ing beneficially upon the kidneys and the skin. The high tension in the arteries can be combated more efficiently by bloodletting than otherwise, its beneficial effect being seen upon the pulse, the nervous system, and the kidneys, by lowering the blood pressure.

A very valuable agent is water, given, perhaps, plain after filtration or boiling, as young children take carbonated waters with reluctance. Given ad libitum and at regular intervals, if the patient does not call for it, it acts as a diuretic, without causing any irritation. If refused by the mouth, it acts well as an enema

if large doses are given.-Archives of Pediatrics.

PUERPERAL FEVER IN PRIVATE PRACTICE. -Dr. Charles J. Cullingworth (Brit. Med. Jovr.) in an address on the undimin ished mortality from Puerperal Fever, and especially as it ap plies to private practice, says: It was not to be expected that those who had already been engaged for some time in practice would at once assimilate the new ideas and adopt what appeared to many of them not only new but revolutionary and unnecessary methods. But as time wore on and a younger race of men came upon the scene it was not unnaturally hoped that an improvement would take place, that a mortality which had been conclusively shown to be preventable would show some signs of diminution. How is it that this hope has not been realised? Either the profession is not convinced of the possibility of stamping out puerperal fever by the methods that have been proposed, or it has failed to carry out those methods with the thoroughness that can alone ensure success. As a responsible teacher of midwifery, I have often asked myself the question how far the teaching is at fault. Do we teachers sufficiently impress upon the minds of our students the infinite importance of this subject? Are we ourselves careful to show by our own example the importance of the precautions that we lay down in the lecture theatre? Are we careful never to convey by thoughtless word or careless act the impression that the rigid adoption of antiseptic measures is excellent in theory but does not after all matter so much in prac. tice? If we are not, is it to be wondered at that when our students go out into the world and are released from the discipline of the school and hospital they should forget how much depends

on attention to minute detail, and should discharge their consciences in this matter of antiseptics by pouring a few drops of carbolic acid or a drachm of tincture of iodine into the water in which they wash their hands, or by simply bidding the nurse administer a similarly prepared solution as a douche? I am not painting an imaginary picture. The methods at present employ ed by many who, if questioned, would be quite ready to proclaim their belief in antiseptics, and who assure one they have used "every antiseptic precaution," are often so crude and imperfect as to be a ludricrous travesty of genuine antiseptic midwifery. The questions I have just been asking, I ask of myself as well as others. It is clear that something is wrong. We shall be most likely to find out what that something is by a process of self-examination, both on the part of teacher and taught however disagreeable that process may be. A great deal has been written on the superiority of asepsis as compared with antiseptsis and it has become the fashion in some quarters to speak of antiseptics as though they had had their day, and to maintain that a condition of asepsis can be attained by cleanliness alone. It is well, however, to bear in mind that the triumphs of our lyingin hospitals have all been won by the scrupulous use of antiseptics, and that sterilisation, which is the essential element in aseptic surgery, is impossible in midwifery practice. When we have thoroughly washed our hands, as we all now recognise the necessity of doing before making an examination in the lyingin room, it costs very little trouble to adopt the additional safeguard of immersing them for a moment or two in an antiseptic solution. And as a matter of experience those who are most diligent in the use of antiseptics are also the most diligent in carrying out all the details of elementary cleanliness. I firmly believe that if the simple antiseptic precautions with which everyone is familiar were conscientiously adopted, puerperal fever would be as rare in private practice as it is now in the best lyingin hospitals. "The only way," as I have elsewhere observed, "to avoid (the present) terrible mortality, and to avoid also the terrible amount of puerperal disease, which, because it is not fatal, is apt to remain unrecorded, is for every practitioner in midwifery to recognise his personal responsibility in the matter."

FISSURED NIPPLES. As a prophylactic measure Lepage recommends that the nipples should be regularly washed with the following solution: Mercuric iodide, 2 to 4 grains; spirits of wine, 1 ounce; glycerol and distilled water, each 1 pint. If, after using this for a few days, the ulceration disappears, a solution of boric acid may be substituted. Aristol is also highly recommended by Vinay in an ointment containing 1 drachm to

5

of vaseline. Joise has observed that cocaine, when applied to cracked nipples, has the power of diminishing the milk secretion, and from this fact he was led to the use of this agent when he desired to complete suppression of milk. He applies a 5 per cent, solution in equal parts of glycerine and water five or six times daily to the nipples. Suppression of the milk is observed in from two to six days. By producing anæsthesia of the nipple, cocaine prevents its erection, and thus favors the decrease in the quantity of milk.-The Practitioner.

