CLINIQUE.

GYNECOLOGICAL RETROSPECT. By MRS. J. G. BRINKMAN, M. D., N. Y. Amann (Munich), on the mechanical treatment of versions and flexions, claims that the cure of uterine malposition is only to be obtained through intra-uterine treatment. He thinks mechanical treatment necessary, even in complicated cases where textural changes have recurred in the uterus and its surroundings, and considers that it favorably affects these complications. He makes a point of having the staff of the pessary shorter than the uterine canal, and thus avoids friction. A description of his method of treatment may be found in the Am. Obst. Jour., 1878.

In a paper on the use and abuse of pessaries (Lancet, Feb., 1878), Dr. Bantock, while advocating their use, considers that their abuse arises from the improper selection of cases; the use of an ill-fitting instrument and the misuse of one properly fitting. While they are capable of doing much good, it must not be forgotten that they are equally capable of much injury in the hands of the ignorant or careless.

The use of the intra-uterine stem has been largely discussed in the Am. Gyn. Trans., vol. 2. Dr. Van de Warker presented a special plea for its use. The paper with the discussion occupies forty-five pages of the volume, which is an indication of the interest felt on this subject. Dr. Noeggeroth stated that operations on the cervex do often cure dysmenorrhoea, no matter what the method is, not by in any way correcting the position of the uterus, but by their effect on the vaso motor and other nervous centres.

Dr. Graily Hewitt (Lancet, Dec., 1877) remarks if it be a fact that mechanical diseases almost never recur unless in cases where the general nutrition of the body is at a low ebb, the greatest care is necessary on the part of those having the responsibility of the training of young women to nourish and strengthen the body. He calls particular attention to the insidious effects of prolonged uterine nausea in producing a kind of semi-starvation. As regards treatment in these mechanical diseases, some require little, while others are cured with great difficulty. Duration is an ele ment of importance. The consistence of the uterus is a matter much affecting treatment. If the uterus be still softer than normal it is a hopeful feature in the case, although it may take some months of general treatment to restore its tenacity, but the cure of the flexion is more easy. If the uterus be very firm, atrophy at the seat of the bend is more apt to coincide. A want of attention to these considerations will involve disappointment in many cases. Postural treatment he considers of the utmost importance in all cases. As regards the use of pessaries, when the uterus is soft they may do good service, but when the flexion is chronic, he thinks the uterus should be straightened by the sound, or by the use of tests. He strongly recommends a generous diet, and also points out the fact that while fresh air is essential long walks or long carriage rides are inadmissable.

the vagina. (Iodide, Bromide, Ferrocyanide of Potassa and Salicylic Acid.

The New York Medical Record, Feb., 1878, has a report of three cases of pudendal hematocele in virgins; they all occurred upon the right side.

Am. Gyn. Soc. (Trans. 1878), Dr. Emmet reports an innovation in the procedure for the restoration of the vaginal canal in absence or atresia of the vagina. He makes a free opening, and washes out the cavity, thoroughly, with warm water. The site of the constriction, if one exist, he opens more widely than any other part of the canal, and completes the operation at one sitting, when possible. The operation is followed by the insertion of a large glass tube or plug, two inches in diameter, which is kept in position persistently. Dr. Emmet has had complete success follow this method of treatment.

The Am. Obst. Jour., 1878, has a reprint from the Wiener Med. Wochenschrift, 1878, of a paper by Louis Bandl, of Vienna, on the pathology and treatment of urethro-vaginal fistula, illustrating the value of Bozeman's method of operating. Only a few cases of urethro-vaginal fistula are on record. The author first reviews the relations of the opening of the urethra in cases of large vesico-vaginal deficiencies, and brings forward the views of distinguished writers regarding their treatment. In searching the literature of urethrovaginal fistula, Bandl found that not one case had been cured in the direct way. He wrote for advice to Bozeman, who replied, " Divide the urethra toward the bladder, freshen the edges, then to unite them." By strictly following out Bozeman's method, he had the satisfaction of making a perfect cure of his cases.

