one application generally suffices. Mode of operating:-a common bougie or catheter is to be passed first, and the length is to be noted at which the urine begins to flow an inch short of this gives the site of the membranous part. The armed instrument is then to be passed to the same length, and the caustic made to revolve, by twisting the instrument for the space of an inch and a half, when it is to be drawn within the bougie and extracted-if there is much pain or ardor urinæ, a hip bath may be used-leeches will occasionally be found useful-patient should lie on a hard mattrass, and a cold enema with 20 drops of laudanum at going to bed will assist in preventing the discharge.-Lancet, Oct. 14, 1843.

Mr. James Douglas, Lecturer on Anatomy in Glasgow, proposed, in the Medical Gazette, Sep. 29, 1843, to substitute a solution of sugar of lead with opium mixed with mucilage, as an injection, for the nitrate of silver, he having found it very successful in several cases.

NAPHTHA IN PHTHISIS.

There has been a sort of controversy going on lately on the question if naphtha does or does not cure phthisis. Now probability would say no-some gentlemen say yes. Those who like facts have been favoured with the following from Dr. Rankin of Bury St. Edmunds, who has published them in the Lancet. He has given it in eight cases, three females and five males. Of these, three are already dead, the remainder are still alive, but dying gradually. In five of these cases there were unequivocal signs of cavities in one or both lungs, with emaciation and copious purulent expectoration. In the other three, the disease was not so far advanced: but, besides the signs of tubercular deposit, crepitous and submucous râles, with the appearance of pus in the sputa, indicated that softening had commenced. In none was the most trivial benefit perceptible; neither was the perspiration checked, as it is stated to be, as if by magic; nor were the cough and expectoration diminished. In two instances nausea was complained of, and every patient, without exception, implored its omission.

NITRATE OF SILVER TO PREVENT BED-SORES, and For Burns.

Mr. Jackson, in a Paper read before the Sheffield Medical Society, has recommended the nitrate of silver for the prevention, or the cure of bed-sores.

The form which he uses is in the proportion of ten grains of the nitrate of silver to one ounce of water, applied by means of a camel-hair brush over every part exhibiting the slightest appearance of inflammation, two or three times a day, until the skin has become blackened; afterwards only occasionally.

Mr. Jackson lauds it in the treatment of burns and scalds. He instances several cases of superficial burns in children in which he found that in a very short time after its application the pain ceased, and vesication was totally prevented.

In the deeper burns he uses it, not that he finds that it can produce any effect upon the charred parts, but that, as Mr. Higginbottom has said, he finds the superficial burn healed, and the extent consequently circumscribed.-Provincial Medical Journal.

For our own parts, we question whether any applications will answer in the long run, either for preventing or for curing bed-sores, unless pressure is removed -and, if it be removed in time, whether any are necessary. Give us a good

piece of "buffalo's skin" with or without a hole in it, and attention to cleanliness, and we will make a present of all the drugs in the Pharmacopoeia to our adversary. Prevent pressure then, and it may be prevented, and the bed-sores will take care of themselves.

CURE OF EPISTAXIS.

According to Dr. Negrier, one way of doing this is to hold up one or both arms, and close the nose at the same time. Simple, if successful. We have no doubt that, as in most cases bleeding at the nose stops of itself, holding up the arms would, in such, be certain to answer.

f

MIDWIFERY.

ON THE TREATMENT OF PUERPERAL CONVULSIONS BEFORE THE FULL Term
OF UTERO-GESTATION. By S. HARRIS, M.D. of Clarkesville, U.S.

The object of the author is to call the attention of the profession to a material point in the treatment of puerperal convulsions, when the ordinary remedies fail, and it becomes necessary to resort to delivery, at a time that the os uteri is found undilated, and undilatable by gentle means. The general rule is, that if the os tincæ is not dilated, or dilatable by easy means, no forcible entry into the uterus must be made under any circumstances. This is the rule laid down by the highest authorities in midwifery. The great difficulty is, when a case occurs in which delivery or death is the only alternative. Must we then, says Dr. Harris, quietly seat ourselves, and witness the certain triumph of this terrible disorder? Must the case be given up to nature, or are we not justifiable in making a forcible entry into the uterus, and extracting its contents? He expresses himself decidedly in favour of this last painful resource; he even considers it practicable in most cases, unless in the very early stages of pregnancy. He cites the case of a strong healthy young woman of about 16 years of age; in the fifth month of her pregnancy she was attacked with puerperal convulsions. All the ordinary means had been employed without any good effect. When he was called in, he found her in a state of total insensibility. Breathing laboured and stertorous-pulse weak and fluttering, sometimes imperceptible-no uterine action-os tincæ almost entirely closed, hard and unyielding-paroxysms recurred with unabated fury. Forcible delivery was accomplished. Blisters and warm applications were applied to the extremities, which were cold and clammy. She had two or three fits after delivery. She remained comatose for nearly 24 hours after, frequently without any pulse at the wrist. By proper care, however, she was soon restored to perfect health, and since then she has been pregnant three or four times. He cites another case somewhat similar, wherein he succeeded equally well in extracting the child without doing any serious injury to the uterus; but in which the patient eventually died, the forced delivery having, as he thinks, been too long delayed. The author of this paper acknowledges that it is only as a pis-aller he can recommend this course of forcibly entering the uterus and delivering the fœtus. He ventures to affirm, that if timely resorted to, it will, under the guidance of reason and the promptings of ingenuity, result very often in the preservation of human life.-American Journal of the Medical Sciences, July, 1843.

