forehead, and right ear swollen, oedematous, and of a mahogany color. The right side of neck swollen, with red streaks extending to the shoulder and arm. Complains of lancinating pains in right arm, fore-arm, and hand; also of scalp. I saw her again on the evening of the 19th, when all of the above symptoms were aggravated. The right half of the face and right half of forehead, scalp, neck, and arm presented the appearance of rapid extension of gangrene. The lower half of right lip completely gangrenous; upper lip also. The fauces, tonsils, and pharynx not affected; lancinating pains in right mammary region, abdomen, and lower extremities. There was no redness, œdema, or other indications of the disease extending to the mammary region, abdomen, or right lower extremity. Skin normal in color; the slightest touch of the integument over the right side of the thorax, thigh, and leg produced the most excruciating pain, and not upon the left; became comatose during the night of the 19th. On the morning of the 20th, gangrene had extended during the night to the shoulder and arm, as far as the elbow, and to the median line of the neck posteriorly; had stertorous breathing; temperature 108, respiration 30; died at twelve o'clock, seventy-two hours after she had first noticed the papule. The third case: Mrs. H., residing in this city; was called to see her October 20, 1878; thirty years of age, and of previous good health; mother of five children. Found her dying. She had been under the treatment of another physician. The history of the case was obtained from her husband. Four days previous to her death she noticed a small papule on the right side of her chin; on the following night the lower lip began to swell, extending to the median line, and next day involving the right half of the upper lip and extending over the left side of the face; complained of lancinating pain over right side of face, head, and neck; was five months pregnant, aborted on the third day, became comatose on the night of the third day, and died on the morning of the fourth day. When I saw the case, the lower and upper right half of the lips were gangrenous; between the pustule and lower lip an area of healthy tissue intervened, similar to case second. The fourth case occurred in this city:Mr. P., residing at 2140 Park Avenue, a wool merchant, aged twenty-four, and of previous good health, who had been in Colorado, purchasing wool, returned from Colorado, October, consulted me October 3, 1883, for a cough, the result of a cold. On examination I observed on the face, one inch below the right half of the lower lip, near the median line, a small papule, not larger than a small pea, with an areola half an inch in diameter, of a pale pink color. I directed his attention to it, and he remarked that it was nothing but an ordinary pimple. My experience with the cases reported led me to suspect that it might be the beginning of a malignant pustule. As he had been handling wool in Colorado I stated my suspicions, and asked him to call next morning, incised the papule, and applied a flyblister. He attended to his usual business on the 3d of October, and called at my office on the morning of the 4th. The papule had not increased in size. The areola was of a much darker color, but not increased I removed the vesicated skin from the papule, and applied another blister. Had headache, temperature 99, and respiration 20. I felt almost convinced in area. that I had to encounter another case of this dreadful disease. By much persuasion he permitted me to incise the pustule freely; was requested to go home, and told that I would see him in the evening. On the evening of the 4th temperature 100°, pulse 95, respiration 20; no perceptible change in the pustule; red lines extending outward from left side of pustule, curving upwards over the face; lower right half of lip swollen and hard, with a band of hardened tissue extending from the left angle of the mouth outward for two inches; the face oedematous. Incised the lower lip transversely from the median line to the angle on the line of junction of the skin and mucous membrane to the depth of one inch, and applied pure carbolic acid to the wound; also injected pure carbolic acid into the pustule; applied a poultice of flaxseed, tar, and tinct. iodine- three parts of meal, one part of tar, two dr. of tinct. iodine. Morning of the 5th, inflammation around pustule less; lower lip more swollen, and presenting a gangrenous slough; left half of upper lip swollen and presenting the same appearance as lower lip twelve hours previous. Temperature 101, pulse 115, respiration 22; face more oedematous, and dark-red lines extending from the lips upwards and backwards to the zygoma and left orbit. I incised upper lip, and applied carbolic acid and