THE TREATMENT OF PLACENTA PREVIA.-Dr. J. Braxton Hicks thus summarizes his opinions upon the treatment of placenta previa : ist. After a diagnosis of placenta previa is made, proceed as early as possible to terminate pregnancy. 2d. If the os be fully expanded and placenta marginal, rupture the membranes and wait to see if the head is soon pushed by the pains into the os. 3d. If there be any slowness in this respect, employ forceps or version. 4th. If the os be small and placenta more or less over it, the placenta is to be carefully detached from around the os; if no further bleeding occur, wait an hour or two. Should the os not expand, and if dilating bags are at hand, the os may be dilated. If the forceps can be easily applied, they may be used; but if not, version by the combined external and internal method should be employed, and the os plugged by the leg or breach of the fetus; after this is done the case may be left to nature, with gentle assistance, as in footling or breach cases. 5th. If the os be small, and neither forceps nor dilating bags are at hand, combined version should be resorted to, leaving the rest to nature, gently assisted. 6th. If during any of the above maneuvres much bleeding should occur, it is best to turn by combined method in order to plug by the breech. 7th. Where the fetus is dead, or labor occurs before the end of the seventh month, combined external and internal version is the best method. 8th. If, however, a routine method is employed in all cases, it will be found that version by the combined method-no force following-gives a result as good, if not better, than any. After-treatment.-The after-treatment must be conducted on the modern principles; should oozing occur after the expulsion of the placenta, the swabbing of the lower uterus by styptics will be easy; and inasmuch as the outlet of the uterus is liable more especially to be blocked by adherent clots, it will be wise to irrigate the uterus daily with some antiseptic solution, or insert iodoform pessaries in the vagina, particularly if the irrigation cannot be done.-British Medical Journal. THE TREATMENT OF SMALL CYSTIC TUMORS BY INJECTIONS OF CHLORIDE OF ZINC.-The treatment of small cystic tumors, such as ganglion, hygroma, ranula, etc., is frequently attended with greater difficulties than that of larger growths. Both the surgeon and patient are anxious to avoid an extirpation; the former on account of frequency of recurrences, and the latter in consequence of the scars that so frequently result. In young ladies in whom ganglia occur, especially on the back of the hand, it is doubtful whether the resulting cicatrix is not as much of a deformity as the former globular swelling, and a scar over the knee is as inconvenient to a servant girl as an old hygroma. It is not therefore surprising that the injection method has, to a great extent, replaced extirpation. The author formerly injected tr. iodine or carbolic acid or alcohol, but had recurrences in one-third of the cases. Since a year he has resorted to injections of chloride of zinc in o. I per cent. solution with very satisfactory results. Conformably to the size of the tumor he injects 0.21.5 ccm. of the solution (without previous injection of cocaine). Occasionally repetitions of the injections are required. The immediate effects are slight. Scarcely any pain is experienced. The cyst becomes firmer, and the surrounding parts edematous, the edema subsiding in a few days. The cyst shrinks during the following four or five weeks, and finally disappears completely. The author has successfully treated in this manner five ganglia on the back of the hand, three house-maid knees, hydrocele in a child six weeks old, one ranula. He recommends the method as convenient, reliable and unattended by irritation.-Deut. Zeit. f. Chirurgie-Int. Jour. Surg. TREATMENT OF PROLAPSUS OF THE RECTUM IN CHILDREN.-In persistent cases of this affection in children, in which the various palliative measures of treatment have failed, the safest and most satisfactory method consists in the application of nitric acid to the mucous membrane of the prolapsed gut. It is applied as follows: the child's bowels are moved by the administration of a dose of castor oil, or by the use of an enema, the patient is then anesthetized, and the surface of the prolapsed bowel carefully dried and cleansed of mucus by wiping it gently with absorbent cotton. The whole of the mucous surface of the exposed gut is next painted with nitric acid, applied by means of a camel's hair brush or a swab of cotton, care being taken not to allow the acid to come in contact with the skin adjacent to the verge of the anus. A pledget of oiled cotton or lint is now introduced into the central depression of the prolapsed mass, and by pressing it upwards with the finger the bowel is reduced. A compress of lint is then placed over the anus and held in position by bringing the buttocks together by broad strips of adhesive plaster. The bowels are kept quiet for two or three days, and then opened by the administration of a small dose of castor oil. A recurrence of the prolapsus may take place with the first few passages, but a permanent cure is generally effected by one application of the acid; should this not be the case, the cauterization may be repeated at the end of a few weeks, and even in the most aggravated cases a second or third application will be followed by a satisfactory result. LET CONGENITAL ATRESIA OF AUDITORY CANAL ALONE. (A. D. Williams, M. D., in St. Louis Med. & Surg. Jour.)-I have seen several cases of congenital atresia of auditory canals, but have never ventured to operate on a single case and have always advised against any surgical interference whatever. My chief reasons for so advising are: 1o. It is practically impossible to keep a meatus made with the knife, permanently open. 2o. It is found that in all such congenital deformities many essential deeper parts of the auditory apparatus, are either entirely wanting, or so modified that they are useless. If an artificial meatus could be established, audition could not result. 3°. In such deformities the natural relations of the parts are so changed that it would be very dangerous to cut into them at all, for fear of striking vital structures. In an elaborate article on this subject (Arch. Otol., Sept.-Dec., 1889), Dr. Eugen Goel, of Silesia, sums up all the clinical and post mortem facts thus far established, giving a table showing the actual condition of eleven carefully recorded cases, and concludes, so far as surgical interference is concerned, in these words: "The cases of malformation which show externally a rudimentary auricle and an atresia of the auditory canal, should be an absolute noli me tangere for the surgeon." He further concludes that the malformations are the result of inflammatory processes in embryonic life. 17 SOLUBLE RELIABLE PERMANENT WM. R. WARNER & CO.'S SOLUBLE COATED GRANULES PREPARED ESPECIALLY FOR PRESCRIBING. 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PANCREATIN.—The albuminoid principles of the Pancreas;- promotes intestinal digestion; transforms starch into sugar and dextrine; converts proteids into peptones; emulsifies fat; curdles the casein of milk; and in general exhibits all the important functions of this organ. In the presence of an alkaline solvent this action is largely increased. CEYLON CINNAMON.-Valuable in atonic conditions of the intestinal mucous 'membranes with flatulence and diarrhea. SPIRITUS VINI GALLICI.—Simple Elixir with Oil Mentha Piper. This men. struum will especially commend itself to physicians. SOLD IN ONE AND FIVE POUND BOTTLES. TRUE SALICYLIC ACID. CRYSTALIZED FROM WINTERGREEN OIL-ITS NATURAL SOURCE. DR. P. W. LATHAM, Downing Professor of Medicine at Cambridge (England), lecturing on the treatment of gout and rheumatism at the Royal College of rhysicians, says: "The True Salicylic Acid obtained from the vegetable kingdom must alone be employed. If you have to give large doses, avoid giving the artificial product obtained from carbolic acid, however much it may have been dialyzed and purified. Give the acid without any alkali or base," etc. A reprint of this exceedingly valuable paper will be sent on application. A DESIDERATUM not always appreciated: The quality of medicines used in the prescription is as important a factor in the cure of disease as a correct diagnosis; and a physician violates no code, either of ethics or morals, in demanding of his druggist that which he knows to be reliable, instead of leaving to the latter to decide whose preparations he shall or shall not use. THE WM. S. MERRELL CHEMICAL CO. Manufacturing Chemists, Laboratories: CINCINNATI, New York Office and Warehouse: 96 Maiden Lane, NEW YORK CITY. |