minutes to half an hour, the pains, if present, are increased in severity, in frequency, and in duration, presenting a marked clonic character, following each other in frequent succession, with a decided intermission between each. In this respect it differs decidedly from the action of ergot, which in full doses produces one continuous tonic spasm of the uterine muscles. It is this property of ergot which has, when administered before the delivery of the placenta, produced in so many instances the irregular contractions of the uterus, of which the hourglass is a well-known example. The employment of ustilago seems to be entirely free from such unpleasant complications. In addition to being a valuable adjuvant in stimulating weak uterine contractions, ustilago seems to possess the property which some years ago was ascribed to quinine, namely of exciting uterine pains when entirely suspended.

As to the time required for the action of the drug to become apparent, it may be said that it differs in different cases, depending, undoubtedly, upon the rapidity with which it is absorbed from the gastro-intestinal tract and carried into the system. In only two instances did it require over thirty-five minutes before the ustilago acted upon the uterine tissues, and in one case most of the drug was ejected by emesis. In the remaining seven cases the average time required was twenty-five minutes.

The effect produced by ustilago upon the other unstriped muscular tissues of the body has not been inquired into. Probably it produces the same increase of intestinal peristalsis and the same rise in the arterial pressure due to vaso-motor spasm as is produced by ergot. This is yet open to investigation.

2. The indications for the employment of the drug. We shall consider the first indication for its use to be a failure of the pains, with complete dilatation of the os uteri. In none of the cases was the drug employed until the pains of labor had either become so weak that they were inefficient to accomplish the expulsion of the fetus, or until they were entirely suspended. This, then, we consider the second indication for its use, namely, the inefficiency or entire suspension of the parturient pain. After the ustilago had been taken, it may also be noticed that in no case was there the slightest tendency toward a post partum hemorrhage. In each case, after the expulsion of the placenta, the uterus remained in a state of firm contraction. While, during the three months, the great majority of remaining cases in which the customary ergot had been employed showed no tendency whatever toward this alarming accident, however, in two instances was there such an occurrence de

manding prompt attention. The third indication, then, for the employment of ustilago we shall consider to be a condition of uterine inertia threatening or producing post-partum hemorrhage.

3. The dose and mode of administration. The preparation of ustilago employed in all reported cases, as well as in our own, was a good fluid extract. The dose of this varies from one half to two drams, one dram being a fair average. This may be repeated at intervals as required. Should it be necessary, it may be used hypodermically in doses of from five to fifteen minims.

Finally, the advantages of ustilago over ergot. The employment of u-tilago seems much to be preferred to that of ergot. It does not produce irregular contractions with all the consequent complications and sequela; containing two and one-half per cent of fixed oil, while ergot contains twenty-five per cent to twentyeight per cent, the dangers of absorption are reduced to a minimum; and finally, as it can be procured at a cost of fifty per cent less than that of ergot, it seems to be on a fair highway toward the supplanting of the latter in obstetrical practice, should the results of the investigations thus far be confirmed by subsequent researches.-Medical News.

OBSTETRIC PRACTICE IN RURAL DISTRICTS. In the Edinburgh Medical Journal, Dr. Wm. Fairbanks writes a very sensible and practical paper on this subject. He says that he has kept a careful register of all his obstetric cases, and that the series reported at present comprises the cases treated between 1874 and 1884. He hopes that the statistics which he presents, while inadequate in themselves, may serve to modify in the direction of truth the equally insufficient data of other records.

The series comprises: Natural labors, 538; operative labors, 107; total, 645. Forceps cases, 82; turning, 10; craniotomy, 10; induction, 5. Presentation: Vertex, 614; brow, 1; face, 1; breech, 17; foot, 5; shoulder, 2; hand, 5. Maternal deaths, 5; infantile deaths, non-viable, 14; premature, 7; full time, 40. Mortality in forceps cases: Mother, 1; child, 0. Twins, 8; placenta previa, 3; placenta adherent or retained, 5; post-partum hemorrhage, 8; spontaneous evolution (seven months), 1; hydrocephalus, 1; intra-uterine amputation of forearm, 1. Youngest mother, fourteen years and three days. Longest interval between two pregnancies during married life, twenty-one years.

