to show the value of the deceased's life, damages if found at all, could be merely nominal, such as six cents on the dollar. Jury found for plaintiff in the sum of a dollar. Verdict was set aside by the Court as unwarranted by the evidence. At the second trial the jury found for the plaintiff in the sum of fifty dollars.

Remarks.-The operation of thoracentesis is of great antiquity, being mentioned in the writings of Hippocrates, Galen, Paulus, Egenetæ and Celsus. It was performed by them for the relief of empyema, but the operation as applied to cases of hydrothorax was not performed previous to the first part of the seventeenth century.

Among the important questions bearing upon the preceding case, and on which experts were requested to enlighten the jury, are the following. They are appended for the benefit of the reader, and may furnish food for thought.

I. "Do you know of any cases on record in the medical text-books where the surgeon, in attempting to remove an effusion from the pleural cavity, has plunged his instrument through the diaphragm, into the liver, with fatal effect?"

Answer. Donaldson, in "American System of Medicine," vol. iii., p. 533: "Aran plunged a trocar into the liver when operating through the same point," viz., the seventh intercostal space. Aitken, "Science and Practice of Medicine," vol. ii., pp. 673 and 674, edition of 1866, says: "The most appropriate spot of puncture is between the seventh and eighth, or eighth and ninth, or ninth and tenth ribs, in a line let fall from the lower angle of the scapula; but as a rule, let the trocar be introduced as low down as possible consistent with the safety of important organs in the chest or abdomen. The exact position of the liver and spleen must be determined first in every instance. Lænnec himself once transfixed the diaphragm and pierced the liver, and that through the fifth intercostal space. An enlarged liver or spleen may be detected as high as the fifth rib. Dr. Watson once witnessed an operation in which the trocar was pushed through the diaphragm into the spleen, which was unusually large. The patient died a day or two later of peritonitis. * "The point of the instrument should be raised rather than depressed, so as to avoid injury to the diaphragm, liver or spleen."

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II. "Supposing a needle three inches long be inserted into the sixth intercostal space, over the right side and on the axillary line, and at a right angle to the chest wall, what

important organ would such a needle pass through or injure, assuming the parts to be in their normal position?"

III. "Would it be possible in your opinion to produce a wound, one inch in length and one-eighth of an inch deep, by means of the needle of an aspirator introduced at right angles to the body, for a distance of three inches, into the seventh intercostal space on the right side, assuming the organs to be in their normal position?"

IV. "What is the distance from the sixth intercostal space on the mid-axillary line of the right side to the nearest point of the liver, assuming the parts to be in their normal position ?"

V. "Assuming the needle of an aspirator to be inserted at the sixth intercostal space of the right side, passing through both layers of the pleura, through the diaphragm, and through both layers of the peritoneum, would it be possible to produce, in the convex surface of the liver, a wound one inch in length and one-eighth of an inch in depth?"-Med. Rec.

Cæsarean Section.-University Hospital.

BY PROFESSOR WILLIAM GOOdell.

AT the clinic of Professor William Goodell, held at the University Hospital on Wednesday, 13th inst., the highly interesting operation of Cæsarean section upon a woman, the victim of carcinoma of the cervix, was performed before a large class of students and members of the profession. Professor Goodell, before presenting the patient, stated she was thirty-two years old, and had given birth to eight children.

The first intimation of the presence of the malignant. growth manifested was hæmorrhage from the uterus, which appeared about a year previous, when on examination the true condition of her ailment was revealed. She was admitted to the hospital last October, when the cancerous mass was curetted and thoroughly cauterized by Paquelin's cautery. About two weeks after this operation, the patient declared she had felt distinct foetal movements within her abdomen, which was the first knowledge she had that she was pregnant. As the cancerous tumor had progressed to such an extent as to completely block up the cervix, Professor Goodell thought it would be impossible to extract a

living child per vaginum, or deliver the woman without danger to her life. At this date, through reckoning of the fœtal movements, the pregnancy lacked from one to two weeks of full time. Consequently he brought the patient before the class to deliver her by the new Cæsarean section. The patient was then etherized and placed in the dorsorecumbent position. The abdomen was thoroughly scrubbed, and under every antiseptic precaution an incision was made in the median line, extending above and below the umbili cus. A corresponding opening was then made in the womb, which was opened in situ and the foetus revealed, with the left sacro anterior presentation, which position had been diagnosed, and demonstrated to the ward classes by Professor Goodell. The child was next delivered through the wound.

Although vigorous, it was smaller than the average size, and had evidently not reached full term. The uterus was then brought through the abdominal wound, and all hemorrhage arrested by an elastic tube passed around the cervix. The uterus and abdominal cavity were then thoroughly cleansed with hot water, and in the former were placed sixteen deep and as many superficial sutures. The external wound was then closed, and dusted over with iodoform, over which was placed iodoform gauze, cotton, and a bandage. No drainage was provided for, as it was not thought necessary. Very little blood was lost; the patient bore the operation well. The time occupied in delivering the child was three minutes, the remainder of the hour being occupied in closing the wound.

