it, as an envelope for the testis, became the subject shortly afterward of a hydrocele. The disturbances in the circulation, incident to the operative procedures, were somewhat similar, I should suppose, to that which is produced by the ligation of the veins for varicocele. There was quite a rapid development of the hydrocele, and in the course of the case there was considerable inflammatory reaction, with suppuration of the sac, which all subsided, and the patient was cured upon the incision of the sac.

Have you had any experience in the excision of a portion of the vein?

Dr. RAND.-In one case, and I think this so much simpler that it is the preferable method, except, perhaps, in exceptionally large varicoceles.

Dr. PILCHER.-You feel secure in it?
Dr. RAND.-Reasonably so.

The point upon which I would like to have the gentlemen present express an opinion is the advisability of resorting to any treatment for a radical cure of a hydrocele following such an operation. One of these cases has not yet recovered, and it is some three months since the ligature was applied.

Dr. FOWLER. The propriety of attempting the radical cure, it seems to me, would be evident. As to the method of cure, there is room for wide difference of opinion. The doctor mentioned the injection of carbolic acid, injection of tincture of iodine, and other methods of radical cure. One case was mentioned in which tapping was done frequently. It is the common experience, in ordinary hydrocele, tha a certain proportion of cases, after several tappings, do not recur, just as in the case which the doctor mentioned. My judgment would be that these cases should be treated just as any case of hydrocele, and the individual surgeon's preference for special methods of radical cure would of course guide him in the treatment.

The injecting of carbolic acid I have used in ordinary hydrocele. I have injected, at a clinic, and allowed the patient to walk home, reporting again at the next clinic day. I remember one case in which a patient was treated by carbolic-acid injection for hydrocele. On the third day thereafter he attended the Grant funeral, and marched the whole length of Broadway, and with no evil results. I should not

advise this course, however.

My preference, however, is for the method of complete incision, after Volkmann, and obliteration thereby of the cavity of the tunica vaginalis testis. Recently I have found it convenient to omit suturing, and simply pack the incision with gauze. This operation I have also done in the clinic, and have had patients walk away after dressing the parts. In a number of instances no anæsthetic was used. A curved

bistoury was passed into the cavity of the tunica vaginalis, and with one sweep the entire length of the cavity is laid open. An injection of cocaine, where it is expected to do this, will make it an almost painless operative procedure, occupying but a short time.

Dr. RAND.-In your judgment the altered condition of the circulation in the testicle and cord, resulting from ligation of the veins, would not necessarily prohibit treatment by injection or by any other method. My question was especially in reference to the advisability of treatment by injection; previous ligation of the varicocele would certainly not contra-indicate treatment by incision.

Dr. FOWLER.-I think not. I can see no reason why the same measures of treatment might not be applied in hydrocele arising from the conditions you have described and the ordinary hydrocele of everyday practice.

Dr. PILCHER.-I should think it might possibly be well for the surgeon to take into consideration this fact, which, perhaps, animates the doctor in submitting the question, namely, that the vascular conditions which determine the development of hydrocele are probably temporary, and that in the course of a few months, at farthest, the restoration of the circulation in the parts, the veins leading from which had been occluded by the operation, would be attained, and that all that would be required up to that time would be palliative measures. If that was the case, I should think it would be well to use palliative treatment for the first six months or more, and if, at the end of that time, there was persistence of trouble, then submit it to whatever method of radical cure might be chosen, for by that time definite and permanent circulatory conditions might be presumed to have been brought about.

NOTES ON THE COURTS AND DOCTORS.

BY SIDNEY V. LOWELL.

The Court of Appeals of this State has recently decided the case of Freeman Murray, as administrator of John Blanchard, against Luke Usher, &c. This was an action to recover damages for alleged negligence causing the death of John Blanchard, who was a day-laborer in a saw-mill, on the upper Hudson, operated by the defendants. His death was caused through the fall of a defective platform at the mill. Usher & Watkins, the millers, cared for their operative from the time of the accident until his death, employed a physician and paid his

funeral expenses. They endeavored to show all this on the trial in mitigation of damages, but the trial Court excluded the testimony. This ruling has been affirmed on appeal by the Court of Appeals. That Court of last resort, also went further and decided that the Act of 1847, under which only can a recovery be had for negligence causing death, did not allow recovery for the expense of the medical treatment of a person whose death had been so caused by another's negligence. This would seem unfortunate. The decision was not altogether expected. Under the common law, if a person sustained an injury through the fault of another, if he lived he could sustain an action against the wrong-doer. If he died, however, his cause of action died with him. To remedy this state of things the Act of 1847 was passed, allowing a recovery in such a case, but limiting the judg ment to $5,000; the suit to be brought by the administrator of the deceased. It would seem as if the law should, as an element of damage, allow a recovery for a medical attendance, that being the very first thing called for and necessary after every physical injury. Now that the law is settled that no recovery can be had under the existing statute, the latter should be made to fit the public need. The foot should not be shaped to the shoe, but the shoe to the foot.