Of the five maternal deaths, none seem to be fairly chargeable to the accoucheur.

Turning now to the infantile mortality, this must be largely reduced before the accoucheur

can account himself responsible for it. Deduct cases in which the fetus was not viable, 14; cases in which the child was born before Dr. Fairbanks was called in, 11; cases in which the child had long been dead, 6; total, 31; and the infantile mortality for which he is accountable is thirty, or nearly 5 per cent. The causes of death in these thirty cases were: Premature

birth, 6; ante-partum hemorrhage, 5; craniotomy, 8; turning, 1; prolapsed funis, 2; prolapsed funis and turning, 3; breech presentation, 1; hydrocephalus, 1; induction, 2; induction and turning, 1; total, 30.

With reference to craniotomy, he says, "Many things must happen, and a new generation arise, before the various cutting operations will supp ant craniotomy in moderate degrees of pelvic contraction." For this he gives the following reasons: (1) Craniotomy in such cases, when done at the proper time and carefully, does not add appreciably to the mother's risk. (2) The cutting operation does add to the mother's risk, and she and her friends know it. (3) Patients refuse to be operated on.

With reference to the use of forceps, he says that the more frequently a practitioner uses the forceps the larger in all probability will be his proportion of easy forceps cases, and therefore his statistics will look better in this respect than those of a man who postpones the use of the forceps until the case is desperate. Yet it may reasonably be a subject of inquiry, whether any percentage of instrumental interference should lay one open to the charge of meddlesomeness. His rule is never to interfere except in the best interests of mother and child, never merely to save his own time. This is the best and only test a practitioner need regard, and in applying it with cultivated judgment he has no censor but his own conscience.

As to the time at which it is desirable to interfere instrumentally in labor, Dr. Fairbanks says, "The length and character of the first stage helps to determine the point. The strength and temperament of the patient are also factors in the case. But the great question to be settled is this, Are the pains telling upon the patient in a degree out of proportion to their effect upon the progress of labor? If they are, it will not be very long before help is called for." He seldom allows strong expulsive pains to go on for more than one and a half to two hours after full dilatation of the cervix, unless they are manifestly equal to the occasion; and if pains become feeble, after having been in good force for an hour or so, the forceps are generally resorted to.

With regard to the use of ergot, he says, "In three fourths of the foregoing cases the older practitioners would have used it, and

sooner or later, let us hope, the babies would have been born; but the mortality table would probably have been very different. Angus McDonald's words in, if I mistake not, his first course of lectures to four of us students have a permanent place in my memory, 'In midwifery practice always prefer steel to ergot.' And so I have. My rules for giving ergot have been: Never give it to a tired uterus. Never give it in a first labor. Never give it in a case of grave disproportion. Don't give it in cases of slight disproportion. Hardly ever give it till the head is born. From the present series of cases it would be easy to illustrate and establish these rules, but I fancy they are almost generally accepted."

He is in the habit of inducing labor by means of the elastic rubber catheter or with Barnes' bags. Chloroform, he says, is seldom needed for the women among whom he has practiced, even in forceps cases, turning .or craniotomy. He speaks disparagingly of the value of chloral as an anodyne in painful and tedious dilatation of the cervix.

With regard to rupture of the perineum he does not seem to think that sewing up of slight tears is necessary. He speaks confidently of having saved severe lacerations by using the forceps, while the bad tears which occurred were in cases which the forceps had not been applied.

PLACENTA PREVIA.-John Morris, M. D., of Baltimore, comes to the following conclusion in regard to the treatment of placenta previa :

1. No expectant plan is justifiable in cases of placenta previa. The uterus must be emptied as soon as possible after the discovery of the trouble, no matter what the stage of the pregnancy may be. A halting, hesitating practice means danger both to mother and child.

2. That the life of the child must not be considered in the treatment of the case.

3. That the manner of emptying the uterus must be left to the individual judgment of the medical man in attendance.

4. That in cases of central adherence of placenta the safest and best practice is to separate the placenta entirely.

5. That in cases where placenta is adherent in the latero cervical zone of the uterus partial detachment may be sufficient, but if the hemorrhage is not arrested the whole mass should be removed and means of delivery at once instituted.

