DR. HIMMELSBACH spoke, and DRS. FRIEDLANDER and MONTGOMERY closed. Adjourned.

A special meeting was called upon February 2d, at 8:30 P. M., to listen to an address delivered by DR. SIMON BARUCH, of New York, in response to special invitation, upon

"THE ROLE OF HYDROTHERAPY IN INFECTIOUS DISEASES."

The noted hydrotherapist discussed the Brand bath-its purpose is not temperature reduction, but nerve stimulation. Brand never uses a temperature below 65° to 70° F., to this is added friction for 15 minutes. The interval is 3 to 4 hours, regardless of temperature rise. The bath fell into disrepute because its details have been misunderstood. The distinguished therapist, Lauder Brunton, advises temperature too low in his description of the Brand bath. The shock is proportional to the difference between the water and skin temperatures; the time of reaction is proportional to the time of application. The skin may contain 60 per cent of the blood during reaction. Cutaneous reaction may be nervous, e. g., the gasp of the new born, or vascular, e. g., the use of cold in frost bite.

For the Brand bath the patient is put in a tub at 70°, in a hammock or sheet; a cup of coffee is given previously. During the bath he twice receives affusions of cold water at 50°. Continuous friction is a most important element. The bed is previously prepared with a linen sheet over a blanket in which to receive and wrap the patient. During infectious diseases heart failure is a great. danger; all glandular functions fail for want of blood. This failure is not primarily due to heart degeneration, but to failure of the peripheral circulation, which the bath relieves by stimulation of the peripheral nerves, thus relieving the beart. The skin flushes, pallor and cyanosis disappear, the urine increases in quantity and toxicity.

Typhoid Fever.-With a temperature of 1010, use ablutions to the body with cold cloths from water at 80°, with friction. With a temperature of 103°, use the bath at 90°, with friction-if the temperature returns, in 4 hours repeat the bath at 85°, and at 80° 4 hours later, etc. If it reduces

the rectal temperature 20, it is not typhoid, and this is as diagnostic during the first week as the presence of the rose spots during the second week. The objections of the

patient are not to be admitted. The thready pulse may scare the inexperienced, but it is slower and less compressible. The Brand bath is to be abandoned in all cases not seen till after the first week; in such cases measures must be chosen according to the reactive power of the patient. The sheet bath is a substitute; use a rubber sheet, blanket, and linen sheet wet in water at 90° and wrapped about the body and around the limbs separately; friction is applied and cups of water at 60° poured over the body till it ceases to warm the sheet promptly, then wrap him up and he falls asleep. In cases of delirium the patient may be placed in a little water at 90°, and affusions of water at 50 to 60° poured from a basin over the head, back and chest. Brief applications may be used to tide over. The effectiveness is increased by length of application and friction.

DR. BARUCH described a patient seen in his New York practice with coma vigil. Though the case seemed hopeless, he tried Nawnheim salt baths at 80°, with friction; the CO, stimulated reaction, the patient slept four hours, and after four repetitions consciousness returned and recovery ensued. Abdominal compresses aid and are a substitute. In pneumonia use cold compresses at 60° covered with a cotton jacket.

Dr. Baruch's paper was discussed by DRS. KERR, EVANS, ABRAMS, HUNTINGTON and KROTOZYNER.

The regular monthly meeting convened February 9th, 8:30 P. M., in the Y. M. C. A. Parlors. Program as follows: "PROFESSOR KILLIAN'S RADICAL OPERATION FOR CHRONIC EMPYEMA OF BOTH FRONTAL SINUSES, WITH PRESENTATION OF CASE,"

by DR. A. BARKAN. Dr. Barkan described the operationan incision along the supraorbital margin and border of nasal bridge to below the glabella, this incision following the tissue folds and allowing the minimum scar. The entire front and orbital wall of the sinus with the frontal process of the superior maxilla are resected, but the chief points in the operation are the saving of a bony bridge along the upper margin of the orbit, and the saving of the trochlear tendon to prevent double vision. The sphenoidal cells can be reached and eradicated if necessary.

Dr. Barkan presented a case of chronic frontal sinusitis of ten years standing cured by Professor Killian's operation. The result gave a fair cosmetic effect and great relief to the patient.

"Demonstration of a Case of Excision of the Clavicle," by DR. Wм. MCNUTT, JR., and DR. D. B. PLYMIRE.

"Demonstration of Two Cases of Hemorrhage Into the Spinal Cord with X-Ray Photographs," by DR. C. M. COOPER.

Case I.-Was advanced in years; gave a history of syphilis while a young man, but no known sequelæ. A fall upon the right trochanter marked the diagnosis but marked the beginning of paralytic symptoms that developed into a paralysis of the Brown-Sequard type. Rest in bed and the iodides caused improvement, indicating that the lesion was a gumma.

