The following morning a digital examination discovered a foetus and membranes escaping from the os. There was also metritis and general inflammation of all the immediate soft parts, with nausea, vomiting, diarrhoea, ischuria, and increased temperature. In a few days a general peritonitis supervened. After a dangerous illness of three months, the patient finally strong spasms, during which the head was thrown CASE IV. I find the following in the Canada Medical Journal: A young woman took a teaspoonful of oil of tansy to induce miscarriage. There was coma, dilated pupils, and finally recovery, without action on the uterus. From the cases cited above, it appears that neither the herb nor oil of tausy has any specific action upon the uterus, although a strong decoction of the herb, under some circumstances, may act powerfully as a local irritant, as well as a poison, to the nervous centres. It further appears that no antidote of the poison has thus far been discovered, and the proper treatment seems to be to remove the noxious element from the stomach in the safest and most expeditious manner possible. In the case under my care, I should have used a hypodermic injection of apo. morphia, had it been conveniently at hand. Stimulants appear to be essential, in order to continue the action of the heart through the period of depression. GEORGE JEWETT, M. D. FITCHBURG, February 12, 1880. 66 sav MR. BRYANT AND ANTISEPTIC SURGERY. MR. EDITOR,In a recent number of your very excellent journal your London correspondent, in reporting what passed at the debate on antiseptic surgery of December 3d, described my observations as age," whereas much of what I said was very compliCASE V. Dr. Pereira quotes a case from the Med-mentary to the distinguished advocate of antiseptic ical Magazine, November 24, 1834, in which frequent surgery, and I claimed to be an antiseptic surgeon as and violent clonic spasms were experienced, with much much as Mr. Lister. disturbance of respiration. The action of the heart grew weaker, until death took place from its entire suspension. An autopsy showed no signs of inflammation of stomach or bowels. The amount of oil of tansy taken was four drachms. CASE VI. Dr. Hildreth reports a case of rapid death from a much smaller quantity, with similar symptoms, the poison having been taken to procure abortion. CASE VII. In the Medical Times and Gazette, Dr. Pendleton relates the case of a woman, aged twentyone, who took a strong decoction of the leaves of tansy to procure abortion. She became incoherent, with contracted pupils; there was afterward coma, followed by paralysis of the voluntary muscles, without spasm or convulsion, and death in twenty-four hours, without action on the uterus. CASE VIII. Dr. Charles H. Rice, of Fitchburg, has kindly furnished the history of the following case: In January, 1876, he was called to attend a woman three months advanced in pregnancy, who stated that she had taken a strong infusion of tansy daily for one week to produce abortion, without effect. She then used a very strong decoction of the herb (a half pound to a pint, by estimate) as a vaginal injection. In a few hours there was vaginal discharge, first watery, then bloody, accompanied with pain in loins and uterine contraction. Twelve hours subsequently she had a violent chill, at which time the doctor arrived. He immediately administered a hypodermic injection of morphine, and ordered sulphate of quinine, grs. ii., every two hours. It is true I criticised briefly a paper in which all Mr. Lister's joint cases were tabulated, and I expressed surprise that the material upon which the very dogmatic assertions relating to the treatment of joint affections had been based was so limited, but I am not aware that I said one word to justify the use of such a term as your correspondent has used. The whole debate is, however, about to be published, and you will be able to read for yourself what passed, and to judge fairly. Believe me faithfully yours, THOMAS BRYANT. LONDON, February 10, 1880. THE TREATMENT OF ASTHMA. MR. EDITOR,-In Dr. F. I. Knight's review of Berkart on Asthma, he incidentally alludes to the results of my treatment of asthma. with large doses of iodide of potassium. In connection with the above I desire to state that the drug in doses of five or ten grains seldom gave relief, but large doses continued for a long period gave