compared with the one under discussion. Regarding the arguments that have been offered against the system, i. e., that the virus could not be kept fresh for any length of time, the greater liability to the production of erysipelas, herpes, etc., he declared that these results do not follow when proper care is exercised in selection and management. The claims in favor of this mode of vaccination were:

1st. Its unlimited supply. He had furnished 5,000 points a day, and could produce 50,000 if necessary.

2d. Its absolute immunity from the possibility of inoculating other diseases. To show that syphilis could be inoculated by vaccination, he related the fourteen cases that were reported by Hutchinson, of London.

At this point the speaker's time expired, and he was obliged to stop.

Dr. Scott, of Ohio, inquired of Dr. Martin whether he had any experience with vaccination with matter taken from a heifer that had been inoculated with small-pox. Dr. Martin replied that he had no experience of his own, nor should he ever have, because he was certain that small-pox could be transmitted in that manner.

Dr. Griffith inquired of Dr. Martin if he had any knowledge of any authentic case in which variola had occurred after the use of animal vaccination. Dr. Martin replied in the negative, and added his experience in confirmation of the statement that vaccination and re-vaccination rendered the person safe for life. He did not believe that a satisfactory re-vaccination was ever followed by small-pox.

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ON THE RECOGNITION AND MANAGEMENT OF THE GOUTY STATE IN DISEASES OF THE SKIN. DR. L. DUNCAN BULkley, NEW YORK.-Dr. B. remarked that this peculiar condition of the system was frequently overlooked by practitioners treating chronic skin diseases, and that the gouty state was not often treated unless there was actual deposit and pain in the joints. But if we would do the most good in these cases, we must go further back than the actual blood condition, and arrest the trouble in its earlier manifestations. These manifestations were generally disordered conditions of the stomach,

a train of phenomena known as dyspepsia.

There was

usually flatulence and eructation after eating. Impairment of appetite, pale and flabby tongue, constipation, obstruction to the flow of bile, palpitation of the heart and dyspnoea, were common, also languor and inaptitude for exertion, drowsiness after meals, and waking from sleep in an irritable condition. The urine should be frequently and thoroughly examined in every case, and deductions made. In the management of these patients great care should be given to diet and hygiene. To keep up a proper action of the liver, and to relieve constipation, he relied upon blue mass and colocynth. In other cases he gave aloes and iron. For other primary dyspeptic symptoms he was very careful to select such drugs as would best meet the indications. He had found diuretics very valuable, and generally preferred acetate of potash in 30 grain doses, a few hours after meals. He had used also the salts of lithia and Kissingen water with much benefit.

Dr. Hibbard, of Indiana, thought there was great difficulty in specifying what kind of diet in any individual case was best adapted to the disorders of the digestive apparatus, and that we made a mistake if we laid down any definite rules with regard to it.

Dr. Cabell, of Virginia, inquired of Dr. Bulkley whether he had used any other mineral water except those he had mentioned. Dr. Bulkley replied he had used the German bitter waters, but had not been as well satisfied with their ef fects as with those produced by repeated doses of Kissingen. With reference to the effect produced by visiting springs, he thought it was the effect produced by the change of climate upon the gouty state, rather than any direct effect upon the skin disease, which accounted for the good results which sometimes followed a visit to those places, and the use of the water. Dr. Cabell thought that the thermal baths had a very good effect in these troubles. In using the German mineral waters, his experience had been different from Dr. Bulkley. He coincided entirely with Sir Henry Thompson in ascribing to them, when taken regularly in small quantities for months, a much more permanent effect than could be expected from

the use of any of the antacids, such as lithia or any other alkali.

Dr. Duhring, of Philadelphia, said he wished to corroborate what Dr. Bulkley had said; he had, however, some difficulty in making out just what Dr. B. meant by the gouty state, but as that was a topic too broad to be entered upon at that time, he wished to ask, what diseases of the skin he included in that condition known as the gouty state? He presumed eczema, psoriasis, etc. Dr. Bulkley replied that he considered acne, furuncles, lichen, and urticaria as manifestations of the gouty state.