Case II.—Was a seaman, 38, who, through a fall, suffered a fracture luxation of the sixth cervical vertebra with paralysis of the right side, and later the left side with the intercostals. The right pupil was dilated but reacted; the lesion was in the lower part of the cervical enlargement. Dr. Cooper reached a diagnosis by exclusion, excluding fracture luxation, inflammation, and hemorrhage into the gray matter as causes, arguing that the slow development of the paralysis, dissociated sensory phenomena, with return of reflexes later, indicated hemorrhage into a previous existing cavity in the cord. The case was illustrated with charts and radiographs, and was of a technical nature.

Discussed by DR. SHIELS.

Dr. Barkan's paper was discussed by DRS. PISCHEL, ARNOLD, KRONE, NAGEL and SHIELS.

"Report of a Case of Chronic Glanders Occurring in Man," by DR. B. J. LLOYD, Assistant Surgeon, P. H. and M. H. S.

The case reported contracted the disease in Canada on a ranch, last April, while working with horses and cattle. It began as an abrasion on the forearm, emaciation followed, the lungs showed little, but a bacillus resembling the tubercle B., but lacking its stain, appeared in the sputum. The inoculation tests upon guinea pigs were successful, and the B. mallei was recovered in pure culture upon potato.

"THE COMPLICATIONS OF DYSENTERY, AMEBIO AND SPECIFIC, AS OBSERVED AT AUTOPSY, AN ANALYSIS OF 120 CASES," by CHAS. F. CRAIG, 1st Lieut., Asst. Surgeon, U. S. A. Dr. Craig prefaced his analysis with the statement that the complications of dysentery are many and severe, and are not dealt with adequately by the text books. The amebic form is due to the ameba of dysentery, the specific form to the B. of Shiga. At autopsy the differences of the two forms are great. The chronic specific form is most subject to complications, especially of the lung. Nephritis and abscess of the liver are common also. Of 120 cases, 101 showed some nephritis.

DR. OPHULS said that infection of the lungs is often a terminal condition in wasting diseases of whatever character, and splenic pigmentation may result from any disease causing destruction of the blood corpuscles.

DR. RYFKOGEL described a case in which he was called upon to make the diagnosis. Adjourned.

THE SAN FRANCISCO CLINICAL SOCIETY.

The 46th meeting of the society was convened in the offices of Drs. Schloss and Morton, Parrott Building, Wednesday evening, January 27th, President Plymire in the chair.

"A RECENT CASE OF RUPTURE OF THE UTERUS" was reported by DR. D. A. HODGHEAD. I mentioned at our our last meeting having seen another case of uterine rupture, and have been asked to describe it here. It was not my own case, but I saw it in consultation, and it emphasizes two symptoms occurring in rupture of the uterus. The first stage had been prolonged, then the second stage came on slowly and had lasted ten hours when the consultant was called. I tried to apply forceps and found fecal matter coming either from the uterus or rectum through the vagina. The patient was at once taken to a hospital. The pulse was 140, the forceps were applied again, no fecal matter appearing; but the head was soft, the bones could not be outlined, the forceps would not hold and slipped repeatedly. As it seemed to be a case of hydrocephalus, and the baby dead, we punctured the head, relieved it of fluid and removed the fetus. There was a tear on the right side posterior within the os, leading

into the bowel through an old adhesion probably, as the woman was 45 years of age and had borne several children. The patient's condition was so precarious that we cleaned out and packed, and did not attempt to operate. She died eight hours later. At the State Society last year I called attention to two prominent symptoms of uterine rupture, viz., a rapid increase in the pulse rate from 70 or 80 to 140 per minute, and cessation of uterine action. The upper two thirds of the uterus thickens and contracts, while the lower segment thins and stretches and is subject to pressure from above during the long second stage of a hydrocephalic birth, hence it is the lower segment that

tears.

DR. PLYMIRE: I would state that in a case I saw last year those symptoms were marked, the second stage was prolonged by carcinoma of the cervix, resulting in rupture of the lower third.

DR. BELL: I had a similar case two years ago, ergot, and all similar aids were unavailing, and I now believe it to have been uterine rupture. The child lived.

DR. MORTON: We cannot see that shock and hemorrhage would influence the pulse, but rupture of the bowel makes me suspect that they used a vectis. I saw a case 10 years ago to which I was called in consultation. I found the uterus ruptured and the fetus up under the liver. The physician in charge denied the use of the vectis at first, but later admitted it. While the child is still present and the tear a small one low down, it does not seem as though the contractions ought to cease.

DR. HODGHEAD stated that the physicians had used no instruments other than the forceps.

DR. MCLEAN reported further upon his case of tic douloureaux which went to the country. He is taking salicylate soda and phenalgin aa. gr. vii. ss. p. r. n. His attacks are less violent and frequent. Intervals of half an hour now elapse. He writes of having had another tooth and some more alveolar process removed.

"THE BIOLOGICAL TEST FOR BLOOD,'

by DR. FRANCIS WILLIAMS. This paper contained a review of the history, purpose and technique of the test, and appended a report of some experimental work done in the laboratory of physiology of the College of Physicians and