FOR OBSTINATE VOMITING.-The following is often useful for the relief of obstinate vomiting:

Rectified spirit, 3 ijss.

Mehthol, 3 j.

Tincture of nux vomica, 3 ss.

M. Ten drops to be taken every hour in a teaspoonful of chloroform water.-The Practitioner.

M. S. One teaspoonful every four hours.-Med. RecordTherap. d. Gegenwart.

PURULENT CONJUNCTIVITIS.-In a previous communication. Dr. de Schweinitz called attention to the value of copious irri

gations of potassium permanganate, 1-2000, in the treatment of purulent (gonorrheal) conjunctivitis. Subsequent experience has confirmed his good o pinion of this drug. At least a pint of th solution should be passed through the conjunctival cul-de-sac in a gentle stream, preferably by means of an irrigator, four or five times a day, according to the indications. Formic aldehyde, 1-5000, which has achieved a just reputation in the treatment of various types of purulent conjunctivitis, has the disadvantage of causing severe smarting. In some recent cases of conjunctivitis neonatorum the drug has been employed in a strength of 1-6000, with happy results, although it is not impossible that the faithfulness with which the solution was used may have contributed as much to the result as any antiseptic property which it has a property which in a strength of 1-6000 must be exceedingly feeble.-Phil. Polyclinic.

Rub the chemicals with the water until the solution becomes colorless.

Then add:

M. Sig. A half-teaspoonful to be given every three hours during the day, and every four hours during the night.

Dr. A. O. Stimpson, in the Medical and Surgical Reporter, recommends this treatment during the intervals, the spasms to be relieved by spraying the mucous membrane of the throat with a two per cent. solution of cocain, and enveloping the throat in a cloth wet with a solution of a tablespoonful of ground mustard to a quart of hot water.

OFFICIAL LIST OF THE CHANGES OF STATION, AND DUTIES OF COMMISSIONED OFFICERS

OF THE UNITED STATES MARINE

HOSPITAL SERVICE.

For the 16 days ended March 31, 1897:

Banks, C. E., surgeon, detailed as inspector of Marine Hospitals and Marine Hospital stations, March 9, 1897.

Brooks, S. D., passed assistant surgeon, to proceed from Port Townsend, Wash., to principal ports of Japan and China on special duty, March 30, 1897.

Geddings, H. D., passed assistant surgeon, to proceed from Marseilles to Paris, France, on special duty, March 22, 1897.

Stimpson, W. G., passed assistant surgeon, to assume charge of Marine Hospital at Port Townsend, Wash., in addition to quarantine station, during absence of passed assistant surgeon S. D. Brooks, March 31, 1897.

Nydegger, J. A., passed assistant surgeon, relieved from duty in Hygienic Laboratory April 2, and upon expiration of leave of absence to rejoin his station at South Atlantic Quarantine, March 29, 1897.

Wicke's H. W., assistant surgeon, to proceed from New Or leans, La., to Boston, Mass., for duty, March 27, 1897.

Greene, J. B., assistant surgeon, when relieved from duty at Baltimore, Md., to proceed to Detroit, Mich., for duty, March 31, 1897.

Clark, Taliaferro, assistant surgeon, to proceed to Chicago, Ill., for duty, March 27, 1897.

Hastings, Hill, assistant surgeon, to proceed to New Orleans, La., for duty, March 27, 1897.

Lavinder, C. H., assistant surgeon, to proceed to New York, N. Y., for duty, March 27, 1897.

Appointments:

Taliaferro Clark, of the District of Columbia; Hill Hastings, of Kentucky; and Claude H. Lavinder, of Va., commissioned as assistant surgeons, March 25, 1897.

ARMY.

From March 18, 1897, to March 31, 1897:

Captain Julian M Cabell, asssistant surgeon, having been found by an Army retiring board incapacitated for active service on account of disability incident to the service, is by direction of the President retired from active service, this date, March 29, 1897. He will proceed to his home.

Captain Charles Willcox, assistant surgeon, is relieved from duty at West Point, N. Y., to take effect upon the expiration