ient time had elapsed for its absorption, the patient having even harder contractions with less distress than before, and the os uteri being speedily dilated.

During the first stage of a physiological labor, I believe that the circular fibres of the os are passively relaxed; and that the active, usually gentle, contraction of the fibres of the body of the uterus serves to overcome the resistance which the tissues of the cervix and os present to dilatation.

Now, if the circular fibres of the os retain their tonicity, or if they contract with those of the body during a pain (and I have felt them contracting in a number of cases), no dilatation can be effected; or at any rate, it will be with great difficulty, and the resulting distress will be greater than when they offer only the minimum amount of resistance.

The cases above narrated and referred to have taught me that opium possesses the power of relaxing the circular fibres, at least of the os, and of stimulating the longitudinal and oblique fibres into active contraction. It is upon these principles that opium is exhibited in dysmenorrhoea, when it is dependent upon spasmodic contractions of the circular fibres; or where it is owing to the presence of "menstrual decidua," clots, etc.

In abortions it is an invaluable remedy, facilitating dilatation, diminishing hæmorrhage, promoting the expulsion of the placenta, and lessening suffering.

Ergot on the other hand, by causing contraction of the circular fibres, retains the placenta, and therefore should rarely be given (in abortion) until after the fœtus and secundines have been expelled.

Placenta previa.-I have used opium in three cases of placenta prævia, one at the sixth month and two at term, saving the mother in each instance. In another case I attempted to turn, but, having made an erroneous diagnosis as to position, the placenta being planted directly over the os uteri, I introduced the wrong hand, and, failing to get hold of the feet properly so as to bring them down, I detached the (entire) placenta rather than lose time by changing hands. I mistook a R. Occip. Post. for a L. O. Anter. position. The hæmorrhage ceased at once, and the mother subsequently did well.

I think that opium meets two important indications in placenta prævia: 1. It facilitates dilatation, thus shortening the period of greatest danger. 2. It promotes the

expulsive power of the uterus. It also serves to lessen hæmorrhage by a special hemostatic action.

It is an interesting fact that, in one of these cases, when the respiration was reduced to four in the minute by cumnlative action of the opium, which had been too frequently repeated by mistake, the uterus expelled the child with one pain, thus illustrating my statement that opium does not possess the power of arresting normal uterine contractions.

Hour-glass Contractions, etc.-While hour-glass, cylindrical, or other irregular tonic contractions of the uterus (particularly those which occur after the expulsion of the foetus) may be (and doubtless are sometimes) spontaneous, still in my experience they have always seemed to be due to ergot. Since I have learned the special power of opium, as set forth in this paper, I have used it in these cases with invariable success, although some of the most. approved obstetric authorities say such use "is objectionable."

I will give the following cases in point:

Case V-December, 1864. Mrs. McD., aged about thirty-eight. Primipara. Labor progressed steadily until the head had fully distended the perineum. Retrocession followed every pain, and, as they were neither strong nor long, no progress was made. The vulva, too, was well dilated, and I gave fɔ̃iss Squibb's fl. ext. ergot to complete the delivery. Fifteen minutes afterward the peculiar contractions produced by ergot commenced, and the child was soon born. Placing my hands upon the fundus of the uterus (it having been pressed upon by the hand of an assistant while the child was being delivered and the funis tied and severed), I discovered it to be much elongated, reaching above the umbilicus; and, making a vaginal examination, found the placenta to be beyond the roach of my fingers, and, introducing the hand, discovered it so tightly grasped by an hour-glass contraction that I could not remove it. Gave morph.-sulph., gr. 3, noting the time. A little less than half an hour afterward I was awakened (having fallen asleep from great fatigue) by a contraction of the uterus under my hand. The placenta was expelled with considerable impulse, and the uterus contracted down almost entirely below the os pubis (which, by the way, judging by my experience, it seldom does, teachers and text-books to the contrary notwithstanding). Case VI.-Mrs. S., multipara. A delayed labor de

pendent upon insufficient pains. Gave f3iss ergot. The child being born, I delivered the placenta at once (as I now invariably do after giving ergot). A cylindrical contraction immediately followed, the fundus rising considerably above the umbilicus, in fact almost as high as the ensiform cartilage. The cylinder was about three inches in diameter, firmly and uniformly contracted. An opiate was given, and in due time a permanent globular contraction followed.

Dr. J. D. Trask, in his essay upon "Rupture of the Uterus, published in the American Journal of Medical Sciences, January and April, 1848, gives four cases of rupture of the uterus due to ergot. The following case is given to show how this accident might be produced in a diseased or even very powerful uterus, as well as to il ustrate the apparently antagonistic effects of ergot and opium upon the gravid uterus.

