3. The effect of the drug is manifest in about fifteen minutes, and is complete in thirty minutes after its exhibition. The successive doses should be given at not less than hourly intervals. [Presumably small doses only are meant, e. g., mx of the fluid extract. J.]

STATISTICS OF THE PORRO OPERATION.

(R. P. Harris, Br. Med. Jour., Jan. 11, 1890.) This note presents a revised record of the Porro operation in all countries for thirteen years ending December 31, 1888. The total list numbers 264 cases. A growing improvement is noted in the results in all countries with the exception of France. Of the first 50 women out of the 264 cases, 30 died; of the last 50 but 10 were lost, a mortality of only 20 per cent. The total mortality from the operation was 117 deaths, of which 74 occurred in the first half of the total number of recorded cases, 43 in the last. Dr. H. thinks that with due care and skill at least 80 per cent. of cases should be saved. The recent results compare favorably with those of the improved Cæsarean section. [Up to October, 1889, five operations had been added to the Porro record with no addition to the number of recoveries. The recorded Porro cases as given by Dr. Harris, December 20, 1889, numbered 272, with 150 deaths; the Saenger operations, 212 with 50 deaths. J.]

PHTHISIS NOT AN INDICATION FOR ACCOUCHEMENT RAPIDE.

Dr. Wm. Duncan (Br. Med. Jour., Jan. 18, 1890), in a paper read before the Obstetrical Society of London, advocated the practice of induced abortion in pregnancy complicated with progressive phthisis, and reported a case in which he had operated. When the patient was seen for the first time in the latter months, he advised artificial premature labor in case of marked phthisis. These views were were based upon his belief that the progress of phthisis was hastened during gestation. The paper was discussed by a large number of the prominent obstetricians of London, every one of whom condemned the practice as unjustifiable. That the progress of phthisis is accelenated by pregnancy has not been proven. Lactation, however, affects it unfavorably and it is this which should be suppressed.

RUPTURE OF THE UTERUS.

Wiedow (Nouv. Arch. d'obstet. et de gyn., Nov., 1889) reports a case of rupture of the uterus in a iv. para, due to hydrocephalus; child extruded into the peritoneum, placenta expelled per vias naturales. Laparotomy eighteen hours after rupture. The tear extended from the fundus through the neck of the uterus, and split the posterior layer of the broad ligament. The elastic ligature was applied to the cervix, the

broad ligament was sutured, its cavity drained into the vagina with iodoform gauze, and the uterus amputated. The peritoneum was flushed with boiled water. The stump was stitched in the lower angle of the abdominal wound. Recovery.

PUERPERAL FEVER.

Widal (Br. Med. Jour., Dec. 28, 1889) believes puerperal infection to be produced by the streptococcus pyogenes entering the animal economy by first lodging in the ulcerated uterine mucous membrane. The diffusion of the micro-organisms by the uterine vessels explains the distribution of this affection in various organs.

W. has observed that the false membrane sometimes found in puerperal fever has no analogy to the false membrane of diphtheria. The false membrane of puerperal fever and the pus of abscesses are of the same origin, and are produced by the streptococcus pyogenes. He finds the streptococcus pyogenes in the endothelium of the affected veins in phlegmasia alba dolens. This is the origin of the affection, the formation of clot being secondary.

The streptococcus of erysipelatous dermatitis produces the suppuration of phlegmonous erysipelas and that from puerperal discharges. causes erysipelatous dermatitis as does that from an erysipelatous patch.

TREATMENT OF PLACENTA PREVIA.

(Br. Med. Jour., Nov. 30, 1889.) Dr. Braxton Hicks submits the following rules among others for the treatment of placenta prævia : Induce labor immediately on making the diagnosis of placenta prævia. (After the period of viability. J.)

If the os be fully expanded and the placenta marginal rupture the membranes and wait. Employ forceps or version in failure of the expelling powers.

If the os be small, separate the placenta from the lower segment and be guided by the subsequent indications.

If the practitioner elects to follow a routine method in all cases, version by the combined method, no force following, gives as good results as any.

Dr. Murphy presented a table of 38 cases, with but two deaths. He advocated the induction of labor in any case after the seventh month, and in the event of much bleeding, earlier. His chief reliance is bipolar version.

Lomer has treated 28 cases, losing but one. One hundred and ninety cases had been treated in Germany by Braxton Hicks' method (bipolar version) with but nine deaths. Dr. L.'s rule is to turn and

then wait. Slight traction may be called for to control hæmorrhage, but hastened extraction is unnecessary and pernicious.

NITRITE OF AMYL IN HEART DISEASE COMPLICATING LABOR.

W. F. Wright (Ed. Med. Jour., Dec., 1889) reports a case of labor complicated with mitral stenosis, incompetence and aortic regurgitation. At the close of the third stage the woman was seized with extreme dyspnoea and hæmoptysis and became deeply cyanosed. Instead of venesection the doctor bled the patient into her own vessels by administering five or six drops of nitrite of amyl by inhalation. The result was immediate relief of all the symptoms with ultimate recovery.

