that time he has been in the habit of ausculting very frequently during the progress of the labor.

Dr. Forrester, under the circumstances, did not believe the labor could have been hastened by version or the forceps, to the benefit of the child. Does not, however, believe that the opportunity for deriving advantage from version had passed because the membranes had been ruptured, and the waters, or more probably only a part of them, had escaped, for the most favorable time for version is immediately after rupture. Both version and delivery by forceps would have required too much time to be of

service.

Does think, however, that Dr. Hornor should have tried to reduce the prolapsed cord by the postural method of treatment as recommended by Dr. Thomas, in spite of the fact that the expulsive efforts were active and forcible. During the intervals of the pains it is probable that the presenting head would have been drawn out of superior strait sufficiently, when the woman was placed on her breast and knees, especially as the escape of a part or all of the waters had left additional space in the abdominal as well as uterine cavity. Had a tendency to reprolapse shown itself, this could have been prevented by pressing moderately through the abdominal walls upon the fundus of the uterus, this causing the presenting part to completely fill the os uteri until forced into the excavation. He could not agree with Dr. Hornor that when the small loop of cord has once left uterine cavity it can not be returned into it, because there is no longer room for it. We all know how frequently the whole head and a great part of the forearm are introduced into the uterus. Are not they many times larger than the prolapsed loop?

It seemed to him that in some cases advantage might be gained by making a posterior inclined plane, by elevating the hips, the woman remaining on her back.

GLEANINGS FROM THE RECENT TRANSACTIONS OF THE LOUISVILLE MEDICO-CHIRURGICAL SOCIETY.

Prevailing Diseases.-Committee is not aware of any disease

prevailing in an epidemic form since last meeting. Dr. Thruston reported the prevalence of ophthalmia neonatorum in his practice. These cases were treated and promptly arrested by him, by the use of cupri. sulph. Dr. Thruston made use of the copper crystal as a stick, washing the eye before and after the operation with luke warm water by means of a syringe. Other members had derived benefit from use of argt. nitrat gr. j.

The use of warm milk, True pus in the atmos

aq. 3., first washing away the secretion. as a palliative, was recommended. phere, in wards where the disease was epidemic, was alluded to. The assertion which had been made by some oculists that the disease was the result of specific disease in the parents in all cases was generally discarded by the members.

Skin Diseases.-Dr. Octerlony reported a case of rupa simplex non-syphilitic. Two months subsequent to the eruption, patient was seized with tertian ague, upon the occurrence of which the whole lower extremities occupied before by the eruption became the seat of erysipelas. A solution of benzoic acid gr. x., vel. xx., ad. aqua. Oss., was recommended to relieve the itching of certain skin diseases, especially useful in chronic urticaria. In a case of secondary syphilis presented by Dr. Brandeis-the primary disease was treated by hypodermic injection of corrosive sublimate. The suffering sustained by the patient after these injections was intense, the disfiguration following the operation was great and permanent, and the security against secondary symptoms nothing. Dr. Octerlony treated eczema with ungt. plumbi iodidi, sometimes adding a little chloroform to relieve itching; cases recently under this treatment were chronic cases and attended with induration.

In a case of measles, during the eruptive stage, a slight cooing sound suddenly became audible over the heart, the sound was systolic, and has existed in the patient ever since. It could not have existed before, as a daily examination of chest was made to detect pulmonary symptoms from the commencement of the disease. Dr. Octerlony thought measles should be enumerated among the causes of endocarditis.

Surgery. An aneurism of the popliteal artery had caused such destruction of the surrounding bony structures as to render amputation necessary. The tumour, which was the size of a large orange, was situated between the artery and head of the tibia, the popliteal over-riding the tumour. The knee was greatly swollen and discolored; an external opening also existed in the soft parts. The patient was emaciated almost to the last degree-amputation was performed in the middle third of the thigh, and from this time the the patient gained in health and flesh to an extent quite incredible.

Pathology.-Dr. Gaillard alluded to the fact that two years ago a rare case occurred in the practice of Dr. Brandeis, of this city, in which a perfect cast of the bladder was removed, the specimen being now in the museum of one of the colleges of this city. The cast was fibrous in structure and thickly studded with triplephosphates. Dr. Gaillard had recently noticed the report of another similar case, the specimen being now in the British Medical Museum. The patient thus afflicted fell, receiving a blow upon the spine; retention of urine followed, and this was relieved by the catheter for several days, after which in an attempt to again introduce the catheter, the instrument met with some obstruction in the bladder, and the patient could not be relieved; he died, and a post mortem examination revealed a cast of the mucous coat which was fibrous in structure and flocculent on one side.