poultice; injected carbolic acid into the tissues near the angle of the mouth; applied lint wet with sol. act. lead to the face. Evening of the 5th, temperature 102, pulse 124, respiration 24; the oedema of the face has not extended beyond the limits in the morning; tissues of upper lip of darker color; lower lip sloughing; pustule and surrounding areola improving in color; slight discharge of pus from pustule. Morning of the 6th. Passed a very restless night. Temperature 102, pulse 120, respiration 20. Tissues of lower and upper lip sloughing; removed with forceps and scissors a great portion of the slough of the lower lip; continued to apply carbolic acid. The oedema and color of the face remained in much the same condition of previous day. Evening of the 6th, temperature 103, pulse 130, respiration 24. No perceptible change in the pustule, lips, or face since morning. Morning of the 7th, temperature 102, pulse 128, respiration 22; oedema of face diminished; pustule and lips discharging pus. Evening of the 7th, temperature 1033, pulse 135, respiration 26; has been chilly dur ing the day, and is in a profuse sweat at six P. M. Morning of the 8th, temperature 1023, pulse 126, respiration 22; sloughing of upper lip profuse. Evening, temperature 104, pulse 140, respiration 30. Morning of the 9th, temperature 103, pulse 138, respiration 28; entire slough of lower lip removed, presenting a healthy granulating surface. Upper lip sloughing; removed from angle of mouth a large slough; face less swollen and less discoloration. Slightly delirious during the previous night. Evening, temperature 105, pulse 142, respiration 30. Morning of the 10th, temperature 102, pulse 130, respiration 28. Night, temperature 103, pulse 130, respiration 34. Condition of face improved; slough removed from upper lip. Morning of the 11th. Passed a restless night; had slight chill followed by a profuse perspiration; temperature 103, pulse 140, respiration 28; tongue dry, and sordes on teeth; bowels loose; redness and oedema of face rapidly disappearing; the lips presenting healthy granulating surfaces; swelling and fluctuations below the symphysis of lower jaw; punctured, and half ounce of pus evacuated. Evening, temperature 105}, pulse 130, respiration 30. Morning of the 12th, temperature 102, pulse 130, respiration 28; profuse perspiration through the previous night. Evening, temperature 1033, pulse 140, respiration 28. Morning of the 13th, temperature 100, pulse 106, respiration 24. Swelling with fluctuation over infraorbital foramen. Punctured, and evacuated one ounce of pus. Evening, temperature 103, pulse 140, respiration 30. Morning of the 14th, temperature 99, pulse 110, respiration 22. Profuse perspiration, alternating with chilliness during the previous night and day, and complains of pain and soreness of right leg. On examination found an area of dark-red color, one inch wide and two inches long, situated on the outside of the anterior border of the tibia, at the junction of the middle with the upper third of the bone. Introduced bistoury to the depth of one inch and a half, without reaching pus. Morning of the 15th, temperature 100, pulse 132, respiration 24; passed an uncomfortable night; had profuse perspiration; wounds of lips improving. Evening, temperature 104, pulse 140, respiration 32. Morning of the 16th, temperature 103, pulse 140, respiration 30. Severe chill during the night, followed by severe lancinating pain in lower right pleura. The swelling in the leg continued, and a deeper incision, extending between the tibia and fibula, gave exit to three ounces of dark-colored pus. Evening, temperature 105, pulse 160, respiration 36. Morning of the 17th, temperature 102, pulse 128, respiration 30; had alternate chilliness and perspiration during the night. The acute pain in the side relieved, with a dull aching pain ensuing; slight cough on full inspiration. Percussion revealed dullness over the lower lobe of right lung. Evening, temperature 1043, pulse 140, respiration 36. Morning of the 18th, temperature 104, pulse 128, respiration 30; expectorates frothy mucus, tinged with blood; continues to have profuse perspiration several times a day, so that his clothing is continually wet. Morning of the 19th, temperature 101, pulse 126, respiration 28. Expectoration of bloody sputa increased. Perspiration continuing. Abscess in leg discharging unhealthy dark-colored pus. Evening, temperature 103, pulse 132, respiration 32. Morning of the 20th, temperature 101, pulse 124, respiration 28. Expectoration of a dark-brown color. Less dullness on percussion. Abscess still discharging pus of a lighter color. Evening, temperature 1033, pulse 132, respiration 30. Morning of the 21st, temperature 100, pulse 120, respiration 22. Expectoration less and of lighter color. Urine