40 cold, and now pulse is quick and weak, and expectoration purulent. Physical signs : Dulness in right chest, chiefly upper parts, where some subcrepitus ; small tubular sounds below; tubular expiration above right scapula. Ordered a tonic containing nitro-hydrochloric acid, and counter-irritation with acetum cantharidis. July 20th, 1846.-Improved, and has continued in practice, but takes great care of his health. Still dulness in upper right chest, with mixture of tubular sounds and

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... s. June, 1867.-Has been living an easy life for several years in charge of an invalid. His breath has been always short, and more so of late years, as he has become stout, with more or less constant cough and wheezing. Physical signs : Dulness and cavernous sounds at right scapula ; tubular above left scapula; lower and anterior portions of the chest very wheezy, and clear on percussion (emphysema). T2vezzty-tzvo years have elapsed since this patient was first examined, and twenty-nine since the inflammation from which originated the disease in the lung. This was long ago arrested in its phthisical career, but the contraction of the cicatrices and consolidation around the cavities have produced emphysema in other parts of the lung, and the limited health and activity of an habitual asthmatic. June, 1868.-Heard lately of this patient's death from increasing dyspnœa, with œdema of the lower part of the body. (To be continued.) I THE comparative rarity of dislocation of the knee seems to justify the record of the following case. Practically it is of interest on account of the recovery of perfect use of the joint. On the 15th of last July, James W-, in the employment of the North British Railway Company, while endeavouring by means of an iron crowbar to put the brake upon one of two trucks, which were being prepared to run down an incline into the goods steamer, unfortunately allowed the bar to get between his legs, whereby he was at once thrown down when the trucks got in motion. He was lifted aside, and I saw him shortly after. He lay flat on his back, with both limbs fully extended. He complained of great pain in the right leg and knee, down to the toes. On examining the limb, I found that in front the knee had lost its natural shape, there being a depression below the patella, while behind the head of the tibia could be felt pressing backwards in the popliteal space. There was no rotation of the leg whatever. Everything was quite rigid about the joint, and no crepitus could be felt. In order I to effect reduction, while the thigh and pelvis were kept firm by an assistant, I grasped the leg, and made steady traction. After pulling for a little without reduction being effected, I was induced to flex the knee slightly, and, in doing so, I was speedily gratified by seeing the head of the tibia glide slowly forwards over the condyles of the femur, into position, showing thus very clearly the extent and nature of the injury. The patient was afterwards placed in bed, and the limb maintained at perfect rest. Considerable ecchymosis occurred, as evidenced by great swelling and discoloration of the skin on the posterior part of the joint. The joint itself at first remained free from any effusion ; but subsequently, when the swelling resulting from the bruise began to subside, a good deal of passire effusion occurred.