It had been steadily increasing until I saw him. At that time it was as large as an adult hand, perfectly symmetrical and movable. By firm pressure the fingers could be readily pushed around it in all directions. Through the rectum the lower margin could be felt smooth and round. It appeared to have its origin from the spine about the second lumbar vertebra. After a careful examination I came to the conclusion that it was a cyst of the mesentery. As to its exact character I was uncertain, and therefore asked the patient's permission to aspirate, in order to perfect the diagnosis. This he readily assented to,and the result was a pint or more of what has been pronounced by all that have examined it,pure,unadulterated chyle. At this time the patient is well nourished and in good health. He said that in the hot weather he had lost flesh and felt debilitated, but as that was always so in the heat of summer, he had not even given it a thought. His brother, however, told me that he (the patient) had lost more in weight during the past summer than usual, and that he was not as robust as he had been in the past.

In looking up the literature on the subject, nowhere can I find the mention of a tumor similar to this; nor can I find among those that I have consulted, one who has ever seen or heard of such a cyst. I take the tumor to be a cyst of the thoracic duct. I arrive at this conclusion by exclusion.

Todd found several cases where the upper end of the duct presented the appearance of an aneurismal enlargement. (Holmes' Surgery, Vol. II, p. 451.)

Cooper saw a case of tumor of the thoracic duct, but this was filled with pus, and was supposed to be cancerous, as the testicle and abdominal glands were involved in a like condition. (Holmes' Surgery, Vol. II, p. 452.

M. Andral,fils, found the duct in a phthisical patient dilated into a sac, from the diaphragm to the body of the fifth dorsal vertebra, and filled with pus. (Holmes' Surgery, Vol. II, p. 452.)

From these cases we can infer that the thoracic duct is capable of dilatation, and if, from some cause or other, the flow of chyle is interrupted, the vessel might dilate and form a sac as large as the one from which this fluid came.

The nourishment of the body might still be effected by anastomosis.

On the other hand, one or more of the coats of the duct might be

torn or ulcerated and a dilatation result, just as we have aneurisms formed. After a while, this opening leading into the cavity might be occluded from some cause or other, and the sac and its contents isolated. This to my mind is the most probable explanation of the formation of this cyst. While many cases of chylous dropsy of both the abdominal and pleural cavities are reported, nowhere can I find mentioned a case of encysted chyle.

As to treatment, in my opinion none is required, for if a permanent fistula is established and the sac still connected with the duct, the drain will exhaust the patient and thus cause his death.

A CASE OF ELECTRICAL SHOCK.

BY DR. A. B. ROBERT, EL PASO, TEXAS.

Aug. 11, 1886, at 7 P. M., I was called in to see Mr. W. M. R., aet. 28, single and previously of excellent health, who had received a severe shock from a "blind" wire connected with the central telephone office. Reaction was slowly taking place, with the entire muscular system in clonic convulsions. Pulsations in right arm rapid and of very low tension, not perceptible in left. Temperature 97° F., respiration 50; slight precordial pain. No cerebral symptoms.

Gave spts. vini Gallici hypodermically every fifteen minutes till reaction had taken place.

At 8 P. M. convulsions limited to left upper and right lower extremities. I called in Dr. J. A. McKinney, and we gave of morphia sulphate one-half grain every hour till sleep, which was after the third dose. There were severe neuralgic pains at this time extending from spinal column down the left arm.

Aug. 12. 7 A. M. Temperature, 994°; respiration, 40; pulsations, 100, full and more regular. Slept well during the night, but at no time did the convulsion of left arm cease, while that of the right lower extremity ceased during the night. Slight inertia of bladder. Continued the morphia at longer intervals, and used sinapisms, alternating with cold packs, to the spinal column.

12 A. M. Respiration, 40; temperature, 994°; pulsations normal. Neuralgia still severe, but less often. Continued the treatment of the morning.

7 P. M. Respiration, 35; temperature, 99°; pulsation normal. Convulsions of arm considerably lessened in severity.

Prescribed chloral hydrate, grains, twenty-four; potassium bromide, grains twenty, every two hours till sleep.

Aug. 13. 7 A. M. Temperature, respiration and pulsation normal. Slept well during night. Inertia of bladder has almost disappeared. Convulsions limited to muscles of forearm. Gave saline laxative, and of fluid extract of ergot one dram every three hours.

