is absence of all breath sounds below the in- | and examining it,—a method that invariably ferior angle of the scapula, but above the latter gives positive results. point a crepitating friction, combined with a creaking sound. This crepitating râle is quite common in empyema, after the effusion has been in great part removed, and is very difficult to distinguish from the crepitation met with in cases of pneumonia. The history and the fact that it is associated with the leathery, creaking friction rub serve to clear up its nature in this case. Below the upper level of the fluid there is absence of vocal resonance. Over the left lung the respiratory murmur is puerile. The diagnosis of empyema, in this instance, was free from difficulties. It rested on the rational symptoms, particularly the suppurative type of temperature-curve, the physical signs of pleural effusion, and the results of aspiration. The recognition of pleural effusion is rarely difficult in the adult, but the character of the pleural exudate, whether sero-fibrinous or purulent, often remains in doubt until after aspiration has been performed. The symptoms, however, are often significant, as in the case before us. Let me emphasize the fact that the daily occurrence of rigors, fevers, and sweats, when a pleural effusion is present, points strongly to the presence of a purulent exudate. The bulging of the chest-wall, as well as the displacement of neighboring organs, is also apt to be more marked in purulent effusions than in sero fibrinous ones. Again, the chest-walls may be the seat of oedema in empyema,-a condition rarely noted in serous effusion. The etiological circumstances are rarely of great value. The patient is often a sufferer from pulmonary tuberculosis, which may be followed by sero-fibrinous pleurisy on the one hand, or by empyema, as in this case, on the other hand. Quite often empyema follows sero-fibrinous pleurisy. Both sero-fibrinous and purulent pleurisy are frequently secondary to other affections, and, for the most part, too, follow the same affections. Empyema may be a primary disease, though rarely, as when caused by infection with the pneumococci or the bacillus of Eberth. Finally, any or all of the above-mentioned pleurisies may occur in a tuberculous subject, though they cannot always be regarded as being of tuberculous origin. It is always well to settle the question of the discrimination of these two forms of pleurisy by withdrawing a small amount of the exudate The most interesting feature connected with the present case for which there may be an obvious explanation has yet to be told. You will observe from the history that, since the 25th day of May until the present,—about five months, there has been a little tendency to re-accumulation of the exudate. She informed me, at the time of re-admission into the hospital, that she had, ever since her former discharge (June 12th), been expectorating much yellow matter. At first thought, it occurred to me that a fistulous communication might have been set up between the pleural sac and a bronchus; but the absence of all physical signs pointing to pyopneumothorax rendered this view untenable. It is probable that some, at least, of the pus that she has been, and is, expectorating so freely comes from the pleural sac; that there has been localized destruction (necrosis) of the pulmonary pleura, followed by soaking of the exudate through the lungs into the alveoli or bronchi, as first pointed out by Traube. Such instances sometimes terminate in recovery, when not associated with tuberculosis. They are rare, indeed. The prognosis in this case is grave, for the reason that the patient is a victim of tuberculous disease; but, independently of other affections, empyema is a serious disease. The treatment of empyema, when it is associated with pulmonary tuberculosis, is identical with the treatment of sero-fibrinous pleurisy. The same indications for aspiration are presented, but a radical operation is not to be undertaken. For the pulmonary consumption she is using creasote internally (mv, t. i. d.) and also the syrup of the hypophosphites (3j, t. i. d.). SIR THOMAS CRAWFORD.-We learn from our foreign exchanges the death of Sir Thomas Crawford, K.C.B., LL.D, etc. Sir Thomas Crawford was a native of the North of Ireland and was born in 1824. He entered the Army Medical Service in 1843, served through the Burmese War of 1852-1853, in the Crimea, and in India. He returned to England in 1882 to assume the duties of Director-General of the Army Medical Service, which office he filled until his retirement, in 1889. PROFESSOR HENRY W. RAND, of the Long Island College Hospital, recently departed this life. ORIGINAL COMMUNICATIONS. MICROSCOPICAL REPORT OF blood and detritus. The connective tissue of the stroma was markedly proliferated and contained numerous blood-vessels. Here and there deposits of pigment, probably due to A PEDUNCULATED TUMOR capillary hemorrhages into the stroma, were GROWING FROM THE OVI DUCT BY ALEXANDER KLEIN, M.D., Tutor on Pathology. found. ANATOMICAL DIAGNOSIS. Rudimentary