A unique case of ectopia of the testicle in a man of twenty-four is given by Popoff. The scrotum was normally developed, and the right testicle in situ. The left half of the scrotum was empty, and at the root of the penis there was a swelling the size of a walnut, covered with normal skin, and containing an oval body about four-fifths the size of the testicle, but softer in constituency. The patient claimed that this swelling had been present since childhood. His sexual power had been normal, but for the past six months he had been impotent. In childhood the patient had a small inguinal hernia, and Popoff thought this caused the displacement of the testicle.

A somewhat similar case occurred in the Hotel-Dieu, Paris. Through the agency of compression one of the testes was forced along the corpus cavernosum under the skin as far as the glans penis. It was easily reduced, and at a subsequent autopsy it was found that it had not been separated from the cord. Gluiteras a cites a parallel case of dislocation of the testicle into the penis. It was the result of traumatism—a fall upon the wheel of a cart. It was reduced under anesthesia, after two incisions had been made, the adhesions broken up, and the shrunken sac enlarged by stretching.

Rupture of the spermatic arteries and veins has caused sudden death. Schleiser is accredited with describing an instance in which a healthy man was engaged in a fray in the dark, and, suddenly crying out, fell into convulsions and died in five minutes. On examination the only injury found was the rupture of both spermatic arteries at the internal ring, produced by a violent pull on the scrotum and testicles by one of his antagonists. Shock was evidently a strong factor in this case. Fabricius Hildanus gives a case of impotency due to lesions of the spermatic vessels following a burn. There is an old record of an aged man who, on marrying, found that he had erections but no ejaculations. He died of ague, and at the autopsy it was found that the verumontanum was hard and of the size of a walnut and that the ejaculatory ducts contained calculi about the size and shape of peas.

Hydrocele is a condition in which there is an abnormal quantity of fluid in the tunica vaginalis. It is generally caused by traumatism, violent muscular efforts, or straining, and is much more frequent in tropic countries than elsewhere. It sometimes attains an enormous size. Leigh mentions a hydrocele weighing 120 pounds, and there are records of hydroceles weighing 40 and 60 pounds. Larrey speaks of a sarcocele in the coverings of the testicle which weighed 100 pounds. Mursinna describes a hydrocele which measured 27 inches in its longest and 17 in its transverse axis.

Tedford gives a curious case of separation of the ovary in a woman of twenty-eight. After suffering from invagination of the bowel and inflammation of the ovarian tissue, an ovary was discharged through an opening in the sigmoid flexure, and thence expelled from the anus.

In discussing injuries of the vagina, the first to be mentioned will be a remarkable case reported by Curran. The subject was an Irish girl of twenty. While carrying a bundle of clothes that prevented her from seeing objects in front of her, she started to pass over a stile, just opposite to which a goat was lying. The woman wore no underclothing, and in the ascent her body was partially exposed, and, while in this enforced attitude, the goat, frightened by her approach, suddenly started up, and in so doing thrust his horn forcibly into her anus and about two or three inches up her rectum. The horn then passed through the bowel and its coverings, just above the hymen, and was then withdrawn as she flinched and fell back. The resultant wound included the lower part of the vagina and rectum, the sphincter and, the fourchet, and perineum. Hemorrhage was profuse, and the wound caused excruciating pain. The subject fainted on the spot from hemorrhage and shock. Her modesty forbade her summoning medical aid for three days, during which time the wound was undergoing most primitive treatment. After suturing, cicatrization followed without delay.

Trompert mentions a case of rupture of the vagina by the horn of a bull. There is a case recorded in the Pennsylvania Hospital Reports of a girl of nineteen who jumped out of a second-story window. On reaching the ground, her foot turned under her as she fell. The high heel of a French boot was driven through the perineum one inch from the median line, midway between the anus and the posterior commissure of the labia majora. The wound extended into the vagina above the external opening, in which the heel, now separated from the boot, projected, and whence it was removed without difficulty. This wound was the only injury sustained by the fall.

Beckett records a case of impalement in a woman of forty-five who, while attempting to obtain water from a hogshead, fell with one limb inside the cistern, striking a projecting stave three inches wide and 1/2 inch thick. The external labia were divided, the left crus of the clitoris separated, the nymphae lacerated, and the vaginal wall penetrated to the extent of five inches; the patient recovered by the fourth week.

Homans reports recovery from extensive wounds acquired by a negress who fell from a roof, striking astride an upright barrel. There was a wound of the perineum, and penetration of the posterior wall of the vagina, with complete separation of the soft parts from the symphysis pubis, and extrusion of the bladder.

Howe reports a case of impalement with recovery in a girl of fifteen who slid down a hay-stack, striking a hay-hook which penetrated her perineum and passed into her body, emerging two inches below the umbilicus and one inch to the right of the median line.

Injuries of the vagina may be so extensive as to allow protrusion of the intestines, and some horrible cases of this nature are recorded. In The Lancet for 1873 there is reported a murder or suicide of this description. The woman was found with a wound in the vagina, through which the intestines, with clean-cut ends, protruded. Over 7 1/2 feet of the intestines had been cut off in three pieces. The cuts were all clean and carefully separated from the mesentery. The woman survived her injuries a whole week, finally succumbing to loss of blood and peritonitis. Her husband was tried for murder, but was acquitted by a Glasgow jury. Taylor mentions similar cases of two women murdered in Edinburgh some years since, the wounds having been produced by razor slashes in the vagina. Taylor remarks that this crime seems to be quite common in Scotland. Starkey reports an instance in which the body of an old colored woman was found, with evidences of vomiting, and her clothing stained with blood that had evidently come from her vagina. A postmortem showed the abdominal cavity to be full of blood; at Douglas' culdesac there was a tear large enough to admit a man's hand, through which protruded a portion of the omentum; this was at first taken for the membranes of an abortion. There were distinct signs of acute peritonitis. After investigation it was proved that a drunken glass-blower had been seen leaving her house with his hand and arm stained with blood. In his drunken frenzy this man had thrust his hand into the vagina, and through the junction of its posterior wall with the uterus, up into the abdominal cavity, and grasped the uterus, trying to drag it out. Outside of obstetric practice the injury is quite a rare one.

There is a case of death from a ruptured clitoris reported by Gutteridge. The woman was kicked while in a stooping position and succumbed to a profuse hemorrhage, estimated to be between three and four pounds, and proceeding from a rupture of the clitoris.

Discharge of Vaginal Parietes.—Longhi describes the case of a woman of twenty-seven, an epileptic, with metritis and copious catamenia twice a month. She was immoderately addicted to drink and sexual indulgence, and in February, 1835, her menses ceased. On May 8th she was admitted to the hospital with a severe epileptic convulsion, and until the 18th remained in a febrile condition, with abdominal tenderness, etc. On the 21st, while straining as if to discharge the contents of the rectum, she felt a voluminous body pass through the vagina, and fancied it was the expected fetus. After washing this mass it was found to be a portion of the vaginal parietes and the fleshy body of the neck of the uterus. The woman believed she had miscarried, and still persisted in refusing medicine. Cicatrization was somewhat delayed; immediately on leaving the hospital she returned to her old habits, but the pain and hemorrhage attending copulation was so great that she had finally to desist. The vagina, however, gradually yielding, ceased to interfere with the gratification of her desires. Toward the end of June the menses reappeared and flowed with the greatest regularity. The portions discharged are preserved in the Milan Hospital.

The injuries received during coitus have been classified by Spaeth as follows: Deep tears of the hymen with profuse hemorrhage; tears of the clitoris and of the urethra (in cases of atresia hymenis); vesicovaginal fistula; laceration of the vaginal fornices, posteriorly or laterally; laceration of the septum of a duplex vagina; injuries following coitus after perineorrhaphy. In the last century Plazzoni reports a case of vaginal rupture occurring during coitus. Green of Boston; Mann of Buffalo; Sinclair and Munro of Boston, all mention lacerations occurring during coitus. There is an instance recorded of extensive laceration of the vagina in a woman, the result of coitus with a large dog. Haddon and Ross both mention cases of rupture of the vagina in coitus; and Martin reports a similar case resulting in a young girl's death. Spaeth speaks of a woman of thirty-one who, a few days after marriage, felt violent pain in coitus, and four days later she noticed that fecal matter escaped from the vagina during stool. Examination showed that the columns of the posterior wall were torn from their attachment, and that there was a rectovaginal fistula admitting the little finger. Hofmokl cites an instance in which a powerful young man, in coitus with a widow of fifty-eight, caused a tear of her fornix, followed by violent hemorrhage. In another case by the same author, coitus in a sitting posture produced a rupture of the posterior fornix, involving the peritoneum; although the patient lost much blood, she finally recovered. In a third instance, a young girl, whose lover had violent connection with her while she was in an exaggerated lithotomy position, suffered a large tear of the right vaginal wall. Hofmokl also describes the case of a young girl with an undeveloped vagina, absence of the uterus and adnexa, who during a forcible and unsuccessful attempt at coitus, had her left labium majus torn from the vaginal wall. The tear extended into the mons veneris and down to the rectum, and the finger could be introduced into the vaginal wound to the depth of two inches. The patient recovered in four weeks, but was still anemic from the loss of blood.

Crandall cites instances in which hemorrhage, immediately after coitus of the marriage-night, was so active as to almost cause death. One of his patients was married three weeks previously, and was rapidly becoming exhausted from a constant flowing which started immediately after her first coitus. Examination showed this to be a case of active intrauterine hemorrhage excited by coitus soon after the menstrual flow had ceased and while the uterus and ovaries were highly congested. In another case the patient commenced flooding while at the dinner table in the Metropolitan Hotel in New York, and from the same cause an almost fatal hemorrhage ensued. Hirst of Philadelphia has remarked that brides have been found on their marital beds completely covered with blood, and that the hemorrhage may have been so profuse as to soak through the bed and fall on the floor. Lacerations of the urethra from urethral coitus in instances of vaginal atresia or imperforate hymen may also excite serious hemorrhage.