entire relief in the majority of cases. Some patients, however, were unable to take the iodide of potassium even in small doses; in such cases I used as a substitute hydriodic acid, and, as Dr. Knight says, "with surprisingly satisfactory results." The form I have oftenest used is the syrup of hydriodic acid, and that prepared by Robert Gardner, of New York, I consider the best; it is agreeable to the taste, and not very likely to be affected by exposure to light and air. It should be given as follows: be gin with small doses, twenty or thirty drops well diluted with water, and taken about half an hour to an hour before meals; if taken after meals it may disturb the stomach, set up fermentation, and cause colic, acid stomach, and pain in the head; increase the dose gradually, and a tablespoonful dose should not be exceeded. In cases of chronic bronchial catarrh, and in fact in all cases where iodide is indicated, I have found the syrup of hydriodic acid of great value. Later in the season I propose to send to the JOURNAL a report of a large number of cases of asthma treated on the above plan, and with very gratifying results. I am very truly yours, J. P. OLIVER. REPORTED MORTALITY FOR THE WEEK ENDING FEBRUARY 21, 1880. ton one. Two thousand four hundred and forty-eight deaths were reported; 944 under five years of age: principal zymotic " diseases (small-pox, measles, diphtheria and croup, diarrhoeal diseases, whooping-cough, erysipelas, and fevers) 447, consumption 369, lung diseases 359, diphtheria and croup 155, scarlet fever 76, typhoid fever 44, measles 44, whooping-cough 32, diarrheal diseases 33, erysipelas 23, malarial fevers 27, cerebrospinal meningitis 19, small-pox eight, typhus fever one. From measles, New York 20, Chicago seven, Brooklyn six, Philadelphia five, St. Louis and New Haven two, Buffalo and CharlesFrom whooping-cough, Pittsburgh eight, New York seven, Buffalo and Cleveland three, Brooklyn, St. Louis, and New Orleans two, Baltimore, Boston, Cincinnati, Milwaukee, and Chelsea one. From erysipelas, New York five, Brooklyn four, Philadelphia and Worcester three, St. Louis two, Chicago, New Orleans, Pittsburgh, Providence, Nashville, and NorthampFrom malarial fevers, New York nine, New Orleans six, Brooklyn four, St. Louis three, Baltimore two, Chicago, District of Columbia, and Cleveland one. From cerebro-spinal meningitis, Chicago nine, Cincinnati, Holyoke, and Newton two, Philadelphia, Brooklyn, Baltimore, and Fall River one. From small-por, Philadelphia five, Worcester two, District of Columbia one. From typhus fever, Baltimore one. One hundred and thirty-nine cases of measles, 45 of diphtheria, 20 of scarlet fever, two of whooping-cough, and two of typhoid fever were reported ton one. in Brooklyn; diphtheria 30, scarlet fever six, in Boston; diphtheria ten, scarlet fever four, in Milwaukee; scarlet fever 43, diphtheria 19, measles two, typhoid fever one, in Providence; scarlet fever 12, diphtheria four, in New Bedford. The deathrate of whites in District of Columbia was 20.98, of colored 41.8. No more cases of small-pox have been reported in Cleveland: it has appeared (during the past week) in two new localities in Worcester. The total number of deaths reported is about four per cent. less than for the previous week; of deaths under five nearly sixteen per cent. more. There was a very marked diminution from diphtheria, with an increase from cerebro-spinal meningi. tis and malarial fevers. In 36 cities and towns of Massachusetts, with an estimated population of 1,010,860 (population of the State about 1,690,000), the death-rate was 20.22 against 22.09 and 20.41 of the previous two weeks, with an increase from lung diseases, scarlet fever, erysipelas, and cerebro-spinal meningitis. For the week ending January 31st, in the 20 chief Swiss towns, lung diseases were very prevalent and fatal, small-pox causing deaths in Geneva and Lucerne. In Belgium, small-pox caused 38 deaths in ten towns; croup was very prevalent, the other zymotic diseases not having been widely prevalent; lung diseases were wide-spread and very fatal. In Germany there was a diminution in the general death-rate of cities reported 1.5 per 1000. The infectious diseases remained without change or with less mortality. Lung diseases also were less fatal. Typhus fever and small-pox prevailed in St. Petersburg and Paris. Small-pox had broken out