Dr. Gaillard verbally reported a case of empyema which he had been asked by Dr. Holloway to examine. The patient (male) was about forty-five years of age; an Irishman. He had been treated by several physicians for phthisis pulmonalis. Dr. Holloway had detected when the patient passed into his hands hydrothorax, and the patient had been relieved by the usual operation for paracentesis.* Several weeks after this operation. he was closely examined by Dr. Holloway and himself. The

*This occurred early in January, 1871, the amount of serous fluid removed being eleven quarts.—ED.

left portion of the thorax presented almost the barrel shape of pulmonary emphysema. There was bulging of the intercostal spaces; the apex-beat of the heart was very near a line dropped vertically from the right nipple. The pulse was frequent (about 100 to the minute), small, intermittent, and irregular. There was a tumor-shaped projection over the epigastrium, and this whole mass vibrated at each systole of the heart. This pulsation was evident to the eye, and communicated a marked impulse to the hand under palpation. It was a sensitive, pulsatile tumor, below the line of the diaphragm; but under auscultation no bruit was detected. Deprivation of food and drink, with free purgation, produced no change in the appearance or behavior of this tumor. There was entire flatness over the whole lower lobe of the left lung, and over this region there was no vesicular murmur, and very slight tubular respiration. Over the upper lobe of the left lung there was marked dullness, no vesicular murmur, with the tubular respiration much impaired. Over the entire right half of the thorax there was puerile respiration. The number of respirations was about thirty to the minute. The patient was cachectic, depressed, and feeble. There was no orthopnoea. This group of symptoms marks one of the most interesting cases ever presented to the physician. The diagnosis reached by the examiners was that the symptoms presented were due to the presence of fluid in the left pleural sac, but there was doubt as to whether this fluid was serous or purulent in character. The absence of hectic fever, colliquative diarrhoea, and night sweat, rendered the assumption of empyema somewhat unjustifiable, while the symptoms were of too grave a character to be attributed to simple effusion. Dieulafoy's Aspirateur (described on page 225, vol. ix., of this Journal), was used, and all doubt immediately removed; the barrel of the syringe was by the backward action of the piston loaded with pus. As there was no time for delay, the operation for empyema was arranged for the next day. The operation was

†There were numerous petechia upon the upper extremities-Ed.

skillfully and successfully performed by Dr. J. M. Holloway. There was nothing of note occurring during the operation excepting marked cyanosis with extreme dyspnoea, this being relieved by ammonia and whisky. Thirteen pints of pus were removed. As the trepline was used to remove a segment of the rib (at the point of election), nothing was done to insure the maintenance of a free drain. The patient was much relieved, and did well for many days (nine), when he died suddenly apparently from some cardiac trouble. The nurses could give no description of his last symptoms. It was interesting to observe during the flow of pus from the sac that the epigastric tumor gradually faded away, and that the apex-beat of the heart retreated from its position over the right pleural sac to a position approximating its normal location.

The points of special interest in this case are: 1st. The peculiar, sensitive, pulsatile tumor over the epigastrium. 2d. The extreme pulmonary atelectasis throughout the entire left lung, with suspension of tubular breathing in the lower lobe, and diminished tubular breathing in the upper lobe (the finger passed through the aperture made by the trephine did not reach the lung). 3d. The large amount of pus in the pleural sac. 4th. The absence of orthopnoea under such circumstances. 5th. The extreme deviation of the apex-beat of the heart. 6th. The absence of colliquative diarrhoea, night sweat, and hectic fever. The aspirateur used was made for Dr. Holloway by Tiemann, of New York. Dr. Gaillard asked the opinion of members as to the prognosis in idiopathic empyema as contrasted with that in empyema of traumatic origin, stating that he had always observed best results in the latter variety of this trouble.

Dr. Octerlony alluded to a case in which a very large quantity of pus was removed. It was found in the sectio cadaveris that the lung was one vast abscess containing pus.

Diseases Affecting the Nervous System.-A case of epilepsy in a lad ten years of age, who had frequent and severe seizures; the fits were arrested by use of blisters applied behind the ears, the