The fact that the greatest decrease in the birth rate could be elicited between the first and second ribs. seems to have occurred in the regions where the colored race is most numerous seems a little anomalous to Dr. Billings, and he is inclined to account for it, in part at least, by imperfections in the statistics. These may have existed either in the figures of the late census or that of 1880; in either case the apparent increase might be partially thus accounted for, but it seems not unlikely that the great changes in the conditions in the sonthern States within the past two or three decades are now having a more decided effect than ever before, and affecting the colored race as much or perhaps even more than the white. Isolated dry rales were audible in the area of dulness. The amount of expectoration increased, but no tubercle bacilli could be found in the sputum. A solution of methyl violet injected into the second interspace at once appeared in the sputum. Bronchiectasis was diagnosticated, and ordinary medicinal measures failing to bring relief, pneumotomy was determined upon. The patient being chloroformed, an incision about three and onehalf inches long was made in the second intercostal space. With the point of the actual cautery at red heat, the lung was entered through the thickened and adherent layers of the pleura. Less than a drachm of A noteworthy fact pointed out by Dr. Billings is that putrid, offensive pus escaped. There was no escape of the present conditions as to population were predicted air. A sound passed a distance of little more than an as long ago as 1843 with a very close approximation to inch into the depth of the lung. The hemorrhage was absolute accuracy. Looking to the future a still further insignificant. The wound was drained, packed with decrease in the birth rate may be reasonably expected gauze, and covered with a protective dressing. The before population, with its present tendencies, reaches expectoration at once diminished decidedly, and the what we may call its regemen or equilibrium. Under sputum in a short time lost its offensive odor. In the present conditions, with the increased knowledge and success of sanitation, the infrequency of wars and general pacific tendency of our civilization, and the gradual filling up of all lands suitable for civilized habitation, a decreasing birth rate would seem to be almost the only protection against the realization of the worst anticipations of the Malthusians. While this is true of the United States, it applies still more forcibly ordinary tubal nephritis together with mitral conto the overpopulated sections of western Europe, which striction and regurgitation. On December 16, 36 can not very much longer relieve themselves by sending ounces of fluid were withdrawn from the right chest. their surplus population to this country. Next day there was excruciating pain in this region and 106 ounces were withdrawn (thirty hours after the first tapping). Seventy eight hours later 120 ounces were removed from the same side. On this occasion there was again intense pain and dyspnea and great edema of the neck, probably due to the pressure on the supe. rior vena cava. Thirty hours later 50 ounces were removed. Bronchiectasis Successfully Treated by Pneumotomy.-Hofmokl (Wiener medicin. Presse), has reported the case of a man, forty-three years old, who for five weeks had complained of slight pain in the right side of the chest, with cough that was most marked at night. There was moderate expectoration, the ejected matters as well as the breath after a short time having a most offensive odor. There was also slight febrile movement. The appetite was impaired, sleep was disturbed, emaciation was apparent. The chest was short, but broad and well arched. Respiration was short, quiet, rhythmical, and principally abdominal. The chest was a little flatter anteriorly and posteriorly on the right than on the left. The respiratory movement appeared to be symmetrical. Vocal fremitus was a little less distinct on the right anteriorly than on the left. The percussion resonance was sonorous on the right side above the clavicle; over the clavicle there was ab solute dulness; in the first, second, and third intercostal spaces the resonance was almost entirely wanting, be coming manifest again externally at the mammillary line. Elsewhere the percussion sounds were normal. On auscultation the respiratory murmur was found to be vesicular in the right supra clavicular fossa; of bronchial character in the first and second interspaces near the sternum; elsewhere in the area of impacted reson ance indefinite and vesicular. Whispering pectoriloquy course of the treatment, air was on coughing expelled through the opening. There was progressive improve ment in both the local and the general condition, until recovery ensued. Rapid Pleural Effusion.