July 11th. Patient improving, pulse 125, stronger, respiration 30. About 3 oz. bloody serum mixed with pus removed; the same treatment.

July 13th. Child found playing in the basement. Drew away a small amount of nearly clear serum, wound suf fered to close.

July 18th. Child looking better, pulse 100, respiration 25, heart nearly in its normal position, upper portion of· left lung more resonant, air enters all the large bronchi, evident sinking of front upper-portion of left side of thorax, which side is now inch smaller than the opposite.

August 26th. Looking finely, left side 1 inch smaller than the opposite, some friction sounds discovered in lower portion of left side of thorax.

September 28th. Child well. Left side still 1 inch smaller than its fellow.

The case may be of interest as helping to prove :1. The little danger if air does enter the thorax. 2. The advantage of keeping a free opening while pus is secreted.

3. The use of carbolic acid injections.

4. The little trouble in improvising an instrument without the expense of purchasing a complicated one.

NOTES ON LAMINARIA TENTS.

By J. C. NOTT, M. D., New York.

MUCH diversity of opinion exists among gynæcologists as to the comparative merits of sponge and laminaria tents. It is conceded, generally, that sponge tents should be used with caution, as they are occasionally followed by mitritis or inflammation of tissues connected with the uterus-the sponge, in expanding, drives its little projections into the substance of the mucous lining, which is abraded or lacerated in the act of removal, causing more or less bleeding, and often a good deal of pain. Another objection to the sponge is, that after absorbing the animal fluids it becomes excessively putrid and offensive, and, there is good reason to believe, may produce blood poisoning. These objections to sponge hold, to say the least, in a much less degree against the laminaria digitata. When the uterus is irritable-sensible to the probe or touch of the fingerwhen there is any tenderness or disease of surrounding tissues, it is a good rule to dispense with the use of tents of any kind, and the violation of this rule often leads to serious complications.

Our instrument-makers and druggists import the laminaria both in the raw state and made up into tents ready for use. It comes from France, England, California, and the Bay of Fundy on our own Atlantic coast.

I have not been able, so far, to obtain satisfactory information as to the natural history of the article, or the precise localities from which the specimens are taken. I have made a series of experiments on the varieties found in our market, which go to show that they differ much in their physical characteristics, and their applicability to the purposes for which they are employed.

From Messrs. Tiemann & Co., 63 Chatham Street, I obtained specimens of the raw material from California in its rough state. These differ much in appearance from those of other localities; they are generally hol low, of a dirty pipe-clay color, covered with rough bark, cylindrical, and as large as lead pencils of different sizes. When placed in water for 24 hours, they absorb and expand very slowly, and, after fully expanding, remain so hard, woody, and uneven, as to make one believe that they would bruise and irritate the cervix uteri. I should, therefore, condemn the California laminaria as unfit for use. It may be that the specimens I have seen are too old, and that younger plants would answer better. I am told, too, that there is a difference in the male and female plants-the female being hollow and the male solid. That I have seen from California is hollow. I hope to get other specimens from the Pacific coast for experiment.

From Mr. Hornstein, No. 52 Maiden Lane, I procured some specimens of the crude laminaria, which he had imported from France, and from which he manufactures very pretty-looking tents for this market. This material resembles closely that of California in physical qualities. It expands slowly in water, and, when fully saturated,

is hard, uneven, and woody in texture,-almost as hard as a piece of wet white-pine wood, and, therefore, objectionable.

Judging by the eye alone, the laminaria tents, as presented for sale by our surgical-instrument makers, are of two kinds and very different in appearance. The first are beautifully finished, perfectly smooth and cylindrical, with nicely-rounded extremity, of tawny, yellowish, or greenish color, and are entirely denuded of bark. From their roundness, smoothness, and bougielike shape, they look very tempting, but so far as I have tested them they are objectionable-they expand too slowly; after being soaked in water for 24 hours, they still feel hard and woody, and many of them, when fully expanded by moisture, are almost triangular in shape, presenting edges as sharp as those of a three-cornered file, and well calculated to do injury to the uterus. These tents differ a good deal among themselves--those of tawny color preserve pretty well, when expanded, their regular cylindrical shape, while the greenish ones, develop into irregular, angular shapes. Both, I think, should be rejected on account of their hardness and slowness of expansion. Tents of such hardness and tardiness of expansion are likely to irritate, provoke uterine contractions, and be expelled. The second kind of prepared laminaria tents above alluded to as sold in our market, though by far the best, are not, I think, generally fully appreciated by the profession, on account of their rough, ungainly appearance, and from their usual smaller size. This variety has been obtained by Messrs. Tiemann & Co. from the Bay of Fundy, and is peculiar

in appearance; it varies in size from a knitting-needle to that of a large goose-quill; its shape is ovoidal near the root, and the stem, which is from one to two feet in length, becomes as flat as tape towards the upper extremity. It is covered by a thin cuticle, which is as black as charcoal, and is more or less rough, from the unevenness of the cuticle. When prepared as tents for sale, it is cut into pieces of proper length, pared round at the extremity, and the surface is scraped off a little, to remove the unevenness, but enough of the bark remains to preserve their black color. These tents, made from the Bay of Fundy laminaria, absorb moisture rapidly, and will expand to their maximum in less than half the time required by the European or California varieties. They soon, when placed in water, become as soft and pliable as the tendon of a muscle while fresh. These tents, as sold, look so rough and hard-so like a splinter of wood, that I had a great prejudice against them until I learned how to manage them--I did not see how the uterus could tolerate them.

The manner of using them is simply this: Take one of these tents, no matter how rough, or rude in shape, and immerse it in hot water a few minutes, when it becomes coated with mucilage like slippery-elm bark, and so flexible that it may be shaped in any curve to suit the channel of the uterus; it is then as easily introduced as a well-oiled gum-elastic bougie of the same size. The patient is unconscious of its passage or presence, and if a single one is not sufficient to insure the amount of dilatation desired, two, three, or more, may be inserted and placed beside each other. These may be allowed