examined; quantity thirty ounces daily, and slightly albuminous. Evening, temperature 1023, pulse 128, respiration 26. Morning of the 22d, temperature 101, pulse 124, respiration 26. Expectoration less. Less dullness over lung. Evening, temperature 103, pulse 130, respira tion 30. . . Morning of the 25th, temperature 99, pulse 120, respiration 22. More air entering right lung. Less cough and expectoration. Otherwise no improvement. Evening, temperature 1023, pulse 128, respiration 30. ... Morning of the 28th, temperature 993, pulse 124, respiration 24. Less cough and expectoration, and profuse perspiration at intervals of four to six hours. Evening, temperature 103, pulse 132, respiration 30. Morning of the 29th, temperature 99, pulse 120, respiration 22. With the exception of temperature, the patient appears to be improving. Evening, temperature 103, pulse 130, respiration 24. On the night of November 1st he had a severe chill, after which the temperature rose to 106°, followed by severe pain in left thorax, which proved to be the beginning of another attack of pleuro-pneumonia, which passed through all the stages that I have just related in the attack on the right side, with temperature, pulse, and respiration during the course of the disease a counterpart of the first attack. On the morning of the 10th of November, temperature 1023 pulse 130, respiration 28. Patient continued to improve from this date. A slight cough with expectoration of light-colored sputa continued until December 28th, with occasional attacks of perspiration; the temperature was taken until the 28th of December. The characteristic symptoms of two of these cases were alike in several respects. The locations of the pustules were both on the right side of the face, and located at the same place. The intermediate integument between the pustules and lips was not affected by the disease in either case. The inflammation or extension of the disease appeared to be from the right side of the pustules along the integument covering the basilar portion of the inferior maxilla, to near the angle of the jaw, and then curving upwards over the face along the anterior border of the masseter muscle. On the second night, or twenty-four hours after pustules were noticed, and twelve hours after red streaks or lines extended along the lower margin of jaw, and then the lower half of the lips became affected, and twelve hours after the upper lip became affected in both cases, and then the right half of the face, forehead, and scalp in the case of Mrs. R., and the face of Mr. P. became oedematous. From the observation of these cases it appears that the disease may be divided into four periods or stages: first, the period of incubation, which may be from a few hours to fourteen days, with no prodromes; second period, the formation of pimple, papule, and pustule, lasting from twelve to twenty-four hours; third stage, the extension of the oedema and inflammation, occurring twelve hours after the formation of the pustule; fourth, the stage of gangrene, occurring in from twelve to twenty-four hours later. The disease extended by the poison being carried by the superficial lymphatics only. I am led to this conclusion from the fact that in three of the cases the disease extended from the right side of the pustule, curving upwards over the face; and not until the lines of inflammation or œdema had reached above the line of Wharton's duct did the lips show evidence of disease. Again, the dis ease in all of the cases was confined to one side of the face, head, neck, and scalp, and did not pass over the median line of the face or the median line of neck posteriorly. The treatment of all of the cases was similar in most respects. In the second case, Mrs. R., the treatment was free crucial incision of the pustule; injection of pure carbolic acid into the pustule; quinia in large doses, car bonate ammonia, tinct. ferri chloridi, and whiskey tain their vitality for years and are unaffected by ordipunch internally; free incision of the lips, and injec-nary changes of climate or temperature." 