Foreign Bodies in the Vagina.—The elasticity of the vagina allows the presence in this passage of the most voluminous foreign bodies. When we consider the passage of a fetal head through the vagina the ordinary foreign bodies, none of which ever approximate this size, seem quite reasonable. Goblets, hair-pins, needles, bottles, beer glasses, compasses, bobbins, pessaries, and many other articles have been found in the vagina. It is quite possible for a phosphatic incrustation to be found about a foreign body tolerated in this location for some time. Hubbauer speaks of a young girl of nineteen in whose vagina there was a glass fixed by incrustations which held it solidly in place. It had been there for six months and was only removed with great difficulty. Holmes cites a peculiar case in which the neck of a bottle was found in the vagina of a woman. One point of the glass had penetrated the bladder and a calculus had formed on this as well as on the vaginal end.

When a foreign body remains in the vagina for a long time and if it is composed of material other than glass, it becomes influenced by the corrosive action of the vaginal secretion. For instance, Cloquet removed a foreign body which was incrusted in the vagina, and found the cork pessary which had formed its nucleus completely rotted. A similar instrument found by Gosselin had remained in the vagina thirty-six years, and was incrustated with calcareous salts. Metal is always attacked by the vaginal secretions in the most marked manner. Cloquet mentions that at an autopsy of a woman who had a pewter goblet in her vagina, lead oxid was found in the gangrenous debris.

Long Retention of Pessaries, etc.—The length of time during which pessaries may remain in the vagina is sometimes astonishing. The accompanying illustration shows the phosphatic deposits and incrustations around a pessary after a long sojourn in the vagina. The specimen is in the Musee Dupoytren. Pinet mentions a pessary that remained in situ for twenty-five years. Gerould of Massilon, Ohio, reports a case in which a pessary had been worn by a German woman of eighty-four for more than fifty years. She had forgotten its existence until reminded of it by irritation some years before death. It was remarkable that when the pessary was removed it was found to have largely retained its original wax covering. Hurxthal mentions the removal of a pessary which had been in the pelvis for forty-one years. Jackson speaks of a glove-pessary remaining in the vagina thirty-five years. Mackey reports the removal of a glass pessary after fifty-five years' incarceration.

There is an account of a young girl addicted to onanism who died from the presence of a pewter cup in her vagina; it had been there fourteen months. Shame had led her to conceal her condition for all the period during which she suffered pain in the hypogastrium, and diarrhea. She had steadily refused examination. Bazzanella of Innsbruck removed a drinking glass from the vagina by means of a pair of small obstetric forceps. The glass had been placed there ten years previously by the woman's husband. Szigethy reports the case of a woman of seventy-five who, some thirty years before, introduced into her vagina a ball of string previously dipped in wax. The ball was effectual in relieving a prolapsed uterus, and was worn with so little discomfort that she entirely forgot it until it was forced out of place by a violent effort. The ball was seven inches in circumference, and covered with mucus, but otherwise unchanged. Breisky is accredited with the report of a case of a woman suffering with dysmenorrhea, in whose vagina was found a cotton reel which had been introduced seven years before. The woman made a good recovery. Pearse mentions a woman of thirty-six who had suffered menorrhagia for ten days, and was in a state of great prostration and suffering from strong colicky pains. On examination he found a silk-bobbin about an inch from the entrance, which the patient had introduced fourteen years before. She had already had attacks of peritonitis and hemorrhage, and a urethrovaginal fistula was found. The bobbin itself was black. This patient had been married twice, and had been cared for by physicians, but the existence of a body 3/4 inch long had never been noticed. Poulet quotes two curious cases: in one a pregnant woman was examined by a doctor who diagnosticated carcinomatous degeneration of the neck of the uterus. Capuron, who was consulted relative to the case, did not believe that the state of the woman's health warranted the diagnosis, and on further examination the growth was found to have been a sponge which had previously been introduced by the woman into the vagina. The other case, reported by Guyon, exemplified another error in diagnosis. The patient was a woman who suffered from continuous vaginal hemorrhage, and had been given extensive treatment without success. Finally, when the woman was in extreme exhaustion, an injection of vinegar-water was ordered, the use of which was followed by the expulsion from the vagina of a live leech of a species very abundant in the country. The hemorrhage immediately ceased and health returned.

There is a record of a woman of twenty-eight who was suddenly surprised by some one entering her chamber at the moment she was introducing a cedar pencil into her vagina. With the purpose of covering up her act and dissembling the woman sat down, and the shank of the wood was pushed through the posterior wall of the vagina into the peritoneal cavity. The intestine was, without doubt, pierced in two of its curves, which was demonstrated later by an autopsy. A plastic exudation had evidently agglutinated the intestine at the points of penetration, and prevented an immediate fatal issue. Erichsen practiced extraction eight months after the accident, and a pencil 5 1/2 inches long, having a strong fecal odor, was brought out. The patient died the fourth day after the operation, from peritonitis, and an autopsy showed the perforation and agglutination of the two intestinal curvatures. Getchell relates the description of a calculus in the vagina, formed about a hair-pin as a nucleus. It is reported that a country girl came to the Hotel-Dieu to consult Dupoytren, and stated that several years before she had been violated by some soldiers, who had introduced an unknown foreign body into her vagina, which she never could extract. Dupuytren found this to be a small metallic pot, two inches in diameter, with its concavity toward the uterus. It contained a solid black substance of a most fetid odor.

Foreign bodies are generally introduced in the uterus either accidentally in vaginal applications, or for the purpose of producing abortion. Zuhmeister describes a case of a woman who shortly after the first manifestations of pregnancy used a twig of a tree to penetrate the matrix. She thrust it so strongly into the uterus that the wall was perforated, and the twig became planted in the region of the kidneys. Although six inches long and of the volume of a goose feather, this branch remained five months in the pelvis without causing any particular inconvenience, and was finally discharged by the rectum. Brignatelli mentions the case of a woman who, in culpable practices, introduced the stalk of a reed into her uterus. She suffered no inconvenience until the next menstrual epoch which was accompanied by violent pains. She presented the appearance of one in the pains of labor. The matrix had augmented in volume, and the orifice of the uterine cervix was closed, but there was hypertrophy as if in the second or third month of pregnancy. After examination a piece of reed three cm. long was extracted from the uterus, its external face being incrusted with hard calcareous material. Meschede of Schwetz, Germany, mentions death from a hair-pin in the uterine cavity.

Crouzit was called to see a young girl who had attempted criminal abortion by a darning-needle. When he arrived a fetus of about three months had already been expelled, and had been wounded by the instrument. It was impossible to remove the needle, and the placenta was not expelled for two days. Eleven days afterward the girl commenced to have pains in the inguinal region, and by the thirty-fifth day an elevation was formed, and the pains increased in violence. On the seventy-ninth day a needle six inches long was expelled from the swelling in the groin, and the patient recovered. Lisfranc extracted from the uterus of a woman who supposed herself to be pregnant at the third month, a fragment of a large gum-elastic sound which during illicit maneuvers had broken off within five cm. of its extremity, and penetrated the organ. Lisfranc found there was not the slightest sign of pregnancy, despite the woman's belief that she was with child.



CHAPTER XIV.

MISCELLANEOUS SURGICAL ANOMALIES.

Marvelous Recoveries from Multiple Injuries.—There are injuries so numerous or so great in extent, and so marvelous in their recovery, that they are worthy of record in a section by themselves. They are found particularly in military surgery. In the Medical and Philosophical Commentaries for 1779 is the report of the case of a lieutenant who was wounded through the lungs, liver, and stomach, and in whose armpit lodged a ball. It was said that when the wound in his back was injected, the fluid would immediately be coughed up from his lungs. Food would pass through the wound of the stomach. The man was greatly prostrated, but after eleven months of convalescence he recovered. In the brutal capture of Fort Griswold, Connecticut, in 1781, in which the brave occupants were massacred by the British, Lieutenant Avery had an eye shot out, his skull fractured, the brain-substance scattering on the ground, was stabbed in the side, and left for dead; yet he recovered and lived to narrate the horrors of the day forty years after.

A French invalid-artillery soldier, from his injuries and a peculiar mask he used to hide them, was known as "L'homme a la tete de cire." The Lancet gives his history briefly as follows: During the Franco-Prussian War, he was horribly wounded by the bursting of a Prussian shell. His whole face, including his two eyes, were literally blown away, some scanty remnants of the osseous and muscular systems, and the skull covered with hair being left. His wounds healed, giving him such a hideous and ghastly appearance that he was virtually ostracized from the sight of his fellows. For his relief a dentist by the name of Delalain constructed a mask which included a false palate and a set of false teeth. This apparatus was so perfect that the functions of respiration and mastication were almost completely restored to their former condition, and the man was able to speak distinctly, and even to play the flute. His sense of smell also returned. He wore two false eyes simply to fill up the cavities of the orbits, for the parts representing the eyes were closed. The mask was so well-adapted to what remained of the real face, that it was considered by all one of the finest specimens of the prothetic art that could be devised. This soldier, whose name was Moreau, was living and in perfect health at the time of the report, his bizarre face, without expression, and his sobriquet, as mentioned, making him an object of great curiosity. He wore the Cross of Honor, and nothing delighted him more than to talk about the war. To augment his meager pension he sold a pamphlet containing in detail an account of his injuries and a description of the skilfully devised apparatus by which his declining life was made endurable. A somewhat similar case is mentioned on page 585.

