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and offensiveness, and the examination was postponed forsome days. On September 28th I was again sent for, whenI found her in great pain; the pain was periodic and had allthe characteristics of that accompanying labour. An exami-nation was at once made, when the os was found dilated toabout the size of a crown piece, being soft and elastic, whilesomething could be felt presenting on each contractionof the uterus. Even at this time I did not believe herpregnant with a living child ; however, two hours later,the pains being all along slight, a living child was

born, the placenta and membranes coming away withthe foetus. The sac was ruptured when discharged, butthere had been no escape at any time of liquor amnii-thatis, in quantity sufficient to attract attention. This I hadnoticed myself, as had also the patient, and a midwife nowpresent. The foetus, which lived ten or twelve minutesafter birth, was between six and seven months old, rathersmall, but fairly nourished. The placenta was somewhatlarge and pulpy, but not markedly abnormal in any way.The patient being weak, and the placenta and membranesintact, no further examination was made. The uteruswas felt through the abdominal wall fairly contracted, thepains-never severe-had almost ceased, and there was nosign of flooding ; so the patient was given a small dose ofergot and opium in a little brandy, and was bandagedand left. On the following morning the midwife (cer-tificated) sent for me and showed me what she called"a false conception," which had been born twelve hoursafter the first foetus. This was an apparently healthyfœtus of about two months, enclosed in its membranes.The villi of the chorion were absent in great part,except where they had developed into the now recognisableplacenta. The foetus was about two inches long, and appearedhealthy. The usual precautions against septic poisoning weretaken, and the patient, with a nutritious diet and a ferru-ginous tonic, soon regained her former health. This womanhas eight living children, the result of her eight formerpregnancies, and she has never had a miscarriage, nor hasshe at any time suffered from any uterine irregularity untilthat noticed in this paper. Had this been a case of firstpregnancy the sanguineous discharge, increasing at themenstrual periods, would have at once suggested the pos.sibility of the uterus being double; but as the case standsthe bilobed uterus is out of the question. Had the uterusbeen double here it should have shown some sign of itsabnormal construction during former pregnancies, when itwas much more likely to do so than in the present case,where we must suppose an impregnated ovum in each of itstwo cavities.This ca.’3e much resembles the one recorded by Tyler

Smith, and mentioned by Playfair in his "Science andPractice of Midwifery."Northampton.

WOUND OF THE CORNEA AND IRIS;RECOVERY OF SIGHT.

BY J. HAWKES, M. D.

A. B-, a healthy boy five years of age, while amusinghimself in helping to shell peas on Aug. 7th, struck his

right eye with the point of the knife. I was immediatelysummoned, and found an incised wound in the lower thirdof the cornea and the anterior chamber full of blood. Thechild’s grandfather, who was present at the time of the

accident, stated that he saw a portion of a dark substancelike membrane escape through the wound. The lids wereclosed with strips of plaster, and a wet pad with a bandage ’,applied. Low diet was prescribed, and he was ordered to bekept in bed. On Aug. 13th I removed the dressing, and founda small colourless clot resting on the lips of the wound; thiswas lightly extracted, the lids closed as before, and a cir-cular belladonna plaster applied to the right temple; lowdiet was continued, and exercise forbidden. At the end ofanother week the dressing was again removed and the eyeopened. The blood had disappeared, the wound in thecornea had nearly healed, and the eye was sensible to light.The belladonna plaster and strapping with a light pad werecontinued, On Aug. 23rd no febrile symptoms had super-vened, and the child was going on well. The strapping andpad were removed on the 26th, and a shade directed to be

worn. The wound in the cornea had closed. On Sept. 4ththe eye was clear, all trace of inflammation had subsided,and the child could distinguish objects. On the 15th theshade was dispensed with. The corneal wound had nowcompletely healed ; that of the iris was well marked, causingan elongation of the pupil where it was incised, as shown inthe accompanying illustration.

Sketch of right and left eyes.

In my experience wounds of the cornea usually terminatefavourably. Some years since I was called to a woman whohad just received a blow on her eye from the fist of another.The cornea was ruptured, but the crystalline lens hadescaped and was lying on the patient’s cheek. Under theemployment of strapping and a pad the wound healed with.out any trouble, a fair amount of useful vision being ensured.Kensal-green, W.

__ _________

A MirrorOF

HOSPITAL PRACTICE,BRITISH AND FOREIGN.

MIDDLESEX HOSPITAL.SEVERE BLOW ON THE RIGHT TEMPLE, FOLLOWED BY

RIGHT HEMIPLEGIA AND COMA, AND THEN BY SPASTICRIGIDITY OF THE LEFT ARM; TREPHINING; EVACUA-TION OF INFLAMMATORY FLUID BY INCISION THROUGHDURA MATER; QUICK DISAPPEARANCE OF CEREBRALSYMPTOMS ; COMPLETE RECOVERY.

(Under the care of Mr. HULKE.)

