three days, and the subsequent paralysis over a month. During the past six months she has had four attacks,. the third one being very severe-the headache lasting nearly a week. The last attack came on about a month ago, before the eye had recovered from the effects of the preceding one. Following this last attack the paralysis has remained complete. Since the beginning of the disease the symptoms of each seizure have increasd in severity, have been more prolonged, and the recovery from the paralysis has been lengthened and less perfect. After the fifth attack an undetermined degree of divergent squint and ptosis persisted during the intervals between the seizures. Present condition.-When the patient is requested to open the eye, she succeeds in rais ing the lid about one line, divergent squint is present, and the pupil is widely dilated and immobile, the ring of the iris being 1 mm. in width. The external rectus is normal, but no movements can be detected in the direction of motion of the muscles supplied by the third nerve. Acuity of vision: R. E., V = 20/xx, and all lenses are rejected. With this eye she reads No. I. Snellen at three to twenty inches, showing normal accommodation. L. E., V =20/1x, and no glass improves distant vision. With this eye she reads only No. X. Snellen at twelve inches without glasses, and with + 5.50 D. She reads No. I. Snellen with some difficulty at six and a half inches, thus showing a paralysis of accommodation. The ophthalmoscope shows a similar and normal fundus in both eyes. The ocular diagnosis is, therefore, a paralysis of the left motor oculi in all its branches; together with an amblyopia of the left eye without evident intra-ocular disease. The patient is an emmetrope. At the present time, and while the ocular paralysis is complete, there is no weakness of the left arm, at least not greater, as compared with the right, than is usually found with right-handed persons. The tongue is protruded in the median line, and the facial lines are symmetrical. All the other cranial nerves are intact, and co-ordination, the reflexes, and other nervous functions are perfect. Here follows the literature on this subject with regard to the pathology of the disease; the authors say the following: Regarding the pathology of the disease, the different authors different authors vary widely. Saundby, Remak, and Perinaud refer the condition to a functional disturbance; v. Graefe and Manz think that in most of these cases there is a basilar meningitis. V. Graefe says, in reporting his case, that the blow on the head probably caused a fracture of the base of the skull, which may have been followed by an exostosis, which by periodical inflammatory enlargement pressed upon the nerve. Manz speaks of congenital malformations or arterial anomalies as a possible cause. In every case he thinks there is a chronic progressive anatomical lesion, and that it is not in any sense a "functional" disease. Moebius and v. Hasner think that in most of these cases the nucleus of the nerve is affected. It must be admitted that the theory of Mobius is well supported by the clinical history of the affection, and agrees fully with the evident central origin of our own case. The pain, from its character, he refers to an involvement of the descending band of fibres, passing to the fifth nerve (absteigende Quintuswurzel), which lies above and a little to the outer side of the mucleus of the third. The clinical features in the beginning point strongly to a congestion, with or without compression, of the nucleus of the nerve, with more or less involvement of the surrounding parts. The pathological process later results in permanent anatomical change. Moebius, however, distinctly admits that a peripheral (basilar) lesion may cause this form of paralysis. Up to the present time three post-mortem examinations have been made in these cases. The first, that of Gubler, was hardly a typical one. The lesions in this case, so far as they affected the third nerve, were meningeal. The exudate extended, however, as far forward as the optic chiasma, and was especially thick about the circle of Willis and along the borders of the medulla. In addition, a bloodclot was found in the pons. The patient of Weiss died of phthisis. The lesion in this case was found strictly circumscribed, and involved the nerve-trunk itself; the nucleus was found free from change. The left oculomotor, as it left the peduncle, was found flattened, grayish, and covered with numerous granulations, which on microspical examination, were found to contain numerous tubercle bacilli. The right oculo-motor, as well as all the other cranial nerves, were intact. The case of Thomsen, above