Gravity in Transverse Presentations. Dr. E. E. Barnum, of Lancaster C. H., Va., reports an interesting case in the Buffalo

ed. and Surg. Jour. The patient had been in labor about twenty-seven hours, with shoulder presentation, the arm protruding, ovthen the Doctor was called in consultation. After ineffectual attempts at performing version, and the impracticability of operative procedures being determined, the Doctor, remembering the efficacy of the force of gravity in reducing prolapsed cord, proceeded as folBows:

"The woman was placed in the knee-chest position upon the bed, when we attempted to pesh back the fetus, hoping either to replace the arm and get a vertex presentation, or else to be able to perform pcdalic version; but so firmly was the fetus held in position that we again failed. I next brought the patient on her knees, to the edge of the bed, with a strong assistant at each side. Her head was slowly Lowered until her position was nearly inverted -her head almost touching the floor. Then compelling her to breathe rapidly, to prevent her bearing down' involuntarily during her paias, we soon began to feel the gradual withdrawal of the fetus from the superior strait. Within a very few minutes-probably not more than five-we were able to replace the 212. With the next pain the head presented by spontaneous version. The patient was then directed to "bear down hard, and was placed in bed, the descent of the arm being prevented by means of a finger in the vagina.

Labor proceeded rapidly, and within fifteen or twenty minutes the child was born alive." The Doctor concludes as follows:

"From a careful study of this case, with the aid of all the obstetrical literature that was within my reach, I have formed the following conclusions:

I. This was a typical case of transverse presentation when first seen by my friend, Dr. Eubank, twenty four hours after the beginning of the labor, and many hours after the hand << was born."

II. In that late stage of the labor, version by the usual methods was a physical impossibility; embroyotomy was not possible, on account of the absence of the necessary instruments, and Cesarean section would only hasten the death of the mother.

III. By the method of treatment employed by me the presenting part was removed from the superior strait, the malposition was corrected and the child was born alive, -the whole time from the beginning of the treatnent to the birth of the child not exceeding Shirty minutes.

IV. The proposed method of treatment does not necessitate the exposure of the patient, and if the changes of position are made slowly and carefully, very little, if any, distress or harm will be experienced by her.

V. Special complications may call for special treatment-for instance, convulsions might require the use of chloroform, etc.

VI. I believe that this method will be found useful in performing version by external manipulation, by internal manipulation or by both combined, and in many cases, as in mine, it will give nature a chance to correct the presentation by spontaneous version.

VII. A failure of this method will not pretion or embroyotomy. vent or complicate treatment of Cesarean sec

Whether this method of treating transverse presentations is, as I believe, original with me or not, I can bear testimony to its efficacy in the only case of the kind which ever occurred in my practice "

dict, after having tried the efficacy of quinine, camphor, atropia and morphia, and many other sure cures.-The Medical Fortnightly.

Sir Andrew Clark's Method of Teaching
Clinical Medicine.

Dr. Clarke is known as a most skilful physician and able teacher of medicine. In a recent lecture (London Lancet) he discusses the several methods followed by clinical teachers, and then describes his own. He says that "the criterion of true instruction is not acquiring but thinking. Genuine clinical teaching requires the active co operation of teacher and student, the assimilation as well as the acquisition of knowledge; seeing, handling, doing as well as trying, failing, and succeeding."

Dr. Clark's method is "to help his students to get plain, practical clinical instruction, and so to get it that they may pass from the hospital into practice accustomed to its methods and cautions, without fear of disaster, and ready for sound, honest work."

An unknown case is brought before him. and his class, and he proceeds to deal with it as nearly as is possible in the same manner as he would in private practice.

He lays importance upon always following a definite plan of procedure; it may not be the best, but it is far better than no plan. He first asks the patient to tell the symptoms of which he complains, how long he has been ill, and in what way his illness began. Secondly, he endeavors to learn from the patient the number and name of the troubles he has suffered in the course of his life. Thirdly, he makes the acquaintance of the medical history of the patient's family.