A STUDY OF NINE HUNDRED AND SIXTY-FIVE CASES OF CHRONIC PULMONARY DISEASES. DY DR. F. H. DAVIS.-This record showed that of this number, chronic catarrhal bronchitis was the most common, and 403 cases are recorded. Dr. D. thought that in chronic bronchitis, if the patient could avail himself of that expensive prescription, a change of climate, a cure could be obtained. In 15 cases where this could not be done, he had effected a cure by compressed and rarefied air inhalations. He had found that inhalation of compressed air, followed by exhalation into rarefied air, diminished the capillary congestion and consequent hypertrophy of the mucous lining of the bronchi, and restored the tone and contractility of these vessels. To be efficient it should be followed up for six to twelve months, and accompanied by a strict regulation of the habits of living, clothing, exercise, etc. In these cases the most efficient drug he had found, was the muriate of ammonia in combination with some anodyne and expectorant. The addition of six to eight drops of chloroform was very beneficial in combination with each dose to some otherwise intractable cases. Among this whole number there were but 30 who showed signs of any constitutional impairment, but the general vigor, appetite and digestion was up to the ordinary standard, proportional to the age.

This record contained 119 cases of chronic bronchitis, presenting a special gastric and nervous complication. In addition to the usual physical signs of chronic catarrhal bronchitis, we find in these cases symptoms of indigestion

and gastric irritability; a lack of tone of the digestive organs, a tendency to acidity and fermentation following the ingestion of food. These cases occurred among those who had been addicted to the excessive use of alcohol and strong tea. In these cases treatment should be directed primarily towards controlling the gastric and nervous irritability. He had used with the most success, a combination of liq. ammoniae acetatis, syr. ipecac and tinct. opium. The cenothera biennis, (evening primrose) either in decoction or the fl. ext., would relieve promptly some of these cases where other means had failed.

There were recorded 283 cases as chronic rheumatic bronchitis. In these cases auscultation revealed sonorous and sibilant rales, rather than the mucous rales of the catarrhal variety, with harsh, dry cough and scanty expectoration. Associated with this was more or less evidence of general muscular and articular rheumatism of a chronic grade. In these patients colchicum acted almost as a specific, affording prompt and certain relief. The record contained 123 cases of phthisis pulmonalis; 56 of these were hereditary, and the remaining number were caused by apparently different agencies at work, i. e., alcohol, constitutional syphilis, extreme poverty and consequent unhealthy living and surroundings, together with insufficient clothing, exposure, hard work, etc. He thought the proper essentials to success in the treatment of these cases, were proper food and clothing, good hygienic surroundings, regular habits of living, out-door exercise, but not with prolonged exposure to inclement weather, and a regular systematic practice of deep respirations. This could be best attained by the inhalation of compressed air, as before mentioned-an apparatus for which he fully described. The only other element of treatment was cod-liver oil, or ext. of malt, to build up the strength of the patient.

Dr. Scott, of Ohio, directed the attention of the section to the fact that Dr. Flint had published a monogram upon tuberculosis of the lungs, in which he said "that the deposit took place in the air vesicles." He did not believe that; he thought that any deposit which took place in consequence of arrest in the activity of the circulation of the lung, occurred

outside of the air vesicles. Any condition of the atmosphere, or a poisoned condition of the blood, such as would interfere with the functions of the lungs, would cause an arrest of the circulation at that point, and not in the air vesicles.

Dr. Lester, of Missouri, said that Dr. Davis had stated that consolidation of the lung, resulting from bronchitis, occurred but rarely in infants. He believed that catarrhal inflammation of the bronchial mucous membrane was of frequent occurrence in infants, and that they died of collapse of the lung as a result, but as a chronic condition it was rare. He thought, also, that nine-tenths of all the cases of consumption were of inflammatory origin, following catarrhal pneumonia. He thought that tubercular phthisis was a rare disease in the western part of the country, especially in the mining districts.

Dr. Waterman, of Indiana, remarked that while he did not discard the use of local remedies in the treatment of consumption, the principal theory was, how to increase healthy blood, and an active circulation through the lungs. His plan was to stimulate the stomach with whisky, then give it good food and stimulate digestion by the same.

Dr. Ulrich, of Pennsylvania, said, in regard to the inflammatory origin of consumption, that he had lived for twenty years on the banks of the Mississippi, in Louisiana, and had never known a case of tuberculosis to originate in that locality, and yet the people suffered a great deal from pneumonia. He then reiterated what he said in a former discussion, that consumption is caused by the wretched manner in which some people live, and their in-door employment.

SECTION II. OBSTETRICS AND DISEASES OF
WOMEN AND CHILDREN.

Reported by Edw. Warren SAWYER, M. D.
FIRST DAY, JUne 5.

Byrd, Ills. Presented a paper, read by Battey, on some of the diseases requiring dilatation of the female urethra. A number of cases were cited. The first was that of a vascular growth entirely surrounding the meatus of the urethra. It had