safe, and may produce a partial inversion by allowing the fundus to collapse and follow the escape of the child from the uterus, in the manner supposed in the second case reported.

3d. Similar objections exist to the too frequent practice of hurrying the separation, &c., of the placenta before contractions are excited in the womb, by pulling at the navel string, whereby injuries to the placenta, dangerous floodings, and even inversions of the womb are sometimes produced.

4th. In cases where the placenta is attached to the inverted uterus, the separation of it may be as safely performed before reducing the organ as it can be afterwards, and in some cases it will be most safe and expeditious so to do; but no uniform rule of procedure will be found applicable to all cases, and each should be treated, like other diseases, on general principles.

15. Asylum for the Insane, at Canandaigua. By GEORGE COOKE, M. D., Superintendent.

As far back as 1848, Dr. Amariah Brigham, the first superintendent of the State Asylum at Utica, called the attention of the board of managers of that institution, and through them the attention of the Legislature, to the necessity for the further provision for the insane of our State. Since that time the annual reports of the asylum have shown a yearly increasing number of applications, and hundreds of the insane poor have been sent back to the county poor houses to make room for more recent cases, while those who have been able to defray their own expenses have been compelled to seek an asylum in some of our sister States, where more ample provision has been made for this unfortunate class. Impressed with the importance of the subject, and persuaded that several years must elapse before the State could afford relief, in the summer of 1855 I dissolved my connection with the State asylum, and, with the approval of the managers, formed a plan for establishing a small institution in western New York. In accordance with this plan, a property was purchased within the limits of the corporation of the village of Canandaigua, about one mile from its centre, containing seventy acres of land, upon an elevation overlooking the village and lake, with a large and substantially built stone house in the midst of a grove of twenty

acres.

This house was prepared for the reception of ten patients, and was soon filled. In the spring of 1856, the erection of a wing was commenced, having a front of one hundred feet, and a depth of from thirty-six to sixty feet, with corridors, parlors, dining rooms, bed rooms, bathing rooms and closets, for thirty-five patients. This wing is two stories high, of the rural gothic style of architecture, and contains four wards. It is carefully constructed of brick, is secure against fire, and is well warmed and ventilated. It has all the modern appliances and conveniences for care and treatment, and is well furnished throughout. A similar wing upon the other side of the stone building is designed, and we hope soon

to commence its erection. The house will then accomodate seventy patients.

Since the opening of the institution, ninety patients have been received; twenty-nine have been discharged recovered; sixteen improved; twelve unimproved, and six have died. There are now remaining twenty-seven, six of whom are nearly recovered. Quite a large proportion of the patients received have been chronic cases, beyond hope of restoration. Most of the recent cases have recovered favorably. Of the deaths, two were of apoplexy; two of congestion of the lungs, with typhoid disease, and only surviving a short time after admission-neither of them proper patients for removal from home; one of exhaustion three days after admission, and one of erysipelas, to which she was strongly predisposed. No accute diseases have had their origin within the house, and no case of diarrhoea or dysentery has been prescribed for.

The institution has received patients from all classes of society. It was established more particularly for those who defray their own expenses, but it has received the indigent as far as its finances would permit, and has also received some patients chargeable to Ontario county. If the plans now under consideration shall be carried out successfully, the institution will have a charitable foundation, by which some patients will be received free of all charge.

The object of the founders is to secure its permanence, to estab lish a hospital for eighty patients, complete in all its appointments, and to make it subserve a charitable and useful purpose. Thus far it has received the approval of those most familiar with its aims and daily history.

We desire to extend a knowledge of the institution among the medical profession, and I thank the society for their courtesy in extending to me permission to make this brief statement of its origin, history and present condition.

16. Diphtherite. Its prevalence in Albany, N. Y.

By SYLVESTER D. WILLARD, M. D., of Albany.

Within a few months past, Albany has been visited by an epidemic sore throat malady, recognized as the distinct disease diphtherite.

In my present remarks, it is not my design to enter into an elaborate consideration of the subject, but rather to present a few facts, with such statistics of fatality from the prevalence of the disease in this city, as I have been able to gather.

There are two diseases to which diphtherite bears marked similarity; one is cynanche tonsillaris, the other is croup; but it exists independent of both of these, variously modified by the epidemical influences that produce it.

Just as in the prevalence of cholera, there is a tendency to a disturbed condition of the mucous coat of the bowels, which is produced by the modified action of whatever agent causes cholera, so co-existent with the prevalence of diphtherite, and doubtless induced by the same atmospheric condition, there prevailed among our adult population, in a mild form, a diffusive inflammation of the throat.

In some of these cases, and I estimate them to have been more than two thousand, there was but a simple blush upon the fauces, in others the palate, uvula and tonsils were in a high degree of vascularity. The general health and appetite of these were undisturbed. The only sensation experienced, was that of dryness and roughness of the parts affected. This morbid condition yielded readily to the application of nitrate of silver, an astringent gargle, or in a few days resumed its normal state without any aid whatever. Many such cases came under the observation of every physician.

Simultaneous with the appearance of diphtherite, as a modification of that disease, and produced by the same influence, there

*It has been suggested to me that this is a small estimate.

occurred also cynanche tonsillaris. This form of the malady prevailed in the recent epidemic, among children and young persons, being mostly confined to those under twenty years of age. Upon looking into the fauces, it was at once observable, that the tonsils were so swollen as nearly to touch each other. The high degree of inflammation, which comes on suddenly, is followed by the suppurative process, becoming more extensive, and involving the whole tonsils, which are in some instances, entirely thrown off in the suppuration, after which, resolution may ensue. In a few cases, the tonsils have had from the very outset, a dark, mahogany color, and the ulcers on their surface assumed a greenish cast. These have been followed by gangrene, mortification, and consequently death. But the disease diphtherite has prevailed among children, mostly under the age of twelve years. Its onset is sudden and insidious, the false membrane having been' formed to some extent, when the first symptoms of illness attracted the attention, and occasionally when the attention was directed only by the alarming condition of other members of the same family. The membrane rapidly extends upon the palate, tonsils, rima glottis, into the larynx, and trachea, producing mechanical obstruction to respiration, and the patient dies in precisely the same manner as in croup. In some instances the first examination of the patient showed the tonsils swollen and covered with a pseudo membrane of a pearly or oyster-like appearance; such were almost uniformly rapid in progress, and terminated fatally in two or three days. Those more slow in their progress, developed a blood poison, and after several days, the mucous membrane of the nose, fauces and bronchi, throw of a thick offensive acrid secretion, as so often exists in scarlatina. The congestion extends to the cellular tissue and skin about the throat and chest, the parotid glands become swollen, and there follows before death, incipient mortification and decomposition. In the progress of the disease, where it advances less decidedly to an unfavorable termination, there is a strong effort on behalf of nature to separate and throw off the pseudo membrane from the the fauces, and to expel it from the breathing passages. The line of demarkation forms in four or five days, and the separation may often be hastened by seizing portions of the membrane with forceps, and gradually and gently detaching it; but the tendency on the part of the disease is to reproduce it, so that when large: patches of it have been expelled by expectoration or otherwise, it has been speedily reproduced, and life destroyed.