two of them being between twenty and thirty years of age, were attacked with the disease, and nearly at the same time, one of them very severely. The first had had typhoid, from which she was quite convalescent; the second was passing through gastric fever when attacked, her life was in the balance for many days; the third had had common fever, and was up before the spinal arachnitis showed itself. Now it was whilst this state of things was going on that the new and much more terrible disease, which, for the present, and following the great majority of the American writers, I shall call "spotted fever," appeared amongst us. Is it likely, I would ask here, and keeping in mind the facts just stated, that this new affection is but a modification of spinal arachnitis. I cannot think so. We saw that this latter affection first existed per se, then became a complication of typhus and other types of fever. Where is the difficulty in supposing that it may also be a complication of the "spotted fever?" This view, and this only, appears to me capable of explaining all the facts known. For, whilst it must be admitted that the great majority of the cases presented the remarkable spots and spinal arachnitis at the same time, it is not to be forgotten that many of the cases which had the spots did not present any symptoms referrible to the brain or spine. One wellmarked instance of this was given to-night by Dr. M'Swiney, and of the two cases which came under my own notice, one had no symptoms whatever referrible to either the brain or spine. I know, too, that many similar instances have been met by others; and when such cases have been examined, no trace of inflammatory action has been found in either the brain or spine. For I do not admit that congestion, with some serous effusion-which, it will be recollected, is a state common to any of the acute diseases that run a very rapid course is due to inflammation. If it be, then the essence of our typhus fever must be inflammation, which I presume few will maintain. Taking, then, all the facts at present known, and more particularly the one that our typhus fever has, within these two years, been frequently complicated by spinal arachnitis, into consideration, it appears to me that no other conclusion can be arrived at than that the late terrible disease which has visited us is a specific fever, and that the spinal arachnitis is but a complication, which may or may not be present. On the treatment of the spinal arachnitis, when it complicates common typhus, I have got the idea that it is not usually as actively treated as it requires. In my own hands I know that antiphlogistics, including local bleeding and mercury, have been followed by the most satisfactory results; and when the disease was seen very early a fatal result was most unusual.

(To be continued.)

HARVEIAN SOCIETY OF LONDON-MAY 23.
Dr. J. E. POLLOCK, President.

THE PREVENTION OF VENEREAL DISEASE. Ar the fifth meeting of the Harveian Society's Committee, the following communications were read :—

Mr. Rooke reports from the Dreadnought Seamen's Hospital, that there are a daily number of forty-seven male cases seen there on an average, or about one-third of the surgical patients. No special beds are reserved for venereal cases. "This return chiefly represents the primary affection. Many of the sequelæ of syphilis, such as ulcers, diseases of bones, and internal organs, are not included. If the Contagious Act were extended to the waterside parishes of the chief mercantile ports the advantages to the sailors of the mercantile marine would be incalculable. The history of our patients proves that they are exposed to, and contract disease, immediately on the arrival of their ships in port. The sailors of many ships are picked up by lodging-house keepers, who provide them with beds, liquors, and diseased women, whilst they are waiting to be paid their Consequently, when the sailor goes to the shippingoffice to receive his pay, the larger part, if not all, is already pledged to the boarding-house keeper. In a very few days he

wages.

applies for admission on board the Dreadnought, suffering from syphilis, and often from delirium tremens. The class of women who consort with sailors, are of the lowest order, so that the difficulties of carrying out, a systematic inspection would be very little."

Dr. Rogers reports from the Strand Union, an average daily attendance of two males and three female venereal patients, or about ten per cent. of the surgical cases. There are no venereal beds in the workhouse; "we always send our patients to the Lock Hospital."

The report from Whitechapel Workhouse gives an average daily attendance of one male and one female venereal patient. There are ten male and fifteen female venereal beds in the workhouse.

The report from the Poplar Hospital says, that only two or "There are no beds three venereal patients are seen daily. for lock patients, the beds being entirely reserved for acci

dents."

