such as to convey the idea of a cord having been tied tightly around the vessel. Immediately below this contraction the vessel appears again to dilate, but not in its entire circumference; a pouch or sack, somewhat of the size and form of a split hazel-nut, occupies its anterior and internal surface. Between this sack and the vessel there is an obvious communication, the former being readily emptied by pressure. Below this last described tumour, till pretty near its bifurcation, the artery is of uniform calibre. It is somewhat, but inconsiderably, larger than the corresponding portion in the opposite extremity. From just above the internal condyle to its bifurcation, the the vessel is again uniformly dilated to fully double its natural dimensions. The radial and ulnar arteries are distended to pretty nearly twice their natural size, uniformly throughout their entire extent.

On the posterior and internal portion of the fore arm, corresponding to about the middle of the ulna, is a soft, compressible tumour, slightly pulsating, and in size somewhat about that of half an ordinary sized walnut. In the palm of the hand, immediately beneath the pisiform bone, is an ill-defined pulsating swelling, which resembles an aneurism by anastomosis; beneath this, and corresponding to the cleft between the middle and index finger, is a tumour of a similar nature, somewhat less in size, and less distinctly pulsating.

Pulsation is visible immediately above the sternum, along the bra chial, the radial, and the ulnar arteries; in the tumour on the back of the fore-arm, and in those in the palm of the hand. Pulsation is not visible in the carotids, nor in the tumours on the little and ring fingers.

By pressure applied to the axillary artery all pulsation in the tumour is arrested. Fremissement is well marked along the brachial, less distinctly along the radial and ulnar arteries. On taking the patient by the hand, and using gentle pressure, a tremulous purring sensation is communicated by the tumours in the palm.

On applying the stethoscope immediately beneath the acromial end of the clavicle, there is heard an intensely loud continuous murmur. This sound becomes somewhat augmented at every ventricular systole. As the stethoscope is moved towards the sternum, the murmur becomes less and less audible. At no part of the sternum can this murmur be heard. The heart's sounds appear perfectly normal. A bruit de soufflet is audible along the entire course of the brachial, radial, and ulnar arteries. A murinur exactly resembling the placental soufflet is heard in the various pulsating tumours. Nothing abnormal can be recognised in any of the other vessels in the body.

The pulse at both wrists is 72, and regular; being, however, on the affected side considerably fuller and somewhat stronger than on the other.

The temperature of the affected limb (one of the symptoms the patient complained of as most distressing), was, when measured by the thermometer, always several degrees higher than that of the other. The amount of the difference was found to vary with the

condition of the circulation, being augmented by whatever produced an acceleration of the heart's action. Any slight excess of exercise, she states, causes the limb to be bathed in perspiration.

There is a dull, aching pain, of variable intensity, at all times present in the arm, from which some relief is experienced, as also a partial emptying of the vessels, and slight diminution in the size of the various tumours, by holding the arm in an elevated position.

The patient's general health does not appear to have suffered much; her strength is but little impaired, her appetite good, her bowels regular, and her sleep undisturbed. Her catamenia did not appear the last two menstrual periods, but had always been previously regular.

The patient's history is briefly as follows:

Her parents, and numerous brothers and sisters, are healthy. She has been married eight years, and has had five children, nothing remarkable as to hæmorrhage or otherwise having occurred at her confinements. Her circumstances being independent, she has never pursued a laborious life, nor employed her right arm in any way calculated particularly to fatigue it. She has ever considered herself healthy and strong, except that intestinal worms have been to her for some years a source of much trouble. She states that from childhood, so far back as she can recollect, she thinks she had observed the veins of the effected arm and hand to have been larger and more swollen than those of the other; but having experienced from this no inconvenience, she never attached to it any importance. About a year and a half ago, she, for the first time, observed a throbbing to occur in the effected arm after exertion, or increased exercise of any kind. Somewhat about the same time, as well as she can recollect, she first felt a sharp stinging pain occasionally shooting down the arm, commencing, as she describes it, at the inferior angle of the scapula, and shooting through the arm to the hand. For some time she attached but little importance to these symptoms, the pain being but occasional and momentary, and the throbbing caused alone by exertion. Since then to the present time they have been gradually becoming more distressing; the occasional sharp stinging pain has been replaced by one constant, dull, and aching; while the throbbing and distressing sense of heat, which at first was brought on alone by excess of exercise, is now ever present, even while at rest. She can give no definite information as to the period of the first appearance, or the progress of the various tumours, but is of opinion that they have all formed within the last eighteen months. She has had much medical advice, having consulted several physicians, and having been for some time in hospital previously to coming into Steevens', but is of opinion that she has derived but little benefit from treatment.

