DRAINAGE, IMPORTANCE OF, IN THE TREATMENT OF DISEASE OF THE UTERUS.-(W. S. Wiley, M. D., in American Journal of Obstetrics.)

I. Perfect drainage of the uterine canal is of the utmost importance in all diseases of the endometrium.

2. It has been practically overlooked by gynecologists and its importance disregarded in treatment.

3. It can best be secured by free dilatation by means of a steel dilator used once a week, not too near menstruation, and supplemented by hard-rubber drainage plugs, curetting and intra-uterine applications if indicated.

4. In many cases to-day being treated by the use of pessaries, and called cases of anteflexion and retroversion and flexions, all symptoms can be permanently cured in a few weeks by the use of the dilator, the drainage plug, curette, and simple intra-uterine applications properly made.

5. Sponge or other tents left in the os, and obstructing drainage for more than a few hours, should never be used, for they not only obstruct the drainage, but are liable to cause uterine contractions, and force the contents of the uterus out through the Fallopian tubes, and cause local peritonitis, etc.

6. The same objections are applicable to vaginal or uterine tampons, so frequently used to stop uterine hemorrhage, as have been made to the sponge tent, and that by the proper use of hot intra-uterine douches of 120° after dilatation, or by tying or compressing with forceps the circular or other large arteries, with very rare exceptions all uterine hemorrhages can be controlled; and if a tampon is used, it should be left in place only a few hours, and of course be prepared by being soaked and squeezed out in a solution of bichloride of mercury or some reliable antiseptic.

7. With few exceptions, the many cases of chronic uterine catarrh treated by the use of hot douches, rest, and iodine to the vaginal vault, can readily be cured by, first, improving the circulation of the pelvis by means of boroglyceride and alum solution applied twice a week, on long firmly rolled cotton pledgets; and, second, by dilating with a steel dilator about two or three times a month, and properly making simple carbolic acid intra-uterine applications, and if indicated, the use of the curette and hard-rubber drainage plug.

8. That the same treatment will give better results in those obstinate cases of chronic uterine disease in which the use of chromic acid, nitric acid, and other strong caustics, or the actual or galvanic cautery has been resorted to.

RESUSCITATION OF ASPHYXIATED INFANTS.-Alexander Duke, M. D.—As an addition to the plans in general use for the resuscitation of an asphyxiated infant, I suggest the following method, which I have found both simple and effective in all cases where I could hear the heart's beat. Directly the infant is born, and I see no signs of life, I request the nurse to take charge of the uterus, and thus proceed: Should I find the funis pulsating strongly, I wait till this has almost ceased, and then divide it. I then raise the limp and flaccid body of the infant and, turning it face downward, with arms and legs pendant, allow the thorax alone to rest across the open palm of my left hand, and at intervals of five seconds (which I measure by counting slowly), compress the ribs with my hand, as one would work a rubber syringe. While my left hand is thus fully occupied, the position of the head allowing the tongue to fall forward and facilitate the escape of mucus from the mouth, I cleanse the lips of infant with napkin held in my right, and insert my indexfinger well into the pharynx, so as to establish the "atmospheric highway." I then proceed to change the child to my right hand, so that the tips of my fingers, resting near the heart, will at once detect any improvement in its action. If I do not find this satisfactory, I plunge the child into a large basin of hot water, rubbing the chest and back vigorously; the latter I consider more important as the friction to spine without doubt stimulates the respiratory powers, and a little spirit poured over the back by the nurse and well rubbed in, is also efficacious (in conjunction, of course, with the artificial respiration, which has been kept up as regularly as possible).

Some years ago, while assistant master at the Rotunda Hospital, I was called to a case of post partum hemorrhage, and having attended to this, which took some considerable time, I inquired where the infant was, and was told it was still-born. I found it under the bed, with a heap of soiled linen; fortunately, the heart still beating, though very feebly. By adopting the treatment I have endeavored to describe, I had the satisfaction of saving the infant's life. In conjunction with the treatment before enumerated, I have

sometimes found it advantageous to suspend the infant by the legs, downward, with back close to fire, keeping up respiration with the free hand. It is most important that the infant should respire fully and shout lustily, so as to fill the lungs with air. The disregard of this measure frequently gives rise to what is known as atelectasis, which defect in the respiratory function lasts through life.

