near the umbilicus, instead of into the loose tissue of the labia majora. The round ligament differs from the true supporting ligaments of the uterus in that it has no fixed point of attachment, and also that it contains muscular fibres, which permit it to elongate during pregnancy and to contract during involution. The writer believes that the shortening of these ligaments by operation has but a transient value, as the ligaments will soon afterward respond to their physiological office and elongate again. He advises a closer imitation of nature's manner of supporting the uterus, and prefers giving attention to the utero-sacral ligament. His plan of operating consists of suturing the cervix to the utero-sacral ligament with one or two silver wire sutures, introduced in such a way that the cervix is drawn upward and backward. This manœuvre causes the utero-sacral ligament to be folded upon itself, and union takes place between these folds and also to the wall of the cul-de-sac, which shortens the ligament about one-half, and makes a firm point of support for the cervix. During the past two years the author has operated twenty-three times, using the two deep sutures in each case, and as far as can be known, each case is a success thus far.-University Medical Magazine. The Treatment of Fracture of the for the Same. Büngner (Deutsche medizinische Wochenschrift, June 8, 1892) recommends for the treatment of fractured clavicle the following dressing: An elastic T-shaped bandage is used, the cross-piece of which should be sixty centimetres long and four wide. The three tails which are fastened to the cross-piece, as the spokes to a wheel, should be each 120 centimetres long and ten broad. The cross-piece should be made fast to the sound shoulder, in such a manner that the middle and one side tail should rest on the back, while the remaining side tail should rest on top of the shoulder. The middle tail is then carried over the back, through the axilla and around the upper third of the arm of the injured side; it is then carried back to the starting point, and fastened. By this means the arm is drawn directly backwards. The lower tail is likewise carried over the back and around the arm of the injured side, so that it grasps the elbow; it is then carried back to the starting point and fastened. This part of the dressing not only draws the arm backwards, but also somewhat upwards. The remaining tail is then carried over the sound shoulder, downward around the wrist, so as to form a sling for the arm of the injured side, then back over the seat of fracture and fastened to the two tails on the back. The author claims for this bandage: 1. The arm is not fastened to the side, as in a Velpeau or Desault dressing, and is, therefore, not so uncomfortable. 2. The elasticity of the bandage always holds it in the proper position, no matter what position the patient may assume. 3. It can be used in any fracture of this bone. 4. It need be applied next to the skin only for ten days, and then can be placed over the patient's coat. 5. It better reduces the deformity than any other bandage.— University Med. Magazine. Vomiting in Chloroform Anæsthesia Passet (Münch. med. Woch., June 7, 1892) says that the chloroform vapor acting on the mucous membrane of the mouth produces a flow of saliva. This saliva is swallowed, and a certain part of the chloroform is thus conveyed into the stomach. The gastric mucous membrane is in this way irritated, and vomiting is set up. This increased flow of saliva at the beginning of the administration may be seen in animals, especially in cats, as well as in the human subject. For some time after the anæsthesia chloroform is exhaled with the breath, and even this may irritate the mucous membrane of the mouth in the same way, and with the same result. The action of chloroform upon the stomach varies in different individuals. The author adds that the only rational way of preventing the vomiting is to avoid the swallowing of chloroform, and that this may be done more easily than might appear by directing the patient to spit out the abundantly secreted saliva. British Med. Journal. The Radical Cure of Hernia by the Method of Carl Schwalbe. disappears, but may last some hours in those in which a large quantity of fluid has been injected into already infiltrated tissues. Chloroform anæsthesia is to be used in the case of children, and the injections made every three or four days, but later not so frequently. In adults daily injections are to be given for six to eight days, so as to cause a marked infiltrate as soon as possible; then wait until the inflammation has somewhat subsided and repeat the injections as required. In the Deutsche Zeitschrift für Chirurgie, Bd. 34, Schmidt gives the results of his trial of Schwalbe's method of treating hernia by the hypodermic injection of alcohol. The method is very safe, one death only having been. Of five cases of umbilical hernia so recorded in twelve hundred cases, treated, four were cured, the time being whereas the mortality of cutting opera- seven years, two years, nine months, tions varies from 4 to 6 per cent., and and two months. The fifth case was the failures or return of the trouble, considerably improved. A sixth case according to Socin, is 50 per cent. The remained cured until death occurred a procedure is as follows: The injection year and a half later. Of two inguinal needle is to be made aseptic by boiling hernias one was cured at four and the in soda or antiseptic solution, and the other at one and a half years. One case part to be operated on cleansed with failed on account of the patient not conether, shaved, and washed with a bi-fining himself to bed. The author conchloride solution. The hernia having cludes by advising that a more general been reduced, the left forefinger is in trial be given the method.