duct of probably embryonal [Service of PROF. W. EASTERLY ASHTON, Medico Chirurgical origin (Müller's ducts) communicating with Hospital of Philadelphia.] the lumen of the tube, showing chronic inflammatory changes and hæmorrhages into its lumen as well as into the stroma. [It is impossible to say, with a certainty, whether the peculiar bean-shaped enlargement at the end of the pedicle was of original formation or not. The presence of a considerable quantity of blood and fluids, together of a medium-sized bean. On section the latter was found to contain blood and detritus. The pedicle contained a fine hair-like lumen, which seemed to communicate with the cyst below and with the lumen of the oviduct above. The growth bore no evidence of being adherent to any other structure. MICROSCOPICAL APPEARANCE. Sections of the pedicle showed the same to consist of a dense lining membrane, a distinctly glandular structure rich in bloodvessels, and an inner lumen, the latter in places distinctly lined with columnar epithelium. The above-mentioned bean-shaped, cyst-like body consisted of an outer fibrous membrane and an inner lumen subdivided by septa, the latter only partly covered with columnar epithelial cells (probably due to inflammatory exfoliation). Between the septa were found with the distorted appearance of the septa, seem, to my mind, to point to a secondary change.] CONJUGAL ONANISM. By J. A. DE ARMAND, M.D., ROM time to time medical writers volun FROM teer some plan, not always new or promising, for the suppression of the device, more or less universal, which receives the designation given above. A late writer in the St. Louis Courier of Medicine, after reciting a case not at all remarkable or out of the ordinary, expresses the conviction that if somebody would write a book which could be read and understood by the laity a great evil would be overcome. Admitting this to be a consummation devoutly to be wished for, yet the writing of a book or a dozen books would hardly accomplish in a small degree the | line undeviated from in the lower orders, may wonders dreamed of. A few years ago an or may not be in a state of congestive exciteIowa author expressed the opinion that nothing ment at the time of congress. This being true, short of acquainting the laity with a safe and it manifestly cannot prove so very harmful if harmless means of preventing conception would the act is abridged in its duration or limited in uproot a social evil which, in his opinion, was its extent. An old and more or less fanciful fast bringing to invalidism unnumbered men theory gave to the complete sexual act the and women. This whole question needs to be complimentary flattery of relieving the conhandled with delicacy, for, while it is one that gestion of the os uteri and neighboring parts concerns and probably affects the present and by the contact with the seminal fluid. This is future people, it is not one that needs to be a theory that never had any bottom to stand hawked about to the edification of a few people on. So far, then, as the female is concerned, who enjoy the border line of dangerous there can be very little, if any, harm resulting ground. from the sudden interruption or termination of an act that is largely a passive one. With a view to studying this question in a few of its details, let us notice not only some of the means offered for relief, but the conditions which are supposed to call loudly for relief. Let us notice the result of the participation in the vice, that its effects may be studied as a group instead of by the selection of an isolated case for oratorical hysterics. carnal pleasure, there do not seem to be strong grounds for believing that safety lies alone in normally performing an abnormal act. The seminal fluid is fabricated as demanded. The powers of the human organism, in its efforts to keep step with a perverted judgment and a penchant that is ungoverned, is one of the most remarkable traits of which our bodies are examples. Most writers on this subject, so far as my observation goes, find much to bemoan for the man in this lapsus naturæ. When it is remembered that a very large proportion of these same writers find no reason for offering anything but matrimony as a cure for the seminal losses and sexual weakness which follow selfBy conjugal onanism is meant the interrup- abuse, it is not strange that their wild fears are tion of the copulative act whereby the seminal estimated on the basis of worth, and not judged fluid is not permitted to enter the vagina. by the pitch at which they are delivered. The aim is the prevention of conception. A When it is remembered that the sexual act has number of mechanical devices have been been prostituted from the purpose of propaoffered, having for their aim the accomplish-gating and continuing the race to an act for ment of this purpose. Thus far none of them can be considered effective, and surely none are devoid of harmful effects. The first matter that presents itself, aside from an ultra-moral ground founded on scriptural injunction, which need not concern us here, being