culty in swallowing, but these latter conditions have now almost vanished. Now these conditions must, of course, be due to intra-cranial lesion, not localized, probably, nor situated alone upon one side, but most likely bilateral. Were it due to cerebral hæmorrhage, the recovery would not have been so rapid, unless the hæmorrhage was very limited. If, however, the mischief is caused by the embolic closure of an artery that has free anastomoses, the integrity of the circulation is quickly re-established and recovery is rapid. In this case there is no retinal lesion. The sudden giving way of the legs is symptomatic of certain specific cerebral lesions, of specific deposits, which view is strengthened by the condition of the eye and the nocturnal pain. The deposits must be removed, and for this purpose we will give this woman one-sixth of a grain of the green iodide and one-sixth of a grain of extract of belladonna three or four times daily, watching its effect. If the bowels should become relaxed, we will add to each dose one-eighth of a grain of the extract of opium.

A PATHOLOGICAL MUSEUM.

When we note this man's waxy appearance, and notice his difficulty of breathing, together with the oedema, there is not much difficulty in reaching a diagnosis. He passes an abundance of urine of low specific gravity, but there is no albumen; and this reminds me to call your attention to the pre-albuminuric stage of fibroid kidney, which does exist. His eyesight is good, though the ophthalmoscope reveals wellmarked albuminuric retinitis. We have all the symptoms that ought to indicate albuminuria, but there is no albumen. For a long time this stage was not credited, but its existence is now undoubted. But in this case the supposed albuminuria is not the main point. The urine has a very deep color, which is due to bile. The history of the case points to lesion of the liver, though the abdomen is too much swollen to allow us to map out this organ. There is also a mitral murmur, which would indicate a condition that would account for the dropsy and for the anæmia. This man is really a pathological museum. He has fibroid degeneration of the liver, spleen, kidneys and heart, and bronchitis thrown in. We cannot hope to do much for such a case, but we must relieve the abdominal swelling and promote nutrition. For the first indication we will give him compound jalap powder, enough each morning to produce two or three stools, and for the second, ten drops of dilute nitric acid thrice daily, which sometimes produces very good results in albuminuria. After we have accomplished these two purposes, we must look to the general fibroid condition, but we must proceed carefully. We will then use the chloride of

gold and sodium in doses of one-fifteenth of a grain along with the bichloride of mercury, in doses of one-thirtieth of a grain, in pill, thrice daily.

ARTIFICIAL DILATATION OF THE UTERINE CERVIX DURING LABOR.*

BY DR. W. R. CHITTICK, DETROIT, MICH. Artificial dilatation of the uterine cervix, in cases where it may be practiced and where it is called for, is, in my opinion, a justifiable and worthy procedure, provided the operator understands just how to go about it. There are many cases of labor in which by judicious and reasonably prompt action on the part of the attending physician, much time and suffering may be saved the patient, if he chooses to practice this procedure.

I know many specialists are opposed to the practice of this operation and usually condemn it when opportunity is offered them to do so. Why they do so I cannot understand when they advocate operations and procedures that are fully as open to criticism, and are, in the minds of many general practitioners, looked upon with an unapproving eye.

This is a day of civilization, and consequently one of many artificial procedures. We cannot expect to find all women now-a-days having normal labors; if we were all in a state of nature it would be different, but even then there would occasionally be difficulties. The obstetrician of to-day must be armed with ergot, forceps, opiates and sometimes chloroform, and is not always slow to use one or more of them-especially the ergot.

Why then should we not practice a procedure that is advocated by some of our best practitioners-the more especially as it is one calculated to shorten the period of labor? The majority of confinements are severe enough; long hours of suffering are endured by mothers who, if they could, would soon shorten the time, and who many times are tempted to, and often do, take means to terminate the life of the foetus, thinking that by that means they will lessen their sufferings as well as get rid of the trouble and care of a child.

If we can by any legitimate means shorten the time of child-birth I think we certainly ought to do so. When our patients call us in they expect to get some help from us, and if we educate and train ourselves to give them the greatest amount of relief that science and art can devise, then we will perform the functions of true physicians.

