thing escaped his notice, and he frequently suggested little devices for his own comfort. On Saturday, January 23d, the third day after the accident, breathing became difficult from the accumulation of mucus. This was removed from tho throat and larynx by a pair of long placental forceps with cotton. Then nitro-glycerine, one-fiftieth of a grain, was given, which had a most marvellous effect in clearing the lungs with great rapidity. The administration of this drug was continued every three or

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... our hours up to the time of his death. Brandy and aromatic spirits of ammonia were also given from time to time. On Saturday afternoon dissolution seemed imminent, but the heroic determination of the patient to live until his mother arrived from the West, together with the happy effect of the nitro-glycerine, seemed to be the factors iu averting imminent death. On Sunday, January 24th, the fourth day after the accident, the temperature arose to 102°, the pulse to 96, and the respiration to 40. By trying to breathe as gently and quietly as possible he seemed to keep the collection of mucus at a minimum. He would sleep an hour or two at a time. Now and then for a moment he would be delirious. On Monday, the fifth day, the temperature went up to 104°in the afternoon, the respiration varied from 40 to 44, and the pulse from 98 to 112, and at times would become very weak. Death took place early Tuesday morning, the sixth day after the accident. An examination was made of the spine in the cervical region, nine or ten hours after death. Drs. W. T. Bull of New York, Symington of Santa Fé, New Mexico, Perry and Nute of Exeter, N. II., being present. The space between the atlas and atloid seemed to be unusually wide, but the ligaments were not torn. Neither did there appear to be any rupture of the various ligaments anywhere in the part of the spinal column examined. A fracture of the lamina of the fifth or sixth cervical vertebras was found, but no displacement. Neither was there a dislocation anywhere. Oil opening the spinal canal over the seat of fracture the dura was moderately injected and the spinal cord was found to be soft and diffluent. The bodies of the vertebra; were in place. If a dislocation or displacement occurred at the time of the accident it is probable that it immediately righted itself. The cord, however, was probably crushed and irretrievably damaged at the moment of the accident, remembering that the paralysis was immediate. In the light of the autopsy no operation could have accomplished anything, thus verifying Moullin's statement2 that "in cases of fracture by indirect violence, the operation of trephining offers little or no hope. It is probable that in the majority of cases the cord is only subjected to momentary compression, but yet it is so reduced to a pulp that recovery of function very rarely follows." Such a case as this, however, is a most trying and unpleasant one for the surgeon, for, as Dr. Gay remarked, his inclination is to attempt some operative interference, but his judgment opposes it. The length of time the patient survived such au injury is remarkable and unusual I think. Operation in case of injury of the spine has been recommended since the time of Ambrose Paré, and has been not infrequently done in suitable cases, not, however, with great success. General Ilosp. ; Demonstrator ofAnatomy, Harvard Med. School. Captain J. B., age sixty, of late lighthouse-keeper and formerly sailing-master, was sent to me in July, 1891, by Dr. MacKeen, of Cow Bay, C. B., on account of an abdominal tumor, probably renal. Several months before, be had stepped through a bole in the floor while going about in the dark, and struck heavily against a beam. He was unconscious for a few minutes and on coming to found that he was severely bruised in the left side just below the ribs. He was confined to his bed for a few days, and soon resumed his usual work. He first consulted Dr. MacKeen on Juno 20, 1891, on account of hypogastric pain and hematuria. The bladder was found to be distended with uriue and blood-clot. Considerable quantities of fresh blood and clots were passed for nine days when the urine became clear and has remained so ever since. When I examined him in July, I found him to be a man of about six feet in height, weighing about two hundred pounds, and the picture of health and strength. In the left of the abdomen could be felt a hard, quite movable mass, about the size of a cocoanut, filling that side to a point between the linea alba and linea semi-luna™. There was no tenderness on pressure and no suggestion of fluid. The position of the descending colon was not made out, though it would probably have been easily located had it been distended by air injection. Nothing abnormal was to be found in the other organs or in the uriue. Dr. Fitz examined the patient with me, and agreed with me that the mass was probably an enlarged kidney, which, even if cancerous, was so movable as to offer a good chance for its removal. The patient entered the Carney Hospital, and on July 22d I operated. On opening the abdomen through the left semilunaris I found the descending colon outside and somewhat behind tho tumor. A small cut was made through the peritoneum which covered it, and by stretching and tearing an opening of suflicient size was made for the removal of the mass, without damage to the large branches of the inferior uiesenteric vessels. Gauze pads packed into the abdominal cavity kept the intestines out of the field of operation and also prevented the blood from getting into the peritoneal cavity. The tumor was covered by a network of enormous veins that ruptured at the least violence, and it was necessary to work very rapidly in order to secure the renal vessels, the hemorrhage being tremendous. As soon as the vessels could be felt ami partially isolated a large clamp was placed on them and the ureter, tho 1 Itoad before tho Surgical Section of tho Suffolk Dlstriot Mrdioal Society, May I, 1892.