found insensibility. The patients in the same ward had seen him half an hour before, crawl out of bed, and, after sitting on the chair a few moments, fall to the floor apparently in a faint. He was lifted to his bed and taken no further notice of till the nurse gave the alarm.

It was thought that the extensive application of carbolic acid would account for his condition. So accordingly the dressings were instantly thrown off and the part washed thoroughly with soap and water. At the same time sinapisms were applied to his chest and the calves of his legs, and blister to the nape of his neck; brandy was given as freely as it was possible, and a turpentine and castor oil enema. For the first hour his condition improved rapidly, but as soon as the stimulating effect of the brandy and sinapisms had passed off he seemed to lapse into his former condition. The symptoms varied in intensity from time to time, until about ten o'clock, when he vomited freely, and from that time rapidly regained his consciousness and fell almost immediately into a natural sleep.

The odour of carbolic acid in the vomited matters was distinctly perceptible, but unfortunately none of the secretions were tested.

When fully recovered the patient said that a very few minutes after the application of the ointment he experienced a peculiar burning prickling sensation over the whole body, and that although he had the greatest desire to micturate he could not pass a single drop of urine. He had no recollection of getting out of bed, and that he was in a faint when the patients found him on the floor there can be little doubt.

As to the disease it improved with marvellous rapidity, and although nothing was afterwards applied but cod liver oil, he was pronounced cured on the sixteenth day after admission, and has had no recurrence of the disease since.

Dr. Fraser in a few remarks to the students stated that the case is instructive in two respects: 1st. As regards the danger incurred by the extensive application of carbolic acid to the skin, when the cuticle is removed, as it always is in eczema, leaving the cutaneous absorbents and capillaries exposed, through which it is readily absorbed and produces its known depressing effects upon the circulation through the nervous system. These effects have also been occasionally observed to follow its injection into large abscesses. 2nd. As regards its efficiency as a therapeutical remedy in eczema, in which disease, however, judging from its effects in the present case, it should be employed with caution, or to portions only of the diseased surface at a time, and its effects closely watched.

The action of the acid on the urinary organs which has been observed by others was also pointed out, and so was the treatment which succeeded so well in combating its dangerous effects in the present instance.

HOSPITAL REPORTS.

MONTREAL GENERAL HOSPITAL.

Cases in Medicine and Surgery under the care of Dr. D. C. MacCallum. CASE 1.-Removal of Deep-seated Malignant Tumor of the Neck.

Reported by Mr. JOHN H. MATHIESON.

Xavier Yenard, æt. 53, was admitted into the Montreal General Hospital on the 7th July, 1870, with a tumor on the right side of the neck,, below and behind the angle of the lower jaw. He first noticed it about six months ago, since which time it has been steadily increasing, and is now about the size of a lemon. It is firm in consistence, irregular in outline, and quite movable.

July 8th. The patient having been put under the influence of chloroform, Dr, MacCallum carried an incision, from a point on a level with the inferior lobe of the ear, vertically downwards for about five inches; a second at right angles to this, over the centre of the tumor, forwards for about two inches. He then reflected the flaps down to the sternomastoid muscle, beneath which, and extending forwards into the submaxillary triangle and backwards into the occipital, the tumor was situated. Lying over it was the external jugular vein and some of its branches, the spinal accessory nerve, and some branches of the cervical plexus. These structures were dissected off the surface of the tumor, a few fibres of the sterno-mastoid divided, and all drawn forwards over the tumor and retained there by a blunt hook. Having removed all the superficial attachments the tumor was then turned out from beneath the sterno-mastoid, and carefully separated from its deep attachments by the finger and the handle of the scalpel. While doing this respiration suddenly ceased and the pulsation at the wrist became extinct. Sylvester's ready method of artificial respiration was resorted to, and in a few minutes the suspended functions were restored. The remaining attachments were then separated, and the whole of the tumor removed.

The sheath of the common carotid artery and internal jugular vein was laid bare in removing the tumor, and the pulsation of the artery was visible. There was not an artery wounded. Whilst separating the deep attachments in the submaxillary region, a large vein was lacerated which bled freely. The bleeding was easily controlled by compressing the vein against the inferior maxilla. The wound was washed with carbolic acid lotion (one part up carbolic acid to thirty of water) till oozing ceased, and then the edges were brought together by metallic sutures. A

small compress was applied over the vein which had been lacerated, and the wound dressed with carbolic acid lotion.

The tumor weighed 3 iij and 3 v, and when examined microscopically was found to be composed entirely of large, granular, cancer cells. It had not yet involved any of the surrounding structures.

July 10th. The dressings were changed, and some of the stitches taken out. No pus has formed. There is very little swelling and scarcely any inflammation. Dressed as before with carbolic acid.

July 11th. The remaining stitches were removed; a drop or two of pus has formed at the point of union of the flaps.

It healed rapidly, and with the formation of very little, not more than a drachm, of pus altogether. On the 19th of July it was entirely healed and on the 21st of July he was discharged.

CASE 2-Pleuro-Pneumonia of the Upper Lobe of the Left Lung. Reported by Mr. KENNETH GUNSOLUS.

Bridget Mullen, aged 15, was admitted on Friday, July 8th, suffering from great prostration and intensely laboured breathing, accompanied by high fever.

