selves, first, in a graduation scale of six degrees, with halves and quarters indicated on the staff of the instrument, without, however, impairing its smoothness in the least. Next, the handle of the sound is bent obliquely downward to make room for another straight, narrow handle, the end of a steel spring, which projects from the hollow centre of the staff. Finally, and the most important, though least prominent alteration consists of a narrow slot, equal in length to half a degree on the scale, and situated on the concave side of the curve just where it joins the staff.

By pushing the straight handle of the spring forward, a small sharp blade is made to project from the slot, which, running in a convex groove, increases the farther it is pushed, until in the center of the slot it attains an elevation of little less than three millimeters above the surface of the sound.

If pushed further, it does not diminish again, and in order to disappear, must be withdrawn forward into its original place. On the steel spring next to the handle, and where the operator always has it in sight, a small scale is marked of the length of the slot, and this describes by its divisions whether the knife is couched; whether it has attained a quarter or a half of the slot-the latter marking its highest elevation.

Now for the manner of its application. A stricture has been diagnosed in any portion of the urethra. It has been dilated as far as it can be with comfort and safety, and now presents a resilient ring of a certain lumen which will bear no further interference without pain and constitutional disturbance.

Or, again, it may be a case wherein the surgeon decides to use the knife from the beginning. In either instance an accurate measurement is made of the distance of the stricture from the meatus, and also is the stricture located from the outside as nearly as possible. Then this dis

REYNDERS&

N.Y.

tance is measured off from the conical end of the sound, and threequarters of a degree added on the staff of the instrument, three-quarters of a degree being the distance from the point of the sound to the centre of the slot. When, then, this instrument is introduced, just the same as a common sound, and up to the full length indicated, there is a close certainty that the centre of the slot is opposite the point of stricture. Of course the blade is couched, its handle projecting from the end of the staff to the full length of the slot which is marked thereon. Now the operator, who has also located the stricture from the outside, ascertains whether the shoulder of the sound is at the point selected.

If so, the slot on the upper side is in precise position. Holding the handle of the staff with the right hand, the thumb of the same hand is set against the handle of the spring which terminates in the blade and pushed rapidly forward. Then changing to the opposite side of the handle it may be easily and rapidly withdrawn. The distance to which the spring is pushed determines the depth of the incision-if to the second line on the scale, it makes the deepest cut, a little less than three millimeters.

And now the instrument is withdrawn with as little inconvenience as a simple sound.

Should it be proposed to cut several strictures near each other, the length of the canal thus infringed upon will be measured, and, when the blade projects, the instrument is withdrawn to that extent. If it is deemed necessary to incise the whole canal, then, with the blade set, the instrument is simply withdrawn, slitting its furrow as it passes.

In either case every relation can be exactly measured and determined by the scale, and every intention precisely carried out, without more or less than is desirable. The whole application is not a whit more difficult than the ordinary passing of a sound.

There is still a point wherein this instrument possesses advantages. It is easily cleaned. That with a urethral instrument is of no small importance. The handle of the sound is unscrewed and thus releases the staff, which is taken apart in two halves, joined at the point by a projecting hinge. When thus opened, the hollow space is disclosed wherein the steel spring and blade lie loosely.

It may then be noticed that at the bottom of this space is a thin groove in which runs a little point under the blade, that serves as a director.

The whole is accessible in every point for cleaning.

I have named this instrument the "Urethral Incising Sound," as it is intended for the treatment of intractable cases of gleet and recurrent cases of stricture, especially in the pendulous portion of the urethra.

I have preferred it to any other instrument of this kind for the following reasons:

First. It is more easily introduced and withdrawn than any other, presenting, in fact, no greater difficulties than an ordinary sound.

Second. By a concealed blade it may be made to incise any specified portion of the canal, and no other, and again can be made to incise the entire length if desired.

Third. In my hands it has been entirely safe, and seems as if it could hardly be so used by any medical man as to do either harm or fail of its purpose.

Fourth. It can be cleaned perfectly, and with the greatest ease.

* DIAEBTES MELLITUS RUNNING A RAPID COURSE. I. W. LYON, M.D., HARTFORD.

Mr. J. T., aged 18 years, height about five feet ten and a half inches, well built, of fair complexion, and light brown hair, a student of Trinity College, was first seen November 12, 1877, at 8.30 P.M. He entered his room, where I was waiting for him, with a trembling, unsteady gait, hat and clothes on; had been out to urinate. His countenance was haggard and voice weak; he had attended recitations that day, but was excused from reciting. I found his hands and skin very cold, pulse ninety and very weak. He said that he felt weak, but was inclined to make light of his illness. He was constantly tormented with thirst, and was drinking large quantities of fluids, water, tea, and milk, and he was passing water very frequently and in large quantities; he told me that he was up five or six times in the night to urinate. I directed him to cease his studies at once, to remain in bed, to preserve all the water that he passed during the next twenty-four hours, and to send me a specimen in the morning for examination. During the next twenty-four hours he passed ninety-six ounces of urine; its specific gravity was 10.34, and, by both Fehling's and Trommer's test, sugar was found in considerable quantity. His appetite, which up to Monday the 12th had been greedy, now fell off, and he wanted liquids only. On Tuesday he was weaker, though abundantly supplied with beef-tea and cream. Quinine and brandy were also given, but the patient grew worse rapidly, so that by Wednesday morning it was evident that he could live but a little while longer. His nails were blue, and the surface of the body bluish from capillary congestion.

