fulness of neck gradually increased in lower right side of neck, surrounding and imbedding this lump so that on May 12, 1887, the patient presented the appearance seen in Fig. 1. For some time previous to this date fluctuation had been easily perceived. It did not pulsate, nor was there any thrill or bruit. It was somewhat livid in color. The skin was movable over the tumor. On aspiration with hypodermic, a bloody serum was drawn, very albuminous, which coagulated on addition of nitric acid. This fluid examined with a microscope revealed white and red corpuscles and similar corpuscles to the white but of double size. They were very similar to the so-called Drysdale's corpuscles. These were somewhat cleared up on addition of acetic acid and ether. At this time the pain suffered by the patient was considerable,most severe in the right arm. The tumor had made rapid growth and was still enlarging. Respiration and deglutition had not been interfered with. At this time the lymphatics of left side of neck began to enlarge; some slight edema of right arm was also noted. May 20, edema of right breast was noted with decided increase of edema of arm; respiration is also now affected,she must keep the sitting position in order to get any rest; morphia in large doses is necessary for pain. May 23, edema of both legs was noted; right arm and breast are enormously enlarged; the edema steadily increased with rapid growth of tumor so that on June 4, 1887, she presented the appearance seen in Fig. 2. Two days after this photo was taken, by Dr. Begg's my assistant, she had several attacks of asphyxia with great irregularity of heart action. Death occurred June 7, about four and a half months from inception of illness. Autopsy one hour after death; body of a corpulent woman: Both legs, right arm and right breast were markedly edematous, left breast much less so, on right side of neck ex tending from middle of manubrium sterni to chin, and from left sterno-cleido-mastoid muscle which bulged out considerably, round to right trapezius; overlying inner two-thirds of clavicle and extending downwards to second rib, was a large tumor, the skin over which was tensely drawn and of livid color; at the most prominent part of the tumor the walls were exceedingly thin; at several parts of the mass fluctuation could be readily obtained; the tumor walls evidently were of irregular thickness. A crescentic incision was made through the skin at the lower border of tumor, and skin dissected off of same. It was then seen that the mass was intimately adherent to all the surrounding parts. The lower part of mass was lifted up, and the clavicle which was found to be eroded on inner third, with the sternum were removed. Traction being made in an upward direction and lungs being drawn down, the knife was carried downwards and backwards to the vertebræ, severing the branches of trachea below its bifurcation; this with all the surrounding glands and connections was then raised and the dissection carried up the neck to summit of tumor and the normal tissues cut just above the level of the epiglottis. The cystic cavity contained a bloody serum, which coagulated with nitric acid and was found to contain white and red blood corpuscles and large granular corpuscles like unto Drysdale's corpus cles. These cleared up to a considerable extent on the addition of nitric acid, and more so on addition of ether. The inner surface of cyst presented a trabeculated appearance very much like the inner surface of a heart auricle, with masses or nodules projecting into cyst cavity. The tumor seems to spring from the right lobe of the thyroid gland, and is intimately connected with and involves the connective tissues of neck on right and left sides, projecting deeply between the great vessels and veins of the neck; the cervical glands were markedly enlarged, the intervertebral subtance between the last cervical and first dorsal was softened anteriorly and disorganized to a depth of onehalf its extent between the bodies of the vertebræ. The cyst contained 900 cc. of fluid. Relations of thoracie and abdominal viscera were normal. Pleura presented a few organized adhesions at apex of both lungs, each pleural cavity contained about 500 cc. of serum. Pericardial cavity contained an immense amout of fluid, pericardium normal. All the cardiac cavities, the aorta and venæ cava contained post-mortem and ante mortem clots, the aortic clot extended through the arch and showed branches for each vessel of arch.. On greater flap of mitral valve was a spot of atheroma; other valves were normal; left ventricle was in systole. Both lungs contained numerous small spheroid bodies from two millimeters to one centimeter in diameter: on section they were seen to be of a whitish or light grey color, soft in texture, resembling brain substance. In upper lobe of left lung was one of these bodies about two millimeters in diameter, calcified. The lower portion of middle lobe of right lung was carnified. Abdomen-pelvis. Liver was slightly nodular, it had undergone marked fatty change, on section it seemed to be cirrhotic. Kidneys and spleen were in a state of passive congestion, other abdominal and pelvic organs were normal. Cranium and contents normal. I desire to acknowledge the faithful and efficient manner in which Dr. Wm. H. Begg's recorded the clinical and post-mortem progress of the case, as well as for his work in taking the photos, and micro-photo of the tumor tissue. In our first examination of the tumor which was hurried and superficial, taking the progress clinically of the case, I was of the opinion that I had a cysto-sarcoma of the mixed celled variety to deal with, but more careful and systematic examination has satisfied me that I was in error, and to Dr. D. V. Dean of this city, I owe an acknowledgement of thanks