Braxton Hicks calls attention to the fact of general eczema existing frequently in connection with diabetes. It was present in nine out of ten of the patients who consulted him for eczema of the genitals. It is well known that eczema of the genitals has often been the first symptom which has led to the suspicion of diabetes; but in the cases reported by Hicks, the eczema existed so freely on parts remote from, as well as on the genitals, that it could not have been produced by saccharine urine. H. suggests that the frequency of the combination may be considerable when it is borne in mind that blood laden with sugar is most probably irritating, and, also, that pathologists incline to the opinion that both diseases are dependent upon neurotic states. Treatment of the eczema failed to relieve in these cases, while treatment directed to the diabetes was successful.

Gerhard Leopold, of Leipzig, has written an admirable paper on the condition of the mucous membrane of the uterus during menstruation, pregnancy, and childbed. (Arch ƒ Gynakologie, XI, 1; XI, 3; XII, 2,) of which the Am. Obst. Jour., 1878, gives extracts.

The author disproves the statement made by Williams (Brit. Obst. Jour., 1875), that the entire mucous membrane is shed during menstruation. Leopold's conclusions are based upon the observation of nineteen cases. They range from the first day of the flow to about the second day before the coming period.

Experiments have been made by E. M. Hamberger (L' Province Medicale), Dec., 1877, with the view of determining the absorbing power of the vaginal mucous membrane. The drugs were found in the urine in from two to three hours after their introduction into

The mucous membrane increases in thickness at the approach of the menstrual period, from two to three m. m. to six or seven m. m., gradually decreasing during the flow. At the end of the flow the mucosa is found devoid of its superficial layer, which resumes its normal condition within a day or two. The glands of the menstrual membrane become enlarged and tortuous the well known short fusiform cells with large nuclei, which are found in a condition of active reproduction in the lower layer in contact with the muscular tissue. In marked contrast to the frequency of the enlarged capillaries and arteries in the uppermost layers of the mucosa is the scarcity of veins, which appear only here and there, running in a direct course toward the muscularis.

or two.

The same process takes place in membranous dysmenorrhoea, in which all but the deepest layers are cast off. Not even in this condition is the entire mucosa expelled. From the eighteenth day on, the mucosa again begins to hypertrophy. Thus this membrane is in a condition of constant change.

CHOLECYSTOTOMY.

BY GEORGE W. BLODGETT, M. D., Formerly House Surgeon Homeopathic Hospital, Ward's Island; Resident Surgeon Hahnemann Hospital, New York. In the British Medical Journal for June 8th, 1878, Dr. Marion Sims, writing under the head of Re marks upon Cholecystotomy in Dropsy of the Gall Bladder," reports a very interesting case of obstructive disease of the gall-duct from biliary calculi, in which, after aspiration of the gall-bladder had once been per formed with temporary relief, the obstruction seeming permanent and death imminent, he resorted to incision of the gall-bladder and the establishment of a biliary fistula in the hope of thus relieving and prolonging the life of his patient.

At the time of operation there was a condition of profound cho'æmia, and although for the time marked relief was afforded, yet on the ninth day death resulted from cholæmic blood changes.

Dr. Sims, in commenting upon the case, states that, had the operation been attempted before the state of the patient had become deeply toxic, a different result might, in his opinion, have been looked for.

He speaks of cholecystotomy, together with antisepticism, as opening up a new and great field in abdominal surgery.

In biliary obstruction, hepatic abscess, or impacted gall-stone, he advocates exploratory incision of the abdominal walls for purposes of diagnosis, to be followed in proper cases by operative procedure. In cases of hepatic abscess the use of the trocar, the removal of impacted calculi, followed by the application of antiseptic sutures to the incision in the duct, and cholecystotomy for the relief of a distended gall-bladder with cholæmia.

Dr. Sims speaks of the operation as being entirely new in so far as he knows, and very properly names it cholecystotomy.

The Chicago Medical Journal and Examiner for September, 1878, in referring to Dr. Sims' case, says: "So much for the conception and execution of a new operation by an American surgeon, to which he has given a most appropriate name as above. With aspiration as a means of diagnosis and antisepticism as a means of safety, there seems no reason why it should not take its place with ovariotomy and other similar operations as a dernier resort, and at the same time as a most positive relief where it is appropriate." Dr. Sims operated April 18th, 1878.

