of the antiseptic collyrium should be increased to a pint, or more, and the nurse directed to stream it from an old rag into the inner canthus with the lids separated.-Progress.

Antipyrine in the Infectious Diseases of Children.

HILDEBRAND (Arch. f. Gynäk.), reports under this title the histories of twentytwo cases of typhoid fever in young children in which antipyrine, in doses of eight grains, invariably produced a dim

inution of the fever-heat of at least 2° C. In some instances five grains lowered the temperature as much as 3o C. The course of the disease was not shortened, but the patient's condition was ameliorated, the mental disturbance being less marked than usual, and the diarrhoea and bloody evacuations checked. Slight depression was obserbed in three cases, severe collapse in three, and impending heart-failure in

two.

The amount of the drug given should be carefully regulated and the patient watched with more than ordinary vigilance In scarlet fever and diphtheria the results were not so satisfactory as in typhoid fever. In these diseases antipyrine should be employed with great circumspection.-New York Medical Journal.

OBSTETRICS.

The Proper Use of Ergot in Obstetrical Practice.

DR. FRANK HAMILTON POTTER, Buffalo Medical and Surgical Journal. Allow me to present the following points for consideration :

1. Ergot is a drug which in any of its preparations tends to deteriorate rapidly, and should never be used, excepting when prepared from a pure and fresh specimen.

2. It is a stimulant to the tubular and non-stricted muscular structures of the body, causing them to contract.

3. It acts especially upon the muscular structure of the uterus, throwing it into a state of tonic spasm.

4. Its action on the uterus is, however, uncertain; sometimes it contracts

the entire organ, at others only a small part of it.

5. If the entire organ is contracted, labor may be delayed through the rigidity of the os, and the child destroyed by the interference of the placental circuIation.

6. Or the contractions may be so powerful as to force the child at once into the world, causing any or all of the lacerations of the soft parts of the

mother.

7. The life of the child may be endangered, also, through absorption of the essential oil of ergot.

8. If given after the birth of the child, and before the expulsion of the placenta and membranes, it may prevent the removal of the latter, and thus be indirectly a cause of puerperal septica

mia.

9. It may act in a similar manner in cases of abortion, actual or threatened, and cause a similar result.

10. The proper use of ergot in obstetrical practice is limited to those cases in which, after the expulsion of the placenta, the uterus refuses to contract, or having once contracted shows a tendency to secondary relaxation. Even in these cases, however, reliance should not be placed upon it alone, but its action should be supplemented by the other means used to provoke uterine contraction.

[These conclusions though valuable. in the main, need qualification. While ergot in large doses tetanizes the uterus, in small doses it merely intensifies the

The

normal rhythmic contractions. The experience of any physician who has used ergot after labor will substantiate this statement. We must take exception also to the author's fourth conclusion. action of a good preparation of ergot propererly exhibited is by no means uncertain. There are few things in medicine more certain than the action of ergot upon the parturient or post partum uterus. We cannot, however, always trust to its prompt absorption by the stomach. It is better given in the lying-in room by the hypodermic needle. Nor can we accept the author's views with reference to the irregular action of ergot on the muscular structure of the uterus. That it sometimes seems so to act we grant, clots of placental masses lying wholly above the os internum may become incarcerated by the complete closure of the internal os. This excessive contraction of the circular fibres at the os internum is due solely to the fact that the action of the muscles at this point is unresisted, not to the supposed irregular action of the drug. The cervix below remains normally flaccid during the first few hours after labor, in all cases, with or without ergot.

If the foreign body lies partly in the grasp of the os internum, the excessive contraction of the circular fibres at that point is resisted and the action of ergot then favors its expulsion. However, However, we are in accord for the most part with the author's views as to the proper limitation of the drug. Its general use to Its general use to provoke contractions in the second stage deserves nothing but condemnation.

We have other means that are safer and better in mere inertia uteri during the expulsive stage of labor.

The danger of giving ergot in the third stage before the expulsion of the placenta, we believe has been exagger

More in deference to current opinion than to the teachings of our own experience we have recently withheld the routine use of ergot till the expulsion of the placenta. Thirty to sixty minims of the fluid extract given at this time promotes security against hemorrhage, tends to prevent the formation of deep thrombi in the vessels of the uterus, and generally favors the evacuation of its cavity, results all tending to the prevention of sepsis. After-pains, moreover, are usually prevented by the early and persistent retraction of the uterus. While not required in every case, we believe the proper use of ergot in the third stage of labor is never prejudicial, is generally a valuable prophylactic measure and is often imperative.]

