surgical interference, call so frequently for the use of the speculum, that it is now used by almost every practitioner of medicine both in city and country. The object sought in the use of the speculum is to bring into view and easy reach as much as possible of the vagina, with the entire os and cervix. Various specula have been invented for this purpose, but all have fallen short of this much desired end.

My modification of Sims' speculum, which is perfectly relf-retaining, is perhaps nearer the accomplishment of this object than any other instrument yet invented; and still there is something wanting even in this speculum. It is ths: while the perineum is carried back to any extent required, and the posterior labia are well separated, the middle and anterior portions of the labia, in fleshy or in loose and flaccid persons, are not sufficiently kept apart to afford a full view of the vaginal walls. In the ordinary surgical treatment, with cauteries, this is not a serious inconvenience; but in operating for fistules, it is a matter of great moment, for the hands of an assistant are required to keep the labia apart, and also to hold the wires as they are being inserted until they are twisted together.

This labia retractor, as shown in the accompanying figure, supersedes the use of hands by assistants in these operations. The wings of the speculum, and the outer borders of the retractor, antwer as racks or fastenings, to which the wires may be attached in fistulous operations.

With my labial retractor and speculum, the ultimatum of reaching the interior of the vagina does seem to be attained. I have used these instruments frequently in the presence of physicians, and, in every instance, to the complete satisfaction of all who have witnessed the application. And recently, in the operation for double vesico vaginal fistula, with Prof. Bush, of this city, with the happiest results.

spring of the bow or bend must be sufficiently strong to keep the labia apart. A spring, with a screw or ratchet attachment, would perhaps answer a better purpose. The single spring is, however, cheapest. This instrument is well made by Gemrig, of Philadelphia.-A..Jo. M. Science.

ANALYTICAL DEPARTMENT

"Qui e nuce nucleum esse vult, frangit nucem."-PLAUTUS.

ART.

-ANALYSIS OF VARIOUS ARTICLES. Published in the Medical Times and Gazette, the British Medical Journal and the London Lancet. (Original copies.) By PROF. JAS. M. HOLLOWAY, M.D., Associate Editor.

Pancreatic Juice.-M. Chauvin and M. Morat have recently presented before the Academy of Sciences of Paris the results ef experiments with pancreatic juice, confirmatory of those made by other physiologists. In addition they have decided that the action of this juice upon the three species of alimentary substances is to completely digest them, even in the interior of the stomach, in the presence of the gastric juice, and also in the presence of hydrochloric acid largely diluted with water. [Such results will go very far to increase the therapeutic application of this secretion as a remedy in the treatment of some forms of indigestion, of phthisis, and of tabes mesenterica. They are, moreover, indirectly confirmatory of the views now more generally held by physiologists in relation to the digestion of hydrated starch by saliva after the food has passed from the mouth into the stomach. The saliva and the pancreatic juice are both alkaline; if one of these fluids can continue to exercise its digestive power in the presence of a free acid, it is not unreasonable to infer that the other also can.-J. M. HI.]

Nitrous Oxide Gas.-Mr. Coleman, at the Dental Hospital of London, has recently made an improvement in the administration of this gas for the extraction of teeth. This improvement is based upon the well known fact that the admixture of atmosphere with the gas impairs its efficacy. He therefore first displaces the residual air in the lungs by causing the patient to inhale nitrogen.

After this the nitrous oxide is administered. It is claimed for this method that there is less lividity of the countenance, the patient comes more speedily under the influence of the gas, and it is more economical.

Dilatability of the Female Urethra.-Dr. A. Garden, Surgeon Indian Army, reports three cases of extraction of vesical calculi from females by rapid dilation of the urethra without the employment of the knife, in which the patients recovered complete control over the bladder in a very short time. The largest stone removed measured two inches through its shortest diameter.