For the sake of brevity, a detail of the daily treatment has been omitted, the more especially as it appeared to exercise but little control over the disease. It consisted for the most part, of general sedatives, with the local application of refrigerating lotions, and the occasional employment of pressure,-pressure generally of the entire

limb, and specially on the distinct tumours, varying its position and degree as appearance indicated. The latter part of this treatment required caution, as also a prolonged interval between the periods of its imployment; for, even when inconsiderable, it soon caused no slight augmentation of the patient's sufferings. Most relief appeared to be derived from cold applications to the limb.

At the expiration of somewhat more than two months, the patient, at her own request, left hospital, having apparently derived but little benefit from its treatment.--Dublin Quarterly Journal.

A Case of Enlargement of the Thyroid Gland, treated by Seton. By HENRY KENNEDY, M. B.-In November, 1845, a woman, aged 35, applied to me on account of an enlarged thyroid gland. She had been married nine years, and had four children; she has lived of late years in Dublin, and has always been healthy in every respect excepting the disease she applied about. The gland had begun to enlarge so far back as the year 1832, thirteen years before my seeing her. At first it had increased very slowly; but the last year or so, she said, it grew more rapidly. When I saw it the tumour was at least the size of the largest orange; it was very hard to the touch, as if it were solid, but was divided into two portions, of which that on the right side was much the largest; it did not vary in size at the menstrual periods. It was not, however, on account of the bulk of the tumour, for in that respect there was nothing remarkable, that the patient applied for relief, but because it had affected her swallowing from a very early stage of its growth; and this symptom had latterly become much more distressing: solids were more difficult to get down than fluids, as might be expected. She referred the obstruction to the seat of the tumour. She told me she had shown it to other medical men, but she considered it still increasing. I ascertained that iodine had lately been used, both internally and externally for some weeks.

Under all the circumstances of the case, the tumour and dysphagia on the increase, and iodine having got a full trial, I determined on some more decided line of treatment, the more readily as the patient herself was most anxious that something should be done. The plan by seton seemed to hold out the best prospect of success, and it was carried into effect, having previously brought the general health into the best condition. The first seton was passed on the 30th of November, 1845. A common curved needle of the largest size, with its eye nearly full of doubled silk thread, was passed from below directly upwards, through the anterior portion of the tumour, about half an inch from the middle line of the neck, and including a space of at least one inch and a quarter between the entrance and exit of the seton. This was then fixed so as to prevent its slipping out, and the patient was desired to keep a poultice constantly applied, and also to keep her bed for two days; no bad effects followed. It is enough to state here that this first seton was withdrawn in ten days; that at the end of a fortnight a second one was passed; that it was double the size of the first, and its introduction was followed by a very considerable de

gree of constitutional iritation, which, however, subsided in about four days; suppuration then became very fully established, and the second seton was withdrawn, after being in twelve days. With the exception of poulticing, nothing was done during the next four months. In this time considerable changes had taken place in all the anterior portion of the tumour, and that part of it which occupied the left side; it had become very hard, and gradually, but steadily, diminished in size. The larger portion of the tumour, however, occupying the right side of the neck, remained stationary. It appeared, indeed, as if it had grown somewhat larger; but this was not certain. A third and last seton was passed through this portion of the tumour in the month of April, 1846; its direction was upwards and outwards, so as to take in the longer axis of the swelling. This seton was four times larger than the previous one; it was passed with a large packing-needle, with the edges and point properly ground. After sixteen days the seton was withdrawn, the suppuration being then very considerable. Finally, after four months more, the entire tumour had so much lessened, that it might be considered as cured. The entire process occupied between eight and nine months.

