the zinc negative. The disadvantages of the Grenet battery are, that, owing to the porosity of the carbon plates, the fluid rises in them by capillary action, and, after awhile, so corrodes the metallic junction at the top that the current is prevented from passing.

The Frommhold battery is not quite so powerful as the Grenet, but, being wholly of metal, this corrosion of the junctions is not possible, except from splashing; care must, however, be taken not to touch the lead plate, as the platinumblack on its surface is very easily removed. With a little care, the Frommhold is a durable and satisfactory instrument. Two cells of either of these forms will give sufficient current to drive any medical induction-coil, and, indeed, they are ample for the purposes of the general practitioner who must use a portable instrument or none.-The Physician and Sur-geon. (To be continued.)

Clinical Records from Private and Hospital Practice. I.-Case of Extra-uterine Pregnancy. By N. Chapman, M. D., Glymont, Md.

The interest of the following case is comprised in the anomalous position of the foetus, and the illustration it afford, of the capacity of nature to overcome seeming impossibilities.

Mrs. B., married, aged about forty, mother of four children, the last child born October 26, 1874.

Menses established in due time; had her last menopause about the 15th of May, 1876, followed by the usual signs of pregnancy.

I was called to see her November 27, 1876, for some trouble not connected with her pregnancy. While with her, she requested me to examine her abdomen, saying that it did not look as it did in previous pregnancies. I did so by palpation alone (for reasons hereafter to be mentioned), and found an oblong tumor lying in the left lateral half of the abdominal cavity, between the umbilicus and left lumbar region, arising out of the pelvic cavity, toward the left inguinal region, reach

ing nearly up to, but not under, the lower border of the ribs on the left side. The apex of the tumor extended into the

pelvic cavity.

By careful palpation, I was satisfied, as far as one is justified in forming a conclusion from such an examination, that it was a case of abdominal pregnancy. While manipulating the tumor, I felt the movements of the foetus, though the patient said she had not felt them. Concealing my apprehensions, I informed her that I would examine her condition more thoroughly at some future time, and left her.

On the night of the 28th of November, 1876, I was called to her in great haste, and upon arrival was informed that while sitting quietly in a chair she experienced a sudden gush of blood from the vagina, and had been bleeding profusely since. Upon examining the bed and person of the patient, I found the statement had not been exaggerated. I immediately made a digital examination, found the os patulous, and dilated about an inch and a half. Upon passing my finger into the womb, it came in contact with a body soft and rugated to the touch, the characteristic sensations produced by contact with a retained placenta. I concluded there were two and a half inches of detached surface exposed. I found, by sweeping my fingers around the edges, that it was firmly adherent.

It immediately struck me that it was a case of abdominal pregnancy (with the placenta implanted over the os), similar to the case of Helen Zopp, recorded on page 239, "Cazeaux's Obstetrics," third American edition.

While making the examination, in order to form an adequate conception of the amount of hemorrhage, I placed my conjoined fingers under the posterior lip of the os, and could feel a stream of blood which seemed as large as a goose quill trickling through my fingers. The undetached position of the placenta over the os being the proper condition for the use of the tampon, I immediately gave a large dose of tincture of opium, in order to gain time for reflection and to obtain professional assistance.

Watching the effect of the tampon, I was gratified to find the external hemorrhage was controlled, and as long as the

placenta remained in situ I had no fears of internal hemorrhage, though the womb was carefully watched. Dr. J. W. Thomas came to my assistance about 10 A. M. the next day. After informing him in the anteroom of the circumstances of the case, he suggested that probably upon examination I would not find the state of the womb (i. e., dilatation and hemorrhage) which had existed when I used the tampon.

At my request, he removed the tampon, and reported the os entirely closed and comparatively no hemorrhage. Upon examination, I was agreeably gratified to find the statement correct. Enjoining quiet and strict observance of the recumbent position, with an occasional dose of deod. tinct. opii and tinct. ferri, I took my leave. The hemorrhage ceased altogether in about a week. I then permitted her to get up and move about her room, avoiding all exciting and disturbing influ

ences.

Here I deem it best to say what I have deferred in regard to the peculiar temperament of my patient, which influenced my actions when I first observed her condition, and my subsequent management of the case.

