PREVENTION OF LACERATION OF THE PERINEUM IN PRIMIPARE.Algernon Temple, M. D., Professor of Obstetrics and Gynecology, Trinity Medical School at Toronto, Canada, writes to the British Medical Journal:

For many years I have been greatly disappointed with the means recommended for prevention of laceration of the perineum; and, after most careful study of the subject, I came to the conclusion that the only method of any value was to prevent extension of the head from occurring, and to compel it to be born in a state of forced flexion.

In primiparæ, the vulval orifice is small and resisting, and the occiput in its descent does not reach the pubic arch (as it does in multipara) before extension commences; as a result of this extension, the long occipito frontal diameter, which measures about four inches and a half, is obliged to traverse the perineum, to be followed by the fronto-mental, which measures about three inches and a half, making in all part of a circle about eight or nine inches in length. This naturally stretches the perineum and vulval orifice to its utmost capacity, and it is during this time that rupture is apt to occur.

To guard against this overdistension in cases where I fear laceration, after the head has reached the floor of the pelvis, and just previously to extension, I have been in the habit of applying the short forceps, and then, by carrying the handles backward, I flex the chin on the chest, while, at the same time, gentle traction is made downward and backward. In this way, I deliver the occiput first, keeping the chin close to the chest; this brings the cervico-bregmatic diameter, which is but three inches and a half, through the vaginal orifice. This plan saves the perineum one inch or more of distension. I have had the best results from this practice, and have taught it to my class of students for the past three years.

The practice, as taught by Dr. Gaussen, I think somewhat difficult to carry out with the fingers, though he desires to obtain the same end as I here advocate. With the forceps, it is easy and safe.

I think this subject one of great importance, and worthy of a trial by any who may have any doubt as to its efficiency. In fact, I may say I am doubtful of the propriety of carrying the handles of the forceps forward, as taught in the text-books, in any case.

DR. DUJARDIN BEAUMETZ ON HYPNOTICS. Chloral appears to act on the heart, and, as has been affirmed by Gubler, it is a heart-poison in large doses. In all febrile diseases of a congestive form, chloral is far superior to opium

for the production of sleep; as in typhoid pneumonia and alcoholic delirium. On the contrary, this remedy is contra-indicated in cardiac affections, especially in troubles of the aortic orifice; here opium is much better. Chloral is a most useful remedy in certain forms of intoxication, especially in poisoning by strychnine, in delirium tremens, and uremic convulsions, but in these it is still inferior to paraldehyde.

The sleep produced by paraldehyde is analogous to that produced by chloral. It is usually calm, but in some instances the sleep is preceded by excitement. It is eliminated almost entirely by the lungs, but when large doses are given some portion escapes in the sweat.

One of the most interesting facts regarding the action of paraldehyde is its antagonism to strychnine. Ether, chloral, chloroform, have similar powers in this respect. They all act, as does paraldehyde, on the cells of the nervous matter. We know that strychnine also stimulates the cells of the cerebro-spinal axis. It consequently happens that when the nerve elements are acted on by one agent they will not receive an impression from another, and thus in a strictly physiological and scientific manner can be explained the antagonisms of these several remedies and strychnine.

Compared with chloral, paraldehyde has these advantages:

It is less irritant, and better supported by the stomach. It is not a heart-poison. It is a more efficient antidote to strychnine. But it has less analgesic action, and less power to relieve pain than chloral, and hence when insomnia is caused by pain the latter is preferable, and morphine is still more efficient. In nervous insomnia, in that due to the abuse of alcoholic drinks, paraldehyde is much superior to chloral. Especially is paraldehyde most useful in the different forms of mental disorder. They have also shown that it is a valuable hypnotic in certain cases of insomnia with the excitement occurring in the course of some cerebral affections, in the convulsive neuroses, and especially in epileptic crises, and in the multiform manifestations of hysteria. Dr. Dujardin-Beaumetz has also treated many cases of morphiomania by paraldehyde, giving fortyfive to sixty minims a day. It does not appear to lose its effect by repetition, since the same results have been obtained through months of

treatment.

