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usual. The highest temperature during the quarter was 87°’3on the 4th August, and the greatest cold was 500.2 on the 21st ISeptember. The quarter was drier than last year, the numberof rainy days being 29, and the rain-fall 6’2 inches, against 38rainy days and 6’9 inches in 1856. A much larger quantity ofrain fell, however, in September of this year compared with lastseason. August of the present year was comparatively a drymonth. The prevailing wind during the past quarter, as inthe same period of last year, was from the S. W.

ON A CASE OF FACIAL PARALYSIS.

BY D. DUNCAN, M.D., Assistant-Surgeon R.N.I BEG to forward a case that came under my notice in the

early part of September last. My notes of it are as follows:-Alexander M-, aged twenty-nine, seaman on board the’

English schooner Panope. On Sept. 9th, at a quarter to

twelve P.M., he was brought alongside the Recruit in a shore-boat, and I was requested to look at him. I learned that hehad been engaged in a brawl on shore, and had received asevere blow or blows from the hands of some Greek whom inall probability the drunken sailor had insulted. The patientwas labouring under the combined effects of stimulants andconcussion from the blows he had received, so that it was im-possible to arrive at any correct history of the affair, moreespecially as the statements of the seamen that accompaniedhim were evidently unworthy of belief. On examination, hishead and face were found covered with blood, which was tracedto the right ear as its origin. No fracture or wound of the

scalp could be detected. There were found several slightbruises on the face, probably the result of his falling on theground. The nose was fractured, probably also from the samecause. The most prominent bruise was the mark of a blowfrom a stick or stone over the mastoid process. He was ordereda billet on the lower deck, and I awaited until he should re-coverfrom the combined effects of the concussion and intoxica-tion.

Sept. 1Oth.-Eight A.3l.: The patient has completely re-covered his senses, but presents a most singular aspect. Thewhole of the muscles of the right side of his face are paralysed,except the masseter and temporal, which seem yet to retaintheir power of action. Sensation is also much impaired on theaffected side of the face. When he attempts to close his eye-lids, those on the affected side will not act, and the eyeballrolls upwards, carrying the cornea under the curtain of theupper lid. When told to laugh, the right side of the faceremains perfectly inanimate, the angle of the mouth on theleft side is drawn upwards, and the left nostril dilated, whilethe corresponding one retains its position. He has also lostthe power of controlling the motions of the tongue, and conse-quently is quite unable to articulate. Cupping-glasses appliedbehind the right ear. To take an ounce and a half of catharticmixture. Low diet.12th.-No improvement. To have a calomel and opium pill

twice a day.13.-The paralysed condition of the muscles of the face still

continues; conjunctiva of the right eye inflamed, owing toexposure from inability to close the eyelids. To wear a shade.Ordered a lotion, consisting of sulphate of zinc, five grains;water, one ounce; and a cantharides plaster to be applied be-hind the ears.

16th. -Has recovered the power of moving the eyelids, andpartial use of the muscles of the face; gums tender from calo-mel. Omit the calomel and opium pill; and apply the plasteras before. To drink lemon-juice-and-water.20th.-Has fully recovered sensation, and the power of

moving the muscles of the affected side of the face, but is stillunable to articulate; mouth recovering. Discharged to his

ship.The patient remained unable to articulate until about the

10th of October, when, without any other treatment, the

power of speech gradually returned. On Nov. 1st, when lastseen, he still spoke extremely slow, and as if his mouth con-tained some foreign body. To questions asked suddenly, hereplies with difficulty and hesitation. I have inquired, andlearn that he spoke quite fluently before the accident.The paralysis of the superficial muscles of the face is easily

understood; but I cannot explain or account for the loss ofspeech.H.M.S. Recruit, Patros, Greece.

A MirrorOF THE PRACTICE OF

MEDICINE AND SURGERYIN THE

HOSPITALS OF LONDON.

Nulla est alia pro ccrto noseeildi via, nisi quam plurimas et morborum etdissectionum historias, tam aliorum proprias, collectas habere et inter be com-parare.-MORGAGNI. De Sed. et Caus. Morb. lib. 14. Procemium.

ST. THOMAS’S HOSPITAL.

SUPPOSED FRACTURE OF THE BASE OF THE SKULL WITH SYMP-. TOMS OF COMPRESSION OF THE BRAIN, AND HaeMORRHAGE

FROM THE EAR; RECOVERY.

(Under the care of Mr. SIMON.)IN the following case there are no other symptoms to lead to

the supposition of fracture of the skull than those of compres.sion of the brain,’with hemorrhage from one ear. The latterof itself alone cannot be taken as altogether diagnostic of frac-ture, because sometimes much haemorrhage may occur from theear from any violence producing rupture of the tympanum.When, however, the haemorrhage is very considerable and con-tinuous, and associated with other symptoms of grave mischief,such as an actual fracture, we may suppose the petrous portionof the temporal bone also is fractured. The haemorrhage wasnot continuous, however, although it is stated it was consider-able at first, and the symptoms of compression were evidentlypresent. There was some mischief going on, but we will notundertake to say positively it was a fracture of the base. At

any rate, the patient made a good recovery. The notes of thiscase were taken by Mr. James Ellis, who was the dresser ofthe patient, and now house-surgeon to the hospital.

