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mixture of tartaric acid and bicarbonate of potash, withten grains of bromide of potash in each dose, three orfour times in the twenty-four hours. After most carefullyconsidering the case, the gentleman I had called in came tothe conclusion that a rheumatic taint was at the bottom ofthe remaining mischief, and prescribed for her fifteen grainsof salicylic acid, together with small doses of carbonate ofsoda, carbonate of ammonia, and tincture of nux vomicathree times daily. In this treatment I coincided. She wasquite in a natural mood in the afternoon that we saw hertogether, and we were agreed that there was no cause foralarm, and that there was reasonable hope of her beingrestored to her usual state of health in the course of a fewweeks. I saw her no more till next morning; she had thentaken three doses of the salicylic acid mixture. I found hercomatose and rapidly sinking. The urine contained albumen.We had another consultation as soon as possible, but shedied in the course of a few hours. Although probably thebrain symptoms were more severe all along than I expected,and most likely the head mischief would have ended herdays, yet I cannot help feeling that our last attempts tocure our patient only resulted in the abrupt snapping of thethin cord of life she had left to her.Pangbourne.

A MirrorOF

HOSPITAL PRACTICE,BRITISH AND FOREIGN.

ST. THOMAS’S HOSPITAL.POISONING BY CYANIDE OF POTASSIUM ; RECOVERY ;

REMARKS.

(Under the care of Dr. ORD.)

Nulla autem est alia pro certo noscendi via, nisi quamplurimas et mor-borum et dissectionum historias, tum aliorum tum proprias collectashabere, et inter se oomparare.—MoBaA&Nl De Sed. et Caus. Morb.,lib. iv. Procemium. -

THE following case is one presenting some points of greatinterest: the large amount of the poison taken, the severityof the effect produced, and the recovery from this condition,considering the duration of time which had elapsed betweenthe taking of the dose and the commencement of treatment.Cyanide of potassium produces symptoms similar to thosewhich follow the administration of prussic acid, and pro-duces its poisonous effect with nearly the same rapidity.For the notes of the case we are indebted to Mr. A. A.

Brockatt, late house-physician.Sophia P-, aged thirty, was admitted at 4 P.M. on

Oct. 4th, having taken cyanide of potassium with an intentto commit suicide about fifteen minutes previously. Sheappears to have been living a very unhappy domesticlife, and took a piece of the salt, "the size of an ordinarylump of sugar," and chewed it, swallowing the greateramount, a stock being kept in the house for businesspurposes. In a few seconds she became very giddy,and her head swam; but she remembered nothing moreuntil she found herself in bed at the hospital. Accordingto a statement made, she fell suddenly on her face withoututtering a sound; the assistance of the police was thenprocured and she was brought direct to St. Thomas’s. Oneof the policemen removed several pieces of the salt frombetween her lips while in the house.When seen at the hospital, about ten minutes later, she

was completely insensible, and, except for an occasionalgasping inspiration, was in a state of apnaea. Her face wasflushed and of a livid hue, the limbs flaccid and cold, the pupilsdilated, and the eyelids closed; the pulse was imperceptibleat the wrist, and the jaws were tightly clenched. She hadpassed urine unconsciously, but not fasces. An odour ofbitter almonds pervaded the whole room. The patient wassupposed to be dead when brought into the hospital.

Artificial respiration was at once resorted to, with coldaffusions and flagellation of the chest with a wet towel.The mouth having with great difficulty been opened with ascrew gag, the contents of the stomach, which had the samecharacteristic smell, were pumped out, and about fifteenounces of a solution of ferrous sulphate (twenty grains to

the ounce) injected. The stomach was not full. While thiswas being done the breathing entirely ceased, and artificialrespiration had to be hurriedly resumed. An injection offorty minims of ether was administered, and her conditiongradually improved, but artificial respiration had to be keptup more or less continuously for one hour, and for shorterintervals during another, as her breathing stopped wheneverit was left off. Even at the end of this time the respiratoryacts were extremely shallow and irregular, but they improvedmarkedly after another ether injection. Previously to thisa quantity of solution of carbonate of potash had beenpoured down her throat.The patient gradually began to recover consciousness in

about two hours after admission, but appeared to be in avery dazed condition, was extremely sleepy, and could giveno account of herself. She recovered, however, during theevening, and complained of nothing but extreme drowsinessand an uneasy sensation of heat behind the sternum and i!1the epigastrium. Before recovering consciousness she wasvery sick, and continued so at intervals for a few hours;.the first vomit gave a decided prussian blue tinge withsulphuric acid, and was of a dirty-green colour. Her breathsmelt faintly of bitter almonds during the next day, and sheslept almost continuously, but she had no further symptoms,and left the hospital in four days quite well. She admittedhaving been drinking during the day, but was not intoxicated.Remarks by Mr. BROCgATT.-The above is one of the fe1B’

recorded cases of recovery from poisoning by cyanide ofpotassium. The dose in this case was a very large one.Several cases have been recorded which have proved fatalafter five grains, but it was here estimated that she musthave had at least forty grains. The great symptom was th&persisting interference with respiration, and I have no doubtthat perseverance with artificial respiration, combined withthe subcutaneous injection of ether, was the great factor insaving the patient’s life. It seems unlikely that antidotescould have had much influence in the happy result attained,as fifteen minutes had elapsed before they were administered.

LINCOLN COUNTY HOSPITAL.THREE CASES OF OVARIAN TUMOUR; OVARIOTOMY ;

RECOVERY ; REMARKS.

(Under the care of Mr. T. M. WILKINSON.)FOR the following notes we are indebted to Mr. M.

Johnston, house-surgeon.CASE 1. Multilocular Cystic Disease of the Left Ovary’;

Small Cyst of Right Ovary.-E. K-, aged fifty-four, wasadmitted on Feb. 15tb, 1886, having been sent by Dr. Lettof Redbourne. Married; has had five children, one (the lastaged twenty-one) still living ; the others died of consump-tion. Had always been healthy. She first noticed painwith swelling in the left iliac region about eight monthsago, which had increased rapidly in size since that time.Menstruation had ceased for about twelve months, with on:exception about midway during that interval, when it lastedseven days, and whilst in the hospital a discharge came onlasting three days. Her appearance is healthy althoughthin and emaciated. Heart and lungs normal. Abdomendistended by a tumour, which is dull on percussion for threeinches above the umbilicus, resonant in left flank, but dull,in the right; the tumour appears movable, and composedchiefly of solid matter. There is a great deal of fluid in theperitoneal cavity superficial to the tumour. Abdomenmeasures 42 in, around the umbilicus. Uterus high up,normal, and free from tumour.Ovariotomy was performed on March 9th. Chloroform

was first administered, but, causing asphyxia, the A.C.E.mixture was given, and answered well. On opening theabdomen there was a rush of peritoneal fluid. The tumour

was a multilocular cyst, with a large amount of solid andsemi-solid gelatinous material, which weighed 7t lb.; the

, amount of fluid, cystic and peritoneal, was five gallons. Therewere some slight adhesions to the omentum. The original in-

, cision had to be considerably enlarged to admit of the removalof the tumour. The pedicle was tied with silk, cut short, and

l returned. On examining the right ovary, it was found dis-. eased, a single cyst, about the size of a small orange, beingL removed with the ovary. The abdominal cavity was sponged

out, and the edges brought together with deep carbolised1 gut and superficial silk sutures, a glass drainage-tube beingleft at the lower part of the wound. The dressing was dry