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appearance, but also with its color, which resembled that of blackberry-juice. The tumor was examined by Dr. Flint, and found to be cancerous in character. There was no hereditary taint of cancer, neither were there any glandular enlargements in the neighborhood. He remarked that he had never seen an encysted cancer before. In this connection, he referred to the case of a physician's father, from whose temple a similar sized tumor had been removed under like circumstances, followed in the course of a few years by an enormous cancerous deposit in the liver, from which the patient died. The liver measured about 23 inches in its different diameters.

He next exhibited a portion of the coccyx, which he had removed from the person of a soldier who had been wounded four years before through the buttocks while lying face downwards on the ground. The ball entered on the right side and passed out on the left, just to the back of the ilium. A large abscess was the immediate result of the wound, which in time forced the patient to leave the army, since which time he has suffered with numerous fistulous sores, becoming much emaciated in consequence. One of these openings existed above Poupart's ligament, another on the inside of the thigh, near the internal condyle of the femur, and one or two opened near the crest of the ilium. The excessive suppuration had reduced him so much that he was unable to get about. There was a good deal of difficulty in striking dead bone through the openings, but this was finally accomplished through one of the cloace on the posterior part of the thigh, the bare bone being found in the situation naturally occupied by the coccyx. An incision was made upon the point, and a portion of the coccyx was removed. From that time all the sinuses had healed up, this portion of dead bone being the source of all the patient's trouble.

He remarked that this was the second time that he had performed a similar operation. The first patient was a clergyman, who had necrosis of the same bone, as the result of a large post-rectal abscess. In answer to a question from Dr. Rogers, Dr. Sayre remarked that he could not be mistaken either as to the locality from which the bone was removed, or the bone itself, and was therefore certain that it was a portion of the coccyx, and nothing else.

POST-MORTEM APPEARANCES OF HANGING.

DR. TERRY exhibited the upper portion of the windpipe and subjacent integuments removed from a woman who committed suicide by hanging. She sent a little girl, who was with her, into a yard to get some water, and when the little one returned the woman was found suspended from the top of the door-frame in a large tripled loop, one end of which had been slipped over a large spike, the other end supporting the front of her neck. The girl gave the alarm instantly, when some gentlemen came in and cut down the suicide; she gasping only a few times before she expired. He exhibited the specimens for the purpose of showing the mark produced by the rope. Death had been produced by asphyxia.

a manner as barely to keep the nose from touching the floor. The details of this case were already familiar to the members. He also stated that some cases were recorded in which persons had been cut down and were alive after hanging for half an hour.

DR. HOWARD remarked that he had asked the question because he had witnessed several well-ordered executions, and had never met with a single instance in which death had taken place other than by suffocation at the end of fifteen or twenty minutes.

DR. ROGERS stated that the horizontal method of hanging by slinging the throat in a noose was very common among the Chinese upon the Isthmus, he having seen numbers who had thus committed suicide by attaching one end of the rope to the axles of railroad cars.

DR. HOWARD had seen a culprit fall for ten feet with such violence as to break the rope, and yet the cervical vertebræ were not dislocated.

DR. MASON asked if in any of the cases referred to by
Dr. Howard the hyoid bone had been broken.
DR. HOWARD stated that he had not made a post-
mortem examination in any of the cases.

RUPTURE OF THE PULMONARY ARTERY.

DR. TERRY also presented a heart removed from a patient of twenty-five years of age who had complained of dyspnoea, a dry harsh cough, and a good deal of palpitation. He was able to work but little. Five days previously he complained of a sharp stabbing pain about the heart. He went from one room to the other to get relief, but the pain continued, and extended to the left shoulder and down the left arm. After four or five days it suddenly increased and he experienced a faintness as if he were going to die, and lived but three hours

after.