Frederick B-, aged forty, admitted October 25th, 1856.having been struck on the head by a cab. On admission, thecabman stated that he believed him to have been under theinfluence of liqnor at the time of the accident. He was throwndown by the cab, the wheel of which struck him on the head.There was a small superficial scalp wound over the protube-rance on the left parietal bone, and from the ear on the sameside there was considerable haemorrhage, but no externalwound. Mr. Smith (a student), who conveyed him to the

hospital, did not notice any colourless fluid flowing from hisear at the time of the accident. His pulse was 56, feeble, slow,and labouring; the pupils slightly dilated, and only movinga very little under the stimulus of light; the expression of hiscountenance was dull and heavy, and he could not be roused;his breathing was stertorous, and after he was removed to theward his lips puffed with each expiratory ettort, and the alsenasi also alternately contracted and dilated with the respiratoryact; his body was warm. Ordered ice to the head; hair tobe cut.26th.-One A.M.: In the same state. House-surgeon ordered

fifteen leeches to the head, which bled well. Was very restlessduring the night, wanting to get out of bed, but in the morn-ing was more conscious, and said he was better. Head washot, skin moist and warm, eyes dull, irides almost motionlessunder the influence of light; pulse 60, feeble and labouring;breathing less stertorous; bowels unmoved. Calomel and colo-cynth pill immediately. In the morning the muscles of theleft side of his face were paralysed. In the evening an enemaopened the bowels.

C)

27th.-Better; no discharge from the ear during the night;head still hot; skin moist and warm; pulse 60, labouring.Twenty-two leeches to the left temple.28th.-Passed a much better night; less restless; complains

of pain in his head, though not so bad as yesterday; breathingrather slow; pupils act slightly; expression of face less dulland heavy; pulse 66; bowels open. Takes nourishment.29th.-More sensible at times; at others, rambling; answers

quite coherently. Head less hot and painful. Got up in thenight and immediately fell, being unable to stand.30th.-More pain in the head than yesterday; face more

natural; patient quieter in the day than at night time. Appe.tite good. Pulse 60. Twelve leeches to left temple.

31st.-Less pain in the head; more coherent; sleeps more

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in day time than in the night. Still attempts to get out ofbed, but yet less restless than on two preceding nights.Nov. 2nd.-Head is easier, but giddy when he moves it.

Passed a better night. Irides act very little; bowels open;and he takes notice of what is going on around.4th.-More restless last night. Left side seems to be more I

paralysed. !5th. - speech incoherent, and mind disposed to ramble. I

Slept little during the night, attempting to get up. I

7th.-Double vision. Appetite voracious.14th.-Better; head and general health much improved.

Double vision only when looking at an object close to the eye.17th.-Much the same. No double vision.Dec. I.-Wanders much at night; gets out of bed, and

fancies he is following his occupation of a baker.Sth.-Ordered half a grain of morphia, at night.9th.-The patient’s gait was tottering; he drags the para-

lytic side after him.15th.--Sleeps better and wanders less during the day; feels

pain occasionally in the heart.17th.-Was much excited, talking wildly, and fancying all

sorts of queer things.26th.-He continued to improve till to-day, when he became

more excited, although for the previous two days he had beendrowsy.He was discharged in January, much better, with no pain,

and his health and faculties much improved.

ST. BARTHOLOMEW’S HOSPITAL.

MOST EXTENSIVE LACERATION AND COMPOUND COMMINUTED

FRACTURE OF THE LEFT FOREARM; CONSERVATION OF THELIMB; RECOVERY.

(Under the care of Mr. SKEY.)IF abundant proofs were wanting to illustrate the true value

of conservative surgery, we should only have to refer to themany examples constantly appearing in our "Mirror," whereinattempts have been made successfully to save lacerated and in- Ijured limbs, which the majority of surgeons would not have hesi-

I

tated to remove. We have seldom witnessed a case which lookedmore hopeless than the following, the particulars of which wesubjoin, and which very clearly shows what conservative sur-gery can do, when the surgeon himself has the fortitude tocarry out its great principles. Complete success, with thepossession of a useful forearm, attended the efforts used tosave it.John B-, aged eighteen, was brought into the hospital on