6. That the colpeurynter is the only tampon that can be safely used in these cases-that sponges, silk handkerchiefs and other forms of tampon are nasty, filthy, and septic, and should never be employed.

7. That the bimanual treatment, whenever possible, is the best and speediest form of delivery.

8. That chloroform must be administered in all cases in which manual interference is necessary.

In my judgment there is no emergency in obstetrics so dangerous, and in which skill, judgment, and energy are so necessary, as hemorrhage resulting from placenta previa. Statistics show that the maternal mortality in these cases is from twenty-five to forty per cent. Dr. Parvin could not have had much experience in these cases, or he would not have recommended delay or palliative measures as he has done in his recent book. Patients die from two causes, anemia and septicemia. Septicemia becomes essentially fatal in the presence of anemia. The anemia is the result of the repeated hemorrhage permitted to take place under the expectant plan of treatment.

Statistics show that in cases of placenta previa two thirds of the children perish before the full term, and of those that are born alive one half perish soon after birth, therefore, considerations of humanity would lead us to think only of the safety of the mother; indeed, in adopting measures for speedy delivery without regard to the safety of the child more children would be saved in the end.

The manner of emptying the uterus must be left to the individual judgment of the prac

titioner.

The colpeurynter is the only tampon that can be safely used. It answers many purposes; it softens the cervix and leads to gentle and gradual dilatation of the os; it relaxes the vagina and soft parts and thus prepares the way for the use of the dilators, such as Molesworth's or Barnes' bags, or even the fingers if practicable. The fingers are the best dilators, and in a majority of cases prove the most efficient agent. The colpeurynter should be filled with hot water, hot as the patient can bear; this should be renewed every hour. Cotton and sponge tampons are a nuisance and should be discarded.

The safest and best mode in cases where the placenta is centrally adherent is to separate it entirely. This arrests hemorrhage and clears the way for further procedures looking to rapid delivery. It is claimed, it is true, that the hemorrhage does not proceed from the placental surface supplied by the tortuous uterine arteries, but from the uterine veins. This may be true to some extent, but when the placenta is removed pressure can be brought to bear on these bleeding vessels and the hemorrhage thus be arrested. Separation of the placenta itself furnishes a source of irritation which excites

the uterus to action, but we can not trust to the mere hemostatic resources of nature. The cases in which there is no uterine action are the most dangerous and require the promptest measures. The manipulation necessary in this condition will generally induce contractions. Astringents and ergot are useless. They only serve to encourage delay when delay means death.

When the head presents and labor pains are active no manual interference is necessary. In cases of this character the hemorrhage is absolutely arrested by the pressure of the head.

The bi-manual plan of delivery recently brought into use is no doubt the best and speediest form of delivery; but it is not always practicable.

SCHEURLEN'S CANCER BACILLUS.--Horatio R. Bigelow writes as follows from Berlin to the Boston Medical and Surgical Journal:

Those who watched the painful fetal development, birth, and growth of the bacillus tuberculosis, and of the coccus of erysipelas, will not be surprised that the bacillus of cancer is suffering parturition throes quite as tormenting. Every time a new pathogenic germ is heralded, the mass of unlucky bacteriologists, who have no concern in it, rise up to strangle it before fully born. Six years ago the sages of pathology predicted its coming, basing their opinion upon a logical balancing of anomalous instances. Every student who has watched with becoming intelligence the march of science, who has seen the old landmarks of etiology and pathology leveling themselves and giving place to established facts, who has noticed how one wellestablished discovery led up to another, and how probable the deduction was that anomalous forms of disease might be due to similar causes, will not now be astonished that Scheurlen has announced a new bacillus. Fränkel's arraignment, to those who can read between the lines, amounts to nothing as scientific argument. S. Guttmann and Stabsartz Schill both confirm the results after personal experimentation and investigation. Schill has been for years engaged in the same line of inquiry. Not in one instance nor in two did Scheurlen find these bacilli, but in every case examined by him. Because Koch was not fortunate in finding it, this has no bearing whatever upon the question; neither did he find the coccus of erysipelas, but yet no one to-day doubts Fehleisen's work. If it be true that certain eminent doctors of New York have travestied this matter, as the telegrams of yester

