ART. I.-Hypertrophy of the Cervix Uteri Cured by Excision.

[Published by vote of the Academy of Medicine.]

BY DR. JAMES BIGELOW, Indianapolis, Indiana.

THE subject of this operation being the one upon whom I per-" formed the plastic operation on the vagina for prolapsus uteri,'" reported in this journal for October, 1866, I will only state the outlines of the history of the case prior to that operation.

A robust, medium-sized lady, aged forty-two, married and sterile, the subject of dysmenorrhea for sixteen or seventeen years, suffering excruciating pain especially for four or five days immediately following the cessation of her menstral flux, gradually became the subject of prolapsus of the womb, with elongation of the neck of that organ. After more than six months' ineffectual effort to cure or relieve her medicinally, the operation of denuding the vaginal walls and procuring their adhesion was performed (as described in that report), which succeeded in retaining the uterus in situ. It was hoped by that operation, in' addition to curing the prolapsus, to facilitate the cure of the hypertrophy of cervix.

That operation was made in July, 1866. After she had recovered from the operation, I used iodine, mercury, etc., internally, and made deep eschars with pot. cum. calce locally, and, for a period of three months, kept the cervix completely enveloped in iodized cotton lint without benefit, the os still remained very'

small and menstruation painful. Frequent passive hemorrhages had supervened from the uterine and nasal cavities. Efforts were made to determine if there was any uterine polypus, but without success, owing to the unyielding condition of the os. At this time the cervix was increased very much in length and thickness, the os occupying a position in the plane of the vulva, and encroaching on the meatus urinarius, so as to render micturition difficult and painful. In consultation with Drs. Todd and Comingor, of this city, it was decided that amputation would afford the patient great relief, if not a permanent cure. Accordingly, on the 18th of June, 1867, assisted by those gentlemen, chloroform was administered (which failed to produce more than momentary anesthesia, which somewhat retarded the operation), the patient placed in the lithotomy position, the uterus drawn down with a tenaculum, the chain of an ecraseur placed around the organ one inch below its body and tightened so as to strangulate the vessels, and by a few rapid turns of the lever of the instrument, the neck was excised, separating two and a half inches of the hypertrophied cervix. After a few minutes' delay, finding there was no hemorrhage, a piece of lint saturated with Ferri persulph. was applied to the stump for greater security, and the parts replaced in their normal position. The hemorrhage from the operation to convalescence did not amount to two ounces. The pain either at or after the operation was inconsiderable. The bowels were kept quiet and disinfectant washes used per vagina for a few days, and in two weeks she was allowed to sit in her easy chair. In two months the cicatrization was complete, leaving a neck and os of normal dimensions, except that the latter is slightly contracted. Menstruation is now easy and regular, and her general health much improved.

Upon making a section of the excised cervix, a polypoid growth four lines in thickness was found attached by a broad base about one line below the point of excision, and reaching down the canal to within one inch of the os tincæ. This was, no doubt, the cause of the passive hemorrhage, and may have been, to some extent, the cause of the increasing hypertrophy of the neck. There was no perceptible disease of the body of the uterus at any time.

In looking over the literature of this operation, I do not find any statistics of much practical value. In the United States it has been performed up to the year 1855, as follows: By Drs. Jameson, of Baltimore, in 1824; Strahn, of Virginia, in 1829;

Warren, sr., of Boston, in the same year; Moore, of New Hampshire, in 1847; Atlee, of Philadelphia, in 1848; Eve, of Georgia, in 1850; Parsons, of Rhode Island, in 1852, and Ogier, of Charleston, in 1852; but I have not been able to find the published results of these operations. In Lisfranc's method the danger of hemorrhage was so great as to make the operation formidable, and therefore not much practiced in this country.

With a properly-constructed ecraseur, supplied with a thick, heavy chain, in the use of which a short time is given after it is tightened on the part before it is excised, the danger of hemorrhage from the excision of such vascular parts is escaped, and operations of that character rendered simple and safe. 37 VIRGINIA AVENUE, February 11, 1868.

ART. II.-Aqua Nicotiana.

BY J. S. UNZIKER, M. D., Cincinnati.

TAKE of fresh green tobacco leaves eight pounds, cut them and add alcohol one and a half pounds; water sufficient; mix and distil eight pounds.