October l3tla, with an extensive laceration of the left arm by aturning lathe. The injury appearing to demand amputation,Mr. Skey was sent for, and arrived within an hour. On care-

fully examining the limb, it appeared that the integumentsand the muscles of the back of the forearm from the elbow tothe wrist were torn away; the radius exposed in one-half itslength, and broken into pieces towards its middle; and thetwo remaining portions 4of the shaft separated by half an inchdistance, each part reduced by the obliquity of the fracture toan elongated point. The supinator longus and the radial ex-tensors were lacerated, while the common extensor of the

fingers was rent asunder, except only a small portion of thelatter muscle passing to the little finger, and the extensor carpiulnaris; the arteries and nerves were entirely destroyed. Thewound was further engrained with dirt. Some astonishmentwas expressed amongst the students by Mr. Skey’s announce-ment of his intention to endeavour to retain the arm, andsaying he would put the arm up in splints, and watch its pro-gress. The wound being carefully washed with a soft sponge,the dirt was removed by means of scissors, and all fragmentsof bone were detached; the muscles, both entire and mutilated,’were restored as much as possible’ to their natural position.Slight extension was made on the arm ; the integuments werobrought as much as possible over the wound, and united bythree or four sutures ; the wound was then bound up in cottonwool, and the arm laid on a splint.Mr. Skey confessed he had never seen the attempt made to

retain a limb subject to so severe an injury; but he had theconviction that, with all our vaunt of conservative principles,we never put Nature’s power to the fullest test. "Here is acatt3 of extreme injury. Let us watch its progress carefully. Iam quite prepared for the responsibility of the attempt to savethe arm."The patient was ordered eight to ten ounces of brandy each

day up to the fourth. Slight redness appearing around the

wound, the sutures were removed, and a light bread-and-waterpoultice was applied; brandy reduced to four ounces.

In ten days the wound began to granulate; the flaps retainedtheir hold on the subjacent structures. Slight motion of all thefingers in extension was apparent.At the expiration of five weeks the wound was reduced to

about one-third its original size. The man was in good health,and the arm was preserved.

In his Lecture on the Muscles of the Back of the Forearm,Mr. Skey has always assigned to the extensor communis of theI fingers the primary office of simple antagonism to the fiexors.The future condition of this patient will prove highly inte-resting as a study of muscular action.

ROYAL LONDON OPHTHALMIC HOSPITAL.

REPORT OF OPERATIONS PERFORMED FROM THE 25TH OF OCT.TO THE 25TH OF Nov., 1857.

(Under the care of the Surgeons.)IN the subjoined report of operations, we would draw atten-

tion to the plan adopted at this hospital in the treatment offive cases of that incurable affection, glaucoma-a disease whichis associated with much pain at its commencement. In two othercases the eyeball was taken away, for what is called ’chronic

ghp1coma, a portion of iris being excised from the opposite eyein each. This report has been furnished to us by Dr. C. Bader,curator to the hospital.

1. Lachl’ymal appa1’atus.-Application of the actual cauteryto the lachrymal sac in three cases.

In one case there was a fistulous opening at one inch dis-tance from the sac beneath the skin, which was laid open beforecauterization.

One case of tinea with ectropium, brought to the operatingroom, was treated by slitting open both lower lachrymal ducts,cutting off the eyelashes, and application of the nitrate ofsilver to the edge of the lids.Removal of a small sebaceous tumour from near the lachrymal

sac; it appeared whilst the case was being treated for an affec-tion of the lachrymal sac, and closely resembled an infiltrationof the skin, but that it was possible to squeeze out some of thesebaceous contents.

2. Eyelids.-Seven operations for entropium of the upper,and two of the lower lid. In the latter cases, an oval piece ofskin and muscular tissue, its long axis parallel to the edge ofthe lid, were removed, and sutures employed. Of those of the

upper lid, two were treated by the skin incision, close to andparallel with the palpebral edge, and grooving the fibro-carti-lage to the same extent. In the seventh case, the usual ope-ration of removing the palpebral edge, as far as the eyelashesare concerned, was resorted to.

Three cases of ectropium of the lower lid. In one, caused bya flabby, granular state of the conjunctiva, an oval piece was

removed out of the latter. In the second case, a triangularpiece, its base towards the palpebral edge, was removed out ofthe whole thickness of the lid. In the third, it was conse-

quent on necrosis of the malar bone ; the skin was made mov-able by a incision, the flap brought up, and the wound belowit united by sutures, and entomological pins.

In one case of lime-hurn, followed by fleshy bands stretch-: ing from the inner surface of the lids to the ocular conjunctiva, a

probe was carried beneath these bands, they were then divided,! and the conjunctivas kept separate by introducing a glass mask,. with an aperture in the centre, which sits well off from the

transparent cornea.. 3. Jlfu8cles of the eyeball.-Twenty-five operations for in-

ternal strabismus : subconjunctival division of the muscles.One case of external strabismus (patient of Mr. Poland) was

i operated on by the old method ; the muscular insertion was asfar backwards as midway between the corneal edge and opticnerve.

I Mr. Bowman-in the case of a lad-divided the external- and internal rectus in either eye, with the view of obviatingL the continual oscillations of the globe consequent on a con-

genital defect of the retina. Under the influence of chloro-I form, the oscillations ceased, but returned some time after-I wards; and then the old operation (division of the conjunctiva

and muscle) was performed on the external rectus.4. C*<M’M6.&mdash;One case of staphyloma, replacing the cornea,

which was lost during purulent ophthalmia, was treated byI continued pressure, after allowing some of the distending fluid

to escape through a puncture made through the thinnest partL of the staphyloma.: In a case of extreme conical fnrnea of both eyes, with slight