Mr. Guye reports from the Paddington Workhouse, that "the Guardians subscribe liberally to the Lock Hospital, and not more than a dozen cases come to the Workhouse Infirmary during twelve months, to remain but a day or two in the receiving wards, previous to reception into the Lock. No beds are, therefore, reserved for venereal cases."

The report from St. Olave's Workhouse gives a daily aver age of five female patients, or one in forty of the surgical cases There are three beds for males, and five for female

seen.

venereal patients.

Dr. Bullen reports from the Lambeth Workhouse, that there are about two a-week of in-patients' venereal cases during the year. "I have had from eleven to twelve cases of females in a ward at one time."

Dr. Clark reports from Shoreditch Workhouse, that syphi litic patients are sent from thence to the Lock Hospital. That "we treat somewhere about thirty patients yearly with gonor rhoa, and the sequela of syphilis. We have no beds for venereal patients."

Dr. Skegg reports from St. Martin's Workhouse, that there is a daily average of two male and three female venereal patients seen there, or one in thirty of the surgical patients. "No special number of beds for Lock cases."

of two males and three female venereal patients. There are The report from Hackney Workhouse gives a daily average four beds for males and five for female venereal cases.

Dr. Smart reports from Bethnal Green Workhouse, “the number of cases which come under my notice is very small at present. I have only one case of gonorrhoea, and about six cases of secondary syphilis. I do not suppose I get more than twenty cases during the year. I have no beds set apart for

such cases."

Mr. Harris reports from St. Luke's Workhouse that there are no venereal patients seen there-no venereal beds in the hospital. "Under the Poor-law, venereal cases, as such, are not received. Destitution is the plea. No venereal disease is seen by me, as Medical Officer, except occasional broken-down constitutions under secondary and tertiary syphilis."

Dr. William Bennett reports from St. Giles's Workhouse that "there are scarcely any venereal out-patients. The few who apply to be admitted are nearly always females, and they are sent to the Lock Hospital, with the exception of an occasional case of secondary syphilis."

Dr. Williams reports from the Hospital for Sick Children, Great Ormond-street, that the number of syphilitic children treated during the year 1866 was 93 males and 105 females; or in the proportion of 1 to 7 and 1 to 4 of the surgical patients cases, although syphilitic children are, of course, admitted." seen during the year. "There are no beds set apart for such

Dr. Smith reports from Notting-hill Dispensary that there is a daily average of 5 males and 3 females, or about 1 in 8 of the cases venereal. No beds.

Mr. Hunt reports from the Western Dispensary for Diseases of the Skin, that there are no in-patients. "It is rare that condary and tertiary forms are very common. During the last a case of primary syphilis appears for treatment; but the se 40 days about 800 patients have been under treatment; of these, about 100 were syphilitic, nearly equally divided among males and females, and comprising young infants, a small proportion. Very few prostitutes ever attend here."

Mr. Lewis reports from the Western Ophthalmic Hospital,

that "out of 2040 cases treated during the past year, 11 are described as syphilitic."

Mr. Hulme reports from the Central London Ophthalmic Hospital, that of 2000 cases seen annually by him, or 40 a-week -of these 40, about 7 are venereal iritis or keratitis.

Dr. DRYSDALE said that Mr. Jonathan Hutchinson's report to the Venereal Committee showed that out of 65 patients seen by him on one morning at the Ophthalmic Hospital, Moorfields, 13 were venereal cases, or 1 in 5.

The PRESIDENT remarked on the fact that the workhouses seemed to send all their venereal patients away. Would Mr. Lane explain how they managed at the Lock?

Mr. LANE said that the Governors of the Lock had the privilege, as usual, on subscribing five guineas, of sending a certain number of patients there annually. The workhouses, therefore, subscribed 10, 20, or even more guineas annually, and sent their venereal cases there. If they did their best in the Lock, they had never more than 30 beds for such cases, and were obliged constantly to send them away. The rest of the beds in the Lock Hospital were for Government cases.

Mr. CURGENVEN said that he had observed that at the Royal Free Hospital, the worst cases were sent there from the workhouses.

