cent, and had quit visiting her regularly, and thought she was doing very well. One day her mother found her up and before the glass arranging her toilet to meet a young man in the parlor. Her mother at once disapproved the idea, and she sat down in an easy chair in a pouting mood, and in thirty minutes she called for the chamber, and had a very copious hemorrhage from the bowels, with very little rise in her temperature. I was sent for immediately,

and prescribing, left her comfortable.

At my next visit I found her with fever, temperature 103.5°, and complaining of her left limb. On examination, I found the limb swollen some and very painful over the course of the femoral vein, from which developed a case of phlegmasia dolens. The pulse was quick and intermittent, once in every six to eight beats. After putting her on a treatment for the phlebitis she gradually recovered, yet the intermittent pulse was a trouble all through the case to ultimate recovery. The limb remained slightly edematous. The next case was the most peculiar one of the whole group. J. H., aged 27 years, strong and robust, had always enjoyed good health with the exception of an attack of rheumatic fever several years ago. He was taken ill Oct. 10, with symptoms of typhoid fever. His bowels were inclined to be constipated; his evening temperature was 104°, and morning temperature 101°. This condition of things lasted about twenty-two days, when he had a hemorrhage from the bowels. Not being very profuse, it yielded to moderate doses of opium, and after a few more days he was considered convalescent, and I quit visiting him for a few days, but in about six days he began to complain of his shoulder and elbow and wrist joints paining him so he could not move his right arm without giving great pain. I was sent for and found him with a temperature 104.5°, and pulse 110, and suffering very great pain. I diagnosed rheumatic fever, prescribed accordingly, and had the satisfaction of seeing him relieved in about thirty-six hours. Temperature fell to 99°; pulse 78 per minute, tongue cleaning and appetite returning. I again pronounced him convalescent, and ordered him a tonic treatment. In about three days I was sent for again, and being absent Dr. Riley visited him for me. (I will here remark that Dr. Riley had frequently visited this patient with me.) He found him with a temperature of 97°, skin cool, and pulse 25 beats per minute, and very intermittent. I saw him next morning, about sixteen hours after Dr. R. hal left him. His pulse was some

better when the doctor left, had risen to 55 per minute, but was still intermittent. We found him at the visit above named in a similar condition to what he was the day before-pulse 25, skin cool, temp. 97°. And now the stomach was rejecting everything taken, without any apparent effort, would eject even a teaspoonful of water without appearing to be sick. We resorted to injections of stimulants and nourishment by the rectum, which made a little improvement in the pulse rate, raising it to about 40, but still it was intermittent. At our next visit, which was in about six hours, the patient had sent for Dr. Rice. After hearing the history of the case he could not arrive at any opinion, as he expressed it, yet the patient was in about the same condition, pulse 30, temperature 97°. All this time he was receiving stimulants by the rectum, but they seemed to be losing their virtue, and the outlook was gloomy for him. I proposed to the doctors that we would give, in addition to what we were giving, a hypodermic injection of morphia and of atropia. They agreeing, we did so, and had the satisfaction of seeing him rally, and after a long and tedious convalescence, he ultimately recovered, and is in good health to day. Of course the physiological effect of the morphia and atropia will be admitted at once, and I will state that we had to keep up those injections at intervals of six to twelve hours, else his pulse would become slow and intermittent, and while under their influence his stomach would retain milk in small quantities.

In concluding this very brief report, for I could make it much. longer by reporting several other cases of slow and intermittent pulse among my patients and those of Dr. Riley (and I will here express my gratitude to Dr. Riley for his unselfish kindness shown in visiting those cases with and for me), I will ask the attention of the profession to the character of the complications as reported, and their experience as to such complications.

In regard to the treatment of my typhoid cases, I will say I give as little medicine as possible, relying largely on good fluid nourishment and stimulants. As an antipyretic I gave quinine in large doses at the time of high temperature, say ten to twenty grains at a dose, once or twice in twenty-four hours. In all my cases I gave turpentine emulsion early and freely, and gave aromatic sulphuric acid in ice water when very thirsty, and opium to control the diarrhea, my constant care being to place my patient in the best hy gienic conditions possible.

CITY HOSPITAL REPORT.

By H. C. DALTON, M. D.,

SUPERINTENDENT.

DEPRESSED FRACTURE OF THE SKULL.-HERNIA CEREbri.—

RECOVERY.

Jacob Richert, æt. 9. German, single, a previously healthy boy, received a kick from a horse, causing a depressed fracture of the frontal bone, located 2.5 cent. (1 in.) above and 2 cent. (in.) behind the right external angular process. Area of depression, 2X4 cent. (X1 in.). The overhanging posterior margin was chiseled off, the sunken part was removed, revealing a few slight lacerations of the dura mater. The wound was then washed and dressed antiseptically, the anterior portion of the incision being closed with sutures while the posterior portion was left open for drainage. Cold cloths were applied. The patient suffered little, rested well, but took very little nourishment, his temperature remaining about 38° C. (100.4° Fah.) for the first five days. At the end of this time he began to grow restless, would at times, moan in his sleep. Temperature went to 39° C. (102.2° Fah.) and pulse became somewhat rapid and full. The wound, which at first showed a tendency to heal, opened when the catgut sutures were absorbed, and discharged pus. Constipation required the use of purgatives and enemata. The restlessness gave place in a few days to a drowsy, somnolent condition, and the fever continued up to the 14th day. He then became brighter, the temperature dropped to 37° C. (98.6° Fah.) and the wound appeared to be granulating in a healthy manner. The granulations, however, became exuberant during the next ten days, and arose 1 cent. (in.) above the general level. Five days later his general condition again became worse. He did not rest well, complained of pain in his head, and edema developed in the tissues around the, at this time, pulsating tumor.