A most remarkable case of a soldier suffering numerous and almost incredible injuries and recovering and pursuing his vocation with undampened ardor is that of Jacques Roellinger, Company B, 47th New York Volunteers. He appeared before a pension board in New York, June 29, 1865, with the following history: In 1862 he suffered a sabre-cut across the quadriceps extensor of the left thigh, and a sabre-thrust between the bones of the forearm at the middle third. Soon afterward at Williamsburg, Va., he was shot in the thigh, the ball passing through the middle third external to the femur. At Fort Wagner, 1863, he had a sword-cut, severing the spinal muscles and overlying tissue for a distance of six inches. Subsequently he was captured by guerillas in Missouri and tortured by burning splinters of wood, the cicatrices of which he exhibited; he escaped to Florida, where he was struck by a fragment of an exploding shell, which passed from without inward, behind the hamstring on the right leg, and remained embedded and could be plainly felt. When struck he fell and was fired on by the retiring enemy. A ball entered between the 6th and 7th ribs just beneath the apex of the heart, traversed the lungs and issued at the right 9th rib. He fired his revolver on reception of this shot, and was soon bayonetted by his own comrades by mistake, this wound also penetrating the body. He showed a depressed triangular cicatrix on the margin of the epigastrium. If the scars are at all indicative, the bayonet must have passed through the left lobe of the liver and border of the diaphragm. Finally he was struck by a pistol-ball at the lower angle of the left lower jaw, this bullet issuing on the other side of the neck. As exemplary of the easy manner in which he bore his many injuries during a somewhat protracted convalescence, it may be added that he amused his comrades by blowing jets of water through the apertures on both sides of his neck. Beside the foregoing injuries he received many minor ones, which he did not deem worthy of record or remembrance. The greatest disability he suffered at the time of applying for a pension resulted from an ankylosed knee. Not satisfied with his experience in our war, he stated to the pension examiners that he was on his way to join Garibaldi's army. This case is marvelous when we consider the proximity of several of the wounds to a vital part; the slightest deviation of position would surely have resulted in a fatal issue for this apparently charmed life. The following table shows the man's injuries in the order of their reception:—

(1) Sabre-cut across the quadriceps femoris of right leg, dividing the tendinous and muscular structures.

(2) Sabre-thrust between the bones in the middle third of the right forearm.

(3) Shot in the right thigh, the ball passing through the middle third.

(4) A sword-cut across the spinal muscles covering the lower dorsal vertebrae.

(5) Tortured by guerillas in Indian fashion by having burning splinters of wood applied to the surface of his right thorax.

(6) An exploded shell passed through the hamstring muscles of the right thigh and embedded itself in the ligamentous tissues of the internal condyle of the femur.

(7) Shot by a ball between the 6th and 7th ribs of the left side.

(8) Bayonetted through the body, the steel passing through the left lobe of the liver and penetrating the posterior border of the diaphragm.

(9) Pistol-ball shot through the sternocleido muscle of one side of the neck, emerging through the corresponding muscle of the other side of the neck.

(10) Sabre-thrust between the bones of the left forearm.

(11) Pistol-shot through the left pectoralis major and left deltoid muscles.

(12) Deep cut dividing the commissure between the left thumb and forefinger down to the carpal bones.

Somewhat analogous to the foregoing is a case reported in 1834 by McCosh from Calcutta. The patient was a native who had been dreadfully butchered in the Chooar campaign. One of his hands was cut off above the wrist. The remaining stump was nearly amputated by a second blow. A third blow penetrated the shoulder-joint. Beside these and several other slashes, he had a cut across the abdomen extending from the umbilicus to the spine. This cut divided the parietes and severed one of the coats of the colon. The intestines escaped and lay by his side. He was then left on the ground as dead. On arrival at the hospital his wounds were dressed and he speedily convalesced, but the injured colon ruptured and an artificial anus was formed and part of the feces were discharged through the wound. This man was subsequently seen at Midnapore healthy and lusty although his body was bent to one side in consequence of a large cicatrix; a small portion of the feces occasionally passed through the open wound.

There is an account of a private soldier, aged twenty-seven, who suffered a gunshot wound of the skull, causing compound fracture of the cranium, and who also received compound fractures of both bones of the leg. He did not present himself for treatment until ten days later. At this time the head-injury caused him no inconvenience, but it was necessary to amputate the leg and remove the necrosed bones from the cranial wounds; the patient recovered.

Recovery After Injuries by Machinery, with Multiple Fractures, etc.—Persons accidentally caught in some portions of powerful machinery usually suffer several major injuries, any one of which might have been fatal, yet there are marvelous instances of recovery after wounds of this nature. Phares records the case of a boy of nine who, while playing in the saw-gate of a cotton-press, was struck by the lever in revolution, the blow fracturing both bones of the leg about the middle. At the second revolution his shoulder was crushed; the third passed over him, and the fourth, with maximum momentum struck his head, carrying away a large part of the integument, including one eyebrow, portions of the skull, membranes, and brain-substance. A piece of cranial bone was found sticking in the lever, and there were stains of brain on all the 24 posts around the circumference of the hole. Possibly from 1 1/2 to two ounces of cerebral substance were lost. A physician was called, but thinking the case hopeless he declined to offer surgical interference. Undaunted, the father of the injured lad straightened the leg, adjusted the various fractures, and administered calomel and salts. The boy progressively recovered, and in a few weeks his shoulder and legs were well. About this time a loosened fragment of the skull was removed almost the size and shape of a dessert spoon, with the handle attached, leaving a circular opening directly over the eye as large as a Mexican dollar, through which cerebral pulsation was visible. A peculiar feature of this case was that the boy never lost consciousness, and while one of his playmates ran for assistance he got out of the hole himself, and moved to a spot ten feet distant before any help arrived, and even then he declined proffered aid from a man he disliked. This boy stated that he remembered each revolution of the lever and the individual injuries that each inflicted. Three years after his injury he was in every respect well. Fraser mentions an instance of a boy of fifteen who was caught in the crank of a balance-wheel in a shingle-mill, and was taken up insensible. His skull was fractured at the parietal eminence and the pericranium stripped off, leaving a bloody tumor near the base of the fracture about two inches in diameter. The right humerus was fractured at the external condyle; there was a fracture of the coronoid process of the ulna, and a backward dislocation at the elbow. The annular ligament was ruptured, and the radius was separated from the ulna. On the left side there was a fracture of the anatomic neck of the humerus, and a dislocation downward. The boy was trephined, and the comminuted fragments removed; in about six weeks recovery was nearly complete. Gibson reports the history of a girl of eight who was caught by her clothing in a perpendicular shaft in motion, and carried around at a rate of 150 or 200 times a minute until the machinery could be stopped. Although she was found in a state of shock, she was anesthetized, in order that immediate attention could be given to her injuries, which were found to be as follows:—

(1) An oblique fracture of the middle third of the right femur.

(2) A transverse fracture of the middle third of the left femur.

(3) A slightly comminuted transverse fracture of the middle third of the left tibia and fibula.

(4) A transverse fracture of the lower third of the right humerus.

(5) A fracture of the lower third of the right radius.

(6) A partial radiocarpal dislocation.

(7) Considerable injuries of the soft parts at the seats of fracture, and contusions and abrasions all over the body.

During convalescence the little patient suffered an attack of measles, but after careful treatment it was found by the seventy-eighth day that she had recovered without bony deformity, and that there was bony union in all the fractures. There was slight tilting upward in the left femur, in which the fracture had been transverse, but there was no perceptible shortening.

Hulke describes a silver-polisher of thirty-six who, while standing near a machine, had his sleeve caught by a rapidly-turning wheel, which drew him in and whirled him round and round, his legs striking against the ceiling and floor of the room. It was thought the wheel had made 50 revolutions before the machinery was stopped. After his removal it was found that his left humerus was fractured at its lower third, and apparently comminuted. There was no pulse in the wrist in either the radial or ulnar arteries, but there was pulsation in the brachial as low as the ecchymosed swelling. Those parts of the hand and fingers supplied by the median and radial nerves were insensible. The right humerus was broken at the middle, the end of the upper fragment piercing the triceps, and almost protruding through the skin. One or more of the middle ribs on the right side were broken near the angle, and there was a large transverse rent in the quadriceps extensor. Despite this terrible accident the man made a perfect recovery, with the single exception of limitation of flexion in the left elbow-joint.

Dewey details a description of a girl of six who was carried around the upright shaft of a flour mill in which her clothes became entangled. Some part of the body struck the bags or stones with each revolution. She sustained a fracture of the left humerus near the insertion of the deltoid, a fracture of the middle third of the left femur, a compound fracture of the left femur in the upper third, with protrusion of the upper fragment and considerable venous hemorrhage, and fracture of the right tibia and fibula at the upper third. When taken from the shafting the child was in a moribund state, with scarcely perceptible pulse, and all the accompanying symptoms of shock. Her injuries were dressed, the fractures reduced, and starch bandages applied; in about six weeks there was perfect union, the right leg being slightly shortened. Six months later she was playing about, with only a slight halt in her gait.

Miscellaneous Multiple Fractures.—Westmoreland speaks of a man who was pressed between two cars, and sustained a fracture of both collar-bones and of the sternum; in addition, six or eight ribs were fractured, driven into and lacerating the lung. The heart was displaced. In spite of these terrible injuries, the man was rational when picked up, and lived nearly half a day. In comment on this case Battey mentions an instance in which a mill-sawyer was run over by 20 or 30 logs, which produced innumerable fractures of his body, constituting him a surgical curiosity. He afterward completely recovered, and, as a consequence of his miraculous escape, became a soothsayer in his region. West reports a remarkable recovery after a compound fracture of the femur, fracture of the jaw, and of the radius, and possibly injury to the base of the skull, and injury to the spine.

There is on record an account of a woman of forty-three who, by muscular action in lifting a stone, fractured her pubes, external to the spine, on the left side. Not realizing her injury she continued hard work all that day, but fell exhausted on the next. She recovered in about a month, and was able to walk as well as ever.

Vinnedge reports recovery after concussion of the brain and extreme shock, associated with fracture of the left femur, and comminuted fractures of the left tibia and fibula.

Tufnell mentions recovery after compound comminuted fracture of the leg, with simple fracture of both collar-bones, and dislocation of the thumb. Nankivell speaks of a remarkable recovery in an individual who suffered compound comminuted fracture of both legs, and fracture of the skull. It was found necessary to amputate the right thigh and left leg. Erichsen effected recovery by rest alone, in an individual whose ribs and both clavicles were fractured by being squeezed.