Mr. LANE said that provision should be made in Mr. Hardy's Act, now before Parliament, for the admission of venereal cases into workhouse hospitals.

Dr. TILBURY Fox stated that Mr. Hardy's Act was already in operation.

:

The following motion was made by Dr. CHARLES DRYSDALE, seconded by Mr. JAMES LANE, and carried unanimously:"That this Committee (considering the vast amount of preventible venereal disease existing in London, and also the fact that destitute women, when suffering from such diseases, are not admitted into the workhouse infirmaries, but, in the majority of cases, sent to the Lock Hospital, which is quite inadequate for their reception) are of opinion that immediate provision should be made for the reception of destitute persons suffering from this disease, either in special hospitals, or in special wards, set apart for such cases in the workhouse infirmaries; and they would earnestly recommend that provision should be made for this purpose on the carrying out of Mr. Hardy's Bill."

Mr. JAMES LANE said that now was the time to secure such provision. Diseased prostitutes were at present obliged to go on with their trade, in order to live.

Mr. CURGENVEN said that there was to be a general rate over the whole of London for the maintenance of the hospitals under Mr. Hardy's Act.

Dr. BEIGEL said that prostitutes are liable in Prussia to imprisonment for five months, and, if foreigners, may be banished. Procurers, also, are liable to imprisonment for a time not less than six months, with hard labour. According to the old law, punishment was awarded to women for infecting men, with hard labour, for a period of years. Unqualified persons are fined if they attempt to cure syphilis. Dr. Beigel also added that the enlargement of accommodation in Prussia had much lessened diseases, whilst the registration of women had not seemed to him of much use in Berlin towards that end.

Dr. C. DRYSDALE said that Mr. Cutler, in his evidence before the Venereal Diseases' Committee, had shown that in the Prussian camp, with 20,000 men, there were only in 1865, seven men and four women diseased, whilst at Aldershot nearly half the men were diseased.

The PRESIDENT asked Dr. Stuart, of Woolwich, who has the charge of the inspection of prostitutes in that town, to be so kind as to give the Committee some information as to the effects of his inspection.

Dr. STUART, of Woolwich, said that the action of the Contagious Diseases' Act, 1866, had been most salutary as far as Woolwich was concerned. In October, 1866, the proportion of venereal cases to the number of troops stationed there was as 1.75 per cent. of the number. In April, 1867, this had decreased to 5 per cent. At first the women who were examined were very frequently and gravely diseased; but latterly disease was much less frequent, and milder in type. There was no registration for the women, so that as yet the examinations had only extended to the lowest classes of them. These were by no means averse to being examined. When diseased the girls were sent to the Lock Hospital. The examinations were conducted in a small house adjoining to his own private residence.

Mr. JAMES LANE said that there was a remarkable contrast

between the cases now sent from Woolwich and those which formerly came from it, and there was an equally striking con trast between the cases sent from workhouses and by the Government now; the latter being so much milder.

It was proposed by Mr. JAMES LANE seconded by Dr. TILBURY FOX, and carried by the meeting, "That this Committee is of opinion that the clauses contained in the Contagious Diseases' Act, 1866, might, with some slight and obvious alterations, be adopted in the carrying out of the regulations formerly proposed by Mr. Lane, and accepted by the Committee."

Dr. VINTRAS said that venereal cases ought to be admitted into ordinary hospitals. He did not think the Governors would care what class of cases were taken in.

Dr. BEIGEL said that at the Metropolitan Free Hospital the Governors paid their money and never troubled themselves with the class of cases.

Dr. DRYSDALE said that this was only the case in the more liberal and generous hospitals. It was quite different in many others.

Mr. CURGENVEN said that, if the ordinary run of Governors knew that venereal diseases were treated in a hospital, they would no longer subscribe, and Guy's and Bartholomew's had large private funds, which accounted for their venereal beds. Mr. LANE said that it should not be left to the mercy of Governors whether this class of cases should be treated or not, and therefore Government or parish funds should be used for the purpose of providing accommodation for female venereal patients.