At the post-mortem examination the pericardium was distended considerably, containing about a quart of coagulated blood. At the root of the aorta there was an ecchymosis in the cellular tissue, and about half an inch above the root of the pulmonary artery there was a rent of half an inch in length in that vessel, through which the blood escaped. This was accounted for, in the opinion of Dr. Terry, by a patent ductus arteriosus, which allowed a cross current of blood to enter the pulmonary artery and impede the regular curent in that vessel to the extent of distending it to rupture.

At this stage of the proceedings the President introduced Dr. Neftel, of Russia.

OVARIOTOMY.

DR. PEASLEE exhibited an ovarian tumor, and remarked upon it as follows:

I have brought this here for the sake of showing an interesting point in diagnosis, as I thought it would prove to the Society, and not because of any interest that may be possessed by the tumor itself. It is an ovarian tumor removed from a woman some hours after death, and hence has not interest in connection with an operation. This patient I first saw four weeks ago, In answer to a question from Dr. Howard, he stated she having been tapped eighteen times, and there havthat there were several modes by which death by hanging been removed from thirty to sixty pounds of fluid ing was produced; if dislocation of the cervical verte- at the different tappings. She had always rallied after bræ occurred, it was of course sudden, by pressure on these without symptoms of inflammation, but she was the medulla oblongata, but if by mere pressure upon not then in a condition for a removal of the tumor, and the trachea it must be a slow one by suffocation, con- if she had been. I should have first preferred, as I alsuming probably fifteen minutes in the operation. In ways do (unless there is some particular reason to the this connection he also referred to the case presented contrary), to tap her once myself in order to perfect at a previous meeting by Dr. Finnell, in which the de- the diagnosis. This diagnosis, I may say, remained ceased was found lying in a prone position alongside of somewhat doubtful. She had been tapped by two difa mantel-piece with his head suspended in a rope, in such ferent physicians, and so far as I could learn no decided

is not a purulent infiltration, but it is simply softened
grey substance, which is also present in pneumonia
which has reached its third stage. I have made an
attempt to settle this point by a microscopical examina
tion, but have not been able to determine by the
appearances whether pus was present or not. These
cells (a diagram of which was shown) may be pneu-
monic cells, or they may be the ordinary pus globules
which have undergone such a granular change, so that
the test by acetic acid was not very satisfactory.

DR. LOOMIS was of the opinion that the case was one
heretofore known as infiltrated tuberculosis, but better
described as cheesy pneumonia, the result of a more
chronic inflammatory action.

opinions as to the precise nature of the tumor had been
expressed. I found the circumference of the abdomen
about forty inches. The appearances presented were
those of a monocystic ovarian tumor. Examining her
per vaginam, I felt a very solid, unresisting mass pro-
jecting into the pelvis. Fluctuation through the ab-
dominal wall was very distinct; the uterus was in the
natural position, and the sound passed in to the natural
extent, two and a half inches. (I may mention here
that she had given birth to one child.) I regarded the
tumor as ovarian, tapped her, and drew off 60 pounds
of fluid from a single sac. The remaining portion of
the mass that I felt in the pelvis per vaginam was
then brought into view. I then examined the woman
with a sound to ascertain whether, after all, this might DR. SMITH also exhibited a fatty liver removed from
not be a fibro-cystic tumor of the uterus. I could in- an infant one year old, who died with pneumonia,
troduce the sound, and hold the uterus up above the having suffered for a considerable period from diar-
symphysis pubis, and make it so prominent that I could rhoea. The interest of the case centred upon the con-
take it in my hand and feel every portion of it distinct-currence of diarrhoea with the hepatic lesion, a fact
ly. I could feel the fundus of the organ and the pedicle which has often been noticed by writers upon the sub-
of the tumor separated from it and extending into the ject. The intestinal canal showed no traces of ana-
mass, giving a perfect demonstration that it could not tomical lesion.
be a fibro-cystic uterine tumor. The pedicle, as seen
here, is about two inches in depth and very delicate. I
proposed, after the tapping, to await the result of her
refilling, which I concluded would be in about three
weeks, when I should be prepared to remove the
tumor. She went on for five or six days, when she
was seized with a bilious attack, and vomited a great
deal. This reduced her considerably; but she recovered,
to be attacked a week afterwards by bronchitis, from
which she sank.

