The first and most important step in the treatment is, however, to establish and fix the habit of full, deep respiration.

Deposits and exudations can only be re-absorbed through the re-establishment of the active capillary circulation in the part, and this is of course dependent on its free expansion. In the accomplishment of this purpose, we believe the inspiration of compressed, and the expiration into rarified air, as already explained, to be the most certain and efficient aid.

Prompt and rapid improvement has taken place in every case of simple inflammatory phthisis that I have placed upon this course of treatment.

In cases involving a tubercular, scrofulous or syphilitic family history, the results are very much more uncertain and unsatisfactory, as regards anything more than temporary relief or improvement.

In tuberculosis, advanced to the stage of softening, I do not think any benefit could be expected from the use of compressed or rarefied air, but, on the contrary, I should fear the occurrence of hæmorrhage from its use, as sometimes happens when patients, so far advanced in tuberculosis, go into too rarefied a mountain atmosphere.

In a number of cases of chronic bronchitis, the use of the compressed and rarefied air has relieved the inmediate symptoms of cough and dispnoea very promptly. Whether its continued and persevering use would finally overcome the sensitiveness and chronic congestion of the nucous lining of the air-passages, so as to effect a permanent cure, remains yet to be proved, as regards my own experience.

The German writers upon the subject claim that it does so effect a permanent cure, and theoretically its effects upon the capillary circulation of these mucous membranes ought to diminish chronic congestion and thickening.

For emphysema the expiration into rarefied air, is also claimed to be a means of radical cure. In this class of cases, or in valvular diseases of the heart, I have not as yet had an opportunity of testing satisfactorily its effects.

THE MAJOR AMPUTATIONS IN THE COOK COUNTY HOSPITAL DURING THE ELEVEN YEARS ENDING DECEMBER, 1875.

BY C. T. FENN, M. D., Chicago.

In the latter part of December, 1876, the old County Hospital, occupied since January, 1866, was vacated, and the patients were removed to the new hospital. This departure from filth and miasma to cleanliness and wholesome surroundings, inaugurates a new period in the history of the County Hospital; and all statistical reports, which in the future may be collected from the records of the hospital, must always bear in mind the difference of the sanitary conditions during the first and second period. In view of these facts, we prepared the following list of all the major amputations performed in the old hospital from 1866 to 1876.

The table does not include amputations of the hand and foot, or disarticulations of the wrist and the ankle joints. Primary amputations are those which were done within the first forty-eight hours succeeding the injury.

Intermediate amputations are those which were performed between the third and thirtieth days.

Secondary amputations are those which were done after the thirtieth day.

Pathological amputations are those which were undertaken for the cure of disease.

CAUSES LEADING TO AMPUTATION.

There were fourteen amputations for ill-conditioned stumps; one in the upper extremity; thirteen in the lower extremity. All were, more or less, remote from the seat of original operation: one being at the hip-joint for malignant disease of legstump; one in the middle third of the thigh for secondary

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hemorrhage from leg-stump; six in the upper third of the leg, two of which were for ulcerated foot-stumps; one for gangrene of foot-stump and leg; and three for ulcerated legstump. One of the latter resulted in death, and one in a second re-amputation above the knee. Five in the lower third of the leg for unhealed leg-stumps, two, double, resulted in death; one in a second reamputation. One in the leg, seat not designated. One of the arm for inflammation of fore-arm-stump. Mortality after re-amputations 21 per cent.

There were eight amputations for ulcers, all in the lower extremity.

There were eight amputations for malignant diseases. Three in the upper extremity; five in the lower extremity.

There were ten amputations for frost-bite. One in the upper extremity, and nine in the lower extremity.

There were twenty-seven amputations for caries. Two in the upper extremity, and twenty-five in the lower extremity. Twenty-five of these cases involved the joints; one the wrist, one the elbow, nine the ankle, twelve the knee, and two the hip. Of the nine cases of caries of the ankle-joint, one died; of the twelve cases of caries of the knee, two died.

There were one hundred amputations for injuries. Forty were in the upper extremity; sixty were in the lower extremity.

There were four amputations for gangrene, all in the lower extremity.

There was one amputation for cellular inflammation in the upper extremity.

There was one amputation for atrophy and deformity in the upper extremity of the right side.

There were eleven amputations for causes not stated. Four in the upper extremity, and seven in the lower extremity.

Of fifty-three amputations in the upper extremity, seventeen were of the right, twenty of the left, and sixteen not referred to either side.

Of one hundred and thirty-one amputations in the lower extremity, forty-nine were of the right, forty-two of the left, and forty not referred to either side.

Of the forty-one amputations whose result was fatal, ten were in the upper extremity; thirty-one were in the lower extremity.

DEATHS.

Of the thirty-nine deaths which occurred, nine had for their immediate cause shock or collapse; four on the first and five on the second day. Nine deaths were put down as due to exhaustion; five within the first five days, three between the fifth and the tenth days-one being in consequence of a double re-amputation of the legs on an old man 75 years of ageand one on the fourteenth day. Seven deaths were caused by septicemia, one in consequence of a double amputation of the legs on the fourth day, the others on the sixth, eleventh, fifteenth, eighteenth, twenty-first and seventy-first days respectively. Fourteen were due to pyaemia, occurring respectively on the third, seventh, ninth, tenth, fourteenth, fifteenth, twentyfirst, twenty-fifth, thirtieth, thirty-first, thirty-fifth, fifty-ninth and sixty-fourth days.

AN ANALYSIS OF FIVE HUNDRED CASES OF SKIN DISEASES.

BY W. J. MAYNARD, M. D., Chicago.

(Condensed from a Report on Dermatology, to the Chicago Medical Society, May 21st.)

In the past too little attention has been paid by the teachers of medicine to the subject of Dermatology. I was once told, that in treating cutaneous diseases, it was only necessary to remember that, "Skin diseases could be divided into two classes, specific and non-specific. For all non-specific cases give arsenic for a cure, and for all those that have a specific origin, give iodide of potassium." If so concise and brilliant a manner of inviting attention to this large field of practical medicine is generally adopted in the teachings of others, it is