tion Company is the only line approved by the Committee on Foreign Transportation, because this line offers at reduced rates to all the members of the Association and their direct family round-trip ocean-passage in first cabin at $90 per full ticket in inside rooms, and $105 per full ticket in outside rooms.

In the Medical Journal of March 8th you will find the whole arrangements made with the Committee.

As our steamers are rapidly filling, and many physicians have already secured their berths, it is strongly recommended to all who intend to go to Europe to secure their berths as early as possible, by remitting us the requisite deposit money of $10 per adult. The balance of the passage money must be paid at least two weeks prior to sailing.

The first comer gets the best place.

All further information about staterooms, the ocean voyage, or the journey in Europe will be cheerfully furnished on application at the Company's passenger offices, 39 Broadway, New York, and 86 La Salle street, Chicago, Ill.

Theobromin, a constituent of cocoa, is chemically almost identical with caffein; caffein is a trimethyl-xanthin, and theobromin is a dimethyl-xanthin. Both caffein and theobromin act as diuretics, but the latter possesses many advantages in therapeutic application.

During this year's convention of German. scientists at Heidelberg, Dr. v. Schroeder, of Strassburg, reported on therapeutic experiments made by Dr. Gram, of Copenhagen, at the local clinic. The results of this investigation were summarized as follows:

1. Theobromin is a diuretic whose therapeutic value is due to direct action on the kidneys, as proved by v. Schroeder for both caffein and theobromin.

2. The radical difference between theobromin and caffein lies in the want of theobromin to excite the nerves; and its use is not, therefore, accompanied by sleeplessness, unrest, and similar depressant effects which are caused by

caffein and make its action uncertain and often harmful.

Theobromin is to a certain extent a caffein without its depressant nerve effect, while acting fully on the kidneys, and may therefore be termed a pure kidney specific.

3. Theobromin has effected good diuresis in kidney and heart affections, even in cases where digitalis and strophanthus failed to give satis faction.

4. Pure theobromin is not suitable for use; it is soluble is not less than 1600 parts of water at ordinary temperature, difficultly absorbed by the system, and causes nausea.

Dr. Gram therefore recommends the use of theobromin-natrium salicylicum (diuretin) the use of which he found gave no ill side-effects even when administered to very weak patients.

Diuretin is a white powder, soluble in one half its own weight of water when warmed, and remaining dissolved after cooling. The dose is 15 grains, with a maximum total per day of 90 grains.

A PASTEUR INSTITUTE has been opened in New York City by Dr. Paul Gibert for the preventive treatment of hydrophobia and the study of contagious diseases. Dr. Gibert will be assisted by Drs. G. Van Schaick and A. Liautard.

DAMAGE SUIT.-Physicians in the western. part of Massachusetts are much interested in the case, lately tried in Springfield, of Homer C. Ross against Dr. Wallace H. Dean, of Blandford. The plaintiff asserted that he had lost the use of an arm because it was improperly set by Dr. Dean after it was broken in an accident. But the best known doctors of the vicinity testified that the treatment was all right, and that the arm could be used. Dr. Francis Bacon, of New Haven, extended the man's arms and held them up for a time, when he suddenly stopped supporting them. The fact that they remained extended long enough to exhibit the absence of paralysis was conclusive. The result was, that Judge Barker instructed the jury to bring in a verdict for Dr. Dean without leaving their seats.-Boston Medical and Surgical Journal.

REVISION OF THE UNITED STATES PHARMACOPEIA: OFFICIAL ANNOUNCEMENT.-The convention for the revision of the United States Pharmacopeia will be held in the city of Washington, May 7, 1890, at noon. As it is necessary that some preliminary arrangements should be prepared in advance of the convention, I have taken upon myself the responsibility of appointing the following delegates to act as a Committee of Arrangements: Dr. Samuel C. Busey, Dr. C. H. A. Kleinschmidt, Dr. Robert T. Edes, of Washington; Mr. P. W. Bedford, of New York, and a committee appointed by the National College of Pharmacy of the following members: W. S. Thompson, J. A. Milburn, and S. E. Waggaman, M. D. As soon as arrangements are completed a circular will be mailed to each organization whose credentials are received by me before April 10th, and to any delegate who will forward his address on a stamped envelope inclosed to me. Robert Amory, President Convention, 1880.

