especially when walking. The ribs on the affected side have flattened, and the measurement is two thirds of that of the healthy one. The heart has been forced from its natural position, and lies.immediately under the sternum. The diastole and systole of the organ conveys to the ear the impression, that the heart is surrounded with some substance which suppresses the sound, or, that it is deeply imbedded in the substance of the lung. Percussion over the diseased side reveals several cavities; and yet a sufficient respiratory murmur is heard, to show the existence of some healthy lung. There are, undoubtedly, five cavities in the lung, each one having a fistulous opening through the walls of the chest. The cavity which he "blows out" night and morning, has its opening between the fourth and fifth ribs, and three inches from the point where the ribs join the sternum. The orifice is three fourths of an inch in size, with healthy, organized edges. A probe can be introduced four or five inches. This opening he constantly keeps closed air-tight, excepting when he is emptying it. He usually uses a paper tent, made with the leaves of an old book, probably from their softness, which he rolls up tightly, until sufficiently large, when it is introduced its full length, leaving only enough externally to withdraw it when necessary. The tent, thus introduced, has some times slipped into the cavity, and has been extracted with difficulty. He is unable to breathe when this orifice is open. When he wishes to free the cavity from the accumulated pus, he withdraws the plug, simultaneously closing his mouth, and making an effort to cough, when the air and matter must pass out through the external opening. I confess my astonishment and surprise at the noise and force of the outrushing air, when he simply withdraws the tent. Some days he is compelled to cleanse this cavity three times, but uusally only morning and evening. If he neglects to do so, he commences discharging it by the mouth, and can at any time, by bending his body downward and forward, cause the matter to flow from the mouth. The amount thus discharged is about eight ounces each time, or sixteen ounces per day. The surface of the affected side is covered with cicatrices and deep fissures.

It is a matter of astonishment how this man has thus lived through sixteen years with such a disorganized condition of the thoracic cavity.

ART. III.-Uterine Tumor, Successfully removed. By G. W. BOERSTLER, M. D., Lancaster, O. Being an extract from a letter to Prof. M. B. Wright, M. D.

I do not aim to add any thing new to the "etiology or pathology" of such out-growths from the uterine walls, but to impress upon the profession the fact, that surgical procedure is not only justifiable, but an imperative duty in such cases, even, when very unpromising aspects are present.

Nature can not cure, and "art" must be resorted to as the only chance to rescue such patients from premature death.

The surgical treatment of those out-growths from the "uterine walls" is of modern date, and was for a long period considered beyond the resources of art. The great advances in "physiology, chemistry, and the microscope," have enabled the surgeon to give us a correct pathology and proper diagnosis; thereby enabling us to adopt a rational procedure.

The invaluable "Prize Essay" on the surgical treatment of certain "Fibrous Tumors" by the highly gifted and accomplished physician Washington L. Atlee, M. D., of Philadelphia, has, in my judgment, contributed more to our knowledge and treatment of such cases, than any work I have had access to; and has furnished me the means of saving an invaluable life.

He is justly entitled to the motto: “ Palmam qui meruit ferat.” July 1st, I visited the wife of Dr. B., in consultation with Drs. Miner, Short, and Potter. We received the following history:

For about one year Mrs. B. felt a fullness, and slight prominence about the "fundus uteri,' and a little to the right-this slowly increased (though without pain) until the volume of the uterus was as large as at an eight months' pregnancy. The menstrual flow appeared at proper periods and usual quantity for the first five months, when it became hemorrhagic, and for the last three months the hemorrhage increased so much that the fearful drain left her blanched and prostrate, her respiration hurried, pulse 130 per minute, and the usual thrill of " anemia."

The touch revealed unusual heat in the vagina; the "os-tinca" fully dilated, and filled with a tongue-like process of the tumor. Advancing my exploration the hand was arrested two inches

above the "os" by firm adhesions to the inner surface of the uterus, and around the entire tumor.

The grave question was presented, what can be done? Not to remove the tumor must soon be fatal to our patient. How to remove it perplexed us. Upon full consultation it was decided to attempt the removal.

The danger of the operation was fully declared to the patient; and she calmly expressed her willingness to submit.

Dr. B. put her under chloroform, and I proceeded to break up the adhesions with the fingers, but soon found bands too unyielding to my efforts; and I then resorted to a blunt-pointed "bistoury," guarding the edge with the index finger, and thus cautiously cutting the fibrous bands as near the surface of the tumor as possible; and proceeding slowly till the hand was partially benumbed by the uterine contractions, when I requested my friend Dr. Sotler to continue the operation, which he did with precaution and skill. We alternately relieved each other till we stripped the tumor from its adhesions to its base, in two hours and one quarter.

