Resolved, 1. That the Shelby County Medical Society, as a body, express to his afflicted family our deepest sympathy in this hour of their gloom. Resolved, 2. That the profession has lost one of its brightest lights, the community in which he lived a useful citizen. Resolved, 3. That a copy of these resolutions be spread on the minutes of this Society, one be sent to his family, one to the American Practitioner and News, and one to the Louisville Medical Monthly for publication. R. D. PRATT, M. D., Committee. In the Louisville Courier-Journal of the 9th instant the eminent editor, Mr. Henry Watterson, paid the following tribute to the memory of Dr. Palmer: THE LIGHT Gone Out. All that was mortal of Edward R. Palmer was laid to rest in the beautiful Cave Hill Cemetery yesterday afternoon. The city of Louisville has been since the earliest times a medical center, but from Gross to Yandell that great profession has contributed to its riches of genius and learning no practitioner more brilliant and lovable than Dr. Palmer. He came of good old Vermont stock-the stock of which heroes are made and to the end, which came all too early and all too quickly, he carried the breezy, overflowing vitality of his race-a great overgrown boy, big of brain and big of heart, at once a scholar and a man of the world. Dr. Palmer was in his fifty-third year; but he had lost none of the buoyancy or the grace of youth. His enthusiasm was spontaneous and infectious; his ardor in receiving and in giving pleasure was unceasing; and yet he was a student and a worker whose intrepidity of thought was not surpassed even by his eloquence, which, both in delivery and in phraseology, adorned every subject he touched with tongue or pen. The popularity of such a man was inevitable and universal; and the sudden tragedy which closed his distinguished and useful career fell upon all hearts with paralyzing effect. In society, in business, in the clubs, the sadness and sorrow were deep and sincere; but nowhere will this generous and eminent man be so missed as among the sick and needy, to whom he was as a ministering angel, whose coming and going were noiseless, without money and without price. To his family we tender the homage of our respectful sympathy. Abstracts and Selections. THE SERUM TREATMENT OF DIPHTHERIA.—Withington (Boston Medical and Surgical Journal) has treated 91 cases with the serum; 11 of these are excluded, as they did not present bacteriological evidence of diphtheria; if these were included the percentage of recoveries would have been increased. The remaining 80 cases belonged to a class of more than average severity; of these cases 13 died, representing a mortality of 16 per cent. Short details are given of the fatal cases; 2 of these ought perhaps to be excluded, as they were complicated with scarlet fever. Intubation was performed in three cases and tracheotomy in another. In only one case did the injection precede the intubation. If another 40 cases with a mortality of 30 per cent, not treated with the serum for several reasons, were added to the above, there would then be 25 deaths, or a mortality of 21 per cent. The average hospital mortality is 45 to 50 per cent. In a corresponding period in the previous year there were 84 cases with 44 deaths. The author draws particular attention to the improvement in the general condition of these patients treated with the serum. Of the cases intubated or tracheotomized 80 per cent died. The patients were not discharged until all membrane had disappeared, and two negative reports had been received from the bacteriologist; 21 cases were injected a second time at an interval of one or two days; 5 cases were injected for prophylactic purposes, and none developed the disease, but one child, admitted with diphtheria, had received an injection exactly three weeks previously. Not only Behring's serum was used, but a similar serum prepared by Gibier, of New York, 10 cubic centimeters (of No. 1) of the former and 20 to 50 cubic centimeters of the latter being used. A change in the membrane, with subsequent exfoliation was noted. Urticara occurred in 13 cases. Nephritis and endocarditis could not be attributed to the serum. The author speaks very highly of the value of the serum. Springthorpe (Austral. Med. Journ.) first gives details of 6 cases treated by him with the serum. No bacteriological examination was made. Three were instances of the virulent disease, and two of these recovered. The dose used in the fatal case was too small, and the case came under treatment late in the disease. In another case improvement was effected by the treatment, but the patient died. Another fatal case was, in the author's opinion, one of