day report, it only lowers them as scientists in the eyes of those competent to judge, and presupposes a snap judgment of a subject which they have never investigated, and concerning which, consequently, they are incompetent to pass an opinion. There is a bacillus of cancer just as really and absolutely as there is one of consumption. Its morphological characteristics are not yet clearly defined, and there are many other doubts to clear up and questions to answer. But all of this can come only after many months of hard and patient labor. It stands exactly upon the same ground that the coccus of erysipelas possessed when announced, and it will possibly go through the same fiery ordeal that all original work must go through before accepted. To be a competent critic there are certain well-recognized prerequisites:

1. A man must be thoroughly well trained himself in habits of research, and especially in those lines of inquiry related to the subject in hand.

2. He must come to his work free from any preconceived ideas that would warp his judgment, and free from personal feeling which would belittle his learning.

To those who know the ins and outs of professional feeling in Berlin, the fact that the discovery was made in Leyden's clinic. and not elsewhere is not without significance.

THE NATURE OF THE HYMEN.-Mr. Bland Sutton, at a recent meeting of the British Gynecological Society, pointed out that the vagina was formed in the same manner as the rectum, by an invagination of the epiblastic layer, termed the proctodeum, coming into contact and fusing with the posterior segment of the primitive gut. The distinction between the two parts remained throughout life; for, in the rectum, a ridge of adenoid tissue marked the situation where the squamous epithelium of the anus joins the columnar cells of the rectum. In the vagina the corresponding spot was indicated by the hymen or its remains.

The mode by which the proctodeum and the gut became fused was as follows:

When two cul-de-sacs came into contact and exercised pressure upon each other, the edges gradually cohered and joined organically. At this stage the lumen was yet obstructed by a thin septum. This grad ually became thinner from pressure, and ultimately perforation took place. The hole gradually increased and the septum slowly disappeared until a complete channel was the result.

In the case of the anus, it was clear that, if the invagination failed to reach the gut, an imperforate rectum would be the result. From a study of these conditions he was convinced that the hymen was merely a thin septum resulting from the imperfect coalescence of the proctodeum with the urogenital section of the cloaca. Should the septum be complete, it was termed an imperforate hymen. Occasionally the perforation was multiple, eccentric, or cribriform.

Similar evidence as to the nature of the hymen was obtained from the opposite end of the alimentary canal. The mouth and pharynx, with the associated structures, were derived from an involution of the surface epiblast named the stomodeum. This met the blind anterior end of the foregut at a spot eventually corresponding to the cricoid cartilage. Should these parts fail to unite, an imperforate pharynx was the result; when the coalescence was imperfect, then a hymen-like diaphragm might be found. So far as the alimentary canal was concerned, diaphragmata of this nature occasionally existed between the pharynx and the esophagus, in the duodenum immediately above the entrance of the bile-duct and in the rectum at the point of union of anus and gut.

Thus the formation of a diaphragm, sometimes complete, but more commonly perforated at the entrance of the vagina, was only in agreement with what occurred in other parts of the body when two cul de-sacs coalesced to form a continuous passage. Lastly, abnormalities of the vaginal orifice were not infrequently associated with defects of the alimentary canal, as might be expected, taking into consideration its embryological relations with the cloaca.-Medical and Surgical Reporter.

ANTIPYRIN AND ANTIFEBRIN IN HAY-FEver. Dr. W. Cheatham, of Louisville, Ky., in a letter to the Medical Record, October 8, 1887, says that he used antipyrin for hayfever frequently during the summer and autumn of 1886, and always with the best results. During the summer of 1887 he tried both antipyrin and antifebrin for this affection. He then reports the following

case:

"Mr. B., foreman in a large railroad repair-shop, has had so-called hay-fever for ten years; the difficulty begins with him in early spring, and ends with cold weather. He has taken, during the whole summer, a daily dose of fifteen grains of antipyrin, which has given him great comfort, reliev

ing him entirely of all the fever symptoms, stimulating him for work, giving him good rest at night, and lessening very much all nose and eye symptoms."

