sac; gradually the swelling will become smaller, until finally the sac will be emptied and the surrounding oedema relieved. In the beginning, there will be some pain, but in a short time, as the sac becomes placid, the pain will cease. When the piles are internal, an enama of warm water should be given, and the patient directed to discharge it as upon going to stool. This effort will cause the tumors to protrude, when they can be treated by taxis as described above. After this has been accomplished, attention to the condition of the bowels and the use of astringent lotions, ointments, and injections is indicated. Scarlet Fever with Special Reference to Pathology and Treatment. The following summary of a paper on the above subject, read before the same association, by Dr. R. Renfrew, of Glasgow, is given without abridgment, as it presents briefly the pathology and treatment adopted by very many medical men throughout America, not alone in the treatment of scarlatina, but also of other zymotic diseases: Scarlet fever is one of the zymotic diseases. The zymotic diseases are produced by an organized substance entering the body, which has the power of multiplying itself. In multiplying itself the blood is disordered, the nervous system deranged, the circulation quickened, and the secretions and excretions are changed. The poisons of the zymotic disease are not thrown off by the usual eliminating organs, but each poison is eliminated by a particular part of the body-small-pox by the skin, cow-pox at the point of introduction, enteric fever by the lower part of the ileum, scarlet fever by the fauces and nose. When the poisons are thrown off there is always irritation and inflammation. As the poison of scarlet fever is thrown off by the fauces and nose, a large portion must pass into the stomach to be reabsorbed, intensifying and prolonging the disease. The remedies given in scarlet fever should be those that will destroy the poison, moderate, and assist physiological changes. To accomplish these ends a mixture of chlorate of potash and tincture of steel is given, which contains chlorine, muriatic acid, iron, and chlorate of potash. The chlorine destroys the poison; the acid supplies acid to the blood, which is in a subacid condition; the iron improves the red discs, which are in a black and melanosed condition; the chlorate of potash supplies oxygen, to assist in oxidizing the disintegrated material that is floating in the blood. Pressure to the Uterus in Case of Lingering Labor.—Dr. W. S. Playfair, of King's College Hospital, gives the history of a case in which he employed successfully Von Ritgen's method of external pressure, in a case of powerless labor. After the discharge of a large quantity of liquor amnii, the head was found at the brim of the pelvis in the first position. The pains had ceased almost entirely, although ergot had been freely given. The husband objected to the use of the forceps, and before insisting upon their employment, the doctor concluded that he would try external pressure. Both hands were spread over the uterus, and firm and steady pressure was made downward, at intervals of five or ten minutes: "The effect was more favorable than I anticipated; with each application of the pressure the head was felt to descend, and in about three-quarters of an hour it was distending the perineum. Now, for the first time, some slight contraction was felt, and the head was soon expelled. Such a procedure is indicated when the head is in the right position; the pelvis is roomy, and the delivery retarded by deficiency or absence of uterine contraction." CLINICAL LECTURES. "Ex principiis nascitur probabilitas: ex factis, vero veritas." LESSONS FROM THE MEDICAL CLINIC AT THE "HOSPITAL DE LA CHARITE," GIVEN BY S. JACCOUD, Assistant Professor to the Faculty of Medicine at Paris, Physician to the Hospital St. Louis; Chevalier of the Legion of Honor; Corresponding member of the Royal Academy of Science of Lisbon, and of the Medical Societies of Berlin, Vienna, Würzburg, etc. Containing 29 Wood-cuts and 11 Chromolithographs. [Translated by Dr. J. D. JACKSON, of Danville, Ky.] Icterus-Sclerosis and Amyloid Degeneration of the Liver. Amyloid Degeneration-Its Characteristics-Sclerosis of the Connective Tissue, or Interstitial Hepatitis-Its Symptoms-Its Connection with Common Cirrhosis-Results of Autopsy. Gentlemen: It is again a case of icterus to which I would attract your attention to-day. I am not ignorant of the fact that a diversity of subjects is one of the grand attractions, and one of the essential conditions of clinical teaching; but the cultivation of variety ought not to be carried to the sacrifice or ignoring of the advantages which result from the putting together and comparison of facts. Seized with a mild and transitory icterus, the patient with