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30th.-The incisions are now only superficial. The patientis in no pain and feels in good health.

Sept. 3rd.-Flexion of the right foot impaired; cannotget the foot to a right angle. Leg much wasted; backsplint with foot-piece applied. Left leg wounds doing well.

18th.—Hardly any discharge from wounds.Nov. 19th.-The left knee quite healed.Dec. 1st.—Went out. He could walk without crutches,

but could not bend the left knee properly. The right leg wasnatural, although there was an absence of pulsation both inthe posterior tibial and dorsalis pedis arteries.

LIVERPOOL WORKHOUSE HOSPITAL.MENINGO-CEREBRITIS; DEATH; NECROPSY; ABSENCE OF THE

LEFT KIDNEY AND URETER ; REMARKS.

FoR the following notes we are indebted to Mr. W. PiercyFox, assistant medical officer, Liverpool Parish Infirmary.

E. W-, aged thirty-four, was admitted into the Liver-pool Parish Infirmary on April 23rd, suffering from theeffects of drink, and also with a wound over the left parietaleminence, about an inch long, which penetrated to the bone.The policeman who brought him in stated that the womanwith whom he was living threw him against the fender, andthus caused the injury to the head. He presented the usualappearance of one suffering from delirium tremens, althoughhe looked somewhat more stupid. He complained of greatpain across his head, and he walked to his ward with someassistance. It was stated that he had vomited beforeadmission, but this symptom never appeared afterwards.On April 25th his left arm and leg became paralysed, andvery soon after he lapsed into a semi-comatose condition, ’,from which he never rallied. He right arm seemed also tobecome paralysed two days before death; his pupils wereunequal, the right being much larger than its fellow ; thetongue lay like a sodden mass in his mouth, and he wasunable to protrude it. He had to be fed for five days beforehis death. His pulse was feeble throughout, and his tempera-ture remained normal, or thereabouts, till the day of his death,when it mounted up to 105.4°. He died on April 29th.Necropsy thirty-four hours after death.—The dura mater

was somewhat more congested than normal. Abnormaladhesion of the pia mater to the convolutions, the membranetaking portions of brain substance with it on its removal.There was partially organised lymph adhering to the piamater all over the surface of the brain, being more distinctover the posterior lobes. The convolutions were perceptiblysoftened, the brain matter being paler than normal. Athrombus was detected in the left middle cerebral artery,partially blocking up the vessel. The heart was healthyand the lungs only somewhat congested. The liverpresented amyloid disease, most marked in the neighbour-hood of the suspensory ligament and probably connectedwith old and prolonged suppuration in the right knee-joint,which was found at the post-mortem in a disorganised con-dition ; the cartilages ulcerated and the joint partiallyankylosed by fibrous adhesions. The left kidney was foundto be totally absent. There was no trace of a ureter orvascular supply. There was also no opening in the bladderfor the left ureter, the little ridge and fold of mucous mem-brane in which it should have been met with being absent.The right kidney was healthy, and of much larger size thanusual.

-Remar4-s.-This case is interesting in the first place onaccount of the medico-legal question involved. Did themeningo-cerebritis arise from drink, or from the injury, orfrom both combined? He had complained of pain in hishead for three weeks previous to the accident, which mightlead us to suspect the presence of the inflammation beforethe receipt of the injury. In this case the disease wouldbe accelerated by the injury, as it probably was. Had thewound been inflicted with homicidal intent, the perplexitiesof the case might have become of great importance tothose engaged for the defence. Happily, no suspicion ofhomicide rested upon anyone, the coroner’s jury returningan open verdict. Complete absence of the kidney is suffi-ciently rare to be worthy of record. In most cases adwarfed, shrunken kidney can be found embedded in theconnective tissue of the renal area. In this case not asingle trace of its existence could be discovered, andeven no provision had been made in the bladder forthe entrance of a ureter. The opposite kidney was suffi-ciently large to excrete the necessary material for the

system, and no symptom referable to the malformationcould be expected. The connexion of the old knee-jointdisease and the partially amyloid liver was a speciallyinteresting question. We all know that even gross.amyloid disease often disappears after the suppurationthat caused it has ceased. When departing does it lingerlongest about the region of the suspensory ligament as itdid in this case ? The question can only be arrived at afterfurther observations.

