when it attacks the apex. Primary acute pleurisy is not fatal, unless it is accompanied by pericarditis. Pleurisy, if under treatment it ends in death, is secondary to tubercle or to cancer or to disease of the kidneys. Edema of the larynx is very seldom dangerous; edema of the lungs is usually so. Acute bronchitis is a frequent cause of death in young children and old people. Fatal bronchitis, in persons between ten and sixty years of age, is either capillary or secondary to tubercle. Phthisis is most pernicious when it is hereditary. Consumptive patients, who lose flesh and color and appetite, with but little signs of disease in the lungs, are in a worse case than those who have marked local symptoms, but whose appetite and nutrition are good. Hemoptysis, even when copious, is not always of ill omen.

It is rare for hemorrhage from either the lungs or the stomach to be immediately fatal, except it proceed from aneurism. Chronic valvular disease of the heart, when it complicates phthisis, does not aggravate the latter-rather it checks its progress. Sudden death is more frequent from aortic than mitral lesions; in regurgitant than in obstructive disease of the aortic valves, and in stenosis than in dilatation of the mitral orifice. Apoplexy, when in gravescent, is commonly fatal. In apoplectic attacks, the ultimate prognosis depends chiefly upon the degree and continuance of unconsciousness; the immediate prognosis upon the degree in which respiration is afflicted. Chronic diseases of the spinal cord are more likely to end favorably in women than in men. Chorea is only fatal when the patient can not sleep. Malignant tumors are more rapidly fatal in the young than in the old. Cancers in the aged are exceedingly slow in their process, and may even in rare cases atrophy. Stone in the kidney may frequently be cured without operation. The opposite is true of stone in the bladder. Diabetes is rapidly fatal when it occurs in young men, more curable in middle life, and of little danger in later years. Diarrhea is dangerous only in infants and in persons above sixty years of age.-London Medical Examiner.

A SAENGER CESAREAN SECTION.-In a report before the Cincinnati Academy of Medicine Dr. E. S. McKee said that it had been his good fortune last spring to see a case operated on after the Saenger method. The operation was made at the Charitè Hospital by Prof. Gusserow, of the University of Berlin.

The patient, Katrina H., age eighteen years, of a very blond type, was quite short in stature; she was rachitic, did not walk until six years old, and only then with the assistance of an apparatus. Her menses appeared at fourteen years, but were always irregular. She came into the Charitè and was taken in labor. Her pains continued for two days, becoming very severe toward the last. Measurement showed the following:

These facts in the case led Prof. Gusserow to determine on cesarean section. Owing to the excellent results obtained by Saenger, Leopold, and Credé, the Saenger method was chosen.

Though the antiseptic precautions were considerable, they were not so great as is customary in Berlin for cases of laparotomy. The operator and his assistants took complete baths, put on fresh linen, and wore no clothing which had been about infectious material. The visitors were not required to bathe or change their clothing, but were in honor bound not to come had they been in contact with infectious matter within the twenty-four hours. The abdomen was washed with a solution of bichloride 1-1000, special care being given to the umbilicus.

The patient was placed under chloroform, the abdominal incision made, commencing three fingers' breadth below the umbilicus and extending within the same distance of the symphysis pubes.

The abdomen being opened the uterus presented nicely, and the walls closed behind it. A rubber tube the size of the finger was passed tightly around the uterus