in pointing this out, and demonstrating the elements of which the tumor consisted. The microscope reveals the tumor to be col loid degeneration, passing to the cystic stage. The following micro-photo by Dr. Beggs will give a fair idea of the changes. Fig. 3. The dark central masses are the colloid material in the vesicles or follicles of the thyroid body. Those lines going from the letters pass to the little processes that extend from the central mass out to the capsule. Those lines passing from the numbers pass to the clear space between the colloid masses and the capsule. In these clear spaces can be seen the loosened and partially destroyed cells lining the follicles or vesicles of the gland. The processes seen extending from the colloid masses were what deceived me into thinking them giant cells. If this were so, the mass of protoplasm would occupy the entire cavity of the vesicles and these processes would be seen making their way into and through the surrounding tissues; but in the sections made from the tumor the clear space around the colloid material is undoubtedly the beginning cystic change and the projections are caused by the adhesion of this colloid material to the walls of the vesicles. That the cystic change was of a multiple character is manifest from the appearances presented on the inner surface or cavity of the large cyst, where are seen many loculi and trabeculæ crossing in all directions resembling reticulated tissue in the gross appear ance; furthermore, in the body of the tumor, were found small cysts, near and far from the central cavity, of different sizes, the larger being near the cyst wall, some only separated by a thin transparent membrane which would have very soon broken down, and the small cyst become one of the loculi of the large cyst cavity The appearances presented in the sections made of the enlarged lymphatic glands of the left side of the neck were of the same character as found in the tumor tissue, only not so extensive. The arteries of the neck of the right side were imbedded in an increased amount of connective tissue, and did not penetrate, save small branches, into the tumor tissue; in other words, the capsule of the thyroid gland seemed intact and the extension of the degeneration was confined to the lymphatic glands. There were no changes in the arterial part of the circulation. The venous part of the circulation on the right side of the neck presented a remarkable but not unknown state of affairs. The first thing that was found anomalous was manifested by an absence of the superior vena cava, the right and left innominate veins opening into the right auricle independently. Starting from the right auricle there was found a clot organized, filling almost the entire cavity of the auricle and intimately adherent to its walls. Tracing the right, innominate, subclavian, internal and external jugulars, middle, inferior and superior thyroid in their passage through the mass removed, which is described in post-mortem record, these veins were found to be absolutely impervious and in all save the subclavian, the thrombus was perfectly organized and intimately adherent to the walls of the veins, so that it was with the greatest difficulty we could remove it. The central part of the thrombus in the subclavian (right) was still somewhat soft and of a yellowish-red color, evidently the only partially organized thrombus. The entire venous system resembled solid cords rather than veins. From the light given us by the post-mortem and microscopical examinations it is evident the malignancy was not so much due to the tumor as to the pathological condition found in the veins. I am of the opinion the degeneration taking place in the thyroid gland was a result of the blood stasis produced by the thrombus, with a probable scrofulous diathesis. The thrombus was probably started or caused by the blow received in her fall, and the small lump at first manifest in the neck was the original thrombus, formed after the receipt of the blow. The edema can be readily accounted for. As a matter of fact the rapid progress of the case, both toward death as well as the growth of the tumor, was due to the occluded venous tracts of the right side. This occlusion progressing downwards into the right heart, accounts for the attacks of asphyxia and heart irregularity as well as gives us the immediate cause of death, from heart failure, from the mechanical conditions produced in the right side of the heart. THE BACILLUS AND PTOMAINE OF TETANUS. -Nicolaier recently discovered a bacillus which had the power of producing in animals the phenomenon of tetanus traumaticus. Rosenbach afterward succeeded in procuring the same bacillus from the wound of a man who had died of lockjaw. Lately Brieger has prepared a ptomaine from flesh which produces in animals the same symptoms as those which are produced by injecting the specific tetanus bacillus. He gives the name tetanine to this substance. It has also been found in a human cadaver which had been undergoing decomposition for several months. It is thought that the discovery of this ptomaine explains some facts observed in connection with the liability of certain regions to lockjaw. For instance, in one locality where it was very prevalent, large areas of land were covered a great portion of the year with the refuse from fish-oil factories, and it is sup posed that as the matter dries, the ptomaine finds its way into the air; or it may be present in the earth, contact with which may lead to ts introduction into wo unds. WEEKLY MEDICAL REVIEW, EDITED BY THE MEDICAL PRESS AND LIBRARY ASSOCIATION. Contributions for publication should be sent to Dr. B. J. Primm, 3136 Olive Street. All remittances and communications pertaining to Advertisements or Subscriptions should be addressed to J. H. CHAMBERS, 914 LOCUST STREET, St. Louis, Mo. SATURDAY, SEPTEMBER 24, 1887. THE SAME OLD TUNE. On all sides, picking up journals at random, we find the continual harping on "Misrepresentation of Homeopaths." We have always felt that it was giving them undue attention to argue the matter, and preferred waiting to see this illogical sect die of its own rotteness; and in using this expression, (which will be received with a chuckle by the "homeopath" who has lined his purse from the adoption of the name,) we feel that it is not born of the antipathy arising from predjudice, but that even in their own ranks the sophistry of their proceedings is recognized and expression given thereto, as will be seen in the remarks given below from the N. Y. Med. Times, the leading representative organ of that body. But forbearance ceases to be a virtue, and we must have our say.