when emboli are found in the veins, they are not the results of inflammatory action, but are the results of the coagulation of the blood produced by the absorption of a poisonous element into the circulation. That such coagula are formed by absorption of poisonous elements is proved by the experiments of Mr. LEE, who injected decomposing animal matter into the jugular veins of brute animals. If, therefore, surgical fever may exist with or without inflammation, why may not its analogue, puerperal fever, exist in the same way? If surgical fever be a fever peculiar to the surgical patient, why may not puerperal fever be peculiar to the puerperal female whose condition is about the same? Puerperal fever being, then, a fever peculiar to the parturient condition, what is it that produces it in such cases? Some toxæmic agent introduced into the circulating fluid. Dr. BOISLINIERE has just quoted DUBOIS, and I presume correctly, though I myself do not recollect what DUBOIS has said on this subject, and says that he, DUBOIS, asserts that the fever does not arise from the absorption of the vitiated fluids in the uterus, for if such were true it would be likely to happen very often, as the conditions always exist. To this it may be replied, is it not also true that amputations and other operations are often made and no fevers follow? But, at other times, surgical fevers after operations are the rule, and freedom from them the exception. Fever sometimes prevails in surgical wards of certain hospitals with alarming frequency and results-nay, even in the wards of all the hospitals in a city; so does puerperal fever occursometimes as an epidemic, sometimes as an endemic, sometimes confined to one hospital alone. There are certain changes in the condition of the atmosphere, or there may be telluric emanations which will favor the absorption of zymotic matter, and render both surgical and puerperal fevers more prevalent. What these predisposing circumstances are, it is impossible in the present state of our science to determine. But I do not mean to assert that puerperal fever is owing only to the absorption of zymotic matter

from the uterus itself; it may be introduced from without. This has been demonstrated by the circumstances which occurred in the Vienna Hospital, as communicated by Dr. ARNETH. I need only refer to these, as they are familiar to every one present.

Since the publication of ARNETH's paper, experiments have been made on animals, which have given the following results: Any kind of putrefying animal matter introduced into the vagina of a parturient female, produces a malady bearing a strong resemblance to puerperal fever. and frequently followed by death. Very small quantities of fluid in the vagina of a woman or animal attacked with puerperal fever being introduced into the vagina of some other parturient animal, cause puerperal fever or something very much like it. Now I can not agree with Dr. BOISLINIERE that women may have puerperal fever when not parturient. They may have peritonitis, which may arise from causes very different from those producing puerperal fever. They may have metritis, peritonitis, or any other form of inflammation, and so may males. But this is different from inflammation following the toxæmic conditions of the puerperal female. That, as I have already stated, arises from the vitiated condition of the blood itself.

Now, entertaining these views, to-wit, that puerperal fever is a disease dependent upon the vitiation of the blood, and may be followed by inflammation, sthenic or asthenic, or by no inflammation at all, and that it varies in different endemic or in sporadic cases, I can not think that any one plan is applicable to its treatment. We can not rely on the hyposulphites, nor on veratrum, nor on opium, nor on any one remedy; and I regret to hear Dr. BOISLINIERE quote Dr. ALONZO CLARK with seeming approbation. In one case Dr. CLARK gave to a woman opium in most enormous doses; on the second day, for instance, she took 472 grains : on the third day she took 236 grains; after that the dose was rapidly diminished, until on the seventh she took only 8 grains. But this by no means proves that opium is the remedy in puerperal fever. It merely proves the extent

that a patient may bear it without dying. Dr. ARMSTRONG, who believed that puerperal fever is always a form of peritonitis, relied greatly on the lancet, calomel, and opium; but he asserted that if he were to be deprived of any one remedy, he would rather be deprived of any one than opium. He, like Dr. CLARK, placed great reliance on opium, though he did not go to the astonishing extent that Dr. CLARK did. Every case is to be treated upon its peculiar merits; sometimes the inflammatory element runs so high, that it alone is to be considered, and it may demand the use of the lancet and other depleting remedies. I do not by any means discard the use of the lancet on such occasions. I will further assert that I have often bled and leeched, and never had occasion to regret it. I never lost a patient when I bled, with the exception of one, and this occurred twenty-five years ago. But I do not mean to assert that on all occasions antiphlogistic treatment is neces sary. Due respect to the prevailing tendencies of disease must be preserved. At this time, when there is a great proneness to diarrhoea in this city, we must be very chary of the use of purgatives, and even a slight purgative may produce such a condition of the bowels.