DR. ROGERS exhibited a cartilaginous growth which he had removed from the os brachii, just beneath the deltoid, of a lad fifteen years of age. It was so situated that when the arm was brought forward, raised and rotated, the sharpened point of the growth would insinuate itself under the muscle and arrest its further action. If, however, it was rotated backwards, the growth was brought into view under the anterior edge of the deltoid, and was thus easily removed. It was composed principally of cartilage with a small spiculum. of bone through its substance. There did not seem to have been any cause for the trouble in the shape of an injury. The patient recovered entirely.

He lastly exhibited a small exostosis which he had removed from the last phalanx of the great toe of a young girl ten years of age.

This sac, on examination, presents some interesting points. It appears to be extremely thick, but the least traction will tear it. That thickness is apparently the result of successive inflammations; still she never complained of any of the usual symptoms of such a complication during life. The sac is lined throughout by a soft pulpy exudation, which makes up more than half of the thickness of the sac itself. You see here whence proceed these long strings of exudation which so frequently block up the atheeter during an operation, yet, MEDICAL SOCIETY OF THE COUNTY OF strange to say, in this instance nothing but a highly albuminous viscid fluid escaped through the canula.

He stated in conclusion, that the patient from whom he had removed the fibro-cystic tumor of the uterus, whose case was reported at a previous meeting, was now perfectly well.

DR. POST presented a specimen of salivary calculus, taken from Wharton's duct, which had the peculiarity of being nearly, tubular.

CHEESY PNEUMONIA.

After which the Society went into executive session.

NEW YORK.

STATED MEETING, MARCH 2, 1868.

DR. E. R. PEASLEE, PRESIDENT, in the Chair.
THE PRESIDENT announced the admission to membership
of Drs. John H. Dorn, Geo. A. Mursick, and Wm. R.
Whitehead.

THE GENERAL PARALYSIS OF THE INSANE.

He

DR. OSCAR G. SMITH read a paper upon this disease, DR. LEWIS SMITH presented a lung taken from a man otherwise known as General Paresis, and as the Perienwho died about the age of fifty. He had a cough for a céphalite Chronique Diffuse of M. Calmeil. He stated considerable time, and was supposed to have tubercu- that, although abundant opportunity had been offered lar disease. On making the post-mortem examination, for the study of its pathology-for it was invariably almost the entire upper lobe of the left lung was in the fatal-yet no two observers were agreed upon it. M. state called grey hepatization, and that form of it which Calmeil had perhaps thrown the most light upon this, some writers designate as purulent infiltration. He as well as upon its symptoms; and his views had been remarked that he presented it simply on that account, confirmed by late microscopical investigations. the lesion being that stage of pneumonia. "Some had first pronounced the affection to be an inflammation writers, it is known," says he, "do not consider that of the cortical substance of the cerebral hemispheres; there is more than one variety of grey hepatization." an inflammation non-suppurative, producing a gradual On making an incision into this lobe, a considerable degeneration of tissue, the healthy structures being deportion of it was found in an almost diffluent state, and stroyed and their débris being found mingled with these portions removed presented very much the ap- lower forms of growth. Among the morbid appearpearance of pus. Now, the question is one of some in- ances commonly to be found were the following, though it terest in pathology, whether we should consider this was not certain that any one of them was peculiar to this a stage of purulent hepatization or grey hepatization, disease, or even to insanity: Diploë of cranium diminthe substances deposited in the lungs having become ished or destroyed; its tables thickened or thinned, or softened. This is the opinion entertained by many, eburnated. Dura mater adherent to the bone; arachnoid that when this very soft condition of the lung exists, it I thickened and opaque in portions; and between these