At the present time (January, 1847), the eye cannot detect any tumour, but to the touch one remains, which is probably the size of a small chesnut. There is no deformity whatever, and very trifling marks of where the setons had been passed. The patient, too, feels no difficulty of swallowing, at least none that causes any inconvenience.

As I wish here to confine myself merely to the facts of this case, I have purposely omitted the consideration of several points which might fairly admit of discussion; such as the nature of the tumour; the question of a more general use of this plan, after the more ordinary means have failed, particularly iodine; the nature of the dysphagia, as to whether it was nervous or mechanical; the causes of those enlargements, and other points connected with the subject in a general way. It is to Quadri, of Naples that we are indebted for the plan of treatment put in force in the present case. Not being certain of what the result of the treatment would here be, I did not take the precaution of getting a cast of the tumour when it was of large size. This, probably, is of less consequence, as the patient has been seen by several gentlemen, to whom I may here refer. Dr. Clarke, of Herbert-street, saw her repeatedly; he took much interest in the case, and kindly gave me his assistance. At a late stage, and after all the setons were withdrawn, the patient was seen by several physicians and surgeons of this city.-Ibid.

Poisoning by Sulphuric Acid.-On Monday, Dec. 29th, 1845, a boy, aged 9, was admitted into the London Hospital, under Dr. Little, suffering from the effects of oil of vitriol. He was at play in the street, when a strange boy give him a teaspoonful of it to drink; he swallowed about an ounce of the acid, and was instantly seized with excruciating pains in his throat and stomach. He ran home, and,

according to his father's account, looked as if somebody had been smearing his lips with white paint. He was carried as quickly as possible to a neighbouring surgeon, who administered a great quantity of chalk and magnesia; five minutes, however, must have elapsed before anything was done. His father then brought him to the hospital, and he became very sick, throwing up a quantity of brownish matter, from which the chalk readily subsided, leaving a supernatant liquor, strongly resembling porter; it was chiefly mucous, charred by the sulphuric acid. He appeared to be suffering a great deal, the countenance was anxious and deadly pale, the extremities cold, and the pulse scarcely perceptible. Under active treatment he rallied, and in about seven hours fell into a quiet sleep; he passed a very comfortable night, and got out of bed twice to void his urine. In the morning, the countenance still looked anxious; he complained of pain in his throat and stomach, though it was not increased by pressure; the lips were swollen, and surrounded by reddish-brown scabs, the effects of the acid; the tongue also was covered with a pearlywhite epithelium, which had already begun to peel off from its sides, the skin was hot and dry; the pulse one hundred and thirty-two, hard and jerking. He was ordered albuminous food, and two leeches were applied over the top of the sternum. This febrile condition lasted for four days, the skin remaining hot and dry, and the pulse quick and jerking; during this time he was copiously salivated, and he spat up a great deal of white, shreddy epithelium; the urine was high coloured and increased in quantity, while the bowels remained obstinately constipated. On the fifth day an active purgative relieved them, and from that time he gradually got well. The urine which he voided during the first four days of his illness was submitted to chemical analysis. Its quantity was greater than natural; it had a deep red colour, a strong acid reaction, and a specific gravity varying from 1046 to 1030; it did not contain the least trace of albumen, but held so much of the triple phosphates in solution; that on neutralizing with ammonia they were thrown down in the form of a copious white precipitate. On testing for sulphuric acid, there was found, on the first day, a quantity equal to sixty-two grains of the strongest oil of vitriol; on the second day, forty grains; on the third day, 18.3 grains, and on the fourth the equivalent of 12.7 grains. The urine was not examined on the following day, but on the sixth it had again become natural. In all, therefore, 133 grains of monohydrated sulphuric acid were thus got rid of a quantity which is about equal to an ounce and three-quarters of the dilute acid of the London Pharmacopoeia.

The case offers the following peculiarities:

1. That he should have recovered after the poison had remained so long in the stomach.

2. Its detection in the urine shows that the acid had been absorbed. 3. Its action was almost entirely local, the only constitutional symptoms being a little fever with copious diuresis.