ANNOUNCEMENT.-Beginning with the issue for March, 1890, the Annals of Gynecology, formerly published in Boston, was enlarged and improved, and a Department of Pediatry added, under the editorship of Dr. Louis Starr, of Philadelphia, formerly Professor of Diseases of Children at the University of Pennsylvania, author of "Hygiene of the Nursery," associate editor of " Pepper's System of Medicine," Physician to the Children's Hospital, and author of" Diseases of the Digestive Organs." The journal is now published by the University of Pennsylvania Press, Philadelphia, under the name Annals of Gynecology and Pediatry. Dr. E. W. Cu-hing, of Boston, who has recently become surgeon of the Woman's Charity Club Hospital for Women, continues to edit the Department of Gynecology.

WESTERN PENNSYLVANIA MEDICAL COL LEGE-The Fourth Annual Commencement Exercises of the Western Pennsylvania Medical College were held in the Grand Opera House, Pitt-burgh, on March 27th. The degree of M. D. was conferred on twenty-nine graduates, being about twenty-five per cent of the class in attendance during the past term.

In the evening of the same day the Alumni Association of the college, now numbering one hundred and twenty, was entertained by the Faculty at a banquet provided at the Seventh Avenue Hotel.

THE FIRST VICE-PRESIDENT OF THE AMERICAN MEDICAL ASSOCIATION DEAD.--John W. Jackson, M. D., who was the first Vice-President of the American Medical Association, died at Kansas City, March 13th, of embolic pneumonia resulting from pyemia, at the age of fifty-eight. He was the chief surgeon of the Wabash railway system, and last year was President of the National Association of Railway Surgeons.

J. M. RITTER, M. D., Richmond, Ia., says: My experience with S. H. Kennedy's Extract of Pinus Canadensis has been highly satisfactory, especially in the treatment of gonorrhea and gleet. In these lesions I regard S. H. Kennedy's Extract of Pinus Canadensis as the remedy par excellence. In one obstinate case of gleet, particularly, I obtained the very best results from the remedy as an injection. The case was one of six months' standing; the patient had consulted other physicians, but with negative results. I prescribed the Pinus Canadensis (white) as an injection, properly diluted. The malady yielded immediately, the discharge lessened, and finally yielded entirely, to the great delight of the patient.

THE following story is told by a New York physician of the late Willard Parker:

"When Dr. Parker was just beginning his famous career he was sent for by a rich but avaricious man who had dislocated his jaw. The young surgeon promptly put the member in place. What is your bill, doctor?' asked the patient. Fifty dollars, sir.' 'Great heaven!' And the man opened his mouth so wide as to dislocate his jaw a second time. Dr. Parker again put things to rights. What did you say your bill was?' again asked the patient. 'I said it was $50; now it is $100.' The man grumbled, but paid it.”

THE STATE SOCIETY.-The Kentucky State Medical Society will meet at Henderson, May. 14, 1890. From latest advices it appears that a programme of unusual interest has been prepared, while full arrangements have been made. by the profession and citizens of our sister city for giving the delegates a warm welcome.

MEDICAL LEGISLATION IN ALABAMA AND FLORIDA.-The Medical Practice Act of Alabama has been found to be ineffective for the prosecution of illegal practitioners, by reason of a failure in the enactment to prescribe a penalty. This omission will probably be remedied by the legislature of the current year. The Medical Act for the State of Florida is also said to have a defect, in that it does not specify that an examination in the practice of medicine shall be required of candidates. This oversight it is thought may be obviated by making the examination in therapeutics broad enough to embrace the omitted branch.-Journal American Medical Association.

SICKLY CHILDREN AT Two DOLLARS.When Stanley's expedition reached Usambiro, the station of Missionary Mackay, on the south shore of the Victoria Nyanza, the sick list was so heavy that a halt for rest was imperative. Mr. Mackay soon found that the feeble and sick children were being bought up by the natives for two goats apiece, so that he was led to purchase about twenty-five weak children, " on Mission account," to save them from slavery. To use his own words, "The amount I have paid is two dollars per head."

