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rus on his voyage out. This fracture did not unite and consolidate in the usual time and manner. Having met with repeated accidents to the injured arm, he at last came to hospital with great swelling and unhealthy inflammation of the arm in proximity to the trunk. The case was treated by incisions, poultices, and tonic medicines, but death ensued in 28 days after admission. Operation was contra-indicated by great inflammation and extensive sloughing. On inspection the bony fragments were found to be carious and disunited. All the soft parts around the shoulder were gangrenous. It was believed that syphilitic taint was the hindrance to the healing process. The fifth case was that of a man who was thrown out of a cart on the road and sustained a severe fracture of the right parietal bone without depression. The patient never spoke after the accident, but passed into a comatose state, and died in four days after the injury. On dissection, the brain was found to have been lacerated.

Two cases of compound fracture of the leg were so serious as to demand amputation, primarily in one and secondarily in the other. The first was that of a boy, aged ten years, who was run over by a railway truck on which he had been riding, and a very ghastly compound fracture of the left leg was the result. The limb was immediately amputated below the knee by the circular incision. The case has turned out well.

The second case was that of a seaman, upon whom a heavy tub of coals, by mismanagement, fell from aloft on ship-board, fracturing the left leg simply, and wounding him on the head besides. The injured limb speedily became perfectly cold and insensible below the fracture, and in a few days mortified. The cause was subsequently ascertained to have been from injury to the arteries of the limb. By waiting for the line of demarcation, it was hoped that the knee might have been saved, but the attempt proving futile, on the eighteenth day from admission, amputation of the thigh was performed by circular incision above the knee. This patient has made a favourable recovery.

Dislocation — Under the head of dislocation is recorded the fatal case of a man who was admitted into hospital April 5th, 1861, from an injury of the right knee, received a considerable time previously, and for which he had been under treatment at Napier. He was under the necessity of wearing a leather case laced round the joint, to enable him to move about with the aid of crutches. He was also the subject of stricture for the cure of which Holt’s dilator was used with perfect success. He also suffered much from rheumatism. It was not expected that much could be done for the knee, but about eighteen months ago, owing to the persuasion of a lady visitor, he became exceedingly desirous to have the operation of amputation performed above the knee. His importunities were resisted until November last, when he peremptorily insisted to have his diseased limb removed. After the unfavourable features of his case had been placed before him in full detail, he declared his steadfast determination to be delivered from his bad knee, or perish in the attempt. Yielding to his solicitations and the desire of his friends, the right thigh was amputated above the knee, while the patient was under the influence of chloroform. The operation was completed satisfactorily, and for several hours afterwards no danger was apprehended, but after a slight haemorrhage on reaction taking place, convulsive rigors set in with much violence, and death ensued twenty hours after the operation. On examination the kidneys were found to be in a state of granular degeneration. The knee was found to have been primarily dislocated. The crucial ligaments ruptured and the inter-articular cartilages destroyed by ulceration. The head of the tibia was found carious.

Wound — Under this head is the fatal case of a man, who was accidentally shot in the head at the Great Barrier Island. The skull was shattered and the substance of the brain protruded through the fracture. He died in seven-and-a-half hours from admission.

Hernia — A case of strangulated inguinal hernia, of 57 hours standing, was admitted in a state of extreme exhaustion, with inverted peristaltic action and vomiting of the intestinal contents. In consultation, the operation was decided on as a forlorn hope, and was happily crowned with success, the patient returning to work in a few weeks.

Poison — Under poisoning is the fatal case of a man who swallowed a large dose of opium for the purpose of self-destruction. He was discovered to be in an insensible state and soon after was brought to hospital. After the employment of the stomach pump, and the usual treatment in similar cases, the patient seemed to rally considerably, returned rational answers, and took nourishment. But soon a relapse into a comatose condition took place, and death ensued 53 hours after admission.

General Debility — Three old men died whose ages averaged 73 years, and whose only home for many months had been the hospital. Of the 73 who remained at the end of last year, 1864, 23 are still in hospital, on 1st January, 1866. These may be regarded as permanent inmates. 13 have died, and 37 have been discharged. 102 patients remain at the end of 1865, of whom 7 are unlikely to survive long, of the rest the majority have a fair prospect, if not of cure at least of permanent relief. One of them is a man brought from Mauku, with an united fracture of the right thigh, sustained several months before admission. A variety of plans having been tried unsuccessfully.