scarlet fever with putrid angina. After trying a combination of large doses of mercuric perchloride internally and the antitoxin hypodermically, the author thinks that such a combination is not admissible. The author is of opinion that (1) the antitoxin neutralizes the diphtheria toxines but not those of other micro-organisms; (2) uncomplicated diphtheria may be promptly arrested mainly in this way; and (3) repair in nervous and other tissues depends on the extent of the damage done by the toxines, and is uninfluenced by the antitoxin. In an addendum two other cases are related; in both diphtheria bacilli were found; one recovered and the other was in progress. Here again, owing to the deficient supply, the amount of antitoxin used was small.-British Med. Jour. BRONCHO-PNEUMONIA AND FOCAL PNEUMONIA.-The most important and extensive investigations of the bacteriology of the various forms of acute focal inflammations of the lungs are those of Finkler, Netter, and Mosny. Finkler, from an examination of thirty-seven cases of bronchopneumonia and other forms of acute focal pneumonia, found that various species of bacteria occurred in these processes, but that the streptococcus was most frequently met with in the focal forms other than true bronchopneumonia. Netter studied 95 cases of broncho-pneumonia, 53 of which were in adults and 42 in children. Of the 53 cases in adults, 35 were mono-infections, in which the micrococcus lanceolatus was found in 15, the sirococcus in 12, the bacillus of Friedlander in 9, and the pyogenic staphylococci in 3; while 14 were poly-infections with two or more of these species of bacteria. Of the 42 cases in children, 25 were mono-infections, in which the micrococcus lanceolatus was found in 10, the streptococcus in 8, pyogenic staphy lococci in 5, and the bacillus of Friedlander in 2; while 17 were polyinfections with two or more of these species of bacteria. Netter concludes from his study, that neither in children nor adults is there any relation between the species of bacteria and the type of inflammation in the lung. Mosny studied 17 cases and found the streptococcus in 11, in 5 cases accompanied by other bacteria; the micrococcus lanceolatus in 4, and the bacillus of Friedlander in I case. Three of Mosny's cases were pseudolobar, and in these the micrococcus lanceolatus was present. In the course of this work cultures have been made from the lung in sixteen cases in which broncho-pneumonia was present, exclusive of cases of diphtheria and scarlet fever. In eight of these cases the micrococcus lanceolatus was found as the only pathogenic organism present, in two the streptococcus, in three the staphylococcus pyogenes aureus, in one the micrococcus lanceolatus and the streptococcus, and in two only the bacillus coli communis or various unknown bacteria grew in the cultures. In two cases of atypical pneumonic consolidation the micrococcus lanceolatus and the streptococcus were present. From these results it is clear that, as in the broncho-pneumonias of diphtheria and scarlet fever, the species of bacteria associated with pneumonia conditions other than the lobar type are subject to great variation. Of other pathological conditions in the lung from which cultures have been made tuberculosis only will be considered. In all of five cases of various types of pulmonary tuberculosis either the streptococcus or the staphylococcus pyogenes aureus, or both, have been found in the diseased lung. From one of these cases the bacillus diphtheria was also isolated, and found to be characteristically virulent for a guinea-pig. No examination was made of the throat or trachea at the autopsy, for there was no suspicion of diphtheritic infection.-Boston Medical and Surgical Journal. PLEURISY IN THE PUERPERIUM.-Budin and other obstetricians (Jour. de Méd. de Paris) discussed this subject at a recent meeting of the Sociéte Obstétrique et Gynécologique de Paris. Budin denied that pleurisy always became purulent. Charpentier stated that he attended a young woman sinking from puerperal septicemia. He used the curette and she got better. On the twelfth day she caught cold and pleurisy set in. On aspiration a little serous fluid escaped. A few days later, on renewal of the puncture, the fluid was found to be purulent. Picheven described a bad case of pleurisy coming on a week after delivery. The left appendages were tender and swollen; hitherto the puerperium had been normal. The urine was albuminous, the temperature 102°. Pleural effusion was very rapid, and the patient seemed very ill. The pleura was tapped, over two pints of fluid being withdrawn. To Pichevin's surprise the fluid was found to be quite clear and free from pus. The patient began at once to recover. Bar agreed that empyema did not necessarily occur in pleurisy attacking very septic midwifery cases. Guéniot admitted that the effusion in these cases was sometimes serous and at others purulent, without being able to explain why this difference was frequent. Doléris laid more stress on the bacteriology of the question. Clear serum might contain pneumococci, or even ptomaines without germs. Forman, in a case of pleuro-pneumonia beginning before premature labor, tapped the pleura during the puerperium. The fluid was purulent and contained pneumococci.