There was another slight temporary improvement in the symp. toms, but about Nov. 12th (the 37th day of his illness), the headache returned, being especially severe at night,; patient would frequently utter a peculiar, plaintive cry. On the 14th, he had two epileptoid convulsions with loss of consciousness. Pulse was irregular and weak; temperature natural, respiration slow. Part of the fungous mass was on the verge of sloughing off, evidently because of the constriction at its base, from its own growth. The symptoms be

came more serious, when it was concluded that active interference was indicated. As much of the constriction as possible was relieved by the removal of some of the sloughy parts, and by stretching and loosening the encircling tissues. During the next twelve hours, the patient's condition remained bad; he obtained but little rest, and complained much of pain in his right ear and shoulder. A day later, he awoke in the morning, bright and cheerful, and from that time improved constantly. A few days afterwards, a plate of the fungus, one cent. thick sloughed off en masse. With the assistance of moderate pressure, by means of adhesive strips, a continuation of this process soon reduced the size of the tumor to a level with the adjacent skin, and healthy granulation with cicatrization followed, so that the wound was entirely healed by Feb. 25, 1887. His general health was then excellent and mental condition perfect.

REPORTED BY DR. BRANSFORD LEWIS, SENIOR ASSISTANT PHYSICIAN.

ANEURISM OF THORACIC AORTA-DEATH-AUTOPSY. D. R., male, æt. 50, Irishman, single, teamster. 14, 1886.

Admitted July

Patient's mother died of consumption; his father, who suffered from rheumatism during life, died from acute disease, of the nature of which patient had no knowledge. Of himself, patient, a hard drinker, gave a history of a venereal affection which appeared to have been chancroid; otherwise he had been a strong, healthy man most of his life. He had noticed swelling of the feet at odd times during the last several years; had been troubled with shortness of breath for about one year previous to his entrance. It was increased by the slightest exertion. He had had slight transient attacks of rheumatism, which were brought on, he thought, by heavy lifting required of him in his business as teamster. Recently he had complained of pain in the left mammary region and the small of the back. Bowels were usually constipated, to which condition he ascribed the vertigo frequently present. A powerful heaving pulsation was to be seen and felt over the precordial and aortic areas. Percussion gave dulness below a line on a level with the top of the sternum, extending from the right linea mammillaris to three centimetres to the left of the sternum; the left border ran from that point to the apex, located in the seventh

interspace, 3 cent. (1 inches) without the left mammary line. Dulness below merged into that of the liver. Percussion of the lungs anteriorly normal; posteriorly there was diminished resonance in the right infra-scapular region. The respiratory rhythm was altered; a short inspiration was followed immediately by an expiratory movement which was abruptly cut short (seemingly on account of pain, although he complained of none); after a pause of some length, expiration was completed and followed directly by inspiration. A few subcrepitant râles were audible posteriorly. Increased vocal resonance and fremitus in the right infrascapular region. A double murmur was to be heard, both at the apical and at the aortic area, transmitted from the latter into the carotids, and closely simulating aortic stenotic and regurgitant murmurs. There was accentuation of the pulmonic second sound. Radial pulse 68, full, regular, of good strength and synchronous on both sides. There was no bulging of the precordia. Urine of natural color; deposited heavy sediment; specific gravity, 1024, chlorides and phosphates normal in quantity; no albumen. Small, round, renal epithelium, a very few casts and some bladder epithelium were observed with microscope. No hoarseness or irregularity of the pu pils ever appeared.

From the time of his entrance, although efforts were made to tone him up with nutriment, tonics and rest, together with internal administration of iodide of potassium, patient steadily grew weaker, suffered more and more from dyspnea, and edema appeared in his limbs. Two days before his death (which occurred August 23, 1886) he was suddenly taken with excruciating pain in the precordial region; this caused redoubled intensity of the dyspnea, and patient finally sank, with cyanosis and other symptoms of heart failure.

Autopsy. Brain and membranes normal. Pericardium contained 60 cc. (2 oz.) of fluid. A general dilatation of the aorta extended from its origin to within 8 cent. (3 inches) of its diaphragmatic orifices. Its largest diameter, 10 cent. (3 in.) was located in the transverse portion; from that point it tapered gradually to the normal calibre. At the junction of the transverse with the descending portion, in its posterior wall, was a sacculation 4 cent. (14 in.) deep, and having an orifice 8 cent. (3 in.) in diameter. Its walls were covered with layers of fibrin, were thin and friable, and, like those of aorta, were lined with atheromatous