stated. From the outset it seemed that success would crown our efforts at last, as the ring was largely dilated and dilatable, the utetus soft and pliable, and the fundus, after a slight effort, could be carried up to the ring. Through the abdominal walls the enlarged ring was easily felt, and the finger could be forced into the depression of the inversion. Alternately relieving one another, after one hour and twenty minutes, the fundus was well up within the ring. I was on the point of again resting, when suddenly the left horn of the uterus yielded to the pressure of the thumb of my right hand. Following up this ground gained, I succeeded, in a few minutes, in completely replacing the inversion, and felt the uterus contract considerably upon my finger in its cavity. The patient being then examined by Drs. Nicoll and Bourke at my request, she was replaced in bed, hot cloths were applied over the abdomen, and, after her recovery out of the anaesthetic, quinine and morphia controlled the fever and pain. The patient made a quick recovery, returning home six days after the reduction, and, from a letter received on the 22d day of February, was improving in general health rapidly.

In the early history and general treatment of this case, there are many points which strike me as worthy of a few moments' consideration. In the first place, it is almost conclusive, from the pain and hæmorrhage, that the inversion was produced by traction exerted upon the umbilical cord and placenta, when the uterus had not, and was not contracting, as it should have done after the expulsion of the child. Had the uterus thus contracted, prolonged and firm traction on the cord could not have been made, for that proper behavior of the uterus necessarily casts off the placenta. Her attendant, therefore, should have recognized, from this very retention of the placenta, that the uterus did not contract sufficiently to cast it off, and, in place of giving his atten tion to the placenta, he should have given it to the uterus. If the invaluable practice of having the uterus followed up by the hand had been resorted to, which was evidently not the case, it would either have stimulated the uterus to do its duty, or have shown, by its not contracting, the necessity of making it do so for no other reason than doing what misdirected efforts endeavored to accomplish. Again, had her attendant followed up the uterus during the delivery of the placenta, in the manner mentioned, he could not have failed to recognize that the organ was not contracting, but becoming inverted, and he thus would have been made aware of the danger of his procedure. Further, the character and continuance of the flooding should have told him at once that he had a non-contracted uterus; and had he then used his most ready means of ascertaining the cause of the hæmorrhage the use of his two hands externally and internally-he would have recognized, from the absence of a uterus beneath his hand on the abdomen, and the tumor in the vagina, that the

uterus was inverted. The non-observance of the ordinary precautions in a simple case of labor was undoubtedly, in this case, the cause of this patient's life being endangered by hæmorrhage, and of her suffering, during two years, from an inverted uterus.

In regard to the treatment, and its results, there are several points that seem to me to admit of a few moment's consideration. The old method of traxis certainly in this case succeeded admirably, the constricted cervix yielding gradually to the wedging ef fect of the fingers and the pressure of the body of the uterus. That the fingers possess a very limited power of expansion when confined thus in the vagina, I admit; but, in my opinion, this is compensated for, in a great degree, by the wedging of the uterine body between the fingers, by the upward force exerted on the palm of the hand by the arm-power of the operator. It is by this force, in my opinion, that the constricting cervical ring can be dilated sufficiently to admit of reduction of the uterine neck, and, in the case reported, I am confident that the ring was thus only dilated; as already stated, the dilating force of my fingers, per se, being exceedingly limited. Another point, of which slight mention is made in our leading text-books, but which in my hands worked admirably, and to which I attribute chiefly my success, is the constant use of the hot vaginal douche, preceding and succeeding each effort at reduction. The advantage of thus using hot water is self-evident, it acting in the same manner as when used in cases of rigid es, by relaxing and softening the muscular fibres of the cervix. But it was especially after efforts at reduction that it seemed to accomplish the most good, both in removing the consequent tumefaction of the uterine body, following the severe and protracted handling, as well as subduing irritation of the organ and its appendages, and thus diminishing the dangers of inflammation. Certainly, from what I saw of its effects in Mrs. R.'s case, it appears to me to afford aid of the greatest value in cases of inversion.

In conclusion, I desire to state that I essayed Courty's method of gaining a point of resistance by introducing the index and middle fingers up the rectum, but found that in such a cramped position no resistance of value could be obtained. I also gave the instrument known as White's repositor a trial, but laid it aside in a few moments, as I found it impossible to exert the pressure in the line of the uterine axis, the instrument carrying the uteri toward the promontory of the sacrum. In justice to Prof. White, I must state here that this was owing to a faulty construction of the instrument, its shaft being too straight, and its rubber cups too yielding.

Finally, I desire to express my indebtedness for invaluable assistance to my friends Drs. H. D. Nicoll, J. C. Jay, Jr., and Jeffrey Bourke, to them certainly belongs a large share of the success attending my efforts.-New York Medical Journal.

Resection of a portion of the Continuity of the Ulna and Radius for the Correction of Deformity from Ununited Colles's Fracture.

Dr. William A. Byrd, of Quincy, Illinois, describes (Richmond and Louisville Med. Journal, Oct., 1874), the following interesting case which resembles in many respects one lately reported by Mr. Annandale (see Monthly Abstract of Medical Sciences for March, 1875, page 127).

In the summer of 1873, Dr. Byrd was consulted by a clerk, aged 41, as regards the advisability of an attempt to correct a deformity of the left arm. On examination of the limb there was found an ununited Colles's fracture of the left radius. The ulna passed up alongside of the hand until the lower end of it was somewhat beyond the junction of the fifth metacarpal bone and the carpus, and curved at a point opposite the fracture in the radius, the concavity looking toward the radius. The hand was smaller than its fellow, with palm cupped and the fingers partially flexed, with an inability to close them completely or with any degree of force. When he would pronate or supinate the hand, it would describe an arc of the circumference of a cone, the apex of which would be the lower end of the ulna-a very uncouth motion, indeed.