Here Dr. PALLEN recited the history of a case in his own practice in which there was decided inflammation, and the patient at first was constipated, and in whom a troublesome diarrhoea supervened upon the exhibition of a little calomel guarded by opium, but who recovered under the use of astringents and brandy. But, continued Dr. PALLEN, it is also a common result in puerperal fever that diarrhoea supervenes, nature thus eliminating from the system the toxæmic element. Experiments have proved that it is in this way, i. c., by the diarrhoea, that nature eliminates the poison of putrefying matters when injected into the veins. I need not recite in this Society these experiments, as they are familiar to all. I will not enter at present into the question of the contagiousness of puerperal fever or its resemblance to erysipelas, as I fear I have already occupied too much of the time of this Society.

A CASE OF SYMPATHETIC OPHTHALMITIS FOLLOWING A PENETRATING WOUND WITH LODGMENT

OF A FRAGMENT OF A PERCUSSION

CAP IN THE OTHER EYE:

With remarks upon Sympathetic Inflammation of the Eye.

By JOHN GREEN, M.D., of St. Louis.

E. G. D., æt. 22, mechanic, received a penetrating wound of the left eye from a fragment of percussion cap, Nov. 5th, 1867. The eye was somewhat sore after the injury, but remained free from active inflammation for about six weeks, during a part of which time vision was tolerably good. Within a day or two after the receipt of the injury he consulted a professed oculist, who told him that there was and could be no foreign body within the eye-ball, and promised to cure him in a week. At the end of a month's treatment, he was informed that there was a foreign body in the eye, and that the eye must be taken out, but no reason was assigned to justify so serious an operation. Perplexed by these contradictory but equally positive opinions from the same person, he lost confidence in him and consulted another practitioner, who told him that a part of the injured eye would have to be removed in order that he might wear a glass eye, but that the operation must be deferred several months, until the beginning of summer. While under this man's treatment, vision was lost in the left eye, and also began to fail in the right eye; at first without pain, afterwards with occasional attacks of moderate photophobia and tenderness on pressure, but without any of the usual manifestations of acute inflammation. At the end of about two months of pretended treatment, he lost all perception of light in the injured (left) eye, and became so blind in the right eye, as no longer to be able safely to guide himself. He then consulted a third adviser, who told him that had he been called in season, he would have cured both eyes.

The case was first seen by the writer Feb. 21st, 1868, three months and a half after the date of the injury. The left eye was in a state of chronic irritation, red, tender on pressure, and the eye-ball much softer than normal. The pupil was distorted and quite small, and behind it the densely opaque crystalline was seen in a state of complete cataractous degeneration. The cicatrix of the wound made by the entrance of the bit of cap was to the inner side, and about half a line distant from the margin of the cornea. All perception of light by this eye had been lost for many weeks. The right eye, which had begun to be affected about two months before (six weeks after the injury to the left eye), presented the usual appearance of an eye nearly destroyed by sympathetic inflammation. The pupil was irregular, contracted, and obscured by a thick deposit of lymph; the pupillary margin was everywhere adherent to the anterior surface of the lens. The iris had undergone an entire change in texture, and presented a thickened and spongy appearance, as if soaked and saturated with lymph; the pupil, gray in color from the deposit of lymph on the anterior capsule of the crystalline, appeared like a deep pit or excavation in the centre of this softened and spongy

All signs of the normal fibrous nature of the iris had disappeared. There was considerable photophobia, with increased flow of tears and marked injection of the bloodvessels of the conjunctiva and sclerotic; the eye-ball was quite sensitive to the touch, and seemed a little softer than normal. Vision was nearly gone, only a vague perception remaining of the forms of very large objects; the test letters No. CC, of SNELLEN (four inches in height), could not be distinguished at a distance of two feet, or indeed at any distance with certainty.

The inflammation in this eye, which in the space of two months had produced such destructive effects, had nevertheless begun so insidiously as scarcely to have attracted notice until vision had become seriously impaired. The eye had been slightly sensitive to light, and perhaps a