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pain, with nausea, retching, and slight vomiting, came on,he applied at this hospital for relief at 9.30 P.M., and wasimmediately admitted.On admission he appeared a hale, healthy-looking man ;

complained of sharp pain across the abdomen, felt sick, andsaid that he had vomited slightly two or three times, andretched considerably during the afternoon. There was a

swelling, the size of a hen’s egg, in the right groin, belowPoupart’s ligament, and internal to the femoral vessels,which was hard, tense, and painful on pressure, and to whichno impulse was imparted on his coughing.He was put into a warm bath, and the house-surgeon

tried to reduce the hernia, but without success. Mr. HenrySmith was then sent for, and, as reduction by taxis failedin his hands, he operated at once. An incision was made,and the sac exposed and opened in the usual manner; theportion of bowel was then seen to be claret-coloured, butnot very dark. The constriction was found to be atGimbernat’s ligament, which was freely incised, and theintestine was then easily returned into the abdomen.With the exception of slight pain across the belly during

the two days following the operation, he recovered withouta single bad symptom. The wound healed up rapidly, sothat at the end of a month he was able to wear a truss, andleave the hospital.CASE 2.-John B-, aged fifty-seven, labourer, admitted

under the care of Mr. H. Smith, suffering from strangulatedinguinal hernia, Jan. 26th, 1870. He has had a reducibleinguinal hernia for the last twenty-four years, for which hehas always worn a truss. During the last week he hassuffered from obstinate constipation, but was freely purged bysome medicine which he took two days ago. On rising onthe morning of the day before admission, he neglected toput on his truss, and walked about his room without it; hethen found that he could not return the hernia, as usual.He applied to a medical man, who failed to reduce it. Onthe following day, he applied at King’s College Hospital,and was admitted as in-patient.On admission (10.30 A.M.) a left inguinal hernia, about

the size of a hen’s egg, tense and irreducible, was present.The bowels had not acted for two days. He felt sick, buthad not vomited. He was put in a warm bath, and the re-duction of the hernia by taxis was attempted by the house-surgeon, but without success. Mr. Smith saw him about1 P.M. He was unable to reduce the hernia. As, however,no urgent symptoms were present, he determined to operatein some hours’ time, should the hernia be still irreducible.As reduction remained impossible, Mr. Smith operatedabout 10 P.a,r. He made an incision 4 in. long on the out-side of the swelling, exposing a good deal of fat. On thisbeing divided, he came to the sac, which was very thick.The sac was then freely opened, and about an ounce of clearfluid escaped. The knuckle of intestine thus exposed wasfound to be chocolate-coloured, and very tightly constrictedat the external abdominal ring, the margin of which wasfreely incised. A second constriction was found at the in-ternal ring. On the free incision of its edge, the bowel waseasily returned into the abdomen. During the two fol-lowing days he had slight nausea, and vomited once ortwice; but these symptoms soon subsided.On the fifth day after the operation, as the bowels had

not acted, a dose of castor oil was administered, whichpurged him freely. The wound healed up rapidly, so thaton the 1st of March he was able to leave the hospital.

UNIVERSITY COLLEGE HOSPITAL.A CASE OF TYPHOID FEVER.

(Clinical Remarks by Dr. WILSON FOX.)

A YOUNG woman was admitted into University CollegeHospital on March 17th with the following symptoms:Acute febrile disturbance, which had lasted for eight daysgreat prostration ; no very marked mental disturbance.The temperature in the evening was 104&ogr;; in the morning101‘. The abdomen was tympanitic, and the bowels wereloose, the stools being watery and bilious.

In some clinical remarks upon the use of the thermometeiin the diagnosis of typhoid fever, Dr. Fox stated that thEtemperature in this case, taken together with the duration

of the febrile symptoms, excluded the acute exanthemata,typhus, and pneumonia. Great difficulty, however, wouldoften be experienced with cases presenting the above-men-tioned list of symptoms in deciding between typhoid feverand tuberculosis with meningeal complications. In thelatter affection one would expect to find some mental dis-turbance, photophobia, occasionally a tendency to strabis-mus, and also hyperæsthesia and some special form ofparalysis.. The presence of any of these symptoms wouldassist the diagnosis. In the present case they were absent,and the patient was calm, rational, and collected. Therewas often considerable difficulty in distinguishing the earlystage of typhoid fever from a severe bilious attack, espe-cially in children, as in young patients suffering from thelatter complaint the temperature mounted frequently to103° or 104°, remained at this elevated point for a fewhours, and then rapidly fell again without any appreciablecause. It was important to make the diagnosis, if possible,in cases of this kind, as the administration of purgatives-the ordinary treatment for a bilious attack-would in theearly stage of typhoid do very great mischief. In cases ofdoubt it would be well to abstain from the use of aperientmedicine and to give merely salines.

In speaking of the treatment of typhoid fever, Dr. Foxstated that in the early stage of the affection, whilst thepatient’s strength remained good, and the pulse was full,frequent, and regular, it was advisable to give little or nomedicine, and to abstain from the old plan of giving slops-such as arrowroot, sago, and broths containing vegetablematter. Farinaceous and starchy food should be most care-fully avoided in typhoid, as in other acute febrile affections;for, in cases of this kind, the salivary and pancreatic secre-tions were much reduced, or quite arrested. Starchy food,consequently, remained undigested, and caused tympanitisand diarrhoea. The diet should consist of milk and beef-tea, with, for the purpose of relieving thirst, seltzer water,barley water, and the common toast-water, which was veryagreeable to feverish patients. Milk might be given freely,as it was a readily assimilable article of food. The chiefindication for withholding or administering alcoholic stimu-lants, was the state of the pulse. So long as the patient’sstrength was maintained, and the pulse was good and re-gular, no alcohol should be given; but when the pulse beganto flag, and became wea,k, slow, and fluttering, brandy shouldat once be administered, and, if necessary, with a free hand.In the ordinary course of severe typhoid, towards the endof the fever, a daily allowance of from twelve to eighteenounces was generally required. In some cases the pulse re-mained good throughout the whole course of typhoid fever,and no brandy was required; but these were exceptionalcases. With patients from the upper and middle classesstimulants were most frequently required; and with delicatewomen, and men exhausted by brain work, an early ad-ministration of brandy was necessary.

MIDDLESEX HOSPITAL.CASE OF RETENTION OF URINE FROM IMPERVIOUS

STRICTURE ; PARACENTESIS VESICÆ SUPRA PUBEM;RECOVERY.

(Under the care of Mr. HULKE.)CASES in which, with care and patience, a catheter cannot

be passed through a stricture occur so rarely that manysurgeons in large practice have never been obliged to re-sort to tapping the urinary bladder. Such cases, however,do occasionally happen, and they are generally treated inone of two ways,-either by an incision through the peri-neum into the urethra, behind the stricture, or by tappingthe bladder through the rectum. A small residuum of ex-ceptional cases remains, where neither of these methodscan be practised. Thus a very large prostate is a compli-cation which may make it impossible to reach the bladderthrough the rectum. In the following case extreme obesityrendered the perineum so deep that the supra-pubic para-centesis was alone practicable. The total absence of infil-tration and of diffuse cellulitis, where the abundance ofloose fatty tissue made its occurrence very probable, is aninteresting fact. Mr. G. E. Norton, house-surgeon, hasobliged us with the notes.