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on simple admixture with the urine, renders that fluid alkaline,—a change which Dr. Owen Rees believes to be the cause ofalkaline urine and phosphatic deposits in the great majority ofcases that come under treatment. We think it right, however,to draw the attention of urinary pathologists to the considera-tion of alkaline urine in rheumatism.

CHARCOAL CAUSING THROAT DISEASE.

DR. EDWARD SMITH has observed that the burning of coke,both in the ordinary fire-grates and in forges, has exerted amost prejudicial influence in inducing cough and dyspncea, andother evidence of chest disease. Its action appears to be thatof an irritant upon the mucous membrane of the throat, causingmuch suffusion and inflammatory exudation, and also pharyn-geal constriction, whereby inspiration is impeded. We givetwo cases from the Hospital for Consumption at Brompton, inillustration of the classes in which this condition is found.A married man, aged thirty-three, living at Camberwell,

applied, in November last, with cough and dyspnoea, accompa-nied by a red and swollen condition of the mucous membraneof the fauces. The frequent use of one-sixteenth of a grain ofmorphia with acacia, drank slowly, and a small quantity ofraw egg used many times a day, effected an improvement, sothat on Nov. 15th and Dec. 9th he had obtained relief in bothof the symptoms. On Dec. 23rd he felt a sensation of tight-ness in the throat, which was accompanied with an increase inthe inflammation in the pharynx. An emulsion of cod-liveroil was ordered to be drank slowly, thrice a day; and on Jan.6th the throat was less irritable, but it was dry in the morningand the cough continued. Finding that the cough was due tothe state of the throat, inquiry was diligently made into allthe circumstances to which it could be attributed; and it wasascertained that it was always much worse when he burntcoke in his room, and much better when coal was used.Being a poor man, he had preferred coke, from its being lessexpensive than coal. He was advised to discontinue the useof coke, and directly afterwards the dryness of the throatceased and the cough was much relieved. The mucous mem-brane was improved, but on Jan. 20th it was still red and suf-fused. This is a case in which the domestic use of coke wasinjurious. The other case which we shall relate has referenceto the influence of the same agent in manufactures.A single man, aged twenty-eight, complained of much debi-

lity, with occasional seminal emissions. He was also hoarse,and had soreness of the throat, referred to the bottom of thetrachea. The phosphate of iron relieved the former symptoms;but after attending at the hospital six weeks, he complainedstill more of his throat; and on examination it was found to bedesquamated and much inflamed. It was then ascertainedthat he was a watch-case manufacturer, and had daily occasionto use a charcoal furnace. When he inhaled the fumes, hecomplained of their irritating influence, and attributed his dis-ease to them. It was, however, his misfortune to be obligedto continue his occupation.

Dr. Smith, in connexion with this class of diseases, referredto the probable effect of the roasting of chesnuts in the streetsof London, which has been introduced during this winter forthe first time. It is always effected over a grate filled withlive charcoal, and the fumes which are given off are intenselyirritating. He considered that, so far as it goes, it is likely toincrease the class of throat diseases, and affections of the lungsresulting from and associated with them. In reference to thedomestic use of coke, he advised that in small rooms, and inopen grates, it should be discontinued; and that in all casesof stubborn throat affections, accompanied by cough, this pos-sible cause should be borne in mind.

TORTICOLLIS.

Ov a previous occasion we noticed an example of this affec-tion at King’s College Hospital, in which the flat insertion ofthe sterno-cleido-mastoid muscle of the right side was dividedsubcutaneously by Mr. Wood, and with success. The patientwas a little girl, in whom the deformity was congenital. (THELAxCET, Nov. 14th, 1857.) Another instance came under ournotice, at St. Mary’s Hospital, on the 13th of January, of a girlnineteen years old, who has had wry-neck for some years fromcontraction of the fibres of the sterno-mastoid muscle of the

right side. The rigidity existed in the clavicular portion ofthe muscle, and produced such deformity that the poor girl,who was healthy in other respects, and very intelligent,was quite incapacitated from getting a situation as a servant.