NEW YORK BENEFICENCE.-The returns from the annual hospital Saturday and Sunday collections for 1889, in the city of New York, which are probably very nearly complete, amount, up to the present time, to $57,021, thus making the largest collection ever made. In 1879, the year in which the collection was started, $26,465 was received; in 1880, $14,535; in 1885, $46,085; in 1886, $53,051; in 1887, $50,449, and in 1888, $52,039.

The

AMERICAN MEDICAL ASSOCIATION. forty-first annual session will be be held in Nashville, Tenn., on Tuesday, Wednesday, Thursday, and Friday, May 20th, 21st, 22d, The addres-es will be given on "General Mediand 23d, commencing on Tuesday at 11 A. M. cine," by Dr. N. S. Davis, Chicago, Ill.; "General Surgery," by Dr. Samuel Logan, New Orleans, La.; "State Medicine," by Dr. Alfred L. Carroll, New York, N. Y.

A FORTUNE FROM ANTIPYRIN.-Dr. Knorr, the discoverer of antipyrin, has found a mine of wealth in the late epidemic of influenza, having taken in, by means of his royalties, considerably more than a million of dollars. He gets sixty cents on every ounce produced, and the drug sells at $1.40 per ounce. This, if true, would indicate a consumption of not less than forty tons of the article by the victims of la grippe.

DR. MICHAEL FOSTER has been elected a member of the Italian Reale Accademia dei Lincei in the Section of Physical, Mathematical, and Natural Sciences. Among the other foreign members elected at the same time were M. Berthelot, Dr. A. Chauveau, and Prof. Karl von Nægeli, and W. Kühne.

THE newly recommended ferruginous tonic hemoglobin, announced by the pharmacists, is somewhat expensive. Deschiens recommends the following formula: Hemoglobin, 100 grams, syrup, q. 8. to make one liter. At the rate which American druggists charge for it in prescriptions (five cents a grain) the above prescription would cost just $75 for the hemoglobin, to say nothing of the syrup.

VOL. IX. [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 dinourisht facts at present more than any thing else. -KUSKIN,

Original Articles.

A CASE OF PURULENT EXUDATIVE PERI

TONITIS.

Illustrating the Possibilities of Laparotomy.

BY E. J. KEMPF, M. D.

I

L. K., a married lady, twenty-eight years old, of ordinarily good health, the mother of three children, had an attack of remittent fever, followed by an abortion. She had no physician before I was called in. I found the patient pale and weak from loss of blood; her temperature was 103° F., pulse 120; she complained of pain in the back and also of pain in urinating; her abdomen was swollen and tender, and there was a whitish, bad-smelling discharge from the vagina. washed out the vagina with a hot 1 to 4,000 corrosive-sublimate solution, and then curetted the cavity of the uterus with a dull curette. Shreds of membrane and clots of blood came away. I then washed out the uterus with diluted tincture of iodine, after which I applied a tampon of glycerine on borated cotton. The uterus seemed excessively tender and swollen, and I have no doubt that it was in a state of inflammation; the vaginal vault was hard; the abdomen was tender, especially on the right side, and there was slight tympanites. For these symptoms I prescribed hot applications to the abdomen, and antifebrine, morphine, quinine, and calomel internally. The hot vaginal injections and glycerine tampons were used twice a day for a week, when, the acute symptoms subsiding, the fever disappearing,

No. 9.

and the patient getting better, I directed the hot vaginal injections to be used once a day.

Afterward I treated the patient with glycerine tampons for six months, when the treatment was discontinued, as the patient seemed well, could do her work, and was as strong as

ever.

One year after the first illness my patient became very ill almost suddenly. She had a chill, followed by a fever. Her pulse was 120, full and bounding; her abdomen was tympanitic and excessively tender; she had great pain in her abdomen, in the uterus, and in the pelvis; there was a discharge of dark blood from the uterus; the vaginal vault was as hard as a board, and there was great pain in the posterior part of the vaginal vault. I used the same treatment as in the first attack. My patient, however, got worse and worse, and seemed very sick. The pain spread over the whole abdomen and was intense. The tympanites or swelling of the abdomen became enormous; the temperature ranged from 100° F. to 104° F.; pulse was generally from 140 to 150, very frequent, small and hard; consciousness remained almost painfully clear; the tongue was furred, red, and very dry; a bitter, disagreeable taste was complained of, and the breath was foul; the facial expression was one of great anxiety, the eyeballs seemed to have fallen back into the head, the nose was pinched and the edges were waxy, and the voice was weak and irritable; the irritability of the stomach was very great, there was instant rejection of every thing that she took except milk and lime-water, so that I had to give the morphine hypodermically; the bowels were constipated; the urine was high-colored; the belly was smooth and regular and intensely tender, and a full tympanitic note was found on percussion.