Mr. G. F. Hodgson has had experience with paraldehyde which supplements the observations of Dr. Dujardin - Beaumetz. Mr. Hodgson finds it to be a hypnotic of great value, in that it produces sleep like the natural state, promptly and without any unpleasant after

DERMATITIS FEROX.-The disease to which I have ventured to give the name of dermatitis ferox is, in its more developed form, so exceeding rare that as yet no one to whom the drawing of a case, taken at the St. John's Hospital for diseases of the skin, has been shown has recognized the affection.

The outbreak seems in every instance to take the form of one or more scattered patches on the face, hands, or upper part of the chest, and sometimes on all three together. The patches, at first only reddish, speedily become of a vivid red, and then red mixed with brown, the cuticle turning dry and crumpled, and then peeling off, to be replaced by another layer, which in its turn shares the same fate, Now and then a small part of a patch may ulcerate, but this is an extremely rare complication, and usually the morbid state disappears by the gradual declension of the redness and slow reproduction of unhealthy cuticle, which is also little by little replaced by a more normal covering. There is usually no discharge, nothing in the shape of a scurf or crust. The patches, as a rule, form very slowly, and it is only after a time, and when they have become rather extensively developed, that the health begins to suffer; but in other cases a difference in the process may be noticed in so far that the eruption takes place rather quickly, and that the health fails within a few days after its appearance. Sometimes, when the disease attacks the side of the face in the male, firm crusts will form, so that at the end of a week the case looks like one of rather advanced erythematous sycosis. Such crusts may crack, and under the lens small spots can be seen, which look as if thick serum were exuding from them, but in the early stages at least there is no weeping, as in eczema. The site of each crust is surrounded by a red inflamed ring, much broader than is seen round a sycosis patch, which is also infinitely slower in forming. In every case which has yet come under my care the affection of the skin has shown itself first,

and the constitutional disturbance later, sometimes much later.

The patches are in general quite isolated, and at first not very large, the predominating shape, if any thing with such an irregular outline can be said to have a shape at all, being a ragged oval. Usually they are, as stated, of a lake color, and this seems to betoken a milder phase; in two cases, where the hue might very fitly have been compared to carmine, the constitutional disturbance was out of all proportion to the extent of skin affected. After a time, and particularly when they are seated on the face, two or more patches gradually fuse, and take on a dark, angry hue, which gives the part the look of having been burnt with fire. Now and then they assume a papular form, and then resemble flattened, aggregated lichen spots; these appear to be overlaid by a cuticle not unlike the horny covering of lichen. On other patches the cuticle, after taking on a brown crumpled look, is cast off, as in the rising stage of eczema. In a third set of patches the scarf skin may be fairly adherent.

The constitutional symptoms point to much and often grave disturbance of the health. General uneasiness, a feeling of being unwell, sometimes of the system having taken the alarm, loss of appetite, nausea, headache, inability to walk straight, and prostration, are perhaps the most prominent and frequent among the many signs which arrest the attention of the practitioner.

It will thus be seen that, while the affection in some features resembles acrodynia and erysipelas, it is yet distinct from both. It runs a much slower course than either, and in it the constitutional symptoms come on much later. The phlyctenæ, pustules, edema, and perspirations of the former are wanting. When it attacks the face it is accompanied by none of the swelling and closing of the eyelids which so distinctly mark erysipelas. It is sometimes attended, too, by the formation of huge bulle at a distance from the chief site of active disease. Though, perhaps, in this complaint the skin is just as much poisoned by the air as it is by the aniline and arsenic dyes in a case of glove or sock poisoning, yet we do not find the sudden swelling. heat, tenderness, and subsequent discharge of serum seen in the latter affection. On the contrary, every one of these symptoms may be absent; indeed, redness and exfoliation are usually the sole local signs. But while I never saw much internal disturbance, and particularly internal disturbance culminating in deliriumi, from the aniline-dye affection, I have met with both under a very pronounced form in this kind of dermatitis. And no form of poisoning of the skin which I have either

read of or seen, or any variety of erysipelas known to myself, is ever followed, as dermatitis ferox sometimes is, by a raised, fused, red, papular eruption. For all such reasons the latter seems to me a distinct individual complaint-Mr. J. L. Milton, Edinburgh Medical Journal.

