which act as stimulants to both circulation and respiration. As a cardiac stimulant and tonic, strychnine is inferior only to digitalis, and should always be used when there is exhaustion in pneumonia. Cocaine resembles strychnine in its cardiac action; atropine as a heart stimulant is decidedly inferior, but exceeds both strychnine and cocaine in its influence upon the vaso-motor centres, and is, therefore, especially applicable to those cases in which collapse occurs or is threatened at a time of crisis, at which period its power of checking excessive sweating often gives it further advantage. Of these alkaloids atropine is probably the most active in increasing respiratory movements in the normal man, but it has less power in asserting itself in the face of opposition than has either strychnine or cocaine, and is, therefore, practically less available. Strychnine seems to be more active and efficient than cocaine, and does not, as does cocaine, produce cerebral excitement. Caffeine can not be looked upon as a powerful respiratory stimulant, but affects decidedly the cerebral cortex, and, therefore, if employed at all, must be used in small dose as an adjuvant, or in special cases when it is desired to overcome stupor.-Drs. Wood and Fritz, The Practice of Medicine.

A MOST VALUABLE RECONSTRUCTIVE.

As a remedy in phthisis, cod-liver oil holds the first place, yet there are physicians who have abandoned it as useless. Their error lies in forgetting that it is not adapted to all stages of the disease; that while it is highly useful in the chronic formfibroid lung and chronic tuberculosis-it is not always serviceable is caseous pneumonia or acute phthisis. It has also been too often prescribed in its crude form, and thus the patient has acquired a disgust for it and the physician lost faith in it. Various attempts to emulsify it have been made, so as to render it more acceptable and more easily borne. Emulsions with alkalies have been made, but the patient would derive about as much benefit from soap as from these. In the preparation of hydrated oil (Hydroleine) the important point of presenting the oil to the lacteals as nature elaborates it seems to have been attained. Besides containing Pancreatine it is in every way a most satisfactory and acceptable preparation. It is highly useful in a variety of diseases, notably those characterized by wasting.-Massachusetts Medical Journal.

CONTRAINDICATIONS OF ALTITUDE IN PHTHISICAL CASES.

1. Phthisis with double cavities. 2. Fibroid phthisis and all other conditions in which the healthy pulmonary area hardly suffices for respiratory purpose at sea level. 3. Catarrhal and laryngeal phthisis. 4. Acute phthisis of all kinds, especially when associated with nervous irritability. 5. Phthisis with pyrexia. 6. Emphysema. 7. Chronic bronchitis and bronchiectasis. 8. Organic diseases of the heart and great vessels. 9. Disease of the brain and spinal cord. 10. Anæmia. 11. Patients too feeble to take exercise. 12. Patients who have degenerated organs from long residence in tropical countries.-C. T. Willams in Medical Record.

OBSTETRICAL.

VINEGAR AS A HEMOSTATIC.

I wish to confirm the article I saw in your valuable journal a few days ago concerning the use of vinegar as a uterine hemostatic. My faith is so strong in its favor that I have never used anything else for the past four years.

I use it in a fountain syringe, diluted, equal parts, with hot water. I push the nozzle well up into the womb when the hemorrhage is post-partum.

When there is an abortion on hand and the placenta is loosening and coming away piece at a time, which process, as every physician knows, sometimes requires days to complete. I use intra-uterine injections by means of a fountain syringe and uterine irrigator.

If there is no immediate danger I attempt to clear the uterine cavity by dilating the os and using a curette, but where there is threatened syncope and a general anemic condition this procedure might prove fatal, and in such cases I use my injection and place a tight tampon.

In all cases (and there are a great many I might relate, but it would require too much space) I have returned inside of twentyfour hours and found my patient quiet, free from pain, with a

good pulse, etc., and on removing the tampon found the fragments outside of the cervix and no hemorrhage except a small black clot.

Cessation of the pains is an indication for removing the tampon. Afterwards I use injections of only hot water.

In post-partum hemorrhages I do not use a tampon, but will repeat the injection if necessary.-C. S. Estep, M.D., in Medical Council.

MISSED ABORTION.

Dr. Eccles, of London, read a paper on this subject. He reported three cases which he had seen in consultation, in the practice of Dr. Moore; another, that of Dr. English, and a third in the practice of Dr. Ferguson, all of London. The first ran into a chronic septic condition, but, after emptying of the uterus, the patient speedily regained her health; the second attracted attention from the frequency of uterine hemorrhages, and the contents of the uterus were removed with difficulty, the placenta being detached piecemeal; in the third case there was a history of menorrhagia, and, after a period of six months, a severe hemorrhage, followed in thirty-six hours by the expulsion of the placenta and membranes en masse, the embryo being absent, having doubtless been extruded or absorbed at an earlier date. Considering their not infrequent occurrence, Dr. Eccles remarked that medical literature was surprisingly barren of any reference to the subjects of missed-abortion, etc.-Medical Council.