Gilman records recovery after injuries consisting of fracture of the frontal bone near the junction with the right parietal; fracture of the right radius and ulna at the middle third and at the wrist; and compound fracture of the left radius and ulna, 1 1/4 inches above the wrist. Boulting reports a case of an individual who suffered compound fractures of the skull and humerus, together with extensive laceration of the thigh and chest, and yet recovered.

Barwell mentions recovery after amputation of the shoulder-joint, in an individual who had suffered fracture of the base of the skull, fracture of the jaw, and compound fracture of the right humerus. There was high delirium followed by imbecility in this case. Bonnet reports a case of fracture of both thighs, two right ribs, luxation of the clavicle, and accidental club-foot with tenotomy, with good recovery from all the complications. Beach speaks of an individual who suffered fracture of both thighs, and compound comminuted fracture of the tibia, fibula, and tarsal bones into the ankle-joint, necessitating amputation of the leg. The patient not only survived the operation, but recovered with good union in both thighs. As illustrative of the numerous fractures a person may sustain at one time, the London Medical Gazette mentions an injury to a girl of fourteen, which resulted in 31 fractures.

Remarkable Falls.—In this connection it is of interest to note from how great a height a person may fall without sustaining serious injury. A remarkable fall of a miner down 100 meters of shaft (about 333 feet) without being killed is recorded by M. Reumeaux in the Bulletin de l'Industrie Minerale. Working with his brother in a gallery which issued on the shaft, he forgot the direction in which he was pushing a truck; so it went over, and he after it, falling into some mud with about three inches of water. As stated in Nature, he seems neither to have struck any of the wood debris, nor the sides of the shaft, and he showed no contusions when he was helped out by his brother after about ten minutes. He could not, however, recall any of his impressions during the fall. The velocity on reaching the bottom would be about 140 feet, and time of fall 4.12 seconds; but it is thought he must have taken longer. It appears strange that he should have escaped simple suffocation and loss of consciousness during a time sufficient for the water to have drowned him.

While intoxicated Private Gough of the 42d Royal Highlanders attempted to escape from the castle at Edinburgh. He fell almost perpendicularly 170 feet, fracturing the right frontal sinus, the left clavicle, tibia, and fibula. In five months he had so far recovered as to be put on duty again, and he served as an efficient soldier. There is an account of recovery after a fall of 192 feet, from a cliff in County Antrim, Ireland. Manzini mentions a man who fell from the dome of the Invalides in Paris, without sustaining any serious accident, and there is a record from Madrid of a much higher fall than this without serious consequence. In 1792 a bricklayer fell from the fourth story of a high house in Paris, landing with his feet on the dirt and his body on stone. He bled from the nose, and lost consciousness for about forty-five minutes; he was carried to the Hotel-Dieu where it was found that he had considerable difficulty in breathing; the regions about the external malleoli were contused and swollen, but by the eighth day the patient had recovered. In the recent reparation of the Hotel Raleigh in Washington, D.C., a man fell from the top of the building, which is above the average height, fracturing several ribs and rupturing his lung. He was taken to the Emergency Hospital where he was put to bed, and persistent treatment for shock was pursued; little hope of the man's recovery was entertained. His friends were told of his apparently hopeless condition. There were no external signs of the injury with the exception of the emphysema following rupture of the lung. Respiration was limited and thoracic movement diminished by adhesive straps and a binder; under careful treatment the man recovered.

Kartulus mentions an English boy of eight who, on June 1, 1879, while playing on the terrace in the third story of a house in Alexandria, in attempting to fly a kite in company with an Arab servant, slipped and fell 71 feet to a granite pavement below. He was picked up conscious, but both legs were fractured about the middle. He had so far recovered by the 24th of July that he could hobble about on crutches. On the 15th of November of the same year he was seen by Kartulus racing across the playground with some other boys; as he came in third in the race he had evidently lost little of his agility. Parrott reports the history of a man of fifty, weighing 196 pounds, who fell 110 feet from the steeple of a church. In his descent he broke a scaffold pole in two, and fell through the wooden roof of an engine-house below, breaking several planks and two strong joists, and landing upon some sacks of cement inside the house. When picked up he was unconscious, but regained his senses in a short time, and it was found that his injuries were not serious. The left metacarpal bones were dislocated from the carpal bones, the left tibia was fractured, and there were contusions about the back and hips. Twelve days later he left for home with his leg in plaster. Farber and McCassy report a case in which a man fell 50 feet perpendicularly through an elevator shaft, fracturing the skull. Pieces of bone at the superior angle of the occipital bone were removed, leaving the aura exposed for a space one by four inches. The man was unconscious for four days, but entirely recovered in eighteen days, with only a slightly subnormal hearing as an after-effect of his fall.

For many years there have been persons who have given exhibitions of high jumps, either landing in a net or in the water. Some of these hazardous individuals do not hesitate to dive from enormous heights, being satisfied to strike head first or to turn a somersault in their descent. Nearly all the noted bridges in this country have had their "divers." The death of Odlum in his attempt to jump from Brooklyn bridge is well known. Since then it has been claimed that the feat has been accomplished without any serious injury. It is reported that on June 20, 1896, a youth of nineteen made a headlong dive from the top of the Eads bridge at St. Louis, Mo., a distance of 125 feet. He is said to have swum 250 feet to a waiting tug, and was taken on board without having been hurt.

Probably the most interesting exhibition of this kind that was ever seen was at the Royal Aquarium, London, in the summer of 1895. A part of the regular nightly performance at this Hall, which is familiar on account of its immensity, was the jump of an individual from the rafters of the large arched roof into a tank of water about 15 by 20 feet, and from eight to ten feet deep, sunken in the floor of the hall. Another performer, dressed in his ordinary street clothes, was tied up in a bag and jumped about two-thirds of this height into the same tank, breaking open the bag and undressing himself before coming to the surface. In the same performance a female acrobat made a backward dive from the topmost point of the building into a net stretched about ten feet above the floor. Nearly every large acrobatic entertainment has one of these individuals who seem to experience no difficulty in duplicating their feats night after night.

It is a common belief that people falling from great heights die in the act of descent. An interview with the sailor who fell from the top-gallant of an East Indiaman, a height of 120 feet, into the water, elicited the fact that during the descent in the air, sensation entirely disappeared, but returned in a slight degree when he reached the water, but he was still unable to strike out when rising to the surface. By personal observation this man stated that he believed that if he had struck a hard substance his death would have been painless, as he was sure that he was entirely insensible during the fall.

A writer in the Pall Mall Gazette, in speaking of the accidents which had happened in connection with the Forth Bridge, tells of a man who trusted himself to work at the height of 120 feet above the waters of the Firth, simply grasping a rope. His hands became numb with cold, his grasp relaxed, and he fell backward down into the water, but was brought out alive. In another instance a spanner fell a distance of 300 feet, knocked off a man's cap, and broke its way through a four-inch plank. Again, another spanner fell from a great height, actually tearing off a man's clothes, from his waistcoat to his ankle, but leaving him uninjured. On another occasion a staging with a number of workmen thereon gave way. Two of the men were killed outright by striking some portion of the work in their descent; two others fell clear of the girders, and were rescued from the Firth little worse for their great fall.

Resistance of Children to Injuries.—It is a remarkable fact that young children, whose bones, cartilages, and tissues are remarkably elastic, are sometimes able to sustain the passage over their bodies of vehicles of great weight without apparent injury. There is a record early in this century of a child of five who was run over across the epigastrium by a heavy two-wheeled cart, but recovered without any bad symptoms. The treatment in this case is quite interesting, and was as follows: venesection to faintness, castor oil in infusion of senna until there was a free evacuation of the bowels, 12 leeches to the abdomen and spine, and a saline mixture every two hours! Such depleting therapeutics would in themselves seem almost sufficient to provoke a fatal issue, and were given in good faith as the means of effecting a recovery in such a case. In a similar instances a wagon weighing 1200 pounds passed over a child of five, with no apparent injury other than a bruise near the ear made by the wheel.

Infant-vitality is sometimes quite remarkable, a newly-born child sometimes surviving extreme exposure and major injuries. There was a remarkable instance of this kind brought to light in the Mullings vs. Mullings divorce-case, recorded in The Lancet. It appeared that Mrs. Mullings, a few hours after her confinement at Torquay, packed her newly-born infant boy in a portmanteau, and started for London. She had telegraphed Dr. J. S. Tulloch to meet her at Paddington, where he found his patient apparently in good condition, and not weak, as he expected in a woman shortly to be confined. On the way to her apartments, which had been provided by Dr. Tulloch, Mrs. Mullings remarked to the Doctor that she had already borne her child. Dr. Tulloch was greatly surprised, and immediately inquired what she had done with the baby. She replied that it was in a box on top of the cab. When the box was opened the child was found alive. The Lancet comments on the remarkable fact that, shortly after confinement, a woman can travel six or seven hours in a railroad train, and her newly-born babe conveyed the same distance in a portmanteau, without apparent injury, and without attracting attention.

Booth reports a remarkable case of vitality of a newly-born child which came under his observation in October, 1894. An illegitimate child, abandoned by its mother, was left at the bottom of a cesspool vault; she claimed that ten hours before Booth's visit it had been accidentally dropped during an attempt to micturate. The infant lived despite the following facts: Its delivery from an ignorant, inexperienced, unattended negress; its cord not tied; its fall of 12 feet down the pit; its ten hours' exposure in the cesspool; its smothering by foul air, also by a heavy covering of rags, paper, and straw; its pounding by three bricks which fell in directly from eight feet above (some loose bricks were accidentally dislodged from the sides of the vault, in the maneuvers to extricate the infant); its lowered temperature previous to the application of hot bottles, blankets, and the administration of cardiac stimulants. Booth adds that the morning after its discovery the child appeared perfectly well, and some two months afterward was brought into court as evidence in the case. A remarkable case of infant vitality is given on page 117.