J.

Adenoma of the Placenta. The affections of the placenta have not yet received the degree of attention to which, on account of the relations they often entertain with abortion or the progress of confinement, they are fairly entitled. Quite recently DR. KLOTZ, of Innsbruck, showed in a valuable paper appearing in the Archiv für Gynæcologie, that the placenta is liable to an affection which has hitherto been never observed, viz., the adenoma. The foling theses embody the principal conclusions of Dr. Klotz's paper:

1. There exists a true adenoma of the placenta starting from the spongy portion,-i. e., from the ectatic gland spaces of the decidua serotina.

He

with cloths dipped in the liquid. applies them for from half an hour to two hours, at the same time protecting the nipples. He has often had immediate relief, and seldom requires to make more than three applications.

onic connective tissue and having a nucleus; besides, the glandular epithelium is reduced to a tissue of its own, from which new epithelial cells are formed.

3. The fusion mass grows by budding of its connective tissue constituents; hence the adenoma of the placenta belongs to the connective tissue tumors.

4. The adenoma of the placenta is liable to return after removal, unless powerfully cauterized.

5. Death and expulsion of the foetus are consequences of the adenoma.

6. The placenta is retained for weeks and months; its spontaneous expulsion is probably impossible.

7. Klotz observed three cases of adenoma of the placenta, in none of which (after an expiration of five years) a return was witnessed. All three women enjoy at present perfect health, but of course conceive no longer.-Ther. Gaz.

To Prevent Mammary Abscess. Although DR. GOODELL ridicules the idea of aborting mammary abscesses, which he does not think can be done, yet Mr. Miall (British Medical Journal) says that when mammary abscess is on the point of forming, he has frequently seen all the symptoms rapidly disappear in a few hours, under the influence of fomentations with hot water and carbonate of ammonia. He uses an ounce of the carbonate in a pint of water, and when solution is accomplished the temperature of the fluid will be hardly too high for fomentation to be commenced,

Abdomen.

ELISCHER, of Budapest (Central. f. Gyn.), has had the best results from the application of a cold compress around the abdomen. For five years he has employed this method after all difficult labors, and the results have proved so beneficial that he has adopted it in normal child bed. Among the better class the bandage is continued for fourteen days, or, if possible, longer. The cloth is to be folded four thick, and covered with gutta percha or water-proof stuff. Where inflammation exists, or increased sensitiveness, the bandage should be changed every few hours; but in ordinary cases once or twice a day is sufficient. This method appears to be not only prophlyactic against pendulous abdomen, but it diminishes the striæ, which so often disfigure the skin, and also lessens after-pains.

articles opium, strychnine and ergot. In its action as a narcotic and sudorific it resembles opium; in its property of inducing tetanic and clonic spasms, followed by paralysis, it is similar to strychnine; in its power hinted at of exciting the uterus, it may be linked with ergot.-Journal American Medical Association.-Ibid.

Intra-Peritoneal Injections in Acute
Hemorrhage.

RUTGERS (Ctrlbl. f. d. Med. Wissenseh) reports the case of a woman who had lost so much blood from post-partum hemorrhage that she was apparently

moribund. The veins did not swell on applying ligatures above them, so that it was impossible to employ intra-venous injections. The following solution was injected into the abdominal cavity through a canula: Salt, 90 grains; sodium hydrate, 5 grains; distilled water, 34 fluid ounces. After experiencing severe pain in the abdomen for three days, during which time the temperature was subnormal, the patient rallied and did well.-New York Medical Journal.

Indication of Premature Labor.

DR. WALTER COLES, in a paper on this subject (St. Louis Courier of Medicine), says that the operation should be done :

1. In all cases where the pelvic deformity is slight (or with a diameter more than 2 or 3 inches), and the children have been found by experience to be large and vigorous at maturity.

2. In cases of first pregnancy, whenever there may be uncertainty as to the result of labor at term; especially where the pelvis is so contracted that labor at term would probably be very difficult, or even impossible.

