the carotid artery and internal jugular. This irritation of the trunk of a nerve, in accordance with the usual law, is felt at its peripheral distribution; hence the thoracic and abdominal pains and nausea. How shall we explain the occurrence of neuralgia in the distribution of the fifth pair and the disturbance in function of the nerves of special sensation; impressions may be transmitted back to the nerve centre and fron. thence reflected to other nerves. In this case the impression upon the pneumogastric is also transmitted to the nerve centre, reflected and distributed throughout the fifth nerve. But the trifacial is not the only nerve involved. The impairment of the functions of the auditory, olfactory and optic nerves, must be undoubtedly accounted for by the same general law of reflex action.

2. The tumour may involve the branches of the descendens noni, which anastomose freely over the sheath of the vessels. If this be the correct view, the nervous phenomena are all of a reflex character.

The first is probably the true explanation.

Treatment.-Under either of these theories the true method of treat ment consists in the removal of the tumour, the cause of the irritation With this view a succession of blisters will be applied over the tumour and the blistered surface dressed with the compound ointment of iodine To relieve constipation an active cathartic is administered.

Subsequent Progress of the case.-The size of the tumour diminished the sensation of vomiting and nausea ceased gradually. As the tumor disappeared the functions of the enumerated nerves of special sensation were again fully established without any special medication, nor were any medicines given for the relief of neuralgia. All the symptoms the patient presented and from which she suffered for two years, disappeared, as soon as the neck was reduced to its normal bulk. This case illus trates beautifully the ordinary law of transmission and reflex action.

AMPUTATION, DISARTICULATION AND RESECTION STATISTICS OF THE CONFEDERATE STATES ARMY.

Amputations of the thigh, whole number, 507; primary, 345; rece vered, 213; died, 132; 38 per cent. Secondary, 162; recovered, 43, died, 119; 73 per cent.

Amputations of the leg, whole number, 464; primary, 314; recovered, 219; died, 95; 30 per cent. Secondary, 150; recovered, 76; died, 74; 49 per cent.

Amputations of the arm, whole number, 434; primary, 294; rec vered, 252; died, 42; 14 per cent. Secondary, 140; recovered, 87 died, 53; 37 per cent.

Amputations of the fore-arm, whole number, 114; primary, 69; recovered, 61; died, 8; 12 per cent. Secondary, 45; recovered, 35 ; died, 10; 22 per cent.

Disarticulations, whole number, 135; primary, shoulder-joint, 79; recovered, 54; died, 25; 31 per cent. Primary, elbow-joint, 4; recovered, 3; died, 1. Primary, wrist-joint, 7; recovered, 5; died 2; Primary, hip-joint, 3; recovered, 1; died, 2. Primary, knee-joint, 5; recovered, 2; died, 3. Secondary, shoulder-joint, 28; recovered, 8; died, 20; 71 per cent. Secondary, elbow-joint, 3; recovered, 3; died, 1. Secondary, knee-joint, 6; died, 6.

Resections, whole number, 130; primary, shoulder-joint, 41; recovered, 28; died, 13; 27 per cent. Primary, elbow-joint, 25; recovered, 22; died, 3. Primary, wrist-joint, 2; recovered, 2. Primary, kneejoint, 2; died, 2. Secondary, shoulder-joint, 26; recovered, 19; died, 7 21 per cent. Secondary, elbow-joint, 29; recovered, 23; died, 6; Secondary, wrist-joint, 1; recovered, 1. Secondary, hip-joint, 2; rece. vered, 1; died, 1.

Amputations of the foot; primary-Chopart's, 16; recovered, 13; died, 3; Symes's, 2 ; recovered, 2; Pirogoff's, 4; recovered, 2; died, 2. Secondary-Chopart's, 8; recovered, 7; died, 1; Symes's, 4; recovered, 4 (1 unsuccessful, requiring subsequent amputation above the anklejoint).

