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movement of forearms, and has much diminished sensationwhen the arms are grasped firmly, but no perception whenpricked with a needle. Has not the slightest consciousnessof the passage of catheter, and is quite incapable of strain-ing, or in any way of aiding the flow of urine. Ordered lowdiet, milk and beef-tea.17th.-Temperature 102° ; pulse 88; respiration 22. Slept

fairly. Has rather more movement of the forearms, butno other movement.-Evening: Temperature 101.8°; pulse86; respiration 24. Seems more comfortable, and had somesort of sensation when the catheter was passed.18th.-Temperature 100.8°; pulse 82; respiration 20.

Rather more movement of arms. Not the slightest sensa-tion of pricking with a needle on legs, abdomen, or chestas high as two inches above the nipple line; above thispoint has perfect sensation. No bypersesthesia along theline of junction of paralysed and non-paralysed parts. Canturn his head from side to side, and sometimes raises it alittle from pillow. Has no feeling of pricking in the handsor forearms, and has very slight sensation in the upperarms. The movement of the forearms is simply flapping,for he has not the least power of grasping, and cannot movehis fingers. - Evening : Temperature 101 2°; pulse 74;respiration 20. Expressed himself as feeling relieved whenthe urine was being drawn off; the stream rose and fell witheach respiration.19th.-Temperature 1012°; pulse 82; respiration 22;

urine strongly alkaline, specific gravity 1030, albuminous,and containing numerous blood-corpuscles. There had been

slight haemorrhage when the catheter was passed, but thehigh colour of the urine is due to its mixture with bloodprevious to the passing of the catheter, and to being in thebladder twelve hours. No. 12 catheter passes in quitereadily, though there is a slight obstruction about the pro-static portion.- Evening : Temperature 101° ; pulse 82 ;respiration 20. Bowels open after twelve grains of jalappowder and four grains of calomel; patient quite unconsciousof their action. Urine strongly ammoniacal and very dark;no haemorrhage by side of catheter or when the catheterwas withdrawn. Ordered fifteen drops of tincture of opiumevery night.20th.-Temperature 100.4°; pulse 80; respiration 24.

Slept well. Incontinence of urine; catheter passed; urineammoniacal and high-coloured. Bladder washed out withtepid water, to which a very small quantity of carbolic acidwas added (just enough to discolour litmus paper). Tendencyto bedsore. Had a sort of fainting fit whilst the bed wasbeing changed, and when his head was raised too much.No feeling of fracture, no swelling, no displacement per-ceptible. Sensation posteriorly as low as spines of scapulæ.Ordered two ounces of brandy.-Evening : Temperature102° ; pulse 82; respiration 20. Urine and fseces passedinvoluntarily, and, notwithstanding that the patient is on afracture bed with central hole, and on water pillows, andthat the greatest cleanliness is observed, there is a bedsorethreatening on the sacrum.21st.-Temperature 102°; pulse 90; respiration 26. Urine

ammoniacal and offensive; bladder washed out again withcarbolic-acid water; allowed meat and beer.-Evening :Temperature 103’2’°; pulse 94; respiration 24.22nd.-Temperature 1012°; pulse 82; respiration 28. Urine

(a pint) drawn off of nearly natural colour, acid, specificgravity 1020, containing only a trace of albumen, butshowing under the microscope crystals of triple phosphate.Evening: Temperature 103 2°; pulse 90; respiration 32.From this date till July 7th the temperature varied from

976° to 101°; the respiration became quicker, and averagedabout 25, and the pulse was about 85. On June 30thsloughing of the sacrum commenced. On July 7th a blisterwas applied to the nape of the neck, above the seat of pain,but beyond its action on the cuticle it did not produce anyeffect, good or bad.

July 10th.-Temperature 992°; pulse 88; respiration 20.Had great difficulty in breathing at 4 o’clock this morning,and there was an accumulation of mucus in the bronchiwhich threatened to choke him. Temperature 100°; pulse104; respiration 34. This passed off by the continued ad.ministration of brandy and milk.-5 A.M.: Temperature992°; pulse 96; respiration 22.12th.-Temperature 99.5°; pulse 94; respiration 22. Slough

on sacrum increasing.14th. - Temperature 984°; pulse 88 ; respiration 28.

Slough increased to size of a man’s hand; the elbowsthreatened, but are now much better.-Evening : Tempera-ture 1018°; pulse 96; respiration 28.The temperature then gradually increased, till on the

18th it was 1044°; pulse 102.-Evening : Temperature 1044°;pulse 128; respiration 26.

19th.-4 A.M.: Temperature 104’4°.-10 A.M.: Tempera-ture 102°; pulse 110; respiration 23. Has had a severeattack of diarrhoea, and was only kept up by continueddoses of brandy and a draught containing opium andcatechu after each loose motion.-Evening : Temperature1048°; pulse 120; respiration 18. A little delirious; only

answers when spoken to very loudly, and then only in

monosyllables.20th.-Temperature 1056°; pulse 108; respiration 34.