1 tion of pure carbolic acid, with local application of alcohol to the face. The bacillus anthracis is a bacterium, first discovered by Pollender in 1849. All parts of the bodies of aniThe third case, Mrs. H., I did not treat. mals dying of the disease are actively poisonous, and The fourth case, Mr. P., was under my care from may convey the disease by direct or mediate contathe time the papule was formed; free crucial incision gion; it may arise from eating the flesh, though the was practiced at once, and pure carbolic acid was in- poison is said to be destroyed by cooking; contagion jected into the tissues around the pustule; he was put may also be conveyed by butter or milk. The bites upon quinia, four grains every three hours; tinct. ferri of flies may also convey the poison. Contagion occurs chloridi, thirty drops every three hours, and whiskey in those who have to deal with the wool or hair of anipunch. As soon as the lips showed indications of the mals which have died of the disease, snch as wool disease free incisions were made, and carbolic acid was packers and sorters, horse-hair cleaners, farriers, taninjected into them, and also into the angle of the ners. The poison may enter the system either by mouth; lead-water and laudanum applied to the face, local inoculation or by inhalation of the dust containwhich appeared to act better than alcohol; used as a ing it. The diffusion of the poison by water and its dispoultice, linseed meal, tar, and tinct. iodine; when in-tribution by means of wool-waste and bone-dust, used dications of septic poisoning occurred he was given as manure, especially deserve notice, as capable of aqua chlorinata in drachm doses every four hours, spreading the contagion. which was continued until December 20th. The attacks of pleuro-pneumonia were treated by counterirritation of the thorax, and quinia, carbonate of ammonia, with the addition of morphine. The immediate cause of death in the three cases was, I believe, by thrombus of the cerebral veins or sinuses, the intimate connection of the pterygoid plexus with the facial vein, also the connection of the ophthalmic vein with the angular vein, a continuation of the facial, and the vein passing from the internal surface of the nasal cavities up through the foramen cæcum to the longitudinal sinus, the pterygoid veins and ophthalmic veins emptying into the cavernous sinus. Mr. H., Mr. R., and Mrs. H. became rapidly comatose, had stertorous breathing, and complete paralysis before death, all symptoms of compression of the brain. Billroth reports a case of death from malignant pustule, in which the post-mortem examination showed thrombus of the temporal veins, which was traced to the ophthalmic, and through the ophthalmic to the brain. Bartholow gives as the most frequent cause of sudden death in erysipelas of the face and head thrombus of either the longitudinal, cavernous, or lateral sinus. "In cases of malignant pustules rigor mortis usually sets in early and passes off quickly; the body is often cyanosed; the face may be swollen; petechiae on chest and abdomen are not uncommon; decomposition usually sets in early. The blood is generally dark, lake, and tarry, and in the heart often uncoagulated; the subcutaneous cellular tissue of the parts affected is hæmorrhagic, and hæmorrhagic patches radiate into the surrounding tissues, which are extensively infiltrated with a semi-gelatinous blood-stained fluid. In the pulmonary and gastro-intestinal form other anatomical characters are observed. "The most important point in the microscopic anatomy is the presence of the bacillus anthracis in the blood and tissues, either diffused or forming masses in the lymphatics and vessels; the bacillus anthracis, as seen in the blood, consists of a motionless, short, apparently homogeneous rod or filament, rarely less than 300 of an inch long, either straight, curved, or bent at an acute angle. The usual mode of multiplication in the blood is by transverse fission. The bacillus anthracis requires for its growth the presence of a nitrogenized pabulum and a supply of oxygen; its vitality is destroyed by a temperature of 60° C.; when dry the rods themselves can be preserved but a short time, while the spores re "In the earlier stages diagnosis is very difficult, except in persons who are known to be exposed to contagion. At a later stage the characteristic features of the pustule render the recognition comparatively easy, and microscopical examination of the serum contained in the vesicles shows the presence of the bacillus anthracis. Inoculation experiments on guinea-pigs or mice will, if successful, readily decide it, but no absolute conclusion can be drawn from failure to inoculate. "The prognosis is extremely unfavorable." RETAINED PLACENTA.2 BY O. W. DOE, M. D. IN 1861 Mr. Priestley communicated to the Obstetrical Society of London a paper on the Treatment of Cases of Abortion with Retained Placenta, urging manual interference if the placenta be retained longer than six hours, and earlier should hæmorrhage occur to any unusual extent. In this opinion he was seconded by such men as Dr. Tanner, Dr. Hall Davis, Dr. Tyler Smith, and others. Since that time this question has been very much discussed, and recently as great a diversity of opinion regarding the treatment to be followed has existed in those cases where the placenta and membranes are not expelled with the foetus as has lately been shown in the New York Academy of Medicine regarding the nature and cause of