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two membranes, thin jelly-form layers, remains of old extravasations, often appearing half-organized. Pia mater opaque and thickened, adherent to the brain. Cortical substance of brain thinned and atrophied; frequently soft, but more commonly hardened by destruction of its cells and shrinking of its connective tissue. To this last Rokitansky attached great importance, believing an overgrowth of the connective tissue to be the cause of the paralysis, by pressure upon and consequent destruction of the brain cells. Wedl ascribed the lesions to disease of the capillaries; other pathologists to meningitis. Dr. Franz Meschede (in Virchow's Archives, 1865) pronounced the affection a parenchymatous inflammation of the cortical structure of the hemispheres, commencing in the inner layer and spreading outwards. He found destruction of the brain-cells, condensation of the connective tissue, and wasting of the vessels. The cells were to be seen in various stages of fatty degeneration. This view Dr. Smith regarded as best accounting for the mental symptoms, which often closely resemble those of ordinary insanity. Wedl's theory could hardly be sound, for we should expect degeneration of the capillaries chiefly in the aged, whom this disease never attacks. Nor could the affection be due to meningitis, which constantly occurs without producing its symptoms.

DR. J. C. SMITH said that Dr. Luther V. Bell, of Boston, had first brought this affection to the notice of the profession in this country, by an article published in 1843. Dr. Bell had become familiar with it in Europe, but, until that year, had seen no case of it in the McLean Asylum, nor could he find record of any. During a service of five years at this asylum, Dr. Smith had not himself found these patients more violent and destructive, or more troublesome to manage, than others. Sexual excesses he had been wont to regard, not as a cause of the disease, but rather as a symptom of its early stages. In the first stage, of mental aberration so slight as hardly to be noticed, and in the first part of the second stage, of excitement and sleeplessness, these excesses were often wonderful. There was often also an excessive indulgence in alcohol, contrary to the patient's habit. In the five years he had seen but one well marked case in a woman. The disease evinced an unmistakable preference for localities. In the northern and eastern parts of the country it was much more prevalent than in the south and west. Boston, where it was quite common, appeared to suffer more than New York; or, rather, more cases were found in its asylums, which received wealthy patients, while such cases here might perhaps be sent away from the city for treatment. Though most often developing itself rather suddenly, yet occasionally the disease was so slow in its approach as to be deceptive. In the case of a well known gentleman of Boston, its first indication had been that he sent a very large number of bills over the city, each one for $9.99. Among the most characteristic symptoms in the early stage were a certain clumsiness in the use of the fingers, as in buttoning the coat or thrusting them into the vest pocket, which, once observed, could always be recognized; and a very slightly faltering or slip-shod gait. The tongue was protruded almost always with difficulty or hesitation, being finally thrown out with a jerk, and as suddenly drawn back with a grimace. According to almost all writers, it was very rarely drawn to one side, as in some other forms of paralysis. Treatment was so unsatisfactory that many gave none whatever. But the bromide of potassium might be expected to prove serviceable in the early stages. It would at least overcome the vigilance and

secure rest.

The diagnosis between this form and other forms of insanity is based chiefly upon the character of the delusions, the paralytic symptoms, and considerations of age, sex, etc. The delusions are commonly of the exalted kind, the patient being the possessor of untold wealth or power or fame; but occasionally they assume the melancholic form. In the early stages there may be simply failure of memory, with lack of mental poise, the patient being easily swayed by trifles; later there is often great violence, and he will persist in tearing off all clothing and committing the greatest extravagances; and finally dementia supervenes. The paralysis is usually first noticeable in the enunciation, afterwards becoming general. This, like the other signs of the disease, is not uniformly progressive. The course of the affection is marked, at intervals, by epileptiform seizures, which for the time completely prostrate the patient mentally and physically; but after which he may, in a few weeks, regain almost his former intelligence and strength, so as even to resume his business. But such improvement is DR. JACOBI had been led to look into the literature always delusive and transient. Irregularity of the pupil, of the subject by the case of a friend affected with with or without contraction, is frequently observed. syphilis and threatened with grave cerebral symptoms. Authorities differ about the thermometry of the dis- There were a few positive cases on record, in which ease; but the best affirm that there is no increase of the so-called paralytic insanity had been caused, not temperature, even in the initial stage or at the periods simply by venereal or other excesses, but by the syphof highest excitement, while there is a decided and pro-ilitic poison itself. It was worth while to know this gressive decrease, from the time when paralysis and mental imbecility become marked up to the patient's death. General paresis rarely attacks persons under twenty years of age or over sixty. Women are remarkably exempt from it. Of 133 cases admitted to the asylum at Utica, from 1849 to 1866, but 11 were women. As it seldom supervenes upon ordinary insanity, and has commonly a brief course, which always ends fatally, time becomes an important element in the diagnosis. Calmeil gives thirteen months as the average duration of the malady, and Esquirol says that it rarely exceeds three years.

