Cities.

unless there happened to be cases of some infectious disease aboard. It is plain, therefore, that infected cargoes from ports never visited by frost might be brought to our city without any disinfection whatever at a time of the year when we have had several weeks of temperature above 80° F. With such quarantine regulations, it is unnecessary to invoke the doctrine of the domestication of yellow fever in New Orleans, or to pretend that it depends on some undefined local conditions, which are always found wanting the next season after a severe winter.

The sanitary functions of our board of health in the city of New Orleans, together with some other points suggested by the letter of your correspondent to our Medical Journal in November last, must be reserved for a future communication, as this is already sufficiently prolonged.

New Orleans, February 6, 1879.

S. S. H.

Population estimated for July, 1879.

REPORTED MORTALITY FOR THE WEEK ENDING FEBRUARY 15, 1879.

Two thousand and forty-six deaths were reported: 382 from consumption, 214 from pneumonia, 112 from scarlet fever, 90 from diphtheria, 78 from bronchitis, 32 from croup, 26 from whooping-cough, 23 from typhoid fever, 14 from diarrhoeal diseases, 14 from cerebrospinal meningitis, 12 from erysipelas, two from measles, none from small-pox. Allowing for Cincinnati, not reported, there is shown an increased total mortality and from pulmonary diseases, diphtheria, cerebro-spinal meningitis, and measles; about the same from diarrhœal diseases, and a decrease from the remaining "zymctic" diseases. Philadelphia reported 71 deaths from acute pulmonary diseases, not included in the above.

From bronchitis, 35 deaths were reported in New York, 14 in Chicago, nine in Brooklyn, seven in Pittsburgh, four in St. Louis and Baltimore, two in Milwaukee and Charleston, one in District of Columbia. From whooping-cough, 18 in New York, three in Brooklyn, two in Baltimore, one in District of Columbia, Pittsburgh, and Lowell. From typhoid fever, seven in Boston, five in Philadelphia, three in Chicago and Pittsburgh, two in Brooklyn, one in Baltimore, Lawrence, and Holyoke. From cerebro-spinal meningitis, three in Chicago, two in New York, one in St. Louis, Baltimore, Providence, Charleston, Lowell, Worcester, Cambridge, Lawrence, and Lynn. From erysipelas, three in New York, St. Louis, and Boston, two in Brooklyn, one in Cambridge. From measles, one in New York and Baltimore. Baltimore reported one from trismus nascentium. In Washington and Savannah the death-rate among the colored population was double that of the whites. The returns from sixteen of the nineteen cities in Massachusetts, with a population of 763,850, showed a decreased mortality from whooping-cough, about the same from erysipelas and diphtheria, and increased from the other zymotic diseases, particularly typhoid fever. Acute diseases of the respiratory organs were very prevalent in Nashville, where no deaths from "zymotics were reported, in Louisville, Richmond, San Francisco, and in New Orleans. Scarlet fever was prevalent in Buffalo and Richmond; diphtheria in Buffalo and San Francisco, influenza in Mobile, and catarrh in Buffalo. No deaths from diphtheria or scarlet fever in New Orleans. Sergeant Purssell's meteorological record for the week, in Boston, is as follows:

Barometer corrected for temperature, elevation, and instrumental error. Explanation of weather symbols: O., cloudy; C., clear; F., fair; G., fog; H., hazy; R., rain; S., snow; L. S., light snow; T., threatening.

Station: Latitude 42° 21'; longitude 71° 4'; height of instrument above the sea, 77.5. For the week ending January 18th in 149 German cities and towns, with a population of 7,532,088, the death-rate was 27, an increase from 24.8 of the preceding week, referable chiefly to pulmonary diseases. Of 5848 deaths, 552 were from consumption, 425 from acute diseases of respiratory organs, 178 from diphtheria and croup, 85 from scarlet fever, 50 from measles, 46 from whooping-cough, 27 from puerperal fever, three from typhus, one from small-pox. The death-rates were in Berlin 27.4; Bremen 26; Breslau 31.2; Carlsruhe 17.7; Cologne 29.7; Dantzic 40.7; Dresden 29.8; Frankfort-on-the-Main 20.1; Hamburg 29; Leipsic 24.6; Munich 33.9.

