dom from pressure, how little pain was suffered; how easily sleep came. This case also then quickly recovered. Can we tell what would have happened, probably, in all these three lucky cases, if there had been no surgical interference. Why, suppurative meningitis, or perhaps inflammation of the brain. Liddell (American Journal of Medical Science, January 1880, p. 113), extracts a case just similar to these just related from the Surgical volume of the war of the Rebellion, as follows: There was a compound depressed fracture of the right parietal bone from a fall on the head. After the man recovered from his stunning, his sensibility was restored and his mental faculties were normal. It was decided not to operate, but to await events. In twelve days he had increased headache and severe convulsions. The next day more headache; he was trephined; on removal of the bone, pus gushed out copiously. He then had hernia cerebri-almost died-but finally recovered, to have Liddell place him in the category of those who are sometimes saved by trephining. Bryant (Surgery, p. 176) says, that Mr. Cock said truly, when he wrote thirty years ago (now 37 years) that "much has been written and said on the treatment of injuries of the head; and the result of modern experience and judgment has so far altered the practice of our predecessors, as to render us cautious of inflicting an additional injury on our patient for the sake of gratifying an impertinent and useless curiosity as to the exact nature and extent of the original lesion." Longmore (Holmes' System of Surgery, vol. ii., p. 178,) in commenting on the success of American surgeons in trephining during our civil war, says, "that it has a tendency to unsettle his notions; that in European military practice the experience of recent years would cause the trephine to be employed only in cases which were otherwise hopeless; perhaps the American surgeons may have applied it with less hesitation in ordinary cases of depressed fracture." Hewett (Holmes' System of Surgery, vol. ii., p. 250) says, "that trephining for pus between the bone and dura mater appears in Pott's hands to have been most successful "—"but no such success has attended the practice of other surgeons." Dr. S. W. Gross, of Philadelphia (American Journal of Medical Science, July 1873, p. 58), says, Pott did not wait for fatal symptoms-that he has examined the history of the cases that have occurred in late wars; their symptoms do not differ from those presented by cases a century back. The only difference in Dr. Gross' opinion being that Pott was right in his treatment, and that modern surgeons are very decidedly wrong in delaying operative interference until it is too late to be of any avail. Dr. Gross further says (p. 70), "that in cases of depressed fracture, primary symptoms of compression are of less importance than the existence of intruding fragments of bone, which induce, sooner or later, inflammation of the brain or its membranes." I understand that Liddell, of New York (American Journal of Medical Science, January, 1880, p. 117), also approves of operation at once in compound depressed fractures of the cranium, even if there are no cerebral symptoms. However, he would not operate if there was a slight depression of a thicker part of bone, nor over the frontal sinuses. Stimson, (p. 247), On Fractures, thinks that the mortality following the use of the trephine is to be charged, not to the operation, but to the lesions whose symptoms finally led to it, after a delay that had deprived it of most of its chances of success. In compound linear fracture, Stimson trephines if he thinks it probable that the inner table is splintered (p. 250); and of simple fractures, where without intercranial symptoms we do not interfere, he thinks it is possible that the antiseptic method may prove so efficient in removing the dangers incident to exposure of the cavity of the cranium, that surgeons will consider it justifiable, in cases of undoubted depression, to cut down upon the fracture immediately, with a view to prevent occurrence of epilepsy, or intellectual disturbances. So much for trephin ing; and we wish to add, that we endeavor, in general treatment, to follow the teaching of Agnew (Surgery, vol. i., p. 299), who does "not compromise with the modern follies of expectancy; who urges a hand-to-hand conflict; who uses venesection, the ice-bag to the head, a purgative, veratrum, calomel, etc." Agnew says, during our civil war, our surgeons lost four-fifths of their cases of intra-cranial injuries, while the English and German surgeons, during their late wars, saved one-half, under the antiphlogistic system of practice. I will close with the relation of a case of severely bruised brain; one of the most remarkable cases of recovery that I ever saw. About seven years ago a healthy, robust, middleaged farmer, had his team of horses run away with him. Being thrown from his wagon, he was found insensible and carried home. When I visited him several hours after the accident, I could find no wound of the head or broken bones. He was in so deep a stupor that I had no hope of his recovery; but, as he could swallow, I commenced giving him calomel and the next day several doses of croton oil. As his bowels did not move, I commenced the use of enemas of water, and continued them every three hours. As my patient was nearly ten miles away, and I only went once a day, the friends continued to give him quite a number of them—all of which he retained. He neither drank any water or took any food for about ten days, nor could I get his bowels to move, though I tried to give him salines-all I could. His urine did not dribble, but passed at least twice in twenty-four hours, which was a surprising thing to me, as we are all familiar with the incapable bladder in bad cases of head injuries. In a week he began to have spells of raving, being so restless and mad, that he tore his clothes to tatters, and required two men to keep him in bed. In ten days, in the morning, I demanded of him, in a shrill, imperative tone, that he put out his tongue. He did put out his tongue, but immediately withdrew it. When ordered a second time to show his tongue, he muttered slowly that he could, but that he wouldn't do it. From this time he slowly recovered. Were not the enemas spoken of, absorbed? Did they not keep him alive? The medicines given had no effect. The alimentary canal remained insensate, though the anal sphincter was sufficiently strong to prevent the return of the enemas given. As soon as he was able he went to work. One day, while chopping wood, he had an epileptic fit. He did not have as much sense as before he was hurt, but was industrious and decent. He had fits, now, off and on for five years. It has been two years now since he had one. He is well and works every day. In his case there must have been, concussion and great bruising of the brain. In a small minority of cases (Agnew, vol. i., p. 302) no lesion of bone is found in traumatic epilepsy. Bryant (Surgery, p. 162) considers shaking and bruising the brain as synonymous terms; while Agnew (vol. i., p. 276) says, "that even concussion, with molecular vibration, may result in a shock, or collapse, which may continue a single hour or many days before reaction sets in." Hewett' (Holmes' System of Surgery, vol. ii., p. 320) describes just such a case as that related, where the man was suffering "from so-called concussion of the brain." He died in twenty years after being hurt, and when his head was examined the convolutions of the anterior part of both hemispheres of the brain were extensively excavated," showing that the case was one of badly bruised brain, with subsequent destruction, and absorption of the brain-tissue. COMPARATIVE MORTALITY, INSURABIL- BY P. V. SCHENCK, M. D., Clinical Lecturer on Gynæcology, Missouri Medical College, St. Louis, Mo. DOES longevity depend upon the condition of all the organs and their working in harmony one with another, each meeting the wear and tear which nature makes for the support of life, or does it depend upon a general law of population resting upon an edict that it is appointed unto man once to die, and that that day and hour is so fixed that all these influences are wrought for that special end? Flourens contended that man by virtue of his natural constitution ought to live one hundred years, and that it is improvidence on the part of the individual that abridges this period. The time has gone by when disease of any kind can be considered a mysterious providence. That few die from old age can be taken as an index of the fact that men die before their time. That mortality is decreasing and longevity becoming more assured there can be no doubt. In the seventeenth century London was the most unhealthy capital of Europe; now she is one of the healthiest. At the beginning of the fourteenth century Paris lost her population at the rate of fifty in every thousand; now it is only twenty-eight in every thousand. The mortality in England during the last century has decreased two-fifths through improved medical and sanitary science-facts in proof of Franklin's maxim, that public health is public wealth; and of the converse, that sickness is poverty. The fact that |