It was arranged that a sub-committee be formed to write a report and present it to the committee at an early date, and that a general meeting of the Profession should be held at the latter end of June, when the presence of several members of Parliament, such as Mr. Hardy and others should be solicited, and that an effort should be made to effect some early legisla tion upon this important question.

The PRESIDENT asked Dr. Yandell, of Louisville, Kentucky, if venereal diseases were prevalent in America, and if there was any police registrations.

Dr. YANDELL replied that these diseases were very preva. lent; but that there was no provision for preventing them Dr. Sanger had been lately asked to report to Congress, and he believed that there was a bill before Congress this very year to remedy the evil.

Dr. DRYSDALE said that recently a letter from Mr. B. Hill had appeared in the British Medical Journal, censuring the practice of some gentlemen, who had acted as medical officers to private brothels. As he thought the subject important he would mention, that two much respected members of the Harveian Committee, Dr. De Meric and Dr. A. Vintras, had given public evidence before the Venereal Diseases' Committee, of which Mr. Skey was president, as to having so inspected some houses of that kind. Now, he could quite understand the views of an eminent surgeon, Mr. Solly, who gave evidence in the Committee, that he thought that venereal diseases were, "intended as a punishment for our sins, and that we should not interfere in the matter." Such views were clear and definite, and belonged to what had been styled the a priori school of ethics; but Mr. Hill was apparently in favour of preventing venereal disease, and, yet, he objected to Dr. De Meric for thus preventing it. He (Dr. Drysdale), adopting as he did the utilitarian standard of ethics, must say, that he thought the function of a medical man was to cure and prevent disease, and certainly as long as Government so utterly neglected their part in this question, as in this country and America, he thought it rather meritorious than blameable in individuals to supply voluntarily the omission. As to questions of receiving emolument, that was merely an accident in medical questions. The primary question was to get work done; and, of course, it was not so likely to be done efficiently by gentlemen of independent in. comes, as by those who were paid for the work done.

Dr. CHAPMAN thought that the views held by Mr. Solly and Mr. Hill were opposed to all prevention of any disease which persons brought on by carelessness and bad habits, and was of the ascetic or puritanical school of arguments. Utility or the greatest happiness principle required the prevention and cure of all diseases as such.

Dr. STUART, of Woolwich, said that several articles had already appeared in the local Woolwich papers censuring the examination of prostitutes, and objecting to thier being brought into a decent street, like that in which he resided. The girls, too, sometimes pretended to be menstruating, in order to avoid examination, although they were notin that state.

THE ST. ANDREWS GRADUATES' ASSOCIATION. THIS body has been formally reconstituted after having been for some time in abeyance. The immediate cause of its sudden revival is the injustice with which the Medical Graduates of this ancient University are threatened by the new Scotch Reform Bill, and on which we have commented in our leading columns. As soon as the bill was printed, and the design of its framers became manifest, those who had been active in the old Association of St. Andrews Graduates, felt that the time for renewed effort had arrived. A meeting was called last Wednesday afternoon, at the house of Dr. Richardson, to consider whether any, and if so, what steps should be taken in the matter-the result being the reconstitution, with an enlarged basis of the old St. Andrews Graduates' Association, as will be seen from the subjoined report of the proceedings:

Dr. RICHARDSON having been called to the chair, said that he and some other friends had called the meeting because they felt that the University was in danger of losing both its prestige and its rights, and that a great insult was offered to its medical graduates. He observed that the old St. Andrews Association had. taken very active steps in the matter of Medical Reform, and partly through its exertions was to be attributed the fact that the University still enjoyed certain privileges. He gave a history of its efforts respecting Mr. Headlam's bill, then as to Mr. Cowper's, afterwards of the "Medical Act," which became law, and finally of its having succeeded in enforcing the rights of these graduates to office under the Poor-law. Since then the Association had not met. It has, in fact, been dormant, but he felt the time had come to resuscitate it. He would name that, so far as he could make out, there were about 3000 Medical Graduates of the University practising at the present time. These men had paid to Government about £45,000 for stamp-duty alone. But the Government Bill proposes to deprive them all of the franchise, except those who have passed since 1863, and which he believed would not exceed 36 in number. All these men had passed severe examinations before receiving their degrees; many of them held other diplomas, and there was not a shadow of reason for depriving them of their just rights. For his part he would be glad to see a deputation at once wait upon one of the Ministers, and place the simple facts before him. He had no doubt, whatever, that the public would recognise the claims of the graduates. He would, therefore, call upon those who were prepared to propose distinct

resolutions.