in several parts of Poland. In 143 German cities and towns, with an estimated population of 7,605,712, the death-rate was 25.7 against 27.2 and 26.2 of the previous two weeks. Three thousand seven hundred and sixtytwo deaths were reported; 1725 under five: consumption 544; acute diseases of the respiratory organs 462, diarrhoeal diseases 169, diphtheria and croup 136, typhoid fever 59, scarlet fever 59, whooping-cough 56, measles and rötheln 39, puerperal fever 26, small-pox and typhus fever none. The death-rates ranged from 13.5 in Carlsruhe to 41.4 in Altona; Königsberg 34.6; Dantzic 26.6; Breslau 25.4; Munich 34.0; Dresden 21.5; Cassel 16.9; Berlin 24.9 Leipsic 27.6; Hamburg 29.4; Hanover 21.0; Bremen 17.5; Cologne 25.0; Frankfort 17.5. In the same week, Vienna 27.0; Paris 34.1. For the week ending Febuary 7th, in the 20 cities of England, with an estimated population of 7,499,468, the death-rate was 37.0. Five thousand three hundred and twelve deaths were reported. Lung diseases reached the enormous figure of 1557, largely due to the combined effect of very unusual cold and fog; whooping-cough 317, scarlet fever 120, measles 102. fever 43, diarrhoea 29, diphtheria 13, small-pox (London) 13. The deathrates ranged from 16.5 in Wolverhampton to 48.1 in London: Bristol 29.8; Birmingham 21.2; Liverpool 27.8; Manchester 31.6; Leeds 27.3. In Edinburgh 22, Glasgow 25, Dublin 43 (eight deaths from small-pox). Of the 20 chief towns of Switz erland, diphtheria was fatal in ten, lung diseases being very widely prevalent; small-pox caused deaths in Geneva, Lausanne, and Lucerne. The meteorological record for the week in Boston was as follows: Mean. Relative Humidity. Mean. Maximum. Minimum. Feb. 15 16 " 17 567 30.062 29 18 30.032 30.409 34 30.473 44 52 53 "6 19 30.100 25 56 20 30.371 23 30 " 21 29.729 32 1004000 2 P. M. 1 O., cloudy; C., clear; F., fair; G., fog; H., hazy; S., smoky; R., rain; T., threatening. APPEL, D. M., first lieutenant and assistant surgeon. signed to duty at Fort Supply, Indian Territory, relieving Assistant Surgeon Loring. S. O. 39, C. S., Department of the Missouri. Drs. GEORGE MCCREERY and EDWARD D. SCHUE, of New York city, RICHARD C. NEWTON, of New York, and JOHN J. COCHRAN, of Massachusetts, having passed a successful examination before the Army Medical Board, now in session in New York city, were, February 10, 1880, confirmed by the senate as assistant surgeons United States Army, with the rank of first Notes on Fever Nursing. By James W. Allan, M. B., Superintendent and Physician to the City of Glasgow Fever Hospital. Philadelphia: Lindsay and Blakiston. 1880. (Estes and Lauriat.) The Spectroscope in Medicine. By Charles A. MacMunn, B. A., M. D. Univ. Dub. Philadelphia: Lindsay and Blakiston. (Estes and Lauriat.) Pseudo-Hypertrophic Muscular Paralysis. A Clinical Lecture by W. R. Gowers, M. D., F. R. C. P. London: J. and A. Churchill. 1879. Transactions of the Vermont Medical Society for the Year 1879. Cancer of the Rectum. Its Pathology, Diagnosis, and Treat- Supplement. National Board of Health Bulletin. Chaillé, New Orleans, La. (Reprint.) Philadelphia. 1879. The Eighty-Third Annual Report of the Boston Dispensary. Second Annual Report of the State Board of Health of the State of Connecticut, for the Fiscal Year ending November 31, 1879, with the Registration Report, 1878, relating to Births, Deaths, Marriages, and Divorces. Hartford. 1880. Fourteenth Report of the Board of Trustees of the Connecticut Hospital for the Insane for the State of Connecticut, with Superintendent's and Treasurer's Reports. Middletown. 1880. A Protest against Meddlesome Midwifery. By H. Gibbons, Sr., M. D. Read before the San Francisco County Medical Society. Original Articles; MAR FIBROID PHтursist, BY FREDERICK C. SHATTUCK RY EUM FORD THE term phthisis, like the term Bright disease, represents a group of pathological conditions, not, like the term typhoid fever, a single and invariable pathological condition differing in different cases only in degree and more or less accidental complications. This group consists, according to modern pathology, of three members, tubercle, pneumonic infiltration or exudation, and interstitial growth, the fibroid substitution of Bastian. It is true that in the majority of cases of phthisis we find two or all three of the members of the group coexistent and intimately associated with each