Very drowsy; diarrhoea ceased; seems stronger thanyesterday; wants shouting to to obtain any answer; hashadno opiumfor twenty-four hours.—Evening : Temperature1066°; pulse 132; respiration 32. Quite unconscious, andcannot be roused; comatose ( ?) ; has great difficulty inswallowing even liqnids.

21st.-7.30 A.M.: Temperature 1066°; pulse 136; respira-tion 42. He is evidently sinking.-12.30: Temperature1074°; pulse 136; respiration 26.-1.30 P.M.: Just dead.Temperature 1066°. 2 o’clock: Temperature 1052°.On comparing the thermometer with two others, it was

found that it registered fully half a degree less than theydid, but all the temperatures were taken with the sameinstrument.

Autopsy. eighteen hours after death.-Body not quite cold.The spinal column from the third dorsal vertebra was re-moved entirely, and the bodies, transverse processes, andspines were carefully examined for fracture. The canal wasopened and found quite smooth on both aspects. Themembranes were congested below about the fourth cervicalvertebra, the congestion increasing towards the dorsalregion, where there was quite an inflammatory state, and inthe lower dorsal region a distinct deposit of lymph wasfound on the dura mater, and on the lining membrane ofthe canal. On slitting up the pia mater, a distinctly softspot was seen about opposite the lower part of the body ofthe fourth cervical vertebra. There was a constriction ofthe entire cord at this point, and a depression on the dorsal’aspect, into which a split pea might have been inserted.The structure was quite pulpy as compared with the otherpart of the cord, and, after hardening in spirit, a hole wasperceptible, large enough to insert a small pea. On theanterior surface of the membranes at this point there wasa distinct brown discoloration, though no loss of structure.On macerating the spinal column, and dissecting away the,muscles from the anterior part of the vertebrae, there was adistinct tear of the intervertebral fibro-cartilage from thebody of the fifth vertebra, and the surface was quiteroughened. This rupture did not extend into the canal,but was just at the spot where the constriction of the cordwas found, and opposite the discoloured membranes. Therewas a distinct ulceration of cartilage in the mid-dorsalregion, consequent upon the inflammation of the spinalmembranes. Above the depressed spot in the cord all washealthy. The brain was healthy, except the fornix, whichwas in a state of fatty degeneration. The heart and lungswere fairly healthy. The liver was large, extending into

, left hypochondrium; nutmeg. There was a small abscessat the upper pyramidal portion of left kidney ; capsules.healthy. The ureters were dilated, and the walls thickened.

. The bladder was contracted, the coats much thickened. TheL urine in the bladder was of normal colour.

MILITARY GENERAL HOSPITAL, PARKHURST,CASE OF PARALYSIS OF THE INFERIOR BRANCH OF

THE THIRD NERVE.

(Under the care of Dr. McNAMARA, Surg. 106th Foot.)CORPORAL C-, a young, strong, healthy soldier, about

the middle of August got a blow with a stone over the righteye, which caused great swelling and ecchymosis of thelids, completely closing-up the eye. At the outset he alsocomplained of a dragging sensation in the right nostril,caused, probably, by injury in the orbit to the nasal branchof the ophthalmic nerve. This, with the swelling, graduallypassed away. When he first presented himself, on the 8th

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inst., he complained of diplopia and difficulty of seeing ob-jects which were on a lower plane than his eyes; staggeredin his gait; and broke fragile objects when he attempted totake them in his hand. On examination, the pupil was foundto be dilated, and the eyeball (right) turned upwards andoutwards. The man could not see objects with his righteye when held below or to the left without moving his head.He struck to the left of an object held in front of him, onaccount of crossed diplopia, the object appearing to the leftof its real situation. The symptoms were the result of

injury to the inferior branch of the third nerve, causingparalysis of the pupil (through the motor root of the lenti-cular ganglion) and of the internal and inferior recti andinferior oblique muscles. Under treatment with iodide ofpotassium the symptoms gradually abated.

Reviews and Notices of BooksLectures on Fever. Delivered in the Theatre of the Meatl

Hospital and County of Dublin Infirmary by WiLLiAmSTOKES, M.D., D.C.L.Oxon., F.R.S., Regius Professor ojPhysic in the University of Dublin, Physician to thEQueen in Ireland. Edited by JOHN W. MOORE, M.D.,Assistant-Physician to the Cork-street Fever Hospital,&c. pp. 459. London: Longmans, Green, and Co. 1874,

IT is hard to speak of any work by Dr. Stokes in an un.favourable spirit. His long and, in all respects, honourablecareer as a teacher and practitioner of the healing art; hisskilful and successful endeavours to improve the professionin general, and the Dublin school in particular; his can-dour in research; his lucidity and elegance in exposi-tion, conciliate for any book to which he puts his name thegood-will of every reader. His classic treatise on the Dis-eases of the Heart and Aorta must, as a specimen of medi-cal literature alone, retain a permanent value; and his long-continued investigations into the genesis and course of feverhave, even as embodied in oral lectures, attracted interestfar beyond the special scene of their prosecution. These arenow collected in one volume and given forth to the world.

