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Dr. Lusk thought that, in the class of cases under consideration, the putrid infection primarily affected the blood ; the blood- corpuscles were destroyed, and then degeneration took place in all the parenchymatous organs, and when they had Buy Levitra Online With Paypal become un- able to |)erform their functions properly the time had gone by when an operation could be performed with the hope of good results. Dr. Lusk then exhibited a specimen which Dr. Reginald H. Sayre removed from a patient of his last summer, Buy Levitra Online With Paypal a brief his- tory of which has already appeared in Buy Levitra Online With Paypal this journal. In that case the fcetal remains escaped through the vagina and rectum. The patient had the symptoms of intense septic poisoning, but the attack came on before her health had become impaired, and this fact, together with the intelligent care which she received from Dr. Sayre, accounted for her recovery. Dr. Reginald H. Satee said he could add nothing to the history of the case referred to by Dr. Lusk in the latter part of his remarks which would be of interest to the meeting. He thought, had the patient been operated upon before slough- ing took place into the v.igina. she would have been saved Buy Levitra Online With Paypal a great deal of suffering. He fully agreed \yith Dr. Lusk that a great many women lost their lives for want of a timely opera- tion for abdominal pregnancy. 50 PROCEEDINGS 01 SOCIETIES. fN. Y. Med. Jopb., Dr. R. H. Saunders related the history of a woman who visited the clinic at Mt. Sinai Hospital in February last. She had been married two years and a half. When he saw her she complained only of some pain in the back and abdomen ; there was rather a copious vaginal discliarge, which was continuous. She said there was beginning emaciation. There were no symptoms which could be called septic ; no elevation of temperature, sweating, loss of appetite, or diarrhcca. She said she had been seen a year before by Buy Levitra Online With Paypal Dr. Thomas, Dr. Tauszky, and also at one time by Dr. Lange — all of whom had said there was abdominal gestation. Her family physician had seen her at the calcidated fifth month, and thought the fcetus was in the uterus ; but at a subsequent examination he diagnosticated extra-uterine gesta- tion. According to her statement, she had not ceased to men- struate through gestation, nor since. Since the ninth month the abdomen had become smaller. "When Dr. Saunders ex- amined her the abdomen was considerably enlarged, but not excessively so. Apparently it contained absolutely no fluid, and, inasmuch as it was said to have decreased in size, he in- ferred that it had contained fluid which had been absorbed. The woman being somewhat emaciated, he could distinctly make out the form of the foetus, which l.iy with the buttocks toward the liver, and the head downward and to the left. By vaginal examination he could feel the fontaneiles. All move- ments had ceased two months before term. The patient had not kept her promise to return. Further cases were related by Dr. Satee, Dr. Hinton, Dr. Porter, Dr. Arnold, and the Pi!Esident. BPvOOKLYN PATHOLOGICAL SOCIETY. Meeting of January 28, 18S6. The President, Dr. B. F. Westbrook, in the Chair; Dr. A. II. P. Leuf, Secretary. A Case of Great Hypertrophy of the Heart from Valvu- lar Disease. — Dr. GLENTwoRTn R. Butler said that the case the history of which he presented bad occurred in his service at St. Mary's Hospital : A. G., aged twenty-nine years, a native of the United States, a waiter, was admitted to the hospital -January 5, 1886. His family history was negative. He complained of gastric dis- tress, swollen feet, and urgent dyspnoea. The dyspnoea began in the early part of September, 1885, and was coincident with his gastric symptoms. He had snffered frequently from acute rheumatism, the attacks dating from the ninth year of his age. He had recently spit blood on two occasions. The physical signs on admission were as follows : Face cya- notic, pulse rapid, excessively irregular, and very small. The jugulars were distended and pulsating. The chest was deformed, the sternum at its lower part was thrown forward, and the ribs were depressed laterally. Over the entire prsecordia and be- yond its borders a heaving pulsation Buy Levitra Online With Paypal was plainly visible. The apex beat was felt two inches to the outside of and two inches and a half below the nipple. Tlie prsecordial area of dullness was greatly increased, extending from two inches to the left of the nipple to the right of the sternum. Epigastric pulsa- tion was marked. This region, as well as the hepatic, was pain- ful on pressure, and the liver could be felt to pulsate on atten- tive examination. Auscultation revealed a tumultuous action of the heart. The only murmur to be distinguished at that time was a systolic bruit most intense over the tricuspid area, but also heard at the apex. There was also a suspicion of a diastolic murmur at the apex, but the diastole w'as too short to determine the fact. Rest, turpentine Buy Levitra Online With Paypal stupes over the epigastrium, extract of Cae- tus grandiflora in ten-minim doses, iron, and a mineral acid im- proved his condition somewhat. On January 9th digitalis was substituted for the Cactus grandiflora, and dry cups were applied over the liver. On January 15th the heart was acting with much greater regularity and the pulse was materially changed, presenting the characters of Buy Levitra Online With Paypal aortic regurgitation. On ausculta- tion, a to-andfro murmur was distinctly made out over the aortic orifice, the diastolic portion being most intense at tlie apex. The systolic murmur over the tricus))id area had well Buy Levitra Online With Paypal nigh disappeared. The patient's symptoms improved somewhat during the next few days, but death occurred suddenly on the 22d of January, seventeen days after his admission. The case was interesting from a diagnostic point of view. The result of the first examination led to a probable diagnosis of mitral stenosis, with tricusjud regurgitation, Buy Levitra Online With Paypal although at no time during the progress of tlie case was there a presystolic murmur. The signs pointing toward this lesion were the small- ness Buy Levitra Online With Paypal of the pulse, cyanosis, jugular and hepatic pulsation, with evident hypertrophy and distension of the right heart. When the cardiac muscle had partially regained its power the right heart emptied itself more completely, as evidenced by the les- sened intensity of the murmur over the tricuspid area and the disappearance of cyanosis and concomitant symptoms. The left ventricle being better filled and contracting more strongly, the diastole too being longer, propelled its contents with sufficient force to develop the to-and-fro murmur of aortic stenosis and