WINDSOR ROYAL INFIRMARY.CEREBRAL TUMOUR; DEATH; NECROPSY; REMARKS.

(Under the care of Mr. HOLDERNESS.)E. C-, aged seventeen, was admitted into hospital on

April 10th, 1885. Her parents are both living; father deli-cate. Has nine brothers and sisters, three of them deaf anddumb. No history of consumption. Her present illness, th&first of any kind she has had, commenced seven months ago,.when she was obliged to leave service and come home. Sh&complained of being faint and ill. She took to her bed andremained there fifteen weeks, during which time the prin-cipal symptoms were occasional vomiting, pain at the backof the head, and throbbing pain at the top of the head; andwhen she attempted to walk gave way at the knees. Threeweeks before admission she had a sort of fit, in which sheis described as becoming stiff and cold. The patient was ledinto the hospital, being unable to walk alone; the momentsupport was removed she gave way at the knees, and wouldhave fallen. She complained of continuous pain at the backof her head. Shortly after admission she was sick, whichsickness continued at intervals until her death, eight days.after admission. Her sight was impaired ; the optic discscould not be well defined. There was no paralysis, local orotherwise, and no loss of or variation from normal sensation.Urine: sp. gr. 1033, acid, no albumen; with the copper test itgave a slight trace of sugar ; nothing more definite. Lungs.healthy. From this time the patient’s condition got rapidlyworse. Complete optic neuritis developed. The pupils became’very dilated and remained so, and she lay in a semi-comatosecondition, interrupted by cries of pain, and placing her handto the back of her head. On the 16th the nurse of theward, when changing the patient’s night-dress, happened toraise her slightly by placing the hand under her neck. Sheimmediately became stiff and convulsed; the convulsionwas general, lasted a few seconds, and passed off. The comabecame more and more complete, and death ensued on-the 18th.On post-mortem examination of the brain the membranes

were found healthy, and showed no signs of inflammation.The cerebrum and cerebellum were likewise healthy. On,the under surface of the brain, in the floor of the thirdventricle, and situated between the crura cerebri, coveringthe corpora albicantia, and touching the optic commissureand tuber cinereum anteriorly and the pons Varolii pos-teriorly, was an opaque, yellowish, cheesy-looking tumour,,about the size of a racquet-ball, well defined from the

surrounding brain substance, and undoubtedly tubercular incharacter.-Remarks.-The points of interest appear to be :-lst. The

way in which the symptoms seemed to point to cerebellardisease without the cerebellum being directly involved.2nd. No paralysis of the eye muscles was present, althoughthe third nerve was pressed upon. 3rd. What was the-cause of the marked ataxia ? Does this case support theview that the crura cerebri and pons are associated with thecerebellum in co-ordinating movement ?

NORTH-WESTERN AND YORKSHIRE ASSOCIATION OF’MEDICAL OFFICERS OF HEALTH.—On the 2nd inst. a con-ference of members of these Associations was held at Brad-ford, under the presidency of Dr. Hime, borough medicalofficer. The Destruction of Town Refuse having formedthe subject of a lengthy and animated discussion, paperswere read by Dr. Hime on "The Artificial Cultivation ofMicrobes and exhibit Cultures of Cholera, Anthrax, and otherMicrobes in various Nutrient Media"; by Mr. F. Vacher(Birkenhead), on Dr. Jaeger’s Sanitary Woollen System ofDress, illustrated by exhibits" ; by Mr. C. Willis, (Mansfield)," Desirable Reform in the Laws relating to Public Health";and by Dr. Byles (Eccleshill), on " A new design for Middens,.by which automatic drainage and emptying can be effectuallysecured."