The etiology is obscure. Hereditary taint is less frequently traceable here than in other forms of insanity. Innutrition, prolonged and exhausting mental exercise, especially from business anxiety, intemperance, and sexual excesses, are the causes commonly assigned. The treatment should be adapted to the indications of each case. Tonics and nutritious food are generally demanded, with sedatives. The bromides should have a fair trial.

fact, and also to know that paralytic insanity, even when it has advanced to the third stage, of complete imbecility, may be cured, if due to syphilis. Dr. Fleming had reported one or two cases of this kind, that had reached the third stage and were cured by iodide of potassium. If, then, these syphilitic cases are amenable to treatment, every physician should so well understand the disease as to be able to detect them. There was reason for believing that alcohol, also, was a cause of this disease; and, perhaps, the comparative exemption of women might be owing to their being so much less affected than men both by this and by the last named cause. Many of the paralytic insane had been drunkards. Again, the lesions of this affection were very like those found in many of the viscera after the abuse of alcohol. We must not forget that it is an inflammatory condition, commencing in the cortical substance, and gradually invading the whole brain; that the microscope shows, in all cases, hyperplasia of the cerebral connective tissue, and, in many cases, this together with

The

of ammonium had been tried with less success. second case seemed connected with syphilis, and though it had gone on favorably for a time, the patient was now sinking.

DR. CHAMBERLAIN had supposed his case complicated by more or less effusion in some part of the brain, and Dr. Hammond had agreed with him.

DR. JACOBI was positive that there was not on record a single case of local effusions or hæmorrhages in general paresis. When effusions and hæmorrhages were found, they were into the meninges, never into the brain-substance; and meningeal effusions would not produce symptoms of facial paralysis.

DR. LEAMING began the reading of a paper upon Cardiac Murmurs, its conclusion being postponed to the next meeting.