just below the child's head. Provisory sutures were passed through the adductors to keep the bowels from protruding. This will be accomplished unless there is considerable vomiting. In this case this unpleasant symptom was present, and the bowels required retention by means of warm cloths. The uterus was opened and an incision beginning near the fundus and extending down to the uterine segment, that is, where peritoneum becomes movable and sits loosely. A large quantity of dark red blood shot out through the opening, showing that the placenta was in the line of incision. Cutting through this the liquor amnii burst forth. The hemorrhage which now appeared was controlled by drawing tighter on the rubber tube. The child was then removed and found alive and mature, though poorly nourished. It weighed 2.885 grams and was forty-five centimeters long. The placenta and decidua were loosened from the uterus, and great care exercised to entirely clear the uterus of all such matter. The cavity was then strewn with iodoform. The incision was then closed with silver-wire sutures, which passed through the muscles but did not penetrate the decidua. Sixteen silk sutures were then inserted, piercing the peritoneum only. Complete coaptation of the parts was carefully made. A resection of the muscularis was not found necessary in this case, as the peritoneum overlapped the muscle; in such event the resection is omitted. Hemorrhage at four points was checked by ligature. The uterus had remained relaxed since the removal of the child until this period, but was now made to contract by the application of sponges soaked in hot sublimate solution. The suture line was powdered with iodoform. The patient recovered, left her bed in eight weeks; severe vomiting was the only untoward symptom. The child lived. Prof. Gusserow is much pleased with Saenger's method, as are Credé and Leopold. The great success of the cesarean section in Germany is due to the early diagnosis and intervention in the cases by experienced operators.

MICROBIOLOGY.-The importance of microorganisms is daily assuming greater proportions. The part they play in the pathological processes of inflammation, and its consequences, suppuration and necrosis, have been already clearly pointed out. A fresh contribution has just appeared from the pen of M. Vignol, recording the results of experiments that have been for some time past carried on in the Laboratoire d'Histologie du Collège de France on the micro-organisms that are to be found in the alimentary canal.

In the first place M. Vignol made a careful investigation of the various forms of microorganisms that are to be found in the mouth in health. Before commencing it, however, he naturally asked himself the question, What is the normal or healthy state? and the reply was fraught with sc many difficulties and was so immediately dependent upon the period of life, the food, and other conditions, that he found himself at last reduced to the examination of his own mouth and its secretions, after he had spent three months in the country. For the isolation and recognition of the different forms of mircobes he obtained from the mouth, M. Vignol adopted the usual methods of procedure with sterilized gelatine, gelose, and agar-agar, in both sterilized air and in hydrogen gas. The results of his experiments give the astonishing number of eighteen distinct microbes, apart from ferments and the spores of molds, which are only accidentally or occasionally present. Among these eighteen microbes six proved to be already well known-namely, the staphylococcus pyogenes, aureus and albus, the leptothrix buccalis, the bacterium termo, the bacillus subtilis, and the vibrio rugula. Of the others, though some might have been seen by Rasmussen, Miller, and thers, their descriptions were not sufficiently exact to enable them to be identified. Of the remaining twelve, only one, named the spirochete denticula, could not be artificially cultivated, and M. Vignol has commenced a fresh series of experiments with the hope of better success in this direction. The rest

he distinguishes by italic letters, as bacillus a, bacillus b, and so on, giving their mode of growth and dimensions. M. Vignol has further endeavored to follow the action of the microbes on the food by inoculating milk and other fluids with pure cultures. By proceeding in this way he has found that the staphylococcus aureus and albus and the leptothrix buccalis (the very poisonous action of the former of which through the skin is now well known and was described by Prof. Watson Cheyne in the lectures he has just given at the Royal College of Surgeons), while incapable of attacking or effecting the solution of albumen, fibrin, or gluten, and ineffective in converting potato-starch into sugar, yet when milk was inoculated with them coagulation took place, apparently from the development of various acids, among which lactic acid was the most conspicuous. On the contrary, the bacillus subtilis, the bacterium termo, and the vibrio rugula, with the several bacilli M. Vignol has discovered, all, or almost all, render albumen transparent and dissolve albumen and fibrin, though they appear to have little action on gluten and starch. The microbes found in the mouth seem to be capable of resisting the action of the gastric, biliary, and pancreatic juices, for several hours at least.