puerperal fever. Drs. Mundé and Alloway advise either manual or instrumental removal of the secundines immediately after the expulsion of the foetus in every case where the cervical canal is sufficiently patulous to permit the introduction of the finger, curette, or placental forceps, while Dr. Sweringen, with others prominent in the Indiana State Medical Society, prefer to leave its expulsion to the forces of nature, excepting in cases where some emergency demands its immedi ate removal. Two years ago Dr. Warren, of Portland, read a paper upon this subject, in which he urged immediate removal of the placenta and membranes, as recommended by Dr. Mundé, and produced, in substantiation of this method of treatment, letters from Drs. T. G. Thomas, Lusk, Mary Putnam Jacobi, and others 1 Greenfield. 2 Read before the Boston Society for Medical Improvement, April 28, 1884. equally prominent, who strongly advised this procedure. In the discussion which followed Dr. Gordon expressed himself as decidedly opposed to the advisability of forcible extraction, and reported a case where attempts to remove the placenta failed, and six weeks later it was expelled without any trouble resulting from its retention excepting an occasional slight hæmorrhage. Dr. Coles, of St. Louis, has recently read a paper before the Obstetrical Society of that city purposely to controvert the views of Drs. Mundé and Alloway, and styles the doctrines inculcated by them as "dangerous in their tendencies" and "too dogmatic and sweeping in character." The tone of the discussion which followed favored a more conservative method of treatment, in so far as instrumental interference was concerned. The treatment which I follow in my own practice is to attempt its manual, though not forcible, removal at once, as soon as the foetus is expelled; if unsuccessful to tampon and wait from twenty-four to forty-eight hours. If retention still exists, to etherize and remove it manually, or instrumentally if necessary, as the danger of septicemia seems to me much greater than that arising from its forcible removal carefully performed, and followed by antiseptic injections. While this subject is at present so openly disputed by the most prominent members of the profession, I thought it might be interesting to the Society to hear the report of a case which was left entirely to nature, this conservative action arising from an error of judgment rather than from being an intentional act. Mrs. G., aged twenty-seven, a lady of delicate and rather nervous organization, was last unwell from the 18th to the 22d of September, 1882. The catamenia began at the age of fourteen, and had always been regular. On the second and third Sunday in October she fainted in church, and during the third week of that month first began to suffer from nausea. Her husband was taken ill on the 15th of January, and she was not only very anxious about him, but overexerted herself in going up and down stairs. On the 17th the catamenia appeared, as she supposed, but the flow was very slight, hardly sufficient to soil one napkin, and the only pain attending it was an occasional sharp pain above the pubes, producing a sensation as if something in the back passage was pressing against the front. She remained in bed ten days, and was positive that nothing passed away from her during that time. Two days after getting up and going down stairs the flow began again, and continued at intervals for five weeks. At times it was quite profuse, but no clots passed away, and there was no pain, with this exception, that four days after the hæmorrhage commenced she was quite constipated, and took a large hot enema, and when this operated the pain low down in her back was so severe that she asked the nurse to press firmly against it. She was not conscious of anything having passed from the vagina. I saw her in consultation on the 15th of March. At that time there had been no flowing for a week. She complained of feeling continually as if there was a heavy weight in the pelvis, and said she could not lie on her abdomen, as was her custom when well. This weight she could feel move when turning from one side to the other. From external examination there was nothing abnormal to be detected in the hypogastric region. On vaginal examination the os was very small, and did not She appear as if it had been previously dilated; the cervix was of usual length, and directed more anteriorly than normal; in the posterior cul-de-sac was felt a small body which I took to be a retroverted uterus, very sensitive on pressure, and quite freely movable. As she was very nervous and debilitated from her long confinement to the house, I thought it best to defer any attempt at replacement until her general condition was improved by tonics, and the sensitive congested