The utmost unanimity prevailed in the meeting, so that it is unnecessary to report the speeches made, each of which offered some practical suggestions. The resolutions were carried unanimously, as follows:

Dr. ROGERS proposed, Dr. PROSSER JAMES seconded-"That an Association to be called the 'St. Andrews Graduates' Association,' be constituted."

Dr. Collinson spoke. Carried unanimously.

Dr. DRYSDALE proposed, Dr. DUDFIELD seconded-"That Dr. Richardson be president; Dr. Paul, hon. treasurer; Dr. Sedgwick, hon. secretary."

Professor Macdonald and Dr. Griffith spoke.

Dr. WYNN WILLIAMS proposed, Dr. GRIFFITH seconded"That all graduates of the University of St. Andrews be admitted to the Association on forwarding their names to the Hon. Secretary, Dr. Sedgwick, 2, Gloucester-terrace, Hyde Park, W., and on payment of 5s. annually for expenses."

Professor Macdonald and Dr. Rogers spoke.

Dr. BALLARD proposed, Dr. PAUL seconded-"That this Association use every endeavour to secure the enfranchisement of all Medical Graduates of the University of St. Andrews." "That a deputation be formed to wait upon the Chancellor of the Exchequer to represent to him the views of the Graduates, and of their claims to full enfranchisement."-Proposed by Dr. D. DAVIES, seconded by Dr. POWELL.

Dr. ROGERS proposed, Dr. DUDFIELD seconded-" That advertisements be inserted in the medical periodicals, announcing briefly the constitution of the Association, and that a

circular letter to the same effect be sent to all the Medical Graduates of the University in the United Kingdom."

Letters of approval, &c., read from Dr. Greenhalgh, Dr. Tanner, Dr. Theselton Dyer, Dr. Whitmore, and others.

The following graduates were present at the meeting :-Drs. Ballard, Richardson, Wynn Williams, Ray, J Rogers, Des dale, Prosser James, Macdonald, Powell, Dudfield, C

David Davies, Paul, Sedgwick, Griffith, Seaton, and Day Goss. Since the meeting, a letter has been sent to the graduates, according to the resolution, from which we extract the following:"On previous occasions it has been found necessary to arrange for meetings of the graduates in London to consider matters materially affecting the status of the University, and those meetings have been of much service. On the present occasion the same necessity for action has arisen, owing to the provisions of the new Scotch Reform Act. In this Bill it is provided that there shall be one representative in Parliament for the conjoined Universities of Edinburgh and St. Andrews; but by clause 30, no doctors of medicine except those 'on whom that degree has been conferred subsequent to January 1, 1863,’ and those in previous years who have attended in the Univer sity two or more classes qualifying for such Degree,' are entitled to vote in the election of a Member of Parliament for the Universities. The clause, as it virtually excludes the whole body of Medical Graduates of St. Andrews from the franchise, is too obviously unjust to be allowed to pass without opposi tion, and the Association has for its primary and immediate object the establishment of the rights of all graduates who have undergone an examination for their degrees.'

We believe that the Aberdeen graduates are about to adopt a similar course, and it was intimated by several at the meeting that in this case the St. Andrews Association would cordially co-operate in any measure for the common good. We may add that the Association intends to compile a list of St. Andrews graduates, showing what appointments they hold, or have held, and what other qualifications they possess. We should therefore urge upon all at once to join the Association, and while remitting the small subscription to the Secretary to furnish him with these particulars corrected to date.

THE INSTITUTION OF CIVIL ENGINEERS, MAY 21, 1867.