Care must be taken that the leaves do not become heated by being tied up in bundles, as this would impair the preparation and impart to it the odor of tobacco. The leaves should be taken just before the plant begins to bloom, and should then be worked up as soon as possible; for when the leaves once become spotted, the preparation assumes more or less the poisonous effects of dried tobacco, which is not the case if freshly prepared.

This remedy was first introduced in Germany by Dr. J. G. Rademacher, and if prepared, as above stated, can be given with perfect safety to the smallest child, without any of the injurious effects produced by dried tobacco. From this I judge that nicotin is not developed and communicated to the distilation as long as the leaves are fresh. For the last eighteen years I have used the aqua nicotine with the best results in the first stages of pneumonia and fevers generally. It reduces the pulse promptly, the same time acting as a strong diaphoretic, making it especially adaptable to all fevers originating from colds. But where the

tongue is dry, or becomes so after taking it-which is rarely the case-it must be omitted. Its action on the spine and cerebellum is also remarkable. In fevers of children, where diarrhea is present, and the brain more or less implicated, and opiates inadmissable, it gives prompt relieve by reducing the fever, promoting the action of the skin, and gradually checking the diarrhea and removing all cerebral symptoms. The dose for adults is from 388-3j every hour or two, and may, with advantage, be given in the form of a mixture in combination with nitrate of soda, acetate of potassa or bi-carbonate of soda.

ART. III.-Difficult Labor.

EDITOR LANCET AND OBSERVER:-I herewith send you a report of a case of difficult labor that recently occurred in my practice, and is for many reasons to me an interesting one. Thinking it might interest some of your many readers, I have thought it best to send it to you, and if you think it of sufficient importance you may give it a place in your valuable journal.

On the morning of the 17th of January, 1868, I was summoned to attend Mrs. B., who, I was told, was at that time in labor. I repaired at once to her home as was my duty; upon arriving and making an examination, I found her in actual or real labor, she having had pain for some two or three hours, the os being pretty well dilated; but the pains were not severe, and labor did not progress very satisfactorily. When I first made the examination, 1 ascertained that it was a false presentation, the head not presenting, and at this time I could not tell exactly the state of the case, but after the rupture of the membranes had taken place, I found that a hand and a foot presented, and immediately upon a pain coming on, the cord prolapsed; thus I had a hand, foot and cord presentation, making a very ugly case, as I thought. I saw at once that something must be done and that quickly, and determined to make it if possible a footling case.

I commenced by trying to elevate the arm and shoulder, and at this time made the discovery that there was no pulsation in the cord. I, therefore, made haste to deliver by making firm

traction on the presenting foot, and at the same time pushing up the arm and shoulder, and after some fifteen minutes I had the pleasure of feeling that I had accomplished my object. Knowing the importance of speedy delivery, I made, with every pain, firm traction on the feet and body, until I had delivered the entire body; but with the head I was not so fortunate, as it seemed to be tightly locked in the pelvis. As soon as I could get my hands up to the head, I introduced the two first fingers of my left hand into the childs mouth, making traction upon the superior maxilla, and at the same time bearing the chin down upon the sternum, holding the child the while upon my right arm. There being still no pulsation in the cord, I looked upon the case as one in which the child would be dead born, and so told the parents.

I continued to make steady traction with my fingers in the mouth, but did not succeed in perfecting the delivery for fifteen minutes longer, being a full half hour after I ascertained that there was no pulsation in the cord. When the child was born it was to all appearance dead. I made use of all the various methods practiced to bring it to life, without effect, and finally told the friends that it was dead; but the parents begged me to persevere longer, and to satisfy them I did so, but without any hope of bringing it to life. I resorted to breathing into its lungs, and artificial respiration, warm and cold effusion, friction on the spinal column, and tapping lightly on the buttocks with the palm of the hand, keeping up this process for at least twenty minutes longer when one of the female attendants remarked that she saw the heart beating, which I found to be the case, but still no breathing or effort to breathe could be detected; but I kept up the manipulations with the more hope of ultimate success, and after, perhaps, ten minutes had elapsed I had the pleasure of seeing the little fellow make an attempt to breathe. I still continued my efforts, and little by little the respirations increased, until after some time longer full respiration was established. The child was too feeble to cry out, as new born babes do, but after waiting some length of time longer I removed it from the mother, and it did well.

This case, in my opinion, was one of apparent death by syncope and not by apoplexy, and required very different treatment than if it had been apoplexy, this being the reason I did not cut the cord and remove the child as soon as it was born. I believe this to be an important case in many respects, some of which are