body of the uterus relieved by hot vaginal douches. steadily improved under this treatment, and was soon out driving. On June 23d she was taken unwell, as she supposed; the flow continued for a week, though very scanty, being dark and slightly offensive in character. Examination a week later showed the body of the uterus to be very much less sensitive and less easily reached, and though the patient was feeling quite strong, and had come by rail twenty miles to my office, she yet complained of this heavy weight in the pelvis. On the 11th of July she went to Concord, N. H., and there drove about almost daily, and improved greatly. On the 8th of August she was again taken unwell, and returned to Boston during the day. During the afternoon of the 9th she began to suffer from severe paroxysmal attacks of pain in the hypogastric region, which continued until evening, when they became expulsive in character, and at eleven P. M. a placenta was expelled, in size corresponding to at least three and a half months of pregnancy. There was but little hæmorrhage, and her convalescence was rapid and uninterrupted. In summing up the facts in this case we find that she was last unwell on September 22d. She must have conceived soon after, as she fainted on the 8th of October, and began to suffer from nausea soon after the 15th. Her flow first began on the 17th of January, but she had no pain whatever until the 2d of February, when she had a severe pain in her back, while having a very constipated movement of the bowels. She was not conscious at the time of anything passing from the vagina, and the flow was not materially increased. With this exception she had no pain until August 9, 1883, when the placenta was expelled, being ten months and nine days from her probable conception, and one hundred and eighty-eight days from the date when there was the only possible chance of the foetus having passed away. The questionable mistake made, as subsequent results proved, was in not dilating the cervix and exploring the uterus at the time I first saw her in March. As it was then doubtful whether she had really been pregnant, and the uterus being so extremely sensitive, I thought it best to defer operative interference. The possibility of a retained placenta seemed hardly tenable, as we could get no history of a foetus having been expelled, and we were positive in our convictions that pregnancy did not then exist, it being nearly seven months since the catamenia appeared regularly in September. Evidently at the time the abortion took place the placenta was adherent throughout, otherwise there would have ensued decomposition of the detached portion with possible septic poisoning and a more profuse hæmorrhage, and consequently any operative interference at that time would have been necessarily hazardous. Dr. Mundé, among other indications which should induce the practitioner to forcibly remove the placenta, mentions hæmorrhage (without qualifying its ex tent). The case I have reported, as also that of Dr. Gordon, shows it may not be necessary excepting when when the hæmorrhage is profuse. The degenerative changes which lessens the placental attachment to the uterus nature was slowly and safely instituting, and consequently even had I been cognizant of the placental retention I should not have considered myself justified, in view of the very sensitive condition of the parts, in dilating the cervix and curetting the uterus at the time I first saw her, as the danger thereby, it seems to me, would have exceeded that which the more conservative method followed subjected her to. Dr. S. L. Jepson, of Wheeling, Virginia, in the Journal of Obstetrics for 1883, reports two cases of retained placenta, one of sixty-six days and the other of one hundred and fifteen days. He remarks that this latter period was the longest he had been able to find recorded. In each of these cases the placenta was removed instrumentally at these times, interference being necessitated by alarming hæmorrhage. In the case of longest retention the placenta was removed by forceps and curette after great difficulty. Eighteen months later she died twenty minutes after being delivered at full term, by turning. Although there was no autopsy, Dr. Jepson thought it possible that death was caused by a rupture of the uterus due possibly to damage inflicted at the time of the removal of the placenta, as there was sudden collapse, after long continued violent uterine contraction, and immediate recession of the head followed. RECENT PROGRESS IN PATHOLOGY AND PATHOLOGICAL ANATOMY. eases. BY WILLIAM F. WHITNEY, M. D. MENDELSOHN1 has brought together the principal facts which have gradually accumulated, and which point towards the infectious nature of pneumonia. These show that the disease appears with a certain