lower, making some pressure on the perineum. The discharge is more profuse, somewhat offensive, and there is greater heat in the vagina. She is stronger and in better spirits than she was at my first visit. Has slept very little, on account, she says, of the "labor pains." No change in treatment, except the ergot was directed to be taken only three times in the twenty-four hours.

June 25-I saw the case this morning with Drs. Ellis and Gaines. Patient rested badly during the night, and is very low-spirited. Tumor not so hard-discharge freer and more offensive.

June 26-The tumor is evidently undergoing decomposition; it is much softer, and the discharge is profuse, and so offensive that it is very unpleasant to remain in the room with her. No change in the treatment, except cloths wrung out of a solution of carbolic acid are to be applied to her vulva.

June 27-Saw the case to-day, in consultation with Drs. Ellis and Gaines. She is much weaker-pulse small, quick and feeble. Her appetite, strange to say, is improving. Desires frequently to go to stool and to void her urine. At times she is unable to make water, except when the tumor is held up, and then only in a small quantity. The tumor is decomposing rapidly-discharge profuse and very offensive. She complains of "bearing down pain." Abdomen is not so large or so hard. She was brought under the influence of chloroform, the tumor was seized with placenta forceps, and an attempt was made to bring it down, so that the chain of the ecraseur could be passed around it; but it so completely filled the cavity of the vagina that this was found to be impossible. A portion of the decomposed tumor, weighing, perhaps, four ounces, was brought away with the forceps. Ergot omitted-other treatment continued.

June 28 and 29-Saw the case with Dr. Ellis. Condition much the same; continued treatment.

June 30-Saw the case with Drs. Ellis and Gaines. The patient has slept none scarcely for forty-eight honrs. She is very weak, and at times hysterical. We found a portion of the tumor protruding through the vagina. Its attachments were broken up, and it was removed. It weighed three-fourths of a pound. Her left leg is slightly oedematous. She was ordered, in addition to other treatment, anodynes sufficient to control pain and produce sleep, and an injection of a weak solution of carbolic acid into vagina.

July 1, 2 and 3-Patient is weaker, and very low-spirited. Left leg is swelling rapidly, and pits on pressure. Treatment the same.

July 4-Met Drs. Ellis and Gaines in consultation. We found our patient weaker. Appetite, however, continued good. We removed one-half pound of the tumor, the patient being under the influence of chloroform. The discharge is profuse, but not so offensive. Her left leg is greatly swollen. It was punctured with a needle, allowing considerable fluid to escape. Continued treatment.

July 5-No particular change since yesterday. She was again brought under the influence of chloroform, and three-fourths of a pound of the tumor removed.

July 6-Patient feels stronger. Pulse is better, and her appetite is very good. The discharge is not so profuse or so offensive. Today, by means of a long trocar and canula, passed through a speculum, we introduced chloride of zinc into the tumor. Continued treat

ment.

July 7, 8 and 9-Chloride of zinc was introduced into the tumor each of these days, and several sloughs were brought away. The left leg is more oedematous, the swelling extending up in the thigh. It has been punctured daily since the 4th inst. Her right leg is also slightly dematous. In addition to former treatment, she was ordered the acetate of potassa.

The

July 10-Saw the case to-day, with Drs. Ellis and Gaines. tumor can not be felt through the walls of the abdomen, and all that portion that was in the vagina has been brought away. There is not more than one-third of the tumor remaining, all of which is in the womb. The os uteri is considerably dilated, and there is no difficulty in introducing the chloride of zine into the tumor. The discharge is small and slightly offensive. Her general health is improving rapidly. Her appetite can scarcely be satified. She feels able to get up, but was advised to remain in bed.

July 11 and 12-Improving; no change in treatment. July 13-Met Drs. Ellis and Gaines. The sound was passed into the womb, and the tumor was found to be adherent by an extensive attachment to the anterior wall of the neck and body of the womb. She is improving rapidly, and to-day was allowed to sit up for several hours. The swelling of legs is rapidly diminishing. Treatment continued.

July 14 and 15-Continues to improve.

July 16-Visited the patient with Drs. Ellis and Gaines. She continues to improve; sleeps well; appetite good, and says she "feels

quite comfortable." Left leg still quite dropsical. To-day all treatment was discontinued, except the tincture of the chloride of iron.

July 19-I visited the case again to-day, and found her sitting up, and in fine spirits. The swelling has gone out of her legs; her abdomen is soft and smaller, she states, than it has been at any time in ten years. The os uteri is not larger than a silver dollar, and, in my opinion, there is nothing remaining of the tumor except the neck.

August 2-To-day I called on Mrs. H, for the purpose of getting some instruments I had left at her house, and found her ironing some clothing. She stated that she felt stronger and better than she had at any time in twenty years. Her appetite could not be satisfied. She was able to do her housework. I could scarcely realize that she was the same woman who, a few weeks ago, looked more like a corpse than a living being.

