duced to a minimum, beyond which, in the present condition of the technics of bottle-making, it is impossisble to go. This is exactly what Mr. Charles Marchand, the manufacturer of hydrozone, glycozone, peroxide of hydrogen, etc., intends to do. Just as soon as his present stock of amber glass containers is exhausted, he will use exclusively flint glass, every bottle being corked with an automatic safety valve stopper. By adopting these expedients, Mr. Marchand, having done all in his power to prevent breakage, can go only one step further to make good any losses from that direction - replace the bottles that get broken from this cause. Beyond this, it would be unreasonable to expect him to assume further responsibility. The actual danger to life or limb from the bursting of a bottle of hydrogen peroxide, or any of Mr. Marchand's preparations, is trivial, as compared with those arising from the explosion of bottles of beer, ginger ale, champagnes, and other sparkling wines, or even Apollinaris or other heavily aerated waters. When any of these rupture, the fragments are driven, not only with all the force and energy of the already liberated gases, but with the augmented energy of the residual gas suddenly set free, and so may inflict severe, sometimes irreparable damage. The safety-valve arrangement in the stopper of bottles of hydrozone prevents the sudden disengagement of a great volume of gas. Assuming that through some imperfection of the stopper the puncture should close as soon as the pressure from within rose to a point far within that required for the rupture of the bottle, the stopper, not being wired, but merely tied down, will be forced out. But glass is a proverbially brittle and treacherous substance, and it is liable to break in the hands of anybody, at any moment, and without any discoverable or apparent cause, and that whether filled or not. As a consequence there must always be some risk attached to the handling of glass containers. The best that can be done, as we have suggested elsewhere, is to reduce the risk of rupture or fracture to a minimum, and this Mr. Marchand has done, not only by his safety stopper device, but also by the prom ised substitution of the stronger flint glass. The retail trade will, we are sure, welcome this latter change most heartily, since it completes and supplements the efforts made in the mechanical direction, and thus removes, as far as lies in human effort, all danger arising from handling Marchand's goods.- National Druggist, October, 1904. Clinical Reports. CLINICAL SOCIETY OF THE NEW YORK POLYCLINIC MEDICAL SCHOOL AND HOSPITAL. STATED MEETING HELD NOVEMBER 7, 1904. The President, Dr. Daniel S. Dougherty, in the Chair. Dr. J. A. Robertson showed an appendix which had been removed from a patient the previous week. During the afternoon he had severe gastric pains and vomiting. At ten o'clock the, same evening a diagnosis of appendicitis was made, based on the tenderness at McBurney's point at the ventrix. Slight intestinal obstruction was also suspected, as the vomiting persisted, and toward morning became fecal in character. The temperature was 102.8°, followed by collapse the next morning, and during this collapse the operation was performed, the appendix being removed about 9 A. M. Examination of the appendix revealed the fact that it was gangrenous near the tip, and midway there was a stricture. Opposite the point of stricture were two gangrenous spots, just ready to break through. This specimen demonstrated the rapid development of the disease, and emphasized the necessity for early operation. The speaker had seen seven consecutive cases of gangrenous appendicitis within the past two years, and had operated on them, with but one fatal result, and in that case he had hesitated more than twenty-four hours after the appearance of symptoms before operation. In his opinion, operation should be performed during the first twenty-four hours, or not at all. Dr. A. Lyle opened the discussion. He said that the point he thought of greatest importance was the sudden drop of temperature. Gangrenous appendicitis can almost always be diagnosed by this sudden drop of temperature. Many physicians might interpret this as a sign that the patient was on the road to convalescence and postpone operation, and the case would probably result fatally. In the suppurative type of appendicitis, the temperature continues to rise slowly and does not drop as suddenly. Dr. B. H. Wells said that he had seen this patient in consultation with Dr. Robertson, and an important feature, not mentioned by the first speaker, was the sudden cessation of pain. The temperature in appendicitis cases he thought a very irregular guide, as is the pain, or, in fact, any single symptom. The patient may have normal or subnormal temperature and normal or very slow pulse, but if the pain is severe and then suddenly stops, it is well to proceed carefully. The speaker had examined many cases under these circumstances, and often found extensive gangrenous appendix and intestines. Dr. M. Packard said that in his opinion, from the standpoint of diagnosis, it was immaterial how the temperature stood, but