770 and gradually go worse, in spite ot etiloriuated, carbolised, and nitrate ot bliver washes III conjunction with sulphide of calcium internally, and the slough extended through the posteriornare-3 into the nasal chambers. The cervical buboes continued throughout, but did not suppurate. As deglutition became very painful, the child, who was always headstrong, refused to swallow, and was fed by enemata for five or six days before her death, which occurred on the twentieth day of the disease

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... m asthenia and blood-poisoning. It is well to remark that a couple of weeks previously to the fatal attack she was laid up with wh tt seemed to he the commencement of noma vulvæ, but which quickly yielded to an astringent carbolised wash. Ooe other case, at first similar to a great extent to this patient's, occurred, but finally the cervical buboes suppurated, were inched, and the little patient, after being in the jaws of death for a considerable time, recovered. These cases presented dimcultiea of diagnosis in the earlier stages, and would in all probability at first have been set down as mumps were it not that scarlatina was epidemic in the borough at the time and numbers of children were dying, after twelve or twenty-four hours' sickness, of the suppressed form of the disease. Moreover, the appearance of the patients, who seemed from the first vitally stricken, and the excessively high temperatuies, pointed to something more serious than mumps. With regard to suppressed scarlatin, I may remark that pilocarpine seemed of much service in some of these distressing cases. The external application of ammonia, I accidentally discovered, was an extremely useful agent for bringing out the rash and in producing a reaction. In one case—viz., that of a child, in whom, on being called to see, I found the lungs congested-I ordered ammonia liniment to be applied to the chest, and was surprised to discover next morning that it had relieved the congestion and brought out a well-defined scarlatinal rash on the chest, which within a few hours extended over the whole of the body. Afterwards I tried it in several cases with decided success. Finally, I may remark that but one patient came under notice suffering from diphtheria, and in that case the child returned from a friend's house with the disease well developed. A few weeks previously a child had died in the friend's house from membranous croup. Haslar. IN THE LANCET of July 1st, 1882, I wrote a short article entitled "A New Mode of Detecting Stone in the Bladderthe Auditory Method." It was there stated that vibrations produced in a sound by its contact with a calculus were readily conveyed to the ear by means of an indiarubber tube, one end of which was attached to the handle of the sound, while the other was held to the ear, the ordinary bladder-sound being converted by this means into a kind of stethoscope. Direct experiment on the dead subject proved that the larger the b)re of the tubin employed the better were the results. The largest bore of tubing thus used was three-eighths of an inch in diameter, which gave the greatest intensity. But the weight of a tube of that siz3 was an obstacle to the delicacy of touch. This difficulty has been overcome, however, by attaching smaller and lighter tubing in a manner to be described, which gives equal intensity, but without the drawbacks of the larger and heavier tubing. I had always fastened the tubing by slipping it over the handle of the sound if the tubing had a bore large enough, but if the tubing had a small bore it was slipped on to a little projection from the handle made for the purpose. But the method of attachment that carries the greatest intensity of sound is as follows :—A piece of indiarubber tubing about twenty-six to thirty inches long, with a small bore (three-sixteenths to one-eighth of an inch in diameter) is employed. About an inch from one of its ends it is folded on itself, and this part is then held tightly against the handle of the sound, as shown in Fig. -1 , care being taken that the long part ot the tuhe that goes ti) the ear hes next the handle. It can be retained in position by a small clamp, instead of being held by the fingers. By this dmpie means greater intensity of sound is couveyed than by a tube of much larger bore, attached by merely slipping it over the handle. It is probable that the intensity thus attained is due to the part of tbe tubing prf-ssed against the handle of the sound acting as a "drum." And by means of it the vibrations get transferred from the soond with little loss to the column of air within the tubing, and thence, of course, directly to the membrana tympani. To carry out this plau of fastening the tubing in a convenient manner I constructed a sound with a hollow cylindrical handle, open at the end like the mouth of a gun (see Fig. 1 ). The stem is of solid steel and nickel-plated, and does not differ from the short. beaked sounds now in use. The handle is two inches and a quarter long, and hollow, with a diameter of half an inch. Externally it has roughened longitudinal ridges, for convenience in manipulation. A smooth band along the anterior part indicates the position of the beak of the sound. This instrument can be used either as an ordinary sound or, when desired, tubing can be readily attached. A piece of small and light indiarubber tubing, about thirty inches long, is bent at one end, as before described, and the loop so formed is thrust into the tubular handle, as shown in Fig. 2 . The other end, fitted with an ivory or bone earpiece (such as is used with the otoscope), is put into the ear, where it should remain fixed without requiring to be held. If the tubing be of very small bore, then its end may have to he folded or coiled, as shown in Fig. 3 , in order that it may fit tightly into the hollow handle of the sound. It is always necessary that the part of the tubing that leaves the sound to go to the ear should be tightly pressed against the handle of the sound. A binaural arrangement can be easily made by taking a piece of tubing double the length (about four feet and a half or five feet long), folding this in the middle, and thrusting the loop at the bend into the tubular handle of the sound. The two free ends, armed as before with earpieces, are placed one in each ear. The note is thus intensified greatly, bat for all practical purposes the single tube is quite enough. However, with the binaural two persons can listen at the same time, and so verify the diagnosis with greater exactness. A convenient form of lithophone is shown in Fig. 5 . The same sound is employed as shown in Fig. 1 , but instead of a simple indiarubber tubp, one with a ball at one end is used. The bulb is egg-shaped, and barely exceeds half an inch in diameter at its widest part. It can be readily squeezed into the tubular handle, by folding the ball longitudinally and so introducing it into the handle, where it becomes tightly fixed by its own expansion. The other end is fitted with an earpiece. This instrument gives good results. The lithophone does not hamper the delicacy of touch in exploring the bladder. The tubing is light, and is attached in a manner which allows great freedom of movement. The exploration of the bladder is carried on by a combination of the senses of touch and hearing. A particle of saud weighing less than 1/500th of a grain lying on cotton-wool was detected by hearmg its con. tact with the lithophone. It could not be detected by touch alone when the tubing was detached. Of course this ex. treme delicacy is not required in the bladder, but it serves to show the sensitiveness of this auditory method. In ordinary