described, has since died in the insane asylum at Dalldorf. The post-mortem examination, reported by Richter, showed the right oculo-motor, where it passed through the dura, grayish in color and club-shaped. The left nerve was one-half the thickness of the right and white. A fibro. chondroma had separated the fibres of the right-oculo-motor, but had not destroyed them. The nucleus of the nerve and all other portions of the brain were normal. This last is the only typical case of recurring oculo-motor paralysis in which the anatomical diagnosis has been made. In each one of the cases the lesion was peripheral, the nucleus remaining intact. As a matter of fact, a careful examination of the literature of this disease would indicate that it may be of central (nuclear), peripheral, or even "functional" origin. The prognosis in unfavorable. In only one case is there a history of anything like im provement. CITY HOSPITAL REPORTS. H. C. DALTON, M. D., SUPERINTENDENT. drew off clear urine. By ten o'clock the following morning the patient became conscious and said that during the previous night, while sitting in a window, he suddenly lost consciousness and fell to the ground a distance of 16 feet. Until then he had felt perfectly well. His abdomen was much distended with tympanites; was painful and tender generally, but most markedly in the epigastrium and lower abdominal regions. There was no point of especially severe suffering. Vomiting had begun in the night and occurred at intervals during the day. The vomit about noon of the second day became fecal, evidently from the ileum. The pulse was weak and rapid, but the patient did not seem to be much depressed. Temperature 38° C. (100.2° Fah.). An enema produced no action of the bowels, and he had had no movement since his entrance. In determining on a diagnosis, the following points were considered. It could not be obstruction from a band or internal hernia, because first, the trouble seemed to be the result of the fall on the previous night; second, the collapse was not intense enough, the pain was only of moderate severity, in fact towards the evening of the first day, and throughout the second, it was present only. when excited by manipulation, although very little morphia was administered during this time. Rupture of the gut was excluded because that could have occurred only in the lower part of the duodenum, or upper part of the jejunum, the fixed portions of the small intestines-and here were feces coming from CASE. I.-TRAUMATIC RUPTURE OF INTES- the ileum, below the point of possible break. TINE.-SYMPTOMS OF OBSTRUCTION WITH PERITONITIS.-DEATH.-AUTOPSY. BY BRANSFORD LEWIS, M. D., Assistant Superintendent. J. G., male, aged 32, German, single, carpenter. Admitted at 12:30, A.M., August 1, 1887., while unconscious, supposed to be suffering from the effects of the heat. No information about him was obtained, there was no evidence of traumatism and the catheter It was thought that, were that lesion present, a greater degree of, and more rapid, ballooning would have taken place, and the pain would have been more localized, and the prostration greater. There were no straining or other indications of intussusception. So it was concluded that the patient was suffering from a contused gut, which had caused a paralysis of the intestinal muscle and stoppage of vermicular movement at the site affected, resulting in the apparent obstruction, the peritonitis being due to the injury. On the first day he was given moderate doses of morphia, and ice-water cloths were applied to the abdomen. With the exception of the morphine, this treatment was continued during the second day; stimulants were also given hypodermically every three hours. He seemed then to be better, and was very comfortable. On the fourth day the patient appeared weaker, but had less pain, even on pressure, than he had before. The tension of the abdomen was distinctly diminished. He continued to vomit fecal matter. About noon he passed about a quart of feces from the bowel, exactly similar to that which he had vomited. At night delirium with desire to get out of bed, set in. Patient continually called for water, grew weaker and died at 2:45 A. M., August 5. Aug 2, A. M.. " P. M.. Aug. 3, A.M. 66 P. M...... Aug. 4, A. M.... J. H., male, aged 45 years, German, single, laborer, admitted Sept. 8, 1887. The patient claimed a good family history, excepting that one sister had had consump tion. He himself had always been healthy previous to the onset of the illness of which he then complained. It had begun on Sept. 3, with pain in the abdomen, soon extending thence into the chest and head. He also had continued fever, and occasionally