Operations in the Young and Old.—It might be of interest to mention that such a major operation as ovariotomy has been successfully performed in an infant. In a paper on infant ovariotomy, several instances of this nature are mentioned. Roemer successfully performed ovariotomy on a child one year and eight months old; Swartz, on a child of four; Barker, on a child of four; Knowsley Thornton, on a child of seven, and Spencer Wells Cupples, and Chenoweth, on children of eight. Rein performed ovariotomy on a girl of six, suffering from a multilocular cyst of the left ovary. He expresses his belief that childhood and infancy are favorable to laparotomy.

Kidd removed a dermoid from a child of two years and eleven months; Hooks performed the same operation on a child of thirty months. Chiene extirpated an ovary from a child of three; Neville duplicated this operation in a child one month younger; and Alcock performed ovariotomy on a child of three.

Successful ovariotomies are infrequent in the extremely aged. Bennett mentions an instance in a woman of seventy-five, and Davies records a similar instance. Borsini and Terrier cite instances of successful ovariotomy in patients of seventy-seven. Carmichael performed the operation at seventy-four. Owens mentions it at eighty; and Homans at eighty-two years and four months. Dewees records a successful case of ovariotomy in a woman over sixty-seven; McNutt reports a successful instance in a patient of sixty-seven years and six months; the tumor weighed 60 pounds, and there were extensive adhesions. Maury removed a monocystic ovarian tumor from a woman of seventy-four, his patient recovering. Pippingskold mentions an ovariotomy at eighty. Terrier describes double ovariotomy for fibromata in a woman of seventy-seven. Aron speaks of an operation for pilous dermoid of the ovary in a woman of seventy-five. Shepherd reports a case of recurrent proliferous cyst in a woman of sixty-three, on whom successful ovariotomy was performed twice within nine months. Wells mentions an ovarian cyst in a woman of sixty-five, from which 72 pints of fluid were removed.

Hawkins describes the case of a musician, M. Rochard, who at the age of one hundred and seven was successfully operated on for strangulated hernia of upward of thirty hours' duration. The wound healed by first intention, and the man was well in two weeks. Fowler operated successfully for strangulated umbilical hernia on a patient of sixty-eight.

Repeated Operations.—Franzolini speaks of a woman of fifty on whom he performed six celiotomies between June, 1879, and April, 1887. The first operation was for fibrocystic disease of the uterus. Since the last operation the woman had had remarkably good health, and there was every indication that well-merited recovery had been effected. The Ephemerides contains an account of a case in which cystotomy was repeated four times, and there is another record of this operation having been done five times on a man. Instances of repeated Cesarean section are mentioned on page 130.

Before leaving this subject, we mention a marvelous operation performed by Billroth on a married woman of twenty-nine, after her sixth pregnancy. This noted operator performed, synchronously, double ovariotomy and resections of portions of the bladder and ileum, for a large medullary carcinomatous growth of the ovary, with surrounding involvement. Menstruation returned three months after the operation, and in fifteen months the patient was in good health in every way, with no apparent danger of recurrence of the disease.

Self-performed Surgical Operations.—There have been instances in which surgeons and even laymen have performed considerable operations upon themselves. On the battlefield men have amputated one of their own limbs that had been shattered. In such cases there would be little pain, and premeditation would not be brought into play in the same degree as in the case of M. Clever de Maldigny, a surgeon in the Royal Guards of France, who successfully performed a lithotomy on himself before a mirror. He says that after the operation was completed the urine flowed in abundance; he dressed the wound with lint dipped in an emollient solution, and, being perfectly relieved from pain, fell into a sound sleep. On the following day, M. Maldigny says, he was as tranquil and cheerful as if he had never been a sufferer. A Dutch blacksmith and a German cooper each performed lithotomy on themselves for the intense pain caused by a stone in the bladder. Tulpius, Walther, and the Ephemerides each report an instance of self-performed cystotomy.

The following case is probably the only instance in which the patient, suffering from vesical calculus, tried to crush and break the stone himself. J. B., a retired draper, born in 1828, while a youth of seventeen, sustained a fracture of the leg, rupture of the urethra, and laceration of the perineum, by a fall down a well, landing astride an iron bar. A permanent perineal fistula was established, but the patient was averse to any operative remedial measure. In the year 1852 he became aware of the presence of a calculus, but not until 1872 did he ask for medical assistance. He explained that he had introduced a chisel through his perineal fistula to the stone, and attempted to comminute it himself and thus remove it, and by so doing had removed about an ounce of the calculus. The physician started home for his forceps, but during the interval, while walking about in great pain, the man was relieved by the stone bursting through the perineum, falling to the floor, and breaking in two. Including the ounce already chiselled off, the stone weighed 14 1/2 ounces, and was 10 5/8 inches in its long circumference. B. recovered and lived to December, 1883, still believing that he had another piece of stone in his bladder.

In Holden's "Landmarks" we are told that the operation of dividing the Achilles tendon was first performed by an unfortunate upon himself, by means of a razor. According to Patterson, the late Mr. Symes told of a patient in North Scotland who, for incipient hip-disease, had the cautery applied at the Edinburgh Infirmary with resultant great relief. After returning home to the country he experienced considerable pain, and despite his vigorous efforts he was unable to induce any of the men to use the cautery upon him; they termed it "barbarous treatment." In desperation and fully believing in the efficacy of this treatment as the best means of permanently alleviating his pain, the crippled Scotchman heated a poker and applied the cautery himself.

We have already mentioned the marvelous instances of Cesarean sections self-performed, and in the literature of obstetric operations many of the minor type have been done by the patient herself. In the foregoing cases it is to be understood that the operations have been performed solely from the inability to secure surgical assistance or from the incapacity to endure the pain any longer. These operations were not the self-mutilations of maniacs, but were performed by rational persons, driven to desperation by pain.

Possibly the most remarkable instances of extensive loss of blood, with recoveries, are to be found in the older records of venesection. The chronicles of excessive bleeding in the olden days are well known to everybody. Perhaps no similar practice was so universally indulged in. Both in sickness and in health, depletion was indicated, and it is no exaggeration to say that about the hospital rooms at times the floors were covered with blood. The reckless way in which venesection was resorted to, led to its disuse, until to-day it has so vanished from medical practice that even its benefits are overlooked, and depletion is brought about in some other manner. Turning to the older writers, we find Burton describing a patient from whom he took 122 ounces of blood in four days. Dover speaks of the removal of 111 and 190 ounces; Galen, of six pounds; and Haen, of 114 ounces. Taylor relates the history of a case of asphyxia in which he produced a successful issue by extracting one gallon of blood from his patient during twelve hours. Lucas speaks of 50 venesections being practiced during one pregnancy. Van der Wiel performed venesection 49 times during a single pregnancy. Balmes mentions a case in which 500 venesections were performed in twenty-five years. Laugier mentions 300 venesections in twenty-six months. Osiander speaks of 8000 ounces of blood being taken away in thirty-five years. Pechlin reports 155 venesections in one person in sixteen years, and there is a record of 1020 repeated venesections.

The loss of blood through spontaneous hemorrhage is sometimes remarkable. Fabricius Hildanus reports the loss of 27 pounds of blood in a few days; and there is an older record of 40 pounds being lost in four days. Horstius, Fabricius Hildanus, and Schenck, all record instances of death from hemorrhage of the gums. Tulpius speaks of hemoptysis lasting chronically for thirty years, and there is a similar record of forty years' duration in the Ephemerides. Chapman gives several instances of extreme hemorrhage from epistaxis. He remarks that Bartholinus has recorded the loss of 48 pounds of blood from the nose; and Rhodius, 18 pounds in thirty-six hours. The Ephemerides contains an account of epistaxis without cessation for six weeks. Another writer in an old journal speaks of 75 pounds of blood from epistaxis in ten days. Chapman also mentions a case in which, by intestinal hemorrhage, eight gallons of blood were lost in a fortnight, the patient recovering. In another case a pint of blood was lost daily for fourteen days, with recovery. The loss of eight quarts in three days caused death in another case; and Chapman, again, refers to the loss of three gallons of blood from the bowel in twenty-four hours. In the case of Michelotti, recorded in the Transactions of the Royal Society, a young man suffering from enlargement of the spleen vomited 12 pounds of blood in two hours, and recovered.

In hemorrhoidal hemorrhages, Lieutaud speaks of six quarts being lost in two days; Hoffman, of 20 pounds in less than twenty-four hours, and Panaroli, of the loss of one pint daily for two years.

Arrow-Wounds.—According to Otis the illustrious Baron Percy was wont to declare that military surgery had its origin in the treatment of wounds inflicted by darts and arrows; he used to quote Book XI of the Iliad in behalf of his belief, and to cite the cases of the patients of Chiron and Machaon, Menelaus and Philoctetes, and Eurypiles, treated by Patroclus; he was even tempted to believe with Sextus that the name iatros, medicus, was derived from ios, which in the older times signified "sagitta," and that the earliest function of our professional ancestors was the extraction of arrows and darts. An instrument called beluleum was invented during the long Peloponnesian War, over four hundred years before the Christian era. It was a rude extracting-forceps, and was used by Hippocrates in the many campaigns in which he served. His immediate successor, Diocles, invented a complicated instrument for extracting foreign bodies, called graphiscos, which consisted of a canula with hooks. Otis states that it was not until the wars of Augustus that Heras of Cappadocia designed the famous duck-bill forceps which, with every conceivable modification, has continued in use until our time. Celsus instructs that in extracting arrow-heads the entrance-wound should be dilated, the barb of the arrow-head crushed by strong pliers, or protected between the edges of a split reed, and thus withdrawn without laceration of the soft parts. According to the same authority, Paulus Aegineta also treated fully of wounds by arrow-heads, and described a method used in his time to remove firmly-impacted arrows. Albucasius and others of the Arabian school did little or nothing toward aiding our knowledge of the means of extracting foreign bodies. After the fourteenth century the attention of surgeons was directed to wounds from projectiles impelled by gunpowder. In the sixteenth century arrows were still considerably used in warfare, and we find Pare a delineating the treatment of this class of injuries with the sovereign good sense that characterized his writings. As the use of firearms became prevalent the literature of wounds from arrows became meager, and the report of an instance in the present day is very rare.