Having acquired this information and found the patient's statement points to the lungs as the chief seat of the malady, he investigates these organs with all the modern aids to diag

nose.

This completed, he separately investi. gates the conditions of the circulatory, digestive, genito-urinary, cutaneous, and nervous systems. Thus he ascertains the number and degree in which the constitution is being af. fected by the disorders or diseases which may have been brought to light.

Now he is able to statein order the symptoms and signs of the patient's disease, and the signs and symptoms of disorder of the disease which may exist casually or independently elsewhere than in the lungs. He is able to elicit their relations, to interpret their meaning, and to set forth their bearing upon the future course and complications of the case.

Now he can discuss the probable nature of the malady and frame the diagnosis. This This done, he considers the probable future of the case, settles the report to be made to the friends,

and finally determines the treatment to be pursued. From time to time the case is re-examined in order to correct or confirm the diagnosis, to determine the way in which the disease is going, and to consider the use or uselessness of remedies.

Dr. Clark assures his students that "if they adopt this plan, if they follow it step by step, if they follow it unintermittingly, and if they bring all their collateral knowledge to bear upon its development, they will be preserved from confusion in emergencies, they will acquire a growing interest in their work, their minds will have formed a precious habit, their whole nature be lifted up, and in due season their labors will yield fruit both abundant and good. Further, in the carrying on their work in this manner they will have trained their understandings, disciplined their hearts, and

exercised their wills to the utmost of their ca

pacities. They will become cultivated men, and be able to hold their own on topics of mutual concern with the public in the gate, and they will be prepared to deal successfully with those problems of the moral life from which few cases of disease are entirely exempt."-- The American Lancet.

The Gynecological Uses of Aristol, Ichthyol, Iodized Phenol, Resorcin, Creolin and Chloride of Zinc.

C. D. Palmer, M. D., (Cincinnati LancetClinic, October 3, 1891) has found aristol superior to iodol and 10doform. It is unirritating, non-absorbable, and has no toxic effect. It possesses stimulating, alterative and anesthetic properties. He uses it in pure form as a powder, applied by insufflation. In narrow passages it may be used by suppositories. It becomes an admirable dry dressing for some cases of chronic vaginitis, vulvar pruritus, cervical endometritis, cervical erosions and fissures, mammary fissures, and syphilis, primary and secondary. Aristol gauze can be made by impregnating plain gauze with an etherial solution of aristol, containing from one to two grammes of aristol per yard. Crayons for the urethra or uterus can be prepared by using at least one gramme mixed with a sufficient quantity of gelatine or gum acacia. Ichthyol appears to favor the healing processes, mitigating pain and favoring the absorption of inflammatory exudates. Palmer has utilized ichthyol in three ways-giving it internally, applying it externally and topically to diseased structures. His experience has so far been rather favorable, but not sufficient to justify an enthusiastic expression. enthusiastic expression. At present there is no topical medicament within the whole range of medical preparations, excepting Churchill's incture, which he finds himself employing

more frequently for chronic morbid conditions of the endometrium, with or without special functional disorders, than iodized phenol. He employs it by ingestion and injection, without or following curetting. The drug is antiseptic, alterative, astringent, mildly caustic and hemostatic. Resorcin has proved to be an ad mirable remedy, combined with boracic acid and white vaseline, or incorporated with the ointment of the oxide of zinc as a salve, to be applied to certain skin diseases of the external generative organs, and to foul smelling, indolent ulcerations in the puerperal as well as gynecological conditions. Creolin is an efficient germicide, and in some respects more powerful than carbolic acid, more destructive to the micro-organisms of various diseases, and of suppuration. It is less toxic than carbolic acid, but it is not entirely devoid of toxicity. Chloride of zinc is valuable for vaginal and endometrial morbid conditions, All malignant diseases of the uterus, for any cause, rendering partial or complete hysterectomy unjustifiable, are signally improved in general health, given a prolonged lite and materially bettered in all local symptoms by a thorough application of the zinc chloride, after sharp curretting. He has employed intrauterine tampons, siturated with a solution (from 25 to 50 per cent strong) or crayons, equally strong, a protection of the vaginal mucous membrane being maintained at the same time.-Univ. Med. Magazine.