3. In cases of apparently normal pelvis, but where the child proves to be of extraordinary size.

4. In cases where the child dies in utero towards the latter end of successive pregnancies; providing the conditions producing the result are other than syphilitic, etc.

The methods recommended by the author for the induction of premature labor are: 1. The bougie. 2. Tents or other dilators. 3. The douche.American Lancet.

General Treatment of Puerperal Diseases.

KUNGE, of Dorpat, finds that large doses of alcohol, baths, and full diet of nourishing food, in the treatment of the diseases of child-bed, yields in his hands

the best results. The alcohol is the most important of these and must be used in large amounts. The baths should have a temperature of 22 to 24 degrees. This treatment assists the system in resisting the toxic effects of the absorbed matters. The pulse, as in typhus fever, is improved, the inspirations strengthened, and the appetite increased.

Of nine severe cases of septic infection treated in this way only one died.

Antipyretics, on the other hand, at most only bring down the fever, and destroy the appetite.-Cent. f. Gyn.-Ibid.

Measurement of the Fatal Feet During Pregnancy.

DR. GONNOR, from a large number of observations (Journal de Medecine et de Chirurgie Pratiques), concludes that there exists an almost constant proportion between the size of the foetal head and feet.

By the measurement of a foot, as in breech presentations, an estimation of the difficulties presented by the passage of the head is possible. A foot measuring three inches in length will correspond to eight and one-half pounds in weight of the child. A longer foot indicates an increased size of the child.—Ibid.

DISEASES OF WOMEN.

Fibromyomatous Tumors of the Uterus. DR. FREDERICK LANGE reports three cases of fibromyomatous tumors of the uterus in the Oct. number of the Annals of Surgery. In two cases there was expulsion of the tumor masses after spontaneous sloughing; and in the third case, shrinkage of the tumor after central suppuration and softening.

tumor.

Case I.-Mrs. B., æt. 45. Large abdominal tumor had existed for about three years. Within the last year she had been treated repeatedly for long periods of time with ergot administered hypodermically as well as internally, but without any notable success, in reference to hemorrhage as well as size of In view of the sufferings of the the patient, the radical operation of removal was proposed but declined. Some time later there was removed a piece of the tumor about the size of the fist, in a decomposed condition, from the vagina, and this was followed the next two weeks almost daily by others of smaller or larger size. A short time after this a particularly large piece came away, and Dr. L., who saw the case again in consultation was surprised that the enormous tumor had so much disappeared that the uterus now was not much larger than about the fourth or fifth month of pregnancy. The offensive odor ceased when the remainder of the separated tumor was removed from the uterine cavity. The doctor is under the impression that the tumor at first must have weighed at least fifteen or twenty pounds. The patient, a year afterwards, was in good health.

Case II. Mrs. H., æt. 46, Null., had suffered for two years from profuse and prolonged menstruation. There was no doubt that her trouble was due to a fibromyomatous tumor of such a size

1886.-No. 12 C.

that the uterus, on examination reached within two finger's breadth of the umbilicus. During the time from the 12th of October to the 6th of November, about eighteen hypodermic injections of Squibbs' fluid extract of ergot was administered in the hypogastric region. They caused a good deal of pain and inflammatory irritation, which, however, by cold applications was kept down, so

that no abscesses occurred. Small indurations, however, remained at the points of injection. During her menstrual period the patient rested at home; did not get any hypodermic injections, but took ergot internally 15 to 20 drops twice a day.

Two months after, the patient had a bloody and somewhat offensive discharge from the vagina and labor-like pains. The vaginal portion of the uterus was softened and dilated, and a soft mass could be felt within it. "On the following day, under chloroform, a considerable mass, about a pound and a half of sloughed fibromyomatous tumor was removed from the uterine cavity, after lateral incisions into the vaginal portion had been made." The author states that on account of the narrowness of the passages and impossibility of pulling down the cervix, that he was unable to thoroughly explore the uterine cavity with the finger, yet ascertained. that many necrotic irregular pieces of tissue remained undetected as yet. Repeated irrigations were made with corrosive sublimate, 1-5000, but symptoms of septic absorption, and the formation of pus existed. Sloughed masses were removed from the uterine cavity and the pus cavity behind the cervix evacuated. The patient made a rapid recovery.