589 from the loop that presented in the wound and, passing the intestine through the fingers just within the wound in lengths of about three inches, returning one portion before the next was brought into view. Before three feet of intestine had been thus examined Mr. Marsh found that the part he was approaching was fixed so that it could not be drawn forwards. On following this portion a band of the size of a No. 4 catheter, apparently connected with the mesentery and tightly constricting the

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... t, was reached. Before it could be exposed, however, it gave way. The intestine was now quite free, and when drawn forwards it presented upon its wall, just where the distended and the constricted segments met, a round cord-like band of the size mentioned above, about two inches long and apparently consisting of soft fibrous tissue, as if an inflammatory adhesion had become organised. The band was ligatured close to the intestine and removed. No further obstruction could be found ; and as the bowel, though deeply marked by the constriction, was not ulcerated, it was returned and the abdominal cavity was irrigated with iodine water (1 in 500 of the tincture in water, at a temperature of 95°) and the wound closed. The symptoms of obstruction at once disappeared, sickness ceased, flatus was freely passed, and the bowels acted naturally on the following day (Oct. 31st). On Nov. lst a large evacuation was passed. The wound healed by primary union. Nutritive enemata were given and the boy was allowed for the first forty-eight hours to swallow nothing but water in teaspoonful doses every two hours. He complained of severe thirst, and I on Nov. 2nd, seventy-two hours after the operation and during the momentary absence of the nurse from the room, I he got out of bed, climbed over the next bed and drank a tumblerful of water belonging to another boy, and was rapidly making his way back when the nurse returned. This exploit was fortunately not followed by any bad result, and a fortnight later he went to his home in the country. -Remarks by Mr. HOWARD MARSH.-In this case there are two points of some interest : 1. The gradual manner in which the symptoms were developed, and the time, five days, which elapsed before they were pronounced enough to call for operative interference were features but very seldom met with in obstruction of the small intestine by a band. Usually the symptoms are acute and of rapidly increasing severity, but up to the middle of the fifth day this patient looked as if he ailed very little, and the occurrence of faecal vomiting was somewhat of a surprise to those who were watching the case. The explanation no doubt was that as the band was a long one complete obstruction was only slowly produced. 2. The relief afforded by the division of the band was immediate and entire; the bowels acted spontaneously in a few hours, and the boy, as the result showed, was practically well as soon as the operation was completed. The laparotomy was of the simplest kind, and was as well borne as an operation for harelip. HOPE HOSPITAL, WARRINGTON. A CASE has recently come under the care of Mr. Gornall which, while presenting features of difficulty in diagnosis, has, at the same time, afforded an excellent opportunity of putting to the test the opinion which was formed as to its real character. A fine healthy girl, four years old, was notified as suffering from small-pox and admitted into the Hope Hospital at Warrington on Jan. 7th. The facts as to the previous history of the illness, which were known at the time, were not sufficient to warrant action upon the doubts which were entertained, while the condition found on examining her afforded an additional reason for detaining her. It may be said that there is no isolation ward for dubious cases. No cicatrices of vaccination could be found, and it was gatherec that her parents were opposed to the practice and lived in one of the great centres of the antivaccination movement, from which place the child had recently come to stay with some relatives in Warrington. The spots had been out several days, and had been preceded by considerable constitutional disturbance, in connexion with which pain in the back and chest was described. On admission to hospital tie child appeared not to be in any way ill ; her temperature was normal; her appetite, though slightly impaired through soreness of the throat, became in a day or two excellent ; she had on the forehead the dried scabs of three pocks and a few on the scalp in a similar state, while on the body there was a considerable eruption. This consisted of about fourteen spots on the front of the body and thirty on the back ; the limbs were entirely free from them. The pocks, which wer e in the suppurative stage, presented a red inflammatory areola surmounted by, in the great majority of cases, a flat vesicle having a most typical umbilication, and could in no way be distinguished from small-pox; in a few there was a more acuminate form. Examination of the throat revealed nothing more than slight erythema. The case was undoubtedly a suspicious one, though its mildness was quite opposed to Mr. Gornall's experience of small-pox in unvaccinated children, and after further consideration it was determined to vaccinate the patient. This was done with calf lymph by four insertions on the left arm thirty-six hours after admission, and two days afterwards again by one insertion on the right arm. The result was the development of typical vaccinia (the less marked, of course, in the case of the latter insertion) which has run a protracted and somewhat severe course, though the child has remained all along, except for the temporary constitutional disturbance caused by this, in