Dr. Wilcox saw him with me at 11 A.M., and subsequently examined the urine with me at my office.

He died Thursday morning, November 15th, at 7 a.m.

I learned from the patient that before returning to the College, September 14, 1877, he had not been troubled with thirst, nor did he pass any more urine than usual; he was quite positive on these points, and⚫ his parents have since confirmed his statements.

The patient also informed me that his thirst and increased urination had begun about a month previously, and that during the last month he had lost in weight thirty pounds.

The reasons why he went into collapse and died so quickly, were, so far as I can see, mental labor added to the exhausting effects of the disease.

He kept up as long as his appetite continued; when this declined he sank rapidly. There were no complications that I could discover, no albuminuria, no headache up to the last day, no chest disease, no fever.

A VERY FAST PULSE WITHOUT AN ASCERTAINED CAUSE.

A gentleman, aged 67 years, of excellent habits and general health, accustomed to considerable exercise, consulted me at four P.M., February 26, 1878, at my office, saying that he had taken cold, had lost his appetite and spirits, and did not sleep very well.

On looking him over I found evidences of a slight bronchitis; but what arrested my attention was the fact that his cardiac pulsations were 144 per minute; the respiration was eighteen; there was no fever; there was nothing to account for the rapid pulse except the bronchial catarrh. I directed counter-irritation to the chest, a cough-mixture, and perfect rest.

The patient continued to consult me at my office, and though the bronchitis disappeared after a few days, the pulse remained 144.

The heart was found to be normal in size, and there were no murmurs present. The organ was displaced downwards and slightly to the left, so that the apex beat was in the sixth instead of the fifth intercostal space; but this was not due to hypertrophy of the left ventricle, as the base of the heart was correspondingly depressed. The lungs were sound. The urine was carefully examined, and found to be perfectly normal. Quinine and the Tincture of Digitalis were given, but without any effect upon the pulse.

I concluded, after observing the case a few days, that there was fatty degeneration of the left ventricle, and felt that the prognosis was very grave.

The patient went to New York and consulted Dr. Janeway, who confirmed this diagnosis and found slight emphysema of the lungs.

August 28th the pulse was still 144 per minute; the patient was about town attending to his business, and had been so ever since the improvement in the bronchitis, which lasted only a week or ten days as above stated; his general appearance was natural, extremities warm, skin of good color; he felt a little weak and incapable of much exertion, but seemed otherwise well. September 21st had an attack of cholera morbus; during the attack he noticed that his pulse was beating slower. September 22d, 9 A.M., I found the pulse 98 and regular. From this time to the present his pulse has been between 70 and 80 per minute, and he has felt well and vigorous. His apex beat is still in the same situation, the pulse is 76, and of good strength, there are no murmurs, and he appears to be in excellent health in all respects.

A CASE OF COMPLETE PLACENTA PRÆVIA, WITH REMARKS. E. P. SWASEY, M.D., NEW BRITAIN.

Mrs. W., æt. 35, Irish, housekeeper, to whom I was called in the evening of the 19th of December, 1878, on account of sudden uterine hemorrhage. According to her calculation, she was then seven and onehalf months advanced in her fourth pregnancy, and had enjoyed excellent health during this time. I had attended her in the three previous, the first labor having been terminated with the aid of forceps applied at the superior strait. A considerable hemorrhage followed the delivery of the child, and it was found that the placenta was attached low down, but not involving the os. Severe inflammatory fever followed this labor and retarded complete convalescense for several weeks. The second and third labors were normal, with only the usual loss of blood, but the third was succeeded by a violent chill occurring about thirty-six hours after the birth of the child. Immediately after the chill came high fever, the axillary temperature reaching 105°, severe pain over the region of the uterus, complete suppression of all discharge, and a quick; irritable pulse. The chill occurred in the afternoon, and tr. verat. virid. gtt. ij. every four hours, and opium gr. j. at a like interval and alternating with the former, were ordered. The next forenoon quin. sulph. gr. xxx. were given, in anticipation of an increase of the fever towards night. At five P.м. I was called by the husband, who thought her to be dying. I found her bathed in a copious perspiration; there was complete recession of the fever, and from this point she made a speedy convalescence.

On my visit to her, on the 19th of December, I found, on examination, the os high up, directed towards the sacral promontory and quite impervious to the finger. The flowing was slight, unaccompanied by pains, and readily yielded to opium and rest in bed. The next morning the flowing had entirely ceased, and, contrary to explicit instructions, she resumed her household duties the same afternoon. On the 8th of January, 1879, I was again summoned to the bedside of this patient and found she had been flowing a second time, and on this occasion there had been slight uterine pains. She had done the family washing on the day previous. Immediately on the appearance of this second hemorrhage, she had gone to bed and taken an opium powder, so that on my arrival, several hours later, I found the bleeding had ceased. During the time between these two attacks she had enjoyed good health, and had been free from pain. Heedless of advice, however, she was up again the following day, and ten days later she had a third attack of which I was not informed at the time, it yielding to the same treatment as on the previous occasions.

At 7.10 A.M., on the 25th of January, I was called hastily by the husband, who stated that she had had "a terrible flowing" at 5 A.M. Repairing to the house as quickly as possible, I found my patient in a