Marked relief was obtained for a few days, after which the condition of affairs was as bad as ever. A second aspiration was followed by temporary relief, when again the patient sank to his former state.

It was evident that unless some permanent escape for the bile from the distended gall-bladder was fürnished, death would soon close the scene; another aspiration would but defer the evil day. An attempt at the establishment of a biliary fistula alone afforded a ray of hope for the now unconscious patient. Medical literature gave no mention of such an operation, yet the desperate nature of the case would seem to justify the attempt.

On the 4th of February, at 10 A. M., chloroform having been administered, assisted by Drs. Cowl and Cornell, of this city, I cut down upon the peritoneum, immediately over the distended gall-bladder. Hamorrhage having been checked, the peritoneum was divided upon a director and the gall-bladder brought up to the abdominal wound.

Without being opened, its walls, which were considerably thickened, were stitched to the integument along each edge of the incision by means of closely approximated horsehair sutures carried down only to the mucous coat. The irritation from the needle punctures and numerous sutures was relied upon to excite adhesive inflammation and secure union.

The reason for proceeding in this way was that the contact of gall with granulating surfaces might be avoided, and all possibility of its escape into the abdom. inal cavity prevented. Most of the contained bile was drawn off, a free opening to be made when the union should be complete.

No change for the better occurred after operation. The coma became more profound, and death from cholæmia ensued on the morning of the 7th.

A post mortem twelve hours after death gave no evidence of peritonitis. A marked degree of union had taken place; cancerous disease of the pancreas, involving the gall-duct, was found.

The exhaustive comments of Dr. Sims upon his own case are equally applicable to the one detailed above, in which the date of operation was more than two months earlier. Therefore the credit, if there be any credit, of being the first surgeon to conceive and execute cholecystotomy, belongs not to Dr. Marion Sims.

PROF. SIMPSON graphically describes the growth of the pregnant uterus, and its involution after delivery, It is a kind of physiological hypertrophy, unequaled, either in regard to its magnitude or its rapidity, in any other organ of the adult human body, for, during the forty weeks of utero-gestation, the uterus enlarges from nearly 3 inches in length and 14 inches in breadth, to 12 or 15 inches in length and 9 to 10 inches in breadth. It increases from about 2 ounces in weight, to 25 or 30 ounces. The cavity of the uterus before impregnation is less than one cubic inch; while, at the full term of pregnancy, it is extended to above 400 cubic inches, and the surface of the organ increases, from about 5 or 6 square inches, to nearly 350 square inches. Before impregnation, the uterine cavity would not hold above a drachm or two of fluid; at the end of the ninth month of utero-gestation its contents usually weigh from 120 to 150 ounces.

The rapidity, however, with which the uterus diminishes in size after delivery is perhaps still more mar

velous than the rapidity with which it increases in size after impregnation, for, while it takes forty weeks to attain the dimensions of the fully developed uterus of pregnancy, it requires only from four to eight weeks to decrease to the small size of the same organ in its impregnated condition. D. S. NELSON, Chicago Med. Ex. MILK.It is said that the milk from Alpine dairy farms differs from other good milk merely because it contains a high percentage of sugar of milk, and because it possesses a peculiar flavor, derived from the aromatic plants on which the animals feed.

MERE KNOWLEDGE A WAX NOSE.-Mere acquired knowledge belongs to us only like a wooden leg and a wax nose. Knowledge attained by means of thinking resembles our natural limbs, and is the only kind that really belongs to us. Hence the difference between the thinker and the pedant. The intellectual possession of the independent thinker is like a beautiful picture, which stands before us, a living thing, with fitting light and shadow, sustained tones, perfect harmony of color. That of the merely learned man may be compared to a palette covered with bright colors, perhaps even arranged with some system, but wanting in harmony, coherence and meaning.