Nullaautemes t aliapro certo noscendivia, nisi quamplurimas et morbornmetdissectionum historias, tum aliorum turn proprias collectas habere, etinter se comparare.—MORGAGNI De Sed. et Oaus. Morb., lib. iv. Procemium,

FOR the notes of the following case we are indebted to thedresser, Mr. Faunce.The great interest of this case, from a surgical as well as

from a physiological standpoint, justifies a more detailedaccount than is customary in " Reports of HospitalPractice." The occurrence of hemiplegia on the same sideof the body as the blow upon the head suggesting, as it did,a lesion of the opposite side of the brain, introduced an

embarrassing complication into the question of operativetreatment. The slow pulse, low temperature, and late

period when the hemiplegia appeared, were taken to indicatean abscess rather than a diffuse inflammation, and physio-logical considerations placed this on the left side. If anabscess were present, the patient’s only hope of survival wasin its evacuation by trephining. Should the trephine beapplied to the left side of the skull (opposite therefore tothe marks of the blow), and if so, where precisely should itbe put on ? With a full recognition of the labours of experi.mental physiologists in the field of cerebral localisation, thefact could not be overlooked that in most of the publishedcases of trephining for the effects of injury, where the aidof cerebral localisation had. been invoked, there was notwanting a less dubious guide in the presence of visible ortangible marks of the injury. In this case, had the doctrinesof cerebral localisation dominated practice, and the trephinebeen set on the left side of the head, the inflammatory focuswould have been missed. The immediate cause of the hemi-plegia is not evident. The supposition of abscess on or inthe left side of the brain, such as might originate in abruise by contrecoup, and the hypothesis of haemorrhage inthis situation through bursting of a vessel consequent uponcerebral congestion as a late excessive reactionary effect,were both disproved by the man’s rapid recovery after tre-phining on the right side. The value of one-sided spastierigidity (noticed in an earlier case of cerebral abscess frominjury) in connexion with a slow pulse and a slow tempera-

815

tare (noticed in four other cases of intracranial abscess frominjury), as evidence of a local and not diffuse inflammationwithin the skull, is here well exemplified.On October 21st, 1881, an Irish day labourer, aged sixty

years, was admitted into Broderipp ward suffering from theeffects of an injury to his head received fourteen days pre-viously. He complained of severe pain darting through hishead from a slightly ecchymosed lump in the right templedistant the breadth of two fingere from the external angularprocess of the frontal bone and just below the temporalridge. Pressure upon this spot aggravated the pain. Hisface had a heavy expression, and he spoke in a slowdeliberate manner, but his mind was perfectly clear; hegave a consistent account of the accident, mentioning datesand correcting his wife’s narrative when he thought herstatements inaccurate. His pulse beat only 56 per minute,and it was very compressible. His temperature was normal.His tongue was dry, and brown along the middle. Hewalked feebly into the ward, but did not require any support,and no motor palsy or loss of surface sensibility was present.He related that fourteen days previously whilst kneeling onthe ground and stooping his head down to look into a drain(he had on a stout felt hat) a falling ladder, twenty-five feetlong, struck him a glancing blow on the right temple, whichthrew him down and stunned him for a few moments. Hesoon recovered, rose, and went on with his work, at whichhe continued during the remainder of that day, the wholeof the following, and part of the third day after the accident.Throughout this time he had great headache, and on thethird day this was so severe as to oblige him to desist fromworking and go home. Since that time he had not left hisroom till he was brought to the hospital. The severity ofthe headache was such that at times his wife feared "hewould go out of his mind.’ and during the intensestparoxysms it was accompanied with so much giddiness thathe could only walk by steadying himself by grasping achair. His wife said that on the evening of the accidentwhen he come home from work she saw that he had a largebruised lump on his right temple, and that two days later theeyelids of both sides, but especially of the right eye, wereblack, but the "white of the eyes" was not black. Thesymptoms during the next two days after his receptioninto the hospital did not materially change. On the secondday (Oct. 22nd) his pulse was 60 per minute and his tem-perature 97° F. On the third day the pulse was 60, thetemperature 98° F., and he had a restless night, mutteringincoherently. On the fourth day he muttered much, wasquite incoherent, tried to leave his bed, asked for hisclothes, wanted to go home ; but when spoken to he un-derstood perfectly what was said to him, and he repliedpertinently. On the fifth day he was lethargic, but he tookfood when it was offered to him, and he answered per-tinently when addressed. On the following day retentionof urine supervened, requiring the use of the catheter, whichhe resented, pushing down his shirt when it was raised. Helay on his back, with his left hand on the vertex of his head,and he sometimes spontaneously drew up his left foot andplanted it on the mattress, keeping the knee bent. Whenpinched he drew the foot up sharply. His right arm layrelaxed by his side, and he was evidently unable to move it,and the right leg was similarly palsied. A nip excitedscarcely any reflex movement of the right arm and leg. Thequestion of trephining was considered, but his wife ob-stinately refused t o permit any operation. On the seventhday there was increased lethargy. Even when loudly spokento he took no notice. Temperature 98 .6° F. and pulse70. On the eighth day the torpor appeared deeper; he wasfeebler; he still swallowed fluid nourishments when put intohis mouth. On the ninth day, between the times of usingthe catheter, he micturated into his bed ; this continuedthrough the following day. In other respects his conditionwas not obviously changed. On the eleventh day (Nov. 1st)towards the afternoon a spastic rigidity of the left arm wasfirst observed, which resisted extension. This arm wasoccasionally twitched.At 7 P.:’I!. on Nov. 1st, his wife having yielded, the scalp