-White (London) relates the following case (Lancet): The patient had "It seems to me that the only possible explanation of this extraordinarily rapid accumulation of fluid is that the patient had thrombosis of her large azygos vein before it is joined by that from the left side. It is not against this view that we saw no enlarged superficial veins, for the most important anastomoses between the branches of the azygos veins of the two sides and the large azygos vein and the inferior vena cava are deepseated in the abdomen, the thorax, and around the spine. Nor is it conclusively against this supposition that no evidence of thrombosis was found post mortem, for the patient did not die till eight weeks afterward, by which time all signs of thrombosis might very well have disappeared. She had the clinical symptoms of thrombosis of her femoral vein only ten days before her death, and yet the vein was at the necropsy found to be patent. I have often observed that when patients have died no evidence has been forthcoming of throm、 bosis although all the signs of it have been present during life. It seems to me that no other explanation offers itself of this case, in which, supposing the fluid collected at a uniform rate, after the first tapping of the right chest that rate was three ounces and a half per hour, after the second one ounce and a half per hour, and after the third about one ounce and a half per hour. It is also quite exceptional for the distention of the chest with fluid to be so rapid as to cause acute pain, and it is no doubt comparable to the severe pain in the calf, felt in acute femoral thrombosis, and, like it, is probably due to the rapid stretching of the parts by the fluid; also it must be very rare for the pressure of the fluid in the superior vena cava to cause edema of the neck." MEDICAL SOCIETIES American Medical Association.-We reproduce the following interesting report, taken from the Medical News, of the Section on Neurology and Medi. cal Jurisprudence, at the forty-fourth annual meeting, held at Milwaukee, Wis., June 6 and 7: [CONTINUDED]. Dr. M. V. Ball, of Philadelphia, read a paper on Amputation in Tetanus.-Ferraton (Arch. de He said that when communities recognizd that "every to correct the evils that in large part cause crime, and society deserves the criminals it has," they will endeavor will treat malefactors not with a spirit of vengeance, not with a visitation of justice, not as sinners, but merely as stead of hindrance; then only will the penal question room. Symptoms of tetanus had come on twelve days after the accident. Amputation was performed thirty six hours later, bnt the patient was not free from symp. toms for three weeks, during the whole of which time he was kept under the influence of chloral and morphine. Ferraton considers that, in view of the fact that the bacillus of tetanus remains localized in the wound, the general symptoms being produced by a soluble poison, the propriety of local treatment should be very serious ly considered in all cases except those which are so severe from the first as to leave no hope of recovery. If the wound be on the finger or toe there should be no hesitation in performing amputation as soon as the first symptoms of tetanus are perceived. If on the limbs thorough cleansing and opening up of the wound may suffice. On the ground that the bacillus can only multi WHAT SHOULD CONSTITUTE RESPONSIBILITY IN THE ply in the presence of pyogenic organisms, be considers that it will be as effectual to render the wound thor oughly antiseptic as to cauterize. If these means fail, after a proper interval, to be followed by improvement, it will be advisable, if the case be not very acute, to proceed to amputation. Wounds on the trunk or head should be thoroughly opened up, cleansed, and treated with antiseptics. MEDICAL SENSE, IN INSANITY? He pointed out that great injustice is likely to be done io the insane by basing the view of their insanity upon the proposition that if a man is able to understand the nature, quality, and consequences of an act, he is legally responsible for such an act. The question of legal responsibility should be determined, not by laws, but by facts. Medical science has demonstrated that a diseased condition of the brain that gives rise to mental aberration permits of no half way ground in judging of Bacteria in the Soil at Different Depths. sanity. Periods of remission cannot reasonably be -Some investigations carried out by Dr. Alexander A. called "lucid intervals," as is often done. After classifyHouston, of Edinburgh, respecting the number of bacing the types of insanity that have been marked out up teria in the soil at different depths from the surface, go to the present time, such as the moods, the presence of to prove that the micro-organisms become less and less hallucinations and of delusions, the coexistence of the abundant as the depth from the surface increases. For example, the average number of germs in a gram of soil examined, which was taken from the surface, was 1,687,799; at a depth of three feet this average fell to 173,807; and at a depth of six feet it was only 410. These figures are interesting, and would tend to show that at certain definite distances from the surface the soil would be sterile. neuroses and of organic brain-disease, traumatism from excessive use of narcotics, and the mental disturbances occurring from derangement of the organism induced by disease of non-nervous viscera. Dr. Gray called attention to the fact that in paranoia, mania, and melan cholia the reasoning powers and the memory are usually intact, yet the patient has undeniable hallucinations and delusions, under the influence of which he commits acts LESION OF THE RIGHT TEMPORO SPHENOIDAL LOBE. The case reported was at first diagnosticated as one of embolism of the left anterior cerebral artery. The autopsy revealed an extensive hemorroage anterior to and at the lower extremity of the right lateral cornu. Softening followed, involving the hippocampus major for