UTILIZING NIAGARA FALLS.-Sir William Thomson

said he was of opinion that a great deal of natural energy which was now lost might be advantageously applied in the future to lighting and manufactures. There was a great deal of energy in water-falls. In the future, no doubt, such falls as the Falls of Niagara would be extensively used-indeed, he believed the Falls of Niagara would in the future be used for the production of light and mechanical power over a large area of North America. The electricity produced by them might be advantageously conducted for hundreds of miles, and the manufactories of whole towns might be set in motion by it. Powerful copper conductors would have to be used-conductors of a tubular form with water flowing through them to keep them cool. There would be no limit to the application of the electricity as a motive power; it might do all the work that could be done by steam engines of the most powerful description. It seemed to him that legislation, in the interests of the nation and in the interests of mankind, should remove, as far as possible, all obstacles, such as those arising from vested interests, and should encourage inventors to the utmost. As to the use of electricity by means of the Falls of Niagara, his idea was to drive dynamic engines by water-power in the neighborhood of the falls, and then to have conductors to transmit the force to the places where illumination or the development of mechanical power was wanted. There would be no danger of terrible effects being brought about accidentally by the use of such a terrific power, because the currents employed would be continuous and not alternating."-Nature.

INTESTINAL GAS-COLOCYNTH.-Dr. Eads in a case of the above character prescribed tinct. Colocynth gtt x. water iv. a teaspoonful every three or four hours until relieved. Next day found his patient perfectly free from pain, no wind in stomach or bowels, the first permanent relief obtained for two months. When her babe was about three weeks old, it began to suffer very much like the mother. Colocynth gtt i j water 3 ii a teaspoonful three times a day gave prompt relief, and both have remained well for nine months. He believes Colocynth to be a specific in the above con

.dition.-National Medical Review.

[A very good homeopathic prescription, but he will be disappointed in the next unless it is individualized. Colocynth is a specific, but not the specific in such cases.-ED.]

SLIGHTLY AMBIGUOUS.-An enterprising druggist advertises his cough medicine in the following manner: Cough while you can, for after you have taken one bottle of my mixture you can't."

MAKING SOUND VIBRATIONS VISIBLE.-Bend the forefinger of the hand so as to form a circle, with the other hand draw over the aperture a film of soapsuds. By turning the wrist, the angle made with the direction of the light may be readily adjusted; a motion of the elbow alters the distance from the mouth, and the tension of the film can be exactly regulated by moving the thumb and finger. On singing or speaking to the film when in proper tension, beautiful figures" appear, which may be reflected direct to a screen.

HYPODERMICS OF COFFEE FOR MORPHIA VOMITINGS AND OPIUM POISONING.-I gave a warin hypodermic, of twenty minims, in the epigastrium, and in about fifteen minutes the patient expressed herself as feeling decidedly better, having vomited but once during that time. I then gave an additional hypodermic of fifteen minims (warm) in the abdominal parites. She was free from the nausea in less than an hour, and never vomited after the second injection of coffee.

Where the fluid was used warm, about the temperature of the body, no trouble manifested itself.-MONTROSE A. PALLEN, Medical Record.

DR. H. G. PIFFARD offers, as a convenient substitute for Fehling's solution, the following mixture, which may be kept ready made and may be carried in a small vial, to be used any time at the bedside in the house of a patient:

Take of sulphate of copper (C. P.) one part; crystallized tartrate of sodium and potassium, five parts; sodic hydrate (C. P.), two parts. Mix well in a mortar. The resulting mass can be kept in a wide-mouthed bottle until wanted. For use, a piece the size of a pill is dissolved in a couple of drachms of water, in a test tube. A few drops of the suspected liquid are now added, when, if sugar be present, the usual reaction will be manifested.

VOMITING OF PREGNANCY-TREATMENT WITH WINE OF IPECAC.-Found she was pregnant with second child, first month of gestation. She was considerably emaciated; pulse small and thready, 115 per minute; tongue dry and furred, and great tenderness in pressing over epigastric region. She stated she had been vomiting, night and day, for a week, and would throw up everything she would eat; bowels constipated. Having used minute doses of ipecacuanha, in vomiting of drunkards, with success, I determined to try it in her case, and so ordered: Wine of ipecacuanha, gtis. xvj. ; aquafontis, 3ij., M., with directions to give one teaspoonful every hour, day and night, until vomiting ceased. Had no return of the vomiting, and is now perfectly well. I have since used the preparation in nausea of preguancy without vomiting, in which case it acted like magic.