EPILEPSY AND DEPRESSED SKULL.

HÆMORRHAGIC

PACHYMENINGITIS AND CONCUSSION.

BY GILMAN OSGOOD, M. D.

Cases presented at meeting of Brooklyn Pathological Society, January 16, 1890.

CASE NO. 1.-A boy, 14 years of age. Previous history imperfect, but as far as could be ascertained is as follows: No neurotic history. When about 18 months old he fell from a two-story window and received some severe injury to his head. Was very sick for several weeks, but at last recovered. An operation was advised by his attending physicians, but his parents refused to have it performed.

For about four years previous to September 20th, 1889, was in an orphan asylum, and was removed from that institution on account of his having epileptic convulsions, and at this time first came under my observation, with a history of epilepsy of about four years' duration. He appeared to be in very good physical health, excepting that he had partial hemiplegia on the left side, and had a marked depression of skull in temporo occipital region.

This depression was triangular in shape, with its base looking forward. It was one-half inch in depth, and a line drawn from the external angular process of the frontal bone on left side to the tip of the mastoid process of the right temporal bone, passed through the centre of the depression.

The base of the triangle was one-half inch posterior to and parallel with a line drawn from one external auditory meatus to the other. The lower side of the triangle corresponded with a line drawn from the external occiptal protuberance to the upper margin of the orbit. The sides of the triangle were from an inch and a fourth to an inch and a half in length. Since coming under my observation he averaged about one fit in three days, a few occuring at night.

Just before a seizure he would use profane language, and after the convulsive stage would seize anything he could lay his hands on and throw at those about him. Otherwise, there was nothing in his epileptic seizures worthy of notice.

Patient was seen by Drs. Barber, Shaw and others.

It appeared to be a case where an operation was justifiable, and full consent having been obtained, the operation was performed by Dr. I. H. Barber, December 12th, 1889. There were present Drs. Schenck, Browning, Wells, Arnold, Macomber, C. Barber and house staff.

Dr. Barber is present and will describe the details of the operation, and I will simply say we opened what appeared to be a large cyst in right hemisphere. A drainage-tube was inserted, and the wound was dressed with iodoform and bichloride gauze. The wound repaired without the formation of pus. Within 48 hours after the operation patient had three fits, but subsequently had none.

The wound was dressed daily, and the cavity irrigated with warm water. The discharge was quite profuse and was always clear and of

a serous nature.

On the day after the operation his temperature was 10030, which was the greatest elevation attained, excepting on the fifth day, when it reached 101°.

For the first three days after the operation he was very stupid and slept most of the time. His appetite was very good, and the only thing he complained of was a frontal headache.

On the eleventh and twelfth days after the operation, he removed dressings, saying there was an itching sensation about the wound. On the thirteenth day it did not drain freely. There was a rigidity of all the muscles; he did not appear to feel the prick of a pin, and was speechless, which condition, however, was soon recovered from after the removal of dressings and the discharge of about an half ounce of serous fluid.

On the fourteenth day he became comatose, could not be roused, and died the following morning.

A post mortem examination was made, Dr. Shaw was present and will demonstrate the pathological condition.

CASE NO. 2 Is that of a man 45 years of age, who had for a long time been an excessive drinker, and had chronic diffuse nephritis. While intoxicated, he sustained fractures of two ribs, two scalp wounds, and several wounds and bruises about the face. Cause of injuries unknown, but he is supposed to have been kicked.

He came under observation about six or eight hours after receiving injuries, and there was then no evidence of concussion of the brain. He developed pneumonia, and died four days later.

I now present the brain, which reveals numerous small hæmorrhages in the meshes of the pia mater and dura mater of right hemis phere, and a cloudiness of the pia mater, especially marked in its anterior portion. There was also a thickening of and formation of a false membrane on the dura mater.

The pathological conditions then are an old pachymeningitis and slight concussion of brain.

TWO CASES OF COMPOUND DEPRESSED FRACTURE OF THE SKULL.

BY EZRA H. WILSON, M. D.

Read before the Brooklyn Pathological Society, February 13th, 1890.

Frederick Fris, 38, Bavarian, driver; admitted per ambulance, November 11th, 1889. Service of Dr. Valentine.

On the morning of November 11th, he had fallen from his wagon, and was brought to the hospital by the E. D. ambulance.

On admission there was found an extensive compound depressed fracture in the left temporal region. The patient was somewhat comatose but could be roused sufficiently to answer questions in monosyllables. He was operated upon by Dr. Valentine a short time after his admission. The wound was enlarged by radiating incisions; there were three fragments depressed; by means of the elevator and separation forceps these were removed without the aid of the trephine. The hemorrhage was considerable, and several small vessels were ligated before the wound was dry. All antiseptic precautions were observed, and with good results in so far as the kindly healing of the wound was concerned.