accident; thus, these tables indicate that more non-employes are killed than emyloyes, for out of 1444 accidents to employes there were only 115 fatally injured, while out of 325 non-employes injured 124 were fatal.

The various reports show that out of this number of non-employes 32 were classed as tramps, and the manner of their injury, as indicated by reports, shows a marvelous disregard for the orthodox ways of traveling. Some injured while riding on brake-beams, some on top of passenger coaches and some carefully packed with goods in box cars. During these six years but 13 passengers were injured, and only five out of this number were injured on passenger trains while in transit, and but one injured fatally, and he fell from car platform while in a drunken condition, the others being injured by defective platforms and other unforeseen ways. The passenger train mileage during this time was 6,573,423, the freight train mileage was 13,337,639, with a totnl mileage of 19,911,062.

Table No. 17 showing number of non-employes injured from 1879 to 1884, inclusive.

Barracks.

Quarantine

Kimmswick..

Pevely

Victoria.

Blackwell..

Fredericktown

Mineral Point..

Belmont Branch.

3 Charlestown

6

8

Allenville

1 Avon.....

6

68

5

10

Diehlstadt..

4

1 Lutesville..

Little Rock Section

2nd. The circulation in the lungs is increased by the above means.

3rd. By means of the Pneumatic Cabinet and its accessories, medicaments can be carried into the air cells.

Doubtless, those of my hearers who have examined the cabinet will agree with me in saying, the first proposition, namely, that the cabinet enables the patient to breathe normal air while surrounded by a rare atmosphere is true, and can be demonstrated. As a machine, the cabinet is a success. The mechanical ideal has been reached. It works well.

The air within the chamber can be exhausted to any degree desirable, and the lowered pressure thus attained can be preserved for several minutes.

The second proposition to which we are asked to assent is this: The circulation in the lungs is increased by means of the Pneumatic Cabinet.

In that class of cases in which inflammatory processes have resulted in the formation of connective tissue, and the class is a very large one, the pulmonary capillaries are either annihilated or their lumen lessened by presure, thereby modifying unfavorably the circulation in the areas thus affected. Interstitial pneumonia, peri-bronchitis, tuberculosis and fibroid phthisis, are types of the diseases to which I refer. In unresolved pneumonia, in hemorrhagic infarction, in hydrops pericardii, we find disturbance of the circulation which sooner or later, if not corrected, will lead to other morbid processes in the lungs as well as to disease in other parts of the body. The mere mention of these conditions is quite sufficient, I hope, to recall to your minds the pathological changes which it is hoped will be corrected by the use of the Pneumatic Cabinet, because this instrument so favorably modifies the circulation.

With the patient in the tightly closed chamber and the breathing tube in his mouth, and his nose closed so that the air he breathes must all come from without the cabinet, the exhausting apparatus is made use of and the desirable degree of rarity is obtained by

pumping the air out, which operation lessens the pressure on the surface of the body to a corresponding degree. As the pressure is removed from the body, the air rushes into the lungs through the breathing tube, distending the air spaces, bronchioles and bronchi. The space within the lungs being all occupied by the inrushing air, the patient begins to displace the air from the lungs. It should not be forgotten that this act is accomplished by muscular contraction together with the resi lience of the lungs. The force continuing in front, that is to say, the air trying to get into the partially empty cabinet during expiration, the pressure is as great as during inspiration.

The pressure in the lungs therefore being constant as long as the conditions imposed remain, the blood in the pulmonary capillaries must be forced out and kept out, thereby causing anemia of these tissues. The connec tive tissue of the lungs, which forms the normal frame work, is not present in large quantities; therefore, the internal pressure will cause the alveoli to approach each other so closely that the capillaries winding over the air cells cannot escape the pressure-they must give up their contents, the parenchyma must become blanched. It is not until the breathing tube is removed from the mouth that the capillaries can fill again.

