my two sides and my stomach." She seems to suffer intensely. Her general condition is worse. Temperature, 101.8°. Pulse, 126. Dr. Stone saw her with me again. A most thorough examination was made under chioroform anesthesia. Nothing further developed.

February 14. The pain grows worse. She will not eat or in fact take any nourishment. Nutritive enemata started yesterday. Dr. W. W. Johnston saw her with me this afternoon. Bronchophony found at the left apex, otherwise the same. Chlorodyne and morphia were given as necessary. Temperature, 101.6°. Pulse, 116.

February 18. She has had several periods of comparative quiet today. Temperature, 103.2°. Pulse, 126. Delirious at times, though rational when spoken to.

Dr.

February 20. Pain intense. Refuses all medicine and nourishment. Constipation. Passes urine frequently, though in small quantities. Insists on using the bed pan, which causes much pain. Great tenderness around the vulva and anus. Some stiffness and disinclination to move the legs. Very irritable. Johnston saw the patient again this af ternoon. He thinks possibly a tubercular meningitis is developing. Treatment is calomel, 4 grain every two hours. Morphia hypodermically. Omitted nutritive enemata. Temperature, 102.8°. Pulse, 124. Subsultus tendi

num.

February 22. She seems brighter and took nourishment well. Remarked on the changes made in the furniture. Temperature, 103.6°. Pulse, 130.

February 23. The pain is intense. The neck is bent slightly backwards. Loss of voluntary motion below the waist.

HEART DISEASE.-Pawinski (Medical and Surgical Reporter) compares caffein with strophanthus and digitalis as follows: In valvular diseases of the heart, with disturbance of compensation, digitalis and strophanthus are superior to caffein. In respect to regulating the heart rhythm, caffein is also inferior to the others; but in respect to excitation of diuresis, it is much superior.

The

Retention of urine relieved by hot applications over the bladder.

February 24. Atrophic changes have appeared over the bony prominences of the hips and legs. Complete paraplegia. She was catheterized. Her urine was ammoniacal and black in color. Temperature, 104.8°. Pulse, 135.

February 25. She is in a semi-comatose condition. Urine bloody and has an odor like aqua ammonia. Temperature, 107°.

She died at 2.40 P. M. Temperature, 108° ten minutes before death.

Autopsy. February 25, 8 P. M. Body much emaciated and showing numerous spots of atrophic changes over the bony prominences. Rigor mortis not marked. The left lung was bound down by a mass of adhesions; the anterior and posterior upper lobe shows recent congestion. Lower, filled with miliary tubercles. The pericardium contained several ounces of serum. The cecum is greatly distended and bound down by adhesions. The bladder was distended with urine and greatly congested. The brain contained numerous tubercular deposits over the convexity and along the fissures of Rolando and Sylvius. The brain was covered with tubercles and a fibrinous exudate and the substance was softened, especially by the medulla. A section of the spinal cord was removed from the tenth dorsal to the lower lumbar vertebra and the dura was found thickened, and the arachnoid and pia mater were found opaque. Tubercular deposits

were on the inner side of the dura mater. A pseudo-membrane was between the dura mater and the arachnoid extending completely around the cord. The specimen of the brain and cord were preserved and are in possession of the United States Army Medical Museum. best field for the administration of caffein is in diseases of the heart muscle, either functional or degenerative, and especially in the early stages of the disease. But in the later stages, when the heart in consequence of progressive degeneration of the muscle fibers is not able to perform its duty, and there are edema, dyspnea, and dilatation, then we must resort to digitalis.

THE following translation from an old decree, which is taken by Dr. Mireur from a book by Dr. Astruc called "Traité des Maladies Veneriennes, 1743," seems to be interesting enough to put before the physician of today as illustrating the struggle which has been going on so long to stamp out syphilis. It is translated from "La Syphilis et La Prostitution par le Docteur H. Mireur," Paris, 1888, and is based on ancient statistics for a public place of debauch in Avignon, made in 1347 by Jeanne First Queen of the Two Sicilies and Countess of Provence.