By nature morbidly apprehensive, her mother having died in childbirth, her previous pregnancies had been periods of the utmost despondency, and she was disposed to imagine the most unreasonable and improbable evils for herself and children. I therefore did not make a vaginal examination when first consulted by her, my first duty being to allay her anxiety. At the same time, I thought I would have ample opportunity to critically examine her case, and I had to refrain from further examination until toward the close of the eighth month of her pregnancy. In the mean time, I placed her upon an active tonic treatment, with nourishing and easily-digested diet. I waited until the 20th of January, 1877, before examining again. Having then passed the finger to the os, I was surprised to find that it was cartilaginous to the touch, with all the characteristics of the non-gravid uterus, being only a little larger than normal.

Proceeding then to examine the abdomen, I found the tumor much smaller, and that it had risen out of the pelvic cavity,

was disk-shaped, about five by six inches broad, to a considerable extent movable, but with attachments on a level with the umbilicus. I asked the patient if she had observed that her abdomen was smaller than it was at the time of her hemorrhage. She then for the first time informed me that it was her custom in all her previous pregnancies to make an abdominal measurement monthly, and that she had discovered since the 23d of December previous that her abdomen was gradually lessening in size. I then for the first time learned that the foetus was dead and had become encysted, a fact which I should have anticipated from the amount of hemorrhage, and have inferred from the evident septic poison under which her system was laboring, manifested by the dirty greenish hue of her complexion since the hemorrhage. At no time after the cessation of hemorrhage was there any vaginal discharge. The placenta was removed by absorption.

On April 4, 1878, I was again called to this patient, and informed that she was pregnant, and was in her third month.

I found by examination that the womb in its size corresponded to her statement as to the stage of her pregnancy. There being considerable uterine hemorrhage, I prescribed the usual remedies, and informed her that I thought it more than probable she would have an abortion, which she had on the following day, the foetus being sufficiently developed to distinguish its sex. I availed myself of the opportunity to examine the condition of the tumor, and found it was somewhat smaller, apparently about four by four and a half inches in width. It still preserved its disk shape and umbilical attachments.

She informs me by letter of this date (January 31, 1879) that it is about the size of an infant's head; how old an infant, she does not say.

The hypercritical may insist that my original diagnosis was not sufficiently established—that I did not use all means to eliminate error, such as vaginal examination, passing the uterine sound, etc.

I confess that it was my intention to do so had there been another opportunity, not to remove any doubt, but to confirm my opinion; but not having done so did not cause me to

question the accuracy of my diagnosis when I discovered the presence of the placenta in the womb.

In dismissing the subject, I will quote from Prof. T. Gaillard Thomas's article upon abdominal pregnancy in the January number of the American Journal of Medical Sciences, in reply to similar caviling:

66 There may be those who will say that these evidences were too meager for diagnosis. All I have to say in reply is, that I thought otherwise, and had confidence in my belief."— New York Medical Journal.

Apomorphia in Cynanche.

At an early hour on the morning of February 17, 1877, I was called in great urgency to see the infant son of Mr. B. F. J, one of my clientele. The father, who had come for me in person, to insure my immediate attendance, while I was dressing gave me the following condensed history of the case: The child, which was about two years old, had complained slightly the day before, and even the night previous to that; but the parents, being young and inexperienced, "thought it was nothing but a cold," and paid no attention to a series of symptoms (as detailed by the father) that would have excited the fears of older and more experienced persons. "Last night," added the father, "the little fellow did not seem so lively as usual and was a little fretful; but, beyond a mewing sort of a cough, we never noticed anything wrong with him. He slept with his nurse, in the next room to his mother and myself, but, though the door was open between us, neither of us knew that there was anything serious the matter until I went into the room, a few minutes ago, and found him in spasms and choking to death."

On arriving at the house, which was distant but a halfblock from my office, I found my little patient in a truly alarming and pitiable plight. He was lying on the bed, the head and trunk drawn far backward, with marked opisthotonos. The face was cyanosed and livid, the hands clenched, and from between the firmly-set teeth slowly exuded a frothy mucus.