quite inocuous. A moderate sized steel needle or canula I find preferable to the small gold one. The steel canula is sharper, and passes easier through the skin. By pinching firmly the fold of skin that has to be pierced between the finger and thumb, its sensibility to the puncture is much diminished. It does not seem to matter much as regards results, in which region of the body the injection takes place. I have principally chosen the præcordial region for uterine and general pain, and for local neuralgia a spot as near to the region affected as possible.—London Lancet.

PHYSIOLOGICAL AND PATHOLOGICAL PUS.-M. Jules Guerin thus sums up the doctrine he has been so long working at: "There is a fundamental difference between pus secreted by wounds and pus furnished in different morbid collections. In the former case it is modified blood; the return of this fluid, and the elements which compose it to their normal condition, it is physiological pus. In the latter it is a contaminated fluid, changed by the morbid elements of which it is the vehicle-it is pathological pus. Physiological pus possesses, like the blood, a kind of vitality, while pathological pusis a dead, excrementitious product, susceptible in the highest degree of undergoing putrefaction. This great and important difference is especially appreciable with respect to traumatic abscesses and cold abscesses, constituting collections. The former require to be opened as soon as possible, and such opening ordinarily leads to no inconvenience; while the latter, on the contrary, are innocent only as long as they are sheltered from the air, their opening almost constantly giving rise to putrefaction of the pns, and exposing to the danger of purulent intoxication. The differences are, therefore, not merely nominal. Nu.nerous investigations have shown that the decomposition of the pus is especially due to oxygen, hydrogen, and nitrogen, carbonic acid taking little part in this. Putrefaction, properly so called, results from the presence in the air or in the pus itself, of dead organic elements acting as ferments." These different considerations led the author to establish hts subcutaneous method of treatment, or treatment by occlusion.—Med. Times and Gaz.

Iodine, when taken inter

INTERNAL USE OF IODINE.-Prof. Percy says: nally, has, more than any other remedy, the power of counteracting the poison of scrofula." He divides scrofulous diseases into two classes those that are idiopathic, and those that are hereditary, and says:—

"There is a marked difference in the features of the disease in these two instances; the former is nearly always associated with anæmia, and requires restoratives, as well as calalytic remedies; the latter is complicated with nervous derangements, and an enfeebled power of assimilation, which requires a combined treatment of stimulants or sedatives, with the catalytic. In the former cases, the iodine, in combination with iron, quinia, and cod-liver oil, is more efficacious; in the latter, the iodine, in combination with ammonia or potash, with the addition of strychnia, wine, hydrocyanic acid, or hyoscyamus, will be found more beneficial."

The scrofulous diseases of children are more readily benefited by iodine than similar diseases in adults. We beg leave to refer the reader to a paper of ours upon this point, published in the American Medical Monthly 'for January, 1856. Of late we think we have found the arsenite of potash even more effectual than the iodide of potash, in controlling scrofulous diseases, especially of children. Med. and Surg. Reporter.

A Simple Ophthalmoscope.

[From the British Medical Journal.]

SIR:-I find that if a convex lens of about two inches focus be placed in close apposition with a concave one of about nine inches focus, and this combination be held before the patient's eye at the distance the object-lens of an ordinary ophthalmoscope usually is, it forms an ophthalmoscope, uniting in itself the reflecting and refracting elements of that instrument. For, whilst the light from a flame is reflected by two surfaces (the outer concave surface of the concave lens and the internal concave surface of the convex one) into the patient's eye, it is also, on its emergence therefrom, refracted by the effective convex element of the combination, so as to form the usual indirect image of the fundns oculi at the focal length. With such a rough combination I have been able to obtain a distinct image of the optic nerve, retinal vessels, etc.; and I may hence not unreasonably hope a properly constructed mensicus will in itself fulfil the conditions of the mirror and object-lens of an ordinary ophthalmoscope. I am, etc.,

J. Z. LAURENCE.

30 Devonshire street, Portland Place, May 3d, 1864.

-[Canada Lancet.

AN OUNCE OF QUININE AT A DOSE. - Dr. Taussig, in a letter to a friend in London, relates a singular fact which occurred in Rome, where he resides, in December last. It is as follows:

Dr. Hayler, a military medical man, visited in barracks a soldier, suffering from a relapse of ague, and administered to him a small dose of the sulphate of quinine. At the same time he directed a man to fetch one ounce of the same remedy from the hospital, in order that he might have it in readiness for any emergency. The man received the bottle; but, supposing that it was ordered for the patient just mentioned, he took it to him. In the presence of their comrades they put the whole into a cup, adding sufficient water to make a paste of it; and the patient, although he found the medicine uncommonly bitter, did not leave off until he had swallowed it all.

He

Dr. Hayler, on learning that this enormous dose had been taken, at once visited the patient. The most careful investigation left no doubt of the fact; but, with all that, incredibile dictu, except a complete deafness and a kind of stupor, no other bad effect ensued, and no antidote was administered. was directed to the hospital, where he remained a week under observation, and left the establishment in the best state of health. The ague disappeared, probably never to return. I saw the man myself; he is a Swiss, named Albitz, aged 30, of small stature, and of a strong constitution.