Was reflected at the bruise in the right temple, and the peri-cranium was turned back off a sufficient space to permit theapplication of a small trephine. The outer surface of thebone did not exhibit any morbid appearance. A disc8 mm, in diameter having been cut out, the diploe and theinner table appeared to be normal. A small meningealartery, which, as it grooved the bone, had been necessarilysevered, spirted freely, but the bleeding was soon checked

by pressure. The exposed dura mater appeared to behealthy, but it bulged up so tensely into the bore-hole thatcerebral pulsation could neither be seen nor felt. An aspira-tion-needle connected with a partially exhausted syringewas next pushed through the dura mater, and when thepoint of the needle had entered to the depth of an inch, quantity of brown flocculent fluid flowed into the receiver.As the fluid continued to flow through the prick-hole in th(1membrane after the needle was withdrawn, this hole wasenlarged with a narrow scalpel passed to about the samedepth as the needle, which permitted a further escapeof fluid. The total quantity of fluid thus evacuatedwas estimated at from three to four drachms. The scalp-flaps were replaced, their edges united with a fine suture,and a slip of oiled silk inserted into the middle of thewound for a drain. The entire wound was covered with abunch of boric-lint charpie, kept in place by a linen skull-cap. The operation was performed under chloroform. Novomiting followed. One hour later the man seemed less un-conscious ; he indicated his want of food, and took it readilywhen given him, which he had not done for several days.! Next morning, the twelfth day from the date of his admis-sion into the hospital, the patient recognised those aroundhim, and replied pertinently when addressed. He asked fora pipe and smoked ; when this was given to him, holding itwith his left hand, the spastic rigidity of the left arm haddisappeared. Temperature 98° F., and pulse 67. The charpiebeing soaked with the same kind of turbid brown fluid whichhad escaped from the incision through the dura mater, wasrenewed.On the following day (Nov. 3rd) a very marked improve-

ment in his condition was evident. He himself said he feltbetter. The palsy of the right arm was disappearing; hecould raise it off the bed and bring the hand nearly to hismouth. Temperature 97 ’4°; pulse 74.Next day (Nov. 4th), the fourth day after trephining, the

patient felt so much better that he wished to get up. Tem-

perature 97° F. ; pulse 80. - 7th : He could move his rightarm and hand evenly and freely.—8th : He spent the mora-ing in reading the Irish Nation, newspaper. The sutureswere removed, a slight redness having appeared aroundthem. Temperature 97° ; pulse 80.—11th : He had a restlessnight, and this morning he complained of headache. Tem-perature 100’4°; pulse 100, hard; tongue furred. It waselicited that, contrary to a strict injunction that he shouldnot leave his bed, he had taken advantage of the temporaryabsence of the nurse, and had got up and gone to the water-closet. A purge was given which acted freely, and afterthis the headache abated, and the temperature and pulse-rate declined. From this date his recovery was uninter-rupted.By Dec. 1st, one month after the operation, the patient was

considered convalescent, but for precaution he was detainedin hospital until Jan. 2nd, when he went home, feeling quitewell, and with the intention of returning to work.

SUSSEX COUNTY HOSPITAL.SEQUEL TO A CASE OF EXCISION OF THE RECTUM FOR

EPITHELIAL CANCER.

(Under the care of Mr. WILLOUGHBY TURNER, F.R.C.S.)THIS case was reported in THE LANCET on March 15th,

1879. An epitome of that report is as follows :-Mary M-, aged sixty-four, was admitted for an epi-

thelial cancer (cylindrical epithelioma) of the rectum. Shehad had pain and bleeding for two years before admission.The growth occupied the left side of the rectum, and itshighest limit was two inches and a half above the anus. Itextended more in front than posteriorly. A portion of therectum was excised, chiefly with the knife ; but thebenzoline cautery was used to divide the bowel. The resultwas good; she could hold her motions, and there wasentire relief from pain and hæmorrhage. On October 20th,1880, two years and a half after the operation, thepatient was readmitted with a recurrence of the growthin the recto-vaginal septum. This was removed bythe knife. It extended so high that to ensure its entireremoval the peritoneum was exposed and separated fromthe front wall of the rectum for a distance of rathermore than half an inch. The result was again good ; andwhen she left the hospital she was in comfort and hadcontrol over her motions. On June 6th, 1883, the patientwas again admitted complaining of pain in the region of the