yearly are realised. It is very apparent that unless an alteration is made on one or the other side of the ledger each year will find the governing body in a worse plight than the last. In a town of the size and importance of Cardiff-the selfstyled Welsh metropolis-there should be very little difficulty in raising considerably more than the amount required to keep the full number of beds in constant use and it is anything but creditable to the townspeople that any curtailment should even be

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... ested. Instead of decreasing the number of beds available they should rather be added to, for even 180 are none too many for the district served, including as it does not only Cardiff borough, but Pontypridd and the Rhondda valleys with the intervening townshipsan aggregate population of over 400,000 persons. , is interesting as an example of a rare event-recovery from typhoid perforation of the intestine-and in the manner in which this result was brought about. The patient was a girl, aged 11 years, and the disease ran a rather severe course. On the twentythird day there were four haemorrhages from the bowels (about 24 ounces of blood were lost), increased tympanites, abdominal pain and tenderness on deep pressure, and slight rigidity of the recti muscles. These symptoms abated, but not entirely, until the twenty-sixth day, when the patient complained much of abdominal pain. The abdomen was moderately distended and slightly rigid; on deep pressure there was considerable pain which was not localised. At 10 A.M. the temperature had fallen from 1032° F. at 7 A.M. to 994°. At 1 P.M. the temperature rose to 101'4°. On the next day the tympanites was marked ; the lower border of liver dulness was in the nipple line one and a half inches above the costal margin. Pain was continuous and tenderness was great, especially above the umbilicus; there was considerable muscular rigidity. The temperature was 1028°, the pulse was 140, and the respirations were 32. Operation was decided on should the condition not speedily improve. On the following morning the child was better ; the temperature was 996°, the pulse was 95, distension and tenderness were much diminished, and pain was absent. Convalescence proceeded. On the thirty-fifth day a relapse, more severe than the first attack, began. On the thirty-ninth day (the fifth day of the relapse) seven ounces of blood were passed. Seven days later dull and continuous abdominal pain was again complained of. On the next day the tympanites was increased, but the liver dulness was unchanged. Tenderness was very marked, especially at a point just below and to the left of the umbilicus. There was decided muscular rigidity. Vomiting occurred once. The temperature was 103°, the pulse was 134, and the respirations were 56. It was thought that perforation if not present was imminent. At 4 P.M., three hours later, the temperature had fallen to 99'8°; it rose rapidly to 1034° at 7 P.M. Symptoms of perforation and peritonitis-collapse, vomiting, and great tympanites and rigidity-rapidly developed. Death occurred on the next day at 1 P.M. At the necropsy considerable gas and fluid were found in the abdominal cavity. There were much lymph and many recent adhesions. The great omentum was attached to the ileum, serving to close a small aperture in an ulcerated Peyer's patch which had evidently perforated some time before. Another perforation was found which permitted the escape of the intestinal contents. A similar case has been reported by Buhl.' A patient died from haemorrhage 1 Zeitschrift für Rationelle Medici 1857 Neue Folge, Band viii., S. 12 on the twenty-third day after symptoms of perforation. A piece of omentum was found adherent to and completely closing the opening. Cushing2 has emphasised the frequency of what he terms a "pre-perforative stage of ulceration," which he describes as I I a localised inflammation of the serosa leading to a slight adhesive peritonitis due to the near approach of an ulcer to the general peritoneal surface." The symptoms, according to Dr. Miller, are a gradual rather than sudden onset of continuous pain whicla is complained of by the patient himself, associated with more or less general or localised abdominal tenderness and often with slight muscular rigidity. Cushing states that there may be moderate leucocytosis. Vomiting and change of temperature are usually absent. The case described corroborates Cushing's views. There was almost continuous complaint of pain with tenderness on deep pressure and variable but slight rigidity for three days preceding the first perforation and for one and a half days preceding the second. Dr. Miller remarks that if there is a definite recognisable pre-perforative stage operations undertaken then will be more successful than later. But it seems to us that these operations would often be unnecessary quite independently of erroneous diagnoses which would be still more likely to be made than in cases with actual symptoms of perforation. More value is to be attached to his suggestion that the recognition of this stage would put the practitioner on the alert to enjoin greater qaiet ness and the cessation of bathing, and make him watchful for more pronounced symptoms. "HAY-CORYZA." THE Professor of Oto-rhinology in the University of Turin, Dr. Giuseppe Gradenigo, drew attention at a late meeting of the local Academy of Medicine to the increase of hay-fever, or, as he prefers to call it, " corizza da fieno "-an increase observable mainly among the well-to-do classes of Italy. The same phenomenon has also been noted and commented on by French physicians among the corresponding class of their compatriots. This fact would seem to point to hyper-alimentation (or "gout") as a concurrent cause of the malady-if not as its ca7isa cecsans. Be that as it may, Professor Gradenigo would define the coryza in question as "a sub-species of the spasmodic, vaso-motor coryzse which recognise two main etiological factors-an irritating agent in the interior of the nose (polypi, 'creste del setto'-excrescences of the septumand such like) or an agent imported from without (the pollen of certain flowering plants, the dust or detritus of great thoroughfares) coincident with an enhanced susceptibility of the nasal mucosa." The symptoms of the coryza he would classify in the following sequence: fits of sneezing, hyper-secretion of serum, turgidity and congestion of the nasal mucosa, sometimes of the conjunctivas and of the tracheal and bronchial mucosas. Passing in review the various remedies in more or less acceptance he finds none of them really efficacious and would counsel " allontaramento " (estrangement) from the irritating agent ; bland lotions of the nasal passages "con soluzione fisiologica," alternating with the use of inert fatty substances (these latter of themselves sometimes proving effective), while he would prohibit cauterisations of the mucosa or the repeated use of cocaine. The President of the Academy (Dr. Edoardo Perroncito, Professor of Parasitology in the University) asked Professor Gradenigo "if, in the exudations of the rhinitis in question he had found the corpuscles of the pollen of plants used for feeding cattle (piante foraggiere)." " No positive researches in this direction had yet been made," was the reply, "but, till then, the subject cannot