INDUCTION OF PREMATURE LABOR.

T. Arthur Helme (Lancet, October 3, 1896, p. 936) describes a modification of Pelzer's method of inducing labor by the injection of glycerine. The modification consists of the injection of glycerine into the cervix instead of carrying the syringe tube up into the uterus. His conclusions are (1) that the intra-cervical injection of glycerine produces a rapid and progressive dilatation of the cervical canal; (2) that at the same time the lower pole of the ovum becomes detached from the lower uterine segment; (3) that the intra-uterine injection of glycerine between the detached portion of the membrane and the uterine wall may be carried out without fear of puncturing the membranes or of

interfering with the placental attachment; and (4) that labor is effectually induced.

Helme makes repeated injections of 1 ounces of pure glyce rine.-The Boston Medical and Surgical Journal.

A PRACTICAL METHOD OF HUMANIZING COW'S MILK.

The happy results which have followed the use of cow's milk which has been modified so as to conform closely to mother's milk have induced Dufour (Rev. Men. des Malad. de l'Enfance, September, 1896.) to seek out a practical method for the humanizing of cow's milk in any family. As is well known, cow's milk differs from mother's milk in containing an excess of proteids and salts, while it is deficient in sugar. The amount of fat in the two is essentially equal.

Dufour takes a large graduate which contains about two liters and has at the bottom a spout closed by a cork. Into this he pours the quantity of milk suitable for an infant of the required age for one day. The vessel is tightly covered and set away in some place which is cool in summer but moderately warm in winter. After about four hours the cream will have risen. Through the spout at the bottom one-third of the milk is now drawn off, a quantity of water is added equal to the milk which has been withdrawn, and 35 grams of milk sugar and 1 gram of salt per liter. The whole is mixed by shaking and poured into sterilized bottles. If the infant does not gain weight as fast as it ought, one to two spoonfuls of fresh cream should be added to the day's allowance of milk.-New York Medical News.

THE CHOICE OF VERSION OR FORCEPS IN MODERATE PELVIC

DEFORMITY.

In the British Medical Journal, 1896, No. 1870, is published a paper by Milne Murray, in which he advocates the use of forceps in cases of flattened pelvis in which the head presents transversely in the pelvic brim. Murray states that the choice of version in these cases has been based upon the belief that the forceps, applied in the antero-posterior diameter of the head, tends to compress it antero-posteriorly, and to cause a bulging of the transverse or biparietal diameter. This would increase the difficulty of extraction, as the biparietal diameter is already

brought into relation with the smallest diameter of the pelvic brim. Murray doubts the truth of this belief, because he has shown by experiment that when the head is grasped over the occiput and forehead that the occipito-frontal diameter may be compressed one and one-half inches without increasing the biparietal. A vertical and not a transverse expansion results. The various segments of the cranium slide under each other in a telescopic manner.

To succeed in delivering the foetal head presenting transversely in the brim of a flattened pelvis the forceps must not only grasp the head in its antero-posterior diameter, but must also make traction downward and backward in the axis of the pelvis. The head naturally passes through the brim, in these cases, by an exaggeration of Naegele's obliquity, by which the posterior parietal eminence pivots against the promontory of the sacrum, while the anterior moulds itself against the pubes. Murray stated that he had delivered living children where the antero-posterior pelvic diameter was three and one-quarter inches, and even as little as two and three-quarters inches. To secure perfect axis-traction he has attached to his forceps a handle which is movable upon a right-angled traction-bar; by this means he can vary the direction of his traction to suit the abnormalities of the pelvis.

In discussion, Fothergill and Cameron agreed essentially with Murray. Kerr thought that success in such extractions was obtained by rotating the head obliquely into one of the oblique diameters of the pelvic brim. He thought that it is rare to find the two halves of a pelvis of equal size, and that in difficult labor the head will enter the larger portion of the pelvis. He believed that the head rarely passed through the pelvic brim in a strictly transverse position.

(The editor, from his experience, is inclined to indorse the views of Dr. Kerr on this question. While it is no doubt possible to deliver the head in many cases as Dr. Murray indicates, still in many others the head moulds itself into an irregular, oblique position. The suggestion of Dr. Murray that the line of traction should be strongly backward as well as downward is most valuable. In a recent case, in a flat pelvis where the first child had been lost by pressure, and where others had failed with for