The knee was excised six times, three of the cases recovering "with more or less useful limbs." When successful results follow the operations, he doubts whether the limb left is more serviceable than a good artificial one, thus diametrically differing from Sir William Fergusson (Vide Lectures on Progress of Anatomy and Surgery-Lect. vj-On Excision of the Knee).

CASES OF PNEUMONIA. BY J. N. BORLAND.

We have here a table of 190 cases of pneumonia treated within the hospital, there being admitted within the table only three cases in which the diagnosis was undoubted, and which were expressly admitted and treated for the affection, though a number of them were complicated with other diseases. The uncomplicated cases were 107, and were on an average eleven days sick before entering hospital, and remained there twentythree days. Of the single pneumonias, the right lung suffered the most in forty instances, the left lung in nineteen. This proportion corresponds remarkably closely in its percentage with that observed by Dr. Austin Flint (American Journal Medical Sciences, January, 1861) in his analysis of 133 cases, in which the right lung was affected in sixty-four cases, the left in thirtyseven. The thermometrical observations taken confirmed the deductions drawn by Dr. Grimshaw, of Dublin, (Dublin Quarterly Journal, May, 1869).

"1st. Pneumonia has (when uncomplicated) a tolerably definite range of temperature.

"2d. The highest temperature attained is usually between 103° and 104° Fah.

"3d. The maximum temperature is usually attained on the third, fourth, and fifth days, after which the temperature falls, and reaches the normal on the sixth or seventh day.

"4th. The height of the thermometer does not necessarily indicate the intensity of the disease.

"5th. The fall of temperature does not indicate the cessation of mischief, but only that the disease is about to enter on the third stage.

"6th. If a high temperature is maintained for a long time

(more than three or four days), or a fresh rise takes place, it indicates either a fresh attack in a previously healthy part or the advent of a complication.

"7th. The temperature and the pulse usually, though not always, rise and fall together.

"8th. The temperature usually decreases before the frequency of respiration diminishes.”

The greater proportion of the cases were treated according to the plan of Bennett. Thus treated there was a mortality in these one hundred and seven uncomplicated cases of eleven, nearly one in ten; the great difference between these results and those of Bennett (1 in 321), causes Dr. Borland to ask the question, "can it be that pneumonia is a disease of severer type in this country than in Scotland."

In Boston, as has bsen observed elsewhere, there is a pretty regular correspondence between the seasons and prevalance of pneumonia. The smallest number of pneumonia patients received into hospital is in June and July, the number then rises steadily until November, when fluctuations continuing through the winter months, the maximum is attained in April.

DISPLACEMENT OF THE UPPER JAW. BY DAVID W. CHEEVER.

This is a description, by the writer, of three operations (one repeated on the same patient) removing, or displacing rather, the one-half of the superior maxilla in one of the cases, and the entire upper jaw in the other, for tumor in the pharyngo-palatine fossa. The temporary displacement of the entire upper jaw, as performed by Dr. Cheever, is we believe a unique operation, and though the patient died, it was clearly demonstrated that by this mode the largest naso-pharyngeal tumors may be removed. The paper concludes by a comparison of the method of the writer with those of Langenbeck and M. Ollier, of Lyons, which he does not seem inclined to favor, for although M. Ollier claims to have removed by it "probably the largest fibroid ever extracted from this region, "yet Dr. Cheever declares "we shall find, by measurement, that the operater's finger is just as

far from the basilar process when he enters the upper meatus of the nose, as it is when he enters the mouth." However, at the very end of the article he appends the following very candid

note:

"Since the above was written we have satisfied ourselves by an operation for pharyngo-polypus, on the living subject, by Ollier's method that the top of the pharynx can be easily reached by the finger or instruments, through his simple downward cut of the nose. The mobility and elasticity of the bones of the nose in life, give much more room and play to the surgeon's finger than appear possible on the dry skull."

TREATMENT OF ACUTE RHEUMATISM.

BY JOHN G. BLAKE.

This paper is one of the most interesting of the volume, being the results of treatment tabulated in three hundred well marked cases of rheumatism, it being the object of the writer, as he says, "to ascertain by a close scrutiny of results, whether certain remedies and methods of treatment confirmed claims made by their advocates, and to learn if any possessed advantages over others in the cure of this most unsatisfactory disease.”