which he should not be held legally responsible. He cited the case of the paranoiac Dougherty, who imagined himself the beloved of Mary Anderson, and that the world was conspiring to keep him from her, and, in pur suance of this delusion, murdered Dr. Lloyd, of the Flatbush Insane Asylum, and was planning to kill about a dozen public officers whom he believed to be in the at its lower extremity and the anterior extremities of the conspiracy. Yet he declared himself sane and asserted that he knew the nature, quality, and consequence of his act. He was properly pronounced insane, because his mania was so palpable, although some doubt prevailed in the public mind as to his insanity. The only safe test of the legal and testamentary responsibility of a man lies in an answer to the simple question: Is he insane? If he is, he is not legally responsible, and this question can only be properly decided by competent physicians, not by fine spun theories of lawyers. Com mon sense must be applied to such cases rather than metaphysical definitions of mental aberration. superior, middle, and inferior temporal convolutions. The assumption was considered justified that as far as any symptoms observed in this case can be justly referred to the lesion in the right temporal lobe, they tend to show that its function is of the same nature for the left side of the body that Ferrier has found the left temporal lobe to be for the right—that is, a cortical center for hearing and taste. Dr. Charles K. Mills referred to several similar cases, which appeared to demonstrate that the left upper temporal region is most particularly developed for wordsound, and the right has a minor degree of development Dr. Edware B. Angell, of Rochester, N. Y., read a of the same function and takes on the function of the paper entitled left in part, but not entirely, in case of the destruction DOUBLE LESION OF THE BRAIN: CEREBRAL CYST AND of the former. CEREBRAL TUMOR. The post-mortem examination demonstrated an increase in the development of the brain on the right side which had to take up the functions of the disorganized left side. Dr. Charles K. Mills and Dr. G E. de Schweinitz, of HEMIANOPSIA AND CERTAIN SYMPTOM GROUPS IN The first case reported presented right lateral hemiaDr. James G. Kiernan, of Chicago, referred to a nopsia, absence of Wernicke's symptom, dyslexia, temcase of right hemiplegia with aphasia in an adult in which, by education, speech was regained, but was lost the second case there was right lateral hemianopsia, abporary right hemiparesis, and Jacksonian epilepsy. In after a second attack. The autopsy showed that the sence of Wernicke's symptom, dyslexia, right hemipare left speech center had been destroyed in the first attack sis, partial right hemianesthesia, partial word-deafness by hemorrhage, and the second attack destroyed the and word blindness. In the third case there were right right. lateral hemianopsia, absence of Wernicke's symptom, Dr. J. N. Hall, of Denver, Col., read a paper entitled temporary aphasia, dyslexia, right hemiparesis of spas GUNNERY DEVELOPMENTS AND THE MEDICAL JURIST. tic type, probably word-blindness. Case four presented He said that newly introduced explosives are rapidly left lateral hemianopsia, partial left hemiparaplegia and replacing black powder. He described the two most hemianesthesia, temporary aphasia, epilepsy, Wernicke's commonly used of these products-the American wood- symptom. Case five presented lateral hemianopsia, abpowder and the Schultze powder. The staining from sence of Wernicke's symptom, temporary right hemiwood powder is much less distinct than that from black plegia, persistent hemianesthesia. Case six presented powder, and the staining from the Schultze powder is left lateral hemianopsia, left hemiplegia. Case seven even less marked than that from wood-powder. Neither presented right hemianopsia, right hemianesthesia. Case of the two new powders ignites cloth or blotting paper eight presented right lateral hemianopsia, doubtful absence of Wernicke's symptom, slight right hemiparesis. at so great a distance as does the black powder. Case nine presented left lateral hemianopsia, absence of Wernicke's symptom at first, paresis of both legs, later right spastic crural monoparesis. Of two cases probably of cortical origin, one presented typical left lateral hemianopsia; and the second, right hemianopsia, with absence of Wernicke's symptom. Dr. Harold N. Moyer called attention to the fact that the length of the barrel of the weapon should always be considered in making up tables, and stated that there is always leakage of gases in revolvers. Another in teresting point is not only the kind of powder, but also the amount of fulminate in the fixed ammunition, as well as the manner in which it is put into the cartridge, whether fine-grained or practically in a solid mass. Dr. Frank R. Fry, of St. Louis, read a paper entitled SENSORY SYMPTOMS OF THREE SYPHILITIC CORD CASES. Dr. W. J. Herdman, of Ann Arbor, Mich., read a paper entitled Another case was reported of right lateral hemianopsia, followed a year later by left lateral hemianopsia, with absence of Wernicke's symptom, retained macular vision, changes in the color sense, loss of the sense of location. A case was also reported that seemed to teach that there may be either functional or organic disturbance of the word symbol center of the same character as that AMERICAN INEBRIATE ASYLUMS. cause