Bill has collected statistics and thoroughly discussed this subject, remarking upon the rapidity with which American Indians discharge their arrows, and states that it is exceptional to meet with only a single wound. It is commonly believed that the Indian tribes make use of poisoned arrows, but from the reports of Bill and others, this must be a very rare custom. Ashhurst states that he was informed by Dr. Schell, who was stationed for some time at Fort Laramie, that it is the universal custom to dip the arrows in blood, which is allowed to dry on them; it is not, therefore, improbable that septic material may thus be inoculated through a wound.

Many savage tribes still make use of the poisonous arrow. The Dyak uses a sumpitan, or blow-tube, which is about seven feet long, and having a bore of about half an inch. Through this he blows his long, thin dart, anointed on the head with some vegetable poison. Braidwood speaks of the physiologic action of Dajaksch, an arrow-poison used in Borneo. Arnott has made observations relative to a substance produced near Aden, which is said to be used by the Somalies to poison their arrows. Messer of the British Navy has made inquiries into the reputed poisonous nature of the arrows of the South Sea Islanders.

Otis has collected reports of arrow-wounds from surgical cases occurring in the U. S. Army. Of the multiple arrow-wounds, six out of the seven cases were fatal. In five in which the cranial cavity was wounded, four patients perished. There were two remarkable instances of recovery after penetration of the pleural cavity by arrows. The great fatality of arrow-wounds of the abdomen is well known, and, according to Bill, the Indians always aim at the umbilicus; when fighting Indians, the Mexicans are accustomed to envelop the abdomen, as the most vulnerable part, in many folds of a blanket.

Of the arrow-wounds reported, nine were fatal, with one exception, in which the lesion implicated the soft parts only. The regions injured were the scalp, face, and neck, in three instances; the parietes of the chest in six; the long muscles of the back in two; the abdominal muscles in two; the hip or buttocks in three; the testis in one; the shoulder or arm in 13; forearm or hand in six; the thigh or leg in seven.

The force with which arrows are projected by Indians is so great that it has been estimated that the initial velocity nearly equals that of a musket-ball. At a short distance an arrow will perforate the larger bones without comminuting them, causing a slight fissure only, and resembling the effect of a pistol-ball fired through a window-glass a few yards off.

Among extraordinary cases of recovery from arrow-wounds, several of the most striking will be recorded. Tremaine mentions a sergeant of thirty-four who, in a fray with some hostile Indians, received seven arrow-wounds: two on the anterior surface of the right arm; one in the right axilla; one on the right side of the chest near the axillary border; two on the posterior surface of the left arm near the elbow-joint, and one on the left temple. On June 1st he was admitted to the Post Hospital at Fort Dodge, Kan. The wound on the right arm near the deltoid discharged, and there was slight exfoliation of the humerus. The patient was treated with simple dressings, and was returned to duty in July, 1870.

Goddard mentions an arrow-wound by which the body was transfixed. The patient was a cutler's helper at Fort Rice, Dakota Territory. He was accidentally wounded in February, 1868, by an arrow which entered the back three inches to the right of the 5th lumbar vertebra, and emerged about two inches to the right of the ensiform cartilage. During the following evening the patient lost about eight ounces of blood externally, with a small amount internally. He was confined to his bed some two weeks, suffering from circumscribed peritonitis with irritative fever. In four weeks he was walking about, and by July 1st was actively employed. The arrow was deposited in the Army Medical Museum.

Muller gives a report of an arrow-wound of the lung which was productive of pleurisy but which was followed by recovery. Kugler recites the description of the case of an arrow-wound of the thorax, complicated by frightful dyspnea and blood in the pleural cavity and in the bronchi, with recovery.

Smart extracted a hoop-iron arrow-head, 1 3/4 inches long and 1/2 inch in breadth, from the brain of a private, about a month after its entrance. About a dram of pus followed the exit of the arrow-head. After the operation the right side was observed to be paralyzed, and the man could not remember his name. He continued in a varying condition for a month, but died on May 13, 1866, fifty-two days after the injury. At the postmortem it was found that the brain-tissue, to the extent of 3/4 inch around the track of the arrow as a center, was softened and disorganized. The track itself was filled with thick pus which extended into the ventricles.

Peabody reports a most remarkable case of recovery from multiple arrow-wounds. In a skirmish with some Indians on June 3, 1863, the patient had been wounded by eight distinct arrows which entered different parts of the body. They were all extracted with the exception of one, which had entered at the outer and lower margin of the right scapula, and had passed inward and upward through the upper lobe of the right lung or trachea. The hemorrhage at this time was so great that all hope was abandoned. The patient, however, rallied, but continued to experience great pain on swallowing, and occasionally spat blood. In July, 1866, more than three years after the injury, he called on Dr. Peabody to undergo an examination with a view of applying for a pension, stating that his health was affected from the presence of an arrow-head. He was much emaciated, and expressed himself as tired of life. Upon probing through a small fistulous opening just above the superior end of the sternum, the point of the arrow was found resting against the bone, about 1 1/2 inches below, the head lying against the trachea and esophagus, with the carotid artery, jugular vein, and nerves overlying. After some little difficulty the point of the arrow was raised above the sternum, and it was extracted without the loss of an ounce of blood. The edge grazed against the sheath of the innominate artery during the operation. The missile measured an inch at the base, and was four inches long. The health of the patient underwent remarkable improvement immediately after the operation.

Serious Insect-stings.—Although in this country the stings of insects are seldom productive of serious consequences, in the tropic climates death not unfrequently results from them. Wounds inflicted by large spiders, centipedes, tarantulae, and scorpions have proved fatal. Even in our country deaths, preceded by gangrene, have sometimes followed the bite of a mosquito or a bee, the location of the bite and the idiosyncrasy of the individual probably influencing the fatal issue. In some cases, possibly, some vegetable poison is introduced with the sting. Hulse, U.S.N., reports the case of a man who was bitten on the penis by a spider, and who subsequently exhibited violent symptoms simulating spinal meningitis, but ultimately recovered. Kunst mentions a man of thirty-six who received several bee-stings while taking some honey from a tree, fell from the tree unconscious, and for some time afterward exhibited signs of cerebral congestion. Chaumeton mentions a young man who did not perceive a wasp in a glass of sweet wine, and swallowed the insect. He was stung in the throat, followed by such intense inflammation that the man died asphyxiated in the presence of his friends, who could do nothing to relieve him. In connection with this case there is mentioned an English agriculturist who saved the life of one of his friends who had inadvertently swallowed a wasp with a glass of beer. Alarming symptoms manifested themselves at the moment of the sting. The farmer made a kind of paste from a solution of common salt in as little water as possible, which he gave to the young man, and, after several swallows of the potion, the symptoms disappeared as if by enchantment. There is a recent account from Bridgeport, Conn., of a woman who, while eating a pear, swallowed a hornet that had alighted on the fruit. In going down the throat the insect stung her on the tonsil. Great pain and inflammation followed, and in a short time there was complete deprivation of the power of speech.

Mease relates the case of a corpulent farmer who, in July, 1835, was stung upon the temple by a common bee. He walked to a fence a short distance away, thence to his house, 20 yards distant, lay down, and expired in ten minutes. A second case, which occurred in June, 1811, is also mentioned by Mease. A vigorous man was stung in the septum of the nose by a bee. Supported by a friend he walked to his house, a few steps distant, and lay down. He rose immediately to go to the well, stepped a few paces, fell, and expired. It was thirty minutes from the time of the accident to the man's death. A third case is reported by the same author from Kentucky. A man of thirty-five was stung on the right superior palpebrum, and died in twenty minutes. Mease reports a fourth ease from Connecticut, in which a man of twenty-six was stung by a bee on the tip of the nose. He recovered after treatment with ten-grain doses of Dover's Powder, and persistent application of plantain leaves. A fifth case was that of a farmer in Pennsylvania who was stung in the left side of the throat by a wasp which he had swallowed in drinking cider. Notwithstanding medical treatment, death ensued twenty-seven hours afterward. A sixth case, which occurred in October, 1834, is given by the same author. A middle-aged man was stung by a yellow wasp on the middle finger of the right hand, and died in less than twenty minutes after having received his wound. A seventh case was that of a New York farmer who, while hoeing, was bitten on the foot by a spider. Notwithstanding medical treatment, principally bleeding, the man soon expired.

Desbrest mentions the sting of a bee above the eyebrow followed by death. Zacutus saw a bee-sting which was followed by gangrene. Delaistre mentions death from a hornet-sting in the palate. Nivison relates the case of a farmer of fifty who was stung in the neck by a bee. The usual swelling and discoloration did not follow, but notwithstanding vigorous medical treatment the man died in six days. Thompson relates three cases of bee-sting, in all of which death supervened within fifteen minutes,—one in a farmer of fifty-eight who was stung in the neck below the right ear; a second in an inn-keeper of fifty who was stung in the neck, and a third of a woman of sixty-four who was stung on the left brow. "Chirurgus" recalls the details of a case of a wasp-sting in the middle finger of the right hand of a man of forty, depriving him of all sense and of muscular power. Ten minutes after receiving it he was unconscious, his heart-beats were feeble, and his pulse only perceptible.

Syphilis from a Flea-bite.—Jonathan Hutchinson, in the October, 1895, number of his unique and valuable Archives of Surgery, reports a primary lesion of most unusual origin. An elderly member of the profession presented himself entirely covered with an evident syphilitic eruption, which rapidly disappeared under the use of mercury. The only interest about the case was the question as to how the disease had been acquired. The doctor was evidently anxious to give all the information in his power, but was positive that he had never been exposed to any sexual risk, and as he had retired from practice, no possibility of infection in that manner existed. He willingly stripped, and a careful examination of his entire body surface revealed no trace of lesion whatever on the genitals, or at any point, except a dusky spot on one leg, which looked like the remains of a boil. This, the doctor stated, had been due to a small sore, the dates of the appearance and duration of which were found to fit exactly with those of a primary lesion. There had also been some enlargement of the femoral glands. He had never thought of the sore in this connection, but remembered most distinctly that it followed a flea-bite in an omnibus, and had been caused, as he supposed, by his scratching the place, though he could not understand why it lasted so long. Mr. Hutchinson concludes that all the evidence tends to show that the disease had probably been communicated from the blood of an infected person through the bite of the insect. It thus appears that even the proverbially trivial fleabite may at times prove a serious injury.

