his sister, the faculty of the university, chamberlain from the court, and those who had known and loved him. A funeral oration was pronounced, and a hymn sung by a choir of men. It was a sad moment. The young wife could hardly have felt more lonely than those of us who were not united by family ties with him. I learned to regard Græfe as something superhuman, in comparison with whom other men seemed mere pigmies. How often, in the last few months, amid the anxieties and responsibilities of my position at the clinique have I gone to the Professor for advice, and how did every difficulty seem to fade away with his assistance? Thank Heaven that it was my fortune to have seen so much of Græfe during the last year; it has been an experience worth all my other years of study."Detroit Review of Medicine.

ART. III. THE INTRA-ABDOMINAL DOUCHE IN SEPTICEMIA. By JOSEPH W. THOMPSON, M. D., Paducah, Ky. [Communicated to the Society, and read July 5, 1870.]

On the 8th of January last, in connection with Dr. H. M. Gilson, of this city, I was called to see Annie Smith, colored, aged twenty-five years old. We found her abdomen very much. distended, and her health very feeble. There was decided dullness on percussion, with perceptible fluctuation. Four days later, in consultation with Drs. R. Saunders and H. M. Gilson, of this place, and W. Gardner, of Cave City, Ky., I made a minute examination, exploring the cavity of the womb, and found it contained nothing.

Still being in doubt as to the cause of the enlargement, we decided to explore it by abdominal tapping. I accordingly introduced a trocar, and drew off about two and a half gallons of pus. I then inserted a tent into the opening and enveloped the abdomen with flannel, which was confined with a broad

roller. The next day I drew off a large wash-pan full of pus. On the second day from that time I drew off the same wash-pan full and a half. On the 17th, two days from the last treatment, we washed the peritoneal cavity by injecting a half-gallon of warm water. On the 20th; I injected two gallons of warm water into the peritoneal cavity, and followed it by a solution of carbolic acid, five grains to two pints of warm water. We continued to inject the peritoneal cavity every second day with warm water, following it by warm solutions of carbolic acid, which was increased from five to ten grains to the same amount of water at each treatment, until the 30th of that month. On the 30th the strength of the solution was forty grains to two pints of warm water.

That night the tent was dislodged, and at my next visit I endeavored to introduce the canula to inject the cavity as before; but the internal portion of the opening had so much closed that I was unable to pass it. There was then so little distention that we thought it would be hazardous to make another opening with a trocar, for fear of doing violence to some of the abdominal viscera. The discharge diminished rather promptly under the use of the injections. At the last two or three treatments it consisted principally of disintegrated matter.

The history is briefly this: In August last, at her menstrual period, during a rather cool night for that season, the patient retired to sleep, not protected by a bed-cover, and on awakening the next morning she discovered that the catamenial flow was entirely suppressed. For some time, she cannot state how long, the pain in the abdomen was severe, and in a few weeks the enlargement commenced, and continued to increase until I tapped her, as I have before stated. She was very greatly relieved of her suffering by the first evacuation of pus. It is my opinion that the disease was chronic peritonitis, the result of exposure to the cold that night, during the menstrual flow, which acted so powerfully as to suddenly suppress the discharge.

It is regarded as hazardous to inject the peritoneal cavity. Professor T. G. Thomas, of New York, in the second edition of his excellent work "On the Diseases of Women," states that "after evacuation the sac should not be injected, for fear of exciting peritonitis;" but in this case no peritonitis or any other unpleasant symptoms were excited, but on the contrary the patient was evidently benefited by the use of the injections.

The principal point of interest in the case is, that the peritoneal cavity did bear copious injections of warm water, and a solution of carbolic acid, without producing any undue excitement or bad results. It is possible that, had the injections been more timely used and the patient situated with proper surroundings, such as good diet, nursing, and well-regulated hygienic influences, she might have been very greatly benefited. During her entire illness she lived in a little shanty of a house, possessing no comforts. I requested the city authorities to send her to the hospital; but my efforts in that direction were in vain. It is evident that her life has been prolonged and her condition made more comfortable by injecting the peritoneal cavity, even under these circumstances. She is still living, though very

feeble.

