thought she had convulsions. The pulse was very fast and thready, nearly "running." The face was pinched and anxious, with a death-like pallor. With difficulty the uterus was curetted, well washed, and flushed with carbolic acid solution, and then packed to the fundus with iodoform gauze. Its cavity was large and uncontracted and before the washing the odor was very strong. She was being well nursed and was fed with milk, raw meat juice, and brandy. On the 18th the temperature was 104.2° in the morning and the pulse was 120, soft, and very compressible. The gauze was removed from the uterus, but the septic odor was easily perceptible through the iodoform, and the skin was sweating profusely and was blotched over the chest and abdomen. At 3 P. M. 10 c.c. of antistreptococcic serum were injected into the cellular tissue of the abdominal wall. At 8 P. M. the temperature was 102.6°, the pulse was 106, the respirations were 24, and headache was nearly driving the patient frantic. She felt so ill and weak that neither she nor her friends would allow further washing. On the morning of the 19th the temperature was 100° and the pulse was 92. The patient had had a better night; the headache was much less severe, the discharge was not so fetid, and she had a sense of feeling better. 10 c.c. of the serum were injected. At 8:30 P.M the temperature was 101.2° and the pulse 104. The discharge did not smell fetid. The headache, however, was still severe, but a six-grain dose of butyl-chloral relieved it. On the 20th the temperature was 101 and the pulse was 104. The headache was easier, the pulse firmer, the tongue cleaner, the skin drier and less blotchy, and the anxious, pinched face had smoothed out a little. The uterus was washed out with carbolic solution and 10 c.c. of the serum was injected. On the 21st the temperature was 100° and the pulse was 108. The headache was easier, as also were the other symptoms. On the 22d the morning temperature was 99.6° and the pulse was 100. She was still improving, and the head especially was comfortable. The uterus was washed out with strong carbolic solution and a shred came away of what appeared like macerated membrane about two inches long. The fetor was not marked. At 8 P.M. the temperature was IOI and the pulse was 108. The headache was worse, and altogether the patient was not so well. On the 23d, to my great disappointment after such a struggle, the temperature was 104°, the pulse was 120, and all the symptoms were aggravated, the headache being terrible. A severe pain had attacked the left leg which was slightly swollen. The veins in the popliteal space were hard and corded and the calf was very tender to tonch. Large linseed poultices were applied. On the 24th the temperature was 103.4° and the pulse was 116. The head was very painful, but the pain in the leg was not so intense. There was no fetor at all from the discharge and the other symptoms were more favorable. The course of events from this point is of great interest, for the temperature fell 1° every morning until it reached normal on the 29th, the pulse corresponding. The tenderness of the leg gradually disappeared, likewise the swelling, the corded veins softened very quickly, and by the end of the month the patient could move the leg about quite freely and without pain. Her further progress has been uneventful if slow. It seems to me that it is just possible that the serum may have assisted such a very rapid resolution of symptoms which had all the appearance of a genuine phlegmasia. Charles L. Fraser, F. R. C. P., in the London Lancet. TRAUMATIC PULMONARY TUBERCULOSIS.-Schrader (Berl. klin. Woch., November 15, 1897,) says that trauma has long been recognized as a possible cause of acute pneumonia, but that the connection between injury and chronic disease of the lung is less easily established. He relates the following case: A man, aged twenty-nine, previously healthy, and with no family history of phthisis, had a severe fall on the right side of the back, and was unconscious for fifteen minutes. On the same evening he felt ill, and was admitted into hospital two days after the accident. There was then considerable grazing over the right scapula, and pain was complained of in the chest corresponding to the injured part. The breathing was difficult and the temperature 38.8° C. The breath sounds were absent, vocal vibration increased, and the percussion note impaired in the region underlying the injury. The diagnosis of pneumonia of the right middle and lower lobes was eventually made. About thirteen days after the accident tubercle bacilli were found in the sputum. The patient's condition remained much the same for some days. There was loss of weight. Eventually improvement took place, so that four months after the accident there were no abnormal physical signs beyond a slightly impaired note over the lower part of the right lung. The author refers to some recorded cases of supposed phthisis following injury. He draws attention to the fact that before the traumatism the patient was absolutely well. Whether the pneumonia following upon the injury is to be looked upon as a contusion pneumonia which favored the invasion of the tubercle bacillus, or whether it was a tuberculous broncho-pneumonia from the beginning, is difficult to decide. The author is inclined to accept the latter interpretation. The temperature chart was characteristic of tuberculosis. Finally, the author summarizes the evidence in favor of this view: (1) The development and course of the tuberculous lesion were carefully observed after the accident; (2) the disease corresponded to the site of the injury; (3) there was no clinical evidence of tuberculous disease in the lung immediately after the injury, and no history of previous illness; and (4) certain proof of tuberculosis was forthcoming some little time after the accident, the development of which was quite in keeping with that of the ordinary disease.