OBSTETRICAL AUSCULTATION. By H. VAN ARsdale, M.D.

of New York.

Among the sounds which obstetrical auscultation reveals, are two-the uterine souffle, and the pulsations of the fatal heart; the former being an uncertain, and the latter a certain and positive sign of pregnancy. The uterine souffle is dependent on the arterial circulation of the mother; it is perfectly coincident with the mother's pulse. Laennec erroneously thought that this souffle was produced in the principal artery nourishing the placenta, and others were equally in error in supposing it to be produced in the iliac artery. The author, from his inquiries into the nature and value of the uterine souffle, lays down the following propositions :

1. It differs entirely from the various arterial souffles: freedom from any shock, proximity to the ear, and want of uniformity are its peculiar characters. 2. Its presence is not an invariable and sure proof of the existence of pregnancy; it is sometimes detected in fibrous diseases of the uterus.

3. It is produced in the uterine arteries, and the explanation of its irregularities, intermittences and change of place, may be found in the difference of the calibre of the arteries on penetrating the womb, and also in the change of position of the fœtus in utero.

4. The point where the souffle is perceived, does not always correspond with the insertion of the placenta.

5. The period of its appearance is not constant. It is very difficult to discover before the end of the third month; but it is rarely absent at the end of the fourth, and continues to increase in intensity till the end of the sixth month. From this period it varies rather in its nature than in its intensity.

6. It is found most often in the lateral portions of the uterus, a short distance above the crural arches; but it is sometimes heard along the median line.

7. It is of no consequence in the diagnosis of cases of double pregnancy, of diseases of the uterus or placenta, or of the life or death of the fœtus.

The double pulsations, or the pulsations of the foetal heart, are far the more important of the two sounds discoverable by auscultation. From his observations and researches on this important sign, the following propositions have been laid down :

1. These double pulsations are a sure sign of the existence of pregnancy and of the life of the fœtus.

2. The variations in the circulation of the mother have no effect on that of the child.

3. The increase in the number of the double pulsations is unimportant, as being of rare occurrence, and of short duration-whilst, on the contrary, a decrease in the number, during parturition, and especially in a protracted labour, announces danger to the child, and indicates that the labour should be terminated by instruments, by version, &c.

4. These pulsations are not to be expected before the completion of the first half of pregnancy. The average number of beats is 135 in minute, and they continue to increase in intensity from the moment when first heard until parturition.

5. Cases of double pregnancy may be diagnosed from hearing the pulsations of two distinct foetal hearts, and these pulsations usually differ in number from eight to fifteen.

6. The detection of these pulsations is of the first importance in cases of extra-uterine pregnancy, since, if they were not discovered, the case may be mistaken for a fibrous tumor of the ovaries, or a simple cyst, and be treated as such.

7. They are discovered at a point corresponding with the dorsal præcordial region of the fœtus.

8. To discover the presentation, we have to draw an imaginary horizontal line, dividing the uterus into two equal parts. When the head presents, the pulsations are heard in the lower half; and when the pelvis presents, they are heard in the upper half.

9. To discover the position, we have to draw an ideal vertical line, bisecting the preceding one. When the back of the child is turned towards the right side, the pulsations are heard in the right half; and when turned to the left, they will be heard in the left half.

Lastly, the total absence of these pulsations should invariably deter us from performing the Cæsarian operation, or, indeed, from doing anything which may prove injurious to the mother, in the vain hope of aiding the child, which we are now bound to believe to be no longer alive.-(New-York Journal of Medicine, Sept. 1843.)

ON INFLAMMATION AND ABSCESS OF THE UTERINE APPENDAGES. By

FLEETWOOD CHURCHILL, M.D.

