CASHEL UNION HOSPITAL

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third hour, and at 11 A.M. the atropia was increased to one-twentieth of a grain every sixth hour. There is now profuseperspiration at 11.30 P.M. He had retention of unne, re-lieved by catheter, but spasms were less frequent and not soviolent.-19th: Better, can open his mouth wider; getssome sleep now for five to ten minutes, when spasms wakehim. The atropia seems to control the spasms, butwithout the bromide and opiate he has more pain and getsro sleep. Has six ounces of brandy with beef-tea, eggs, andsherry now. In the evenings the atropia was reduced toone-sixtieth of a grain again. The wound has opened alittle ; poultices continued ; retention of urine continues ;bowels relieved by enemata.-20th to 26th : Remained aboutthe same. Treatment continued. The retention of urinepersisted until the 24th.

Oct. 2nd.-The patient has been slowly improving; thetetanic symptoms are much diminished. The atropia wasleft off to-day. The bromide and opium continued every thirdhour. Wound nearly well again ; dressed with boracic oint-ment.-4th: The patient is better, and he can put his tongueout. He has lost much flesh, and his face looks very pinched.To have mixture every sixth hour.-8th : The rigidity ofmuscles is less. Perspiration, which had diminished of late,is now profuse. General condition much worse, and strengthseems failing. Ordered two grains of quinine every fourhours. Opiate only if in pain.-9th to 13th: He has con-tinued in the same low state. The quinine has diminishedthe sweating.-14th : He has taken a turn for the better.Feels hungry.-16th: He has had some meat at his ownrequest. Still some slight rigidity. He has only taken twograins of the quinine with fifteen minims of diluted sul-phuric acid every four hours for the last four days.-30th :All trace of rigidity has now gone. He is able to sit upand walk about the ward, but is very weak. During all thetime the temperature has never risen above 99° F.Dec. 12th.-He has been slowly gaining strength, and his

general condition is good, but still he is not the same strong-looking young man he was when admitted. He went hometo-day.Remarks by Mr. GREENWOOD.-In this case, although a

long period elapsed before tetanus set in, it made rapid pro-gress. A fair amount of nourishment was taken, but thepatient was utterly prostrated and emaciated in a very shorttime. The atropine had a very marked effect in relievingthe spasms, and I consider it is to it the patient owes hisrecovery.

CASHEL UNION HOSPITAL.CASES UNDER THE CARE OF DR. LAFFAN.

CASE 1. Purulent Peritonitis aftera Crush. —W. . L—, agedtwenty-eight years, a healthy-looking farmer, but with someseeming taint of scrofula, was crushed on March 30 tb, 1879,between the shaft of a car and the pier of a gate. Sym-ptoms of peritonitis set in immediately. There were dartingpains, diarrhoea, and a general febrile state. He placedhimself under the care of a physician, and on May 1st wasseen by Dr. Laffan. At this date the abdomen was swollento an immense size. A line of demarcation, however, seemedto run obliquely from the right iliac fossa towards the lefthypochondriac region, and the swelling, which was enormous,was confined to the left side of this line. It was evidentthat a large quantity of matter was present, and that itsevacuation was urgently called for. A trocar was enteredto the left of, and about an inch above, the umbilicus, andabout three basinfuls of pus were let out, to the great relief ofthe patient. Next morning a surprising quantity had againcollected, which was also evacuated. A drainage - tubewas inserted, but as it could not be borne it had to beremoved. The wound had to be reopened on three orfour occasions. No intestine ever protruded through the.wound. The discharge continued gradually to decreaseuntil at the end of ten months it had entirely ceased.Vomiting occurred from time to time during the progress ofthe case, and the general system was reduced to the lowestpoint. Iron, quinine, and a general supporting and tonicplan of treatment were employed, and ultimately the patientrecovered completely. He was seen on November 29th, 1882,and was in perfect health.The following case is interesting on account of its rarity,

the circumscribed character of the inflammation, its recur-rence, the close simulation of hepatic disease by the epigastrictumour, its doubtful causation, and its fatality.

