his share, but he thought the disease was far more common than was usually supposed, and he thought moreover that disease of the appendix was productive of a majority of cases of so called idiopathic peritonitis, particularly in the male sex. It is a prevalent error that this disorder arises from the accidental introduction of a foreign body into a healthy appendix; the appendix is previously diseased. It is liable to a catarrhal inflammation, by which its cavity is dilated, and its walls are sometimes thickened and sometimes attenuated. Into this dilated pouch foreign bodies find access, but these foreign bodies are very rarely what they are called-cherry-stones, beans, raisin-seeds, etc. They are usually composed of hard fæcal matter, deposited around a nucleus, the nucleus in most instances being a minute biliary calculus, or a phosphatic intestinal concretion-sometimes nearly the whole bulk is of cholestrine or of phosphates, but generally layers of fæcal strata, slowly formed, preponderate. The disease is not necessarily fatal. The appendix may become fast to the cæcum, by peritoneal inflammation, preceding perforation, and the abscess may discharge into the intestine, or it may be circumscribed by organized lymph and find exit through the abdominal wall. Dr. Rochester thinks that he has seen one instance of each of these fortunate terminations. Within the past year two operations have been performed in New York, for the relief of this disorder, and both eventuated successfully. One was made by Willard Parker. But the difficulty of positive early diagnosis, and the enormous hazard of the procedure, will prevent a very frequent resort to the knife. In the case reported to-night, this operation might have succeeded; the disease is confined to the appendix exclusively; it could have been removed entire, but this could not be foreseen or conjectured even, and the event might have been just as fatal. In Dr. Rochester's opinion the possibilities of a spontaneous favorable issue are greater than the probability of a successful surgical operation. DR. LOTHROP said, these cases in which Dr. Rochester's experience had been so remarkable, were always of great interest. He was inclined to the belief expressed by Dr. R, that most cases of idiopathic peritonitis in the male, originated in the vicinity of the appendix vermiformis, and were connected with inflammatory conditions of that process. He thought that most practitioners must

have met with cases of pain, and often induration in that region, at first local, but afterwards spreading over the abdomen, giving rise to symptoms often of great severity, many, however, ending in recovery. He could call to mind a most marked case, recently under his care, in which there was great pain, induration and tension in that region, causing great general disturbance, and having some signs of suppurative inflammation, in which he was expecting an opening into the abdomen and consequent general peritonitis. In this case, though there was no sign of escape of pus into the bowel, such as its passage by the anus, yet he thought it was probable. In many, perhaps most cases, he thought the inflammation arose from the presence of a foreign body or fæcal concretion, lodging in the appendix. But yet it seemed necessary to presuppose some unhealthy condition of the appendix, in order that these bodies should either pass into it, or excite destructive inflammation. He had seen one case in which a fæcal concretion of small size was found after death in the process, a half an inch from its opening, yet no signs of its having excited inflammatory action were visible, the death having been caused by some other disease than peritonitis. It might be that foreign bodies could pass into the appendix without always exciting inflammation, otherwise nature would seem to have made a most prodigious blunder, in setting such a dangerous trap.

The cases which Dr. James Jackson speaks of in his Letter to a Young Physician, as "a painful tumor near the cæcum," may have been somewhat of this nature, though less acute than those affections in which suppuration is known to take place, and all ending in recovery.

DR. SMITH mentioned a case of peritonitis in which there was at first all the usual phenomena of general peritonitis. He treated it in the usual manner, and the patient soon improved, and had almost entirely recovered, when she was again taken with the same symptoms, followed by the discharge of a large quantity of pus into the alimentary canal and passed per rectum. Sent the case to the hospital and lost all knowledge of it thereafter. The gen. eral disturbance in this case was undoubtedly due to the local inflammation.

DR. LOTHROP exhibited the specimen of fracture of the femur, just above the knee-joint, of which he had spoken at the previous

meeting.

The specimen showed no trace of the existence of provisional callus, though the bone was removed one month after the fracture, and a certain amount of definitive union had taken place, the fragments not separating till after considerable maceration and handling. There was no osseous formation about the fractured ends externally.

DR. STRONG said that his time had been so occupied that he had not been able to prepare an essay for this evening, but would be prepared at the next meeting.

By vote of the Society the Doctor was excused for not presenting an essay.