-British Medical Jour. DIAGNOSIS OF CHRONIC HYDROCEPHALUS IN EARLY STAGES, before ENLARGEMENT OF THE SKULL HAS Occurred. The difficulty in the diagnosis of hydrocephalus is naturally much increased when the collection of fluid in the ventricles has not yet led to enlargement of the skull. The diagnosis must then rest wholly on the clinical symptoms. Of these an exceedingly important one is the well-recognized spastic condition of the extremity muscles, which, however, varies within wide limits. This condition occurs not infrequently before the head has begun to enlarge, and especially in those cases in which an external hydrocephalus alone exists, or is accompanied by a collection of fluid in the ventricles. In cases of uncomplicated internal hydrocephalus the enlargement of the head is apt to occur at an early period in the disease, and so lead to an immediate correct diagnosis. Attacks of recurring eclampsia are of less importance than the more permanent spastic conditions. Congenital spastic rigidity of the limbs (Little's disease) is usually due to defective development or to diffuse sclerotic processes in the cortex, and may occur quite independently of hydrocephalus. Especially important in differential diagnosis are the fol lowing facts, well stated by Von Ranke (Jahrbuch f. Kinderheilkunde, Part IV, 1895): I. In congenital spastic rigidity the lower extremities usually are alone. affected, whereas in hydrocephalus the arms are attacked as well, and at times even the muscles of the body. 2. The congenital spastic condition is usually first noticed when the child begins to walk; the rigidity resulting from hydrocephalus, on the other hand, is for the most part an exceedingly early symptom. 3. Accompanying eclamptic attacks are an indication in favor of hydrocephalus. The differentiation of hydrocephalus from tetany is usually not difficult, owing to the progressive tendency of the one, and the tendency of the other, after a lapse of two or three weeks, toward recovery. Furthermore, cases of tetany with spontaneous tonic contractures in all extremities are very rare, and when they occur characteristic positions of the hand (obstetric hand) make diagnosis easy.—Boston Medical and Surgical Journal. BIRTH OF A CHILD WITHOUT RUPTURE OF MEMBRANES. Forman (Jour. de Méd. de Paris) observed this rare occurrence in the case of a woman, aged twenty-two, seven months advanced in her second pregnancy. She was suffering from pleuro-pneumonia, the temperature having risen to 103.6°. A few minutes after cupping glasses had been applied to the bases of the lungs the patient felt a desire to defecate; this was followed by a single pain which expelled the entire ovum with a little blood. Forman arrived a few minutes later. He found between the patient's thighs a big cyst with transparent walls. The mother was free from all the evils which may follow precipitate delivery; the uterus contracted well. The wall of the cyst was then cut; about a pint of amniotic fluid escaped. A female child was seen; there was no pulsation of the cord, but after active measures the infant breathed well and took the breast. It weighed three pounds and six ounces, and measured over fourteen inches; the placenta weighed a little under a pound. The cord was very gelatinous and measured 18%1⁄2 inches in length. Judging from the position in which the ovum lay-outside the vulva-it seemed that the breech had presented, and that the placenta had been inserted very low down without being previa. The child lived only sixteen hours, and the mother had a bad attack of empyema. Forman quotes a considerable number of cases of membranes unruptured at birth.-British Medical Journal. SCARLET FEVER.-Crooke, in 1885, found micrococci in the spleen and kidneys of thirty cases of scarlet fever; and in the same year Fränkel and Frendenberg found the streptococcus in cultures or sections from the submaxillary glands, the liver, the spleen, and kidneys in three cases of the disease. Raskin observed the streptococcus in the purulent lymph-glands and joints, and four times in the blood of the heart in scarlet fever; and |