Mr. Ure, therefore, divided the clavicular insertion of the

muscle, when the girl was fully under the influence of chloro-form, and the deformity was at once remedied. We have seenthis proceeding attempted several times at the Royal Ortho-paedic Hospital, and have seen cases in which it was donethere, and the success is pretty good when too many musclesare not implicated. In very bad cases an apparatus is wornto support the head and neck.

Provincial Hospital Reports.TORBAY INFIRMARY, TORQUAY.

FOUR COMPOUND COMMINUTED FRACTURES OF THE BONES OFTHE SKULL AND FACE, WITH OTHER INJURIES; RECOVERY.

[CASE OF JANE STONE.](Communicated by WM. WILKING STABB, Esq., M.R.C.S., &c.,

House-Surgeon to the Infirmary.)

JANE STONE, aged twenty, was admitted on the evening ofthe llth November, 1857, into the Torbay Infirmary, in a stateof collapse, the effect of recent serious injury to the head.She is a native of Exeter, a healthy-looking girl, of a sanguinebut phlegmatic temperament, between seven and eight monthsadvanced in pregnancy, with a fresh, florid complexion.On examination, four distinct compound comminuted frac-

tures of bone could be detected, two of which, each in a stel-lated form, and about one inch in diameter, were situated inthe frontal bone, one over each orbit. The upper lip was cutthrough, and the superior maxilla fractured on the right side,in a line with the canine tooth. This tooth was loose and de-tached, and had, as well as five or six others on the same sidesimilarly loosened, to be removed during the early part of herstay in the Infirmary. The two nasal bones, the septum nasi,and the ethmoid, were much comminuted and depressed. Inaddition to these serious fractures, (in none of which, however,were the bones displaced, except in the one last mentioned,}there were several lacerated wounds: one on the chin, layingbare the lower jaw; one through the helix, &c., of each externalear; and one on the right side of the head.Many of the particulars of this melancholy case will, no

doubt, be fresh in the memories of most medical men, from thepublicity which the trial of Jonathan Roose attained duringthe late Exeter Assizes, for his brutal assault upon the patient.The girl was found, about twenty minutes after the injuries

had been inflicted, lying on the ground, cold, moaning, andwith difficulty roused to consciousness. She was instantly re-moved to the Infirmary, where the nature and extent of herinjuries were ascertained, and one small piece of stone-a frag-ment of that with which the assault had been committed-removed from the fracture in the left temple. She appeared tohave lost a considerable quantity of blood; her pulse, barelyperceptible, numbered about 100 in the minute; her respiration,slow, about 20 ; the pupils and conjunctive were concealed by theswollen palpebrse. Stimulants had during that evening to befreely administered, and the wounds were dressed with simplewater dressing. In the morning reaction had commenced; herpulse numbered 120; she had passed a somewhat easy night.The edges of the wounds were adjusted, as nearly as possible,with adhesive plaster, no sutures being employed, and she wasdieted on milk and beef-tea. During this and the next twodays she remained quite free from pain, but somewhat heavyand lethargic; she appeared, however, perfectly rational whenaroused, and her memory seemed scarcely at all impaired. Herskin continued cool; her pulse gradually fell to 90, at the sametime acquiring strength; she took her food readily, micturatedfreely, and the sluggishness of her bowels was overcome by thedaily morning use of enemata of oil and gruel.On the fifth day slight feverishness set in, with one or two

faint rigors; her tongue became dry, the pulse rose to 100, andshe complained of pain in her head. A saline mixture was

prescribed, and the feverishness, &c., readily and speedilyabated. On the seventh day healthy suppuration had becomeestablished in all the wounds. She was placed on a generousdiet, and from this time her convalescence was steady, uniform,and uninterrupted. The healing of the wound over the nosewas delayed by the discharge of a few small pieces of exfoliatedbone; but she was enabled to undertake the journey to Exeteron Dec. 12th, to attend the assizes, and, returning to Torquay,was confined in the Infirmary of a healthy male child, on the31st of the same month. She was discharged cured Jan. 20th,1858.