CASE 2. Subperitoneal Cellulitis.-D. O’N-, aged forty,a labourer, was admitted on August 1st, 1880. In June, 1880,he noticed a swelling in thevesical region. Duringthesummerhe suffered from general malaise. He suffered from repeatedattacks of rigors during this time. The abscess was opened onMay 3rd, and exit given to a small quantity of pus, and disclosedits seat to be in the subperitoneal tissue. The man left hos-pital in October, and a slight discharge continued at intervals.He worked as a farm labourer during the winter months. Hecomplained of the cold of the winter, and the poor food hehad to subsist on. In May, 1880, he noticed a hard swellingabout the s’ze of a small orange in the epigastric region, andhe stated he was hardly able to work. He complained for ayear and a half of pains at intervals below the false ribs.He was admitted into the hospital again in the middle ofMay, 1881, and had remained in hospital to April, 1882.Between May and June, 1881, he was seized at intervalswith rigors, and on June 27th the abscess broke, and dis.closed the same tissue to be affected as before, and about twoounces of pus came away. His history during the remainderof the year 1881, and up to April 29th, 1882, presentednothing to call for comment.On April 29th, 1882, his condition was as follows : Pulse

92, respiration 26, temperature 98°. He slept well last night,bowels were moved twice. He has no appetite, and subsistsentirely on new milk and one egg daily. Bronchitic signswere present in both lungs, and he expectorates a thin wateryfluid mixed with a little blood. The urine is clear and non.albuminous. He complains of being very sore inwardly. Heperspires for six hours at a time, and presents a cachectic ap.pearance, with that peculiar sallow tinge so often found withliver disease.-30th : Pulse 92, respiration 26, temperature98°. Slept well ; bowels moved once; appetite bad; coughhard, and attended with vomiting. Urine very dark; ex.pectorates a great deal ; features present a wasted appear-ance, eyes sunken and dead-looking, very much emaciated;sweats a great deal.From this date until May 23rd his pulse and respiration

were above normal. He was occasionally purged, his appe.tite was wretched, he slept indifferently, his urine was loaded,and his general appearance wasted more and more day by day.Thecoughand expectoration continued. He suffered regularlyfrom rigors, which were followed as constantly by burning heatand copious perspiration. - On the 12th some congestion atthe base of both lungs was noticed, in addition to the pre-vious bronchitic signs ; he also had pretty constant vomiting.On the 17th albumen was for the first time noticed in theurine. During all the time the epigastric wound remainedopen, but was attended with very little discharge. Towardsthe end he was seized with hiccough; but as usually happens,some of his other symptoms were considerably ameliorated,such as the vomiting, cough, and sleeplessness. The patientdied on the 23rd, inability to take nourishment, diarrhoea., andthe wasted condition to which his prolonged illness, pysemicin its leading outlines, had reduced him, combining to bringabout the end.As to treatment, it may be said that every variety of tonic

and support were given him, including bark, potash, cod-liveroil, mineral acids, and meat and wine.

Medical Societies.ROYAL MEDICAL & CHIRURGICAL SOCIETY.

The Localisation of Cerebral Function.THE first meeting of the session was held on Tuesday,

October 23rd, Prof. J. Marshall, F. R. S., President, in thechair. There was a very large attendance of Fellows andvisitors, and much interest was exhibited in Dr. Ferrier’svaluable paper. The meeting was a general one for thepurpose of electing a medical secretary in the room of Dr.R. Southey, who has resigned in consequence of his appoint.ment as one of the Commissioners in Lunacy, Dr. DouglasPowell was unanimously elected in his place.The PRESIDENT referred to the detection by Prof. koch

of a definite organism in association with epidemic cholera,and he welcomed such a fact as one of the many signs of theprogress of medicine in this age. He hoped the Societymight have an opportunity of verifying this discovery, if it be