other; but we do, on the other hand, meet with cases in which some one of the members is alone, or almost alone, represented, as in acute miliary tuberculosis, acute inflammatory phthisis, and cirrhosis of the lung or fibroid phthisis. It is with the latter that we are concerned to-day. I would define it as a chronic disease of the lungs, the vesicular structure of which in the affected part or parts is destroyed and replaced by connective tissue growth, generally unilateral and associated with bronchial dilatation, running its course without notable fever or emaciation, but, in the long run, directly or indirectly fatal. When the greater part or the whole of one lung is involved, great distortion of the thorax and dislocation of the heart and neighboring organs may result from the diminution in volume of the diseased, and compensatory hypertrophy of the sound, lung. The affection may be confined to one lobe, as in a case I saw some years since. The patient was a laboring man, who had been apparently healthy, but succumbed on the third day to an acute pneumonia of the right lung. At the autopsy the lower lobe of the left lung was found to be converted into a dense mass of fibrous tissue traversed by dilated bronchial tubes. Pleuritic adhesions are nearly always present, sometimes lax and slight, sometimes very thick and tough, even fibro-cartilaginous in appearance. In only one of thirty cases tabulated by Bastian was any fluid found in the pleural cavity. The tissue of the lung is very firm and resistent, and may even creak under the knife, and varies greatly in appearance, chiefly according to the degree of bronchial dilatation aud the amount and character of the pigmentation, which latter is derived either from the blood or from the inhalation of particles of foreign substances, such as coal or iron dust and the like. The bronchial dilatations, not invariably present, may equal or even surpass a hen's egg in size, and are uniform, fusiform, saccular, or globular in shape. The contents may be purulent, muco-purulent, somewhat inspissated, or thin and excessively offensive, entirely independent of gangrene. Any patches of relatively normal lung which may remain near the indurated tissue are apt to be markedly emphysematous, as is often also, to a less degree, the sound lung. This is, partly at all events, the result of the frequent and long-standing cough. The most important and frequent change about the heart is hypertrophy and dilatation of the right cavities from mechanical obstruction to the pulmonary circulation. In the last stages of the disease this is 1 Read before the Essex North District Medical Society at their semi-annual meeting, January 13, 1880. liable to be followed by general dropsy. Bands of white glistening fibrous tissue are sometimes seen passing through the lung, but a mottled gray and black coloration is more common, leading Addison to compare the appearance to that of Aberdeen granite, and Rindfleisch to employ the term "slaty" or schistous induration. Miners' lung may be uniformly black, as well as the fluid which is squeezed out from the cut surface. 66 I will not detain you long with a discussion of the pathology of the affection, in regard to which there has been so much controversy, and is to-day such wide difference of opinion. A striking illustration of this diversity is afforded in Reynolds's System of Medicine. Dr. Wilson Fox contributes an article on chronic pneumonia, and, with an interval of a few pages, Dr. Bastian succeeds him, and treats of precisely the same condition, equally at length, under the heading of Cirrhosis of the Lung, the term given by Sir Dominic Corrigan more than forty years ago. Fox denies, Bastian affirms, its existence as an independent disease. The former says that "nearly all the cases of pulmonary induration which have fallen under my observation have been connected with previous chronic pneumonia associated with the presence of tubercles; " the latter that, though chronic lobular pneumonia, tubercle, and the miliary process are frequently combined, there is no necessary connection between them, and each may and does exist by itself as an independent affection. According to Jaccoud the process is primary only in hard drinkers. The mode of production of bronchiectasis has also been a much-disputed point since it was first described. As connected with fibroid phthisis