canal very active, and guards the skin against atmospheric changes. These indications are met by saline cathartics, as bitartrate of potassa and Rochelle salts, a vegetable and farinaceous diet, and stimulating the skin once in twenty-four hours by hot water or hot air baths, followed by frictions with a rough towel, and causing the woman to wear flannel. In the worst cases, premature delivery at the end of the eighth month, unless life is in jeopardy before. For the convulsion, promote activity of the kidneys and deliver as soon as it can be done with safety. Bleed, if warranted by the condition of the woman, to diminish the tendency to rupture of vessels, and consequent apoplexy; then employ chloroform. To favor dilatation of the os, use the warm douche against the cervix. Dilatation effected, resort to version or the forceps. Dr. E. R. Peaslee, of New York, endeavors to prevent the convulsion by the use of dry cups over the kidneys, acetate of potassa, and a sharp, drastic purgative. In case of convulsion, venesection, chloroform, and expedite delivery. For dilatation, he finds the most expeditious instrument is the hand. Pass the hand with the tips of the fingers up to the os, insinuate one finger, then another, until the whole hand is passed, and the os dilated. If convulsions occur after delivery, continue the chloroform, and assist it with morphia hypodermically. Dr. A. L. Loomis, of New York, uses an infusion of digitalis to produce diuresis, and controls the convulsion by morphia hypodermically. Dr. Anderson, of New York, used ether with partial success, but relieved his patient by inducing free action of the bowels. Dr. Baxter relies upon infusion of digitalis in 3ss doses every two or three hours, and venesection. Few Dr. J. P. White, of Buffalo, favors opium, not hypodermically, but especially by enema. Croton oil to unload the bowels. cases require venesection. (New York Med. Record, 1873.) Dr. F. H. Tucker, San Augustine, Texas, reports two cases successfully treated with chloral and bromide of potassium, after failure of chloroform. A previous case was successfully treated with chloroform. (R. and L. Med. Journal, Dec. 1873.) Dr. John Field, Sheriden, Oregon, was similarly successful with chloral alone. The convulsions were post-partum. (R. and L. Med. Journal, January, 1874.) Dr. Dujardin-Baumetz has employed chloral by enema, one drachm, repeated in two hours; and also as a preventive, when eclampsia threatened, with the happiest results. He prefers it to chloroform, and suggests doses of two and even three drachms. He observed that while the uterine contractions were quite painless, they were more intense and frequent than normal. (Gaz. Méd. de Paris.) Dr. J. A. Langrill, Jarvis, Ont., employed chloral and bromide of potassium successfully; when vomited, it was continued by enema. (Canada Lancet, June, 1873.) Dr. W. B. Tackett, Cuthbert, Ga., has never failed with chloroform. Two cases that died were fully bled. (Clinic, Feb. 7, 1874.) Dr. Barnes, London, in his lectures delivered at the Royal College of Physicians, presents in the treatment four cardinal principles; moderate central nervous irritability, cut off emotional irritants or excitants, cut off peripheral irritants or excitants, eliminate all complicating morbid conditions. To fulfil these indications, anæsthesia by chloroform stands first; puncture the membranes; nitrite of amyl, by its quicker action than chloroform, might prove more valuable; this has yet to be fully tested; opium, belladonna, the bromides, and chloral. Of the great value of the latter he is fully satisfied. In plethoric cases, venesection, or leeches to the temples. The irritation of blisters is positively injurious. (Lancet, Aug. 1873.) Dr. Merkel, Ziegenhain, employed chloral by enema with marked success. (Berliner Klinische Wochenschrift, March 24, 1873.) Dr. P. J. Roebuck, Lancaster, Pa., effectually arrested the convulsions by chloral after venesection had failed. 30 gr. doses every half hour. (Amer. Journ. Med. Sciences, Jan. 1874.) Dr. W. T. Lusk, New York, uses venesection when the patient is not too much depressed, and then chloroform, pushed so as to overpower the voluntary motor nerves. He insists on speedy delivery, using Barnes's dilators when requisite, and the forceps. He strongly objects to manual dilatation. After labor, if convulsions continue, he uses morphia hypodermically. Chloroform is then no longer safe. (New York Med. Record, Oct. 15, 1873.) Dr. Jacobs, Cologne, says the early evacuation of the liquor amnii is the chief point, the convulsions generally ceasing after it. Chloral does not always produce cessation of the spasms, though it induces dilatation of the os. The forceps must be used when the head is high and movable. Chloroform inhalation will prevent the convulsions, and hence it has a double value, aiding operative procedure, and diminishing risk to mother and child. (Berliner Klinische Wochenschrift, June 9, 1873.) Drs. Revillout and Bowyer, France, employed bromide of potassium successfully. (Gaz. des Hôpitaux, June 7, 28, 1873.) Dr. John Barclay, Leicester, Eng., used a half drachm of chloral by enemata with success. (Brit. Med. Journal, May 31, 1873.) Dr. Allan D. Mackay, Stony Stratford, used chloral, 25 gr. doses, successfully. (Brit. Med. Journal, June 21, 1873.) Dr. M. F. Crain, Angola, Ind., reports a case; bromide of potassium had been previously employed; convulsions came on; delivery was accomplished; yet the spasms continued. Chloroform was used by inhalation, and as soon as she could swallow, chloral was given in 15 gr. doses every fifteen minutes: recovery was rapid. (Indiana Journ. of Med., Oct. 1873.) Dr. Ulysses L. Huyette, Rolla, Mo., regards eclampsia as the result of anæmia most generally, and that it is periodic; hence, he proposes to restore the circulation in the nerve centres, oppose the periodicity, deliver to remove the exciting cause. With these views he uses quinine in large doses, during the intervals and by enema, or hypodermically if necessary. Should the patient have reached the condition where quinia would not have time to act, he uses chloroform to complete anesthesia. (St. Louis Med. and Surgical Journal, Dec. 1873.) Chloral Hydrate in Labor and in Eclampsia.