The Prevention of Retroversion of the Uterus.

Lapthorn Smith (Journal of Gynecology, September, 1891) finds that this class of cases is the most pitiful in his practice. At every step, at every effort they make, the sensitive uterus thumps down upon the sacrum, or, what is still worse, in some cases pounds the imprisoned ovaries. All this suffering could be saved if accoucheurs would adopt a few simple rules. First, to instruct their patients not to lie upon their backs more than for a few minutes, but to turn about freely from side to side, and to lie occasionally on their faces. Second, to give them full liberty to sit up to relieve their bladder and bowels, and while they are taking their meals. Third, to take care not to allow the bladder to be distended during the first few days, but to order the nurse to pass the catheter every eight hours at least. Fourth, to abandon the use of the obstetric binder until involution is complete and the patient is up, with the uterus anteverted, when she can recover her figure, if she is foolish enough to wish it, with much less damage by tight lacing and forcing down the bowels behind the uterus instead of squeezing down the

bowels in front of a helpless retroverted uterus. Fifth, to order the very simplest case a daily douche of plain or medicated hot water, so that if retroversion does occur it may not be rendered hopelessly incurable by adhesions. Sixth, to keep the bowels in an easily movable condition so as to avoid forcing the uterus when retroverted still further into the hollow of the sacrum.—Univ. Med. Magazine. Ten Families of Drinkers, and Ten of Sober Members.

DEMME studied ten families of drinkers and ten families of temperate persons. The direct posterity of the ten families of drinkers included fifty-seven children. Of these twenty-five died in the first weeks and months of their life, six were idiots, in five children a striking backwardness cf their longitudinal growth was observed, five were affected with epilepsy, five with inborn diseases. One boy was taken with chorea and became idiotic. Thus of the fifty-seven children of drinkers only ten, or 17.5 per cent. showed a normal constitution and development. The ten sober families had sixty-one children, five only dying in the first weeks; four were affected with curable diseases of the nervous system; two only presented inbora defects. The remaining fifty-819 per cent. were normal in their constitution and development. From this series of investi gations wc derive the sad truth that among children of drinkers the prevailing mortality is fearful, that the survivors represent a pitiful crowd afflicted with unsoundness of mind, idiocy, epilepsy and other disturbances of their nervous syste n, and that only a very small proportion of the descendants grow up as useful members of society.-Herald of Health.

the

DR. JOHN W. CORBETT, Camden, S. C.. writes of The Physician as a Business Man:" "I have read and re-read it with a great deal of interest and profit.'

THE following are some of the hospitals, the for mula of which are given in The Official Formula of American Hospitals":

University Hospital (Philadelphia.)
Episcopal Hospital (Philadelphia.)
Philadelphia Hospital.

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New York Hospital.
Roosevelt Hospital (N. Y.)
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Chicago Marine Hospital, and many others. The book is a neat, cloth-bound volume of 272 pages, and the price is only $1.00. It is worth many times the price, and should be in every physician's library. Published by THE MEDICAL WORLD. Order when you send your subscription for '92.

Original Communications.

Short articles on the treatment of diseases and experience with new remedies are solicited from the profession for this department; also difficult cases for diagnosis and reatment.

Articles accepted must be contributed to this journal only. The editors are not responsible for views expressed by contributors.

Depy must be received on or before the twelfth of the month for publication in the next month. Unused Manuscript cannot be returned.

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the platnest possible words, or his reader will certain isunderstand them. Generally, also, a downright fact by be told in a plain way; and we want downright facts at present more than anything else.-RUSKIN.