I.

In the year one thousand three hundred and forty-seven, our good Queen Jeanne allows a public place of debauch to be established in Avignon; she forbids all debauched women from living in the town, ordering them to be shut up in the place set apart for them and in order that they may be known they are to carry a red tag upon the left shoulder.

II.

Item. If any girl who has already fallen wishes to continue to prostitute herself, the turnkey or captain of police having taken her by the arm shall lead her through the town to the sound of the tambourine and with the tag upon her shoulder and shall place her in the house with the others; forbidding her from being found outside in the town under punishment of a private whipping for the first time and a public whipping and banishment if she repeats it.

III.

Our good Queen orders that the house of debauch be established in the street Pont troué near the Convent of the Augustins as far out as the Port Saint Pierre; and on the same side shall be a gate by which all shall enter but which shall be locked with a key in order to prevent any young man from seeing the

women without the permission of the Abbess or bailiff's wife, who shall be elected every year by the Consuls. The bailiff's wife shall keep the key and shall warn the young people not to cause any trouble and not to treat badly or to frighten the "filles de joye;" moreover if there is the least complaint they shall be taken to prison by the police.

IV.

The Queen wishes that every Saturday the bailiff's wife and a surgeon proposed by the Consuls shall visit each courtesan; and if anyone is found who has contracted disease proceeding from her lewdness she shall be separated from the others, shall live apart so that she cannot indulge herself and that the disease may not be carried to the young people.

V.

Item. If any of the girls become pregnant the bailiff's wife shall take care that no harm comes to the child and she shall inform the Consuls, so that they may provide what will be necessary for the child.

VI.

Item. The bailiff's wife shall absolutely forbid any man from entering the house on Good Friday or Holy Saturday or the blessed Easter Sunday; under penalty of being arrested and whipped.

VII.

Item. The Queen forbids the "filles de joye" from having disputes, from being jealous of each other, from stealing and prating. She orders, to the contrary, that they shall live together like sisters; that if there are quarrels, the bailiff's wife shall be the judge and they shall be satisfied with the bailiff's wife's decision.

VIII.

Item. If a robbery occurs the bailiff's wife shall see that the theft is returned amicably; and if the guilty one refuses

to return, she shall be whipped in a room by a policeman; but if she repeats the fault she shall be whipped at the hands of the public executioner.

IX.

Item. The bailiff's wife shall not allow any Jew to enter the house; and if it happened that any Jew being introduced, secretly or by "finesse" has an affair with any of the courtesans he shall be put into prison and whipped in all the public places of the town.

SOCIETY REPORTS.

THE CLINICO-PATHOLOGICAL SOCIETY OF WASHINGTON, D. C.

MEETING HELD MARCH 5, 1895.

Ar this meeting, held at the office of Dr. Clarke, the following pathological specimen was presented by Dr. Glazebrook. Atlas and axis taken from the body of the negro Forrester who was killed by a policeman while fleeing from

arrest.

The bullet passed in a direction downwards and inwards, one-half inch below the superior curved line (left), one inch to the left of the ligamentum nuchae, through the trapezius muscle, passing over the transverse process of the atlas, then through the groove for the vertebral artery, cutting through the spinal cord, and flattening itself against the left posterior wall of the canal of the atlas.

Dr. Richardson read the paper of the evening, subject, INTUBATION.

Dr. Beatty opened the discussion. He said that the literature on the subject was so comparatively modern that he knew mothing to add to Dr. Richardson's paper. It seemed to him that intubation covered the field, and is to be preferred to tracheotomy.

Dr. Sprigg inquired as to the probability and danger of using too small a tube.

Dr. Snyder, while in the Immigration Bureau, had some experience with this operation. He thinks that Dr. Richardson's description of the modus operandi of introducing the tube is excellent.

It is

The thread should be watched. not an easy operation at first. The benefit secured to little patients is wonderful, that is the immediate or temporary benefit. He thought the physician should protect himself against the accident of having mucus or membrane coughed in his face; the wearing of eyeglasses, and using a towel or handkerchief over the mouth and nose, should be popular.