typical frequency at different seasons of the year, just as intermittent fever, typhoid, or other infectious disThis distribution does not correspond with a more frequent occurrence during the colder and less frequent during the warmer seasons; further, some localities are attacked at times with the greatest virulence, while neighboring places having the same climatic conditions are exempt; and finally, hot and cold regions are visited equally. "Catching cold" as an exciting cause can almost always be excluded when the histories of the cases are carefully considered, and is an atiological factor of the patient's own assumption. The method of onset and close are entirely different from those observed after taking cold. While these last begin gradually, pneumonia sets in suddenly with a severe chill. The termination differs still more markedly. The high fever drops within a few hours to under the normal, and the patient, who has been very sick up to this time, rejoices in a feeling of well being. The direct proof of this suspicion, aroused by clinical observation, is given by the discovery of the constant presence of a form of micrococcus in the lungs. Klebs was the first to characterize this as a parasitic affection, and he described as monas pulmonalis a 1 Zeitschrift f. klin. Med., Band xvii., s. 178. micrococcus which he found in the hepatized lung, carefully freed from bronchial mucus, of a person recently dead. These were often to be seen in great numbers, and often so infrequent that they were only to be distinguished by other granular masses by being arranged in rows. In fresh preparations a quick movement was noticed. The same organisms were also found in the fluid in the ventricles of the brain. This author likewise called attention to the epidemic character of the disease. Eberth next demonstrated the parasite in a case of pneumonia complicated with meningitis. Small, slightly oval or round bodies were found in the richly cellular and fibrinous exudation of the gray hepatized portions of the lungs, as well as in the purulent and fibrinous layer on the pleural surface. In part these were single balls, but the greater number were united in pairs, and had a gentle movement among themselves. Long chains or columns were never seen. Koch has published the appearance found in a case of fatal pneumonia, which, however, is not to be regarded perhaps as of a pure type, as it occurred as a sequel to recurrent fever. The distribution of the parasites in this case recalled that of those found in erysipelas. The micrococci were only found in the alveoli adjoining the hepatized portion, and most abundantly in such as were only partially filled with an exudation. As in erysipelas, the living organisms surrounded the centre of disease by only a narrow zone. Similar bacteria were also found in this case in the capillaries of the kidney. They lay in the vessels. united together in chains, but clearly showing their oval form. The clearest description, and the most convincing proof of the connection of these organisms with the disease, has been furnished by C. Friedlander.2 The cocci are of ellipsoidal forms, their length equals almost a micro-millemetre, their breadth about one third less; they are usually joined together in pairs (diplococci), but often form longer chains. In the fibrinous coagulations in the bronchi they are spread over a considerable surface in a flat layer. They are most abundant in the reddish-gray infiltration, less so in the yellowishgray and gray hepatization. In one case the lymph channels of the interstitial connective tissue which lay on the boundary of the hepatized territory were filled to such an extent as to cause varicose swelling of the walls. The vessels thus filled could be distinguished by the eye in preparations cleared up by acetic acid, as silver-colored lines. The method which he has used to show the presence of the parasites is as follows: Small portions of the hepatized lung are hardened in alcohol, and thin sec tion made. These are colored by staining deeply in an aniline water solution of gentian violet. (Gentian violet, one gramme, aniline water (made by simply shaking aniline oil in water and then filtering) fifty grammes.) Afterwards the sections are placed for a short time in a weak watery solution of liq. iodinii comp. Upon placing in oil of cloves the blue color is discharged from the ground substance and nuclei of the tissue, while the micrococci appear in contrast, intensely colored. The author lays great stress upon the presence of a capsule" as characteristic of this particular parasite. This presents itself as a feebly-colored belt of the same form, and from two to four times as broad as the micrococcus itself, and sharply bounded on 2 Fortschritte der Medecin, November, 1883. 66 |