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and at the cardiac extremity, the coats of the stomach weremuch thinned, and had given way at one point, forming anopening the size of a half-crown piece. On opening the sto-mach, it was found to contain some dark semi-fluid material,similar to that in the cavity of the pleura, which was partially-digested blood; this would seem to have escaped from a largebranch of a vessel which could be traced to the ulceration, andto have been opened by it. On removing this, the mucouscoat was found rather reddened, and thrown into numerousrugee. The opening in the diaphragm was in the left portionof the tendon, near its posterior part; it was large enough toreadily admit the hand; its margms were rounded and thick-ened, and the serous covering of the fissure seemed continuouswith the pleura on one side and the peritoneum on the other; itwas quite perfect except at the left border, which appeared tohave been lately torn to the extent of an inch: this opening inthe diaphragm commenced about an inch and a half to the leftof the aesophageal opening. The peritoneum was everywhereexceedingly pale, and contained a fluid precisely the same asthat in the pleura, to the amount of two or three pints: therewere old adhesions at the upper part, from old peritonitis.The other organs were quite healthy.

CHARING-CROSS HOSPITAL.

CASE OF HYSTERICAL PARALYSIS IN THE MALE SEX,AFFECTING THE HAND.

(Under the care of Mr. BARWELL.)

As a rule, hysteria is almost exclusively confined to women;yet we do now and then meet with undoubted examples in theopposite sex, although it would be ridiculous to apply the termto the latter in its etymological sense. Tate, who wrote hismonograph on Hysteria some thirty years ago, does not evenallude to it amongst males. Many writers, however, since histime have recognised and described this disease in the male sex.The following case, of much interest, we had the opportunityof lately seeing and examining at this hospital :-

J. Wiz, aged thirty, unmarried, applied at the above hos-pital on August 18th, 1858, with loss of motion of certain partsof the left hand. It appears that he has never drunk to excess,but has led a somewhat dissolute life. He has never been ableto sleep much, and three or four hours in the twenty-foursatisfy him. He is of middle size, has dark hair and whiskers,grey eyes, is of a pale, flabby appearance, and wears a heavy,sullen, though not a morose look. A fortnight before thepatient’s application to the hospital, he was at a public-house,when, in some squabble, a woman bit him on the left arm justabove the inner condyle. The teeth did not puncture the skin,yet he declares that he immediately felt giddy, reeled, fell, andnearly fainted; at the same moment he felt pain shoot alongthe arm to the thumb and fore and middle fingers, since whichtime he has not been able to bend them.The diagnosis of this case is founded not merely upon the

history, but chiefly upon a careful examination of the conditionof the parts paralysed, and upon consideration of the nervoussupply of the muscles affected. A minute description, there-fore, of these circumstances will be not only necessary, butalso highly interesting.When the patient is holding the hand in its ordinary posture,

the thumb and the index and middle fingers are quite straight ; i,the other two slightly flexed. When told to bend the index ormiddle finger, he at once says he cannot, and it remains un-moved. If told to flex the little and ring fingers, he partiallydoes so, and bends at the same time the middle finger to someconsiderable degree. He can oppose the thumb to the little

finger, and bend its first phalanx, but not the last. All theimmovable parts, when bent by the surgeon, resist and flyback to the straight posture as soon as released. When he ismade to bend the inner fingers as much as possible, and tocross the thumb over them, he still declares that he cannotbend the index, but the abductor indicis is felt quite hard andtense, showing the action of the extensor muscles to keep thatfinger in the position of pointing. Neither the forearm norhand is wasted in any marked degree.Now, it is pointed out by Mr. Barwell that this paralysis is

not consistent with anatomy. The median nerve supplies notonly the superficial flexor of the fingers, but also the muscles ofthe ball of the thumb and its long flexor. Thus paralysis ofthis nerve would deprive of power the two outer fingers, andwould greatly iniure the inner, but then it would also deprive

of muscular action the ball of the thumb. The long flexor ofthe thumb is paralysed; but as the short one retains its power,this cannot be attributed to interruption of nervous supply,since both muscles are dominated by the same nerve ; theactive condition of the abductor indicis, likewise supplied bythe median, is another anomaly, also the active condition ofthe flexor carpi radialis. It is out of the question to accountfor the condition by the paralysis of any other nerve, since suchmalady would not influence the power of flexion in eitherfingers or thumb. Progressive muscular paralysis is hardly tabe thought of in connexion with this case; for not only doesthe history with the sudden commencement of the disease nega-tive it, but also the hard and unwasted condition of the parts.On reviewing these facts, considering the inadequate history,

and the nervous condition a man must be in who, when bittenso slightly that the skin is not broken, yet falls and almostfaints,-examining also the expression of sullen suffering (hypo-chondriasis) of the man’s face, and considering also that he hasled a dissolute life,-Mr. Barwell has come to the conclusionthat the disease is the very rare one of hysterical paralysis inthe male.The patient is still under treatment, and is getting better.

The result and treatment of the case will be given in a futurenumber.

ROYAL FREE HOSPITAL.PENETRATING WOUND OF THE ABDOMEN WITH A PAIR OF

SCISSORS, AND PROTRUSION OF THE BOWELS, IN A CHILDOF FIVE YEARS , FATAL RESULT.

(Under the care of Mr. ALEX. MARSDEN.)WouNDS of the abdomen are grave under any circumstances,

but they become the more so if any of the viscera have beeninjured. If the latter have escaped injury, and are protrudedthrough the wound, although the case is somewhat serious,there is, nevertheless, a chance that the symptoms of inflamma-tion may be less severe than if the intestines were wounded,and the patient may- escape with life. But the prognosis isgenerally most serious, as was proved by the following case:-A little girl, five years of age, early on the morning of

the 12th of September, was thrown down by a table fallingupon her, upon which was a pair of scissors. In some un-accountable manner, the points of the scissors were drivenby the force of the table into the abdomen, producing a.-V-shaped wound an inch long, in the left lumbar region.Through this protruded between two and three feet of smallintestine. She was at once taken to the hospital, and on ad.mission the bowels were carefully examined by Mr. McGregor,the house-surgeon, who, finding them to be unwounded,although scraped a little at one portion, reduced them withoutany difficulty, sewed up the wound, and carefully bandagedthe abdomen. She was kept quiet, was allowed milk and ice,and opium was given by the house-surgeon.The next day, the little tenderness which was present over

the wound had almost disappeared; she had been sick a fewtimes, but, on the whole, was doing pretty well, being freefrom any pain, even on considerable pressure, and her bowelswere open. Her face had somewhat of an anxious expression,and her pulse was rather frequent and full. This was at threeo’clock in the afternoon. About half an hour afterwards, shebecame suddenly exhausted, and died without any apparentsuffering.At the autopsy, well-marked appearances were present of

active peritonitis, shreds of recent lymph were thrown out, butthe bowels were intact and unwounded, as was originally sur-mised.What is remarkable in this case is, that the general symp-

toms of peritonitis were extremely mild, considering thenature of the injury-so much so, that at one period it washoped she might recover. Her countenance, however, bore anexpression of anxiety, with a dark halo around the eyes, which,taken with the character of the pulse, gave cause to fear the-worst.

CLINICAL RECORDS.

ABSORPTION OF HYDATIDS BY IODIDE OFPOTASSIUM.

’I HYDATIDS are found to be more common in the liver than inany other organ of the body. Sometimes they are known tabe present in the Jungs, or perhaps the cavity of the pleura,,