-Why is it that in such a pursuit as the practice of medicine, the object of which, the prolonging and saving of life, being such as should break down all feel ings of bitterness between its various members, there should be any animosity? There is only one object in its pursuit, that of saving life, and not the way of saving it. If the world had reached that ideal state where everything was perfect, and hence every one thought just as his neighbor, we are sure that a sick man would say: "It is no matter to me, doctor, how you cure me; what I want is to be cured; do it in any way you can." Unfortunately that Utopian state has not been reached and men differ. But what of that? Let them differ, and by mutual suggestion benefit one another. But the difficulty as it now stands is such that one side will not be benefited by the other; at least it says it will not. Whether it will or not is readily seen by following the prescriptions of a homeopath for a while and see. ing the medicines given by him. And right here let us say that we are not speaking from a standpoint wherefrom we only view that body, but from their own; this with particular reference to the name they bear, which they themselves adopt and hold to. conceding to us our own, and not give a triumphant shriek of joy when they see a "phy sician" using Pulsatilla, or powdered brickbats, or ten-penny nails for that matter, as a remedy against disease. Our position admits of the use of anything which we think will cure that position assumed by ourselves, we mean, and not the one they attempt to assign us by dubbing us "allopaths", and conse quently we are entitled to the use of any remedy we see fit. Surely even they will admit that any clear-headed man, not hampered by a "sect", will reap the benefit of any ad If this were otherwise, we would have no attacking point. Were we to call ourselves what they insist upon calling us,-allopaths-vance in any branch, and made by any man. then would we feel that words were useless, for it would mean that we all recognized that there were two ways of curing people, and it was only an argument as to which was the right one. And here comes the whole gist of the matter as we view it. Is there a doctor on earth, who is fool enough, knowing the disease and the remedy, to forego its use because he belongs to a sect, the principles of which forbid its use. We most as suredly do not believe there is, and the moment a man who calls himself a physician professes to be of a sect, that moment does he hamper himself in the practice of medicine. For a sect means a part, and when a physician has only a part of the whole, wherewith to combat disease, he is obviously at a disadvantage. Why do they insists upon dubbing us "allopaths"? No physician that we ever met called himself such, nor does any text-books or code of ethics of that so-called "allopathic" school denominate them so. No, it is because they recognize that as their only sustaining foothold. When that is gone there remains this plain statement of the case, which exists to day, always has existed so far as we are concerned, and will forever exist in the minds of clear-sighted people; to wit, that "physicians" have all the remedies of the world with which to fight disease, whereas a "sect",if true to their principles, have but a part of those remedies. We freely concede to them their position as taken, but expect them to stick to it, if they are honest in their belief, and only ask that they do likewise in But how about a homeopath, a member of a sect, a self-admitted sect,-suppose he should discover a powerful and beneficent agent for good in the treatment of disease, could he use it? Not a bit of it. He would first have to examine it carefully, to see if it conformed to the principles of his sect, for a sect is not a whole, and consequently connot comprise everything, and if it failed to do so, and he proved worthy of his trust, he must of neces sity expunge it from his list of remedies. Can anyone be sufficiently addled-headed to suppose that any man would do this? But "The dull crowd most honor show to those Who on their understandings most impose." and as the understandings of the "dull crowd" are generally pretty poor, they are easily enough imposed upon. It is not that there are too many doctors in the land, it is not that the regular profession is being "crowded to the wall" by "sects", a they are sometimes pleased to think, that thi is written. All we ask is,-do what you sa you will, and not stick out a sign professing a part, and then practice the whole. We ca imagine our friend, the "Hahnemannian, throwing up his hands in horror at this an saying "But we don't, we don't do this thing of course you find backsliders in all profe sions"-to that we will simply refer him f answer to the N. Y. Med. Times, unquestion ably the leading journal of the country Homeopathy, which says: "We do not believe that there is a sing member of the faculties of so-called home |