JOHN FOWLER, Esq., President, in the chair. THE paper read, in abstract, was "Experiments on the Removal of Organic and Inorganic Substances in Water," by Edward Byrne, M. Inst. C.E.

It was premised that the object of these experiments was to try how far the statements generally made, with regard to the action of charcoal in purifying water, might be depended on. They were not undertaken to support any theory, but rather to satisfy the Author himself, who observed every precaution to obtain trustworthy results.

It was stated that many substances were spoken of as having a purifying effect on water, but of all, charcoal (especially animal charcoal) had been considered the most efficacious. Though in works which treated on spring and river waters, the assertion was constantly made, that both vegetable and animal charcoal (particularly the latter) removed the organic and inorganic substances found in waters, yet no experiments were given by which to judge to what extent these statements were true. With a view to ascertain whether water, uncontaminated by either decomposing animal or sewage matter, but containing dissolved vegetable matter, would contain any nitrogenous bodies, some bog water was procured from a locality that precluded the possibility of its containing any animal or sewage matter, the experiments on which served to prove that, in bog water at least, vegetable nitrogenous matter was present.

After some observations to the effect that nitrogenous organic matter might exist in water in an innocuous state, and that as putrefactive nitrogenous matter was the most hurtful of all substances that could exist in water, the Author remarked how much it was to be regretted that, by chemical means, no distinction could be made between the nitrogenous organic matter which existed in a putrefactive, and that which existed in a non-putrefactive state.

The details of four sets of experiments were given, the first on animal charcoal, of which nearly 5 lbs., new, and freshly burned, and of the degree of fineness used in sugar refineries, were packed in an ordinary stoneware filter. The water employed (of which a complete analysis was given) contained, in the gallon, organic matter, 10.80 grains; inorganic matters 88.30 grains. The hardness of the water, before boiling, was found to be 50-50°, and after boiling, 33°; and the oxygen required to oxidize the organic matter contained in one gallon, inted to 0·0116 grain. Several gallons of the water were

allowed to percolate slowly through this charcoal, and upon examination, afterwards, it was found that, of the inorganic matter which had originally existed, 52.60 grains were removed from the first gallon; but from each succeeding gallon less and less; so that, from the twelfth gallon of water that passed through the charcoal only 8.80 grains of inorganic matter were removed. Of the organic matter 480 grains were removed from the first gallon; but, with a gradual decrease, the charcoal ceased to remove any organic matter after the sixth gallon. In fact, immediately afterwards, it commenced to give back a portion of the organic matter removed in the first instance, the quantity returned to the twelfth gallon amounting to 1·55 grain. Thus, of the 13:54 grains of organic matter removed by the charcoal from the first six gallons of water, as much as 4.98 grains were given back to the next six gallons; from which the Author concluded that, had this set of experiments been carried a little farther, all the organic matter removed at first by the charcoal would have been given back again.

The second and third series of experiments were with wood and peat charcoal, which, however, were still less satisfactory than those with animal charcoal. The fourth set of experiments was on animal charcoal, with water previously treated with permanganate of potash slightly in excess. After remarking that the water, in its passage through the charcoal was found to contain organic matter, apparently in the same quantity as before treating it with the permanganate, attention was drawn to a comparison between the first and fourth sets of experiments, to show how closely they agreed to contradict the general statements made as to the removing power of charcoal, and to demonstrate how very little indeed could be done by this filtering material, even on a small scale, towards the purification of water.

The author then said that as the epidemic which had so recently left these shores might return again before the adoption of any scheme to supply the Metropolis with an abundance of pure water, he thought it would be well, if only to check its ravages in ever so slight a degree, to experiment on various materials which were believed to possess the power of removing organic matter; but, to obviate false conclusions, and to render such experiments practically useful, they must be systematic.

In conclusion, he gave it as his opinion that, as by chemical agency bad water could be purified to a very limited extent only, the public mind should more than ever be given to the great question of supply; and, as people valued their lives, they should above all things, in their choice of a source, not be too much influenced by distance, but be willing to undergo the necessary expense of securing the object of their search, not only in abundance, but in the greatest purity.