The death-rate for the week ending February 1st, for the twenty large English towns, with a population of 7,383,999, was 26.2, a trifle greater than for the previous week: for London 26.2, Bristol 20.4, Birmingham 27.4, Liverpool 35.7, Manchester 34.9, Plymouth 16.9. Pulmonary diseases, scarlet fever, and whooping-cough were most prevalent; small-pox

was fatal only in London, where there were 28 deaths, an increase of 4 from the previous week. Small-pox was also fatal in Dublin, where the death-rate from all diseases was 49; in Edinburgh 25 and in Glasgow 29. At last accounts, fevers were causing great mortality in India, with fewer deaths from cholera. Small-pox was prevalent in Calcutta, Paris, Vienna, Budapesth, and Venice, very rife in St. Petersburg; there were a few cases in Brussels, Geneva, and Bucharest. Diphtheria was very prevalent in Paris and Vienna, less so in the German cities, and somewhat in Egypt and Italy. Typhoid fever prevailed extensively in Paris and St. Petersburg, and to a certain extent in most of the continental cities.

Great destitution and mortality continue in Brazil, with a hope of beginning abatement. The plague is reported to be causing less anxiety to those cities of Europe whose sanitary condition is so bad as to make an importation of the disease much to be dreaded.

CIRCULAR.-Owing to the crowded state of the columns of the BOSTON MEDICAL AND SURGICAL JOURNAL, and in view of the fact that many of the medical societies are greatly in arrears in their reports intended for publication, the editor, while availing himself of the opportunity to thank them for their valuable support, would take the liberty to suggest that a greater condensation of the reports of cases presented by individual members for publication would lead to mutual benefit. It is thought that the main points of interest in a case can usually be presented in half of a printed page. Collections of similar cases prepared with special care, from which general conclusions may be drawn, and papers of importance can be printed in full, as heretofore, as original articles. By some such expedient the proceedings would appear more promptly than they do at present, and their interest and value would, we think, be increased.

GYNECOLOGICAL SOCIETY OF BOSTON. - The one hundredth regular meeting will be held at the Medical Library Rooms, 19 Boylston Place, first Thursday of March, at two o'clock, P. M.

The following papers are promised: Menstruation, by R. P. Loring, M. D. My Stem Pessary, by E. Cutter, M. D.

Profession invited.

HENRY M. FIELD, M. D., Secretary. JEFFERSON MEDICAL COLLEGE. The summer course of lectures will begin on Monday, March 24, 1879, and will be continued until Saturday, June 14th.

BOOKS AND PAMPHLETS RECEIVED. - Diphtheria: Its Nature and Treatment, Varieties, and Local Expressions. By Morell Mackenzie, M. D. Lond. Philadelphia: Lindsay and Blakiston. 1879. (A. Williams & Co.)

The Influence of Posture on Women in Gynecic and Obstetric Practice. By J. H. Aveling, M. D., Physician to the Chelsea Hospital for Women. Philadelphia: Lindsay and Blakiston. 1879. (A. Williams & Co.)

Naval Hygiene. Human Health and the Means of Preventing Disease. By Joseph Wilson, M. D., Medical Director United States Navy. Second Edition. With Colored Lithographs, etc. Philadelphia: Lindsay and Blakiston. 1879. (A. Williams & Co.) Annual Report of the Butler Hospital for the Insane. Providence. 1879. Twelfth Annual Report of the Minnesota Hospital for the Insane. Minneapolis. 1879. First Annual Report of the Presbyterian Eye and Ear Charity Hospital. Baltimore, Md.

1879.

Diphtheria and its Treatment. Epidemic of 1875-76. Meriden, Conn. By Chas. H. S. Davis, M. D. (Reprint.) Louisville, Ky. 1879.

Charter and By-Laws of the Pittsburgh Academy of Medicine and School of Anatomy. Pittsburgh. 1878.

New York Academy of Medicine. 1879. Addresses. Dr. Samuel S. Purple's Valedictory. Dr. Fordyce Barker's Inaugural.

A Case of Progressive Muscular Atrophy with Sclerosis of the Lateral Columns. By Dr. J. C. Shaw, President. New York Neurological Society, etc. (Reprint.) Chicago.

1879.

Atthill's Diseases of Women. Fifth edition revised and enlarged, with Illustrations. Philadelphia: Lindsay and Blakiston.

THE BOSTON

MUSEUM
OXFORD

MEDICAL AND SURGICAL JOURNAL.