With the belief that he could remedy the defect to a great extent, Dr. Byrd determined to operate on Nov. 1. He made an incision through the skin over the inner side of the ulna, commencing an inch above the styloid process, and continued up the arm for about three inches. The superficial fascia lying at the bottom of the wound, was then very carefully divided over a grooved director. The muscles were pressed apart, so as to expose the bones. The periosteum was divided for an inch and a half, and separated from the whole circumference of the bone; a chain-saw was then passed around the bone at the lower angle of the wound, and the bone quickly divided. The lower end of the upper piece of the ulna was then raised on a spatula, and an inch of it sawed off. An incision two inches long was then made over the point of fracture of the radius, on the outer side of the arm, down to the bone, the ligamentous union between the fragments was broken up with some difficulty. An effort was then made to bring the ends of the fragments through the wound at the radial side, but failing in this, they were forced out through the wound on the ulnar side, and their ends trimmed with a pair of bone nippers. A hole one-sixteenth of an inch in diameter was then drilled from the outer surface of the upper and lower portions of the ulna, commencing one-fourth of an inch from the point of section, and passing diagonally towards the free ends into the medullary cav ity. A well annealed iron wire was then passed through the holes

and the ends of the wire twisted together, so as to bring the ends of the bones nicely into apposition; the wire was then cut off, leaving a short piece of the twist, which was bent down parallel with the shaft of the bone to prevent irritation of the soft parts. The ends of the radius being in apposition were left without further interference. The wounds were closed with interrupted sutures and a straight splint applied to the arm anteriorly.

Nov. 20. Radial wound healed; ulnar wound healed throughout the greater portion of its extent. An abscess had formed on the palmar aspect of the arm at a point midway between the incisions. When opened, a considerable amount of pus was discharged. This continued to discharge until Feb. 7, 1874, when probing it Dr. Byrd discovered a foreign substance at the bottom of the sinus. Enlarging the opening, he was enabled to extract the wire with two bits of bone that had been included in it in tying the two pieces of ulna together. At this time the ulna had slipped up so as to occupy an almost normal position with the carpus, and the radius had united at the point of fracture; the ulna was still ununited. There was also a small opening at the ulna wound, through which water would pass when injected into the opening on the front of the arm. After this, these openings rapidly healed, and the ulna firmly united. He had some degree of pronation and supination, with good use of the wrist. The fingers became more flexible and the hand less cupped and deformed.— Monthly Abstract Medical Sciences.

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Editorial.

We have received the following from the Secretary of the American Medical Association to which we would direct the attention of our readers:

AMERICAN MEDICAL ASSOCIATION.-The Twenty-sixth Annual Session will be held in the city of Louisville, Ky., on Tuesday, May 4, 1875, at 11 A. M.

"The delegates shall receive their appointment from permanently organized State Medical Societies, and such County and District Medical Societies as are recognized by representation in their respective State Societies, and from the Medical Department of the Army and Navy of the United States."

Each State, County and District Medical Society entitled to representation shall have the privilege of sending to the Association one delegate for every ten of its regular resident members, and one for every additional fraction of more than half that number; provided, however, that the number of delegates for any particular State, territory, county, city, or town shall not exceed the ratio of one in ten of the resident physicians who may have signed the Code of Ethics of the Association."

The Chairmen of the several sections shall prepare and read in the general session of the Association, papers on the advances and discoveries of the past year in the branches of science included in their respective, sections. * * * By-Laws, Article 2, Section 4.

The following amendments to the Plan of Organization are to be acted upon : By Dr. H. B. Baker, Michigan-"The officers of the several Sections shall be nominated by the Section in and for which said officers are to serve"

By Dr. Adams Jewett, Ohio-" The permanent members shall consist of all those who have served in the capacity of delegate, and of such other members as shall have received the appointment by unanimous vote, and of all others who, being members in good standing of any State or local Medical Society entitled to representation in this Body, shall, after being vouched for by at least three members, be elected to membership by a vote of three-fourths of the delegates in attendance, and shall continue such so long as they remain in good standing in the Body of which they were members when elected to membership in this Association, and comply with the requirements of its by-laws."

Secretaries of all State Medical Societies that have adopted the Code of Ethics are respectfully requested to forward to the undersigned a complete list of officers, with their post-office addresses, of those County and District Medical Societies entitled to representation in their respective bodies. This is the only guide for the Committee of Arrangements in determining as to the reception of delegates. It will also enable the Permanent Secretary to present a correct report of Medical organizations in fellowship with the Association.

W. B. ATKINSON, M. D., Permanent Secretary.

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Medical Literature

All of our well known medical publishers are more or less busy in the production of medical works of one kind or another. As many of our readers do not have ready access to their catalogues we will give a brief list of some of the more important works about to be published. Lindsay & Blakiston, of Philadelphia, are preparing in connection with the Messers Churchill of London, among others, the following: Clinical Studies, by Sir John Rose Cormack. The Microscope in Medicine, (4th Ed.,) by Lionel S. Beal, M. B. Experimental investigations in the action of Medicine, by T. Lauder Brunton, M. D. Diseases of the Throat and Nose, by Morell Mackenzie. A Practical Treatise on Diseases of the Eye, by Haynes Walton, and The Surgery of the Female Pelvic Organs, by Henry Savage, M. D.

Messrs Wm. Wood & Co., of New York, are busy at work on Ziemssen's Cyclopædia, the third Volume of which is announced for May. They also announce for October a translation of Uhle & Wagner's Manual of General Pathology. They have in preparation other works, the titles of which are not yet announced. Henry C. Lea, of Philadelphia, will shortly publish A Manual