involving a medico-legal question is a mere farce, as compared with the trial of a cause involving a pure question of law. The medical expert should be selected by the court as an advisory, and wholly with reference to his special knowledge of the question involved. Medical jurisprudence should be properly taught in the colleges. The so-called chair of medical jurisprudence He said that managers of asylums who teach dogmat usually teaches nothing but the mummery of same ically the nature of inebriety and its only true remedies text-book of ancient times. The proper way is to give are not far along in scientific work, and asylums that a forecast of the legal experience that the student will claim large percentages of cures from certain means and encounter in the future. He should be taught to be remedies are not worthy of confidence. Inebriety is the most complex neurosis of modern research. The gold- dents go forth unequipped in this regard. Another frank, truthful, direct, plain, and non-technical. Stucure specifics, so called, are followed by an increased cause of the disrespect of medical expert evidence is the number of insane among those who have used the treatment. This was to have been expected, as the more counsel and as witness. The court might properly take common custom of participating in the trial both as powerful the narcotic used to stop the drink-symptom testimony as to the qualifications of the expert. A the more certain are insanity and profound degenera- good way would be to have lists handed in by each side tions of the brain-centers to follow. The asylum care and let the court choose from the lists. The expert and treatment of inebriates began first in this country, should avoid invading the province of the jury and and has grown and extended to all civilized nations of giving an opinion in the case. The proper course is to the earth. American asylums have developed the dis ease-theory and the practical character of physical treat-put a hypothetic question for the expert to answer. The following papers were also read: Dr. Frank P. Norbury, of Jacksonville, Ill., read a paper on INSANITY IN THE AGED. Dr. Harriet C. B. Alexander, of Chicago, read a paper on ACUTE MENTAL SYMPTOMS IN CHILDREN. Chairman-James G. Kiernan, of Chicago. ment in institutions beyond that of any others in this field. Asylums in the United States represent nearly all stages of development and early growth, from infancy and childhood, with its feeble conceptions and infantile efforts, to the boastful assumption and over confidence of youth, on to the dawning truth of early manhood, when reason and judgment begin to reign. A few of these asylums discern similar great truths, which may be stated with confidence as ideals toward which there is a rapid movement. Inebriate asylums must take the place of jails and station-houses. Inebriate asylums should receive the incurable inebriates and make them selfsupporting and build them up physically and mentally. Inebriate hospitals should receive the recent cases and The Pan-American Medical Congress Explace them in the highest conditions of enforced health and vigor, and thus restore a large number to health cursion to Rome.-It has been definitely deterand sobriety. Inebriate hospitals should be self-sup-cursion to the Eleventh International Medical Congress mined that the Pan-American Medical Congress exporting when once established. They should be man. will sail on the steamship, Werra, from New York, aged on scientific business principles, like military training-schools. Inebriate hospitals should be built September 9, the day following the adjournment of the with money raised by taxes on the sale of spirits, on the Congress at Washington, and will arrive at Genoa principle that every business should be obliged to pro- Rome meeting. Round trip steamer tickets may be September 20, four days before the opening of the vide for the accidents that grow out of it. The inebriate hospitals of to-day are only in the infancy of their work, procured for $142.50 for inside rooms, and $150 and Tickets are good for contending with great opposition and prejudice, misun upward for outside rooms. members of the Congress and their families, and may derstood, condemned, and working against innumerable be used at option of holder to return on any steamer of obstacles. There is an intense personality in inebriate hospitals. Inebriate hospitals and their work are the the line from Genoa, or on Saturday steamers from great new lands which only a few settlers have reached. They are calling to us to come and occupy and thus help the race on in the great march from the lower to the higher. Bremen, or Sunday steamers from Southampton, during the months of October, November, and December. Physicians desiring to avail themselves of this exceptionally low rate should at once become members of Dr. Clark Gapen, of Omaha, Neb., read a paper registration fee ($10) to the Treasurer, Dr. A. M. Owen, the Pan-American Medical Congress by sending the entitled LAWYER'S CRITICISMS OF EXPERT TESTIMONY. Evansville, Ind., and informing the Secretary-General, He said that as at present conducted the trial of a to join the excursion. 