It propagated over the upper left half of the thorax, but can not be heard beyond the right side of the sternum, nor in the so-called aortic area. was most often found in young, well-nourished individuals, especially women, but was by no means a constant phenomenon when found, often being present for several days or weeks at a time, and then disappearing for a longer or shorter time. Favoring circumstances for its production or intensification are a rise of pressure in the pulmonary circulation in consequence of some affection of the lungs or pleura. Clinically it was found that under the influence of digitalis this murmur became at first more audible, but later, as the pulse became slower, it became less distinct and finally disappeared, a markedly accentuated second sound alone remaining. The diagnosis between a diastolic murmur arising in this way and that due to uncomplicated mitral stenosis, aortic insufficiency, tricuspid stenosis or a sound produced in the vena cava superior or inferior would depend upon its character, seat of maximum intensity, line of propagation, the absence of vascular signs, and the presence of an accentuated pulmonic second sound. Pawinski was unable to determine any modification of the sound from inspiration or expiration. The sign is of value in prognosis, since it shows a hypertrophied and powerful right ventricle on which the mitral lesion is dependent for compensation, and in treatment, since it shows excessive pressure in the lesser circuit and indicates measures of relief for that condition.-Boston Medical and Surgical Journal. DIPHTHERIAL PARALYSIS.-Hasche (Münch. med. Woch.) reports a widespread and fatal case of this disease in which no anatomical lesion could be found. He mentions the various pathological changes to which the paralysis has been referred. A boy, aged nine years, developed paralysis about one month after the onset of a faucial diphtheria. Death occurred a fortnight later, the paralysis having extended to the legs and arms. The heart presented microscopic evidence of a moderately well-marked fatty degeneration. No naked-eye or microscopic change could be found in the spinal cord, medulla, nerves, or muscles. Even the vagus and oculo-motor nerves, in the distribution of which there was complete paralysis, showed no change, and their nuclei of origin were intact. Only in one place in the cervical cord was there any trace of a lesion, and this only consisted in engorged vessels and very minute extravasations of blood, the nervous elements being intact. The case shows, according to the author, that paralysis may be produced by a specific poison without any anatomical explanation-in the present state of our knowledge.-British Medical Journal. THE CURABILITY OF CANCER WHEN THE LYMPH NODES ARE INVolved. Dr. B. Farquhar Curtis, of New York, in a paper thus entitled, remarked that it was generally recognized that when the glandular system became extensively involved with malignant disease a complete cure by operative measures was impossible; hence the necessity of early diagnosis and oper- ation. Infection of the glands with some forms of malignant disease-for example, sarcoma of bone-was of late occurrence, while with other forms, especially the carcinomata, it occurred relatively early. In carcinoma of the breast, though Gross had affirmed an average duration of fourteen months before the glands became infected, there were very many cases in which this occurred in a much shorter period, often before the disease had caused the patient sufficient trouble to warrant her in consulting a surgeon in regard to it. The track of the lymphatics from the breast to the axilla being in the pectoral fascia, it was evident that this should be removed in connection with the removal of the breast.-New York Medical Journal. PHYSOMETRA OR TYMPANITES UTERI., Hermes (Der Fraunnarzt) observed this condition in a primipara, aged thirty-seven, and syphilitic. The child had evidently died some time before labor, which lasted over five days, and was mismanaged; the child's thigh was broken in an attempt to deliver with the blunt hook. The practitioner sent patient into hospital. She was in a sinking condition, the abdomen greatly distended. The perineum was torn. The pelvis was slightly contracted in all diameters. On passing the finger into the os a great quantity of fetid gas escaped. The child, very large, and in an advanced state of decomposition, was extracted. The placenta, quite putrid, had to be removed manually. The uterus contracted badly; it was carefully washed out with a solution of carbolic acid at 122° F. There was no severe flooding. The patient died about one hour after delivery. There were no air emboli, said to be the main cause of fatal results in tympanites uteri. There was perimetritis. Under the endocardium in the left ventricle were abundant ecchymoses; the pericardium contained a considerable amount of serum. The fetid air which issued from the uterus clearly came from the dead fetus. The frequent attempts to deliver, badly followed up, admitted air and germs from without. In other cases it has been found that when the fetus had died quite recently fetid gas rapidly collects if air be admitted into the uterus.-British Medical Journal. DIAGNOSIS OF TRICUSPID INSUFFICIENCY.-Hamburger describes a case of tricuspid insufficiency, completed by autopsy, which was under observation a number of weeks, yet auscultation revealed no deviation from the normal sounds. Hypertrophy of the right ventricle and other cardiac signs usual in this condition were present in but slight degree, nevertheless the diagnosis was correctly made from the presence of a strong venous pulse, according to Bamberger the only sure sign of this lesion. Hamburger emphasizes the point because most text-books fail to make it sufficiently plain that serious functional disturbances of the valve are not always accompanied by murmurs. He agrees with Dieulafoi in ascribing their absence to so high a grade of dilatation of the orifice that fluid veins are not formed.Boston Medical and Surgical Journal. THE AMERICAN Practitioner and News. Vol. 20. "NEC TENUI PENNÂ." SATURDAY, AUGUST 10, 1895. No. 3. D. W. YANDELL, M. D., LL.D., and H. A. COTTELL, M. D., Editors. A Journal of Medicine and Surgery, published every other Saturday. Price, $3 per year, postage paid. This journal is devoted solely to the advancement of medical science and the promotion of the interests of the whole profession. Essays, reports of cases, and correspondence upon subjects of professional interest are solicited. The editors are not responsible for the views of contributors. Books for review, and all communications relating to the columns of the journal, should be addressed to the Editors of THE AMERICAN PRACTITIONER AND News, Louisville, Ky. Subscriptions and advertisements received, specimen copies and bound volumes for sale by the undersigned, to whom remittances may be sent by postal money order, bank check, or registered letter. Address JOHN P. MORTON & COMPANY, Louisville, Ky. THE CHAIR OF CHEMISTRY IN THE UNIVERSITY OF LOUISVILLE. At a meeting of the Board of Trustees on the 22d ult. Dr. Henry Miller Goodman was, upon the unanimous recommendation of the Faculty, elected to the Chair of Medical Chemistry in the University. This chair was left vacant by the transfer of Prof. H. A. Cottell to the Chair of Physiology. Dr. Goodman is one of the most talented, learned, and successful young men of the profession in Louisville. He is the son of Dr. John Goodman, one of the leading practitioners of Louisville, and for many years a professor of obstetrics and gynecology in the Louisville Medical College. His maternal grandfather was Prof. Henry Miller, the famous author and teacher in obstetrics, who was one of the founders of the University of Louisville, and for many years a professor in that school. Dr. Goodman was born November 13, 1861. He was educated in the public schools of Louisville, graduating from the Boys' High School in 1880. Having chosen medicine as his profession, he entered the Medical Department of the University of Louisville in 1881, from which institution he graduated in 1883. Since his graduation Dr. Goodman has taught without interruption in the sub-departments of this school. For nearly thirteen years he has |