Dr. McClintock, Dublin, as a prophylactic, administers gallic acid for some weeks before labor. He chiefly relies upon an early rupture of the membranes in the second stage of labor, and the use of ergot so soon as dilatation is complete. Dr. Atthill confirmed these views. He waited fifteen minutes after the birth, before delivering the placenta. Dr. Churchill agreed, but made the uterus expel the placenta at once. Dr. Johnson and others agreed. (Med. Press and Circular, Dec. 31, 1873.) Dr. John Bassett, Birmingham, regards granular degeneration of the kidneys with albuminuria and debility from defective nourishment as causes of the hemorrhagic tendency. He gives iron and an alkali or an acid. He urges pressure upon the womb. Ergot is uncertain. When the flow is very great, he presses upon the aorta, a practice too much undervalued. Opium is of great value in cases of alternate contraction. Ergot, cold, pressure, and opium failing, he injects perchloride of iron. Dr. W. Boyd Mushet insists upon the injection of cold water. Dr. Heywood Smith prefers ice in the uterus. Dr. Talfourd Jones, Brecon, succeeded well in two cases with equal parts of tr. of iron and aq. (Brit. Med. Journal, Dec. 20, 1873.) Mr. Jos. Quirke, Birmingham, found the iron to succeed when all else failed. (Ibid., 27, 1873.) Dr. Ewing Whittle, Liverpool, anticipates hemorrhage when pains are strong and quick, and cease suddenly, with long intervals. He gives in such cases a full dose of ergot, and if the pains do not improve, he repeats at the end of an hour. Of course, he is cautious, that the soft parts and os are first well dilated. He uses a liquid extract twice the Pharmacopoeia strength, in a teaspoonful dose. He claims to have eliminated this complication from his obstetric practice. Has seen but one case in 3750 labors, and in that he had no ergot. (Brit. Med. Journal, Sept. 27, 1873.) Dr. A. Macleod Hamilton, Liverpool, reports a case: 23 perchloride in a half pint iced water injected; complete recovery. (Ibid., Jan. 31, 1874, p. 137, and p. 154.) Dr. J. Braxton Hicks favors the perchloride. He gives ergot in languid action of the uterus just as the head comes upon the perineum. (Ibid., Jan. 17, 1874.) Dr. G. T. Gream objects to the iron as hurtful. early, as it requires at least twenty minutes to act. (Ibid.) He gives ergot 60 m of fl. ext. Dr. T. Snow Beck, London, opposes the iron injections as highly injurious. He urges cold to the uterine cavity. He asks, "is any one justified in having recourse to means which have such serious results, when other remedies, which have never been noticed to be followed by such consequences, may be employed to induce what was required-contraction of the gravid uterus?" (Ibid., Jan. 3, 1874; Nov. 22, 29; Dec. 6, 1873.) Dr. P. B. Giles, Jr., presents seven cases treated with the perchloride of iron; six recovered. He prefers 3j to Oj in paralysis of the uterus; when it alternately contracts and dilates, a stronger solution, as 3j to 3iv or 3vj. In secondary hemorrhages he swabs. the bleeding point with the pure iron. (Obstet. Journal, Oct. 1873.) Dr. Thomas Chambers, Edinburgh, followed this plan with complete success. (Ibid.) Dr. T. E. Williams, Birmingham, was successful in seven cases; one case, three times; never saw the slightest ill effect, and regards the perchloride as a safeguard against septicemia. (Ibid., Dec. 1873.) Drs. W. and J. F: Keith, Sturgeon, Mo., succeeded in a frightful case with the persulphate of iron. (Kansas City Med. Journal, Oct. 1873.) Dr. T. Snow Beck reports cases where death has followed the injection. (Brit. Med. Journal, Feb. 14, 21, 28; March 7, 21; April 4, 1874.) Our conclusions from a limited experience of the use of this method, and from a careful review of the testimony adduced, are in favor of this means of arresting the hemorrhage. The medical attendant should carefully and earnestly employ all the usual means for inducing permanent contraction of the uterus; these failing, he should not hesitate to employ the styptic. Sources of Hemorrhage in Placenta Prævia, etc. Dr. J. Matthews Duncan, Edinburgh, remarks, of the hemorrhage in placenta prævia, that it may occur by rupture of a utero-placental vessel, at or above the internal os uteri; by rupture of a marginal utero-placental sinus within the area of spontaneous premature detachment, where the placenta has a margin at or near the os; by partial separation, as by a jerk or fall; by partial separation from a slight dilatation, the result of uterine pains. The firstwill occur even without dilatation, and without premonition. The arrest of the hemorrhage is probably the result of a local or general anæmia. (Edin. Med. Journal, Nov. 1873.) Dr. T. Snow Beck, London, on hemorrhage during the puerperal period, concludes that the blood comes from the torn utero-placental arteries; it is not a venous hemorrhage by retrogression; when the uterus is not firmly contracted the canals of the veins remain pervious and any noxious secretion, or other soluble substance, at the inner surface is taken up and carried along these canals into the general circulation; the coats of the arteries are so directly adherent to the uterine tissues as to prevent any retraction in their length, or contraction in their diameter; the coats of the arteries and veins are so incorporated with the tissues in the uterine walls that the condition of their canals is only influenced by the contraction or relaxation of the tissues composing the walls; the formation of clots in the canals of either the arteries or the veins have never been shown to exercise any influence as a means of arresting hemorrhage; the injection of styptics into the gravid uterus to arrest hemorrhage risks the death of the patient by the conveyance of the substance into the general system; the only safe means of arresting post-partum hemorrhage and preventing puerperal complications is by closing these canals by the complete and permanent contraction of the uterine walls. (Obstet. Journal, Dec. 1873.) Drs. W. and J. F. Keith, Sturgeon, Mo., report a case commencing with hemorrhage at the eighth month. Labor was necessarily brought on and the delivery accomplished. (Kansas City Med. Journal, Oct. 1873.) Dr. J. P. Chesney, St. Joseph, Mo., presents a paper entitled A New Theory of Placenta Prævia, in the St. Louis Med. and Surg. Reporter, April, 1874. Electro-Magnetic Current in Labor.