tion or in luck in the breed of horses, I had been reading every available treatise thereupon, and was greedy for every scrap of information. In an American veterinary note, I saw that a farmer down West had used phosphorus with marked success as a medicine given throughout pregnancy to mares who threw malformed foals. I immediately put my patient on a combination of phosphorus and quinine. She took the pills regularly thrice daily, and a healthy girl was born, when the pills were discontinued. Soon after the confinement, my patient told me she "missed the phosphorus dreadfully ;" and, there being no sign of milk, I sanctioned the resuming of it, and lactation speedily supervened. This child throve well until it caught hooping-cough, when it nearly died from the most severe attack of that malady which I have seen in a child so young; but that it possessed stamina sufficient to withstand the disease (and, perhaps, the treatment, for we left no stone unturned), speaks volumes for its vital power. And yesterday a healthy child was again born to her (a son), after nine continuous months of phosphorus, which, rightly or wrongly, I accredit with having prevailed upon nature to change the type in this instance. These are the bare facts which seem to me worthy of this much record. To many, no doubt, they will be trite enough, and all may have expected such a result. I was one of those skeptics who "expected nothing," and was anything but disappointed.

ON THE PREVENTION OF LACERATION OF THE FEMALE

PERINEUM.

Alex. Duke, M. K. Q. C. P. I., in the Medical Press and Circular (Louisville Medical News):

The best authorities are, I think, agreed that it is not advisable to support the perineum when that important structure is distended by the passage of the fetal head, and the reason is sometimes given that the support is so seldom properly applied that it is better left undone.

However, as it is a most deplorable accident to happen to any female, not only on account of the additional danger to the patient from sceptic absorption, the additional anxiety and

trouble it gives to both nurse and doctor, and the train of subsequent evils which it frequently sets up, I consider it a subject worth saying a few words about, if only to draw out the opinions of older and wiser heads as to the advisability of adopting some preventive treatment instead of as a rule interfering at ̧ the wrong time with the calamitous results we so often wit

ness.

The best preventive treatment of laceration which I have found (and which I dare not claim as original, as I presume it has been tried before, but which I see no mention of in the text-books of midwifery) is this: When I find the head fairly engaged in the pelvis, and advancing with each pain, I take my seat by the patient's bed, and having lubricated my left thumb or the two first fingers of my right hand, I introduce either into the vagina, and at the onset of a pain draw back the perineum firmly but gently toward the coccyx, relaxing the tension gradually as the pain lessens till the next ensues, and so on till I can draw back the perineum with very slight effort. I thus tire out the muscular structures and produce sufficient relaxation for the head to pass. In most cases so treated the perineum is in no danger, but when the pubic arch is narrow, I take the additional precaution to foment the parts, and use an inunction of lard, and also allow the head while passing through the valve to glide over my lubricating fingers, using them as a shoe-horn, so to speak, while I direct the head forward by pressure with my left hand below the coccyx or a finger in the rectum.

It has always seemed anomalous to me that the perineum should be expected to dilate on such a short notice, namely, the "process of extension," while (dilatation of) the os and cervix occupy such a considerable time, even with the additional help of Nature's hydrostatic dilatator, viz., the bag of

waters.

The drawing back of the perineum produces no additional pain, as it is done during a uterine contraction, and I feel sure if nurses were educated as to proper way of dilataing the perineum previous to its distension with the fetal head, we should see less and hear less of lacerated perineum.

INTRA-UTERINE MEDICATION.

The Retrospect credits the British Medical Journal with the following conclusions by Dr. E. J. Tilt:

Intra-uterine medication should be reserved for very exceptional cases of the following forms of disease:

1. Incoercible blood-loss, resisting milder remedies and menacing life.

2. When internal metritis menaces life or reason, rather by the intensity of its re-action on the system than by the amount of purulent discharge; for insanity may be sometimes fairly attributed to an impairment of brain-tissue, due to long pro

tracted internal metritis.

3. When, independently of ovaritis, internal metritis leads to an aggravated combination of dysmenorrhea and menorrhagia, menacing life or reason.

4. Membranous dysmenorrhoea of exceptional severity.

5. Habitual abortion, independent of syphilis and ovaritis, and seemingly caused by some morbid condition of the lining membrane of the body of the womb.