— University troduced into the inguinal canal as a Medical Magazine. guide for the needle. After being assured that the needle point is not in a blood-vessel, the liquid is slowly injected. Care should be taken not to introduce the needle too deeply, nor into the substance of the skin, and not to inject too much liquid into one place, as otherwise gangrene of the skin may occur. The puncture is to be closed with a piece of plaster. Contrary to Schwalbe, the author does not employ a truss during the treatment of inguinal and femoral hernias. He keeps the patient abed until an inflammatory infiltrate has formed, say for three or four weeks, and has a suspensory bandage worn to support the testicles. Alcohol, of the strength of 50 per cent. is strong enough to begin with, and stronger than 80 per cent. should never be used. Less liquid should be injected in children than adults. In the latter, one to two cubic centimetres, injected from one or more punctures, is sufficient, and not more than five cubic centimetres should be injected at one time. The pain which ensues is not very great and is mostly of a burning character. It usually soon Anæsthesia in Veterinary Surgery. In the progress of veterinary science. there has been perhaps no greater advance toward the alleviation of animal suffering than the introduction of the use of anesthetics, which during the last decade has rapidly gained ground. Concomitant with the adoption of these means have been many refinements in the practice of an art whose sphere of usefulness is thereby extended, and whose position in public estimation must be accordingly elevated. It is now, we are glad to observe, the ordinary practice in delicate and painful operations to resort to the use of general or local anesthesia. On the continent, for general anæsthesia chloral hydrate, by intra-venous injection, is largely employed, as much as two ounces often being used for the horse. This agent is sometimes administered by the mouth to animals of the same class, in doses of from five to nine ounces. This practice has not found much favor with British veterinarians, chloroform and ether being in general use for all animals. Horses and rumi nants are rarely affected unfavorably by chloroform, fatal results veing very uncommon. From two to twelve drachms is usually sufficient to induce anæsthesia, which may be maintained for indefinite periods by proportionate quantities. A mixture of chloroform and ether is preferred for dogs, who require greater care, but though a small proportion of these animals unaccountably succumb to the effects of chloroform, judicious administration, with due regard to regularity of breathing and equalization of dose, mimimizes the danger. For amputation, as of tongue or penis, castration, cystotomy, abdominal section, and firing," it is in every-day use and highly appreciated, while in obstetric practice, where much operative interference and force are often necessary, great difficulties and dangers are lessened and much suffering prevented. For removal of tumors, opening of fistulæ, neurectomy, "firing," etc., subcutaneous injection of cocaine has become 66 common. The appliances for administering chloroform and ether to the lower animals are varied and numerous, but the sponge in a leather bag, perforated at the bottom, appears to be the most general form. It would be difficult to estimate the amount of suffering thus spared the animal, the advantages of more rapid recovery, etc., to the owner, and the increased comfort and safety of the operator; and we hope every means will be adopted to encourage the use of the beneficent agency among those creatures who have to submit to our care.-British Med. Journal. Headache in Childhood. The Archives of Gynecology quotes a foreign authority as saying that seven groups of headache may be classified: 1. Headache from rapid growth. It is usually frontal, is increased by exercise, and co-exists with pain in the joints, periostoses, and hypertrophy of the heart. Treatment: Muscular repose, tonics, liberal diet, phosphate of lime. 2. Headache from intellectual activity. It occurs in intelligent and excitable children, who study too much, or in backward children who acquire their lessons with difficulty. Treatment: For the first class of cases, cessation of intellectual work, physical exercise, but not so severe as to produce fatigue; lukewarm baths. In the second class of cases the work may be continued in moderation, plenty of exercises being enjoined. 