ANNUAL MEETING OF THE CONNECTICUT

fatty degeneration. Compare with this cirrhosis of the liver, which is found almost only in drunkards. Cirrhosis means interstitial inflammation of the liver, with hypertrophy of its connective tissue, compression, and atrophy. These lesions are the characteristic of many affections considered incurable. Cirrhosis will not yield to treatment; neither will paralytic insanity, except in the syphilitic cases. Tetanus shows in almost every case acute hyperplasia of the connective tissue of the spinal cord, and is incurable, except in rare instances. So with enlargement of the lymphatic, or of the muciparous, glands; where it depends upon hypertrophy of their connective tissue, with compression of the proper glandular tissue, the only remedy is the knife. No DR. PEASLEE said that this disease might perhaps be diseases are more obstinate than granular pharyngitis regarded by the specialists as incurable, because they do and granular conjunctivitis; and for the same reason, not see it in its first stages. It was of the utmost imthat we have as yet no means of influencing those in-portance that every practitioner should be familiar with flammatory processes which invade the connective its earliest symptoms, that it might be aborted while, tissue, and result in its hypertrophy. if at all, its abortion was possible. The use of the broDR. CHAMBERLAIN would refer to a single case, which mide of potassium for this purpose would commend he did not hesitate to call one of paralytic insanity, al- itself to every one. For if the disease began as a conthough it presented some points of difference from the gestion, going on to inflammation, with all the pathodescription in the paper just read, was still in pro-logical effects that had been stated, then if any remedy gress, and had at one time so improved under treatment could arrest it, and prevent the congestion from passing as to lead the patient and his friends to believe the re-into inflammation, it must be one that would diminish covery complete. The subject was a very successful the amount of blood sent to the brain. And that the bromechanic, about fifty years of age, who had first devel- mide of potassium had this power, the experiments of oped symptoms of the disease about eighteen months Dr. Hammond had fully proved. before. During its progress he had fallen under the observation of a large number of physicians, going from one to the other, and finally returning to the care of Dr. Chamberlain. He reached a degree of prostration such as, the doctor thought, was rarely followed by even partial recovery. He lost his speech almost entirely, his reason completely; had well marked facial paralysis; was extremely emaciated, with bed-sores upon the sacrum and either trochanter, and abscesses throughout the cellular tissue of the lower extremities and the scrotum; was so feeble that he could not be turned in bed except upon a sheet; and gave every indication of speedy dissolution. He was put upon quite large doses of phosphate of strychnia; and amendment was so soon perceptible, that the doctor inclined to think that this treatment had something to do with it. He regained his strength, and gradually his reason also, and presently began to resume his place in the family. The period of prostration lasted from December, 1866, to April, 1867. About the first of April he got up; and by the first of July he had gained nearly fifty pounds of flesh, and was, to all appearance, in perfect health. He removed to the country, bought a farm, and undertook its management, in spite of a warning to his friends that he was still an insane man and could not safely be trusted. For a long time there seemed nothing to justify this warning; but quite lately he began to make wild purchases, and now he was in bed again with the old symptoms. A careful ophthalmoscopic examination had given only negative results. DR. J. C. SMITH asked if the tongue was protruded in the median line, and being answered that it was not, thought this alone would throw a doubt upon the diagnosis. He deemed the point very important. He believed also that emaciation was uncommon in general paresis. He had often seen patients gain weight largely. They would eat voraciously, and were not particular as to the quality of their food. However coarse, their dinners were the most bountiful in the world.

DR. C. PRINCE had seen Dr. Chamberlain's case, and was disposed to confirm the diagnosis, at least in some respects. He had himself two cases then under treatThe first was doing well under bromide of potassium, in scruple doses thrice a day. The bromide

ment.

RIVER VALLEY MEDICAL ASSOCIATION. THE Annual Meeting of the Connecticut River Valley Medical Association was held at Bellows Falls, Vt., on Wednesday and Thursday, May 6 and 7, agreeably to a vote at the last annual meeting, to hold the session two days this year.

On Wednesday, at 10 o'clock A.M., the President, Prof. Dixi Crosby, being absent, Dr. Z. G. Harrington, of Chester, Vt., was called to the chair.

The Secretary's report was read and adopted.
The report of the Treasurer showed all expenses
paid, and a surplus of $34.90.

Little business was transacted in the forenoon.
The following officers were elected:

DR. H. D. HOLTON, of Brattleboro, Vt., President.
DR. GEO. B. TWITCHELL, Keene, N. H., Vice-Presi-
dent.

DR. F. WHITMAN, Bellows Falls, Vt., Recording Secretary.

DR. A. B. CROSBY, Hanover, N. H., Corresponding Secretary.

DR. SAMUEL NICHOLS, Bellows Falls, Vt., Treasurer. PROF. DIXI CROSBY, the retiring President, gave his annual address. His subject was: Pelvic and Abdominal abscesses. The address was a well written and interesting one, and commanded the most respectful attention of all present.

At its conclusion a vote of thanks was tendered to the Professor.

During the session the following gentlemen presented voluntary papers:

DR. SAMUEL WEBBER, on Neuralgia.

DR. H. G. McINTIRE, on Uterine Inflammation in insane women.

DR. W. B. PORTER, on several interesting obstetric cases, and one on ovarian tumor.

DR. THOMAS GOODWILLIE, of Vernon, Vt., exhibited and explained a new and improved instrument for ad