SALICYLATE OF LITHIA IN RHEUMATISM. In a paper read before the Academy of Medicine, of Paris, on December 8, 1885, M. Vulpian gave the results of a number of experiments with salicylate of lithia, which he had found to be of great service in the treatment of all the forms of rheumatism. He said it was a mistake to suppose that the salts of lithia possessed any remarkable toxic properties; they were no more so than the corresponding salts of other bases, and the salicylate could be given in nearly as large doses as the salicylate of soda. In cases of acute rheumatism, joint pains, sometimes of very severe character, often persist for a long time after the swelling of the articulations has subsided. Salicylate of soda as well as tincture of colchicum have but little effect in quieting these pains, but salicylate of lithia, M. Vulpian said, causes their rapid disappearance. The drug acts especially well in those cases in which the fibrous tissues are affected. In the subacute and chronic forms also salicylate of lithia acts more promptly than the sodium salt. The drug should be given in doses aggregating one dram per diem, but when more than seventy-five grains a day are given, toxic symptoms are apt to be produced. It causes headache and deafness, but never the whistling and ringing sounds in the ears which cause such extreme annoyance to the patient. Sometimes also, though rarely, intestinal colic and diarrhea result. But all these unpleasant symptoms disappear quickly after the discontinuance of the remedy-Medical Record.

MORE ABOUT "STARVING FEVERS."-Apropos of Professor Yandell's paper in the American Practitioner, and some recent editorial notes in the Popular Science News concerning the same, and the safest course in typhoid fever, I would offer a few words:

The old maxim, "Stuff a cold and starve a fever," even as popularly (mis) understood, evidently never contemplated" stuffing a fever," and to that extent, therefore, in the writer's opinion, is sound. But as originally propounded, the maxim was the embodiment of the highest wisdom. "If you stuff a cold, you will have to starve a fever," was what the wise man really said; and the same thing was meant when, for convenience' sake, it was short

ened. Stuff a cold, starve a fever," was still (on the tongue of one who understood it) a warning against feeding when the symptoms popularly called cold" were observed. The fact is, as it seems to me, the term "cold" is a misnomer; the "sickness" being rather the first stage of fever by means of which the organism seeks to clear itself of offending matters, and being, so to say, engrossed in this particular work, no energies are left for digestion and assimilation, and therefore abstinence from food is the greatest aid we can render. For twenty-four to forty-eight hours, at the onset of the disease, and for a much longer period if originally of a more serious type, or when, through unphysiological feeding or other causes, the disorder has deepened, there may be actually no office for food, except to feed the fever as petroleum would a fire. The real limit for fasting, in any or all cases, should be the disappearance of feverishness, and in any case total freedom from delirium. The fact that Professor Yandell survived the treatment-that of having food forced upon him during his delirium, as well as in his lucid intervals-is evidence, to my mind, that he was one of those "too tough to kill," rather than that this practice, universal as it is, indeed, does not inevitably tend to fatality. The one universal dictum with me is, stop eating, appetite or no appetite, until convalescence is well established. While this treatment will not raise the dead, nor cure the moribund, it will always tend to the restoration of the patient in any curable case.--A Boston Physician.

A PORTUGUESE METHOD OF TREATING RINGWORM.-Ringworm of the most obstinate character, according to Dr. Saerlis, writing in the Medicina Contemporanea of Lisbon, can be cured in ten days by cutting the hair from the affected spot, pouring turpentine on it, letting it run over the whole head, and rubbing well with the finger. After this has caused a smarting sensation for from three to five minntes, it is washed off with carbolated soap. Hot water is then used for washing the whole head, and the affected spots touched with dilute tincture of iodine or with a two-per-cent solution of iodine and turpentine. This process is to be repeated once or twice a day.-London Lancet.