It was not to be supposed that there was any important adulteration of the remedy in question, as all such preparations are subjected to a chemical investigation before they are admitted into the hospital dispensary.—Medical Times.

Difficult Obstetrical Cases.

BY GEORGE T. ELLIOT, JUN., M. D.,

Professor of Obstetrics and Diseases of Women and Children in the Bellevue Hospital Medical College; Obstetric Physician to Bellevue Hospital and the Lying-in Asylum.

Retroversion of Impregnated Uterus-Great Accumulation of Urine-Successful Reposition and Recovery-Dr. Mola, House Physician.

ISABEL ARMSTRONG, aged 25, was admitted into Bellevue Hospital on the 27th of October, 1863. She was a healthy woman, and stated that her health had always been good. Has had two children, both now living and in good health. After the second confinement she suffered from falling of the womb, which came down near the vulva, but was never treated for this trouble. Four months ago her menses stopped. She suffered from morning sickness and the other evidences of pregnancy as in her previous gestations, and now has milk in the right breast. On the 15th of October she went to a funeral, and on getting out of the carriage slipped and struck her abdomen against a gravestone. She was much prostrated by the shock, and had to be assisted home in the carriage of a friend. She has since been confined for most of the time to the recumbent position before entering the hospital. I saw her in the afternoon of the 28th, and recognized a large tumor in the recto vaginal cul-de-sac; the os uteri could be reached with difficulty through the vagina, narrowed by the projection forwards of the posterior vaginal wall, but could be recognized on the level with the upper part of the symphisis pubis. The patient had walked the whole length of the ward to the examining bed; she presented no symptoms calling for immediate relief; she had no evidences of inflammatory action. Pregnancy was evident from her history and symptoms, though neither foetal heart nor foetal movements were recognizable. Some cathartic medicine, which had been given on the previous evening by Dr. Mola, had not operated, and I ordered castor-oil to be given, preparatory to a true examination on the morrow.

Oct. 29th.-Bowels have been freely moved. Her condition as before. She again walked across the ward to the examining bed. But now, before proceeding to the thorough examination of the case, I inquired about the bladder, when she declared that she had not passed water for a week, though, she stated, some had dribbled away at times when she walked. This was the first allusion made by her to the state of her bladder. A catheter was then introduced, and one hundred and forty-four ounces of urine were drawn off in the presence of my colleague, Prof. Barker, and other gentlemen. This urine was of natural color, good specific gravity, of healthy odor and reaction, and free from albumen. The abdomen diminished in size, and the diagnosis of a retroverted pregnant uterus could be clearly made out.

She was then brought at once under the influence of chloroform by one of the house physicians, while another, standing on the bed, raised her hips high in the air, so that the abdomen looked downwards towards the bed. I then introduced the fingers of the right hand in the vagina, and pressing the fundus of the uterus through the posterior vaginal wall, succeeded in an instant in passing it along the curve of the sacrum, and leaving it well anteverted. In so doing I distinctly felt the ballottement of the fœtus.

After the effects of the chloroform had passed, she said that she felt perfectly well and comfortable. All traces of the tumor, which had so greatly

distended the posterior of the cul-de-sac, and which had been so readily grasped between the fingers of one hand in the vagina and one in the vulva, had disappeared, while an ample vagina and pelvis could be recognized.

The urine drawn from this patient, and the patient, was shown at my clinical lecture. She never had an unfavorable symptom afterwards. She never once needed the introduction of a catheter, or showed any further tendency to uterine displacement or hæmorrhage; and after ten days of close observation, she left the hospital somewhat wearied with what she had considered to be unnecessary care.

In the American Medical Times, May 4th, 1861, p. 289, Case LXII., is the history of a case of a unilocular ovarian cyst under my care, which is interesting in the differential diagnosis of such cases, as the position of the os uteri was exactly similar.

Perforation in a Case of Contracted Antero Posterior Diameter of BrimMother Did Well-Dr. Mola, House Physician.

Ann Royal, aged 22, primapara, strong, well developed, healthy looking girl, of medium size, entered the lying-in-ward at Bellevue, at 7 P. M., Nov. 12, 1863. Os uteri noted by Dr. Mola as about as large as a ten-cent piece, and not dilatable; pains not strong; head presenting; heart sounds over left iliac region; uterine souffle also distinguishable. 13th, 8 A. M.-Has not slept much last night. Os still rigid; dilated to the size of half a dollar; membranes unruptured and protruding. Head presenting; foetal heart the same. 2.30 P. M.-Pains a little stronger. Waters have broken; presentation recognized, the posterior fontanelle being to the left acetabulum, and just dipping within the brim. Foetal heart as before. 6 P. M.-Head has not advanced. Os not fully dilated, and somewhat rigid. Pains feeble and constant. The examining hand is covered with a greenish, slimy material. Impossible for any one to recognise the foetal heart.