There is another reason why we should make child-birth as easy and as short as our knowl edge and skill will permit, and it is that it will

*Read before the Detroit Obstetrical and Gynecological Society.

serve to make it less dreaded and encourage more wives to become mothers. Then again it will tend to lessen the number of miscarriages and abortions that are so common. It has struck me as a fact that criminal abortions are more common among the more intelligent women than among the so-called lower classes. So, if we can do anything to make the confinements of these women less painful in bringing into the world children who, with the advantages they would have, ought to make better men and women, and, therefore, add to the list of reputable citizens, we will accomplish a good thing.

In regard to the operation itself: As is now well understood, the dilatation of the os is produced by the contraction of the longitudinal fibres of the uterus, which are more numerous, longer and stronger than the circular fibres of the mouth of the womb. The contractions, as a whole, also serve to diminish the size of the womb, and thereby press upon its contents and tend to push out the entire ovum. The foetus being surrounded by the liquor amnii does not directly act on the os, but the bag of waters becoming tense, offers something for the muscular fibres to pull over, and, being pliable, to protrude through the opening made. Now, on a little thought, it must appear clear to everyone that the result of the whole process is simply to open wide the mouth of the womb, mere mechanical dilatation, in order to allow it to expel its contents. Now, the first stage of labor is often protracted much longer than there is any necessity for, and by artificial dilatation we can shorten it from one to six hours.

There are two methods of artificially dilating the os: first, by digital manipulation; and, secondly, by using hydrostatic bags. I have had no experience with the bags, but can say that I have had excellent results from dilating the os with the fingers. I have had cases in which there seemed to be but very little dilatation produced by the natural means, in which, as soon as I applied my fingers, the pains seemed to take on a renewed vigor, and labor progressed happily. I had one such case that remained stationary from the middle of the night until eleven o'clock the next day, when I saw her for the first time, that I delivered within half an hour after first applying my fingers. Everything was ready for dilatation, but for some reason it did not progress.

I think that gentle manipulations are the best. There is no necessity whatever for the use of force, as the manipulations are simply expected to produce stimulation, and this exciting the uterus to renewed vigor, make the pains stronger-sometimes very strong. All

that is necessary is to insert the first two fingers of either hand into the os between pains, and to gently widen them and run them around

between the os and the membranes, especially at the anterior portion. Force should not be used because it is not necessary, and might prove injurious. Neither should the operation be hastened, for nothing is to be gained by it. 83 LAFAYETTE AVE.

PREVENTION OF CORNEAL EROSION AND ULCERATION BY THE LOCAL APPLICATION OF OLEUM RICINI.

BY FRANK G. CONNELL, M. D., DETROIT, MICH.* Ulceration and erosion of the cornea is the most untoward event that can happen in the course of a catarrhal or purulent ophthalmia. Children are common subjects of the misfortune. With them the corneal tissue seems especially weak and friable, while the orbicularis palpebrarum muscles are unusually strong and irritable, and easily grind the surfaces of the orbicular and palpebral conjunctiva together, producing the erosion nd ulceration so justly feared.

It is not the mere loss of tissue from the cornea that makes it so desirable to prevent the lesions mentioned above, but it is the fact that when such lesions heal they are likely to leave the cornea opaque and impervious to light.

The principles which must guide the practitioner in his efforts to ward off an erosion or ulceration of the cornea, are based upon two principal conditions which I fear are not commonly measured for all they are worth. They are: 1. A constitutional weakness and fragility of the corneal substance, which is often remedied by the exhibition of cod-liver oil, potassic iodide, ferrous iodide-medicines of supporting and restorative character; and, 2. the spasm of the eyelids (blepharo-spasm), often associated with fear of light (photophobia) and which may be remedied by the use of anodynes, atropine sometimes, and section, with knife or scissors, of the external canthus of the eye, dividing the muscle which is in violent contraction.

The former condition is not infrequently overlooked by specialists, and the latter condition is as often overlooked by general practitioners. These gentlemen often boast of curing this or that case of chronic keratitis with codliver oil and constitutional treatment long after the specialist has exhausted the patient, in body and purse, with his local applications and too frequent manipulations. The specialist. too, reports with great pomp and pride that he has cured such and such a case of corneal erosion and pannus and blepharo-spasm, by an operation on the orbicular muscle; that the case had been in the hands of general practitioners who had disregarded the local lesions, while they plied the patient ad nauseam with constitutional remedies.