A vast number of additional operations are received, but without positive results, and therefore they have not been included in the above list.

We may well be satisfied with the results of these statistics, which, carefully excluding all doubtful cases, are compiled from those operations only that have reached a positive conclusion. A general summary of the above table shows that the mortality after 1,814 operations, including amputations, resections and disarticulations, amounted to 632, giving a death ratio of 34 per cent.

The only statistics on this subject from the Federal army we find in the United States Army and Naval Journal for November, 1863, which gives the amputation statistics for September, October, November and December, 1862, as follows:-Whole number, 1,342; deducting 516 under treatment January 1, 1863, 826. Of this number, 336 died; a mortality of 40 per cent.

The journal to which we owe the above observation gives the following table-Whole number, 1,342; returned to duty, 100; furloughed, 25; deserted, 11; discharged, 350; died, 336; secondary operation, 34; under treatment January 1, 1863, 516.-Richmond Medical Journal, and Confederate States Medical and Surgical Journal.

HOSPITAL NOTES AND GLEANINGS.

Primary and Secondary Syphilitic Sores on the Eyelids.-It is very rare to meet with a primary syphilitic sore on the eyelid, though secondary ulcers are not unfrequently seen. In the first of the following cases there can be no doubt that the sore on the upper eyelid was a chancre. How inoculation could have been affected it is difficult to conjecture; but the combined facts of its syphilitic appearance, its indurated base, the enlarged gland behind the ear, the eruption over the body, and the rapid manner in which it healed under the influence of mercury, establish beyond a doubt its syphilitic nature.

Secondary sores on the eyelid are often difficult of diagnosis, as in many cases they closely resemble epithelial ulcers; but in cases of doubt a week or ten days' treatment with anti-syphilitic remedies will usually decide their true origin. A syphilitic sore generally commences close to the tarsal edge of the lid, which it partially destroys, leaving a notch which is somewhat characteristic. It will heal at the point where it first commenced, whilst it extends in the opposite direction; whereas in the epithelial sore there is no real repair of the ulcerated surface; it may scab overin one part, and become dry; but a reformation of healthy tissue seldom takes place. The previous history is a very material guide; but syphilis is so often vehemently denied by patients who have suffered from it, that reliance cannot always be placed on their statements with regard to it. The four following cases are good and instructive examples of this form of malady:

CASE 1. Primary syphilitic sore on the upper eyelid of an infant, followed by a secondary eruption over the body.-J. F, aged one year and ten months, came under observation on January 24th of this year, on account of a troublesome sore on the upper eyelid of the left eye, which showed no disposition to heal. The mother stated that it commenced a fortnight before Christmas as a pimple on the upper eyelid, The child scratched it, and

at the inner side, and near its tarsal edge.

it became a sore, which has increased to its present size.

Present state. There is a large, somewhat oval-shaped sore, rather more than half an inch in length, and about a quarter of an inch in depth, extending into the tarsal edge of the lid, which has been partially destroyed and presents a sharp notch. The edges of the ulcer are indurated, and its surface is glazed. The mucous membrane of the upper lid is oedematous, and discharges mucco-purulent secretion. There is an enlarged gland behind the ear, and the whole of the body of the child is covered with roseola. The child appeared very feeble, and much out of

health. It was more than five weeks since the ulcer first appeared, and, although local application, had been used, not the slightest benefit had been derived. Ordered a grain of mercury with chalk night and morning, and dilute citrine ointment to the ulcer.

This treatment was continued until the 7th of February, when she was ordered to omit the powder in the morning, but to take one every night. The wound now speedily assumed a healthy action and began to cicatrize.

On Feb. 14th the sore on the eyelid was quite well, the rash over the body had entirely disappeared, and the child was much better in health and had grown much fatter.

Under the subsequent use of the syrup of iodide of iron, the child on the of March was quite well, but was ordered to be brought to the hospital from time to time, to be under observation.