whom we were concerned in our last conference furnished us the opportunity of studying the most common forms of acute icterus; affected with a chronic icterus already of six months' duration, the woman of Saint Anne's Ward, No. 2, will permit me to expose and discuss the differential diagnosis of the principal lesions which can bring about a persistent icterus. I will tell you in advance that we have to do with a rare and obscure case, and that the difficulties in it are such that they should give absolution to my diaguosis in advance, if it should prove erroneous. The patient, aged thirty-six years, is of a robust constitution; she has always had excellent health, and a considerable degree of embonpoint; although for some months she has fallen off, she still presents to us a very marked development of the adipose tissue. As to her occupation, this woman has for years been a worker in dust; she has cleaned the skins destined to be used in the fabrication of hats; I will add that she has never been charged with other than the mechanical part of this work; she has brushed, picked, and shaken, but has never been employed in the chemical operations of this industry. She has given us very circumstantial details regarding the customary health and the death of her parents, but this information has no special signification with reference to the disease with which she is affected. Follow me well, I pray, in the mode of origin, and the sequence of the phenomena; here, no detail is useless. It is fifteen months since this woman commenced to suffer pains, which, in the meanwhile, always occupied the pit of the stomach and the right hypochondrium; these pains did not burst forth suddenly in all their violence; they developed themselves slowly, gaining little by little in intensity, and it was not until the end of two or three days that they were so severe as to oblige the patient to lie abed. This period continued for two, three, or five days, at the farthest, after which the pain gradually diminished, to disappear at the end of thirty-six or forty-eight hours, without leaving any trace of its passage other than an unpleasant feeling of weight in the right side of the belly, and this sensation furthermore was temporary. This species of attack, which is so clearly characterized by the mildness of ascent and decline, continued thus for from five to eight days, after which the woman found herself very well, and resumed her occupation. The frequency of these pains has been very variable; in the beginning, they returned nearly every month; a little later, they became more frequent, while losing their duration; during a period of about four months she had them in this way every fortnight, and even every week; then there came a lull, and for six weeks at least she had no new attacks. I can guarantee the exactitude of these details; they are not drawn entirely from the sensations of the woman; observing her, as I have done for many months, I have many times seen what she calls her crises, and it is after what I have seen that I describe them. I have, in the meantime, observed two other phenomena, one constant, the other variable; frequently, the onset of the pains has been accompanied with an intense febrile movement, during which the thermometer showed 39°, 5 or 39°, 8 (cent), and the pulse 110 to 120; this fever never remained so long as the pain itself, but whenever it manifested itself the attack was more violent and longer; under other circumstances, the painful access was completely apyrectic: this is the variable phenomenon to which I made allusion a moment ago. As for the constant phenomenon, it is of more importance; during each of these attacks the liver increased in volume, the pain passing away as it assuaged, but this retraction did not always bring it back to its primitive dimensions; and in judging the question by the level of the lower border, it was easy to assure one's self, especially after great accessions of fever, that the organ was markedly lowered for some lines or more. Another interesting modification took place during the attack; the jaundice, which had declared itself in the fifth month of the disease, augmented each month in intensity; it became, during the painful periods, of a deep greenish yellow; this change of shade was always manifest after twelve hours of suffering, and never survived the fit. Some weeks after the appearance of these paroxysms, but rather before the icterus, other symptoms came up in connection with the digestive organs; these were at first alternations of constipation and diarrhoea, not explainable by any change in diet, then a considerable increase of appetite, which always persisted. This boulimia was extremely marked from the beginning; the ordinary ration of bread for two days scarcely sufficed for one, and the woman was |