1 out delay, as the trip, involving, as it will, a stop at the Azores and Gibraltar and a sixty hours' sail along the picturesque coasts of Spain, France, and Italy, promises to be very popular. Many prominent European guests of the Pan-American Congress will return on this occasion. The time allowed will afford American phy sicians an opportunity to not only attend the International Congress and visit Rome, but to extend their journey to the famous sanatoria of South France and the Riviera. NOTES: AND ITEMS The of the sulphur baths apparently affords the mercury better opportunity to come in contact with the syphilitic poison in the various organs, and thus this combination is favorable for a speedy cure Mercurial Inunctions and Sulphur Baths in the Treatment of Syphilis.-Dr. Joseph Dymnecki (Internationale klinische Rundschau) presents an argument for the combined use of mercurial inunction and sulphur baths for patients suffering from longstanding syphilis. Although it is argued that the combination of mercury with sulphur is an insoluble one, yet the experience of the writer in treating thousands The Treatment of Primary Sciatica by of cases at the sulphur springs of Busko since 1859 Acupuncture.-Dr. E. Valentine Gibson (Lancet) proves that this insolubility of the compound has no reports that of one hundred consecutive cases treated unfortunate influence upon the process of cure. by acupuncture, fifty-six were cured; thirty two were increased tissue change which goes on under the action much improved; ten were improved; while in two cases there was no improvement. This is considered to be a very satisfactory result, considering the chronic nature and the severity of the cases. In addition to the acu puncture, they all used the Buxton thermal water, which has a great reputation for the absorption of inflamma. Antipyrine in Diseases of the Urinary tory products. The needle should be single, spear- Organs.-Dr. J. H. Brik (Therapeutische Blatter) has pointed and about two and a half inches long. It should found that this drug is a weak antiseptic, as is boric be inserted directly into the nerve, which will be known acid, and that it does not directly influence the reaction by the pain which shoots down the leg. The needle of the urine, but indirectly, through the nervous sysshould be immediately withdrawn, as nc better results tem, may render an alkaline or neutral urine acid. It are obtained if they are left in situ, and additional pain is a useful analgesic in the purely nervous form of is likely to be caused. The nerve should be pierced nephralgia and in the painful disease of the pelvis and about five times at intervals of a few days, over the parts where there is pain on pressure. Rest is necessarily most essential, as it is in other inflammatory conditions, and a rheumatic or gouty diathesis should be treated by appropriate remedies. . It can ureters, as inflammations and foreign bodies, etc. It is useful in the motor and sensory neuroses of the bladder, neck of the bladder and prostate, but it is of slight effect in inflammations, new growths, and tuberculosis of these parts. The hyperesthesias and neuralgias of the urethra can be relieved by this drug. The best reSalophen.-Dr. Karl Osswald (Deut. Med Woch) sults are, however, obtained when the prostate or the believes that in this remedy, which is a salol in which prostatic urethra are involved. The property which the poisonous phenol group is replaced by a harmless this remedy possesses, similar to that of morphine, of one-acetylpara amidophenol-we have a substance acting upon unstriped muscular fiber, gives its field which will present all of the advantages, with none of of usefulness in diseases of the urinary organs. the disadvantages, of the salicylic acid preparations. be administered by the mouth or hypodermatically, and As decomposition takes place in the small intestine, and in this way it is excreted by the kidneys, or by rectal as it is with difficulty soluble in cold water and is near injection or locally by injection into the bladder. If ly tasteless, it does not destroy the appetite nor inter administered at night it is likely to relieve pain and fere with digestion. In small doses it is nearly entirely produce rest. If ten to twenty drops of a five to twenty excreted by the urine; in larger doses, the excess is per cent solution are injected into the prostatic urethra, found in the feces. It does not cause untoward symp a quite severe burning is apt to follow, which soon toms, even in a daily dosage of two drachms. It is less passes away, and is replaced by analgesia. This effect effective in the same dose than salicylate of soda, be- may last ten to twelve hours. cause it contains less salicylic acid. It can be used with advantage in mild cases of articular rheumatism, or as a The Treatment of Gonorrhea in Women. substitute for the salicylate of soda when the latter-Dr. Brose treats acute cases by douches of chloride drug is not well borne. In patients who present an of zinc or sublimate, the urethra receiving 1 to 5 per idiosyncrasy against the salicylate of soda, and especial- cent solutions of nitrate of silver by injection. In ly in debilitated individuals, or who suffer from sensi- local treatment the cervix demands attention, and the tive stomachs, this drug can be used with advantage. It application of strong solutions of chloride of zinc (to 50 is useful in neuralgias of all kinds, especially in cephal- per cent) has been followed by the best results, although algias or hemicranias, in connection with chlorosis and the practice is not without danger. Intra-uterine apanemia. plications are likely to be followed by salpingitis and |