REMARKS.-There is still a portion of the tumor in the wombperhaps only a part of the neck remains. The questions arise, will the tumor be reproduced? or, will the portion remaining disappear spontaneously? What caused it to decompose? Was it strangulated in the os uteri? ulceration, inflammation, or what? How large was it originally? Is it advisable to attempt a removal of it? I would be glad to hear the opinion of some of your surgical contributors on these questions. It is my opinion that the tumor will be reproduced. The putrescence, I think, was caused by strangulation in the os. The tumor probably weighed, originally, not less than six nor more than ten pounds. Several pounds were removed in putrefied condition, and several pounds, as it decomposed, came away in putrilage, pus, and shreds, while a portion remains in the womb. It would certainly be jeopardizing the life of the patient to attempt a removal of the remaining portion of the tumor.

SUCCESSFUL TERMINATION OF A CASE OF ABSCESS OF THE LIVER.

BY D. W. LAMME, M. D., EL PASO, ILL.

On June 23d, 1867, I was called upon to visit Mrs. Martin, who was living ten miles from El Paso. I found her suffering with a severe pain in her right hypochondriac region, her tongue slightly furred, her pulse quick and small, with some headache. On examination,

I found her liver very much enlarged and hard, curling up, so to speak, over the edge of the lower rib, and extending almost to the crest of the ilium.

I put her on blue mass and saline cathartics sufficient to produce at least one operation of the bowels every day-her bowels being in a state of obstinate constipation. I found, after about ten days, that the tumor had not decreased, and that all the other symptoms were aggravated, the pain being much more severe than before. I then put her on the following prescription: calomel, grain i; opin half a grain every four hours. After taking six doses, she showed evident signs of ptyalism that I discontinued the treatment. I had als blistered her repeatedly from the beginning over the region of the tumor. It was evident, now, after treatment of two weeks to induce resolution, that an abscess had formed and was pointing to the surface. I now resolved to resort to anodynes and hot fomentation, to relieve the pain and hasten the termination, with an occasional cathartic.

On July 19th, 1867, I visited her in company with Dr. D. Lewis. We opened the abscess about midway between the crest of the ilium and the lower margin of the ribs, and evacuated a large quantity of dark, thick, grumous fluid, smelling like sulphureted hydrogen. We did not allow the abscess to empty itself all at once, but left directions with the husband to evacuate it by degrees. I judge that the abscess contained not less than one quart of this offensive matter; her husband told me that he thought not less than three pints.

She recovered rapidly. When I called to see her a few days after, she was visiting at one of her neighbor's. She is now as well as she ever was, and is living at Covington or Newport, Ky.

One point in this case, I think, is worthy of attention. It has been claimed that abscess in the liver is sufficient to protect the patient from the influence of mercury. Annesley says: "There can be no doubt that the system will not be brought under the full operation of mercury, or that ptyalism will not follow on the most energetic employment of this substance where abscess exists." He repeats this opinion more than once, and considers resistance to the action of mercury as conclusive evidence that abscess does exist. Budd sanctions this opinion, and remarks: "It is, then, before suppuration has taken place that mercury can do any good."

It is evident that this doctrine does not maintain in all cases. It

was so short a time after having produced the most marked symptoms of incipient ptyalism, that abscess was diagnosed, and even so short a time elapsed before it was opened, that it must, beyond a doubt, have existed at the time of the administration of the mercury.

REMARKS ON THE THERAPEUTIC VALUE OF BROMIDE OF POTASSIUM.

BY LUNSFORD P. YANDELL, JR., M. D.,

Professor Materia Medica and Clinical Medicine, University of Louisville.

No medicine, at the present time, is probably attracting so much attention as the bromide of potassium. Besides being a very fashionable drug with the profession, it has become a popular favorite, and now occupies the same rank in domestic medicine that the tincture of arnica has so long held in domestic surgery. While a very wide difference of opinion exists among writers and practitioners in regard to its curative powers and its behavior in the human system, the mass of testimony is undoubtedly in its favor. During the past two years my experience with it has been somewhat extensive both in hospitals and private practice; and the result of my observations is, that while it is by no means the panacea which some have deemed it, it is a most valuable medicine, capable of doing great good in many morbid conditions, and nearly destitute of all power for evil when properly administered, even in very large doses. Its failure to produce the effects attributed to it, which is reported in the hands of some practitioners, is due, I suspect, to one of three following causes: Either its administration in improper cases; or its being given in insufficient doses; or being given not sufficiently diluted. When the latter error is committed, pain in the stomach and bowels, sometimes severe, is not an uncommon consequence. And this is easily accounted for when it is remembered that bromide of potassium will blister the tongue when applied to it in substance for a short time. Given internally, in a concentrated form, in large quantities, it might unquestionably develope serious symptoms.

Having become convinced of the harmlessness of this medicine by experiments upon myself, I have not hesitated to administer it freely to others. It is a remarkable fact that, though in drachm doses, it