and many interesting relics from the fields of battle during the late Franco-German war. What impressed us most during our stay was the earnest, almost chivalrous, devotion to the advancement of surgical science shown by the Professor and all his staff. There is no im ́provement or new principle of practice advocated by any member of the profession, in any part of the world, that is not canvassed here, and, if worth it, speedily adopted by Professor Esmarch; for, like the clerk of Oxenford in Chaucer, 'Gladly wolde he lerne, and gladly teche,' A visit to the Naval and Military Hospital, in which we were shown, through the courtesy of the principal medical officer, the medical stores and appliances for the different ships in the German navy, brought to a conclusion a pleasant and instructive forenoon.—British Medical Journal. A METHOD OF REMOVING THE BY JAMES TAYLOR, M.R.C.S., The operation is performed as follows: An incision about one-sixth of an inch long is made through the skin only from the upper edge of The secured first by a pair of forceps, and then a If the floor of the mouth be affected, so that the loop round the tongue would pass over some diseased portion without including it, this could generally be easily remedied by a preliminary incision beyond the diseased portion, SO as to form a groove for the wire loop.London Lancet. ATAXY. the hyoid bone forwards; this incision is simply NERVE-STRETCHING IN LOCOMOTOR to facilitate the passage of the needle. forefinger of the left hand is passed along the dorsum of the tongue until the point of junction of the tongue and epiglottis is defined; the end of the forefinger is maintained at this point for the present. A strong curved needle, having a length of six inches (exclusive of handle), with eye near the point, and armed with the platinum wire of the galvanic écraseur, is passed through the little incision directly backwards in the middle line until the point is felt by the tip of the forefinger of the left hand (in its course the needle, being in the middle line, can by no possibility damage any important tissue). Then the handle is well depressed and the needle pushed on, the point being guarded and guided by the left forefinger until it is protruded through the mouth. The wire is A discussion on this subject was opened by Professor Langenbeck (Berlin), who read a paper in which cases were related in which the operation of nerve-stretching, undertaken to give relief to the pains, had been followed by improvement in the symptoms of ataxy. It seemed as if the stretching of the sciatic nerve led to beneficial changes in the spinal cord.Dr. Morgan (Manchester) had not had much experience in nerve-stretching; but at the present time he had under his care, at the Manchester Royal Infirmary, a case of idiopathic lateral sclerosis, in which there were characteristic gait, ankle-clonus, increased tendon-reflex, and great pain in both lower extremities. The pains were not relieved by morphia or other drugs. It then occurred to Dr. Morgan that nerve-stretching would be of service; accordingly his colleague, Mr. Southam, cut down on the left sciatic nerve and stretched it vigorously, so as to raise the patient from the table. Under the influence of chloroform, and before stretching, the ankle-clonus was most marked; but, immediately after stretching, ankle-clonus ceased in the limb operated on, but remained in the right leg. Pain in both legs, however, had disappeared. In the course of a fortnight, the ankle-clonus returned slightly; 60 beats per minute, compared with a previous 120; but there had been no return of pain. Dr. Morgan thought that nerve-stretching in sclerosis, involving the posterior or lateral columns of the spinal cord, was followed by good results. His patient was in all respects better. Grainger Stewart (Edinburgh) had met several cases in which pain, with paralysis and other symptoms, showed that there were lesions in the nerves themselves. Of these cases, some had recovered entirely, just as they might occasionally recover in locomotor ataxy. He thought that it would be found that a peripheral affection of nerves existed in these cases, which was quite separate from central changes. The relief obtained by nerve-stretching in these cases was undoubted. -Professor Langenbeck pointed out that the disease might arise from affection of the periphery of the nerves; and that the affection of the spinal cord might be secondary; that the painful condition of the nerves, which was so remarkable and pathognomonic, could be relieved by stretching; and that, by relieving the pains, the morbid condition in the cord was relieved or checked.—Dr. Ogle (London) asked whether nerve-stretching was most beneficial in those cases in which the origin of disease was central, or those in which it was peripheral ? –Dr. Brown-Sequard (Paris) pointed out that, in section of one-half of the spinal cord, there resulted hyperæsthesia on the side severed, with anaesthesia on the opposite side; and that, when the sciatic nerve was stretched on that side in which anesthesia was present, it disappeared, and hyperæsthesia appeared instead, and vice versa. —Dr. Langenbeck replied.