in thewrist only to the tendinous investments.

In the medical wards we observed a number of cases in whichthe more severe and dangerous symptoms of heart disease werepresent. In one instance, under Dr. Pavy’s care, a relapsehad ensued, and pleuro-pericardial inflammation was very ex-tensive, the prognosis becoming serious.

Reports.AND NORWICH HOSPITAL.

SOFT MEDULLARY CANCER OF THE ULCERATED

INTO THE PERICARDIAL CAVITY, PRODUCING AND DEATH.

(Under the care of Mr. G. W. W. FIRTH.)by Mr. CHARLES House-Surgeon.

MARIA S-, aged thirty-six, single, a servant, admittedinto the above hospital, on the 9th of October, 185S, withsymptoms of stricture of the oesophagus. The patient hasa florid complexion, is of a spare habit of body, evidentlyemaciated from some exhausting disease, is greatly debilitated,and wears much anxiety in her countenance. Her present ill-ness commenced about four months ago. Previous to that

period, she had always enjoyed remarkably good health. It

began with pain at the pit of the stomach, which was very

evere, and, as she expresses it, of a " scratching, scrapingharacter." Blisters and other external remedies were appliedy her medical attendant, and in four weeks it left her, andlOW her throat, which had felt sore previously, became worse;he experienced a difficulty of swallowing solid food; this diffi-iulty has been gradually increasing to the present time. Sheias never drunk any strong acid, nor taken anything likely tonjure her throat, nor has she ever had anything stick in her;hroat. She cannot swallow thick fluid, such as arrowroot; 9the says it passes to a certain spot, remains there a few seconds,md is then rejected, and she retches for a long time after; but;hin fluid, in small quantities, she can manage, though a longime getting it down. Catamenia are, and have been, perfectlyregular; bowels costive; tongue clean; sleeps tolerably well;Feels most acutely the sensation of hunger.On examining her chest, there is slight dullness over the right

ilide, with diminished respiration; on the left side, respirationis harsh and puerile. Heart-sounds are normal; no extendedarea of dullness in the cardiac region; no bruit in any part ofthe chest, either anteriorly or posteriorly.Mr. Firth ordered strong beef-tea enemata to be thrown into

the rectum three or four times a day, and directed oesophagusbougies to be passed through the stricture every second day-to commence with No. 1, and to use larger and larger onesuntil the full size should be attained. This was accomplishedin about a. month after such treatment was begun. A

tolerably free oesophagea.1 passage was now established, andshe was able to swallow fish, mutton chop cut finely, pottedbeef, and eggs, which, with porter and port wine, formed herdiet. The beef-tea enemata were of course discontiuued. Thisimprovement, however, lasted for three weeks only. Up tothis time, the patient’s system had not rallied as it ought tohave done, considering the large amount of solid nourishmentshe had been taking daily. On this account, Mr. Firth cameto the conclusion that the patient was not suffering from anordinary stricture of the oesophagus, but from malignant diseaseof that canal, and the sequel of the case justified his diagnosis.She now began to retrograde, and suffered acute pain when.the bougies were passed, and could not endure to have thempassed oftener than once a week. She felt so nauseated and illafter swallowing food, and the pain of deglutition was so great,that she refused to swallow any more, and beef-tea enematawere again had recourse to. In spite of all treatment, sherapidly lost ground, and entreated to be allowed to go home.This was granted, and she was discharged on the 18th ofDecember.

Before she left the hospital, Dr. Eade examined her chest,and gave the following report:-" Is considerably emaciated,and complains of constant aching pain between the soapulse;the pulses at the wrist are equal; great loathing of anyfood ; there is neither tenderness nor hardness of the sto-mach. On percussion there is a little dullness over the upperpart of the left side of the chest in frcnt, but no difference inthe percussion note behind. Very little air can be heard toenter the root of the right lung, and the whole of this lung pos-teriorly is nearly silent. The respiration is puerile on the leftside behind, but not so markedly as in front." After leavingthe hospital, she got worse gradually, and was always complain-ing of a severe "gnawing" pain between her shoulders. Couldnot eat anything; was nourished with beef-tea enemata, andat last died, twenty-four days after leaving the hospital, andexactly seven months from the commencement of the complaint.

4M<o_ps;/.&mdash;Body excessively emaciated. Chest and upperpart of abdomen only examined. Lungs healthy; crepitant;no tubercles in them; nearly the whole surface of the right lungadherent to the pleura; left but slightly. Pericardial cavitycontained a large quantity of turbid serum. Heart small, andcovered with lymph, which could be easily peeled off its surface;this was rough to the finger, and had a peculiar soddened ap-pearance ; no endocarditis; all the valves and the aorta healthy.Stomach large; cardiac and pyloric orifices healthy. Liverhealthy; gall-bladder distended with bile, and black in colour;spleen small, but healthy. The trachea and ossophagus weredivided at the root of the neck, carefully dissected downwards,and removed from the body with the stomach. On openingthe oesophagus its whole length, a mass of disease presenteditself, occupying the calibre of the tube, forming an annulargrowth, commencing opposite the bifurcation of the trachea,and terminating four inches and a half below; posteriorly,where it was thickest, it was three-quarters of an inch in depth;had a shining milky colour; rather soft ; and there was a narrowirregular passage through it. At about the middle, on the left

’ side, there existed a round ulcerated opening large enough to; admit a No. 12 catheter, which opened into the upper p4t of’ the Dericardial cavitv. The mucous membrane of the aesophtBJlU8