By requiring the patient to frequently remove the tube from his mouth, thereby permitting the air of the chamber to pass into the lungs, establishing the equilibrium, the blood may be driven out and in alternately. This process may increase or reestablish, reinvigorate the pulmonary circulation. But, alas, this happy use of the Cabinet for im proving the circulation can only be continued a few minutes at a sitting. Some patients cannot endure it for more than five minutes, and no on should remain longer than thirty minutes, nor can it be returned to oftener than once in twenty-four hours. It follows then that the morbid processes must be permitted to go on in the lungs twenty-three and a half hours out of the twenty-four. The enfeebled condition of the patient makes a sitting of twenty or thirty minutes in the cabi net under the conditions imposed very fatigu ing. I have had patients so exhausted at the end of twenty-five minutes that they were obliged to rest several minutes before being able to step into a carriage at my office door. Others have been unable to sleep on the following night because of the soreness in the chest produced by the outward pressure of the air in the lungs, unrestrained by a corresponding pressure of the surface of the surface of the chest. It should

not be forgotten in this connection that the muscles of expiration are severely taxed when the patient tries to expel the tidal air. While in the cabinet inspiration is a passive movement, and expiration is an active one. So that, admitting the correctness of the assertion made by the ardent supporters of pneumatic differentiation that it improves the pulmonary circulation, the practical application can not be made for a sufficient length of time to satisfactorily attain the desired end. It may be said I removed too much air from the cabinet, thereby producing too great outward pressure. I reply by saying the barometer was always carefully observed and the column of mercury was never displaced more than a quarter or three eighths of an inch, the first mentioned displacement indicating the reduction of atmospheric pressure on the the surface of the body only about one eighth of one pound to the square inch.

The third proposition to which we are asked to assent is this: By means of the Pneumatic Cabinet, and its accessories, medicaments can be carried deeper into the lungs than by any other means. It enables the operator to deposit the medicine in the form of spray on the walls of the alveoli. In fact it enables him to make a topical application of the drug. In order to demonstrate the truthfulness of this assertion, Dr. Williams, of Brooklyn, New York, experimented with a calf's lungs before the section on practice of the American Medical Association at St. Louis. A normal lung, removed a few hours before from a calf was placed in the Cabinet, the trachea was fastened to the inlet faucet, and the alveoli inflated by pumping a portion of the air out of the Cabinet. The inrushing air was saturated with a spray of ink. soon as the ink-loaded air had passed through the trachea, bronchi, bronchioles into the air spaces, it occupied all the vacuum in the chamber possible by dilating the alveoli. This was a passive inspiration. By means of another faucet air was permitted to rush into the chamber and re-establish the equilibrium which, aided by the contractile power of the lung substance, caused a displacement of the air from the luugs. This was expiration.

By repeating this process of inflation and contraction normal respiration was simulated. As the ink loaded air was forced into the lungs it was expected to stain, not only the lining of the bronchi and bronchioles, but also the walls of the air spaces. But blocks cut out of the lungs thus treated failed to show staining beyond the terminal branches of the bronchial tubes. It was claimed by the experimenter that the post

mortem changes militated against the experiment. Be that as it may, the experiment should have been stigmatized as an effort calculated to mislead the profession for the reason that no human lungs could safely bear such violent and sudden distention as that calf's lungs were subjected to. The enormous and sudden increase of atmospheric pressure within the lungs as was there produced in order to carry the staining fluid into the air cells was quite sufficient to fracture the walls of a friable alveolus, produce emphysema, or rupture a weak heart. The experimenter seemed determined to demonstrate the possibility of depositing drugs in a finely divided state in the alveoli, the probable deleterious results of such an effort on a diseased human lung being no consideration of his. I mention the experiment only to condemn it. If it were possible to deposit the medicament as claimed, the effort necessary to accomplish the end may do more damage to the lung in a few minutes than the drugs could repair in many hoars. Besides it remains to be proven that the successful and thorough inhalation of medicated air is curative in many of the grave diseases of the respiratory apparatus, such as chronic pneumonia, tuberculosis, and so forth. Can laryngeal phthisis, syphilitic ulcers or erysipelas be cured by local applications?

Local applications are beneficial in these. last named diseases, but they are hardly curative. Neither will medicines driven into the human lungs by the pneumatic cabinet prove curative in that class of cases under considation.

My experience enables me to speak with confidence of the value of the pneumatic cabinet in a limited field. I heartily place myself on record as an advocate for its use in a few of the many morbid processes with which we meet in the lungs, but he who hails with rapturous delight this instrument as a means which will enable him to stop the destructive march of more than a few of the many pulmonary diseases, will find he has run after a butterfly and stumbled over a cow.

In concluding this short article, permit me to call your attention to the following points as worthy of consideration in rendering judgment upon the Pneumatic Cabinet.

First. As now constructed by the Pneumatic Cabinet Company of New York, it is well adapted to the work of reducing the atmospheric pressure on the surface of the body, at the same time permitting relatively dense air to be passed into and out of the lungs.