—British Medical Journal. THE CURE OF VARICOSE VEINS BY SUBCUTANEOUS LIGATURE.-Dr. John Duncan, of Edinburgh, employs carbolized catgut for the radical cure of varicocele (British Med. Journal). The veins are separated from the artery and vas deferens, and a needle armed with catgut is thrust through at the point of separation; it is then reintroduced at the orifice of emergence, made to pass between the veins and the skin, and brought out at the entrance; the two ends are then firmly knotted together and cut short. By traction on the scrotum the knot is made to disappear entirely, and the punctures are covered with salicylic wool saturated with collodion. The same manœuvre is repeated an inch higher and sometimes a third ligature is advisable. A hard lump of coagulum forms between the ligatures, tender at first, but soon diminishing in size and becoming insensitive. Dr. Duncan treats varicose veins of the leg in the same manner; the introduction of the point of the needle into the aperture of exit of the first puncture and the tightening of the loop of catgut is difficult when there is brawny œdema. In such cases the patient should be kept at rest and an India-rubber bandage applied for a few days. A single ligature is not sufficient, and to close the lumen permanently two must be applied about one inch apart. It is essential that no branch be given off in the segment of vein between the ligatures.—Cincinnati Medical News. THESE are the characters by which you are to recognize a hernia of the Epiploon alone. The tumour is dull, and presents no gurgling on pressure; you will find these signs described in your books, and they are deceptive, for an entero-eppocele presents these characters; but one symptom, to which I most especially direct your attention, is the narrowness of the pedicle of the hernia, and the almost complete indolence of this on pressure, joined to the absence of a resistant plane behind the ring. This narrowness of the neck is explained without difficulty, when we recall the texture of the Epiploon. We understand very easily that the fat may be depressed by the constricting band, as by a thread.-M. Desres, in Gaz. des Hopitaux. MECHANICAL STIMULATION OF THE BRAIN. Dr. Brown-Séquard recently announced to the Société de Biologie that he has found, in rare cases, a simple puncture or section of the motor zone" of the brain of the dog, rabbit, or guinea-pig, gives rise to signs of pain, and this when the dura mater has been entirely removed from the region. The sensibility is that of the brain, not of the pia mater, for the surfaces of an incision into the brain substance were found to possess the same sensitiveness. He ascribes it to the congestion induced by the operation, and concludes from it that the congestion may render parts of the brain acutely sensitive, which normally are destitute of sensibility. It has been especially met with when the brain has been exposed for a little time. These observations agree with some made by Dr. Brown-Séquard thirty years ago, showing that the insensitive spinal cord becomes sensitive when it is inflamed. He believes that the movements observed by some experimenters on mechanical stimulation of this part of the brain are simply reflex, and are not due to the excitation of any motor elements. WHAT is the best method of performing vaccination? This question is often asked by younger physicians, and I do not wonder at it, because little or no instruction is given on this point in our medical colleges. The frequent failures that follow the operation, and often spurious results pronounced genuine, and protective, fully attest the fact that there is a great deal of carelessness, if not downright ignorance, often displayed in the simple, yet important matter of vaccination.-W. M. Welch M. D., in Phil. Med. Times. DR. LEWIS D. MASON, treats fractures of the nasal bones, by passing a steel support, such as a needle or hairlip pin, through the line of fracture, raising the depressed portion. The needle is kept in position by an elastic band, passed over the head and point.-Western Medical Reporter. THE NASHVILLE Journal of Medicine and Surgery, commenting upon the case of the wounded President, says: The sublime spectacle of Dr. Bliss scratching the back of the wounded President, so carefully described in the newspapers, puts in a new light the proper function of the medical attendant. Midwifery. PUERPERAL CONVULSIONS. Several cases in which pilocarpin, by mouth and hypodermically, was used in eclampsia, are that it excites uterine contractions and renders reported with varying results. Langer asserts them more powerful, and, in two or three cases, Kroner used (Am. Jour. Obstet.) injections of as many physicians report a similar result; but pilocarpin in four cases without any appreciable effect upon the uterus, although the toxic effect of the drug was marked. The weight of opinion seems to favor chloral in large doses by the rectum. Guyot (France) reports remarkable success, thirteen of fourteen cases being saved. He