negative my action and participation in arranging the year's work. If the year has been fairly prosperous; if the attendance at our meetings has been as good as in preceding sessions; if the opportunity to compare experiences and to keep members in touch with one another's work has not been neglected; if the program of the year has been satisfactory, well filled and well carried out-ten meetings have been held (this is the eleventh) and you have heard twenty-three papers; if in choosing "Tuberculosis" as the principal work of the Society during this session, the choice has proven most desirable, most practical, and one which, however old, is constantly so actual that it has, this year, received, on this continent as well as abroad, more attention and has been the occasion of more scientific contributions than in years before; if we have, for our part, been able to enlist, upon its study and discussion, as lecturers, the men, from among us, the most apt to treat this broad question in its many phases; it is just now appropriate to state to whose energy, efficiency and radiant influence, the credit is due, and my thanks would be nothing were they not the expression of your own high and warm appreciation of the splendid work of our Secretary.

I feel that thanks are also to be extended to the VicePresident and the other gentlemen, who kindly occupied the chair in my repeated absence; and to the Board of Censors, who, intrusted with the welfare of our membership, did not permit our Society to suffer from any condition of affairs which would be alike in nature to pernicious anæmia or acute yellow atrophy. Stern observers of our by-laws, still zealous and ambitious to make a good record, they have striven in earnest, and hence twelve new members have been elected. You will not fail to note that this increase in membership compares favorably with former years and deserves praise. Yet I am not certain that the advent into our ranks of these many `Aovλniadau can be considered compensatory to the disappearance from our midst of such a NESTOR as was the late Dr. William H. Bailey, to speak of but one of the two losses by death that this Society has sustained during the past year.

As to our financial standing, I have not looked into it, but your Auditing Committee has, and they have reported that

:

apparently our banking account has been handled with thoroughness and ability. This you may doubt, when you see, firm at his post, confident, unconcerned, placid as the owner of an undisturbed conscience alone can be, the incumbent of the office. Men of his capacity, who display as much familiarity with the capital as with the interest of a concern, are generally found, at the psychological moment, on the other side of the Canadian border!

What, to my mind, is an eminently proper departure for this Society, comes now, to-night, before you for the second time. I refer to an amendment to our by-laws that would make a "thing of the future" to hold meetings in the adjacent centers namely Cohoes and Watervliet-as well as in Albany, so that the Society might be truly, in fact as in name, a Society of the County. No one can fail to appreciate the advantage that will accrue from this change, should it take place, through the greater interest likely to be manifested in the Society work by the members from outside this city.

Gentlemen:

"Les exemples persuadent mieux que les simples raisonnements."

Mauriceau.

The main object of the medical art is especially to achieve the cure of diseases. Without being indifferent to the science that is done and which opens every day before us new and broader horizons, it is well to keep in mind that no pathological conception has any worth and is deserving of much attention and credit unless it resolves itself into acts and, so to speak, finds facts in which to materialize. Hence, examples make more impression and have more practical bearing than precepts. Long ago, Mauriceau had found the formula of this assertion when he would repeat before his pupils by way of an aphorism: "Les exemples, persuadent mieux que les simples raisonnements. (Better than reasonings do examples persuade.)

I ignore not that it is the custom, in a president's address, to take up some department of the healing art, or to treat some abstract question of historic interest, or to settle more or less dogmatically some doctrinal point, etc., etc. But such as myself should not be rash enough to attempt an

address of a general nature, or to discourse on anything that would offer the least shadow of being in the nature of a thesis; they should heed the word of warning of the "Master," and, satisfied that examples might go a longer way than abstruse and speculative theorizing, confine themselves to some topic of practical moment. "Better than reasonings

do examples persuade."

So, having neither the time to study nor the ability to discuss the broad questions of medical science, the only safe thing has been to turn to my note books and to select from among the cases that have accumulated therein, such as would present the results of my personal experience. Yet, it takes so very few years for such accumulated experience to grow very large, while it remains of that common sort which is the experience of everybody, that a decided risk was incurred to touch upon subjects trite and thread-bare, unless they could offer, as a claim to your attention, at least the merit of their infrequency. Thus, have I chosen to speak to you of the "Retropharyngeal Abscess" and of the "Pulsating Empyema."