3. Headache from digestive troubles. It occurs in children who eat too much or too fast, and occurs in one to three hours after eating. Treatment: Properly regulated hygiene and diet; by bitter tonics before eating; warm drinks after eating. Constipation should be overcome. 4. Headache of nervous origin. It occurs in children who are excited by their manner of living. It is premonitory of future neuropathies, epilepsy and hysteria. Treatment: Baths, walking, massage, valerian, aconite, belladonna, and bromides for the epileptics. They should avoid taking cold. 5. Headache in children of gouty or rheumatic diathesis. It is sometimes accompanied by intense congestive phenomena, which simulate meningitis. There are manifestations of hereditary antecedents; there are neuralgias, arthralgias, myalgias; the urine contains phosphates, oxalates and urates. Treatment: Moderate diet, exercise in the open air, vapor-baths with friction, laxatives, alkalines, salicylate of soda in doses of from four to five grains, and tincture of colchicum in ten to fifteendrop doses daily. 6. Headache from anæmia and poisoning. In the first case it is due to bad air and hygiene, in the second to malaria, carbonic oxide, to excessive medication, to uræmia. Treatment should vary with the cause. 7. Headache from injury to the sensory organs. There may be chronic conjunctivitis, or keratitis, or iritis, which should be treated locally, and also by the internal use of sulphate of quinine in large doses. Troubles of refraction, hypermetropia and astigmatism must be treated with suitable glasses. There may be mucous polypi in the nose, or hypertrophies, which call for local treatment. There may be adenoid vegetations in the ears, otitis, or foreign bodies in the auditory canal, which call for suitable treatment. Purgatives After Abdominal Operations. Miscellany. HEALTH DEPARTMENT OF Statement of Contagious and In fectious Diseases August 12, 1892: WARD. I 2. 3. Dr. Champonnière, in a discussion before the Société de Chirurgie (Gazette des Hôpitaux, No. 22, 1892), says it is at times difficult to establish a precise diagnosis between intestinal obstructions of various causes and true strangulation. In such case the administration of a purgative is an heroic measure to fix the diagnosis, and one offering no danger. He regards it as good practice to purge all patients as soon as possible after laparotomy. He admits that the rule may have its exceptions, but as a general thing this practice has given excellent results. Lawson Tait expressly recommends purgation each time the temperature goes up. Others as well as Champonnière have adopted this method and have been. satisfied with the results. It is admitted that where intestinal ulceration may predispose to perforation under the influence of a purgative, the latter should be withheld. He believes fully, in spite of the contrary opinion of Dr. Routier, that patients may die of intes- 17. tinal paresis, and has observed cases which leave no doubt in his mind regarding it. 4. 5 6 7. 8. 9 10. [I 12. 13. 14. 18. 19. 20. 21 22. 23. 28. An almost unanimity of opinion. Dangers of Excessive Water- as Four unknown persons living in Paris recently betted among themselves as to which would drink the largest quantity of water. One of them drank twelve litres, another nine litres, and a third seven litres. All three died a few hours afterward. 29. 30. for week ending Instit❜tns I Totals Last w'k 51 16 Deaths. Mortality Report for the week end- Other Zymotic Diseases. 6 I 3 7 3 6--26 9 Infectious Diseases reported to the Ohio State Board of Health in 41 cities and towns during the week ending August 12, 1892: Diphtheria: Carthage.. Cincinnati... Cleveland... Columbus. Findlay Cases. Deaths. 2 21 10 32 Typhoid Fever: Ashland.. Bellefontaine II I Chester Hill. Cleveland... Cases. Deaths. I 2 2 15 4 2 .... Kalida In view of these prognostics the Surgeon-General of the United States Marine Hospital Service has issued a circular for the guidance of officers of the service and customs officials, in which he says that information has been received that cholera prevails in the Caucasus, in eastern European Russia, in Persia, in Calcutta, and on the western littoral of the Red Sea; and in view of the threatened further spread of the disease, and because of the danger which attaches to rags, furs, wool, hides, etc., which may have been gathered in the infected districts, and to articles of personal wear therefrom, it is ordered that no vessel having rags, furs, skins, hair, feathers, boxes, or baled clothing or bedding, or any similar article liable to convey infection, hailing from any port in the districts aforesaid, and no vessel from any port carrying the above-mentioned merchandise or immigrants from the present infected districts, or from districts that shall hereafter be officially declared infected, will be allowed to enter any port in the United States unless provided with either a consular certificate No infectious diseases reported to health or a certificate from a medical officer of officers in 11 towns. C. O. PROBST, M.D., Secretary. the Marine Hospital Service, or State or local quarantine officer of the United |