* Instructor in Chemistry, Detroit College of Medicine.

There is a happy medium for the management of these cases, and the successful practitioner will, of course, select it. Many cases may be prevented from progressing to that extreme degree, and this paper is written for the purpose of extolling the virtue of castor oil, when properly used, as a means to that end. It possesses a property of adhering and diffusing over inflamed mucous surfaces that is not possessed by other oils. It is an effectual and competent lubricant for mucous membranes. When the conjunctiva is smeared with it, it adheres and penetrates the folds and envelops the asperities of that tissue, forming an elastic layer of protective, which prevents friction and consequent erosion of the cornea by the lids.

It is my custom to use it freely in all cases, particularly in infants and young children, where there is danger of the cornea becoming softened by the heat and pressure incident to inflammation. Its action in the conjunctival folds and on the surface of the cornea is perfectly consistent with the principles of treatment mentioned previously, and in my experience does not interfere with any other treatment that may be demanded by these cases. With young children whose conjunctiva is inflammed, the cleansing of the diseased surfaces is no easy inatter. The oleum ricini facilitates greatly the toilet of the cornea.

A CASE OF CHOREA WITH PECULIAR NERVOUS ANTECEDENTS.

BY E. J. KAUFFMANN, M.D., L.S. A., ENG., L. F.P.S., GLASGOW, ETC, NEW YORK CITY.*

A case has lately presented itself that illustrates most thoroughly how all the members of a family may be heir to nervous symptoms, transmitted by the father or mother.

PHOEBE MARX, æt. 17 years, has been sick since seven years of age with chorea, which first made its appearance at that period, following measles; she has had chronic symptoms, more or less marked, all of this time, which disappeared at intervals under treatment, but persistently returned. The father of this girl is very nervous and has always been so; is hysterical. The mother, æt. 42, is a very nervous woman, was hysterical to within a short time ago and is just recovering from a "parametritis atrophicas chronicus" (Freund), dition of the parametrium in which especially the nerve fibres and ganglia are involved.

a

sclerotic

con

neurotic elements can be traced through the mother's family.

This case is of especial interest. It is well known that chorea occurs most frequently in families in which nervous diseases are hereditary, but seldom do we encounter such a purely nervous history as this one. There are so many conditions which we know are capable of producing choreic symptoms, that we can almost always elicit some cause apparent from the patient. It is far more frequent among the poor. Want of proper food, neglect, ill-usage, with the weakness and anæmia induced by these means, are very common antecedents. This patient is supplied with all the necessaries of life. An intimate association between chorea and rheumatism has long been recognized; bad habits, and disorders of menstruation, are also said to sometimes induce chorea. Intestinal worms, fright, etc., all of which are causes, were absent in the patient referred to. Some of the movements are imitative and can be much improved by pressure on the nerve supplying the muscle or muscles in which the spasms exist.

Liquor potassii arsenitis is prescribed and administered most frequently hypodermically, with very good results.

Zinci sulphatis, iron, cod-liver oil, are the most important medicines.

Any recognized cause should be removed, such as constipation or worms, and should be carefully looked for in children.

If any rheumatism KI and ammonia are good. Good food, rest, fresh air, etc., all come in for their share, and must never be forgotten-in some cases they form the most important treatment.

Correspondence.

PASTEUR AND THE PREVENTION OF HYDRO

PHOBIA.

While all the world is running mad, I thought a brief account of M. PASTEUR's experiments in inoculating for the prevention of hydrophobia might interest you and your readers.

I had the pleasure last week of seeing the eminent scientist inoculate the four children from Newark. N. J.

M. PASTEUR does not perform the operations himself, as he is not a graduate in surgery, and the French law punishes by a heavy fine any one not holding a diploma who performs any surgical operation, so M. PASTEUR has his assistant, DR. GRANCHET, perform the manual part of the treatment.

Arriving at the laboratory I was ushered into the same room where a man died last month from rabies. He had been severely bitten several months ago, and was seized with con

vulsions soon after reaching the laboratory, and died in a few hours.