The efforts to separate it from its out-growth proving fruitless, I determined to throw an annealed wire around it, with a long double canula. I believed myself successful, for on drawing and fastening the wires, the instrument remained firm under proper traction. In forty-eight (48) hours it came loose; and was withdrawn by Dr. B. "It proved a failure." I received daily reports from Dr. B. and his medical advisers, as follows:

July 2d. Rigor at 11 o'clock last night, fever slight, abdomen distended and tender; complaints of great heat in genitals-no urination. At two (2) at night, threw off scalding urine; vaginal discharge, blood and water; offensive, bowels moved; gave opium.

July 3d. Abdomen as yesterday; also vaginal discharge; pulse one hundred and twenty (120); great thirst; urinated freely; continued opium.

July 4th. Increased fever, distension and tenderness of abdomen greater; pulse one hundred and twenty (120); urinated little, and painful, probably owing to descent of "tumor" filling up vagina under strong uterine contractions; discharge offensive, can not inject deodorizing agents, because "tumor" fills up the sheath; continued opium; ice freely to abdomen and vulva.

July 5th. Less fever and tenderness; pulse one hundred and ten (110); uterine contractions strong and frequent; lower portion of tumor protruding through "vulva" during contractions. Dr. B. used prudent traction on "tumor," and finds it softening; two (2) gushes of colored fluid of two (2) pints during traction. Treatment as previous day.

July 6th. Increased fever and delirium, from eight (8) A. M. to three (3) P. M.; pulse one hundred and twenty (120); abdominal distension and tenderness increased; contractions strong, and propelling "tumor" three (3) to four (4) inches beyond vulva; vaginal discharge small, but offensive; can only urinate on pressing" tumor" off "uretha." Treatment, opium and calomel. Ice as previously. Patient takes iced milk freely.

July 7th. No fever; pulse one hundred and twenty (120), small and soft; uterine contractions strong; skin leaking. Treatment as day previous, with brandy.

July 8th. Condition of patient as yesterday. Treatment, opium and calomel; beef tea, with iced milk.

July 9th. Symptoms more favorable; pulse one hundred and eight (108); uterine contractions strong; tumor descending and softening. Treatment, less opium; takes beef tea freely.

July 10th. I visited patient, and met her medical attendants. A half hour before my arrival "tumor" was expelled under strong contractions of " uterus and tractile" force by Dr. B. From this day madam slowly improved, and by October was in fine health, and so continues.

REMARKS.

The "tumor" weighed six and one quarter (6) pounds, measured at its base five and a half (5) inches from right to left; from base to apex eleven and a half (11) inches. I sent it to my friend Prof. Salisbury. of Cleveland, for microscopic examination, which he kindly gave me, viz:

"The microscope shows it to be a fibrous growth, scattered through among the connective fiber and connective tissue, cells, and granules."

ART. IV. Diseases of Children. By G. W. H. KEMPER, M. D., Muncie, Ind.

Through the whole course of study laid down for the medical student, he meets with no class of diseases, or branch of the profession, that he enters with more reluctance or misgivings, than he does upon the study and practice of discases of children. Of course there are exceptions, but they are rare.

Few young men who graduate and leave our medical colleges for their various fields of practice, consider themselves competent to cope with this class of diseases. There are reasons for this. Most of our medical students are young men of limited. means, and when they commence the study of medicine, are anxious to proceed rapidly through the course of study, and begin a practice as soon as possible. He tells his preceptor so, and his preceptor "puts him through," and ten chances to one but the dreaded work on diseases of children is delayed to the last-slighted often. He goes to some medical college, but here his mind is dazzled by "capital operations," or so called "interesting cases," forgetting, apparently, that those cases we meet with oftenest, are the most interesting, and therefore deserving of most attention. Our medical schools are not able to give it as much thought as it deserves. Most of them have a professor, whose duty it is to lecture upon obstetrics, diseases of women and children. These three are all important branches, but the two former occupy nearly all the teacher's time, and if any one has to be cut short, it is the last. With these ill preparations he begins a practice. He is the pilot to guide these little barks to the haven of health, and now he feels his want of knowledge on the subject. If he should happen, unfortunately, to form a partnership with some old physician, he may get along swimmingly for the time, but if this should be ended, or if he commence a practice alone, he soon finds that he has sadly neglected an important portion of his profession, is unequal to the task, his practice declining, and he feels disgraced, or what is worse, that he may have killed his little patient from scer ignorance. This may be a highly drawn picture, but I fear it is too often realized.

Now, we contend that children's diseases are more easily understood and susceptible of treatment, than any other portion