It is now admitted, as an essential preliminary of all intrauterine medication, that it is indispensable to establish a free passage through the cervix for all fluids injected into the womb or by it secreted; and I have found the dilatation of the whole cervical canal by laminaria-bougies, a day or two before menstruation, to diminish greatly the pain and blood-loss attendant upon membranous dysmenorrhoea and the uterine irritation that follow the expulsion of the membrane.

With regard to treatment when internal metritis is leading to death by blood-loss, I recommend the injection of the undiluted tincture of iodine; for, by doing so, I have repeatedly checked flooding, and also uterine exfoliation in membranous dysmenorrhoea. Tincture of iodine commends itself by antiseptic as well as by hæmostatic properties, and by the fact of its having been found trustworthy, for the purpose under consideration, by Drs. Savage, Routh, Fordyce Barker and Emmet. I have only heard of its use having been followed by one fatal issue-in Dr. Gaillard Thomas' hands.

am not aware of its having led to any pelvic disease of a serious nature; and a manageable amount of acute metritis is the worst result I have observed in my own practice. Similar immunity from serious results cannot be recorded of the injection of a solution of nitrate of silver, in cases of internal metritis. The plan has often led to death, and still more frequently to pelvic peritonitis, from which patients have recovered with difficulty. I am struck by the fact that the liability to serious disease after using intra-uterine injections is not proportional to the energy of the fluid injected, for formidable accidents have followed the injection of glycerine and of plain water. For that reason, when internal metritis has necessitated intra-uterine medication, I have sometimes had recourse to the solid nitrate of silver, and I have dropped into the womb about five or six grains of it, by means of Simpson's "porte-caustique "-thus returning to what Recamier did fifty years ago. I have seen this followed by acute peritonitis, and, as there are cases on record where death has ensued, I am ready to welcome a better plan of treatment.

SIGN OF OBSTRUCTED LABOR.

The Detroit Lancet credits the Canada Medical and Surgical Journal with the following practical note: Dr. L. Bandl, of Vienna, has recently pointed out a phenomenon recognizable by inspection of the abdomen during labor only, which is of considerable practical importance.

He found that in those cases where there exists an abnormal obstacle to the expulsion of the child, such as contracted pelvis, malposition of the child, etc., a distinct transverse furrow appears on the abdomen, about midway between the umbilicus and pubes, just at the junction of the cervix and body of the uterus. This furrow is produced by the wedging in of the cervix into the brim of the pelvis by the presenting part of the concomitant, fruitless, concentric contractions of the uterine body. It occurs only in abnormal labors and affords a valuable indication as to the time and necessity for operative interference, for obviously the undue continuation of this condition would very readily result in the production of a

rupture of the uterus. Indeed, Bandl first witnessed this sign after such an accident. In normal labors, the presenting part passes into the pelvic cavity and fills out the cervical canal equally, thus preventing the occurrence of a transverse furrow. He has seen this furrow in several cases where there was an excessive obliquity of the pelvis and consequent anteversion of the uterus, a condition simulating in its influence on the progress of labor the minor degree of contracted pelvis.

INCARCERATION OF THE PLACENTA AT FULL TERM.

Dr. G. W. H. Kemper (American Practioner), (Detroit Lancet), makes, from his studies, observations as follows: (1) A very large majority of the cases of placental adhesion are amenable to treatment. (2) Although comparatively rare, yet occasionally cases of adherent placenta do occur which resist our best efforts for its detachment. (3) The physician is not justified in leaving such a case unless, after using milder means, he introduces his hand into the cavity of the uterus and make proper efforts to detach and remove the placenta. (4) Having done this much and his efforts proving unavailing, he is not censurable for his failure. Post mortem conditions confirm this assertion. (5) A very guarded prognosis should be given. A woman with the third stage of labor incompleted is always in a critical condition. (6) In the treatment, the words of Blundell are true wisdom: "Leave the placenta in the uterine cavity if it cannot be removed without the risking or bruising or lacerating the uterus, not because it is not an evil to leave it there, but because to leave it in the uterus is a smaller evil than to abstract it with violence; and we had better abide by the smaller evil than to expose ourselves to the greater evil-that of lacerating, bruising and killing."

EDITORIALS.

PREVAILING DISEASES.

PNEUMONIA. Recent reports from different States indicate that this disease now prevails to a greater extent than at any period for many years. There are two varieties of Pneu