I am especially indebted to Dr. Gardner for his valuable assistance in the case.-Gynaecol. Journal.

ART. IV.-PROGRESS OF MEDICAL SCIENCE.

In proof of the progress in practical medicine, I may refer to improvements in relation to particular diseases. Consumption (for example), a disease in which the physician's duty consisted in watching the slow "gradations of decay" (making a prognosis of two year's duration), and alleviating suffering as best he could. But now, under the use of cod-liver oil, mineral acids, bitters and supporting nourishment, he no longer regards the disease as hopeless, and treats it looking for a cure; failing

that, he confidently expects to prolong life. The experience and calculations of Dr. Williams justify the expectation, for he informs us that the average duration of life of phthisical patients has been extended from two years, the limit assigned by Laennec and Louis, to eight years. And he adds, that "in not very few cases the disease is so permanently arrested that it may be called cured." I may mention the treatment of oxaluria, phosphatic, and other diatheses indicated by the state of the urine, the use of iodine in goitre and other affections, iodide of potas in syphilis, gout, etc., bromide of potas in epilepsy, etc., arsenic in many affections of the skin, the alkaline treatment of rheumatism, the successful use of nitrate of amyl in tetanus, and in angina pectoris, of hydrate of chloral as a narcotic, of quinine in acute lumbago, of drachm doses of tincture of henbane, with a little sulphate of magnesia three times a day in orchitis, of large doses of quinine in military surgery as a remedy for pyæmia; the banishment of scorbutus from our ships, etc., etc., also the vast improvement that has taken place of late years in the treatment of diseases of the womb and its appendages, and in diseases of the eye, I may refer to the use of atropia as a substitute for belladonna, and the calabar bean as a local application to contract the pupil.

Formerly all infantile diseases were considered by some as the results of febrile action, and treated as such, by others as the results of weakness, and treated with tonics and stimulants, and by a third class as the results of the irritation of worms, and treated with anthelmintics. Modern investigators have proved that the different organs of the child are liable to nearly the same diseases as the adult, and should be treated accordingly.

The mortality of infants is still very large, but of late years. it has greatly decreased. Towards the middle of the last century 60 out of every 100 children born in London died before they had reached their first year of age; but the mortality has steadily diminished, so that now about 35 in every 100 die at that period. About 600,000 are born annually in Great Bri

tain; of these 300,000 would have perished. Now about 200,000 die, thus showing a saving of at least 100,000 human beings a year. In New York the mortality is still very large; one-third of the children born die in the first year, and onehalf before they have attained their fifth year of age. In Geneva records have been kept since 1590, and it has been ascertained that a child has now five times greater chance of living to the age of twenty-one years than it had three centuries ago.

About the middle of the seventeenth century, 1 in every 40 or 50 women delivered in London died of child-birth and its consequences; but as medical science has advanced, that mortality has decreased, till now about 1 in 150 or 200 die. There are about 600,000 accouchements yearly in Great Britain, still about 3,000 mothers perish. If the old mortality held good, not less than 11,000 or 12,000 maternal lives would now be lost. Consequently we may proudly point to this modern advancement in medical science, effecting, as it does, in this item alone, a saving of the lives of 7,000 or 8,000 mothers a year.

The mortality in the army, years ago, was immense. It was a disgrace to those in authority who positively refused to listen to the repeated appeals of the medical staff. And it was not till after the Crimean war, when Miss Nightingale brought the fact before the nation, that the laws which preventive medicine had established and applied in civil life were put in force. The result was that since the period named, the mortality in the Guards has fallen from 20 to 9, and in the infantry from 18 to 8. And the improvement in war is still more striking. In the Crimean war the sick in hospital were nearly seven times the number of the killed; while in the Chinese war they were nearly equal. The relative proportions of zymotic sickness in the two campaigns were as 6 to 60.

The present death rate of fever in England amounts to 385 per 10,000 of population, while a century ago its death rate was nearly 539, and at the middle of the last century the annual death rate from all causes in London, was 355 per 10,000 of population, but in the middle of the present century, it was only