ACUTE

Hospital Reports.

ST. BARTHOLOMEW'S HOSPITAL.

AFTER A

SUPPURATION IN THE KNEE-JOINT
PUNCTURED WOUND: FREE INCISION: RECOVERY.
Under the care of Mr. COOTE.

MARCH 20, 1867.-Jane T., æt. 14, a slightly-made_girl, was sweeping a cocoa-nut matting on her knees, when a pin was pressed out, which ran into the right knee, and caused her to start with pain. She pulled the pin from the limb, where it had penetrated the greater part of its length over the situation of the synovial membrane. The day following she had a great deal of kneeling work, when she first found the joint somewhat stiff and painful. She applied a poultice on the same night, but continued her work the day following, the pain becoming more severe, until she was unable to continue her occupation, and finally came to the hospital, where she was admitted April 1.

a draught composed of ammonia, chloric. æther, and tinct. of icnchona, three times a day.

April 2. The relief afforded by the incisions is only partial; the countenance is expressive of much suffering ; she has no appetite, nor can she rest at night. Opium was administered at night, and the wine was increased in quantity, but the symptoms generally became more severe; and on the 14th it was found that the swelling was of firmer consistence, and was rapidly extending up the thigh. Mr. Coote made a free incision into the synovial cavity, the whole length of the joint, when there escaped nearly twelve ounces of thick, well-formed matter. The operation was performed while the girl was under the influence of chloroform, so that she suffered no pain.

From that time to the present, the pain and swelling have gradually subsided, and she is now convalescent, the wound having, in great part, closed by granulation has gained flesh, and is in usual spirits. and cicatrism. The limb is in very good position, and she

May 30.-Convalescent.

This case illustrates the serious consequences which may ensue from a penetrating wound of joint. As has been observed by the late Mr. Hay, patients rarely recover without the suffering caused by this formation of pus. It was estimated by the size of the wound that full forty ounces of pus were evacuated by the various incisions in this case.

here almost immediate, but the danger of such a proThe relief afforded by the incision into the joint was ceeding was strongly pointed out by Mr. Coote. It is only in cases where the tension is very great, and the danger of the extension of the suppuration upwards is immediate, that the operation is justifiable, and then the incision must be free, so as to offer a free outlet to the contained matter.

MATER MISERICORDIÆ HOSPITAL.

CLINICAL REPORTS BY DR. HAYDEN. ACUTE RHEUMATISM WITH PERICARDITIS; ALKALINE TREATMENT; RECOVERY.

PATRICK M., aged 31, a corn porter, was admitted into hospital November 12, 1866. A fortnight previously he was hard worked in loading corn; perspired copiously, and, during the intervals of rest, neglected to put on his coat, and became chilled. On the following day he had a slight rigor, and pains in the shoulders, but continued to work till Wednesday, November 7, when he was obliged to keep his bed, and on the 8th he had pains in the wrists and ankles. On admission the tongue was loaded; pulse 102, full and regular; pain in wrists and ankles, the latter being slightly swollen; he perspired freely, and had a severe cough with mucous expectoration. Ordered a mixture containing wine of the seeds of colchicum, tincture of opium, nit. spirit of ether, and liquor potass; also an expectorant mixture.

From the date of admission (12th), till the 20th, no noteworthy change took place; the pulse varying from 102 to 120; the urine being acid, and loaded with lithates.

On the 20th a well-pronounced friction-sound was heard over the base of the heart; pulse 102; respiration 22. Three leeches were applied over mid-sternum, and subsequently a warm poultice; and a mixture was given consisting of liquor ant. tart., Zii.; tinct. opii, 3i.; acetat potassæ, Zii.; Syrupi Croci, ii.; aquæ camphoræ ad 3viii. ; an ounce to be given every third hour.

On the 22nd, the pulse was 114, full, but soft and vacillating; a slight frottement was heard over left base of heart at the end of expiration; loud bronchitic râles audible all over front of chest.