DR. STRONG said that he would report, briefly, a case of puerperal fever. A lady was delivered of a still-born child, and the case went on well until the fourth day, when strong febrile action commenced, and with it all the symptoms of puerperal fever. I saw the case with the attending physician on the seventh or eighth day after confinement. When I first saw her the surface of her body was semi-congested and covered with clammy sweat. Pulse about 130; had incipient retching and instantaneous rejection of everything swallowed. Had had a few hours previous a severe chill. The abdomen was tender and tympanitic. The diagnosis was extensive purulent absorption, and the case looked desperate. The treatment adopted at this time was, morphia sulph. gr., every two hours; quinia sulph. grs. 2, every four hours, and a tablespoonful of brandy every hour. Oleum terebinth was kept constantly applied

to the abdomen. We thought she would not live until morning, but on seeing her next morning found her pulse rather stronger and less frequent, and a little less tympany and tenderness; continued the treatment during the second day. On the third day added to the above treatment three grains of the bromide of potassium every four hours. Gave beef essence plentifully. After the fourth day the symptoms were much better. On the fifth day she was considered out of danger, and is now nearly well. I had never before seen so doubtful a case recover from this disease. The case is one of much interest, and I hope that the attending physician will make a full report of it.

The Committee on the revision of the Constitution and By-Laws ask for more time, which was granted.

Adjourned.

T. M. JOHNSON, Sec'y.

Correspondence.

Life Insurance.

BY W. W. JONES, M. D., TOLEDO, OHIO.

Your article on "Examinations for Life Insurance," in the July number, suggests some further thoughts to which the attention of the profession may properly be called.

In theory, at least, the medical examiner holds his appointment direct from the home office of the company, and is supposed to hold an independent position, and be the guardian of its interest, and it would be considered undignified in him to fail to make an honest report of the cases he examines. Under the present plan or rules adopted by insurance companies, the whole of the examiner's report is subject to the inspection and criticism of the agent and applicant, both of whom are anxious that it should be most favorable. In case an unfavorable or doubtful report is necessarily made, the agent notices it, and the question naturally arises, how can this applicant be got through? If the company has more than one examiner, (and in some instances they have as many as the agent chooses to name,) the applicant performs a pilgrimage. The doctor who unequivocally recommends him for a policy is the best fellow in the estimation of both the applicant and the agent, and gradually gets the most of the examinations to do. An agent of one of the most prominent companies recently informed me that it was absolutely necessary to have some Dutch examiners because the competition was so great; this company already had several other examiners, not all of whom would be recognized by the profession as medical. I knew a general agent to instruct his solicitors "that when they found that the medical examiner did not work for the interest of the agent, to get one who would;” and by reading the report made by the physician they are enabled to judge well how the application will be decided at the home office. They never think it worth while to send on any application that will probably be rejected; neither do they wish to pay the fee.

So long as the interest of the medical examiner and agent are diverse, that of the former depending upon his duty to those he represents, and that of the latter upon premiums, and these upon

the acceptance of the application, these things will happen, unless radical changes are made in the present mode of doing business. The interest of the profession as well as the companies they represent, demands that the present system of medical examinations be more completely divorced from the agencies, and that the examiners be made entirely independent of the agents. The medical examiner should report his examination direct to the home office, and not permit the agent or applicant to inspect his report. Much that it may contain may be of such a nature (especially if unfavorable to the applicant,) as to create ill feeling, repeated examples of which have happened it is believod to all, who have had much experience in making examinations for life insurance. Advantage is often taken to the prejudice of the medical examiner from the heedless disclosure of facts and opinions which his duty makes it necessary to point out in the answers and results of his examination. I believe, that the experience of most physicians who have been examiners will admit the assertion that their losses from these causes, will go far towards balancing their receipts from the fees for such examinations.

Let it not be inferred from the foregoing that I intend to charge agents with dishonest or reprehensible practices. So long as life insurance companies permit the present system to exist they only take advantage of what they consider as legitimate means to do the most business, and while some resort to dishonest means to get a risk accepted, they are the exception and not the rule.

The certificate of the family physician of the party as commonly obtained, is valueless. The company do not pay him, neither do they keep his counsels. If he has any knowledge which he has obtained through his professional intercourse with his patient that would operate against his obtaining an insurance, it would be against his interest to divulge it, and especially if it were put in pen and ink and subjected to the criticism of an agent, I recollect the first instance where I filled out such a certificate, which was rejected on my statements of facts; it cost me the loss of practice in a family worth over a hundred dollars a year, and I did not even get the fee for the certificate.

The medical examiner would be best able to judge after examining the applicant whether the family physician's statement would