I had been in the room only a few minntes when in came the four American boys, accompanied by MRS. RYAN, the mother of the youngest patient. DR. GRANCHET injected the virus by means of a large hypodermic syringe, beneath the skin covering the abdomen. The children felt a little frightened at first, but laughed when the operation was over, and left with instructions to return daily for ten or twelve days.

You, doubtless, have read of the manner of obtaining the attenuated virus. A rabbit is inoculated with virus taken from the brain of rabid dog, and dies. Virus is then taken from the brain of this rabbit and another rabbit is inoculated with it, and so on, till about thirty rabbits have contributed to the cause. The last rabbit is not killed by the virus, but is put to death by the surgeon, and the virus taken from its brain and used for the inoculation of human patients. The part of the brain used is the medulla oblongata. M. PASTEUR thinks that this part of the brain is the reservoir where the rabiotic virus is deposited by the blood.

The microscope has thus far failed to reveal the deadly germ, but the physiological tests leave little room to doubt M. PASTEUR'S demonstration.

M. PASTEUR'S laboratory at No. 45 Rue d'Ulm, near the Sarbonne, contains a large number of cases of rabbits, dogs, and other animals in different stages of hydrophobia; it reminds me very much of the physiological and experimental laboratory which my uncle established during the palmy days of the old Detroit Medical College, and which he modeled after the laboratory of the late eminent physiologist, CLAUDE BERNARD, in the College de France, of this city. It is remarkable how the French have worked and pushed ahead to encourage scientific research in this city, and in every part of the world. M. PASTEUR is about sixty years of age, short, thick-set, and active. I had a long talk with M. PASTEUR, and was very pleasantly entertained, and was shown through the many rooms of his well-equipped laboratory.

There is no doubt that there is a great scare about hydrophobia in Paris, France, and the whole of Europe, and I guess it is reaching to America. Many eminent men dispute the correctness of PASTEUR'S conclusions; but no one questions his genius. His position as a scientist of transcendent ability was assured long before he began the experiments which are bringing him so much attention. No one who has been inoculated has as yet permitted himself to be bitten by a thoroughly rabid dog, for the purpose of testing the efficacy of preventive inoculation. And until that is done, there will

be plenty of men who will question PASTEUR'S discovery. M. PASTEUR was given a pension of $5,000 a year a few years ago. It was soon after the conclusion of his famous experiments, proving the groundlessness of the doctrine of spontaneous generation. And since then he has said little or nothing about generation de novo, or sui generis. It is a well-known fact here that since the days of LA FONTAINE no one has disturbed the poetry of the church as has PASTEUR with his hermetically-sealed tubes, and the germs which developed speedily after exposure to the air and light.

There are men in Paris mean enough to say that the church disliked his doctrines and experiments, and that she purchased his silence on spontaneous generation with the government pension.

In America PASTEUR'S work, as it is reported in the Parisian papers, would give the code of ethics of the American Medical Association a hard rub to keep him within the boundaries of professional regularity.

I can see the look of disapproval which the straight-laced and eminently respectable PROF BRODIE would give the man who allowed his name to get into the papers so often and with so little provocation.

PARIS, FRANCE.

HAL M. WYMAN, M. D.

PAINFUL MAMMA IN YOUNG GIRLS. In the MEDICAL AGE of Dec. 26th, 1885, I noticed an article from the pen of J. N. MORGAN, upon Cases of Painful Mammæ in Young Girls." Of said ailment he appears to be unable to give the cause. In my experience of thirty years, I have had, as all other physicians have, a great many of these cases, and not one did I see but was in the habit of wearing the health-destroying, but to them the indispensable article of female attire, the corset the foundation of so many uterine dis

eases.

It must be remembered that nature cannot sit quietly by and see the daughters of our noble mothers ruined without giving some demonstrative warning. The nervous system in some is very sensitive, and especially so in the young female, just before she is budding into womanhood. Remember the bones in the young are soft and easily moulded into almost any abnormal form; hence, the ribs have been made to lap, one over the other, by tight lacing; the proper circulation and development thereby nearly, or almost, brought to a standstill.