-Dr. Franco-Mazorra observes (Gaz. Heb., No. 34) that the application of chloral in obstetrics has given rise to serious studies, many of which have been collected by the author, in addition to stating his own experience. The author divides his work into two chapters. In the first he treats of the administration of chloral in natural labors, and in cases of rigidity of the uterine neck, which are but a variety. The second heading is consecrated to the study of the influence of chloral in epileptic attacks. In each of these headings are collected the observations relating to each point, reuniting those in foreign parts, and strongly insisting on his personal experiences, of which he has been able to analyze the details. The total number of observations is fifty, and the following conclusions have been arrived at:— 1. The hydrate of chloral ought to be pure, otherwise it may be dangerous to use it, or, at any rate, it may be without any true therapeutic value. 2. In women, during labor, chloral firstly acts as a calmative, then produces sleep, and considerably diminishes suffering. 3. The uterine contractions continue to take place during the sleep caused by chloral. They are shorter, less frequent, and pretty energetic. In general the duration of the labor is shortened by the influence of this agent. 4. The anaesthesia produced by chloral may be sufficiently complete, and make the woman quite unconscious even during the expulsive period, and a certain time after birth. 5. Given in small doses, chloral sometimes causes agitation, which ceases when the dose is increased. 6. The remedy may be given at all periods of labor. 7. Chloral may also favor the cure of puerperal eclampsia, by modifying the general condition of the patient, and producing a forced repose. Puerperal convulsions, of whatever nature they may be, are calmed by chloral. 8. The sleep produced by chloral is light, and after it, women have neither drowsiness nor headache. 9. The only contraindications to its use are weakness or disease in the fœtus, and debility of the mother, which may cause us to fear coma. = 10. Chloral may be administered in clysters, in draughts, or in suppositories. It is necessary to give it in the dose of four grammes 60 grains, if we would obtain immediate calm and sleep, without any period of agitation. If the desired effect were not produced, the dose of one gramme 15 grains, every five minutes is required. 11. In eclampsia, it is well to keep the woman under the influence of chloral for a long space of time. Its action is more rapid, more marked, and longer in women subject to lingering labors, or to want of sleep. = 12. The consequences of labor are not graver when chloral is given. 13. Chloral may advantageously replace chloroform in all those cases in which that agent is used in labors. 14. In the same mode as in eclampsia chloral favors the cure of acute mania. Only one case of death has been registered by the author; it occurred in a primipara with albuminuria, who died after ten fits of eclampsia, in spite of taking four grammes of chloral.' Diagnosis of Early Pregnancy.-Dr. Adolph Rasch insists on the bimanual examination. The vaginal examination should always be We feel assured, by the results of a large experience in the use of this remedy, that puerperal convulsions are controllable in the large majority of cases by the prompt and proper employment of chloral. In this belief we are fully indorsed by every physician who has sought our counsel in these cases. Given in full doses by the mouth, or, when that is impracticable, by enemata repeated at short intervals, we have never known it to fail of relieving the convulsions, and giving the patient a refreshing sleep, from which she awakes improved in every particular. made with two fingers. To distinguish from the enlargement by a tumor, he regards fluctuation as an important symptom. Ten years' experience in a large number of cases bear out the view that this must be felt very early-in some cases at the seventh week; in most after the second month. Add to it the areolar signs of the mammæ, and we are almost certain. Another valuable symptom is the increased desire to urinate, especially at night. As to fluctuation, retained menses or other fluids are so rare, that error could scarcely occur, even if not aided in the distinction by other symptoms. Safer for a short time to suspect pregnancy when it does not exist than the reverse. The best way to feel the fluctuation is to introduce two fingers into the vagina, while the womb is steadied by the other hand, and to alternately manipulate the uterus with the two fingers. In most cases, at an early stage, he found the uterus anteverted; here the manipulation was easier. Fluctuation early is mostly only felt by the fingers in the vagina; sometimes also by the outer hand at the same time. After three months it is mostly felt by outward manipulation alone. The catheter should always be used first. (Obstet. Journal, Nov. 1873.) Diagnosis of Sex in Utero.-Dr. W. E. Ford, of New York, gives the result of 80 observations. Basis, 144 pulsations for a female fœtus; 124 for a male. 62 were accurately recorded. Of 24 females the average pulsations per minute were 143; highest 160, lowest 120. Males, 38, average 142; highest 170, lowest 110. Conclusions: Pulsations are no indication of sex. (New York Med. Record, Dec. 1, 1873.) Dr. F. C. Wilson, of Louisville, from 109 observations, tabulates his results thus: 110 to 125, almost certainly male. 125 to 130, probably male. 130 to 134, doubtful; chances in favor of male. 143 to 170, almost certainly female. (Amer. Practitioner, Dec. 1873.) Extra-Uterine Fotation.-Dr. J. Hutchinson, London, reports a case simulating ovarian dropsy. Tapping was resorted to, and death ensued from peritonitis. The autopsy revealed the true nature of the case. He gives the following rule when the diagnosis of such cases is made out: "Extra-uterine fœtation cysts ought |