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duction, over the region of the heart, of a needle, which made its way through the right ventricle, and was found stickingin the muscular substance. He also met with two other cases- one in which a man pushed a needle into the heart of a girl;the other a wound of the heart of an infant, caused by thenurse (a little girl) pressing it to her bosom. In these latter,death ensued from haemorrhage.For the notes of the following case we are indebted to Mr.

Wm. H. Farrington, house-surgeon to the hospital.S. H-, aged nineteen, a healthy-looking young woman,

walked into the surgery, about two A.M., on the 3rd instant,and stated that she had received a push which had driven thehook of her dress into her chest, about twenty minutes pre-viously. Mr. Farrington, the house-surgeon, examined herchest, and perceived on the right side of the sternum, betweenthe second and third costal cartilages, the skin to be projectedforwards, about the eighth of an inch, by some foreign body,which received a pulsation synchronous with the action of theheart. A small puncture, such as would admit a pin, was theonly wound visible, and situated about a quarter of an inchfrom the projection. There was a single small spot of blood onher chemise. On questioning her, she said it might possibly bea needle, as she sometimes carried them stuck in her dress.She complained of a slight sense of fulness in her throat, andpain in the right shoulder. Respiration was slightly accele-rated. Pulse 120, which might have been due to excitement.She said that if he would take it out she felt quite well enoughto go home, and it was with great difficulty that she could bepersuaded to remain in the hospital. She walked to the ward,and, on arriving there, complained suddenly of great pain inher chest, and faintness. Mr. Farrington went to her a fewminutes afterwards, and found her in great pain. Her counte-nance was livid, and expressive of very great anxiety. The

projection on the right of the sternum still remained, thoughnow quite motionless. The action of the heart was extremelyfeeble, the radial artery being scarcely perceptible. Respi-ration deep and slow. On ammonia being applied to the nos-trils the pulse slightly revived. A small incision was nowmade over the projection, and, with some little force, a pieceof a needle, an inch and seven-eighths long, was extracted, theouter end being slightly bent, and the part containing the eye ebroken off. It took a direction obliquely under the sternum,and rather downwards. Her condition gradually became worse.Brandy was given to her, but she could not swallow it. Deli-rium and tossing about came on; the heart became more andmore oppressed, the sounds becoming more feeble and distant;the pulse occasionally quite imperceptible, and then returning;respiration deep and at long intervals. She gradually sank,and died about an hour after her arrival at the hospital.Autopsy, thirty- two houi-s after deccth.---(Condneted under

the superintendence of -NIr. SKEY.)—The seat of puncture wasfound to be just below the second costal cartilage, and close tothe right edge of the sternum. Two small punctures werefound in the pericardium, their situation nearly correspondingto the external one. The pericardium was fully distended,containing about a pint of blood, the serum having separatedfrom the clot, which quite encased the heart. Beneath theexternal coat of the aorta, just at its commencement, was anextravasation of blood, about the size of a shilling. Abouthalf an inch above the aortic valves were three or four punc-tures, such as would have been made by the needle, throughthe whole thickness of the outer wall of the artery, and withina quarter of an inch of each other, one puncture being aboutone-sixteenth of an inch long, as if enlarged by the pulsationof the artery while the needle was fixed in it. Both lungswere much congested, and contained very little air. The otherorgans were healthy.

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CLINICAL RECORDS.

CEREBRAL CLOT WITHOUT PARALYSIS, BRIGHT’SDISEASE, AND PNEUMONIA.