-Dr. McRae, of Penicuik, has, in three cases, used the current in the second stage. Ergot, digital irritation, and external friction were useless. The os was well dilated, and the pelvis well formed. The forceps was interdicted, as post-partum hemorrhage was feared. The first application was for two minutes; the uterus responded, and a pain, the first for eleven hours, was induced. It was again applied in ten minutes, and the head began to descend; a third application in five minutes caused the delivery of the head. The other cases were equally successful. One electrode, a flat piece of metal the size of the two hands, curved to fit the abdomen, is applied to the parietes; the other is placed against the perineum. The force is moderated as desirable. If the other pole were applied to the os, the whole uterus would be thrown into contraction, the os narrowed, and labor impeded. When the os is dilated or dilatable, uterine action has ceased, oxytocics fail, and, conse quently, post-partum hemorrhage is to be feared, this aid will be found useful. M. Tripiér has also been successful by this means, and even suggests, in post-partum hemorrhage, the introduction of the negative pole within the uterus. (London Med. Record, Nov. 19, and Journal de Med., July, 1873.) Premature Labor.-Dr. B. R. Morris induces labor by galvanism. He uses a portable battery. One pole is inserted within the os, the other is placed over the abdomen, and a continuous current is passed. He regards it as the most safe method. (Brit. Med. Journal. Orleans Med. and Surg. Journal, Nov. 1873.) New Oxytocic Properties of Quinia.-Dr. S. H. Plumb, Red Creek, N. Y., does not think quinia originates pains of labor, but believes that it preserves their natural intermittence, and promotes delivery. (Amer. Journ. Med. Sciences, July, 1873.) Dr. Robert Gray, Armagh, Ireland, has found it to answer well in two cases. It does not produce the same persistent state of contraction as ergot. (Obstet. Journal, Sept. 1873.) Labor, Aids to.-At a meeting of the Obstetrical Society of Edinburgh, this subject produced much of value. Eminent practitioners agreed in the belief that acceleration of labor might be induced by position, and pressure from above. The position on the knees was of old, and is still employed in some parts of Great Britain and Germany, sitting on and between two chairs tied together by the legs, and the backs separated. Pressure upon the fundus and uterine walls by the two hands of an assistant, or by means of a sheet drawn diagonally over the fundus and down behind. Dr. Protheroe Smith employs a binder; but in very many instances the forceps will speedily terminate a very tedious labor, and they should always be employed without delay. Action of Morphia or Opium, and Chloroform in Labor.-Dr. H. L. Byrd, Baltimore, Md., says the contractions of the womb are but little affected by chloroform. The use of this, or morphia, far from retarding labor, often facilitates its progress by removing or obtunding the irritability of the nerves supplying the neck. It is of the greatest moment that the pulse and respiration be carefully watched during the administration of this agent. Any hesitation or faltering in either should demand the instant cessation of the inhalation. (Med. and Surg. Reporter, July 19, 1873.) Difficult Labors and their Treatment.-Dr. C. S. Haswell, Sacramento, Cal., urges the importance of the accoucheur being ready for every emergency, and insists upon the necessity of aiding the woman, and never waiting for nature to perform spontaneous evolution and other difficult processes. He believes that at an early period in labor, and especially before rupture of the membranes, a shoulder may be converted into a vertex presentation more readily than we can turn by the feet; that after the membranes have been ruptured, turning by the head may be readily effected; that this may be accomplished even when the effort by the feet has failed. If the right shoulder presents, the head in the left iliac fossa, the right hand being introduced into the vagina, apply the fingers on the top of the shoulder, and the thumb in the opposite axilla, so as to command the chest, and enable us to apply a degree of lateral force so as to give the body a curvilinear movement, the left hand being applied to the abdomen of the woman over the breech of the fœtus, so as to dislodge the breech, and move it towards the centre of the uterus. The body thus resumes its original bent position, the points of contact are loosened, the force of adhesions overcome, and without any direct action on the head, it gradually approaches the superior strait, and will most probably adjust itself as a favorable vertex presentation. If not, it may be acted upon as in a deviated position of the vertex, and brought into correspondence with one of the oblique diameters. All this must be performed in the absence of a contraction. That hand should be introduced the palm of which is directed naturally to the breech of the fœtus. Podalic version is preferable in cases of inertia, exhaustion, hemorrhages, and convulsions, where speedy delivery is demanded. It is not admissible otherwise, because of the difficulty in introducing the hand, and the greater danger of causing laceration or inflammation. He believes cephalic version gives almost as much certainty of a living birth as in ordinary presentations, provided it is resorted to early. (Pacific Med. and Surg. Journal, Mar. 1874.) Complication of Labor.—Dr. G. C. P. Murray, London, reports a case of that rare complication, varicose hemorrhage from the cervical zone. In this case, the true cause of hemorrhage was only diagnosed in the second labor. Such a state might be anticipated when there exists a varicose condition of the lower extremities, and should put the obstetrician on his guard. (Obstet. Journal, April, 1873.) Paralysis of Bladder after Labor.-Dr. J. J. Phillips, London, reports a case of two years' standing cured by the use of galvanism, |