PRACTICE OF MEDICINE.

BY HENRY CONKLING, M.D.,

Pathologist and Assistant Visiting Physician to St. Peter's Hospital; Physician to the Department of the Chest, Brooklyn City Dispensary.

THE USE OF SULPHONAL.

Field (Therapeutic Gazette, Sept., 1889), after experimenting with the remedy in 200 cases, believes it stands first in the list of the hypnotics. The failures to obtain success will be few, if certain rules are observed. It is considered essential to bear in mind the following: 1. Time of administration.

2. Method of adminstration.

3. The dose.

Sulphonal requires from one to two hours before its action becomes manifested. It should not be given when the digestive process is in full activity. The dose should be taken one or two hours before retiring. The patient should not prepare for sleeping until a feeling of drowsiness is experienced. The drug should always be given in finely divided powder. Mechanical irritation from the coarse grains may produce enuresis. These grains are less soluble in the stomach. Tablets of the compressed drug should not be used. Five grains in powder produced the same effect as fifteen grains in the tablet form. It should not be given in milk or water, as its imperfect solubility will cause some of the crystals to adhere to the sides of the glass, preventing the patient from receiving the full dose. It may be used in wafer or merely placed upon the tongue. Rectal administration produces

same results.

If

After continued use of the drug the author finds that the dose may be decreased. The patient who has used it night after night will require his large doses at first; later on a small dose will answer. a dose of fifteen grains be first given, after a time five grains will be found to produce sleep. The drug, from these observations, was rarely at fault in producing sleep, but it was noticed that if the dose were too large, or if the sleep were interrupted, a feeling of languor, drowsiness and physical weakness was experienced the next day. A small dose will produce sleep, and its effect will be spent upon waking. The sleep is refreshing and never depresses. The nerves and circulatatory systems are not objectionably affected.

Age and idiosyncrasy may sometimes cause the non-action of the drug. In children gastric disturbance always prevents its action. Senile organic change causes non-action; also profound mental disturbance. If, after the repeated administration of doses, varying from ten to twenty grains, observing the rules above given, the drug does not produce sleep, some idiosyncrasy must be suspected.

The author believes that the drug is curative, and mentions a case where it was used for months, producing sleep during the course of the treatment. Upon omitting the drug, normal sleep followed without interruption.

Sulphonal should never be given in more than ten-grain doses, as a rule. Fifteen grains are sometimes used. Twenty grains is the maximum dose, and should not be exceeded. It is a perfect hypnotic, because, although the means is artificial, the result is physiological.

CHLORALAMID.

(Therapeutic Gazette). Chloralamid is a combination of chloral and formamide. It comes in colorless crystals, having a bitter taste, being soluble in ten parts cold water and in one part alcohol. It is more freely soluble in warm water under 140° F. Excess of temperature causes separation of the ingredients.

It may be given in wine, water, or capsule.

The dose is from twenty to forty grains.

It produces sleep in twenty-five to thirty minutes. The sleep lasts

from six to eight hours.

The indications for its use are:

Nervous excitement.

Neurasthenia.

Insomnia in heart or lung disease.

It does not act where the insomnia is accompanied by severe pain or mental disturbance.

EXALGINE.

(Therapeutic Gazette). From various papers on exalgine the following conclusions as to its action may be given :

1. The dose is from two to five grains every three or four hours.

2. It reduces neuralgic and muscular pains.

3. It is not poisonous and produces no depression.

4. It is a non-irritant.

5. It tends to reduce and prevent convulsive movements.

PHENACETINE IN PERTUSSIS.

Heinman (Journal de Medicine, July, 1889) writes of the value of the above remedy in producing a calming effect upon the nervous system and its action in restraining spasmodic action, nervous or muscular. In pertussis it had no action whatever on the duration of the disease, but seemed perceptibly to lessen the frequency of the paroxysms of coughing. This was conclusively proved in several cases in which, upon omitting giving the medicine, the child immediately had a return of violent fits of coughing, which were again held in check by exhibiting phenacetine.

Six grains may be given to a child three years of age in divided doses.

PREVENTIVE MEDICINE.

BY E. H. BARTLEY, M. D.,

Professor of Chemistry and Toxicology, and Lecturer on Diseases of Children, Long Island College Hospital

COUNTRY WELL WATERS.

Dr. Joseph F. Edwards (Annals of Hygiene, Oct., 1889) relates the following fact in relation to the pollution of wells by cess-pools: "We have two wells, the one 14 feet lower than the other and 273 feet away from it; yet when we pump the water from the upper well, we decidedly lower the water in the other." The lower well is 21 feet deep and the upper one 27 feet. The bottom of the former is 8 feet below that of the latter. These facts are mentioned to show that underground currents cannot be determined by the configuration of the surface, and that a well on a higher surface level may be contaminated by a cess-pool situated on lower ground and nearly 300 feet away. He says: "This circumstance makes us feel absolutely convinced that the cess-pool must go; with this instance ever before us we could never feel, with absolute certainty, that any well was abso