Dr. Cheatham says that he used it in the summer of 1886 in fourteen other cases, with similar results. During the past summer he has tried the antifebrin in half his cases. The effect has been about the same as that obtained from antipyrin. In a few of the cases some slight depression was complained of, but this is readily corrected by small doses of belladonna or its alkaloid. Some of his patients have taken both the antipyrin or antifebrin (more frequently the former) daily, from ten to thirty grains of the former or four to six grains of the latter, for several months with no bad effects. He believes it to be of great benefit in hayfever, and is anxious for others to try it.Medical and Surgical Reporter.

FREQUENCY OF TWIN AND TRIPLET BIRTHS. Medical statistics have a certain value, either as pertaining to the beginning, the duration, or the close of life. It does not follow that, because a city or a country practitioner has met two or three cases of trichinosis, or of fracture of the os calcis, or any other rare disease or surgical lesion, upon a single street in the same week, the same event will occur to him on the following week. One or two deaths only from the first-mentioned cause have occurred in Massachusetts in the past twenty years.

The probable error in computation from small is vastly greater than that from large numbers. The obstetrican occasionally writes to know the ratio of twin or triplet births in 1,000, 10,000, or more labors. Other things being equal, such as race, climate, character of population, etc., the variation between any two series of one thousand labors will usually be greater than the variations between two series of ten thousand labors.

We have in the Massachusetts Registration Reports an opportunity to study the ratio in one million births. In twenty-five years, ending with 1886, there were registered in Mas-achusetts 1,016,278 births. There were also registered in the same time 9,028 pairs of twins, and 109 cases of triplets. This gives a ratio of one case of twins in every 113 labors, and one case of triplets in 9,324 labors. So that the common statement that one case of twins occurs in 100 labors, and one of triplets in each 10,000 labors, is not far from correct.

In the period named, the greatest frequency of twins in any year was in 1865, when there was one case registered in 96 births, and the least frequency was in 1885, when there was

one case of twins in 130 births. In 1881 there were registered nine cases of triplets, or one in 5,024 births, and in 1879 but one case in 40,205 births.

As an instance of marked departure from the above, and also an illustration of the error in dealing with small numbers, two cases of triplets occurred in the writer's practice in a series of less than 300 labors.-Boston Medical and Surgical Journal.

A CASE OF ACTINOMYCOSIS WITH CURE. At a meeting of the Society of Physicians, of Vienna, on November 4, 1887, Ullmann presented a man, who, for a year, had begun to grow thin and to suffer from loss of appetite and pain in passing his water. Fever and great turbidity of the urine, which contained pus, were present. Subsequently a tumor formed at the lower part of the abdomen, which was repeatedly opened, and much pus evacuated from the abscess which had developed. Upon his admission to Professor Albert's clinic, there was found a tumor of bony character occupying the right hypochondrium. A wound in the neighborhood of Poupart's ligament, as well as the bluish-violet coloration of the skin, induced Ullmann to diagnosticate actinomycosis. A microscopic examination of of the pus, which contained the characteristic granules, confirmed the diagnosis.

Ullmann thinks, with reference to the above described symptoms which preceded the disease, that the case was one of actinomycosis of the bladder.

The patient was operated on in Albert's clinic, and recovered in four weeks. Examination of the pus, which the author has carried out in several cases of actinomycosis, has induced him to think that suppuration in this disease is not occasioned by the actinomycoces, but is produced by other micro-organisms (staphylococci). - Deutsche Medizinal-Zeitung, November 14, 1887.

PROFESSOR VIRCHOW has made an address before the Berlin Medical Society, in which he explains and defends his statements with regard to the Crown Prince's condition. The pieces which he examined were, as he at the time stated, too small and superficial to enable a positive diagnosis to be made, and he expressed a guarded opinion at the time. He still thinks that they represent a warty growth, and states that the recently observed cancerous growths did not develop from the point from which the specimens examined were removed. The professor does not say whether he still thinks that the Prince has or has not had pachydermia verrucosa.-Medical Record.