IT is a matter of every-day clinical experience to encountercases in the wards of our hospitals in which three or four dis-eases are struggling for mastery in a single patient. Some onedisease will be more prominent than the others, whilst perhapsthe latter may be altogether latent or wholly unsuspected;and it is surprising to witness the tenacity of life, notwith-standing the amount and complexity of the varieties of themorbid influences at work.A patient (Thomas S-), aged forty-one, was admitted

into St. Mary’s Hospital on the 23rdof November, 1859, underthe care of Dr. Chambers. He had received some injury to theright temple from the blow of a stick three days before, whichwas followed by symptoms of concussion; these passed off, andwere followed by others, resembling, to a certain extent, thoseof delirium tremens. The latter were present on his admission;they shortly disappeared, and he remained conscious, but attimes excited and uproarious. He had also erysipelas of theface, which passed off under treatment. From the conditionof his urine, the third stage of Bright’s kidney was diagnosed.After some days, pneumonia of the right side set in; and,finally, he died on the 20th of December, thirty-three daysafter the receipt of the injury. We had the opportunity of witnessing the post-mortem exa-mination, made by Dr. Broadbent, the resident medical officer,on the 21st of December, in the presence of Dr. Chambers,when the following appearances were observed :-A clot, thesize of a large marble, was present in the right hemisphere,near the right anterior cornu, and had become altered in itscharacters, being partially fibrinous, pale, and evidently under-going absorption. There was a little fluid in the ventricles,and at the base of the brain. The right lung was distinctlydivided into three lobes, the lowest of which was affected withpneumonia. Recent pericarditis existed on the whole of theright side of the heart; the membrane could be peeled off,leaving a highly congested surface beneath. Both kidneys swere small and contracted, with very little healthy structureremaining, and in the third stage of bright’s disease; the rightwas rather extensively invaded by numerous cysts, of variabledimensions. The renal arteries were thickened, as is noticedin old cases of Bright’s kidney.

It is remarkable, as was observed by Dr. Chambers, thatthe man should have lived so long with the amount of diseasepresent within him, and yet he had recovered from the effectsof a great part of it. In this single instance, we find a clot inthe brain, pneumonia, pericarditis (latent during life), old dis-ease of the kidneys, and erysipelas.

REMOVAL OF A DEGENERATED SPONTANEOUSHÆMATOCELE.

OF the two kinds of hæmatocele-namely, the spontaneous’.and the traumatic-the latter is by far the most common, pro-duced generally by a blow, which gives rise to bleeding fromsome ramifying vein in the body of the testis. The introduc-tion of the trocar, in tapping a hydrocele, will also occasion it.The idiopathic form is very rare, and is always a more formid-able disease than that arising from mechanical injury. An

example of the former is at the present time in Guy’s Hospital,under the care of Mr. Poland. The patient is a man aboutforty years of age, who has been the subject of swelled testicleof the right side from childhood. It commenced to enlargesomewhat rapidly about two months ago, and subsequentlyattained to a considerable size. Its true nature at first seemedsomewhat doubtful. It was tapped, but no fluid came away;an operation was therefore determined on, and was performedon the 17th of January by Mr. Poland, who removed, underchloroform, the enlarged mass, which, on subsequent examina-tion, proved to be, as anticipated, a degenerated hæmatocele-that is, a hæmatocele the blood of which had become altered,in its red particles being absorbed or changed, and some de-colorized fibrine remaining behind in the sac of the tunica

vaginalis, which was distended to the size of an orange, andcontained some dirty, brownish-yellow fluid. The lining ofthis cavity was much thickened, spongy in texture, and coveredwith filamentous and laminated masses. It resembled verymuch the interior of an old aneurismal sac, and reminded usvery forcibly of a somewhat similar specimen which we sawremoved by Mr. Erichsen, at University College HospitaLThe testicle was flattened and lay behind the tumour; itseemed healthy, being separated from the growth by a distinctseptum. In the course of ablation, the hæmatocele was foundto adhere strongly to the perinæum and to the septum scroti,but did not interfere with the testicle on the opposite side.The wound made by the operation was necessarily large, butthe patient is going on extremely well.

ABSCESS BETWEEN THE ABDOMINAL WALLS.

’VE have had occasion several times to notice the develop-ment of purulent collections within or rather between the ab-dominal walls, and sometimes it is a matter of doubt whetherthey are not intra.-peritonea.l. There is a patient, aged thirty,