VOL. C. THURSDAY, MARCH 6, 1879.- NO. 10.

LECTURES.

BOSTON CITY HOSPITAL: CLINICAL LECTURE NO. XI.

BY DAVID W. CHEEVER, M. d.,

Professor of Clinical Surgery in Harvard University.

Chronic Disease of the Knee. - GENTLEMEN: This little girl has been brought in to be shown to you, and to have an exploration of the knee-joint. She is now eleven years old. At the At the age of six years her knee began slowly to enlarge. After prolonged exercise it sometimes gave her trouble, otherwise none at all. Nine months ago she fell, and since that time her knee has gradually grown worse. This is the only history we have.

In comparison, the two knees, as you readily observe, are unlike. The left is apparently normal. The right is very much deformed, and in two directions, namely: it is enlarged in front; it is widened between the condyles. On its anterior surface the veins are dilated as they are not upon the same portion of the sound knee. There is, besides, over the inner condyle a peculiar swelling, which does not exist over the same condyle of the left leg. In the popliteal space I discover nothing abnormal, but now notice a slight appearance of a tendency to dislocation. On palpation I find the swelling soft and fluctuating, and inasmuch as it followed a chronic injury it probably contains pus and is a cold abscess. The knee-joint is bounded by a capsule, which is similar in both knees. When, therefore, we have a synovitis of this joint there is a uniform, spindle-shaped enlargement, extending high up the thigh under the tendon of the quadriceps extensor muscle. Unsymmetrical swelling consequently indicates cold abscess outside the capsule. On the other hand, we have a history of enlargement of the joint, as well as partial immobility from adhesions. In spite, then, of the unsymmetrical form of the abscess, there seems to be a probability that it is in some way connected with the joint. What should be the treatment? The child is in a fairly robust condition, so that the question arises, Shall we not open the abscess to-day? I think it the proper course, but in order to avoid admitting air into the joint shall pump off the contents by means of the aspirator.

In the recent case of cold abscess from caries of the spine we aspi rated twice, but the abscess refilled. We then opened it with a knife, and found a large cavity which we allowed to drain under a poultice. What followed? Severe sickness, threatening peritonitis, a low grade of pneumonia, and a generally bad condition, from which the patient escaped with difficulty. The abscess is now accustomed to the air, and the patient will recover, but with a discharging sinus. I have mentioned this case simply to show you the effect of laying open a cold abscess. In the case before us, then, we will open subcutaneously, and afterward wait a fortnight for the results. We shall probably give discharge to a thin fluid with cheesy lumps. By and by will arise the question of excision, from which operation the child might recover with shortening of the limb, but would have a stiff joint. Excision, however, is oftener fatal than amputation above the knee. Consequently, I do not feel justified in doing anything in the direction of operative treatment. For the present we will strap the part and apply extension, and if no improvement follow, the question of amputation or other interference will then arise. In evacuating the abscess we find the skin so thin that the usual primary incision is not necessary. I now introduce the needle, and use aspiration. The pus which flows is very thick, and quite unlike what I expected to see. It does not suggest a connection between the abscess and the bone, as it would if it were thin, oily, and flaky. We have drawn about one ounce, and the swelling goes down. For that reason we hope the abscess has nothing to do with the knee-joint. In that case the trouble may end in a cure by anchylosis of the joint. The two knees are now more alike; what remains of the apparent deformity is hard bone, and you see even more than before the evidence of the outward dislocation. This is probably due to a relaxed condition of the internal lateral ligament, which permits an outward movement of the head of the tibia. The character of the pus and the position of the abscess lead me to consider the latter traumatic in character. I now propose to apply a ham splint and rest, and by and by an iron splint, like Sayre's, which will prevent dislocation, give extension, and allow the patient to walk daily.

[One week later.] The abscess in this case has already refilled, and is now just as it was at first. The thickness of the pus and lack of connection with the joint, it will be remembered, led me to think the abscess outside the joint. Aspiration being of no avail, I shall proceed to lay open the swelling. Having done so, I find a mass of lymph and thick pus, but no opening into the joint. Searching more closely, however, I now discover a small chink leading directly into the joint. Otherwise there is no opening. I shall now wash out with carbolic acid and water, and put the leg on a splint. If inflammation goes on and caries develops we shall probably excise the joint. There is no dislocation,