Should it then be strange to have pains in that locality, when we know that there does exist the greatest sympathy between parts of the uterine organs and the mammæ of the female? The sympathetic nerve (so called from

the opinion entertained that through it is produced a sympathy between the affections of distant organs), the dorsal ganglia, solar plexus, and superficial cardiac plexus, must be affected by tight lacing. Some makes of corsets are so long in their points as to rest on the mons veneris, when the female is in a stooping or sitting posture, thus causing additional disturbance.

Hence, if the young female would throw aside the corset, she would develop into such a being as would deprive the medical profession of a large percentage of its earnings, and soon our slumbers would not be broken at night time to prescribe for some poor, nervous, broken-down woman, who had become an object of pity to all who know her.

STANTON, Mich.

J. B. SULLIVAN, M. D.

THE INJECTION OF HÆMORRHOIDS. The injection of hæmorrhoids for radical cure, is the most important discovery in surgery for many years. Its importance appreciates when we consider the simplicity and ease of the operation, and the very large number of persons to be benefitted by it.

It was first discovered and practiced by irregular practitioners; but now that its value is demonstrated, the discovery belongs to the regular profession.

One college professor who taught me how to operate said that it was very unsafe to inject except some clamp is applied to the base of the tumor to shut it off from the circulation, because of the danger of coagula entering a vein, to be deposited in the liver or lungs.

The articles recently published in the AGE make no mention of the use of a pile-clamp. How is this? Is it safe to operate without using a clamp? It would certainly be much easier. Will some reader please give us his views on this subject?

ELMIRA, MICH.

N. P. BLAKESLEE, M. D.

COCAINE IN MINOR OPERATIONS.

In December last I operated on a Mrs. G., removing a tumor, weighing a half pound, from the axilla. I injected 1 grs. superficially and deep along the line I intended making the incisions; after waiting about ten minutes I commenced cutting. She said she could feel a dragging sensation along the line of incision, but there was absolutely no pain, and even when separating the tumor from the deep tissues she did not feel the blade or the handle of the scalpel, which was freely used.

I also removed a cancer from a lady's breast under similar circumstances in this city, with the same results.

MURIATE OF COCAINE A HÆMOSTATIC. Jan. 8th Mrs. S., aged 58, presented herself at my office for the removal of two sebaceous tumors of the scalp, each about the size of a small marble, one situated in the right parietal region, the other in the left parietal. To the left one I made three applications of a four-percent. solution of muriate of cocaine. To the right one I made no application. The former was removed with no pain and a loss of not more than three drops of blood, and never oozed a drop afterward. The latter was quite painful, bled freely and oozed a little for twentyfour hours afterward. A. G. BRUCE, M.D.

ALBION, MICH.

A doctor out west has sued a railway for $10,000, which is the amount of damage which he claims to have resulted to his body, and peace of mind, through an abscess in his nates, the said abscess being alleged to have been caused by the company's negligence. It appears that the doctor combined politics with medicine, and had taken a ticket to a democratic convention. The coaches being full, he repaired to the baggage car, where he sat down on an egg-crate, from which protruded a nail which the company had neglected to polish. The result was that the rusty nail became imbedded in the place necessarily utilized when one sits down, and an abscess followed. The railway company will, doubtless, urge in defending the suit, that the doctor was guilty of contributory negligence. He was not invited to sit dow on the egg-crate, and after selecting that seat, he should have satisfied himself that no nail stood ready to receive him on unpolished point. Are railway companies obliged to keep nails from protruding from egg-crates on their baggage cars? And if not, are they legally bound to keep protruding nails polished and free from rust? Then, again, did the nail cause the abscess? Might not the abscess have been a common boil? Was the doctor's blood in a proper condition to have resisted the injury? In answer to the last question stands the fact that he was a democrat and on his way to a democratic convention, and during a heated presidential campaign. Were the customary liquid stimulants present or absent? If it appears that they were present, was the doctor's blood not "heated," and thus predisposed to abscesses? Questions of this nature will, doubtless, be put to the expert witnesses, and the answers will depend very much on the political biases of the latter. The case will thus prove an interesting one from a medicopolitico-legal point of view.