a matter for consideration at the hands of ano: her profession entirely, is in what manner is the act injurious and which of the parties is most affected. Sexual congress is a physiological act which in its scope and diversity runs through the entire animal kingdom. It is almost as varied in its means as its representatives are in outline and characteristics. In the alchemy of nature there is the egg and the seed, and this fact is the same all through the scale from man down. The means of accomplishment of conception differ, but the end attained is the same. Many of the attendant circumstances of the act cannot be considered as essential to its accomplishment. The female is passive so far as the physiological act is concerned. Any cerebral sensations which may attend the act are incidental only and do not affect in any way the success or failure of the act itself. The condition of the female organs of generation, not following the The copulative act in the male is the exact converse of that in the female. The mere loss of semen is the smallest part of the loss. Through the abuse incident to undue, intense, or prolonged excitement of the nervous telegraphy between the organs of generation and the spinal cord there is danger of injury both serious and lasting. This fact is just as true, although the degree is less, in natural as in artificial means. Unduly repeated acts injure the nervous control and, the greater the violence, the greater the injury. Nature will supply the material, but the sexual orgasm being a nervous explosion akin to a convulsion, if too frequently repeated, will injure the nervous system controlling the function. There can be no doubt but that any deviation from nature's plan Underlying this whole question is a principle which affects countless thousands of the race. The fear and dread of a progeny which poverty and ill health make undesirable on one hand and an unbridled passion on the other are the factors which break up the home or lead to crime against the moral law. The truth of the whole matter to the physician lies in counseling moderation. He does his whole duty who points out the pitfalls that lie ahead. The result of lust is everywhere and always the same. It matters not which road is taken, the landing place is the same old vile depot. To warn the weak and erring is all that can be done, but in doing it let not the cry be in any degree hysterical. There is no great thoroughfare, but there are countless thousands of paths leading to soul-torture and bodily pain, and more is the pity there are so many who will follow them. is more or less fraught with harm, but the | that diphtheria is due to a specific micro ordanger lies not entirely in the manner, since ganism. When and where this specific virus hopeless and irreparable harm often comes from originates science as yet has not been able to simple repetitions of a physiological act. strictly locate. When once established, when a nidus has formed, the question is easily solved; but how can we account for isolated cases? From what we have experienced, our belief is that there is a peculiar effluvia, miasma, or specific bacillus that arises from the ground, and, meeting with a favorable culture-medium, there inoculates itself. Every case of diphtheria that we have treated has been with persons exposed to the inclemencies of the weather, whose clothing or feet had become damp and remained in this condition for hours. To illustrate: H. S., aged 12 years, was allowed to go barefooted during a very damp, rainy day. In the evening he was seized with a chill. The next day he complained of soreness in the throat, with enlargement of the glands of the neck. The day following there was noticed, on the right tonsil, a small diphtheritic deposit. This rapidly spread, and in three days had involved both tonsils, the arch of palate, uvula, and extended into the posterior nares. We might enumerate other cases of the same description. This patient had been exposed, and in his physical condition formed a suitable nidus. This was strictly an isolated case occurring in a town of twelve hundred inhabitants. Then I would not offer to further attack the citadels of virtue and innocence with any devices for controverting nature's plan; I would not rush into print offering to the laity a book that would exaggerate into a crime a procedure that lack of better knowledge makes the only means a poverty-wracked people have of preserving domestic unity; and, finally, I would advise the counseling of weak and suffering humanity that moderation in all the conduct of life is indispensable to a manhood and womanhood of health and an old age of peace and content. HERE is probably no disease in the category of medicine, which the physician is called to treat, fraught with more uncertainty than diphtheria. Much has been said and written. We purpose, therefore, not to enter into any lengthy discussions concerning its etiology or symptomatology further than to serve the object in view. Diphtheria is generally accepted by the profession as a highly contagious disease. From our experience we would rather term it infectious, as we seldom see two cases occurring in the same family. This may be attributed to isolation, carefulness, and cleanliness. Treatment. This is the subject of all im portance in dealing with this dread disease. Let the cause be what it may,-accepting the theory that it is both contagious and infectious, -we now come to the medicaments to be employed, remembering that we have a systemic as well as a local treatment to inaugurate. We fear that physicians in general are led to lay too much stress on the local, neglecting the systemic management. The Local Treatment.