It is with all the more regret, accordingly, that we feelourselves forced to dissent from Dr. Stokes’s teaching,and to express our conviction that it would have beenbetter for his reputation that his book had never beenpublished. He formally avows himself what he had longbeen surmised to be - the , professed advocate of the

identity of typhus, typhoid, and relapsing fevers. He

acknowledges that there are frequently clearly defined dis-tinctions between the disease ordinarily termed typhusfever and that termed typhoid fever, and that commonlyknown as relapsing fever; but he maintains that it is not atall uncommon to meet with cases in which no distinctioncan be made, where the history, symptoms, signs, progress,and termination will apply equally well to one or otherdisease ; and that in some cases the history of one diseasemay be associated with the signs and symptoms of the other.Nay, he has even gone further, and alleges that the samecase may at one stage present all the unequivocal charactersof typhus, and at another stage all the unequivocal cha-racters of typhoid; that typhus may relapse into typhoid,and vice versc2. All these statements have been repeated,and not without a certain degree of reiteration, in the re-cently published lectures.

It is not our intention to combat these opinions. Wedissent completely and entirely from Dr. Stokes’s con-

clusions. It seems almost incredible that it should be

necessary in these days to contend for the non-identity oftyphus, typhoid, and relapsing fevers. Surely Sir WilliamJenner, Dr. Murchison, and Dr. Stewart have brought for-ward proof and demonstration in abundance, even to over-fiowing.

We wish that we could congratulate the author onother portions of his work. Not that we wish to affirm

’ that there are no portions of the book which are deserving

,

of perusal. There are indeed many valuable observationsand shrewd remarks on the nature of the pyrexial conditionthat attends continued fever, but the good is intricatelymixed and combined with what we cannot but regard asdangerous doctrine and teaching. The book is moreovertoo large, the matter badly arranged, and there is repetitionwithout end. The best and most orthodox part of the workundoubtedly is the chapter on Treatment.

Archives of Ophthalmology and Otology. Edited by H. KNAPPand S. Moos. New York : W. Wood and Co. Vol. III.,No. 2; Vol. IV., No. 1.THE papers in the volumes before us on the two subjects

to which they are devoted are about equal in number, andseveral of them are of considerable value. In the second partof the third volume Dr. Knapp, one of the editors, gives adescription of a convenient modification he has planned ofLoring’s ophthalmoscope, which enables the lenses for theerect image to be rapidly changed, and gives some excellentrules for determining the height or depth of elevations ordepressions. It is a paper that should be studied by everyophthalmic surgeon.

Dr. Samelsohn, of Cologne, has a most interesting paperon Embolism of the Central Artery of the Retina, in whichhe cites a case that fell under his care a fortnight after thesudden and complete loss of vision that marked the occurrenceof the attack, though a very slight amount of perception oflight had in the meanwhile been recovered by the patient.The pupil was movable ; there were phosphenes on pressure.’No morbid conditions could be discovered on ophthalmo-scopic investigation beyond remarkable constriction of thevessels, and a small embolism of one artery; there was nocardiac disease. The tension of the eye was slightly aug-mented. Guided by theoretical considerations in regard tothe circulation in the eye, consequent on this occlusion of oneof the retinal vessels, as well as by the increased tension,M. Samelsohn performed a broad iridectomy with improve-ment. Dr. Shroder contributes a paper on a particularform of Haemorrhagic Glaucoma. Dr. H. F. B. Eortam

supplies some contributions to the Pathology of Choroiditis.Dr. Argyll Robertson gives a case of Sarcoma of the Iris,the microscopical examination of which was performed andis described by Dr. Knapp. Dr. Knapp gives an account,with drawings, of Intraocular Hæmorrhage, accompaniedby the formation of amyloid bodies in the extravasated bloodand amyloid degeneration of the choroidal arteries. Finally,Dr. J. Samelsohn details the applications of Galvano-causticto Ophthalmic Surgery, chiefly in reference to lachrymaldisorders, trichiasis and distichiasis, ciliary blepharitis,and nævi or other tumours in the vicinity of the eye.The otological papers are not less numerous and valuable

and we may particularly single out one which contains alarge amount of research-viz., the Contributions to thePathology and Pathological Anatomy of the Organ of

Hearing, by Dr. S. Moos. These, however, consisting of aseries of cases, do not admit of an abstract being made.This volume contains also Loewenberg’s paper on theEffects of Section of the Semicircular Canals, which we haverecently had occasion to notice. Lastly, G. Brunner, ofZurich, furnishes a paper on the Connexions between the,Ossicles of Hearing, in which he states that his own investi-gations have satisfied him that there are no true articula-tions at all between the ossicles of hearing, but that theossicles represent a lever, the parts of which are unitedwith one another as well as with neighbouring parts bysymphysis.