diture of physical energy on his part. The writer has had excellent success with it. Subinvolution of the Uterus-How Is It Best Prevented? Dr. Joseph B. DeLee advises the following to prevent subinvolution of the uterus : 1. Avoid sepsis; conduct the labor with the same aseptic and antiseptic precau. tions that one uses in laparotomies. 2. Leave the case to nature as much as possible. Avoid practices to shorten the life of normal labors. 3. Avoid lacerations of the cervix. Re pair them if deep or if they bleed. Repair the torn perineum accurately. 4. Leave the uterus empty of clots, membrane, and placenta; therefore conduct the third stage of labor properly. 5. If the uterus does not decrease in size rapidly in the early puerperium give ergot. 6. Don't allow the patient to lie on her back too long. 7. Build up an atonic general system. These are my means of prevention, and I have had oniy two cases of subinvolution in twelve years' practice. Manual and Instrumental Dilatation of Newell (Journal A. M. A.) speaks of the various methods of dilatation of the parturient uterus, with special reference to the indications for and the results of the use of the steel dilators as a substitute for the manual method of dilation, particularly in those cases in which some urgent indication for the termination of pregnancy or labor is present. Such conditions, in a general way, are hemmorrhage, toxemia, and diseases complicated by pregnancy, to which must be added the condition of abnormal rigidity of the cervix which Nature fails to overcome even after a fair trial. There is no doubt that the hand is the best and safest dilator, but its usefulness is limited by the fact that it is easily exhausted. The author describes a dilator invented by himself. Edgar says that artificial removal of the barrier of the cervix can be accomplished in three ways, namely: (1) By stimulating the contractions of the uterus and increasing intrauterine pressure by the introduction of foreign bodies within the uterus, as the uterine bougie, the gauze tampon, or hydrostatic bags; (2) by overcoming the sphincter action of the cervix with the hands or metal instruments; (3) by incision of the sphincter, as in deep cervixal incisons, or vaginal Cæsarean section. Oophorectomy During Pregnancy. Abram Brothers (Med. Record) reports operating on a patient seven weeks pregnant for the removal of an intraligamentary cyst and bilateral oöphrorectomy. In operating he used the transverse incision, as he believed this incision guards The patient went to term and was delivagainst hernia in progressive pregnancy. ered of a living child. Sarcoma and Copulation. About twenty-five years ago the late Dr. T. Gaillard Thomas and the late Dr. Paul F. Munde expressed their divergent views as to the communicability of malignant disease of the genital organs in copulation. Of some apparent importance in connection with the question is a communication recently made to the Berlin Medical Society by Dr. Sticker (Semaine medicale, November 14). Sticker caused four dogs to copulate with a bitch that had sarcoma of the vagina. At the end of three months two of the male dogs were found to have sarcoma of the penis, and in one of them the situation of the tumor, which was as large as a mulberry, corresponded exactly to that of the disease in the female, In the other infected dog there were seven tumors, each as large as a lentil. Statistics of Gonorrhea in Men and of Its Consequences in Their Wives. Erb (Muenchener med. Woch.) found, from investigation of 2,000 of his male patients, that nearly one-half of them (48.5 per cent.) had had one or more attacks of gonorrhea. In 84.7 per cent. of these patients the disease had been acquired between the ages of sixteen and twenty-five, in 11.4 per cent. between twenty-six and thirty, in 3.2 per cent. between thirty-one and forty, and in 0.5 per cent. when over that age. Investigation of four hudred wives of men who had had gonorrhea some time before marriage showed that 375 (93.75 per cent.) were either healthy or were suffering from diseases not due to gonorrhea, seventeen (4.25 per cent.) were suffering from diseases which were either certainly or most probably of gonorrheal nature, while eight (2 per cent.) were suffering from diseases the gonorrheal nature of which was uncertain or improbable. In regard to childbearing, ninety-four of the 375 unaffected wives had borne four or more children, sixty-nine had borne three, and eightynine had borne two. It should be borne in mind that many had been married but a few years, the number of children was normal, and would