mucous membrane of the (gaping) cervical canal. Among the most useful are solutions of nitrate of silver, 1:30, and crude pyroligneous acid, to be used as above directed. If a catarrh of the vagina exist, the nitrate of silver solution deserves the preference and should not be removed, but cotton tampons should be inserted into the vagina through the speculum and allowed to remain for a length of time, so that the solution absorbed by the cotton may exert a continuous influence on the vaginal mucous membrane. It should be repeated every third day. Using these methods of treatment, the most extensive ulceration may be healed in one or two months, even when complicated with chronic metritis and uterine hyperæmia. In those cases in which actual or thermocautery is not required, and dilatation of the uterine canal is unnecessary, the patients may be treated at the doctor's office.

[I generally use Goulard's Extract for simple erosions or ulcers with smooth or granular surface. This immediately unites with the albuminous exudation from the raw surface and coats it over with a thick white membrane, arresting the bleeding, and so firm that even the pressure of the elevator in moving the cervix does not remove it. In this way an immediate protection from chafing-in my opinion the most immediate cause of the erosion or ulceration-is afforded to the cervix, and healing progresses rapidly. I do not remember ever having had to repeat this application more than six times, before a healing-over was obtained. This method, however, has the disadvantage of leaving a permanent white scar, caused by the lead-albuminates inclosed in the resulting cicatrix. These products are only got rid of during the evolution and involution of the uterus attending gestation and parturition. If the surface of the ulcer is very uneven (papillary or fungoid) I first cleanse it in the manner above directed so as to leave a smoother cicatrix, but do not consider this preparation an absolute prerequisite to a cure, as the acetate of lead solution (Goulard's extract) seems to shrivel and destroy any small projections from the general surface of the ulcer.-D'ARY.]

When the ulceration is complicated with considerable endometritis it sometimes becomes necessary to dilate the uterine canal by means of laminaria tents or instrumental dilators. In these cases the ulcer does indeed diminish in size under the use of the caustics; its surface becomes smoother, but further improvement does not follow-the ulcer generally continues near the external os, and if left to itself it soon assumes its original aspect. The more or less abundant mucous secretion from the uterus continues as before in spite of the improvement in the ulcer. The catamenia in many cases are irregular, anticipating their proper time, and continuing too long and too abundant. The internal os gapes, as may be ascertained by introducing a sound. Under those circumstances the treatment

of the uterine catarrh becomes an indispensable condition to the healing of the ulcer. According to the condition of the uterine mucous membrane various remedies will have to be employed, the discussion of which does not properly belong to the scope of this article. If there be laceration of the cervix this should be healed up by means of the usual operation, after which the healing of the ulcer will progress satisfactorily. -Med. Vestnik.

CONVALLARIA MAJALIS.

This beautiful little flower, commonly known as lily-ofthe-valley, apart from its dainty appearance and delicious perfume, which have rendered it a universal favorite, has of late become very prominent, especially in Russia, as a cardiac remedy of so much efficiency, as to place it at once at the head of all similar remedies, at least with those who have tried it; and we confidently predict that before long it will take the place of digitalis, leaving this justly esteemed drug to take the second place. The greatest therapeutist Russia has ever produced, Professor Botkin, has adopted it as one of his standard remedies in his clinic, and prescribes it almost daily, Physiological experiments with it, are still being carried on in Russia with all the thoroughness and attention to minutiæ characteristic of the Russian physiologist.

Dr. Troitsky, for instance, has been experimenting carefully on sparrows, fowls and pups, and has positively established the fact that by introducing the extract of the drug into the alimentary canal either per rectum or per orem, it is impossible to cause death with the symptoms characteristic of the specific toxic effect of the plant, as revealed by postmortem changes. Whenever death took place it was only after repeated poisoning and from the exhaustion consequent on the emeto-catharsis caused by the drug. It is well to remember that these doses, in proportion to the weight of the animals, were of such magnitude as would never, under any circumstances be given in clinical practice, and that the author's special object was to cause death, in order to examine the animals postmortem. When, however, the drug was introduced directly into the circulation, by hypodermic injection, death was caused sometimes instantaneously, and the autopsy revealed the specific effects of the drug.

The author ascribes the difference of action between the hypodermic administration and that per rectum or per orem, chiefly to the emeto-cathartic effect of the drug in excessive doses, when given through the alimentary canal, which seems to eliminate the poison with sufficient promptness to preserve life, although at the expense of great exhaustion from the violent emeto-catharsis. Thus the drug acts, as it were, as its own

safety-valve. Cumulative effects it is absolutely free from. Its excellent therapeutic qualities have been well described in the Therapeutic Gazette, for the past and current year, and in THE PHYSICIAN AND SURGEON for August, 1881, page 368, which articles it would pay every practitioner to read over. We have then in the fluid extracts convallaria majalis florum a drug which is free from the dangers of digitalis whilst it produces all the identical decided therapeutic effects, and has moreover a wonderful soothing and calming effect, in those conditions of nervous irritabilitiy, so torturing to the patient and his attendants, which are the usual concomitants of organic cardiac disease, and which are so well described by Dr. Troïtsky in the October number, 1881, of the Therapeutic Gazette. The enterprising drug firm of Parke, Davis & Co., of Detroit, with their usual discrimination, have promptly recognized the merits of the remedy, and have prepared fluid extracts both of the flowers and roots, separately, thus bringing the remedy within every practitioner's reach. The above experiments, as well as my own experience, have all been with the extracts, infusions, and tinctures from the flower. But late clinical experiments of another Russian physician have proven that the herb and the root also possess the same influence on the heart and nervous system, though in a lesser degree. The root has in former times been used as a sternutatory and cathartic, in which latter respect it is both an uncertain and unpleasant remedy, and consequently was soon set aside. Its cardiac influence had evidently been entirely overlooked.

