months, one premature labor at seven months, and six regular confinements at full term. In none of these has there been a return of the sensory or motor paralysis.

This case has been here presented for the purpose of illustrating, to that extent at least, the independence of the motor action in the uterine ganglionic system in the process of parturition.

ANTI-PARTEM PUERPERAL CONVULSIONS WITH THE CONDITION OF THE UTERUS DURING THE PERIOD OF CONVULSION IN THE SKELETAL MUSCLES SHOWING INDEPENDENCE OF UTERINE NERVOUS ACTION OR INACTION, WITH RESULTS.

At 10 o'clock p. m. I was called to West End to see a lady sick. Not informed as to the nature of the case, I found on arrival that she was in the first stage of labor with her second child. She had been taken with symptoms of approaching labor late in the afternoon. On examination I found the os uteri thick, soft and dilated to the size of a nickel. The case was one of cephalic presentation, and as nothing abnormal presented in any way, either as to the progress of the labor, or the condition of the patient, the case was allowed progress without interference. It passed on as a slow case of labor until one o'clock a. m. At this time, suddenly and without warning, the patient went into severe convulsions. Not prepared for such an emergency, I dispatched a messenger for aid and instruments, chloroform, etc. It was midnight and two miles to the city. The convulsive attacks were severe and long-continued, so much so that I feared delay would result in death. I then determined to make an effort to turn and deliver by the feet. On passing my hand through the vulva into the vagina, I met with some rigidity of tissue. This overcome, in the effort to introduce the hand into the uterine cavity, to my

utter astonishment the os uteri, but partially dilated, offered almost no resistance, and the wall of the uterus seemed flacid, this, too, during the severe clonic spasm in the skeletal muscles. I found no trouble in grasping the feet and bringing them down.

In the flacid condition of the uterus, I felt a little afraid to complete the delivery lest post partem hæmorrhage should follow. Soon the convulsive movements ceased, when the delivery was completed; the placenta followed without much delay, and mother and child did well.

REMARKS.

This case has been presented, in juxtaposition with the preceding case of paralysis during pregnancy and parturition, as serving in some measure, to show the independence of the uterine motor nerve, to a limited extent at least, in the process of gestation and parturition. Whether in all cases of eclampsia, or convulsions during labor, there is a like innibition in the uterine motor nerves, I am not in a position to assert Whether all cases of paralysis of motion and sensation, or motion or sensation during gestation, will influence as little the process of parturition as the case here reported, I am equally unable to say, and I report these cases for the purpose of, and with the hope that, they may, call forth the results of the observation of others of my brother-practitioners, to the settling of the questions at issue. In conclusion, I will be pleased to have the experience of others, either directly or through the channel of the medical press.

In submitting this report the chairman of the Section on Gynecology for the Fifth Congressional District, would beg leave to state, in justice to the other members of the section, that it is based entirely upon cases in his own private prac

tice; it has not been acted upon by the section-if such a course has been the custom-the writer holds himself alone responsible for the same.

This statement is made in justice to the other members of the section.

THE TREATMENT OF EMPYEMA.*

BY HUNTER P. COOPER, M. D., LATE RESIDENT ASSISTANT SURGEON PRESBYTERIAN HOSPITAL, NEW YORK; ADJUNCT PROFESSOR OF CHEMISTRY, ATLANTA MEDICAL COLLEGE.

A brief recital of the leading features of the following case, together with a description of the operation performed, will furnish a text on which I will base my remarks:

William Sutherland, aged 23, of Providence, R. I., was admitted to the surgical division of the Presbyterian Hospital during the early part of 1885. For over a year he had been suffering with very severe symptoms, referable to the right side of the thorax, consisting of pain, cough, expectoration, fever, emaciation, and finally a spontaneous discharge of pus from the pleural cavity.

The opening which took place in his chest occurred, without surgical interference, about six or seven months previous to admission. A free discharge of pus from this opening (situated in the second intercostal space in front) continued until his entrance to the hospital. Under the steady drain of this discharge his general condition rapidly depreciated and hectic fever ensued.

When he first entered the hospital, examination of the patient revealed the following condition:

Emaciation and anæmia are well marked; pulse and breathing accelerated; in respiration only the left side of the chest expands; on the right side the chest-wall is rigid

*Reported from the Section on Surgery for the Fifth Congressional District.

and sunken; the ribs are crowded together and very tender on pressure. There is an opening in the second intercostal space about three or three and a half inches from the median line. This opening gives vent to a large quantity of creamy yellow pus every time the patient coughs or makes muscular exertion From the second intercostal space downward there is flatness on percussion, the whole cavity of the chest being evidently full of pus. The lung is crowded into the upper and posterior part of the thoracic cavity, and, judging from the length of time it has been subjected to pressure, it has evidently undergone carnefaction.

Clearly the case was one for surgical interference, and the following operation was performed by Dr. Charles K. Briddon, the attending surgeon:

The patient being etherized, the chest is scrubbed with soap and water, then washed with mercuric bichloride solution (1-1000). A vertical incision was then made in the mid-axillary line, and rapidly deepened until the underlying ribs (5th, 6th, 7th and 8th) were reached. The soft parts were then dissected back until about three and a half inches of each rib were exposed. Portions three and a half inches long of three of these ribs were then excised, the fourth not being removed on account of the patient's feeble condition. To excise the ribs an incision is first made through the enveloping periosteum about four inches long, and the periosteum carefully separated from the bone until a chain-saw can be passed underneath the rib between it and its periosteum. Thus the bone is removed without any danger of wounding the intercostal artery. An incision was made in the 8th intercostal space, giving vent to a large amount of pus. The spontaneous opening in the 2d intercostal space was then enlarged, and a large red rubber drain