injected into the rectum from one to four drachms in twenty-four hours. Dr. Goodell believes it the best single remedy. He directs a drachm by rectum, or twenty grains by mouth, repeated as often as may be necessary, and asserts that he has never lost a case. Other writers are equally laudatory of chloral, while none discard chloroform. With regard to the induction of premature labor in eclampsia, there seems to be a growing sentiment in its favour, and successful cases recorded. are Blood-letting is apparently growing in favour again. Many writers advocate it, or at least speak of it as a too much neglected remedy. Dr. C. C. P. Clark (Am. Jour. Obstet.) is a strong advocate for the use of morphia in heroic doses. He argues that a woman who bears her pregnancy lightly never has convultions, hence a prophylaxis consists in removing all irritating conditions. In eclampsia the nervous system is peculiarly tolerant of opiates. Ordinary doses are useless. Inject at once into the arm a grain and a half of morphia; should the paroxysm return any time after two hours, repeat the dose. If in labour, repeat the dose He says: in eight hours, any way. "This quantity may look large, but I am perfectly confident, after having tried it many times, that it is perfectly safe. I am almost prepared to swear that twice the quantity, not repeated, would do no harm to a patient in a strongly eclamptic condition."-DR. HENRY GIBBONS, Jr., Pacific Medical and Surgical Journal. THE PERINEUM. surface remaining intact. I have known and felt this to occur repeatedly. The tearing will be readily felt by the hand resting on the perineum. I have known quite extensive lacerations of the vaginal surface, with little or no external appearance of injury. In one instance, the extensions of the nymphæ arcund the clitoris were torn away, producing great suffering. With regard to methods for preventing laceration, many are mentioned. They may be thus summarized: Much has been written lately of the structure of the perineum, its support during labor, and its immediate repair after laceration. Prof. Thomas, in the new edition of his work on Gynecology, devotes a chapter to a consideration of the perineal body, and its great importance in sustaining the contiguous structures, and Dr. Henry J. Garrigues contributes a paper of similar import, on the Obstetric Treatment of the Perineum, to the Am. Jour. of Obstet., for April, 1880. These writers both point out the imperfectness of the descriptions of this part of the body in the various works on anatomy. The latter, in particular, seeks to correct many current false impressions. He says: "The fourchette, so generally torn in first labors, is not a fold of mucous membrane, (2) Relax the vulva and perineum by as usually supposed, but is formed of skin. It administering chloroform; by anointing is, indeed, nothing else than the commissura liberally with belladonna; by performing posterior, i. e., the posterior junction of the episiotomy; by drawing forward, with the labia majora; just within is the fossa navicularis." | hand, the perineum and anus, or the perineum The elaborate description of the floor of the pelvis cannot be reproduced here, but it is well worthy of study. The frequency of the rupture of the perineum is variously stated. In a discussion in the Cincinnati Academy of Medicine, Dr. Tait reported 70 ruptures in 142 primaparæ. Other members believed the accident to occur in 90 per cent. of cases. On the other hand it was stated, that in Prof. Braun's division of the Vienna General Hospital, in 1,157 primiparous cases, rupture occurred but 68 times. This indicates, possibly, a smaller tendency to laceration than exists elsewhere; but it certainly indicates the adoption of more effectual measures to preserve from rupture the perineal body. Dr. Tait attributed lacerations mainly to two causes, rapid deliveries and large heads; but Dr. Whittaker asserted that the head rarely caused rupture. The accident resulted during the escape of the shoulders. He had even seen it caused by the hips. Other speakers corroborated in part this view, but held that lacerations were often begun by the head, and increased by the shoulders. I think too little importance is attached to the possibility of laceration of the mucous surface of the perineal body, its integumentary (1) Prevent the rapid descent of the head by pressure upon it, by avoiding the use of ergot, by placing the patient on the left, by dissuading the patient from making voluntary effort. alone by hooking the fingers in the anus (Goodell's plan); by hooking the fingers in the posterior commissure and drawing it backward toward the coccyx with every pain, until the head rests on the perineum. Dr. Burk, of Rotunda Hospital, urges this latter plan as accomplishing gradually what otherwise is left for the head often to do rapidly. Dr. Reamy, in the discussion above alluded to, considers, and I think quite properly, that too much discredit is cast upon the the forceps in this connection. With the injudicious and hasty, it is true, the laceration is increased, but in the forceps we