Notes and Comments.

EDITOR MEDICAL WORLD.-What sort of nerve

tonic do your correspondents take? They seem full of "vim," bright as new dollars, and overflowing with good ideas this month. We felt that way once, but that was in the long ago, before La Grippe swooped down upon us. Now at the termination of a death-grapple with him, we feel like going off and burying ourselves for a month 'till we have gotten a little rested. And that is what we ought to do. After a period of unusual activity, when the powers of mind and body have been taxed to their utmost capacity, and the strain has been kept up for months, there should come a period of hebetude, a rest, as complete as possible, to be continued until nature has recuperated her forces and there comes a longing to be back at one's work. It is a sad thing when a man has lost the capability of resting and enjoyment. Many do; and find that all their acquisitions have turned to dust and ashes, because they have forgotten to preserve the faculty of enjoying life. Perhaps these thoughts are inspired by the fact that have at present so many medical men applying to me for treatment. It is so easy to see that, after the hard work was over, they should have betaken them selves to some quiet resort, at the seashore or in the mountains. whichever offers the greatest change from the usual conditions under which they live. Please don't ask me if I have done so. We doctors rarely take our own advice, and I really have not time just now. Relics of the epidemic still on hand, bills to collect, arrears of neglected work to pull up, etc., etc. "What fools we doctors be.'

Dr. Ward (page 57) wants a cure for asca rides. This is not so simple a matter as it looks. The usual remedies are lime-water and tincture of iron, injected into the rectum; but sometimes these fail. I had one case in which

I used glycerine, but without effect. Naphthol has been pronounced effectual. I would advise a trial of local remedies systematically, until one is found that will destroy the worms and yet not injure the rectum. Very cold water; very salty water; acids; alkalies; chioro om solution; coal-oil; liquid vaseline; each to be tried cautiously, increasing the strength until the limit of toleration is reached. In the meantime a steady course of iron, quinine or mercury, whichever is indicated, should not be neglected.

M. D. (page 58,) has had an unfortunate case. When injections are thrown into the vagina, they sometimes are thrown directly into the uterine cavity; when sudden and alarming symptoms may ensue. This is what has occurred in M. D's. case. It is best to employ for vaginal irrigation an apparatus like that of the Knap Company, with a shield to enough to carry the stream into the vagina; close the vaginal mouth and a tube just long and this tube should have the openings at the side and not at the end. A still better way is not to use the injections at all, but clean the vagina by the use of a soft sponge on a handle, like a large probang.

Dr. Dodge has mentioned some very curious cases (page 61,) but he does not tell us of those in which his prognostications were not realized. Many of us have doubtless had such impressions in regard to our patients for which we could not satisfactorily account. Sometimes they come true; and it is not surprising that a doctor who has practised since 1854 should be able to recollect a number o such curious coincidences. But he forgets the others, because they made no impression upon his brain. I was once engaged to attend two sisters in confinement. The first was a bad case, fully expected to die; but she did very well. Then there occurred a little disagreement between us; I very unreasonably expecting to be paid in something more current than blarney, the consequence was, that a few days before the second confinement was due, I left the house remarking as I went out. "I brought good luck into this house, and if luck goes away with me it will not be surprising." Within a week the second mother and her child lay dead in their coffin. This was a case in which no difficulty was expected.

Why did I say it? I do not know. Idle words, suddenly occurring, in a moment of anger, and regretted the instant they were uttered. Nevertheless, they were repeated far and near, and for years I enjoyed the doubtrul reputation of a wizard, a dangerous man to offend! The death was a pure coincidence, as were Dr. Dodge's cases, and the man who

puts faith in such things as of the supernatural, would better place himself under the care of an expert in mental affections. WILLIAM F. WAUGH, M. D. 1725 Arch St., Philadelphia.

Differential Diagnosis Between Glaucoma and Senile Cataract.