Case VII.--Mrs. M., multipara, about thirty-five. Previous confinements easy. Present labor not worthy of note until the os was nearly obliterated, a ring only being left, when dilatation was for some unknown reason arrested, and no progress made for an hour. The uterine contractions then becoming inefficient, gave 5iss ergot. As soon as the pains peculiar to ergot came on, I made an examination, and found the os less dilated than before, and its fibres contracting with those of the body. Gave gr. morph.-sulph. Within half an hour the pains had become more like those of a "physiological labor," the os uteri relaxed and became dilated, and the expulsion of the child soon followed.

I gave opium in this case,with the expectation that it would produce a relaxation of the circular fibres of the os. It seems to have exerted this power in opposition to ergot as effectually as in the "hour-glass" and other irreg ular contractions above mentioned.

It may readily be seen that the simultaneous action of the ergot upon the os and body might have caused a rupture of the uterus. The contractions produced by ergot are continuous. I have often observed, however, that they have not been general, but have occurred in different sets of fibres successively. Herein lies one great danger of its use. In these, as well as all other irregular contractions of the uterus, I find opium a prompt and reliable remedy. In fact I now use it in those cases of delayed

labor dependent on inefficient uterine contractions, instead of ergot.

This property being established, the administration of opium admits of wide application in uterine therapeutics. In dysmenorrhoea, abortion, irregular contractions of the uterus of all kinds, previous, during, and subsequent to labor, and in placenta previa as an adjuvant to Barnes' dilator, it will be found to be a valuable remedy; more certain in desired action (when given under proper indications) than any other remedy in our profession. Such at least it has been in my hands in quite an extensive obstetri experience.

In dysmenorrhoea, opium is given to quiet the contractions of the circular fibres (when this variety is present). In abortion, it is administered in the hope that the pains are caused by irregular contractions; and, if there is no dilatation (producing a partial separation of the mombranes), it will often prove successful. If, on the contrary, the process has progressed so far as to render abortion inevitable, opium promotes it by relaxing the circular fibres of the os. It may appear at first strange to hear such apparently opposites ascribed to a remedy; but there is no inconsistency in the statement. The irregular (colicky) contractions do not constitute abortion, but they may produce it; and there is much less risk in a temporarily relaxed os uteri without pain, than in a normal condition of the os without contractions of any kind in the body. In the "irregular contractions" as term (at in cases V, VI, and VII), it acts promptly.

I will state that cases might have been multiplied to a large number illustrating this subject; but the practical value of my paper would not have been enhanced at all, as the cases selected are as well or better marked instances, each of its kind, than any others recorded by me since I commenced my observations seven years ago.-[Med. Archires.

ART. II.-ON THE PHILOSOPHY OF COUMTER-IRRITATION AS APPLIED IN PRACTICE. By JOHN G. FRENCH, F.R.C.S., Surgeon to St. James' Infirmary, London.

I do not think that there is anything more easily explained in the remedial art than the modus operandi of counter irritation, although I agree with Anstie that the

principle of action is misunderstood, and that therefore erroneous ideas and practice are based upon it.

It is upon the comprehension of the principle alone to which I desire to direct attention, for I must presume that, as a remedy of great efficacy, its claim is as well established as any other. As a general illustration of the subject it may be said that a disease of deep seat and long standing fails to show the least improvement under what are deemed the most favorable circumstances, as of rest, proper diet, comfortable temperature, pure air, agrecable occupation of mind-even, apparently, of good general health.

If, under these circumstances, an injury is inflicted upon the skin, as by a burn (actual cautery), or by caustic potash, we can yet absolutely rely upon the separation of the destroyed skin from the living, and afterward upon the healing process being carried on until cicatrization is complete, I think the explanation is this, namely, that however reparation may fail in the original disease, it may still be expected with certainty in the recent injury; and that whatever force and action are comprised in that em vi be carried on until that reparation is complete, which, in the case I have put, will be for a considerable time. During this time the original morbid action is observed first to diminish, as rendered evident by the diminution of inflammatory product and pain, and by the gradual restoration of structures morbidly altered to

a natural condition.

Perhaps the more appropriate term by which all this can be expressed, and which is sought for by Dr. Anstie, is "diversion" instead of "counter-irritation;" at least it has the advantage of being the shorter term. But to alter names is so inconvenient, that I think it far more important to acquire distinct perception of the truth, value and meaning of terins before altering them.

Now I believe that all the measures which are comprised in the term counter-irritation consist in the infiction of an injury, and the beneficial result, when obtained, is effected by the corresponding diversion caused by the reparative process of that injury, whatever it may be. So that the point to study is what is the reparative process peculiar to each remedial injury, and then to suit the remedy to the malady.

In the term "remedial injury" everything used as