She states that she first felt unwell on Sunday, July 3rd, when she was seized with severe shivering. This was followed by weakness, fever, difficult breathing, and cough. She was attended by a physician of this city from that time to the present. Her present condition, July 9th, is as follows: Countenance has a dull and somewhat stupid expression; there is a circumscribed flush over the malar eminences; the tongue is coated and she complains of great thirst; skin is dry and hot, and the thermometer placed in the axilla indicates a temperature of 104°; respirations quick and shallow-48 in the minute; pulse 120; cough frequent and unattended by expectoration. Percussion over the left infra-clavicular region elicits a sound of high pitch and of markedly hard quality, and there is unusual resistance felt by the percussing fingers-these conditions are most marked towards the lower part of this region. Over the same surface there is diffused blowing respiration with a dry crepitant râle at its boundaries. The blowing respiration is also very distinct in the lower scapular region of the left side. Throughout the remaining portion of this lung and the one of the right side, there are heard dry bronchial rhonchi. The voice is modified over the dull part, being quite bronchophonic, but there appears to be no alteration in the vocal fremitus.

Dr. MacCallum ordered two drachms of Liq. Ammon. Acetatis to be given every second hour, and ten grains of Pulv. Ipecac. Comp. at bed time. Turpentine stupes to be applied to the chest. Milk diet, with extras of beef tea, corn starch, and four ounces of wine daily.

July 10. Physical signs much the same, pulse 119, respirations 48, temperature of surface 104.

July 11. General symptoms aggravated, pulse 140, respirations 60, temperature 1042; slightly delirious. In addition to the physical signs already observed, there is now a distinct friction sound heard over the left infra-clavicular region. Patient complains of great pain and breathing is accompanied with a moan. The supervention of pleurisy is attributed by Dr. MacCallum to the circumstance of the patient's bed being in such a position that she is exposed to a draft of air when the window is kept open for the purpose of ventilation. He ordered her immediate removal to a sheltered position. The Dover's powder at bed time to be stopped, the Liq. Ammon. Acetatis to be continued, and a powder containing ten grains of Hyd. c Cretâ with five grains of Pulv. Ipecac. Comp. to be given every fourth hour. The chest to be cupped. July 12th. Condition much the same; still delirious; temperature 104°

July 13th. There is a great change for the better since yesterday, pulse 93, respirations 41, temperature 102°, no delirium. Last night she broke out into a profuse perspiration, which still continues. Nurse says she sleeps the greater part of the time. Powder altered to five grains of Hyd. c Cretâ and two grains of pulv. Ipecac. Comp.

July 15th. Continues to improve rapidly. Expression of countenance much more intelligent, pulse 112, respirations 30, temperature 100°. The dullness on percussion is much less, and there is less resistance. The friction sound and diffused blowing respiration have disappeared, and are now replaced by a redux crepitant râle.

July 16th. The perspirations continuing, the Liq. Ammon. Acetatis and the powders are ordered to be discontinued, and the patient placed on the following mixture: R Ext. Senegse Fluid 3 iii, Tinct. Hyos. 3 iii, Vini Ipecac 3 i, Spt. Ammon. Arcm. 3 iii, Aquæ ad 3 vi. A tablespoonful to be given every fourth hour.

July 23rd. She is now convalescent. The pulse respiration ratio is natural and the temperature normal; the dullness has disappeared, and the natural respiratory murmur has returned, but it is weaker than that of the right side.

CASE 3.-Intermittent Fever (Quotidiam) treated with large doses of Quinine. Reported by Mr. JNo. H. MATHIESON.

Anthony Nelson, a sailor, aged 23, was admitted into the Montreal General Hospital on the 5th July, 1870, complaining of fever and ague.

He is a stout, well built man, light complexion. Has previously been very healthy. He was on a trip to Oswego and while there was exposed for several hours during a wet and damp night. Shortly after this he complained of frequent slight chills, alternating with flushes of heat, recurring several times at irregular intervals during the day, and lasting from five to fifteen minutes. He also complained of languor, headache, nausea, and occasional vomiting.

On July 1st was seized with the first paroxysm—the cold stage lasted about an hour, and the subsequent stages of heat and sweating for several hours more. The paroxysm recurred daily without marked modification until his admission.

July 5th.-Pulse 72. Tongue coated with a creamy fur; bowels slightly constipated; urine abundant and pale, slightly acid; skin quite moist; pupils very much dilated; appears dull and languid. Respiration 21 and easy. The spleen is considerably enlarged. He had a paroxysm last night about 9 o'clock p. m. The cold stage lasted for about fortyfive minutes; he shook so hard that he declared "he had to hold himself in his bed." The hot and sweating stages continued till about 5 a. m. He sweat very profusely and in the morning his woollen shirt was thoroughly saturated. He has slept nearly all the time since 5 a. m. till now (11 a. m.) and is quite well, excepting a dull, heavy sensation in his head. Ordered the following:

B Calomelanos gr. v.

Pulv Jalap gr. xx.

July 6th.-Pulse 75. He had a paroxysm last night beginning about 10 p. m., which lasted till between five and six in the morning. The duration of the different stages and the character the same as before. He did not get the powder till this morning, and it has not operated yet. July 7th.-Paroxysm last night at 11 p. m. and continued till about Examined the spleen again and found it a little larger. It extends chiefly forwards and upwards. The area of dullness 5 + 6 inches. Purged freely yesterday.

5 a. m.

Ordered quiniæ sulph: gr. x to be given immediately after the paroxysm in the morning and to be repeated at noon and night.

July 8th.-Pulse 70. Pupils less dilated. Tongue cleaner. Paroxysm occurred last night about midnight. He has taken two doses (gr. xx) sulphate of quinine since the paroxysm this morning, a third dose to be given to-night.

July 9th,-Pulse 72. Tongue clean. Urine less abundant and still pale. Bowels are regular. He slept soundly last night and there was no return of the paroxysm. Was ordered quin sulph. gr. v. three times a day.