Dr. Compton thought the paper was the most complete on the subject that he has heard or read, particularly the detailed description of the operation of intubation. The obturator should always pass through the lower end of the tube, this is very important. Tube clogging in the act of the expulsion of membranes should be watched closely and when it occurs the tube should be withdrawn by the nurse, if the physician is not at hand, and for this reason it is necessary to always have a trained nurse in attendance on intubated patients. The mortality from intubation is slightly less than in tracheotomy.

Dr. Wilmer said that he was glad to hear Dr. Richardson's up-to-date paper. His experience was in 1878, and at that time the favorite position for the child during the operation of introducing the tube was by being held over the nurse's shoulder; he must admit that Dr. Richardson's position is the better. He had seen several cases of syphilitic stenosis in adults in which the tube was passed. One case of a man in whom the laryngeal sound was passed for a long time, and the use of tubes of increasing sizes, with gradually increased doses of iodide of potassium; finally relieved.

Dr. Compton said that during last summer while sojourning at Seabright, and visiting the Seabright County Children's Home, he saw two cases of diphtheritic stenosis relieved by intubation.

Dr. Van Rensselaer said he had witnessed the operation of intubation by Dr. Richardson several times, and never saw him fail to introduce the tube the first, or at most the second, trial.

Dr. Muncaster expressed a desire to know what proportion of recoveries Dr.

Richardson had in the cases which he intubated.

Dr. Clarke said that he had never seen a case of tracheotomy or intubation

recover.

Dr. Tompkins had seen Dr. Richardson introduce the tube and thinks that he is very skillful; he thinks with Dr. Compton that the thread should be left in the tube.

Dr. Frank Leech thought that parents will allow intubation, when they will not tolerate tracheotomy, consequently the operation will not be deferred too long.

Dr. Richardson in closing said that he did not mention a number of facts because he meant simply to describe the technique, and he follows out closely the description in his operation. intubator would attempt to introduce a tube too small; a man who knows anything about his business could not make this mistake, as the tubes are graded according to age of the patient, and again the tube rests on the arytenoids so well as to obviate this difficulty. The holding of the thread taut while introducing the tube is the only way to prevent it getting twisted. Protection of the physician is a good suggestion. As to Dr. Compton's suggestion of leaving the thread in, it would be a good thing, but at best the patient complains of the thread more than the tube, and it allows the nurse to pull out the tube when it is really unnecessary, or the child might pull out the tube and stenosis kills it before the instrument could be introduced again. Dr. Wilmer went into the consideration of intubation in chronic cases, but he had applied his remarks to acute cases alone. The length of time the tube can be left in the larynx, as asked by Dr. Van Rensselaer; in chronic cases the tube is worn one and even three years, so no trouble is experienced in leaving it in except it be a difficulty in removing it when allowed to remain very long. Usually from five to seven days is the duration of time the tube is allowed to remain in acute cases. When fever is absent for twenty-four hours, it is quite safe to remove the tube. For six or seven hours after removing

the tube, breathing becomes more difficult, but soon becomes normal. Percentage of cases of recovery, he has had nine or ten recoveries out of forty cases. He has intubated children practically dead, but has never intubated a child except one, in which all the relief that any operative procedure could afford was not experienced. Dr. Clarke asks about the obturator. There is no doubt that there is considerable tact and skill necessary to pass the tube, and this is only to be obtained by constant practice in passing instruments into the larynx, consequently the general surgeon is not as a rule qualified to perform intubation.

Dr. Compton read his paper, entitled TUBERCULAR MENINGITIS.

Dr. Frank Leech opened the discussion by saying the subject brought up a very interesting case in his own practice. He submitted the pathological specimen of this case affecting the base of the brain (see page 19) and lower portion of the spinal cord, with fibrinous exudate within the dura mater so great as to cause symptoms of compression. The case of Dr. Compton is very interesting because it is the only case on record in which fluid was drawn off from the spinal cord and patient recovered.