I was then sent for, and arrived at 11.30 P. M, when the patient had been brought under chloroform. I made an examination, and found the os uteri, presentation, and position of the head as noted at 6 P. M.; whilst, by passing the hand well up, the cause of delay could be recognized in an undersized antero-posterior diameter of the brim, and the left parietal bone was pressed against and driven in by the promontory at a point between the sagittal suture and the bosse. Foetal heart inaudible. The situation left no doubt in my mind that the child was dead, and had probably died from injury to the cerebral circulation; and it seemed that forceps was inadmissible under the circumstances (especially so when the risks of puerperal fever incident to the season were cousidered), although the degree of deformity did not forbid the trial of a slender pair. Accordingly Dr. Rowe kept up the chloroform, and I introduced Blot's perforator near the posterior superior angle of the right parietal bone, and completely broke up the brain. Churchill's crotchet being then introduced, the head was gradually and readily drawn into the world, the placenta following almost immediately. Half an hour afterwards, Dr. Mola discovered that the uterus-which had been kept pressed down by the nurse—was rather large, and that blood was oozing from the vulva. Accordingly he introduced his hand, turned out some clots, and gave ergot, and in two hours left the patient sleeping comfortably. Dec. 2, 1863.-With the exception of a slight febrile movement on the second day after the operation, there has been nothing worthy of record. The patient will soon be able to leave the hospital.

Child weighed eight pounds in its mutilated state.

CASE CX.-Retroversion of Impregnated Uterus- Death-No Autopsy. Dr. Young asked me to visit Mrs. — on the 14th of August, 1862, who had come to the city about two days before, suffering from ysuria, from which she had been complaining about two weeks. She had been treated in

a neighboring city, and had once had her urine drawn with a catheter, though no thorough vaginal exploration seemed to have been made. On the morning in which I saw her, Dr. Young had seen her, and found her in an unconscious state, and evidently in an alarming condition. He had drawn off two-thirds of a large chamber-potful of clear urine with a catheter, and had recognized a retroverted uterus. He had been obliged to give chloroform to introduce the catheter. I found her unconscions, with a very bad facies, eyes like those of the dying, and recognizing nothing; slight froth on the lips; pulse very rapid and feeble; skin neither cold nor warm; not perspiring; respiration hurried. She tossed, moaned, threw herself on her elbows and knees; frequently rolled in a rapid manner to the edge of the bed, as though desirous of throwing herself on the floor, and necessitating the constant presence of some one to restrain her. No paralysis; no special tendency to roll in the same direction. Unconscious, evidently, but not raving. On examination I found the uterus entirely retroverted, the os on a level with the. upper rim of the symphysis, the fundus down to the sacro-coccygeal articulation. Os sufficiently open to admit the finger. The uterus seemed about three months impregnated. To effect the reduction, we put her on her hands and knees, holding up the hips, as it was necessary to give an anesthetic (chloroform) to quiet her. Pressure on the posterior vaginal wall caused half a tumblerful of bloody and very offensive urine to come away, Continuing the manœuvre, I was enabled to push up the fundus uteri; and then, by introducing two fingers within the rectum, to continue pushing it up until it cleared the promontory. But the abdominal straining would force it down again. The vagina was short, and the cul-de-sac very deep. Satisfied that the uterus could not then be permanently replaced, I desisted. Not altogether liking the respiration, we gave a prompt trial of Hall's method, and she soon breathed as before. Consciousness as before. Without an anesthetic no satisfactory uterine manipulations could have been made. Believing that the case must terminate fatally, and as she would scarcely swallow, we agreed that the colpeurynter should be used to cushion and replace the uterus, that the bladder should be kept emptied, and that she should be nourished by

enemata.

In five hours we met again. She was quieter and sitting up, but if possi ble looked worse. Bladder nearly to the umbilicus. Half a chamber-potful of bloody and very offensive urine drawn. Advised recumbent posture. 15th. Continues to sink. Renal secretion copious and drawn with catheter. Some sent to Dr. Draper for examination did not reach him. The uterus has never fallen back as low as it was, and is movable. Sank steadily, and died during the night. No autopsy permitted.

Apoplexy in a Neonatus-Cause Undetermined—Dr. Mola, House Phy

sician.

John Monaghan was born in the lying-in wards of Bellevue on the 12th of November, 1863, after a perfectly natural but comparatively easy labor. He weighed ten pounds, was well developed, and presented all the appearances of perfect health. Twelve hours after his birth, Dr. Mola's attention was called to the child, who cried a great deal and would not nurse. There were no evidences of anything wrong about him, but by the next morning he had died.

Autopsy, twenty-four hours afterwards.-Scalp showed the customary congestion. On removing the calvarium and dura mater, a large quantity of extravasated blood was found diffused over the whole surface of the brain. This organ was congested, but presented no other extravasations. Lungs, heart, and other organs perfectly healthy.