The general conclusions at which M. Vignol arrives are that many microbes enter the economy with the food and are carried on by the saliva into the stomach. Here their activity may perhaps be temporarily lowered or arrested, while some may perhaps be destroyed, but the majority enter the small intestine and contribute by their action to render ingested substances soluble -that is to say, assimilable by the lacteals; their number, which rises to more than twenty millions per decigram in the feces, shows the intestinal media are favorable to their growth, and renders it probable that the part they play in the process of digestion and the transformation of food is not inconsiderable-conclusions that are quite in accordance with the views of Pasteur.-London Lancet.

DIPLOMA EXTRAORDINARY.-At Albany, N. Y., a man calling himself Dr. Richard M. Dayton was arrested on the 19th instant on a charge of malpractice in causing the death of Mary Willett. He claimed to be a graduate of the "American Health College, Cincinnati," for teaching and practicing the "vitapathic" system, including cures for all diseases of the body and soul. The diploma sets forth that Dayton has been fully instructed and is amply qualified. It authorizes him to legally practice the system any where in the treatment of all physical and mental diseases and to lawfully receive compensation therefor, and "in virtue of our religious organization and second incorporation, we also constitute and ordain him minister of the gospel of life and authorize him to preach and solemnize marriage according to law, to attend funerals, and to lawfully perform all ministerial offices; and by these presents we do fully constitute him doctor of health and minister of life, this 27th day of November, 1886."-Record.

MORELL MCKENZIE'S DIAGNOSIS OF THE CROWN PRINCE'S ILLNESS (Journal de Med. Feb. 26, 1888).-At the desire of his Royal Highness the Crown Prince, I seize this occasion of correcting some communications attributed to me and publishing my own opinion of his illness. It has been announced that I did not consider the illness with which the Crown Prince is suffering as cancer. I have constantly maintained that no proof of the cancerous nature of the disease has been furnished.

When, in May of 1887, I came to Berlin, contrary to the opinion of my colleagues I

maintained that the laryngeal phenomena were of a negative character; that is, that it might either be benign or malignant, and that its nature could only be determined by the microscope. With this end in view I removed a portion of the tissue and sent it to Prof. Virchow, who was unable to discover any signs of malignancy. Further examinations upon other portions gave identical results. In June, during the sojourn of H. R. H. at the Isle of Wight, I declared more than once to his illustrius father that the danger which I feared more than any other was perichondritis.

Three months later this fear was proved to be justifiable. Toward the end of October and beginning of November new symptoms appeared, presenting an appearance which would justify the diagnosis of cancer. At that time it was impossible to remove fragments for microscopic examination, and I advised, in order to be on the safe side, that the tumor should be treated as if malignant, at the same time I submitted a protocol to my colleagues in which I pointed out that, although at first sight the disease might appear to be cancer, I could not consider its malignancy established before a microscopical examination had fully demonstrated it. This document, the expression of my opinion, has been transferred to Berlin, to be preserved in the archives of the state.

Further, although the unfavorable symptoms which then existed could have been considered as pointing to the existence of cancer, this fact was clear to the attending physicians, perichondritis had occurred as a complication. By the middle of December the unfavorable symptoms had disappeared, and the clinical phenomena which pointed to the existence of a cancer existed no longer, a microscopical examination could not be made, but by the end of January a piece was secured, when a necrotic portion of the tissue detached itself from the very place which in the preceding November had presented such a suspicious appearance.

This has been examined carefully and at various times by Prof. Virchow, and this examination, publicly announced to-day, again shows that a cancerous nature can not be demonstrated.

I

To recapitulate, in my opinion the clinica symptoms were absolutely irreconcilable with the idea of malignant disease, and the microscopical examinations support me in this. There is no need of adding, that although in almost all cases of disease of the larynx it may be possible to diagnose the nature of the malady at first sight, still in rare instances the progress of the disease alone can determine its character with precision. Unfortunately the disease of H. R. H. the Crown Prince belongs to that last category, and at this time the science of medicine permits me to make no other diagnosis than a chronic inflammation of the larynx complicated by perichondritis.