the two chief factors in the production are probably increased pressure within the tubes during attacks of cough, and diminution in the size of the lung beyond the limit provided for by contraction of the chest wall and displacement of organs. The etiology is pretty clear except as to the question whether the condition is ever primary, and there is no doubt that it is very often secondary to bronchitis, pleurisy, croupous and catarrhal pneumonia. The symptoms vary greatly in character and prominence with the area of pulmonary tissue involved, the absence or presence of bronchiectasis, and the stage of development reached by the affection. When it is limited to one lobe, symptoms may be nearly or quite wanting, but when it is extensive, cough, expectoration, and dyspnoea, especially on exertion, are usually well marked. The expectoration may be very profuse, notably after rising in the morning, and has often a faint, sickish, disagreeable smell. Fetid expectoration indicates either gangrene or retention and decomposition of the secretion. If there be marked bronchiectasis we may have the expectoration characteristic of that condition, namely, the discharge at intervals of large quantities of secretion, the patient during the interval being nearly free from cough and expectoration. Hæmoptysis is common, and apt to be frequently re peated and moderate in amount, unless it proceed from an eroded vessel in a cavity. Fox mentions a case in which it recurred seventy times in twenty-three years. Fever and emaciation are mostly confined to two classes of cases, those in which the disease is the direct sequence of a croupous pneumonia which never underwent resolution, and the course of which is relatively short, and those in which tubercle and lobular pneumonia appear and reappear on the scene and bring the drama to a close. General dropsy from failure of the right heart has been already alluded to, and albuminuria is not uncommon. Laryngeal symptoms are absent, the appetite is usually good, and diarrhoea, when it occurs, is rather a complication than a true feature of the disease. The diagnosis is often easy, though it may be attended with great difficulty. Our main reliance must be on the lack of correspondence between the rational signs and history and the physical signs. The latter are those of pulmonary consolidation and excavation, while the general condition of the patient often shows that we are not dealing with the ordinary form of phthisis. I saw at Schrötter's clinic at Vienna a remarkably plump and blooming young girl with flatness on percussion, bronchial voice and breath sounds and gurgling râles all over the base of one lung, and was assured by Schrötter that to his knowledge the girl had been in this condition for a number of years. In unilateral cases with contraction it is not always easy to exclude chronic pleurisy, though the authorities state that it can usually be done. According to Walshe, curvature of the spine and drop of the shoulder on the affected side do not reach so high a degree in cirrhosis as in chronic pleurisy. Dilated bronchi may be met with in both affections, though they are perhaps more constant in cirrhosis. But the most conclusive evidence is a history of repeated hæmoptysis which points strongly to cirrhosis. A history of tapping excludes, of course, primary cirrhosis, and some value must, it seems to me, be attached to the fact that a patient has never been tapped. The confidence with which we now plunge a fine aspirator needle into almost any part of the body undoubtedly diminishes largely the number of undetected or doubtful pleuritic effusions. The history of the case alone will ordinarily suffice to enable us to exclude malignant disease. In the last stages of the disease, when secondary inflammatory or tubercular changes are present, difficulties in diagnosis may arise, but careful analysis of the history and the sequence of the symptoms will generally enable us to arrive at the true nature of the case. The prognosis cannot be regarded as favorable, though it is of course much more favorable, as far as duration of life is concerned, than in cases of destruction of an equal amount of lung tissue by the common phthisical process. There are no means within our reach for restoring the vesicular structure, and the tendency of the disease is to progress more or less slowly and invade new