The object of the above remarks, is to call attention to this remedy, now in the market. With me it has long since taken the place of digitalis, and in cases of organic heart disease, when, in the latter stages, the symptoms are becoming urgent, and the patient anxiously begs for relief, the physician will appreciate a remedy that will relieve the patient signally and promptly, without creating in the physician's mind the dread of overdose and cumulative effect.-R. D'ARY.

STRANGULATED HERNIA.

Some time ago, there appeared in THE PHYSICIAN AND SURGEON, an account how a Russian physician saved his patient from the risks of the operation of dividing the stricture of strangulated hernia, after all efforts in taxis had failed, by passing a strong Faradic current through the protruding tumor of intestine. The latter promptly contracted and with the usual characteristic gurgling disappeared within the abdomen almost immediately after application of the current. This method of reduction, if universally successful (in reducible or recent cases) would be preferable to taxis. It should be tried and reported on, for its modus operandi is clear. The following

expedient, as quoted by the Vratch, (copying from Berl. Klin. Woch.) leaves us in doubt as to how the effect is obtained by the means used:

Dr. Tinkelstein, of Roumania, writes: "As soon as possible after incarceration, and without waiting much time in trying taxis, one, two or more tablespoonfuls of pure ether should be poured on the incarcerated intestine, repeating this every fifteen minutes, and covering the hernia in the meanwhile with a compress of several folds of cloth. In order to lessen the burning sensation, instead of the pure ether a mixture may be used consisting of ether and oil of hyoscyamia. After three or four ablutions the hernia either returns of its own accord or may easily be reduced by taxis. In the course of eleven years the author has used this method in fifty-eight cases, of which fifty-four were successful. None of the hernia were purely omental."

The subject is an important one, and every plausible means brought forward as a help in reducing an impracticable hernia deserves careful consideration and trial. But should an occasion present to try the above method, we should hardly feel inclined to strictly follow the author's directions; for the following considerations. The ether can act only in two ways: either as a refrigerant or carminative. If it is intended to act as a refrigerant only, it is applied in a most bungling and wasteful manner. The spray would act much more powerfully and economically, and there would be no sense in using the compresses. If it is intended to act as a carminative, for stimulating the hernia, and (if intestinal in whole or in part) increasing peristaltic motion, a small fold of cloth, soaked in a dram of ether and closely covered would be more effective. If alternate refrigeration and stimulation are intended, the ether spray and hot fomentations in alternation would be more decided in effect. Yet from the addition of oil of hyoscyamus, to “lessen the burning sensation" it is pretty clear that no stimulant or carminative effect is desired by the author. His success, therefore, would seem to have been due rather to the effect of the cold obtained in such an awkward and expensive way. The ether, of course, cannot exert any specific influence in hernia. -D'ARY.

WEIGHT OF FETUS.

After collation of considerable statistical material (nine hundred and thirty-one cases), Professor Cuzzi has come to the conclusion that the weight and length of the foetus at term bear a direct relation to the average duration of the catamenial flow. In two hundred and fifty-four women the flow lasted from one to three days, and the average weight of the new-born child was three thousand one hundred and twenty-six grams (six

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pounds and two ounces), the length four hundred and ninetyone millimeters. In four hundred and eighty-three women the flow lasted from four to six days and the average weight of the child was three thousand two hundred and one grams (six and one-fourth pounds), the length four hundred and ninety-three millimeters. In one hundred and ninety-four women the flow lasted seven and more days, and the weight of the child averaged three thousand two hundred and ninety-one grams (six pounds and seven ounces) the length four hundred and ninetyfive millimeters. Since the weight and length of the child bear a certain average relation to the diameters of the skull, the Professor thinks the above circumstance worthy of consideration in the prognosis of parturition in women with contracted pelves. -Rivista clinica di Bologna.-Vratsh.

ELASTIC LIGATURES IN OVARIOTOMY.

Dr. Kleberg, of Odessa, was the first to propose the elastic ligature for surgical operations, especially on the internal sexual organs. Unfortunately he died before his idea had time to become universally received. More detailed descriptions of his ligature are to be found only in fragmentary sketches of his writing, found after his death and published by Dr. Wagner in Zeitschrift f. Chir., Band XV. Another Russian surgeon, Rein, proposed a similar ligature for Porro's operation, in Annales de Gynécol., 1881.

The permanent elastic ligature of Kleberg seems destined to fulfill important indications in general and gynecological surgery, especially in operations on organs liable to dangerous parenchymatous hemorrhage, such as uterine tumors. Since the introduction of antisepsis, the pedicle in ovariotomies is generally left within the abdominal cavity. The same is done by Schroeder and Spencer Wells in amputation of uterine tumors and amputatio uteri supra-vaginatis. The majority of other surgeons, however, in these latter operations deem it necessary to treat the pedicle extra-abdominally, and allege the following two reasons for so doing: (1) It is difficult to prevent putrid decomposition of a large and juicy pedicle. (2) Dangerous hemorrhage often occurs in the pedicle.

The first reason does not need any refutation, for the strict observance of antiseptic precautions will prevent decomposition equally well, whether the pedicle be small or large.

The second point is answered in the remarkable article of Olshausen in D. Zeitsch. f. Ch., Band XVI. He details illustrative cases, and proposes the following methods of ligature: (1) When the mioma is pediculated, one ligature en masse is sufficient, after producing a furrow for it either by means of the wire ecraseur or a clamp specially made for the purpose (Billroth, Spencer Wells). But if the pedicle is as thick as a finger