sweated profusely, the headache never ceasing. A cough was accompanied by very little expec At the time of his first examination, it was noticed that he was thin and sallow. His pulse was 108, respiration 30, and temperature 100.2° Fah. His bowels had been constipated until stimulated by a purgative. Purgation, even then, was not excessive. The autopsy was held 11 hours after death. Evidences of a contusion were found over the lower half of the gladiolus; the abdominal wall appeared to be normal. A consider able quantity of pus was found in the abdom-toration. inal cavity, and the intestines were covered and bound together by a large amount of inflammatory exudate of recent formation. Congestion was everywhere visible. Located at about the upper border of the middle portion of the umbilical region, and covered by the adherent omentum, a slit-like opening, 1 cent., long was found in the anterior wall of the ileum. It was situated at a point 8 feet above the cecum, and 11 feet below the duodenum; it lay parallel with the canal of the gut. The wall of the latter gave no evidence of previous ulceration, and there were no ulcers in any part of the tract. No fecal matter could be discovered in the cavity. The stomach and intestines contained thin yellow feces. A small hemorrhagic area was found in the tissues covering the right psoas muscle. Its source was not ascertained. The other organs of the body were normal. Physical examination of the heart and liver disclosed nothing abnormal with them; the splenic area of dulness was increased slightly, and sibilant rales were audible in both lungs. There was some tenderness in the epigastric and umbilical regions. The urine was normal. Two days later, the patient became delirious, the delirium being of a quiet type. His bowels were then moving twice a day. Five days after entrance, his lungs gave evidence, by the accumulating rales, of approaching edema. Respiration was jerky. Considerable bleeding from the nose occurred, accelerating the depression, which, a day later, became great. There were dry 100. 30. 101.1° Sept. 15, A. M... The autopsy held ten hours after death, revealed the following: The brain was congested throughout; otherwise normal. Both lungs were edematous and hypostatically congested. The stomach and upper part of the small intestine were natural; in the mucous membrane of the ileum, near the cecal valve, several small round ulcers involving the solitary glands were found. Their borders were firm, and centers excavated; no serious changes. Two feet above the cecum, there was a large ulcerating patch, lying transverse to the intestinal axis, involving one half its circumference, measuring 4 cent. in length. In the center of this area was perforation, the tissues around which were completely softened, and readily broke down on the slightest pressure. External to the bowel, most abundant iu the neighborhood of the ulcer, were large quantities of pus and inflammatory deposit of recent formation; also a small amount of fecal matter. Peyer's glands were congested and the mesenteric glands were enlarged. The spleen was usually soft and large, weight 4030 Gm. (14 oz.) The cortical portion of the kidneys was slightly increased, and their substance cloudy. The other organs were normal. un -Japan is said to have a giantess, who though only twelve years and five months old, is said to stand 8 feet high, and to weigh 270 pounds. Her hand measures over 9 inches in length, and her foot 15 inches. ORIGINAL ARTICLES. A NEW METHOD OF TREATING SUPPURATING CAVITIES. BY FRANK A. GLASGOW, A. M., M. D. In charge of Women's Department St. Louis Mullanphy Hospital; Lecturer on Gynecology, St. Louis Medical College; Physician to Augusta Free Hospital for Children. The object of the present paper is to bring before the profession a new method of treating suppurating cavities, deep as well as superficial, which, I am fully convinced is a great advance over the old plan, viz., to lay open and drain freely. My method is almost the converse. It is in a few words, to cleanse thoroughly, render aseptic, and close antiseptically under pressure. By this method we avoid the drain on the system which is the necessary accompaniment of continued suppuration. It is based strictly on the antiseptic theory. Some years ago it occurred to me that if we could find some non-irritating solvent for iodoform, which would also act as a protective against the action of air or gases, we could achieve much better results in the treatment of suppurating cavities by injection. Ether was then used as a solvent, although I believe not as an injection into cold abscesses until the past year. This would evidently not suit on