Case I. was a young lady, not in the least myopic, who, after complete dilatation of the pupils had been produced by a very weak application of atropine, could read small type up to within five or six inches of her eyes, and who declared that her vision was not at all affected by the mydriasis.

Case II. was a youth at the Moorfields Hospital, who had applied a strong solution of atropine (four grains to one ounce), thrice daily, for more than a week; and, though he omitted it for two days, he had put in five or six drops on the morning the following note was taken: He was emmetropic, and could see well in the distance, though the largest type he could read at about sixteen inches was J. 16, but on holding a pinhole aperture close to his eye, he was able to read easily Jäger I (brilliant type).

I have tried other cases with similar results; but as my notes have already taken up more space than I intended, I will not go into details about them; and will simply remark that, till we have further particulars, it appears, from the observation made by Mr. Benton on May 19th, that "distant objects could alone be discerned" even though the patient could read quite plainly through a pinhole aperture, there is still left the possibility, if not probability, of the further element of loss of accommodation in this interesting case.

The Stomach Bandage in Ascites.—Mr. S. Mackenzie urges the value of firm bandaging in dropsy of the abdomen. He gives a case in the British Medical Journal, from which we quote the portion referring to his treat

ment.

March 30th.-The abdomen now measured thirty-six inches; its summit was about three-quarters of an inch above the level of the sternum, and it was flat on the surface. The edge of the liver could now be felt three inches below the point of the xiphiod cartilage. No irregularities could be felt on the surface of the liver.

May 11th.-The condition of the patient appeared stationary. There was still a considerable amount of fluid in the peri

toneal cavity. She passed about forty ounces of urine in the course of the twenty-four hours. The abdomen was ordered to be tightly bound with a flannel bandage, so as to exercise pressure.

June 4th.-When the bandage was first applied to the abdomen, the pressure caused a feeling of sickness, but soon the patient bore it without discomfort; in fact, it appeared to afford her relief. The measurement around the abdomen, at the level of the umbilicus, was now thirty-three inches. She passed about thirty to forty ounces of urine daily, and did not perspire much. I now ordered a properly made abdominal support to be constructed for her by the instrument maker. It was arranged with straps, so that it could be tightened to a very considerable degree.

June 29th. The patient expressed herself, and appeared to be, in good general health, but she was still much wasted. The abdomen looked much smaller, and measured thirty-one and a half inches at the level of the umbilicus. There was pseudo fluctuation on percussion, but it did not convey the impression of being due to fluid. The liver could be felt in the same situation as before. Its surface was smooth, its edge firm, sharp and regular. The spleen was not to be felt in the abdomen. Its dullness reached the seventh rib in the axillary line. She passed, on an average, fifty to sixty ounces of normal urine daily. She ate and slept well. She was now allowed to get up, but was directed to continue wearing the abdominal support. The latter, owing to the diminution of the size of the abdomen, had required to be altered. After being up in the ward for a few days, the patient was allowed to go into the garden; and there then being no reaccumulation of fluid in the abdomen, she was made an out-patient. This was in July, 1875. The patient has been continually under my observation from then until now. She has had no recurrence of the ascites. Her general condition of health is feeble, but she is able to do her household work and earn her living. Unusual exertion causes slight oedema of the feet. She has never had albuminuria.Med. and Surgical Reporter.

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The Coming Duties of the Accoucheur. -Prof. Gaillard Thomas, lecturing on a case of neglected prolapsus uteri, makes (New York Medical Record, Dec. 22) the following observation :-"The time is not distant when confinement cases will be treated very differently from what they are at the present day. This is a subject of the utmost importance. There is the most urgent need of a radical change in the practice of the majority of the profession, and the time is ripe for the appearance of a stirring and able paper on the Proper Management of Natural Labour,' which will awaken medical men to a sense of their duty in obstetrical cases. The physician should be expected and required to visit his patient from time to time all through her pregnancy, in order to see that everything is progressing favourably for a successful delivery, and to remove, if possible, any condition (as albuminuria, for instance) which is likely to interfere with this; and I am fully convinced that it will not be long before the accoucheur who does not pursue this plan will be held culpable. Again, he will be held equally culpable if he discharge his patient at the ninth day, or at the end of a fortnight, without making a physical examination, to ascertain that the parts have sustained no injury from the strain and pressure of parturition, and that the process of restoration to the normal condition is going on satisfactorily. A little attention paid at that time will often prevent the most serious consequences in the future. If the physician had made such an examination in the case, and had found the cervix lacerated, he might have waited a month, and then, ascertaining that trouble was resulting from it, he should have sewn it up, and also restored the perineal body which had given away.