Snake-bites.—A writer in an Indian paper asserts that the traditional immunity of Indian snake-charmers is due to the fact that having been accidentally bitten by poisonous serpents or insects more than once, and having survived the first attack, they are subsequently immune. His assertion is based on personal acquaintance with Madari Yogis and Fakirs, and an actual experiment made with a Mohammedan Fakir who was immune to the bites of scorpions provided by the writer. The animals were from five to seven inches long and had lobster-like claws. Each bite drew blood, but the Fakir was none the worse.

The venom of poisonous snakes may be considered the most typical of animal poisons, being unrivaled in the fatality and rapidity of its action. Fortunately in our country there are few snake-bites, but in the tropic countries, particularly India, the mortality from this cause is frightful. Not only are there numerous serpents in that country, but the natives are lightly dressed and unshod, thus being exposed to the bites of the reptiles. It is estimated by capable authorities that the deaths in India each year from snake-bites exceed 20,000. It is stated that there were 2893 human beings killed by tigers, leopards, hyenas, and panthers in India during the year 1894, and in the same year the same species of beasts, aided by snakes, killed 97,371 head of cattle. The number of human lives destroyed by snakes in India in 1894 was 21,538. The number of wild beasts killed in the same year was 13,447, and the number of snakes killed was 102,210.

Yarrow of Washington, who has been a close student of this subject, has found in this country no less than 27 species of poisonous snakes, belonging to four genera. The first genus is the Crotalus, or rattlesnake proper; the second is the Caudisona, or ground-rattlesnake; the third is the Ancistrodon, or moccasin, one of the species of which is a water-snake; and the fourth is the Elaps, or harlequin snake. There is some dispute over the exact degree of the toxic qualities of the venom of the Heloderma suspectum, or Gila monster. In India the cobra is the most deadly snake. It grows to the length of 5 1/2 feet, and is most active at night. The Ophiophagus, or hooded cobra, is one of the largest of venomous snakes, sometimes attaining a length of 15 feet; it is both powerful, active, and aggressive. The common snakes of the deadly variety in the United States are the rattlesnake, the "copperhead," and the moccasin; and it is from the bites of one of these varieties that the great majority of reported deaths are caused. But in looking over medical literature one is struck with the scarcity of reports of fatal snake-bites. This is most likely attributable to the fact that, except a few army-surgeons, physicians rarely see the cases. The natural abode of the serpents is in the wild and uninhabited regions.

The venom is delivered to the victim through the medium of a long fang which is connected with a gland in which the poison is stored. The supply may be readily exhausted; for a time the bite would then be harmless. Contrary to the general impression, snake-venom when swallowed is a deadly poison, as proved by the experiments of Fayrer, Mitchell, and Reichert. Death is most likely caused by paralysis of the vital centers through the circulation. In this country the wounds invariably are on the extremities, while in India the cobra sometimes strikes on the shoulder or neck.

If called on to describe accurately the symptoms of snake-venom poisoning, few medical men could respond correctly. In most cases the wound is painful, sometimes exaggerated by the mental condition, which is wrought up to a pitch rarely seen in other equally fatal injuries. It is often difficult to discern the exact point of puncture, so minute is it. There is swelling due to effusion of blood, active inflammation, and increasing pain. If the poison has gained full entrance into the system, in a short time the swelling extends, vesicles soon form, and the disorganization of the tissues is so rapid that gangrene is liable to intervene before the fatal issue. The patient becomes prostrated immediately after the infliction of the wound, and his condition strongly indicates the use of stimulants, even if the medical attendant were unfamiliar with the history of the snake-bite. There may be a slight delirium; the expression becomes anxious, the pulse rapid and feeble, the respiration labored, and the patient complains of a sense of suffocation. Coma follows, and the respirations become slower and slower until death results. If the patient lives long enough, the discoloration of the extremity and the swelling may spread to the neck, chest and back. Loss of speech after snake-bite is discussed in Chapter XVII, under the head of Aphasia.

A peculiar complication is a distressing inflammation of the mouth of individuals that have sucked the wounds containing venom. This custom is still quite common, and is preferred by the laity to the surer and much wiser method of immediate cauterization by fire. There is a curious case reported of a young man who was bitten on the ankle by a viper; he had not sucked the wound, but he presented such an enormous swelling of the tongue as to be almost provocative of a fatal issue. In this case the lingual swelling was a local effect of the general constitutional disturbance.

Cases of Snake-bite.—The following case illustrative of the tenacity of virulence of snake-venom was reported by Mr. Temple, Chief Justice of Honduras, and quoted by a London authority. While working at some wood-cutting a man was struck on a heavy boot by a snake, which he killed with an axe. He imagined that he had been efficiently protected by the boot, and he thought little of the incident. Shortly afterward he began to feel ill, sank into a stupor, and succumbed. His boots were sold after his death, as they were quite well made and a luxury in that country. In a few hours the purchaser of the boots was a corpse, and every one attributed his death to apoplexy or some similar cause. The boots were again sold, and the next unfortunate owner died in an equally short time. It was then thought wise to examine the boots, and in one of them was found, firmly embedded, the fang of the serpent. It was supposed that in pulling on the boots each of the subsequent owners had scratched himself and became fatally inoculated with the venom, which was unsuspected and not combated. The case is so strange as to appear hypothetic, but the authority seems reliable.

The following are three cases of snake-bite reported by surgeons of the United States Army, two followed by recovery, and the other by death: Middleton mentions a private in the Fourth Cavalry, aged twenty-nine, who was bitten by a rattlesnake at Fort Concho, Texas, June 27, 1866. The bite opened the phalangeal joint of the left thumb, causing violent inflammation, and resulted in the destruction of the joint. Three years afterward the joint swelled and became extremely painful, and it was necessary to amputate the thumb. Campbell reports the case of a private of the Thirteenth Infantry who was bitten in the throat by a large rattlesnake. The wound was immediately sucked by a comrade, and the man reported at the Post Hospital, at Camp Cooke, Montana, three hours after the accident. The only noticeable appearance was a slightly wild look about the eyes, although the man did not seem to be the least alarmed. The region of the wound was hard and somewhat painful, probably from having been bruised by the teeth of the man who sucked the wound; it remained so for about three hours. The throat was bound up in rancid olive oil (the only kind at hand) and no internal remedy was administered. There were no other bad consequences, and the patient soon returned to duty.

Le Carpentier sends the report of a fatal case of rattlesnake-bite: A private, aged thirty-seven, remarkable for the singularity of his conduct, was known in his Company as a snake-charmer, as he had many times, without injury, handled poisonous snakes. On the morning of July 13, 1869, he was detailed as guard with the herd at Fort Cummings, New Mexico, when, in the presence of the herders, he succeeded in catching a rattlesnake and proving his power as a sorcerer. The performance being over and the snake killed, he caught sight of another of the same class, and tried to duplicate his previous feat; but his dexterity failed, and he was bitten in the middle finger of the right hand. He was immediately admitted to the Post Hospital, complaining only of a little pain, such as might follow the sting of a bee or wasp. A ligature was applied above the wound; the two injuries made by the fangs were enlarged by a bistoury; ammonia and the actual cautery were applied; large doses of whiskey were repeated frequently, the constitution of the patient being broken and poor. Vomiting soon came on but was stopped without trouble, and there were doubts from the beginning as to his recovery. The swelling of the hand and arm gradually increased, showing the particular livid and yellowish tint following the bites of poisonous snakes. A blister was applied to the bitten finger, tincture of iodin used, and two ounces of whiskey given every two hours until inebriety was induced. The pulse, which was very much reduced at first, gained gradually under the influence of stimulants; two grains of opium were given at night, the patient slept well, and on the next day complained only of numbness in the arm. The swelling had extended as far as the shoulder-joint, and the blood, which was very fluid, was incessantly running from the wound. Carbolic acid and cerate were applied to the arm, with stimulants internally. On the 15th his condition was good, the swelling had somewhat augmented, there was not so much lividity, but the yellowish hue had increased. On the 16th the man complained of pain in the neck, on the side of the affected limb, but his general condition was good. Examining his genitals, an iron ring 3/4 inch in diameter was discovered, imbedded in the soft tissues of the penis, constricting it to such a degree as to have produced enormous enlargement of the parts. Upon inquiry it seemed that the ring had been kept on the parts very long, as a means of preservation of chastity; but under the influence of the snake's venom the swelling had increased, and the patient having much trouble in passing water was obliged to complain. The ring was filed off with some difficulty. Gangrene destroyed the extremity of the bitten finger. From this date until the 30th the man's condition improved somewhat. The progress of the gangrene was stopped, and the injured finger was disarticulated at the metacarpal articulation. Anesthesia was readily obtained, but the appearance of the second stage was hardly perceptible. Le Carpentier was called early on the next morning, the patient having been observed to be sinking; there was stertorous respiration, the pulse was weak and slow, and the man was only partly conscious. Electricity was applied to the spine, and brandy and potassium bromid were given, but death occurred about noon. A necropsy was made one hour after death. There was general softening of the tissues, particularly on the affected side. The blood was black and very fluid,—not coagulable. The ventricles of the brain were filled with a large amount of serum; the brain was somewhat congested. The lungs were healthy, with the exception of a few crude tubercles of recent formation on the left side. The right ventricle of the heart was empty, and the left filled with dark blood, which had coagulated. The liver and kidneys were healthy, and the gall-bladder very much distended with bile. The intestines presented a few livid patches on the outside.

