The introduction of the nurse practitioner grade to provide continuity in patient care including at weekends has been confirmed to improve patient outcomes including survival after cardiac surgery.

Careful identification of patients suitable for discharge with a portable suction device achieved a significant cost-saving and freed hospital beds, thus allowing increased surgical activity. Patients were also able to be cared for within their home environment and maintain their quality of life.

Politzer's bag, which failed to improve the hearing) used were a gargle and nasal wash of weak salt-and-water, together with the induced current used daily as above described. At the beginning of this treatment the hearing distance was rather under two inches on the right side for a watch heard normally at thirty inches, and the tick was only audible to the left ear when the watch was almost in contact. After three days the hearing improved very considerably, and the patient could hear the same watch at three inches and a quarter from the right ear and one inch and a quarter from the left. A rather interesting point in the case of a gentleman who suffered from exacerbations of chronic deafness after fatigue &c., was that whereas before the application of the electric current he was quite unable to hear the vibrating tuning-fork by boneconduction, immediately afterwards it was distinctly audible for a few seconds. Edinburgh. ACUTE INTESTINAL OBSTRUCTION CAUSED BY IMPACTED GALLSTONE .

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834vagus, stopping for some half hour or more at the pulmonary plexuses, and then following the pneumogastric through the diaphragm to the stomach, causing in the first place a flow of mucus, and secondly vomiting. C, The anatomy is more difficult. The auricular branch of the pneumogastric nerve supplies, so far as is at present known, the skin on the baalc of the ear, whilst the skin of the external auditory canal is supplied by the auriculo-temporal branch from the third division of the fifth, this being proved not only by dissection, but also, as Mr. Hilton points out in his lectures on Rest and Pain, " by the frequency of earache accompanying toothache and malignant disease of the tongue, and by stiffness of the jaws (the muscles of mastication being supplied by motor branches from the third division of the fifth) accompanying earache, &c. Now, I am not aware that anatomists describe any communication between the two nerves in question-viz., the auricular branch of the pneumogastric and the auriculotemporal of the fifth, but I think this case goes a long way to prove that communications between them really do exist, and if so almost certainly at their peripheral distribution. At any rate, the facts are most interesting, and have an important practical bearing, which ought not to be overlooked. Twickenham. INJURY TO THE SKULL. (Under the care of Dr. SOUTHEY.) Nulla autem est alia pro certo noscendi via, nisi quamplurimas et morborum et dissectionum historias, turn aliorum, turn proprias collectas habere, et inter se comparare.-Moa4scxi De Sed. et Caul. Morb.,lib. iv. Proaemium.THE following is the second case of the interesting series we began last week (page 796). CASE 2. Fall on the baclo of the head, followed four months after by eerebral symptoms.; death. -John A-, aged sixteen, a fairly nourished, but pale, lymphatic lad, with a vacant, half-imbecile expression, was taken to the hospital by his mother on July 10th last. He cried and sobbed in a frightened, child-like manner, and seemed intellectually degraded. His skin felt hot, dry, and desquamating ; his tongue was moist and a little furred; pulse 108, regular, and small; respiration about 20. The temperature would be normal or below normal in the morning, but suddenly rise to 102° between 2 and 8 P.M. He walked upstairs, but stood like a person weak in his knees, and with his legs somewhat wide apart. He required help to undress himself, but not because of any special paralysis. The only muscle in which any impairment of power could be discovered was the external rectus of the left eye. After he was in bed he assumed the crouching attitude, lying habitually on his left side, with his knees drawn up and his hands between his thighs, as if always feeling cold.The physical examination of the heart, lungs, and abdominal organs elicited no facts indicative of disease.The patient had enjoyed perfect health, and intellectually had been equal to boys of his own age, up to Christmas last (1878-79), when, while sliding on the ice, he had fallen down and s...