All this could have been readily done in the second month after delivery, and it would certainly have been a great deal better to do it than to wait thirteen years before undertaking the operation. It is true that this woman has suffered comparatively little pain and inconvenience in consequence of the neglect of her physician, but this is a very rare exception to the general rule; and, as I said before, the time is not far distant when the medical man will be held responsible for allowing such

a condition to continue without interfering to prevent the evil results so sure to follow from it."-Med. Times and Gazette.

On the Combined Use of Chloroform and Morphia.-Professor Koenig, in a communication to the Centralblatt fur Chirurgie, (No. 39, 1877), says he has combined the hypodermic administration of morphia with that of chloroform in a large number of cases, with very favorable results. It is seldom necessary to give more than one or at most two centigrammes (one-sixth to one-third grain).

The indications for the use of morphia during chloroformnarcosis are twofold: 1. Motor disturbances occurring before or during chloroform-inhalation unless these are very transitory: 2. Operations of such a nature that the chloroform-narcosis cannot be maintained throughout, and especially towards the end. Among the latter may be particularly mentioned operations upon the eye, plastic operations, extirpation of tumours from the soft parts of the face. The object of using morphia is to induce analgesia over and above the chloroform-narcosis, and also that this narcosis should not be pushed so far. As regards any danger which may be connected with the combination of narcotics, Koenig esteems this lightly. He says that out of seven thousand cases in which he has used chloroform. none have died from it, and many of these took morphia also. -London Med. Record, Feb. 15, 1878.

Abortive Treatment of Furunculus.Dr. Lieven observed at the Petersburg Medical Society (Petersburg Med. Woch., Dec. 29) that all modes of treatment hitherto tried (such as early incision, cauterizing, and cold or warm applications) have failed to arrest the further development of furunculus that has once commenced. The following procedure, however, brings it to a stand: A burning, pricking, itching, suddenly occurring in a normal portion of the skin, announces the commencement of the development of the furunculus, and on the same day a small and quite superficial induration can be felt at the spot. If the skin be now superficially scraped with

a small knife, so that a drop or two of blood may be pressed through the epidermis, no furunculus will be developed. This result would seem to show that the affection originates in the uppermost layer of the corium, and perhaps in the capillaries of the papillæ, and not, as hitherto received, in the subcutaneous connective tissue, with succeeding necrosis of the corium and epidermis. Disturbance of the digestive organs (frequently diarrhoea) always precedes or accompanies furunculus; but a plethoric or decrepit constitution is no necessary condition, as it may occur in one that is quite normal.-Med. Times and Gazette.

Sulphate of Quinine.-A property of Sulphate of Quinine not well known.-This property consists in the modification it causes on suppurating surfaces when it is applied locally. The injection of a solution of 60 centigrammes of sulphate of quinine in 60 to 100 grammes of distilled water is very advantageous in the treatment of empyema. The same injection is efficacious in gonorrhoea, and an ointment of sulphate of quinine exercises a cicatrizing action on wounds and chronic ulcers. The injections of quinine have the same action on suppurating cavities and fistulous tracts.- Gazetta Medica Italiana.

Uterine Hemorrhage. In a recent discussion at the Obstetrical Society of London on the value of injection of chloride of iron in uterine hemorrhage, Dr. Robert Barnes said the point of the syringe should be carried to the fundus. This could only be insured by introducing the hand into the uterus. Clots should be removed before injection. One to four is a good strength, but a stronger solution might be used if necessary, but it should not be escharotic. This means of arresting hemorrhage had stood the test of experience, and had saved many lives. The test for its use is the possibility of exciting reflex action. Where this cannot be done, use perchloride of iron. Med. Times and Gazette.