EDITOR MEDICAL WORLD:-During my regular course in ophthalmology at the University of Michigan, under Prof. Frothingham, and more especially during a post-graduate course in the same branch under Prof. Carrow, my attention was often drawn to the lack of care in diagnosing between glaucoma and senile cataract, found among the profession generally. Scenes were often piteously sad during the University Hospital clinics. Patients came from a long distance, supposing they had cataract. Their eye trouble had been so diagnosed by the family physician. They had been bidden to wait until the imagined cataract became ripe. During the ill advised waiting, the precious days and hours were wasted, in which help could have been given, and when, finally, the patient presented himself for an operation, he could only be told that help is impossible. And so, with disappointed hopes and sightless eyes, he took his long journey homeward, only to pour curses upon his well-meaning physician. Often have I heard that faithful teacher, Dr. Flemming Carrow, say to his clinical pupils these golden words: "I will not consent to the graduation of any student who cannot diagnose between glaucoma and senile cataract. These facts lead me to think a brief paper on this subject may do good, and be useful to the busy doctor. I know the subject is found in books, but books are expensive, and in many cases their need is not felt, nor does the practice seem to demand them.

"When well established, it (glaucoma) is often mistaken in old persous for senile cataract, especially because the lens of old age has a smoky hue. This explanation of failing sight is considered adequate, and a resort to skilled advice is discouraged. Under this mistake, the patient is told to wait until the supposed cataract shall be ripe before going for relief, while the delay is simply affording time for total loss of chances of recovery."-Noyes on the Eye, page 506.

It may be proper to say here, though briefly, that glaucoma is a very serious and peculiar disease of the eye ball, whose special characteristic is a greater or less hardening of the globe, accompanied in many cases with opacity of the crystalline lens. Senile cataract, on the other hand, is an opacity of the lens without necessarily any other abnormal condition.

The quite natural confounding of these two different diseases so often noticed in an eye clinic, is the apology for this article. Without any claim to originality, but with some experience in this direction, I will state, briefly, some of those differential diagnostic points be tween the two, which can be appreciated by all:

I.

Hardness of the eyeball. Let the physi cian put one finger of each hand upon a pair of healthy eyes, the lids being closed, alter nately palpating, as when testing for pus in an abscess. Now transfer the fingers to the suspected eyes and note the difference in tension. Any hardness above normal, points to glaucoma.

II. Pain. Cataracts, as a rule develop without pain. Glaucoma, as a rule, causes pain, often of a very severe character. When the patient complains of a dull aching across the forehead and through the eyeball, the physician may well suspect glaucoma, but when the distress is at all extreme, he may be almost sure of it.

III. Opacity of the cornea. A hazy, ground glass appearance, denotes glaucoma.

This is an

IV. Anesthesia of the cornea. easily tested glaucomatous condition. V. Large and tortuous episcleral veins also characterize glaucoma.

VI. A shallow anterior chamber, the iris being discolored, and, together with the lens, pushed forward into it, imports glaucoma.

VII. A large and immovable pupil warns of glaucoma.

VIII. Color of the opacity. In cataract the lens is white, yellowish white or grayish. In glaucoma the hue is greenish. Indeed, the meaning of the word glaucoma is green, so constantly is this color a symptom.

IX. Subjective appearances. In glaucoma the patient often complains of halos or colored rings around candles and lamps when lighted. These are not observed in cataract cases,

though scintillations and phosphenes are some times seen; but these are easily distinguished from the rainbow appearance above alluded to.

I remember a patient, a woman, in Dr. Carrow's clinic at the University Hospital, who said she saw spiders, large and small, in a great number, hanging from the ceiling of her rooms, and so real was her delusion that she attempted to sweep them down, and her failure to do so led her to consult the family phy sician, who diagnosed cataract with the too common result--waiting for the imaginary cataract to ripen until the time for help had gone forever.

X Contraction of the field of vision. This can be roughly estimated by placing a bit of