1288 which have the beneScn.1 effects mentioned on the mucous membrane of the alimentary canal, and their proportion is just sufficient not to impair the laxative action of the other salts. It is the bicarbonate of lime which seems most beneficial in this respect. To get this local effect on the stomach and intestines about a quarter of a tumblerful with warm water should be given twice a day, always on an empty stomach. -R.(,marks.-It is not claimed that there is anything very new in the

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... ing. The matter is referred to and these experiences are recorded because in my opinion a deeply rooted habit has in this instance been the means of obscuring an improved method of treating several minor but inconvenient ailments, and some more serious ones in their earlier stages. The advantages to be gained by the mineral water treatment over that by pills much more than counterbalance the convenience of carriage, which is the only one that can be urged for the latter; as a matter of fact, it is only on a few occasions that this can be allowed to have any weight. ON Monday, April 22nd, 1895, I was sent for to see a married woman aged twenty-five years, who was suffering from retention of urine, vomiting, and diarrhoea. The patient was in a condition of extreme emaciation and prostra tion, and obviously very ill. The tongue was slightly furred, the temperature normal, and the pulse-rate 110. The skin was moist, and she complained of cold, clammy sweats. The lungs were healthy. She stated that she was in the ninth month of her pregnancy and had already had three children, the last one having been born fourteen months before. During her previous labours, beyond the fact that they were tedious, nothing worthy of note had occurred. Since the birth of her last child she had not been in good health and had suffered at intervals for the last three months from attacks of vomiting and diarrhoea with colicky pains. She also complained of having partial loss of power in the lower limbs and of suffering from what she described as "sciatic pains " in her legs. The paresis had been first noticed about four months previously, but she had been suffering from the pains in her legs for about eight months. For some days she had had great difficulty in micturition, and during the previous twenty-four hours had been unable to pass any urine. On passing a catheter about two pints of reddish-brown urine, which was highly alkaline and of an offensive odour, were drawn off. She had had some slight difficulty in micturating for the last six weeks, having had to " strain" very much each time urine was passed ; but it had only been within the last week that the difficulty had become very great. The patient's health had been very good previously to her marriage, but since the birth of her first child she had always been ailing. The family history was good. On inspection the abdomen was seen to be of a peculiar shape and elongated in a transverse direction, and on palpation the foetal head was found occupying the left iliac fossa, whilst the body of the child lay almost transversely across the uterus. Per vaginam I found a non-fluctuating, uniformly hard mass lying just within the vulva. This mass occupied the whole cavity of the pelvis, and it was only with difficulty that the finger could be passed between it and the symphysis pubis. The posterior vaginal wall could be traced from the .perineum up, in front of the mass. Per rectum the tumour was felt lying behind the rectum and firmly adherent to the sacrum. On April 24th, as labour pains had commenced in the evening, Dr. Ainsley was called in consultation, and on examining per vaginam under chloroform the os was found to be dilated to about the size of half-a-crown. Cassarean section was determined upon, and the patient was advised to go into the Hartlepools Hospital. She was admitted to the hospital at 3 A.M. on Thursday morning under Dr. Ainsley's care, when she was found to be in a very unfavourable condition for operation, but as the pains were strong and increasing no time was lost in making preparation. The abdomen was rapidly purified, a drachm and a half of liquid extract of ergot were given by the mouth, a n I five minims of liquor strychnise I were injected subcutaneously. Chloroform was administered and the abdomen opened by the usual incision, six inches long, from above and to the left of the umbilicus to two inches above the symphysis pubis. The abdomen round the uterus having been packed with sponges, an incision about five inches in length was carefully made into the uterine wall, Dr. Macgregor, the house surgeon, pressing on the flanks and sides of the abdomen and pushing the uterus up against the wound and sponges. A slight gush of blood showed that the placenta was beneath the incision. A finger was pushed between the placenta and the uterine wall, and on it the tissue was divided by scissors to its full extent of five inches. A hand was then passed through the placenta and membranes, a foot seized, and the fcotus rapidly extracted and handed to an assistant for him to deal with. The placenta and membranes were swept out, and the uterus was grasped firmly between two sponges, little blood having been lost. The uterine walls were attenuated and flabby, and this, with the absence of contraction, led us to discard the idea of leaving the uterus in sit1t. Dr. Ainsley therefore applied a whipcord ligature low down, put on a Keith's clamp, and cut off the body three-quarters of an inch above the clamp. As an extra precaution the ovarian and uterine arteries were ligatured. The abdomen was sponged out, the stump placed in the lower angle of the incision, and the peritoneum arranged round it. The abdominal wound was sutured and the stump dressed with iodoform and boracic acid. The patient was put to bed in a collapsed condition. A nutrient enema was given and liquor strychnine injected subcutaneously. The patient never rallied, however, but died four hours after the operation. 'C7'v.—Permission was only obtained to look at the tumour. It was found, as had been diagnosed, growing from, and firmly attached to, the front of the body of the sacrum, between the periosteum and the bone. It was rounded and almost the size of a foetal head. The space between the tumour and the symphysis pubis would scarcely admit a finger, and this small space contained the rectum and vagina, the bladder being pushed up above the pelvic brim. The tumour consisted of a thick, firm outer portion forming a capsule, within which was contained softer matter of brainlike consistence. A microscopic examination showed the tumour to be a small spindle-celled sarcoma. -RMfM'.—There was no possibility of removing the tumour and curing the patient, and next to no chance of her surviving abdominal section; but for the sake of the foetus, and because of the axiom in midwifery "that no woman should die undelivered." " the operation was undertaken. That the patient was delivered of a living child in the natural way fourteen months previously showed extremely rapid growth of the tumour, and it is probably well for the infant, who is strong and healthy, that the mother's condition was not recognised earlier. Hartlepool ________________ THE following description of two cases which have come under my notice is worthy of record on account both of the fact that few uncomplicated cases have hitherto been recorded and also of certain instructive symptoms and pathological conditions which were observed. The patients whose cases I describe were seen in private practice, so that it was possible for me to obtain a post-mortem examination in only one instance. CASE I.-A man aged thirty-five had been in fairly good health for twelve months previous to the attack. There was no history of syphilis, nor could I find anything prejudicial in the family history. He had had no previous paralytic symptoms, no muscular atrophy, and no signs indicating relationship to amyotrophic lateral sclerosis, during the course of which diseases the lesion may occur. There was no history of rheumatism and there were no signs of endocarditis. In following his trade he was exposed to cold and damp. The attack came on with great suddenness and with no prodromata of any kind, with the exception of slight headache during the day. I saw him an hour after the attack and found paralysis of the lips, tongue, and jaw,