A READY MEANS OF PRESERVING THE FLUIDITY OF BLOOD.-A student in Professor Stricker's laboratory, Herr Ernest Freund, has, it seems, suggested a most simple and convenient method of preserving blood in the fluid state. His plan consists in coating the interior of a glass vessel with pure oil. Into this receptacle blood freshly drawn is poured, and a layer of

oil is then run over the surface exposed to the air. In this way, we are assured, fresh blood may be kept from coagulating for days if necessary. It is difficult to see how so simple an experiment, if once satisfactorily demonstrated, should afterward be discredited by repetition. We may therefore hope that this apparently trivial application of a physical law will be a real gain to practice as well as research. In particular it should obviously facilitate the operation of transfusion, though it will not entirely replace that still more ready means of treatment, salt solution. It need hardly be said that this mode of preventing coagulation is new rather in its easy and general application than as illustrating a principle for the first time discovered. Professor Ludwig made use of the same idea in estimating the velocity of the bloodcurrent.-London Lancet.

VIBURNUM PRUNIFOLIUM IN ABORTION.January, 1885, I have had the opportunity of testing the use of viburnum prunifolium, so much vaunted in America, in several cases of threatened miscarriage, and I can entirely indorse the good opinion there formed of it. Nothing, probably, in midwifery is more disappointing than the ordinary routine treatment of miscarriage by opium or Indian hemp on the one hand, or ergot on the other. For these drugs as often act in the way contrary to the prescriber's intention as in accordance with it. How often has a dose of Battley's solution, administered to arrest uterine action, and give rest and ease from pain, been followed by immediate and severe expulsive pains, while the attempt to empty the uterus by a dose of ergot has resulted in a perfect calm, and a disappearance of symptoms.

It is a comfort thus to have some hope of success in dealing with such a condition as miscarriage; and although I have so far only the notes of six cases, of which five were successful, yet, these five being consecutive, and the effect exactly following the administration of the remedy, I have no hesitation in my own mind in giving the credit to the viburnum.Dr. W. M. Campbell, British Medical Journal.

PRURITUS VULVA. Martineau (Annales Medico-Chirurgicales) notes that this arises sometimes in the course of affections unconnected with the vulva, at others during the evolution of a disorder or lesion of this part. In the first class are intestinal worms, the oxyuris in particular; these wander at night over the neighborhood of the anus and genital organs. They should always be looked for there and then, especially in children, where there is an absence of any direct cause. Tinea tonsurans

Af

and the pediculus pubis are other causes. fections of the bladder, vegetations, and polypi of the urethra may lead to it. Glycosuria, also, either temporary in wet nurses, as in those who take much sugar, or permanent, as in diabetes. In the second category may be ranged pruritus, consecutive to various primary or secondary inflammations of the vulva, which may be simply local, or proceed from a general diathetic or constitutional cause, as tuberculosis, eczema, herpes, psoriasis, lichen, epithelioma. Vulvar pruritus may be purely nervous, and then appears without any manifest lesion of the mucous membrane or skin; at times it may be associated with urticaria. The diabetic form is best treated with the effervescent citrate of lithia, with the addition of a little arseniate of soda. Locally, during the acute stage, lotions of bromide of potassium or of chloral are recommended, and in the chronic phases a weak solution of corrosive sublimate and alchohol.-Edinburgh Medical Journal.

LACTATION AND MEDICAMENTS (Fehling, Bull. de Therap., 30th August, 1885).-If two grams (half a dram) of salicylate of soda are administered, this substance is readily found in the urine of the new-born. The passage is especially marked when the drug has been absorbed two hours before the nursing. Iodide of potassium acts like the salicylate of soda. Iodoform, even when used in very small quantity, passes into the milk. A simple sprinkling of this drug upon the vulva is sufficient to secure its appearance in the mammary secretion. It was not so with corrosive sublimate, of which it was possible to discover in the milk only very small quantities-so small that it was impossible to estimate them. The narcotics are without effect upon the nursling. The strongest doses of opium or of chloral administered to the nurses have not produced any special physiological effect upon the nursling. Atropine tested upon animals produced dilatation of the pupil in the nursling only when the maximum therapeutic dose was exceeded.Ibid.