-British Medical Journal. TABETIC ANESTHESIA. - Marinesco (Sem. Méd., December 3, 1897,) investigated fifty cases of tabes dorsalis with a view of determining the proportion and extent of the anesthesia which is usually present. Tabetic sensory disturbances are not fixed, but appear and disappear without obvious cause. Thoracic anesthesia was present in forty cases, the anesthetic areas being in the region of the nipples. The anesthetic band may reach the axilla, or extend down the inner aspect of the arm, and even to the ulnar border of the hand and little finger. Anesthetic bands may exist on the back of the trunk in the scapular region. When the area is continuous in front and behind a sense of constriction results. The genital and perineo-anal region is often anesthetic; the scrotum and penis may both be involved. This exists at the onset of the disease, and should be looked for in all cases; anesthesia in one region is rare. In the lower limbs anesthesia of the plantar or dorsal regions of the feet or toes, side of leg, or anterior or posterior aspect of the thigh is common. In ten of the author's cases there was amaurosis. In the majority of these tactile sensation was normal; in others the anesthetic foci were slightly marked, or only one was marked, usually in the lower limbs. Patients of the first group are not ataxic; the knee-jerks are normal or exaggerated. To the anesthetic foci correspond important subjective disturbances, sensations of constriction, disorders of micturition and impotence, lightning pains, formication in legs and feet, and numbness of the ulnar region. When pain or paresthesia is complained of there may actually be anesthesia of the same regions. In three patients suffering from gastralgia, anesthesia of the epigastric or left hypochondriac region was present. In a case with laryngeal spasm there was anesthesia of the mucous membrane. Tabetic anesthesia is bilateral, but rarely symmetrical. Careful examination of the anesthesia confirms the theory of its origin from the sensory nerve roots. The anesthetic area does not exactly correspond to the root area. Its localization depends on three factors: (1) Unequal distribution of the lesions in different roots; (2) innervation of a given area by several roots; (3) participation of an endogenous process in the root lesions. The anesthetic foci are of great importance in the early or differential diagnosis of disease.-Ibid. MESARTERITIS SYPHILITICA.-F. Backhaus (Beit. zur path. Anat., Bd. 22, Heft 3,) comes to the following conclusions: (1) In the aorta there may be an inflammatory affection of the tunica media, characterized by a circumscribed small-cell infiltration. This infiltration afterward undergoes transformation into a kind of connective tissue poor in nuclei. Accompanying the transformation there is always a certain amount of shrinking. Here and there may be found some necrosis of the media. (2) The tunica intima may be secondarily involved, and may show thickening or may be affected through the scar-like contraction going on in parts of the media. (3) The tunica adventitia may show small-celled infiltration, but more often there is a diffuse fibrous increase without tendency to contraction. (4) The affection has only been observed in syphilitic subjects, and is regarded as a hitherto unrecorded result of syphilis. (5) The affection is very likely the cause of aortic aneurisms in syphilitic subjects. (6) The affection is totally different from chronic endarteritis, though the two may be associated with each other.-Ibid. A Journal of Medicine and Surgery, published on the first and fifteenth of each month. Price, $2 per year, postage paid. This journal is devoted solely to the advancement of medical science and the promotion of the interests of the whole profession. Essays, reports of cases, and correspondence upon subjects of professional interest are solicited. The editor is not responsible for the views of contributors. Books for review, and all communications relating to the columns of the journal, should be addressed to the Editor of THE AMERICAN PRACTITIONER and News, Louisville, Ky. Subscriptions and advertisements received, specimen copies and bound volumes for sale by the undersigned, to whom remittances may be sent by postal money order, bank check, or registered letter. Address JOHN P. MORTON & COMPANY, Louisville, Ky. THE UNIVERSITY OF LOUISVILLE. The Sixty-first Annual Commencement of the Medical Department of the University of Louisville took place at Macauley's Theatre on the afternoon of March 29, 1898. Prayer was offered by the Rev. E. L. Powell, pastor of the First Christian Church, Louisville. Upon recommendation of the Dean, the degree of Doctor of Medicine was conferred upon eighty-six candidates by the Hon. J. S. Pirtle, President of the Board of Trustees. The faculty valedictory was delivered by Prof. H. M. Goodman, A. B., M. D., the alumni address by James Weir, M. D., of Kentucky (Class of 1878), and the class valedictory by Thomas Green Dunlap, M. D., of Kentucky. These addresses appear elsewhere in this issue. The following is the list of graduates: |