CASE 2. Secondary syphilitic sore on the upper eyelid.--Chas. T aged 49, admitted Nov. 22d, 1859, suffering from an ulcer on the upper eyelid at the inner part, and involving its free border. The sore was irregular in outline and somewhat oval in shape, healing in one point. and extending itself at another. It commenced at the tarsal edge, at the point which now exhibits a deep notch. He states that he has never had syphilis, but the mucous membrane of his tongue is thickened and rugose, and presents all the appearance of syphilitic tongue. He was ordered iodide of potassium thrice a day, with Plummer's pill every other night, and to apply dilute citrine ointment to the sore.

By the 18th of December the wound was quite healed.

CASE 3. Secondary syphilitic ulcer involving the inner angle of the eyelids.-Sarah P-, aged twenty-three, married three years, applied at the hospital July 31st, 1860, on account of a large sore near the inner angle of the eye, which was encroaching upon the margin of both the upper and lower eyelids, close upon the caruncle.

Present state. The ulcer is larger than a sixpenny-piece, but irregular in outline. Its edges are inflamed and thickened. It has an unhealthy appearance, and although a portion of it has healed at its lower border, in the opposite direction it is extending itself upon the eyelids. She says she has never had syphilis; but she has lost the bridge of her nose, and is now suffering from a fetid discharge of the nostrils which she has had for the last six years. She has great hoarseness which came on about eighteen months ago, and has continued ever since.

Under the same treatment as in Case 2, the wound rapidly healed. CASE 4. Secondary syphilitic ulcer on the upper eyelid of four month duration.-George Acme to the hospital on Dec. 18th, 1860, with

oval-shaped ulcer of the upper eyelid, involving the tarsal edge of the cartilage, and extending upwards on to the integument of the lid. Around the margin of the sore there was considerable thickening, and the surface of it had a glazed appearance. He had suffered from it for four months. On Jan. 15th, 1861, the sore was quite healed under the same plan of treatment as in the two previous cases.-Lancet, May 6, 1865.

SUBCUTANEOUS LACERATION OF THE URETHRA IN ACTU COITIONIS. FOLLOWED BY HEMORRHAGE AND EXTENSIVE ECCHYMOSIS. EVENTUATING IN URINARY FISTULA.

By Louis BAUER, M. D., of Brooklyn, N. Y.

Surgical writers advert to lacerations of the fibrous sheath of the cavernous bodies of the penis, but I have not been able to ferret out a precedent case of the one which has lately come under my charge.

The patient, some thirty years of age, had, at about 7 o'clock in the evening, attempted several intercourses, when, on a sudden, he felt intense pain in his penis, which disqualified him to consummate the act. On examining himself, he found blood pouring forth from the urethra. His penis became immediately enlarged, and, with the adjoining integument. discoloured.

I saw the patient at one o'clock that night. He was very pallid and cold, and felt so exhausted from the loss of blood as to need copious stimu lants. Penis, scrotum, perinæum, and inguinal regions deep-blue from extravasation of blood, and the integuments of the penis so much distended as to give the virile member a monstrous size. The prepuce, more especially, was almost raised to a blister, as we may find in dropsy, if not more so. At the junction of the penis with the scrotum, there was a circumscribed collection of blood, which, on pressure, would be discharged into the urethra. In addition to this, there was retention of urine.

To all appearance, the patient had sustained a transverse laceration of the floor of the urethra, about three and a half inches from its aperture.

The extravasated blood had partly diffused in the connective tissue, partly collected in a space below the wound, from whence the hemorrhage had taken its course through the urethra. Subsequently, the blood had in a measure coagulated and given rise to the circumscribed distension.

The insertion of the catheter was imperatively demanded, 1st, to relieve the bladder, and 2d, to prevent the urine from coming in contact with the wound of the urethra, thus causing urinary infiltration. For this purpose, the catheter should remain in situ. The execution was, however,