780 three-quarters of an inch in length, and half an inch in width. This had become horizontally impacted, with its long diameter across the larynx, extending three-eighths of an inch into the right ventricle, and a quarter of an inch into the left. The patient was seen three days after the accident, and a portion of the bone was removed by the laryngeal forceps. Tracheotomy was performed about a week afterwards, owing to very urgent dyspnoea, and subsequently a fortnight after the accident,

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... Mackenzie passed a blunt hook under the bone with the aid of the laryngoscope. By this means he broke the bone in the centre, and so removed the separate pieces. Professor Tobold mentions a case which came under his treatment where a triangular piece of bone, of about the same size as that in my case, became wedged in the left ventricle, where the greater part of it was buried. Dr. Tobold removed it four days after the accident. The ends of the bone were driven deeply into the anterior and posterior walls of the larynx, so that it resisted all attempts at removal with the forceps. Dr. Tobold then bent a laryngeal probe into a blunt hook, and by this means, dislodging one end of the foreign body, the patient was enabled to cough it up. In my case the bone was more deeply situated than in the two cases quoted, the greater part of it being below the vocal cords. Judging from the fact that the dyspnooa was greatest during the first few days, while subsequently it ceased to be so distressing, it seems not improbable that the bone may have altered its position, and that by the strong inspiratory efforts of the patient it may have been sucked into the very centre of the glottis, where it eventually became so tightly fixed. Although this position of the bone, suspended above the trachea midway between the vocal cords, afforded a tolerably free passage for air, yet it caused its removal to be very difficult and not free from danger, as any rough manipulation might have moved it obliquely across the larynx, to the immediate suffocation of the patient. It would have been impracticable in my case to break or cut the bone, as was done with such good results in Dr. Maekenzie's, as, situated as it was, there was nothing to prevent the separated fragments from falling into the trachea. The hook, made out of a laryngeal probe, which I used, proved of assistance to me in moving the bone, and I consider it a valuable instrument in such cases. I had not read Dr. Tobold's case at the time, and I constructed it to meet an emergency, as he did. I see that he speaks highly of it in his paper. It is so delicate that it may be introduced into the narrowest parts, and by it a great amount of force may be exerted upon any portion of a foreign body one may choose, so as to loosen or dislodge either end of it, or so alter its relation to surrounding parts as to render its extraction more easy. In conclusion, I must revert to the good results I obtained from the medical treatment I employed to reduce the inflammation and swelling of the tissues. If I had not been able to effect this, I doubt if I could have removed the bone excepting by opening the trachea. Brook-street, Grosvenor-square. , aged thirty-two, fishermau by occupation, a native of Newfoundland, was received on board H M.S. Eclipse at Chateau, Labrador, on Sept. 30 h, 1876, in a prostrate and emaciated condition, suffering from the following symptoms of intestinal obstruction-namely, great anxiety of countenance; moist, clammy skin ; pulse 96, feeble; tongue coated by a dirty-white fur; frequent and continuous vomiting of stercoraceous matter; cutting and dragging pains in abdomen, and constipation. These symptoms commenced six days previously. On examination of the abdomen, which was somewhat distended and tympanitic, there was found to be a complete inguinal hernia on the left side descending into the scrotum, tense, elastic, and yielding; no irupulse on coughing; great pain and tenderness produced by manipulation. I placed the patient under chloroform, and tried taxis for five minutes, but with only partial and temporary disappearance of the hernia, probably into inguinal canal. An operation being imperative, and no medical relief being obtainable on shore, it was necessary to obtain the captain's sanction to his being treated on board, as the ship was under sailing orders ; this was granted. At 11 P.M., patient being placed under chloroform, I operated in the usual manner by an incision in the long axis of the hernia. On reaching the sac it was found to be gangrenous, being very friable and shreddy. Such being the state, I opened the sac, and disclosed a knuckle of small intestine about the size of a peach, elastic, claretcoloured, and glistening, evidently retaining its vitality. On inserting the finger, I found the constriction to exist at the internal ring (which was much dilated), consisting of some bands of recent adhesions binding the gut to the neck of the sac. These were readily broken up by the finger, allowing the gut to be returned to the abdomen. The edges of the wound were then drawn together by silk sutures, and dressed with weak carbolic acid lotion, and the whole confined by a compress and spica bandage. Slight venous hæmorrhage only accompanied the operation. Ordered two grains of opium, and two ounces of port wine. Oct. 1st.—8 A.M.: Passed a good night. No vomiting since operation. Aspect tranquil; skin moist and cool; pulse quiet. Expresses himself as easy, free from pain, and very hungry. Passed much flatus per anum. Ordered one grain of opium every six hours. Diet: Beef-tea and arrowroot.-7 P.M. : Has been sleeping during the day. Complains of aching pain at seat of wound, most intense with the bladder distended ; much relieved by micturition. 2nd.-Dozed a good deal during night. Pulse 76; temperature normal ; tongue clean. Is very hungry. Aspect brighter. Pain in bowels and seat of wound greater. Complains of desire, with inablity, to pass urine. Bandage and compress removed. A slight discharge of bloody serum on dressings; edges of wound contiguous, surrounded for about three-quarters of an inch by a reddish blush. Left testis retracted to pubes ; some tenderness along cord. Has slight cough, with muco-purulent expectoration. Lower suture removed to give free exit to discharge. Urine drawn off by catheter twice a day, giving great relief to pain in abdomen. Cough mixture ordered to be taken occasionally. Wound to be dressed with lint soaked in dilute Condy's lotion, and covered by a large linseed poultice. '