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nasal in tone; deglutition was perfect, but mastication wasat first difficult, and, since his admission into the hospital,impossible. He could only take sopped food.March 29.-The incisions adopted were through the middle

line of the lip, along the side of the nostril and across thecheek, beneath the lower lid, and the flaps turned outwards.Mr. Cowell said that he preferred this plan (Dieffenbach’s)in the cases where it will give sufficient room, to makingthe incision from the angle of the mouth to the zygoma,because the haemorrhage is generally less, and the risk ofdeformity is avoided. When the jaw had been removed theantrum was found to be completely filled with what seemedto be a gliomatous growth, and which was firmly adherentto the bones forming the floor of the orbit. The soft partswere, therefore, carefully dissected upwards, and the malarbone and floor of the orbit were entirely removed. The

greater part of the soft pa,late was also taken away. Thebleeding was less than is usual in these cases. A solutionof chloride of zinc was applied to the surface of the cavity;the space was then filled with lint, and the flap readjustedwith silver-wire sutures. No external dressing was applied.The growth was large, and, starting apparently from the

- superior maxilla, had become firmly adherent to the boneswith which it had come in contact, and filled every cavity.Microscopically, the growth was found to be fibro-cellular;’the nucleus multiple; cell-wall varying, but mostly largeand oval.The external wounds rapidly healed; and the cavity in

the mouth slimed over with moist and dried mucus. Painwas gone; and the patient was cheerful, swallowed his foodwithout difficulty, and did exceedingly well. There was nodeformity except a slight flattening of the cheek.A month afterwards a growth was found to be growing

from the anterior edge of the remaining portion of the softpalate. On April 30th the growth had attained the size ofa walnut, and was removed by Mr. Cowell, under chloroform.Smart haemorrhage followed; chloride-of-zinc paste was ap-plied, and he had iced water to drink. The growth wasmicroscopically of the same character.The patient did well, and went out for several drives. On

May 17th, however, he was attacked with erysipelas in thehead, and he gradually sank from diarrhoea and exhaustion,and died May 25th. No autopsy was permitted.

Provincial Hospital Reports.ROYAL BERKSHIRE HOSPITAL, READING.

TWO CASES OF TETANUS TREATED WITH CALABAR BEAN,THE HYDRATE OF CHLORAL, AND CHLOROFORM:

ONE DEATH; ONE RECOVERY.

IN the first of these cases (abridged from notes by Mr.Wm. Royds, house-surgeon) the accidental occurrence of

haemorrhage renders the case incomplete so far as regardsthe therapeutic value of the remedies employed. The secondis interesting from the manifest comfort (to say the least)which resulted from the use of the chloral hydrate.CASE 1. - J. W , aged twenty-five, was admitted on

Jan. 15th, 1870, under the care of Mr. Moxhay, having afew hours previously sustained a severe injury to the righthand and forearm. Ten days after admission he complainedof sore-throat and had difficulty in putting out his tongue,and the following day trismus was well marked. He wasordered one-sixth of a grain of the extract of Calabar beanevery hour, which was increased after a few hours to one-third of a grain every half-hour, but without effect. Onthe fourth day of the tetanic symptoms one-fourth of agrain of the extract was injected hypodermically, withoutresult. On the same morning he took thirty grains of thechloral hydrate, which produced five hours’ sleep. On

waking, the spasms were less violent, and he seemed alto-gether better. The dose was repeated in the evening, againproducing some hours’ sleep. The chloral was continued,in the dose of thirty or forty grains, twice a day for thenext three days, always with relief to the spasms, and fol-lowed by sleep. In the evening of the seventh day, how-ever, when he had been for some hours very little disturbed

by spasm, he died from haemorrhage from a vein which hadbeen laid open by sloughing.CASE 2.-A boy, aged thirteen, was admitted on March

llth, under the care of Mr. May, with tetanus, which hadfollowed an injury of the fingers three weeks previously.On the evening of his admission he took a dose of fifteengrains of chloral, which was followed by sleep, during whichhe still had spasms recurring every few minutes, but scarcelyrousing him. For two days he took three grains of thepowdered Calabar bean every three hours, the spasms con-tinuing with marked severity. On the fifth day he had aviolent spasm, in which he became quite livid, with eyesfixed and staring, and respiration nearly stopped. Artificialrespiration was employed with advantage, and he then tookwith difficulty thirty grains of chloral, which sent him tosleep, slight spasms occurring during the night.Next day he began taking the extract of Calabar bean in

one-grain doses every half-hour. After four doses he was

alarmingly faint, but the spasms were not checked. Chlo-roform was then given, and he got some sleep. Twentygrains of chloral hydrate were then injected into the bowel,with the effect of sending him to sleep. This form of ap-plication was afterwards employed once, and sometimestwice daily, and always. with the effect of relieving spasm.and giving rest.His attack was lengthy and severe, the spasms more than

once threatening death by suffocation. The aid of chloro-form was employed thirteen times, with the effect of re-laxing spasm.On April 19th (the thirty-ninth day) it is noted that he

has scarcely any spasms during the day. He still continuesthe enema of chloral.On May 15th he had so far improved that he was per-

mitted to get up, and on the 28th he was discharged.

WORCESTER GENERAL INFIRMARY.CASE OF IDIOPATHIC TETANUS ; RECOVERY.

(Under the care of Dr. WILLIAMS.)

THE following case has been reported by Mr. C. Hardy-man, house-surgeon :-Edward W , aged eight, admitted May llth, 1870.

Was quite well till three days ago, when, as he was return-ing from work (farm work), he suddenly fell down and be-came unconscious for about five minutes, and was then ableto get up and walk home, not feeling any pain. Went towork the next morning, and on returning in the eveningagain fell down unconscious. Was able after a time to walkhome and went to bed, and was attacked with violent painsand cramp in the legs and abdomen. Early next morninghe was unable to walk, and he got rapidly worse all thatday, and was admitted next morning.May llth.-There is now partial trismus. The abdominal

muscles are quite rigid, as also are the lower extremities.The upper extremities and muscles of the chest are quitefree. Has spasmodic contractions every few minutes, com-mencing in the legs, and travelling upwards to the trunk,and screams with the pain in the region of the diaphragm.Can swallow fluids without pain or spasm. Bowels consti-pated ; retention of urine requiring the catheter. Has

priapism. Ordered five grains of calomel and castor oil.l2th.-Passed a bad night, screaming out every few

minutes with pain in the abdomen. Countenance pinched;pulse 100; bowels not acted; has passed a little urine attimes. Ordered a common enema, which brought away asmall quantity of black, offensive faeces. To take a sixthof a grain of acetate of morphia, and a purge.13th.-Passed a quantity of black-looking fæces this

morning, and seems better. The nurse says he moved his

legs in the night, but they are perfectly rigid this morning,and he has opisthotonos at times. Still partial trismus;spasms not so frequent. Repeat purge.l4th.-Had a better night, and can move his legs a little

this morning; but abdomen is still very tense, the recticontracting on being touched. Passed more dark feculentmatter. Ten minims of tincture of belladonna every fourhours ; repeat purge.He improved daily, and on May 20th he was able to get

up.The contractions of the calf muscles caused him to stand