In a practice of nearly twenty-nine years, two cases only of the first disease and one of the second were met with. Aside from their rarity, and while they otherwise vastly differed, these cases offered, as suppurative diseases, some other points in common, which made it interesting to me to study them together. This study I submit to you now, with much fear, however, that what has interested me might prove tedious recitation to men for whom medical literature contains nothing new.

RETROPHARYNGEAL ABSCESS

On account of its comparative scarcity and the obscurity of its symptoms, there is perhaps no disease of early childhood which is more likely to be overlooked than retropharyngeal abscess; and there is none in which accuracy and promptitude in diagnosis are forthwith a question of life and death.

Of the two cases that came under my notice, the first was that of a baby in the eighth month; he had a suppurative otitis; this otitis coexisted with skin eruptions, especially papular, which bore the stigma of hereditary syphilis; the

otitis appeared as the cause of the pharyngeal affection. Unfortunately, the diagnosis was arrived at late, and the child succumbed while being operated; the pus invaded the glottis and caused suffocation; it is true, the lungs were in a state which did not warrant a different termination.

The second case is the one now to be related.

On May 1, 1892, Marie-Louise B., a child 17 months old, had an attack of measles. On the 29th of the same month, I was called again. The child was feverish, uneasy and appeared to be distressed in swallowing. Upon examination, it was found that the pain was especially referred to the neck and increased with every movement. The throat was red, but did not present that redness and the prominence of the papillæ characteristic of follicular tonsillitis or catarrhal pharyngitis; yet, the secretions were copious and running down from the posterior nares as in well marked rhinitis. The next day, there was greater stiffness of the neck, but the throat and the posterior pharynx did not show much change; it was yet covered with an abundant mucus. Otherwise, there seemed to be no correlation between the apparent superficiality of the local lesions and the severity of the general symptoms. The third and the fourth days did little towards clearing up the diagnosis; one's mind, however, could not fail, in directing its inquiry, to take more and more notice of this peculiar immobility of the head and the impossibility to give it any motion without causing the child to suffer and cry. The fifth day, the voice had a decidedly nasal sound, the difficulty in swallowing had greatly increased, and, during the night, the liquids had begun to return through the nostrils. The child, although appearing weaker, was however less in pain. On inspecting the pharynx and sponging out the frothy mucus, its posterior wall was noticed to be irregular and to bulge somewhat. Thus, the diagnosis was becoming clearer. The next step was to substitute the finger for the spoon and the touch for the sight. As soon as the index was carried into the pharynx, it came in contact, behind the velum palati, with a swelling of the posterior wall offering a firm resistance and the projection of which was on the left of the median line. The sixth day, this swelling had become slightly maniest outwardly, well up on the side of the neck, below the ear.

The seventh day, the general malaise was greater, the difficulty in breathing much aggravated, and the finger, brought in contact with the tumor, found it decidedly softer. The eighth day, there was no longer any doubt that the case was state which required intervention, and, my friend, Dr. Featherstonhaugh, kindly assisting and administering chloroform, I opened the abscess. Though this operation is but a simple incision, yet it requires care and some technique, as the pus escaping from the pocket is liable to rush into the glottis under the suction of the respiratory movements. To avoid such a complication, Plicque (in Concours Médical) advises to keep the head of the child erect, being very careful not to throw it backward, and as soon as the stroke of the knife has been given, to quickly bend it forward. This method does not seem to be without its defects, and I believe that it was partly responsible for failure in my first case; it did not prevent the pus from invading the larynx, and the scene was abruptly closed by an asphyxia which a generalized bronchitis had rendered already too threatening. This time, I thought more advisable to use chloroform and to operate with the child lying on its side, proceeding as follows: As soon as the child had come under the first shock of the anææsthetic, it was rapidly turned on its left side (the side of the abscess), its face in good light; a Denhard's gag was introduced to moderately open the mouth, the tongue was strongly depressed by the forefinger, which also served as a guide for the instrument; and an incision was carried through the tumor to the extent of about two centimetres. Caution is given not to use a blade unless covered and protected with gauze or plaster up to a centimetre and a half from the point; as the common straight small tenotome answered such a requirement, it was used. The incision was made (according to the advice of St. Germain) as low as possible to avoid hemorrhage, and the stroke of the knife was directed downward and obliquely inward towards the median line. Then, the finger, which, before the incision, had been thrust far back into the pharynx (to explore the point on which this incision was to bear, and to make sure that no strong arterial impulse was felt), was now again thrust into the wound for the purpose of bruising its edges, especially at the inferior