MENTHOL AS A SUBSTITUTE FOR COCAINE.Dr. Albert Rosenberg, of Berlin, has found in menthol, in ethereal or alcoholic solution (twenty to thirty per cent), a useful substitute for the expensive cocaine, in cases where local anesthesia of mucous membrane-e.g., of nose, pharynx, and larynx-is required. The effect of menthol is not so lasting as that of cocaine; but it appears to have somewhat of a cumulative action; for when repeated, even after a long interval, the latter application produced a longer period of anesthesia than the earlier.

BEEF PREPARATIONS AS NUTRIENTS.-Dr. Thomas J. Mays, of Philadelphia, recently read a paper before the College of Physicians of Philadelphia, in which he said, concerning the influence of the beef extracts on the frog's heart:

1. That they are absorbed and assimilated.

2. That they contain material which has the power of inducing muscular contraction--a power which has heretofore been shown experimentally to exist only in the higher animal albumens or proteids.

3. That, hence, whatever else they may be, they are nutrients in the full implication of

that term.

After it was thus demonstrated that these beef preparations contained definite nutritive properties, it was deemed desirable to ascertain the value of each, and means to this end were instituted by comparing their effects with those of a two-per-cent solution of dried bullock's blood alternately on the frog's heart in the following manner: In the first place the heart, after being washed out, was filled with the twoper-cent blood solution and then allowed to beat until its pulsations were reduced to a minimum, or until the whole nutritive supply of the blood solution was consumed; after which it was washed out again and filled with a solution of the beef preparation to be tested, and allowed to beat with it until its pulsations were again reduced to a minimum. A large num ber of comparative tests were made of each of the above-named beef preparations in this way, and products were obtained which indicate the mean percentage of the number of pulse-beats given by each preparation, that of blood being taken as 100. These figures are probably not absolutely true, but they give an approximate idea of the nutritive worth of these extracts when compared with that of a two-per-cent blood solution, which is capable of producing a normal cardiac contraction.

the result was very striking; cases which had proved very intractable yielding immediately to its influence. I used two minims to the ounce of water, usually with the addition of five grains of carbonate of sodium, and twentyfive minims of aromatic spirit of ammonia. I have also found it very useful in the dyspepsia of tea-bibber.

Mr. Edward Berdoe writes to the British Medical Journal:

I have lately treated several cases of indigestion with carbolic acid, and found it most useful in that form of dyspepsia known as fermentative, accompanied by constant sour risings and eructations of gas, with pain after meals, and discomfort, even after drinking milk or cocoa. My attention was first directed to it by Dr. Fenwick, who gave the glycerine of carbolic acid (one part of crystallized carbolic acid to four parts of glycerine). The dose is from five to ten minims in mint-water, or other convenient vehicle. As it mixes well, I think it a more elegant and safe form than a solution of the acid in water only. Where there is much pain of the stomach after food, I have found it useful to add five or six minims of the liquor opii sedativus to each dose; and, when there is want of tone in the seat of indigestion and bad appetite, five to ten minims of the tincture of nux vomica will often be found serviceable. have found these remedies also very valuable in the above combination in cases of pyrosis, where, I think, the sedative influence of the carbolic acid on the mucous membrane is far more useful than the bismuth one usually gives in such cases. It is an interesting subject of inquiry whether the carbolic acid acts by arresting fermentative changes in the stomach, or by its well-known anesthetic influence on mucous membranes. I have long given onegrain pills of this remedy in cases of vomiting from various causes, and have rarely found it fail to arrest it. In some of these cases there was no fermentative condition of the contents of the stomach; some of them were cases of reflex vomiting; yet all were, with few exceptions, greatly benefited.

I

TO ARREST NASAL HEMORRHAGE.-We take the following practical suggestion of Prof. John Chiene, from the Edinburgh Medical Journal:

In persistent hemorrhage from the nasal cavity, plugging the posterior nares should not be done until an attempt has been made to check the hemorrhage by firmly grasping the nose with the finger and thumb, so as completely to prevent any air from passing through the cavity in the act of breathing. This simple means, if persistently tried, will in many cases