the pulse was an important factor. If the patient had a rapid pulse, with a normal or subnormal temperature, and a pulse of 100 and a temperature of 98.6° or even 98°, operation should be performed. Another point mentioned by Mannenberg and substantiated by Nothnagel as important in the differential diagnosis of appendicitis is that of the secondary pulmonary sound of the heart, which is usually accentuated in appendicitis. Mannenberg reports this symptom in 170 out of 200 cases of appendicitis which he examined. Dr. Robertson, in closing the discussion, said that at the operation it was found that the complication which had been suspected was found to be present. About eighteen inches from the appendix the small intestine was strangulated and twisted, and the mesentery was twisted throughout, and for a few minutes we debated whether it would be wise to resect this portion of the intestine, but Dr. Wells suggested that it be closed. SPECIMENS OF TUBAL PREGNANCY. Dr. L. J. Ladinski reported three cases of tubal pregnancy occurring in his practice during an interval of twelve days, and showed specimens removed from these patients. The first patient had been bleeding from the uterus for four or five days, but the discharge had disappeared the day before the speaker saw the patient. Temperature was normal, pulse 110. Examination revealed a somewhat enlarged uterus, a characteristically enlarged tube, tender and sensitive to the touch. No bleeding from the uterus, however. A diagnosis of tubal pregnancy was made and operation advised. The following day the uterus was curetted and abdomen opened. There was free blood in the peritoneal cavity. The enlarged tube, with the fimbriated extremity very much dilated, and presenting a large blood clot from which hemorrhage took place, was removed. This was a case, therefore, of tubal abortion. The tube might have been saved, but as the attachment of the sac was close to the uterine end, it was not deemed wise to do it. The patient left the hospital nineteen days after operation. The second patient was twenty-three years old. On the day previous to her admission to the hospital she had been taken with a sudden sharp, stabbing pain in the lower abdomen on the right side. With the onset of the attack she had a hemorrhage from the uterus. It was not time for her menstrual period, as she claimed to have menstruated only three weeks before. She felt dizzy, cold, and extremely weak. Patient denied any possibility of pregnancy. Operation was performed under ether, the uterus being curetted. Upon incision into the peritoneal cavity, free blood welled out. The right tube was found very much elongated, and the gravid sac with the amniotic sac unruptured was found attached to the fimbriated extremity and external to it, and was removed. The distal end of the tube, which was found closed, was opened and everted. The appendix was removed and the wound closed without drainage. The patient made a good recovery. The third patient complained of a sudden sharp onset of pain, with bleeding from the uterus which lasted about twenty days. Examination revealed a tense, tender, elastic mass bulging into the left lateral fornix of the vagina. Uterus slightly to the right of the median line. Patient absolutely denies any possibility of pregnancy. A diagnosis of tubal pregnancy was made; the uterus was curetted and the abdomen opened. Free blood was found upon opening the peritoneal cavity. The left tube was much distended with clots and ruptured. The left tube was removed, including the left ovary, and the abdominal wound was closed in four layers, without drainage. The patient made an excellent convalescence. Dr. Wells opened the discussion of these cases. He said that in extra-uterine pregnancy hemorrhage is usually attributed to rupture, while in reality it often occurs previous to rupture, and is not necessarily accompanied by this later symptom. The ovum is expanded inside the tube, and the villi grow into the walls of the tube, and after a time grow straight through. The blood pressure causes the tube to sweat blood from the little ends of the villi. The same process makes the wall of the tube very weak, and the ovum is growing inside, and when it comes across a naturally large blood-vessel, hemorrhage is apt to follow. A CASE FOR DIAGNOSIS. Dr. M. Packard reported a case of a man who presented himself at the clinic about four weeks ago, with the following history: Family history and previous history good. His present history began about nine months ago, with gradual difficulty in swallowing. The dysphagia became so extreme that it was impossible to take solid food of any kind. On several occasions he vomited blood, which was always of a bright red and never of a chocolate nature. He lost in weight as much as thirty pounds. Naturally, with this history, we suspected a neoplasm of the œsophagus or cardiac end of the stomach. We passed an esophageal sound, which was not restricted at any portion of the œsophagus, but on removal brought up about three drams of pure blood. The stomach was normal in size, but on account of the bleeding a test examination was valueless. Liver and ab |