This state of affairs continued with little variation for eighteen days, and I wondered. why my patient did not die. I was almost constantly in attendance and continually urged a laparotomy, which was obstinately refused.

The case assumed a chronic form and the patient was slowly succumbing to septicemia. She no longer cared what was done to her, and I obtained the consent of her husband and family to perform a laparotomy upon the dying patient, who was upon the point of collapse.

With the assistance of Drs. M. Kempf and J. P. Salb I performed the following operation: I gave the patient an ounce of whisky by mouth, and one half grain morphine (she was accustomed to the drug) and grain of atropine hypodermically. We then lifted her on to a table properly prepared with oil-cloths, blankets, and sheets, and put her under the influence of the A. E. C. mixture. I shaved her abdomen and the pubic region, then washed off the abdomen with soap and water, afterward with corrosive-sublimate solution 1 to 1,000, covering the parts with cloths soaked in the same solution. Then, having prepared our instruments, sutures, ligatures, towels, drainage-tubes, and sponges in as aseptic a manner as we could, I made an incision four inches in length in the median line above the pubis down to the peritoneum. The peritoneum was of a grayish-yellow color, and injected to an intense degree; in fact it resembled a lot of plastic lymph held together by loose tissue. It was intensely friable, and I broke it through with the handle of the scalpel, when a thin, turbid, purulent fluid poured out. By means of an aspirator syringe we drew off fully two gallons of the liquid, which contained a large quantity of floating masses that seemed to be pus cells and flakes of lymph. After the abdomen was emptied of this fluid and the walls of the abdomen sank down to their normal level, I poured about two gallons of 1 to 20,000 corrosive-sublimate solution into the abdomen by means of a fountain syringe, washing out the abdomen thoroughly until the fluid came away clear.

I then made a thorough exploration of the abdomen with my finger. The peritoneum seemed gangrenous as far as I could examine

it; the organs of the pelvis, the intestines, and the omentum seemed inextricably matted together. I had about made up my mind to attempt the removal of the tubes and ovaries, which Dr. Salb counseled me to do, when the patient went into a state of collapse. Realizing that the patient's life hung by a thread, and that at best the case was a hopeless one, and fearing that she would die during the operation if I persisted, I concluded to make an end of the present operation. Accordingly I again flushed the abdomen with the corrosive-sublimate solution 1 to 20,000, and then put in two deep silver sutures and four silk sutures. Between these sutures I placed three large rubber drainage-tubes, one fully nine inches long, which I coiled into the pelvis. After closing the wound I applied iodoform powder, over this borated cotton several layers thick, next a sheet of oilsilk, then a piece of linen, retaining the whole by a broad bandage. We now put the patient. to bed, gave her one ounce of whisky, and applied hot water bottles to her whole body. She vomited the whisky. For twenty-four hours I allowed her nothing but cracked ice.

On the next day I found my patient a shade better. The vomiting had disappeared, the temperature was 98° F., the pulse 80 and not so wiry, the anxious expression of the face was less marked, the eyes did not look so hollow, and the patient even tried to smile. The dressing was completely soaked and had a very bad smell. I placed the patient on the table as during the operation, removed the dressings, and flushed the abdomen with a 1 to 2,000 corrosive-sublimate solution, using about four gal lons of the fluid. There was a good deal of pus on the cotton, and therefore I let run about a gallon of boiled distilled water into the abdomen through the tubes, very nearly all of which escaped in a short time. I then put on the dressing as before.

On the fourth day I removed one of the silver sutures and two silk sutures, as they were causing suppuration in their tract. This left quite an opening into the abdomen, through which a mass of necrosed tissue, very friable, bulged out. I now took all the sutures out, and the wound opened, letting out the mass of necrosed tissue, which I found readily detect