Professor Goodell stated the after-treatment would be the same as in all cases of laparotomy. Nothing would be administered by the mouth during the first twenty-four hours. If it were deemed necessary to give nourishment, nutrient enemata would be resorted to. Opium would be avoided as much as possible. If fever, tympanites, or any outward symptoms presented, saline cathartics would be administered. Professor Goodell stated he was wholly indebted to Dr. R. P. Harris, who had honored him with his presence at the operation, for the statistics he presented. One hundred and fifty-nine operations are on record as having been performed all over the world; of these fortyfive terminated fatally. Twenty-five of these operations were done in this country, with fifteen deaths.—Med. Times.

Gleanings.

DERMATITIS OF EYELIDS DUE TO ARNICA. -We have had occasion to call attention to the fact that tincture of arnica, far from being the soothing agent it is looked upon, is often a violent irritant. Dr. J. M. Crawford recently reported to the Atlanta Society of Medicine (Atlanta Medical and Surgical Journal), a case of a man of 50, who, while drinking, fell and injured his face and eyelids, breaking the skin. He applied the tincture of arnica for a half hour. Two days later the lids were so thickened that the eyeballs could not be viewed. Two days after, sloughing of the whole integument, from eye-brows to tarsal cartilages of both lids took place; and, in one eye, there was extensive effusion and detachment of the retina.

IDIOPATHIC EPILEPSY.-Wood, at a recent clinic, presented a boy, aged 13, who gave a history of epileptic attacks at irregular but frequent intervals since May last. The attacks were attended with loss of consciousness, but not preceded by warning or aura of any kind. The patient stated that, when 8 years of age, he received a blow on the back of the head from a snowball containing a lump of coal, and since that time he suffered from persistent occipital headache until the epileptic attacks commenced, when the headache ceased. Examination of the head failed to show the existence of any scar or depression, while the vision was perfectly normal as to its field. Wood said the question to be considered was, Was this a case of idiopathic or traumatic epilepsy? He was strongly inclined to believe the disease idiopathic epilepsy, as the attacks had no connection with the injury, and they commenced about the time that idiopathic epilepsy developed itself. Unless a careful study of the nature of the attacks was made, it might easily be mistaken for a case of traumatic epilepsy. He proposed to put the boy on a course of bromides.

LESION OF THE BRACHIAL PLEXUS DURING PARTURITION CAUSING COMPLETE PARALYSIS.-Wood next exhibited a colored infant, a month old, who had complete motor and sensory paralysis of the left arm. The child was born after a tedious labor, the breech presenting, and great difficulty being experienced in delivery of the left arm, which was locked above the head. Wood mentioned that the only

other lesion that could possibly cause the phenomena presented in this case, would be clot in the locus niger, where the motor and sensory tracts crossed, but then, he added, such a lesion would also cause paralysis of the leg of the same side. He concluded that the case was one of severe injury (probably rupture) of the brachial plexus, from culpable negligence in the delivery of the child. Nothing could be suggested except amputation at the shoulder joint, as the limb if left on would be sure to waste.

THE TREATMENT OF SPINAL CURVATURE.-Agnew, in discussing the treatment of spinal curvature, said: "Massage will be found beneficial in the early stages of lateral curvature from muscular disability. It is best applied before the patient goes to bed, so that a period of rest may succeed the fatigue consequent on the muscular exercise. As a substitute for massage I frequently use rubber muscle beaters" in the form of balls, or cylinders. A form of drill is also of service, the patient being instructed to walk up and down. a room with something balanced on the head. Muscles which have been beaten or exercised in this way, should not be overtaxed by the patient maintaining an erect position. Complete rest should be insisted on. Extension by means of the chin strap and tripod should. be employed three or four times each day, each seance lasting a few minutes. Strict attention should be paid to generate hygienic treatment. As the patients are generally anæmic, or rickety, they should have plenty of fresh air, good milk, cod-liver oil and iodide of iron. a large number of cases when seen in the earliest stage nothing further is necessary, but when the disease is of long standing and the curve pronounced, a mechanical apparatus is necessary. The best is a plaster-of-Paris jacket, carefully applied and made to lace. It should be put on before the patient rises, and not removed at night until he resumes the recumbent position."

In

CARDIAC FAILURE IN DIPHTHERIA.-At the meeting of the New York Academy of Medicine on November 1st, Dr. J. Lewis Smith read a paper on Sudden Heart Failure in Diphtheria; its Pathology and Treatment. After discussing the various hypotheses advanced to explain this occurence, such as degeneration of the muscular wall and cardiac thrombosis, Dr. Smith inclined to adopt the theory of deficient intervation, making it indeed a form of diphtheritic