I trust some of my professional brethren will give it a thorough trial, and if they meet with the same success that I have, they wil! always give homeopathic doses of wine of ipecacuanha in this troublesome and sometimes obstinate affection.-D. B. NESBIT, Southern Medical Record.

OPHTHALMIA IN NEW-BORN INFANTS.-Dr. Luton, of Rheims, advocates, in the Revue Medicale, the use of iodine dissolved in cherry-laurel water. Ten drops of the tincture in ten grammes of the cherry-laurel water make a colorless mixture, leaving no precipitate, while in the same quantity of distilled water a colored precipitate would soon form. The decoloration is owing to the production of hydriodic acid and iodide of cyanogen, two colorless bodies in solution. A mixture containing one part of tincture of iodine to twenty parts of cherry-laurel water is a collyrium of incontestible power, in the purulent ophthalaia of infants. The liquid is to be dropped between the lids five or six times a day, besides external applications. In efficacy it is declared to be superior to nitrate of silver, while it has the advantage of being both painless and safe.

Look at the errata of the thirty-two pages of Aconitum in Allen's Encyclopædia of Materia Medica, as pointed out by Dunham, and see whether our strictures are correct errata that should have been corrected before going to press.

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To tickle somebody's vanity, the profession is saddled with a so-called standard work — which is worse than none at all, on account of the errors it contains - when, by concerted action of competent hands, a much more complete and reliable work could have been accomplished. Jealousy and vanity were in the way of this, and for the time being, conquered, with what results time only will reveal.

We are sorry to see so much of the vulgar, slangy style predominating of late, and that, too, from some of our most scholarly minds. Slang and vulgarity may provoke a smile, but this is evanescent, and is sure to be succeeded by a thoughtfulness which will carefully weigh its cause, and place its author in the scale below where he really belongs.

What we need is more care in literary work, and this is born of thought, time and patience. In a profession like ours, dignity should constitute one of the advance guards.

INLAND OR SEA-SHORE.

The season rapidly approaches when we as physicians shall be looking around for a place to send our invalids for the heated term, and the first question which arises in our minds in each case is, shall it be inland or sea-shore? We must solve this problem by the aid of unprejudiced investigation.

One of our ablest authors once said to the writer that his earlier contributions to literature were many times re-written, some even as many as twenty. This fact accounts for the grace and elegance of construction, for the evidence of a master-hand which they contain, and is one of the reasons why the productions of this author have won the encomiums of the world for reliable scholarly maturity.

Condensation is an exceedingly difficult task for some, and forms a most important element in scientific literature. Persons inclined to verbosity, should rewrite and cut down their productions before expecting them to see the light which is to introduce them to the field of literature.

In the most kindly spirit we urge authors to re-read their productions with a view to erasure and interlineation, rather than with the feeling of satisfaction that improvement is impossible-a spirit which engenders egotism and conceit.

Many papers which inevitably see the waste-basket, on account of their style, by re-writing would make valuable contributions to literature, and redound to the credit of their authors.

Very much of our medical literature-magazines, books, etc.—is too loosely and hurriedly thrown to gether, and upon this some inexperienced individual succeeds to the title of author.

In a general way we say, change of air is the best

fited by a change from New York City to Long Branch, and we have known others who could not bear even this.

But supposing we have decided that a change to an inland atmosphere seems desirable, where is the best place? In our experience the Adirondack region is certainly one. Situated as it is at a varying altitude far above the sea level (1700 feet), this vast wilderness of 100 miles in diameter unites the beauties of nature with the pleasures of rural sojourn - its quiet and invigorating atmosphere, its opportunities for agreeable occupation in hunting and fishing (for this region abounds in fish and game)-to a degree not to be found in any other. Patients who have been accustomed to the bustle of city life will not be satisfiedand hence less likely to improve-in any place where there is not something to occupy their minds and give them pleasurable occupation, and we know of no place which presents so great a variety.

The whole region is intersected and diversified by a net-work of lakes and streams, which render it picturesque and beautiful in an almost unequaled degree. These systems of water communication afford very convenient means of transit for hunters and pleasureseekers, the lakes being connected by streams, in some cases navigable for bateaux, and in others broken by falls and rapids, around which boats and luggage must be carried.