Hydrophobia.—The bite of an enraged animal is always of great danger to man, and death has followed a wound inflicted by domestic animals or even fowls; a human bite has also caused a fatal issue. Rabies is frequently observed in herbivorous animals, such as the ox, cow, or sheep, but is most commonly found in the carnivore, such as the dog, wolf, fox, jackal, hyena, and cat and other members of the feline tribe. Fox reports several cases of death from symptoms resembling those of hydrophobia in persons who were bitten by skunks. Swine, birds, and even domestic poultry have caused hydrophobia by their bites. Le Cat speaks of the bite of an enraged duck causing death, and Thiermeyer mentions death shortly following the bite of a goose, as well as death in three days from a chicken-bite. Camerarius describes a case of epilepsy which he attributed to a horse-bite. Among the older writers speaking of death following the bite of an enraged man, are van Meek'ren, Wolff, Zacutus Lusitanus, and Glandorp. The Ephemerides contains an account of hydrophobia caused by a human bite. Jones reports a case of syphilitic inoculation from a human bite on the hand.

Hydrophobia may not necessarily be from a bite; a previously-existing wound may be inoculated by the saliva alone, conveyed by licking. Pliny, and some subsequent writers, attributed rabies to a worm under the animal's tongue which they called "lytta." There is said to be a superstition in India that, shortly after being bitten by a mad dog, the victim conceives pups in his belly; at about three months these move rapidly up and down the patient's intestines, and being mad like their progenitor, they bite and bark incessantly, until they finally kill the unfortunate victim. The natives of Nepaul firmly believe this theory. All sorts of curious remedies have been suggested for the cure of hydrophobia. Crabs-claws, Spanish fly, and dragon roots, given three mornings before the new or full moon, was suggested as a specific by Sir Robert Gordon. Theodore De Vaux remarks that the person bitten should immediately pluck the feathers from the breech of an old cock and apply them bare to the bites. If the dog was mad the cock was supposed to swell and die. If the dog was not mad the cock would not swell; in either case the person so treated was immune. Mad-stones, as well as snake-stones, are believed in by some persons at the present day. According to Curran, at one time in Ireland the fear of hydrophobia was so great that any person supposed to be suffering from it could be legally smothered.

According to French statistics, hydrophobia is an extremely fatal disease, although the proportion of people bitten and escaping without infection is overwhelmingly greater than those who acquire the disease. The mortality of genuine hydrophobia is from 30 to 80 per cent, influenced by efficient and early cauterization and scientific treatment. There is little doubt that many of the cases reported as hydrophobia are merely examples of general systemic infection from a local focus of sepsis, made possible by some primitive and uncleanly treatment of the original wound. There is much superstition relative to hydrophobia; the majority of wounds seen are filled with the hair of the dog, soot, ham-fat, and also with particles of decayed food and saliva from the mouth of some person who has practiced sucking the wound.

Ordinarily, the period of incubation of hydrophobia in man is before the end of the second month, although rarely cases are seen as many as six months from the reception of the bite. The first symptoms of the disease are melancholia, insomnia, loss of appetite, and occasionally shooting pains, radiating from the wound. There may be severe pain at the back of the head and in the neck. Difficulty in swallowing soon becomes a marked symptom. The speech assumes a sobbing tone, and occasionally the expression of the face is wild and haggard. As regards the crucial diagnostic test of a glass of water, the following account of a patient's attempt to drink is given by Curtis and quoted by Warren: "A glass of water was offered the patient, which he refused to take, saying that he could not stand so much as that, but would take it from a teaspoon. On taking the water from the spoon he evinced some discomfort and agitation, but continued to raise the spoon. As it came within a foot of his lips, he gagged and began to gasp violently, his features worked, and his head shook. He finally almost tossed the water into his mouth, losing the greater part of it, and staggered about the room gasping and groaning. At this moment the respirations seemed wholly costal, and were performed with great effort, the elbows being jerked upward with every inspiration. The paroxysm lasted about half a minute. The act of swallowing did not appear to cause distress, for he could go through the motions of deglutition without any trouble. The approach of liquid toward the mouth would, however, cause distress." It is to be remarked that the spasm affects the mechanism of the respiratory apparatus, the muscles of mastication and deglutition being only secondarily contracted.

Pasteur discovered that the virulence of the virus of rabies could be attenuated in passing it through different species of animals, and also that inoculation of this attenuated virus had a decided prophylactic effect on the disease; hence, by cutting the spinal cord of inoculated animals into fragments a few centimeters long, and drying them, an emulsion could be made containing the virus. The patients are first inoculated with a cord fourteen days old, and the inoculation is repeated for nine days, each time with a cord one day fresher. The intensive method consists in omitting the weakest cords and giving the inoculations at shorter intervals. As a curious coincidence, Pliny and Pasteur, the ancient and modern, both discuss the particular virulence of saliva during fasting.

There is much discussion over the extent of injury a shark-bite can produce. In fact some persons deny the reliability of any of the so-called cases of shark-bites. Ensor reports an interesting case occurring at Port Elizabeth, South Africa. While bathing, an expert swimmer felt a sharp pain in the thigh, and before he could cry out, felt a horrid crunch and was dragged below the surface of the water. He struggled for a minute, was twisted about, shaken, and then set free, and by a supreme effort, reached the landing stairs of the jetty, where, to his surprise, he found that a monstrous shark had bitten his leg off. The leg had been seized obliquely, and the teeth had gone across the joints, wounding the condyles of the femur. There were three marks on the left side showing where the fish had first caught him. The amputation was completed at once, and the man recovered. Macgrigor reports the case of a man at a fishery, near Manaar, who was bitten by a shark. The upper jaw of the animal was fixed in the left side of the belly, forming a semicircular wound of which a point one inch to the left of the umbilicus was the upper boundary, and the lower part of the upper third of the thigh, the lower boundary. The abdominal and lumbar muscles were divided and turned up, exposing the colon in its passage across the belly. Several convolutions of the small intestines were also laid bare, as were also the three lowest ribs. The gluteal muscles were lacerated and torn, the tendons about the trochanter divided, laying the bone bare, and the vastus externus and part of the rectus of the thigh were cut across. The wound was 19 inches in length and four or five inches in breadth. When Dr. Kennedy first saw the patient he had been carried in a boat and then in a palanquin for over five miles, and at this time, three hours after the reception of the wound, Kennedy freed the abdominal cavity of salt water and blood, thoroughly cleansed the wound of the hair and the clots, and closed it with adhesive strips. By the sixteenth day the abdominal wound had perfectly closed, the lacerations granulated healthily, and the man did well. Boyle reports recovery from extensive lacerated wounds from the bite of a shark. Both arms were amputated as a consequence of the injuries. Fayrer mentions shark-bites in the Hooghley.

Leprosy from a Fish-bite.—Ashmead records the curious case of a man that had lived many years in a leprous country, and while dressing a fish had received a wound of the thumb from the fin of the fish. Swelling of the arm followed, and soon after bullae upon the chest, head, and face. In a few months the blotches left from this eruption became leprous tubercles, and other well-marked signs of the malady followed. The author asked if in this case we have to do with a latent leprosy which was evoked by the wound, or if it were a case of inoculation from the fish?

Cutliffe records recovery after amputation at the elbow-joint, as a consequence of an alligator-bite nine days before admission to the hospital. The patient exhibited a compound comminuted fracture of the right radius and ulna in their lower thirds, compound comminuted fractures of the bones of the carpus and metacarpus, with great laceration of the soft parts, laying bare the wrist-joint, besides several penetrating wounds of the arm and fore-arm. Mourray gives some notes on a case of crocodile-bite with removal of a large portion of omentum. Sircar speaks of recovery from a crocodile-bite. Dudgeon reports two cases of animal-bites, both fatal, one by a bear, and the other by a camel. There is mention of a compound dislocation of the wrist-joint from a horse-bite. Fayrer speaks of a wolf-bite of the forearm, followed by necrosis and hemorrhage, necessitating ligature of the brachial artery and subsequent excision of the elbow-joint.

Injuries from Lightning.—The subject of lightning-stroke, with its diverse range of injuries, is of considerable interest, and, though not uncommon, the matter is surrounded by a veil of superstition and mystery. It is well known that instantaneous or temporary unconsciousness may result from lightning-stroke. Sometimes superficial or deep burns may be the sole result, and again paralysis of the general nerves, such as those of sensation and motion, may be occasioned. For many years the therapeutic effect of a lightning-stroke has been believed to be a possibility, and numerous instances are on record. The object of this article will be to record a sufficient number of cases of lightning-stroke to enable the reader to judge of its various effects, and form his own opinion of the good or evil of the injury. It must be mentioned here that half a century ago Le Conte wrote a most extensive article on this subject, which, to the present time, has hardly been improved upon.

The first cases to be recorded are those in which there has been complete and rapid recovery from lightning-stroke. Crawford mentions a woman who, while sitting in front of her fireplace on the first floor of a two-story frame building, heard a crash about her, and realized that the house had been struck by lightning. The lightning had torn all the weather-boarding off the house, and had also followed a spouting which terminated in a wooden trough in a pig-sty, ten feet back of the house, and killed a pig. Another branch of the fluid passed through the inside of the building and, running along the upper floor to directly over where Mrs. F. was sitting, passed through the floor and descended upon the top of her left shoulder. Her left arm was lying across her abdomen at the time, the points of the fingers resting on the crests of the ilium. There was a rent in the dress at the top of the shoulder, and a red line half an inch wide running from thence along the inside of the arm and fore-arm. In some places there was complete vesication, and on its palmer surface the hand lying on the abdomen was completely denuded. The abdomen, for a space of four inches in length and eight inches in breadth, was also blistered. The fluid then passed from the fingers to the crest of the ilium, and down the outside of the leg, bursting open the shoes, and passing then through the floor. Again a red line half an inch wide could be traced from the ilium to the toes. The clothing was not scorched, but only slightly rent at the point of the shoulder and where the fingers rested. This woman was neither knocked off her chair nor stunned, and she felt no shock at the time. After ordinary treatment for her burns she made rapid and complete recovery.