have a means of regulating and controlling the advance of the head, such as no other method will afford. By the deliberate and cautious use of the forceps, laceration, otherwise inevitable, may even be prevented. So important is the integrity of the perineum considered, that most writers urge an ocular examination of the parts in all cases immediately after delivery. A strong objection to such a rule is the repugnance of both physician and patient to its adoption, but it is not only sanctioned but urged by the leading gynecologists of the country. Opinion is almost uniform too in favor of the immediate operation for repair of the perineum, even in cases of moderate laceration. Pacific Medical and Surgical Journal. POST-PARTUM AND SECONDARY HÆMORRHAGE. Attention has already been called in another part of this paper to the use of hot water uterine injections in post-partum hæmorrhage. The treatment continues to be extensively advocated. Dr. Lombe Atthill (Dublin Jour. Med. Science), states that it is the routine practice in the Dublin Lying-inHospital. He gives the following as the result of his experience : "(1) In case of sudden and violent hæmorrhage in a strong and plethoric woman, it is better to use cold. "(2) When, from the prolonged or injudicious use of cold, the patient is found shivering and depressed, the beneficial effect of injecting hot water is rapid and remarkable. "(3) In nervous, depressed, and anæmic women, hot water may at once be injected, without previously using cold. "(4) In cases of abortion, where from uterine inertia the ovum, although separated from the uterine wall, is wholly or in part retained, the injection of hot water is generally followed by most satisfactory results. "(5) Where the injection of perchloride of iron is considered necessary, previous injection of warm water clears the uterus of clots, etc., permitting the fluid to come directly in contact with the bleeding surface and lessening the chance of septic absorption. The injection of tincture of iodine into the uterus has also strong advocates, one writer considering it the most reliable of all measures. He says (Med. Record): "(1) Iodine controls the hemorrhage, not by coagulating the blood within the uterus, but by exciting the uterus to contract. The blood is expelled in a liquid form, and hence, instead of having the uterus filled with a mass of hard, sticky clots, ready to undergo decomposition, the uterus is empty and disinfected. “(2) Tincture of iodine has never, so far as I can learn, caused any bad result, even when injected into the uterus in full strength. "(3) The iodine treatment never fails to control the hæmorrhage." The editor of the Medical Press and Circular urges the extensive trial of ipecac in nauseating doses, as advised by Dr. J. H. Carriger, of Tennesse (N. Y. Med. Jour.). The remedy is not only anti-hæmorrhagic, but is oxytocic, relaxing and dilating the os, increasing uterine contractions and expulsive pains, and safely and speedily terminating labor. Dr. I. E. Taylor read a paper at the Academy of Medicine (N. Y. Med. Jour.), on " Flagellation, or spanking of the child's back previous to its entire delivery as a means of preventing uterine hæmorrhage; and flagellation of the abdomen of the woman after delivery of the placenta as a substitute for the introduction of the hand into the cavity of the uterus." The title of the paper explains the method advocated by Dr. Taylor. The hips and legs of the child are left within the vagina for twenty minutes or more, while the back is being flagellated. The method serves to stimulate uterine contraction. Dr. Hanks (New York Obstetrical Society) mentioned a case of secondary hæmorrhage after sixteen days, with death of the patient. Dr. Barker thought the result attributable to malarial poisoning, but Dr. Lusk suggested the retention of a supplemental lobe of the placenta as the probable cause. It me to to have In emer It is surprising that so little seems to be known or written of the alum plug in uterine hæmorrhages. appears advantages over all other methods. gencies it is more readily obtainable than hot water or tincture of iodine with the proper syringes to inject; and its use is entirely free from the dangers that attend intra-uterine injections. A piece of alum the size of a hen's egg, smoothed of its sharp edges and thrust into the cavity of the uterus, stops hæmorrhage, causes contraction of the uterus, and prevents septic absorption. Its mechanical presence, and the irritating character of its solution, cause the uterus to contract; this contraction, together with the astringent properties of the alum, stops hæmorrhage immediately; changes which the blood and discharges undergo through the action upon them of the dissolving alum absolutely prevent putrefaction; and the action of the same alum solution upon any lacerated surfaces, prevents absorption. I have seen other than the most satisfactory results from this treatment, and feel perfectly safe with any uterine hæmorrhage, if supplied with an alum plug.-Dr. GIBBONS, Jr., Pacific Medical and Surgical Journal. never the |