territory, even if no more rapid process supervenes, or an intercurrent affection, as is often the case, carries off the patient. Fetor of the expectoration, whatever its cause, is an unfavorable symptom, as are also, of course, fever, emaciation, albuminuria, and dropsy. It follows from the foregoing that treatment must be chiefly hygienic and symptomatic. The patient is to be guarded as far as may be from fresh colds, and a cold, when acquired, is not to be made light of. Fresh air and sunlight, woolen clothing, a generous diet, and the avoidance of severe exertion, which throws extra work on the already overtaxed heart, are of the greatest importance. Sedative cough mixtures may be required to procure sufficient sleep, and fetid expectoration may be combated by inhalations of carbolic acid and the like. These are briefly the salient features of fibroid phthisis, and I will now venture to present a patient who illustrates very well the part which connective-tissue growth plays in the cure - temporary though it may be of ordinary phthisis. You have doubtless all of you seen similar cases, but they are not very common, and this particular case is so strongly marked that I think it will not be without interest. J. A., forty years of age, was sent to me early in September, 1879, by my friend Dr. Bradford. His grandfather died of asthma, and two brothers out of nine have died of quick consumption. He served four years in the navy during the war, contracting typhoid and intermittent fevers. After his discharge, in 1865, was strong and hearty, and worked in a printing-office. In October, 1870, caught cold while house-moving, from exposure, and from this cold he dates his present troubles. Though he had persistent cough did not consult a physician for upwards of a year, at the end of which time he had night-sweats, and was so much run down that he sought advice. Was told by the physician that he had chronic bronchitis. Kept steadily at work, consulting his doctor now and then for the next two years, and was then told that he was in danger of consumption. Spat blood for the first time in 1872, since when has had attacks of hæmoptysis, recurring at intervals every spring except that of 1879. Is positive that he must have spat blood at least eighteen or twenty times, the last time in October, 1879. Between 1873 and 1877 worked off and on. Was laid up once for ten months, once for five, and alternately lost and gained in weight. Since the spring of 1877 has been able to do no work. His weight was at that time at its lowest point, one hundred and eighteen pounds, - and he began to drink Medford rum, a quart of which a week was given him by a friend. Since then has gradually gained in flesh, and now weighs one hundred and seventy-one pounds, the greatest weight which he ever attained before his sickness began being one hundred and sixty-seven pounds. Between September 4 and December 2, 1879, gained ten pounds. Has had the opinion of many physicians during these years, and has been twice an inmate of the Boston City Hospi tal. All agreed in the opinion that he was in consump tion. Gives a history at one time during his sickness of expectoration as from a large cavity. On leaning forward at times large quantities of secretion poured out of his mouth, leaving him comparatively free from cough and expectoration, until the cavity again filled and was emptied. He now complains of dyspnoea, greatly aggravated by exertion, and cough with profuse muco-purulent expectoration, especially on rising in the morning. Is greatly troubled by the fact that his acquaintances refuse to believe him a disabled man, and intimate that he is shamming. Sleeps in an easy-chair by preference, though he can lie down if his head and shoulders are well raised. Is not affected by changes of weather or draughts. There is decided flattening and deficient expansion of both upper fronts, and the integument over the supraclavicular space is drawn inwards during inspiration. There is also marked dullness on percussion on the upper part of both lungs front and back, especially the right front and left back, with intensification of the voice sounds and very harsh but not bronchial respiration. Over the base of both lungs percussion is not remarkable, and respiration is more or less obscured by abundant coarse, moist, and dry râles. There is hypertrophy of the right ventricle, as is |