account of its volatility, the pain caused, and of disappearing completely, leaving the dry product on the surfaces. The dry powder would not completely prevent suppuration. Glycerine was objectionable as merely holding the powder in suspension and in not distributing it uniformly. Chloroform, benzole, benzine, and carbon bisulphide had all obvious objections. The only suitable vehicle was a fixed oil. I have used in all of my cases boiled linseed oil. It will dissolve from fifteen to nineteen grains of iodoform to the ounce. I have always used oil containing an excess of iodo form. Possibly other oils may be more suitable, as oil of sweet al monds, olive, cotton-seed or cod liver oil. Of course the oil must be non-irritating. The first time I used iodoform oil as an injection was in August 1884. The following described cases will illustrate the procedure and the results attained: CASE I.-Mrs. O'T -gave birth to a child one month ago and has been suffering with a continued fever for a week or more since. Has at present high fever. Both breasts are enormously swollen, and fluctuating. She has also an abscess to left of ostium vagina, which gave a history of hematocele. The breasts and peri-vaginal abscess were freely opened, the former discharging about one half a pint of pus each, and the latter about two ounces of mixed blood and pus. All of the abscesses were thoroughly cleansed with a three per cent solution of corbolic acid and then injected with iodoform oil. A tent of lint was carried to the bottom of each. Oakum saturated with the oil was placed over the cuts and then dry oakum. Over all was applied a tight bandage. This treatment was repeated every day or every other day, until I was no longer able to introduce the tents. At no time was there half a teaspoonful of pus excreted. The fever disappeared from the second day and did not return. Iron and quinine were administered. Recovery was rapid. CASE II.-The next case was one of large unilateral abscess of the breast. This patient was in the Gynecological Ward of the St. Louis Mullanphy Hospital. The procedure was the same as in the case detailed above, except that a solution of corrosive sublimate, 1 to 3,000, was used instead of carbolic acid. There were not ten drops of pus discharged at any one time after opening and treating as above. A tent was introduced as long as possible. CASE III. was during March, 1887. Mrs. G. Last parturition seven months prior to visit; has been nursing child up to present time. Has small abscess of right breast, the cause of which was unknown. On being incised the abscess discharged about one ounce of pus. It was washed out thor oughly with solution of mercuric chloride, the hydrogen peroxide injected until foaming had ceased. Afterward again washed with sublimate solution, and then injected with iodoform oil. Being by this time convinced that a tent was unnecessary, I closed the abscess tightly with cotton soaked in the oil and over it dry absorbent cotton. Over all a tight bandage was placed. This dressing was not removed until the fourth day, when the abscess was found to have healed completely. There was no discharge and no sinus. The cut integument gaped somewhat. CASE IV. Last child two months old. Has not nursed baby for several weeks. Patient is very cachetic and weak. She has had a continued fever for about three weeks past. IIas at present high fever. Left thigh flexed and everted. The patient gives a history of hematocele, occurring about three weeks ago, shortly before the onset of the fever. An examination showed hard infiltration about crest of ilium extending to and below Poupart's ligament. Great sensitiveness over this whole region. Impossible to extend thigh on account of pain. Per vaginam and rectum. Uterus not completely fixed. A firm mass was felt high up and to the left of fundus. Diagnosis. Suppurating hematocele of upper outer portion of left broad ligament. Three days after admission, softening having taken place below Poupart's ligament, an incision was made at this point, when a pint or more of very offensive pus was discharged. The cavity was washed out thoroughly with solution of sublimate 1 to 12,000. This was done by means of two gum catheters which were introduced until their points were felt at crest of ilium about midway between the anterior and posterior superior spinous processes. About eight inches of the catheters were within the sinus and cavity. After cleansing, the iodoform oil was injected through a catheter introduced to bottom of abscess. Cotton and oakum dressing was used. The next day the fever had abated and never arose again. On this day there was a considerable discharge of water and oil |