Before adjournment the Executive Committee announced the business of the next meeting as follows: Essay by Dr. Mackall; discussion to be opened by Dr. Cole. Essay by Dr. Kelley; discussion to be opened by Dr. Deale. Place of meeting, Dr. Van Rensselaer's. Time, March 19.

R. T. HOLDEN, M. D.,

Secretary.

MEDICAL PROGRESS.

THROMBUS OF THE VAGINA IN PREGNANCY. Queirel of Marseilles (British Medical Journal) writes that a primipara, aged 19, when in the eighth month of pregnancy, was seized with pain after violent coitus, and a swelling rapidly developed and bulged out of the vulva. It formed a purple pyriform body four inches long and nearly two inches wide at its broadest part. It was evidently

The

about to slough. Queirel applied forceps to the pedicle, cut it flush with the forceps, and passed four sutures through the pedicle behind the forceps. instrument being relaxed, the sutures were tied; suddenly hemorrhage occurred as the last was being tightened. The mucous membrane had to be ligatured around the bleeding point. The patient was afterwards delivered at term, labor being spontaneous and perfectly normal. Queirel observes that this is the seventh case of thrombus of the vagina in pregnancy recorded in medical literature. In one (Auvard's) the thrombus was already sloughy when removed. The patient, as in all the other cases, recovered. The chief importance of thrombus of the vagina in pregnancy is, of course, this tendency to slough, which sets up an essentially dangerous complication. Fortunately removal of the thrombus and disinfection of the genital tract are easily effected.

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HEART SURGERY NEXT?-A contributor to the Medical and Surgical Reporter suggests that the principles upon which wounds in other vital organs are dealt with by modern surgery might often be applied with equal success to the heart. In view of cases on record in which the heart has resisted the effect of gunshot and other wounds for hours and even days, it is at least open to discussion whether a surgeon might not open the pericardium, clean out the clots, and close the wounds in the heart wall, with a chance for the patient of recovery which certainly could not be lessened by the attempt. It is claimed that this is no more improbable now than the safe removal of a tumor from the motor area of the brain seemed to be in the recent past. That the application of sutures. would necessarily stop the action of the heart is not proved; and if it should be, there would remain a question of possibly starting it again. The danger from the entrance of air into the circulation has been proved not so great as has been supposed. Drs. Hare and De Schweinitz of Philadelphia, who have done much work along the line of experimental cardiac surgery, have demon

strated that the intravenous injection of large quantities of air is not necessarily fatal.

ETIOLOGY OF LOCOMOTOR ATAXY.Dr. Pitres of Bordeaux, says the London Lancet, has made extensive investigations in the hope of throwing light upon the still doubtful points in the etiology of this disease. His first results were published in a thesis by Dr. Bereni and comprised 225 cases. The influence of syphilis was found to be great but not overwhelming, and was by no means in keeping with recent ideas on the subject. In considering those cases in which the etiology was certain there were 125 out of 225-i. e., 55.5 per cent. -and even in many of these cases the syphilis was associated with other causes of tabes dorsalis as hereditary joint af fections, alcoholism, sexual excess, etc., so that the exact percentage which could safely be attributed to syphilis was reduced to 22.33 per cent. Of the other patients about 33.44 per cent. had no sign of previous syphilis, and twice during his experience Dr. Pitres has seen tabetic symptoms precede syphilitic manifestations, so that these statistics tend to show that though syphilis is a cause it is not by any means the only one, but that many other conditions also play their part in setting up the disease. There is also in Dr. Bereni's work a chapter on the investigation of the heredity of tabes, but no direct tendency to inheritance was found.

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ERUPTION FOLLOWING VACCINATION. Dr. John E. Walsh of Washington, D. C., in an article in the Virginia Medical Monthly on vaccination, concludes as follows:

1. That eruptions following vaccination are comparatively rare, but more common than we supposed.

2. Eruptions are more liable to be produced in these who have suffered from some form of skin disease.

3. Where a skin disease is present, unless the presence of smallpox makes it necessary, it is better to postpone vaccination until it is cured.

4. That a deep ulcer at the point of