THE ALUMNI ASSOCIATION OF THE MEDICOCHIRURGICAL COLLEGE OF PHILADELPHIA will give a dinner in honor of Surgeon General John B Hamilton, M. D., U. S M. H. S., on Thursday, April 5, 1888, at the College, Cherry Street below Eighteenth Street, at 9 o'clock P. M. On the same evening Dr. Hamilton will deliver the annual address of the Association.

THE MEDICAL ASSOCIATION OF THE STATE OF ALABAMA will meet at Montgomery, Tuesday, Wednesday, Thursday, and Friday, April 10, 11, 12, and 13, 1888.

SPECIAL NOTICES.

PEPSINS.- Dr. William Murrell, than whom no higher authority in therapeutics lives, says that during the last two years he has carefully tested all the pepsins of which he has been able to obtain specimens. Of two different kinds of pepsins, equally popular, one was found to be five times stronger than the other. The French and German pepsins were a long way down in the list and could not for a moment be compared with either the English or the American. The best pepsin examined was Fairchild's. The plan of digesting milk and other articles of food with pancreatic extract answered admirably and should always be resorted to in intractable cases.

CONSTIPATION IN PREGNANCY; HEMORRHOIDS. C. B. Horrell, M. D., Colchester, Ill., says: After a careful trial of Acid Mannate, I have no hesitancy in recommending it as a safe and reliable laxative. For ladies enceinte, it is indeed a God-send, being quite palatable and effective. In the temporary hemorrhoids sometimes following parturition my patients invariably acknowledge relief after one or two doses of the Acid Mannate are administered.

VOL. V. [NEW SERIES.]

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than any thing else.-RUSKIN.

Original Articles.

A TYPHOID FEVER EPIDEMIC.

BY C. B. JOHNSON, M. D.

CASE 1. July 25, 1887. I was called upon to visit a young man, twenty-four years of age, sick at the Barker farm-house six miles in the country.

I found my patient had arrived at the farmhouse a few hours previously from a western State, whither he had gone a year or more before to open up a new farm. Patient had considerable fever and headache, was sick at the stomach, and complained of pain in the back and legs, together with more or less soreness throughout the body. His tongue was coated with a brownish-yellow fur and his bowels were constipated.

On inquiry I learned that about sixty hours before my visit he had had a chill, and very soon after took a long ride across the country to a railway station and spent the subsequent two days in travel. With this history before me, I attributed his symptoms to an attack of malarial fever, aggravated by the fatigue of a long journey in the very hot weather then prevailing. With this view of the case, the patient was put upon anti-periodics.

Next day, but one, I again called, but was met at the door by his attendant, who, in great alarm told me that she had just given him by mistake a teaspoonful of pure carbolic acid instead of the regular medicine. The patient complained of a burning pain. that extended from the mouth to the epigas

No. 7.

tric region. A profuse sweat covered his body, and his pulse was quite feeble. It was, however, ascertained that the carbolic acid had been immediately thrown up, and that the nurse, discovering her mistake, had given him sweet milk freely. Morphine and strong coffee were given and the shock treated by stimulants. The patient suffered with sore throat and irritable stomach for two or three days, when all effects of the carbolic acid disappeared.

This incident served to divert my attention from the patient's real ailment, which soon after was found to be typhoid fever. For epistaxis, gurgling in the right iliac region, tympany and subsultus tendinum, together with continued fever made plain the nature of the disease.

Up to this time the patient's bowels were constipated, and, castor oil being a favorite cathartic with him, he was permitted to use it in full doses. The real nature of the disease not being suspected, no means had been employed to destroy the dejecta. The oil was discontinued, and the discharges which continued for some days thereafter were disinfected after the usual manner. The patient kept his bed for five weeks and made a good

recovery.

At the time of this young man's arrival from the West, a steam-thresher was running at the farm-house, and remained there three days. It was attended by twenty-nine men and boys, five of whom were the patient's brothers, and the remainder, for the most part, neighbors and friends.

The subsequent history of this party of twenty-nine persons becomes interesting, for in the month of August following sixteen of the number were stricken with typhoid fever, two, I am quite sure, had it lightly, and