The treatment was divided into alkaline and non-alkaline. The alkaline was that so strongly recommended and defended by Dr. Fuller, and which is now so very celebrated. The nonalkaline included the use of iodide of potassium, colchicum, opium, guaicum and syrup of lime. Of the three hundred, one hundred and twenty-five were under purely alkaline treatment. Preceding the administration of the alkali, the bowels always received attention, a cathartic or enema being given if needed. The alkalies given were the salts of either potash or soda, and the quantities given were from 3ss. to 3ij., every three or four hours during the first few days, increased if the urine was not found alkaline, and diminished when this was effected, two days usually sufficing to effect this result. We think the writer's experience will be found to have corresponded with the majority of practitioners, when he says, "I have been frequently obliged to diminish the amount recommended by Dr. Fuller before get

ting the urine alkaline; and even when administered largely diluted in barley or rice-water, many of our female patients could not retain doses snfficient to produce any result, consequently their use was discontinued." Now we know that it has been claimed by the advocates of the alkaline treatment of Rheumatism, that the pathological basis of the disease resided in the acidity of the circulatory fluids and excreta, and that if the blood was restored to its alkalinity, as shown to be on the urine being found alkaline to tests, that not only was the course of the disease greatly abridged, but that all of that which we have most to fear in rheumatism-cardiac complications, was shut out. We connot give the result of treatment with reference to this point in words better than those of the writer.

"Of the above one hundred and twenty-five cases treated by alkalies during the existence of acute symptoms, and free from any discoverable cardiac complication until the third day, eighteen developed disease of the heart during their stay at the hospital. Thirteen of these affections were endo-cardial, accompanied by the murmurs observed in those cases. Five were peri-cardial, and two of these under my own care terminated fatally. As these were the only deaths either in my hospital or private practice from rheumatism or its complications, and both having been under alkaline treatment from the very commencement, my faith in its protective influence over the heart was somewhat shaken."

The history of one of these cases we quote in full. "No. 2 was a man of thirty-five years, suffering for the first time from acute rheumatism of a very severe form, most of the large joints being affected; admitted to the hospital the sixth day of the disease; joints swollen, red, and painful; perspiration profuse and acid; urine high colored; no affection of heart. I remarked at the time to the house-officer: This is an admirable case for testing the value of alkaline treatment; let us carefully observe all conditions required by Dr. Fuller.' The bowels were moved freely, acet. and bicarb. Potassæ given in full doses; liquid nourishment of milk, gruel, and beef-tea prescribed, and ano

dynes of hyoscyamus and bromide of potassium at night. Urine became alkaline on the second day; on fourth, patient began to develop symptoms of pericarditis. beginning with pain on inspiration, and feeling of distress in cardiac region. Friction sounds, effusion and its accompaniments of dyspnoea, delirium, etc., followed. Active treatment by myself and Dr. Bowditch failed to relieve the disease; local depletion, repeated counterirritation, with the efforts to sustain strength by means of liquid nourishment in abundance and stimulants in moderation were tried. After a few days had elapsed, and no improvement manifesting itself, the administration of quinine in doses of five grains four times a day, as recently recommended in pericarditis with delirium, was resorted to, but without any beneficial result. The patient died in seven days after the first manifestation of the disease.

["I have often since regretted that no attempt to evacuate the fluid by tapping the pericardium was made in either of these cases, as has recently been successfully done in similar ones."]

Under the non-alkaline plan there were treated one hundred and seventy-five cases of well marked rheumatism. Eighteen of these had heart troubles-chiefly endocardial with mitral murmurs to come on after the third day in hospital. At the time of discharge from hospital, it had disappeared from five of these, from seven of those under alkaline treatment. The average stay in hospital was thirty-five days, deducting ten days for remaining during convalescence, making the treatment extend over twenty-five days. The blister treafment of Dr. Herbert Davies had a fair trial in several cases, but as he remarks, "the manifest inconvenience, and even danger attending it in cases where many large joints are affected, precluded its general use. In those so treated the pain was relieved for the time, but returned in the course of a few days with less severity, and continued about the average time. Its protective influence overthe heart, we could not fairly estimate in the small number of cases treated; none of them, however, showed any tendency to cardiac affection.