naturally be expected to increase in time. Of the diseased wives eleven had borne no children, ten had one, two had two, and one three. Dermatology and Genito-Urinary Diseases. M. L. HEIDINGSFELD, M.D. Color Restored to the Hair by Means of the Imbert and Marquee (Annales de Therapeutique Dermatologique et Syphiligraphique, Vol. 6, No. 16, 1906) report that the beard of one of these investigators, which was formerly quite gray, grad. ually began to take on color, due, as they believe, to prolonged exposure to the X-ray. It was so marked as to attract general attention, and reached a deeper color than the hair originally had before turning gray. A fifty-five-year-old individual with lupus of the left cheek was treated with the X-ray and suffered an alopecia around the ear. The hair, which before the treatment was quite gray, returned very black in color. The hair of the mustache did not fall away, but also took on dark coloration. Prophylaxis in Syphilis. 10 per cent. calomel-lanoline ointment Apes which were inoculated with the same secretion showed typical lesions of syphilis; others, likewise inoculated, but also treated with calomel ointment, remained free from syphilis. Maisonneuve submitted himself to careful examinations for three months, without showing the slightest evidence of syphilis, and the wounds promptly healed within seven days. Spermathanaton. Braun (Die med. Woch., 1906, No. 13) recommends spermathanaton as a remedy for the prevention of conception, which holds for the purpose a place equally high for itself as condoms and pessaries. The tablets are introduced with the finger as deeply into the vagina as possible and remain active for twenty minutes. Irrigation post-coitus is unnecessary. The Maisonneuve (Paris, 1906) reports his remedy kills the spermatozoa, but is other experiments with 10 per cent. calomel. ointment as a prophylaxis in syphilis as originally recommended by Metchnikoff. Metchnikoff's original experiments were with mercurial ointment, but he found this was too irritating to the skin to be used as a general measure. Maisonneuve, after submitting himself to a careful personal examination in order to definitely preclude any evidences of syphilis, allowed himself to be inoculated in the sulcus coronarius on each side, from the virus of two initial lesions from two welldefined cases of primary syphilis in the presence of Metchnikoff and four other physicians. The skin was scarified and the virus thoroughly rubbed into the abraded surface. One hour after the inoculation the parts were treated with a wise absolutely aseptic in character. The author recommends them as reliable, efficient and harmless. He reports eleven cases successfully treated where pregnancy otherwise was always the prompt order of things. Improved Spirochaeta Pallida Staining. Hoffmann and Halle (Münch. med. Wochenschr., No. 31, 1906) report an improved technique for staining spirochaeta after the method of Weidenreich for staining blood preparations. Place in a shallow dish 5 c. c. of 1 per cent. solution of osmic acid and add ten drops of glacial acetic acid; place some slides over the dish and cover same with a petrel dish, in order to prevent the evaporation of the osmic acid. After the slides have been exposed to the action of osmic acid for'at least two minutes, the secretion is rapidly spread, best at one stroke, by means of a platinum blade or a cover-glass on the side of the slide exposed to the action of the osmic acid, which is returned to its former position at the most for two minutes for proper fixation. Preparations are then dried without heat and placed for one minute in a thin light-red solution of permanganate potash, washed with water and dried with blotting paper, and stained with eosin azure after the method of Giemsa. The preparations can be fixed with formalin in place of the osmic acid, but the results are not as good. Spirochaeta Pallida. Buschke and Fischer (Archiv für Dermatologie und Syphilis, Volume 82, October, 1906) report in their exhaustive investigation of the spirochaeta pallida in congenital syphilis, the presence of the parasite in enormous quantities; its histological presence in the lumen and walls of blood and lymph-vessels is strong evidence of its etiological nature. The initial and syphilitic lesions may contain the parasite sparingly or in rich numbers. The parasite is most abundant in the periphery of the infiltration and in the neighboring epithelium, both intercellular and intracellular. It is found in the lypmhvessels of the internal organs and between the connective and elastic tissue