Second. The fatigue to which the patient is

subject while being treated and the length of time between treatments, well nigh counteract all the good which would otherwise be derived through the improvement of the circulation.

Third. It is not yet proven that drugs can be deposited on the walls of the living human alveoli by any force short of that which would probably prove injurious to the delicate lung tissue.

Fourth. The curative effects of medicines brought into contact with diseased areas below the larynx are not known to be more potent than when applied to the larynx when similarly affected.

Fifth. The present plan of leasing the cabinet is so expensive that none but the favored few can afford to have it.

H. J. B. WRIGHT.

OBSTRUCTION OF BOWELS-TWELVE DAYS STERCORACEOUS VOMITING.— RECOVERY-PATIENT ÆT 76.

BY T. S. WASHBURN, HILLSBORO, ILLS. Read at the Mississippi Valley Medical Association, July 13, 1886.

Nov. 3, 1885. Was called to visit Mrs. McAdams, aged 76, well preserved, and of good constitution. She had been complaining for two days, being subject to constipation and occasional attacks of colic; had taken some simple medicine, but got no relief. I found her suffering much pain in bowels just above the right ilium, and extending up and to the left, following apparently the colon from the ileo-cecal valve; some swelling, heat and tenderness -heat of skin, thirst, slight nausea, pulse, 90; tongue coated brown and dry, no action of bowels for two days, pain in paroxysms, urine scanty, high colored. Gave Dov. pulv. gr. 8, opii gr, j, camphor and capsicum aa gr. ij., every three hours until pain subsides aud patient drops off to sleep; after which follow with sulphate magnesia 3j doses.

Nov. 4, A. M. Found patient much the same, pain somewhat less, bnt tenderness and some tympanites, fever, thirst, and urine still less, quite sick at stomach,no stool, no appetite. Order hot fomentations, repeat salts every four hours, hot soap suds clysters every two hours. Also, spts nitre, buchu and P. brava and ipecac for fever and diuretic. Opiates if increase of pain.

Nov. 5. Visit again to-day, and no marked change, no action of bowels, pain located as before, near the ileo-cecal valve, serious

obstruction, fear, pulse 95, countenance more anxious, tongue dry and coated, skin hot, bowels more inflated, and sickness of stomach increasing, with some vomiting.

R Calomel gr. x, podophyllin gr. j, c. ext. colocynth gr. iij, and repeat every four hours, until three are taken, and fl. ext. sennæ and aloes, a teaspoonfull two hours, after each powder; follow in six hours with hot linseed oil, one qt. as injection.

In addition advise water gruel or light soup, hot fomentations of hops or herbs externally, also turpentine stupes. As anodyne salicyl sodæ, gr. v., morphiæ gr., from time to time to control pain.

Nov. 6. The cathartic powders were not well borne and the two last doses rejected, pulse same, no increase of fever or tenderness of bowels. The hot oil injection brought away some remnants of feces, but probably from the lower bowel and rectum only.

Rested fairly at night, still relishes food, but stomach returns it after awhile, (two to four hours), moderate thirst, urine free and plenty.

Having crowded active cathartics to the utmost limit, and persisted in frequent and copious injections, I think best to withdraw active treatment and return to opiates and rest, with nutritious diet, and see how nature would behave. So I left powders of opium gr.j, Dov. gr. v., to be repeated four to six hours, as needed. If stomach remains irritable. give hot water freely.

Nov. 7, a. m. Mrs. M. remains much as usual, no increase of symptoms, and rather less thirst, pulse 85, tongue rather dry, brown coat and tasting bitter, vomits less often, but more offensive (stercoraceous), urine about natural, expression of countenance fairly good, skin temperate, moist. No pain except at times in bowels, but less than has been with less heat and tenderness-No action.

Prognosis. With the above symptoms, and so long continuance (one week) I felt it a duty to inform the friends and kindred of the gravity of the case, and suggest council and the possibility of an operation for relief, which should not be postponed, if thought best. The children decided that her age would hardly make an operation desirable. But desiring to leave nothing undone, I examined the rectum as high as I could reach, but found no impaction. I then introduced a rubber tube of sixteen inches and injected five pints of hot salt water and had attendant support perineum for an hour with a napkin, and ordered the same injection repeated in the evening and to continue powders of morphia and salicyl. soda.