Treatment of Pedicle in Ovariotomy.-C. F. Maunder, Surgeon to the London Hospital, thinks that too much importance is attached by different surgeons to their respective modes of dealing with the pedicle after ovariotomy. Each surgeon who can show a small mortality in his own practice is disposed to attribute the success to the special manner in which he has disposed of the pedicle. The results (recovery or death) should rather be attributed to the general condition of the patients operated upon. The main point to be observed in treating the pedicle is to prevent hæmorrhage. He closes his article with the following paragraph:

"While, then, I advocate, as a rule of practice, keeping the pedicle outside the belly, exceptions will occosionally arise. But, as in every other instance in which an operation is contemplated, our great aim should be to endeavor to discover those signs and symptoms which may lead us to predict a favorable or an unfavorable result. I believe any special way of treating the ovarian pedicle, beyond the object of preventing hæmorrhage, to be a matter of comparatively little moment, and that it will not affect the rate rate of mortality to a noticeable degree.'

Dr. Barnes' Water-Bags.-Dr. Robert Barnes, in replying to an objection urged by Dr. Playfair to the employment of the water-bag for the induction of premature labor, because its use in three instances brought about a mal-presentation, lays down the following propositions: "1. In induced premature labor the accomplishment of delivery is extremely uncertain as to time.

"2. This uncertainty involves danger to the mother and child.

"3. The immature condition of the uterus often entails defective contractile power and increased resistance to the passage of the child.

"4. Hence it is desirable to aid the dilatation of the cervix, and to supplement the contractile power, to watch and control the course of labor throughout, and to bring it to a termination within a definite period.

"5. This aid can be afforded safely and beneficially by the cervical water-dilator, and by the forceps, and turning. "6. By the proper use of these accelerative means, children may be saved which would otherwise in all probability perish.

"7. In the management of cases of placenta prævia these accelerative means are of eminent value.

"8. Labors may always be completed with safety within twenty-four hours."

CLINICAL RECORDS.

"Ex Principiis, nascitur probabilitas: ex factis, vero veritas."

ART. I.-TREATMENT OF CONSTRICTIONS OF THE OS AND CANAL OF THE CERVIX UTERI, AND KUNCKLING OF THE NECK OF THE WOMB. By GEO. SYNG BRYANT, M.D., Lexington, Ky.

When the narrowing is sufficient to obstruct the flow of the secretions and exudations of the mucous membrane of the uterine cavity, these fluids become dammed up and are expelled by muscular effort.

If there is an inflammatory condition of the tissue proper (muscular tissue) of the womb, muscular contraction will, almost of necessity, be attended with pain, Such is the case with the voluntary muscles, and we may safely infer the same to be true of the involuntary muscles. But constrictions of the os and canal of the cervix uteri are not necessarily accompanied with pain, for if the flow be slight, and the fluids are carried off as fast as they are poured out from the mucous membranes no accum

ulation can occur. disease (or connaturally, as with some women) menstruation may be painful, though the canal and os are of normal size, if the periodical flow is excessive, so that it cannot be conducted away as fast as it is poured out from the mucous membrane of the cavity of the body. So a constricted canal is not always attended with dysmenorrhoea, nor is one of normal size necessarily free from it.

When the womb is sensitive from

But there is a class of cases which I have seldom seen unaccompanied with pain. I have reference to chronically inflamed wombs, with more or less hypertrophy, where the mucous membrane, of cervix and body, and submucous tissue are involved; and at the same time the neck bent upon the body, constituting either anteflexion or retroflexion, with anteversion or retroversion. At the knuckling, the anterior and posterior walls of the canal are unavoidably in close contact and the secretions cannot be expelled without effort. In these cases there is much distress at the periods, and sometimes during the intervals; pain being seldom absent in the hypogastric region, loins, sacrum and groins. When confined to one groin it is most frequently in the left. There is usually pain on micturition and defecation. In narrowings and strictures of the os and canal, the intra-vaginal portion of the cervix is generally of a conical shape, and is much elongated, with more or less fibrinous infiltration, causing the mouth and neck, and sometimes the body, to be firmer to the touch than the healthy womb. The sensation imparted to the finger by touching the normal uterus is compared, by Bennet and others, to that which the end of the nose would give. This is a good comparison, which should be borne in mind when instituting an examination by the touch. My observations agree with those of Drs. Sims and Barnes, that the narrowing is al