-Space would not allow us to enumerate the many remedies that Let the reader, consequently, assume have been recommended. Let the application that any intelligent physician who has had ex- be what it may, it should be mild. The phyperience in the treatment of this disease can sician of to-day would not think of making the make a correct diagnosis. strong applications that were made in times Etiology -The concordance of opinion is past. Think of applying to the delicate mem The What can we say for the application of the solid stick of nitrate of silver? We most em brane of the throat and fauces (made still more | morning, noon, and night, in doses propordelicate by reason of the inflammation) such tionate to age. Let the dose be a stimulant, strong drugs and preparations as the undiluted not a sedative. For a child, gr. j. tincture of iron, phenol, hydrochloric acid, nourishment should be most nutritious,-milk and strong solutions of potassium chlorate! with the addition of cream, beef tea, rice, and Such applications are contrary to reason, un- broths. scientific, and do absolute harm. They have a tendency to cause the spread of the disease by their escharotic action on the healthy parts-phatically protest against its use, for silver making new fields for the inoculation of the poison. We want, therefore, a remedy which is mild, efficacious, and possessed of antiseptic virtues. There have been no remedies in our experience that meet the indications better than a combination of menthol and alcohol. And the results we have obtained from the administration of these two drugs make us rather sanguine in presenting them to the profession. Alcohol, we believe, has been the sheet anchor of our treatment. Alcohol, without a doubt, is one of the best antiseptics we possess. It acts in a twofold manner,— first, as an antiseptic; second, as a stimulant; for there is no disease that indicates antisepsis or requires early and persistent stimulation more than diphtheria. Sig. Teaspoonful every hour, diluted if necessary. Let the patient use the solution as a gargle as well as internally. This is for a child from 8 to 10 years; for an adult, double the dose. Do not expect, after the first application, to see the membrane vanish; but persist in its administration, and you will find that, after three or four days, the membrane will gradually fade and disappear. To the above we have, on several occasions, added 5 grains of potassium chlorate. This we think an improvement. The advantage of this formula is that it combines the local with the systemic treatment. You need a stimulant to assist the flagging heart and exhausted nervous system, for here falls the virulence of the malady. In connection with this quinine may be given, nitrate will not stay the spread of the diphtheritic deposit; as said before, strong applications, if allowed to come in contact with healthy parts, are only a means of forming a nidus for auto-inoculation. If applied with all care, what good can it accomplish further than an antiseptic? And we have other remedies that are safer and more applicable than silver nitrate. Under this form of treatment that we have outlined and followed we have not seen those cases of extreme nervous prostration, but the weak heart has been stimulated and the entire system invigorated. The membrane has not extensively spread after the administration of remedies; and, more, we have not, thus far, seen a patient die. We do not wish to convey the false impression that we have never lost a diphtheritic patient; we have under other forms of treatment, but none, thus far, under this. My experience with this disease has not been as extensive as some, yet I hold that alcohol and menthol are potent remedies; and any communications from brother-physicians on this subject will be kindly received and cheerfully answered. ABSTRACTS. ACUTE INFLAMMATION OF THE LINGUAL TONSIL. At the second French Congress of Internal Medicine M. Beausoleil, of Bordeaux, remarked that the lingual tonsil may become inflamed from the same causes which produce inflammation of the palatine tonsil. The attack may begin suddenly; generally it is gradual. The patient experiences various troubles at the back part of the throat, the sensation as if a foreign body were in that situation, and is constantly endeavoring to swallow or expel the object. Deglutition, difficult from the first, becomes very painful, and patients may refuse all nourishment during the acute |