Aug. 14. 7 A. M. Patient sitting up and complains only of general malaise. Only slight tremor of the left hand which entirely disappeared on the following day.

In conclusion I will state that the convulsions of the left arm were not merely tremors but a jactitation, which described a fourth of a circle at intervals of only one or two seconds during the three days. Any impediment that would interfere with this jactitation would produce excruciating pain, and prevented an exact measurement of motor and sensory disturbance.

INFLUENCE OF SEWAGE.-The importance of providing for the exclusion from the rivers of sewage and foul drainage water of any kind lies not merely in the direct consequent reduction in the amount of impurities in the water people drink, but to a much greater extent in reducing the chance of the living germs of noxious organisms finding their way into the water, there to be nourished by and render dangerous dead organic matter which of itself might be harmless enough. In the event of such an epidemic as one of cholera gaining but a first foothold in some parts of the city, this consideration would at once acquire a degree of importance scarcely to be overestimated.-Rept. on Water Supply, Phil. Water Dept. Ann. Rep. '85.

A NEW SIGN OF DEATH.-M. Lessenue states that if a pin be thrust into the body of one supposed to be deceased, the appearance of the pinhole left on withdrawing the pin will determine the accuracy of the supposition. If the person is dead, the hole remains open as when a pin is stuck into leather. If the person is alive, the skin contracts and the pin-hole entirely disappears.

EDITORIAL.

CALOMEL AS A DIURETIC.

Attention has lately been called to the diuretic effect of calomel in the treatment of certain cases of cardiac dropsy. In the July 10, issue of Wiener Medicinische Wochenschrift Prof. Stiller, of BudaPest gives a detailed report of eighteen cases of cardiac dropsy, occurring in hospital and private practice, which he had treated by the administration of calomel according to the method of Jendrassik. The latter obtained more striking effects in the way of immense increase of urinary secretion, but Stiller's results as to effect upon the patients were fully equal to Jendrassik's. Certainly the cases reported demonstrate fully the great value of calomel in the treatment of this class of cases. Intense edema of the extremities, and peritoneal and pleural effusions disappeared under the administration of calomel; while enlarged and congested livers were reduced in size and the attending dyspnea was relieved. And all this took place in cases in which digitalis had utterly failed to relieve or had caused unfavorable symptoms necessitating a discontinuance of it use.

As the result of these observations, Dr. Stiller thinks, that in cases of cardiac dropsy, the most efficient and rapid means of relief is found in the administration of small doses of calomel.

The diuretic action was found by both of the observers men tioned to occur suddenly on the third or fourth day after the com mencement of the administration of the drug. On the appearance of this effect the administration of the drug should be discontinued, to be renewed in considerably decreased doses when the diuretic action notably diminishes. Dr. Stiller found that the administration

of opium with the calomel entirely prevented the tendency to cause diarrhea which complicated some of the earlier cases, while it in no way interfered with the diuretic action.

Referring to these favorable reports, however, the Therapeutic Gazette, Sept. 1886, observes that calomel cannot by any means be regarded as a substitute for digitalis, inasmuch as it is in no sense, a heart remedy. In the large class of cases in which digitalis fails or is contra-indicated, and where none of the various substitutes that have been recommended for digitalis are available, the results referred to above indicate the great value of calomel. The exact indications for use and the full effect that is to be expected from it, that journal well says, are yet to be determined.

CALOMEL TREATMENT OF DIPHTHERIA.

In a paper read before the American Laryngological Association, at its eighth annual meeting and published in the New York Medical Journal, Sept. 11,1886. DR. Wм. H. DALY appears as a warm advocate of the calomel treatment of diphtheria. Without discussing at all the questions of etiology and pathology, he simply states the conclusions to which he has been led by personal observation and experience. He gives the credit of suggesting and advocating this treatment primarily to Dr. Hamilton, of Edinburgh, in the last century, and more recently to Dr. W. C. Reiter, of Pittsburgh, whose "Monograph on the Treatment of Diphtheria," was published by J. B. Lippincott, in 1878.

The rules which he lays down for treatment of the disease are: 1. Give calomel in its purity. 2. Give it in large doses. 3. Give it frequently. 4. Give it until you have the free and characteristic catharsis. 5. Give light nutritious diet. 6. Give little or no other medicine.

To a child three or four years old, he would give pure calomel, untriturated or unmixed with sugar, two to five grains every one,