The author of this paper is of opinion that many females have owed the delicate health in which they have remained for some time after their confinement to inflammation and suppuration taking place in the uterine appendages, that is, in the Fallopian tubes, the broad ligaments, or the ovaries; this condition of the parts has been unnoticed in consequence of the obscurity of the symptoms. He illustrates the disease by citing twenty-three cases of it collected by him from various sources. The first of these cases was that of a woman 44 years of age, who had had five children, the youngest being but two years of age. For some time past she had felt pain in the inguinal regions and above the pubis, which she attributed to pregnancy. Shortly after consulting the Doctor the pain increased, and she felt something give way to the left of the pubis, and immediately after a quantity of puriform matter was passed by the rectum, from whence a sanguineopurulent discharge continued for a week, and then ceased, and she recovered. After a few weeks she had a return of the pain, followed by the discharge, which ceased again after a week or two. During the week preceding the discharge, she suffered from severe dragging pain in the inguinal regions, perspirations, loss of appetite, dysuria and tenesmus, all which symptoms disappeared after the matter was evacuated. The remedies employed were leeches and poultices to the seat of the pain; small doses of calomel and James's powder, and an occasional aperient. Another case was that of a woman aged 40, who was delivered by the forceps of a living child. She had been long in the first stage of labour, and the cervix uteri was torn off. Before assistance could be rendered, the perineum was lacerated, and she had a tedious recovery, during which she had an attack of hysteritis, which was subdued by the ordinary means-in some time after she had an attack of peritonitis, and another attack in a month after. The cause of these sudden attacks was found to be a tumor near the right iliac region as large as a goose egg, and very tender on pressure. Two days after the detection of this tumour a large quantity of matter escaped from the vagina and rectum, and the tumour greatly diminished in size, and lost its tenderness. The discharge occasionally stopped for a day, and then returned, until all tumefaction had disappeared. She gradually recovered strength. In this case the escape of matter into the peritoneum was the cause of the two attacks of the peritonitis.

This inflammation of the uterine appendages may occur in an acute or chronic form. In the former it constitutes one of the varieties of puerperal fever. It is to the chronic form of the disease that Dr. Churchill has more particularly directed his attention. The causes of the attack are not easily assigned; it may follow

blows, falls, or a fright; it more frequently results from cold. It is sometimes attributed to the suppression of the milk or the lochia. The mode of invasion varies a good deal: sometimes there are few, if any, preliminary symptoms; uneasiness, perhaps, in one iliac region, and on placing her hand on the spot the patient detects a tumour. With respect to the symptoms, there is a distinct tumour-this may be found completely above Poupart's ligament, above the linea ileo-pectinea, sometimes occupying one iliac fossa entirely, and even extending upwards nearly to the umbilicus, and forwards to the linea alba-or it may be seated more deeply in the pelvis, just reaching to Poupart's ligament, protruding the groin, and from its fixedness giving the impression of its being firmly connected with these parts. The tumour is hard as a stone until suppuration commences, and equally tender on pressure. Stings of pain radiate in all directions from the tumour-when the tumour is situate in the pelvis and groin, the pain extends across that cavity, down to the anus, back, and down the thigh—standing upright is very difficult and painful, as also walking-there is tenesmus, and a desire to make water frequently. Fever is also present. The terminations may be resolution, or-abscess. The matter of this abscess may escape-a. externally through the abdominal parietes-b. into the peritoneum, causing peritonitis -c. into the vagina-d. into the bladder or rectum-e. into the surrounding cellular tissue-f. the extent of the disease, or the secondary affections caused by it, may prove fatal after an indefinite time. With respect to treatment, the indications are 1st. To procure resolution of the tumour; 2. To promote suppuration and evacuation of the matter. The former is best fulfilled by the application of leeches to the tumour, to be followed by bran- poultices, and repeated, if necessary. Fomentations and a hip-bath will also assist. If, however, suppuration take place, an opening should be made into the abscess, when it is possible, so as to decide the course the matter is to take-the best situation for the opening is through the abdominal parietes-the next through the vagina.—(The Dublin Journal of Medical Science, Sept. 1843.)

ON PUERPERAL CONVULSIONS. BY CHARLES HALPIN, M.D. OBSERVATIONS ON PUERPERAL CONVULSIONS. BY ROBERT JOHNS, M.D.

Puerperal convulsions have been divided into three species-epileptical, apoplectical, and hysterical; the epileptical is the most frequent-they may occur either during the latter months of gestation, during labour, or after delivery. An attack of convulsions may set in at a time, when, from the favourable condition of the woman, we have least reason to expect it. Every thing may be progressing to our satisfaction, when suddenly, and without a moment's warning, a scream, or some stertorous or hissing sound from the woman, attracts our attention. On turning round, we find her in a state of insensibility; if she has been standing or sitting previously, she has fallen to the ground-body violently agitated entire muscular system forcibly and irregularly contracted-hands firmly clenched-arms and limbs flung wildly round, or rigidly extended-head drawn violently backward, and neck twisted so, that frequently the face is turned toward either shoulder; eye-balls projected, either fixed with an appalling stare, or rolling wildly, and ready to start from their sockets; cheeks and lips red or livid-tongue protruded-mouth filled with frothy mucus-vessels of head and neck swollen and turgid-breathing stertorous, or accompanied with a peculiar hissing sound-pulse either full, slow, and soft, or very rapid, and frequently intermittent.

Dr. Halpin lays down the following propositions, as conclusions fairly deducible from his observations.

Puerperal convulsions occur most frequently in first pregnancies; the ratio