fibres. It is often absent in primary chancres, even when the latter are in full development. The author was able to inoculate an ape with virus taken from a tertiary lesion, showing that gummata are infectious. Spirochaeta Pallida. Preis, Budapest (Dermatologic Fournal, 1906, No. 3), recommends that the secretion for the examination of spirochaeta be taken from the borders of the syphilitic lesion and spread carefully and thinly on glass slides, fixed by warming and stained with the Giemsa solution with heat three or four times until steam arises each time. Stain until the red corpuscles are deeply stained and examine the areas which are most deeply stained. The spirochaeta are found for the most part in the neighborhood of the red corpuscles, not near the pus cells. In syphilis the spirochaeta is found almost pure without the presence of secondary bacteria. A New Rapid Method of Staining the Levaditi and Manonelian (Compt. Rend. des Sci. de Biol., 1906, page 134) report that the spirochaeta can be rapidly stained by the use of pyridin after the following method: Formalin, 4 per cent., twenty-four to forty-eight hours; alcohol, 96 per cent., twelve to sixteen hours; wash with distilled water; silver nitrate 1, pyridin 10, water 100, six to nine hours at 60° F.; wash with 10 per cent. pyridin solution, wash with pyrogallic acid 4.0 to water 100.0; then acetone 10.0, pyridin 15.0, water 100 0, for several hours; then alcohol, xylol and polychrom-methylene blue after Unna. Calomel Ointment Prophylaxis. Gaucher (Annales des Maladies Veneriennes, October, 1906) reports a case of syphilitic infection in an individual who had been applying 10 per cent. calomel salve locally as a prophylactic measure, as recommended by Metchnikoff, and concludes from this case that the measure does not prevent the infection of syphilis, as maintained by some investigators. Impotence. T. Poyntz (Montsberichte f. Urologie, Vol. 11, No. 9) recommends the internal administration of muiracithin for complete and incomplete impotence. He reports two cases, successfully treated by this agent, and recommends it in all cases in which there is partial or complete impotence, from nervous and not organic causes. IN the treatment of hand and finger infections, it is very important to release from bandaging as much and as many of the fingers as possible, and as soon as possible. The habit of bandaging up immovably all the fingers, in the treatment of a lesion of some of them, saves the surgeon time but, except in short cases, it often cripples the hand by stiffening the fingers.-American Journal of Surgery. SUBSCRIPTION TERMS: THREE DOLLARS PER YEAR. Remittances of all kinds to be made by check, draft, money order or registered letter to THE LANCET-CLINIC COMPANY, Illustrations for articles published must be made at the Author's expense. The methods of application, the numerous indications for using forceps, the many evils resulting when the blades are improperly applied, are in a general way familiar to all physicians practicing the art of obstetrics. So in trying to consider this broad subject in one paper I realize only too well that much must be left to the imagination, and only the most important phases can be taken up in a somewhat cursory manner. Volumes have been written on forceps, and yet every obstetrician has some fixed ideas as to what should be done in certain cases, how and when to apply, and I, like many others, am not an exception to this rule; and yet, after all is said and done, we follow only in the steps of the masters, and can call ourselves not originators, but imitators. In. 1563 the one-bladed forceps or vectis was first used by Chamberlen, and afterwards he made and used a double-bladed instrument, or the first forceps. This was very crude, but at that, from a medical standpoint, the greatest invention the world has ever known. No discovery before or since has ever been so great a means of alleviating the suffering of helpless women as was the invention of the forceps. Little did he think how universally instruments would be used, patterned after his crude forceps, and to-day a physician's armamentarium is not complete unless his satchel contains an obstetrical forceps. From 1563 no special modification to Chamberlen's instrument was made until 1750, when a curve was given to the blades, the modifier having the proper idea that this made them conform better to the pelvic curve. At this time, 1750, few practitioners owned a pair of forceps; in fact, the majority never saw a pair, and many of the ignorant class had never even heard of the existence of