CHLORIDE OF ZINC AS A CAUSTIC IN CANCER OF FEMALE GENERATIVE ORGANS.-Dr. Braithwaite, in Br. Med. Jour., read a communication on cases illustrating the advantages derivable from the use of chloride of zinc as a caustic in cancer of the female generative organs. 1. When the knife could be used it was usually preferable to employ it, and only resort to the zinc upon the first appearance of a return. 2. In some cases the zinc should be the first, and, indeed, only weapon used, as in commencing cancer of the cervical canal of the uterus, when, from any cause, the organ could not be pulled down into view, as when the uterus was fixed by old inflammatory adhesions. In commencing cancer of the vulva or vagina, if the disease were superficial and not of great extent, this treatment alone was necessary, but it might or might not be preceded by erasion a few days before. 3. It should be applied by means of a very thin layer of cotton-wool, wetted with the zinc solution and lightly pressed between two pieces of blotting-paper. It then did not run. 4. A saturated solution should be used. fluid resulting from the deliquescence of the solid, was the most convenient form. 5. The caustic required time. Usually, in twentyfour hours it had acted sufficiently, but if a deeper action were required it might be left longer. 6. Its use was followed by great contraction of the parts-a safeguard to some extent, against the return of the disease. In this, as in other respects, it was superior to Paquelin's cautery, acid nitrate of mercury, and potassa fusa. One case was related in which a slough was made of the whole interior of the uterus, not too deep to be dangerous, but sufficient to remove the surface and some of the adjacent tissue. The patient was being weakened by hemorrhage, and poisoned by absorption of the sanious discharge.

The

Mr. C. J. Wright asked Dr. Braithwaite whether he had used the chloride of zinc in conjunction with a previous application of a strong solution of the protosulphate of iron-a method which he

himself had largely used in cases of carcinoma uteri, especially where the cervix was mainly or solely affected. He removed the disease with scissors and curette, and then applied a tampon with the iron solution, leaying it in situ for two days. He next applied the zinc chloride in the same way, and left it for the same length of time. Upon removal, a large slough came away, which was really a considerable portion of the uterus. With this method the eschar

was deeper and the pain less. He also asked what precautions were taken to prevent the spread of the caustic beyond its proper object and limits, and advocated the use of a pomade or solution of bicarbonate of soda.

Dr. White related a case of continuous metrorrhagia, possibly from sub-involution, in which, after other methods had failed, a plug of zinc chloride, made up with a paste of flour, brought away a complete cast of the uterus, and entirely arrested the hemorrhage, which had not recurred.

Mr. Croft thought that Dr. Braithwaite had somewhat overstated his case as regards the question of pain. At any rate, in those cases in which he was associated, where the disease affected the vagina, the pain was severe, morphine being required for two or three days afterwards.

Dr. Braithwaite, in reply, said that in many cases, at any rate, the pain was slight. He thought that bicarbonate of soda neutralized the effect of the zinc chloride. He regulated the action of the caustic by using a small quantity, which answered just as well. He freely admitted that in every case where the knife could be used, it should be used. In uterine surgery the knife could not be used so freely or repeatedly as in other regions. He referred to a case of breast cancer which recurred after excision, and was perfectly sound when seen five years after treatment by caustics. His method was not dangerous in deep parts, the slough being only about one-sixth of an inch in thickness. It was said that the relief was temporary. Was that not the case in all cases of cancer? At any rate, the relief was marked. As regards the reproach that it was unscientific, he was of opinion that patients would prefer to be cured by methods that were unscientific rather than be left to die, because the only available means of cure rested under that terrible stigma.-Archiv. of Gyn.

DR. MEIG'S METHOD OF PREPARING BABY-FOOD.-Dr. Arthur V. Meig's directions are as follows:

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"One quart of good ordinary milk is placed in a high pitcher, or other vessel, and allowed to stand in a cool place for three hours; then one pint is slowly poured off from this, care being taken that the vessel is not agitated, the object being to obtain the upper layer of fluid, rich in fat, and leave the lower, comparatively poor portion, behind. When the child is to be fed, there are taken of this weak cream three tablespoonfuls, of lime water two tablespoonfuls, and of sugar-water three tablespoonfuls. The sugar-water is to be made in the proportion of eighteen drachms of milk-sugar to one pint of water. This makes only four ounces of food, and if the infant is old enough to require eight ounces at once, double the quantity of each of the ingredients must be mixed. This is simply warmed in a bottle, as usual, and is then ready for use."

DYSMENORRHEA.-Dr. Towsend, of Albany, in the American Journal of Obstetrics, writes a report of eighty cases in which he favors for dysmenorrhea, rapid dilatation of the uterine canal and the subsequent wearing of a stem pessary for a few weeks. He claims to have had most excellent results in dysmenorrhea in the unmarried, and in sterility with or without painful menstruation in the married.

Of the fifty-seven virgins operated upon, all but four were completely cured; of the twenty-three married women all were cured of their dysmenorrhea, and seventeen of their sterility also. Whether these women would have become pregnant without undergoing an operation is negatived by the fact that the average duration of their married life had been five years; their average age was twenty-nine, and their average date of conception was six and one half months after the dilatation.

The doctor chooses for the operation the week after the monthly period, in order that the uterine tissues may be healed before the next flow. He takes the usual antiseptic precautions, and has the bladder and rectum emptied. His armamentarium is limited, consisting of Sims' speculum, a tenaculum forceps, large and small size of Goodell's modified, Ellinger's uterine dilators with corrugated ends, plain vulcanite stem pessaries (not over one and a half inches