such an instrument, and it was only the few of great skill in the larger communities who had the courage to try to use them. However, in the last one hundred years many changes have taken place in the construction of the forceps. All kinds * Read at the January meeting of the Warren County Medical Society. of modifications have been made in the handles, locks, shanks, curves, shape of the blades and the materials from which they are made, and some have solid blades, while others have fenestrated openings. The names of the modifiers are legion, but at the present time the forceps commonly used in America are those of Sir James Y. Simpson, Elliot. Hodge, and Tarnier's axis-traction; in Germany those of Naegle and Breus; in France those of Tarnier, and in England the Simpson forceps still remain the favorite. FREQUENCY. The better we understand the mechanism of labor, the more skillful we become in the use of forceps, and the less we hesi tate to use them, as we feel a certain sense of security as to our results. Twenty-five years ago forceps were used about once on an average to every twenty-five cases, but to-day, with our improved technique and a better understanding of asepsis, in private practice, it averages now about one to every ten cases. I quote the following, as it is of interest: In the Paris Maternity: (4,580 cases)..............in 6 per cent. of cases. In the Glasgow Maternity: of 66 Some twelve years ago Dr. ——, claimed to have had 1,500 obstetrical cases, and in a personal discussion on forceps, claimed never to have had occasion for their use, and ridiculed the idea I advanced that in a few years the forceps would be used on an average once in every ten to fifteen cases. One week after our discus sion I was called to deliver a woman who had been in labor thirty-six hours, was thoroughly exhausted, and this same physician was attending in the capacity of a waiting midwife. Such ignorance I do not believe would be tolerated at the present day among educated people. In a general way it can be said that whenever the condition is such that the life of mother and child is jeopardized, forceps are indicated. The most common indication demanding forceps that I have met is when the woman is exhausted, pains are feeble and of no value, and the uterus in a state of inertia. A rule that I always follow is, the os being dilated or dilatable, and no progress for two hours, I use the forceps. Seeing as I do quite a number of consultation forceps cases during the year, I have never had occasion so far to modify this rule. When cardiac or severe pulmonary lesions exist, or the woman has an eclamptic seizure, or a severe hemorrhage, no rules are in order, as duty calls us to effect a speedy delivery, if your judgment says that that is the best for is the best for the patient's welfare. Again, if there be a prolapsed cord and I cannot replace it, I deliver as soon as possible by forceps, provided the head is engaged and the child is alive. A knowledge of the frequency and force of fetal heart is of the utmost importance, for if it falls below 100, or go above 160 beats, and especially if meconium be present in vertex or face cases, we know that undue and unequal pressure is being exerted, that the child's life is endangered, and it behooves us to hasten delivery. Broadly speaking, we say that forceps are used for traction and rotation, the most important being traction. Traction should be steady while it is made, with a slight rocking motion, but never the extreme side-to-side combined with an up-anddown rotatory movement, as is here and there unfortunately sometimes practiced. Try to deal as gently as possible with the often edematous soft structures. As a rotator, forceps are being used more and more in such cases as that of occipito- and mento-posterior positions. The straight-bladed instrument was strongly recommended in cases necessitating rotation, but they have little or no advantage over the ordinary forceps. The compression action of forceps is sometimes of serious import, and while some compression will always occur, this action of the forceps should be carefully guarded against. As a dilator of cervix the forceps has no place in obstetrics; dilatation is far better accomplished by other means. METHODS OF, AND CASES SUITABLE FOR, THE APPLICATION OF FORCEPS. All operative procedures at the present day demand some preliminary and preparatory treatment. There are some rules that should never be violated on the part of the operator in using forceps. One is asepsis, cleanliness of patient, instruments, assistants, and operator. The pres |