for him as a professional brother. The result of this case was published in our town paper; but as I was chairman of the Committee of Ethics of our county society, I explained the case satisfactorily. Although I have gone somewhat in detail regarding the matter of this epistle, it has been my desire to show that, with every appearance of having actually stolen patients from Dr. W., I did every thing I could "under the Code" to protect and befriend him. And yet there are some who say there is no necessity for a code.

LACERATION OF THE CERVIX UTERI

AND ITS SURGICAL TREATMENT.

CLINIC BY DR. GOODEell.

an instance: A wealthy gentleman from the city built a fine mansion in the village, and came with a letter of introduction from a college professor to Dr. White. Dr. W., of course, had the family. I was glad to hear of his good luck, especially as the wife of the gentleman was an invalid, and required a great deal of attention. One day upon driving past I was hailed by the servant, who asked me to step in and see his mistress. I obeyed the summons, and found a delicate lady reclining upon a lounge, complaining of a ball in her throat, great oppression in breathing, great pain in left side, and a desire to urinate frequently. She informed me that she was Dr. White's patient, but was somewhat discouraged with his treatment. I at once told her that Dr. White was a splendid fellow, one who had a great opportunity for working out her case; that although he had but few patients, he loved to study, and was on the whole a very safe, if not too cautious a practitioner. But this did not quiet her pain. She said that Dr. W. had not only left her medicine which made her worse, but that he had insisted on her taking it in spite of the pain. I asked her, with honest incredulity upon my countenance, whether he actually said so. I tasted the medicine and repeated the question with a like answer. Being then assured there was no mistake, I said that he was probably right, but that she had better not take any more of the medicine until I saw Dr. W. She then seemed better satisfied. I found, on questioning her, that Dr. W. had not made any vaginal examination, nor had he hinted at any. Some way or other she squeezed out of me an opinion that her whole trouble was uterine, and that an examination was necessary. I think that I told her as much before I knew whether or no White had expressed any opinion. At all events, to humor her, I examined her on the spot, and dis-or the inordinate desire of the woman to hasten covered an abrasion of the os. I promised her that I would tell Dr. W. about it, and left her without any further suggestion.

Now W. is one of those stubborn chaps who do not believe in abrasions; but I tell him almost every woman has them, or ought to have them, and he will be always safe in a diagnosis. He informed me that he did not intend to humor such a prejudice upon the part of his patient, and seemed a little angry. In spite of all I could do, when the husband of the lady sent for me to attend her, I could not persuade her that White was of the two doctors the better man.

This woman comes to the clinic with the neck of her womb projecting from her person. This projecting body bears a very close resemblance to a shark's mouth. The cervix is evidently lacerated on both sides, and these lacerations extend low down. This condition of things interferes very seriously with coition. The woman has come to me not so much, perhaps, on her own account, as to have her person made acceptable to her husband. The patient tells me that she has been sterile ever since her last confinement, that she feels wretchedly and suffers greatly from constant bearing down pains. The best thing to do is not to amputate the cervix, although the tear is very bad, but to bring it down and sew up the lacerations.

It is a well-known fact that the cervix uteri expands greatly during the course of labor, owing either to the impatience of the attending acoucheur

the birth of the child, the membranes are very often ruptured prematurely and the head of the child pushed violently through the as yet undilated os, gives rise to the laceration. If this tear takes place on the anterior or posterior part of the cervix it is very likely to heal of its own accord and without any surgical interference. This is, of course, owing to the fact that the natural movement of the cervix is backward and forward and not from side to side. Lacerations of the cervix are almost always, however, lateral. The complete subinvolution of the womb is thus retarded by the condition of the cervix and so the troublesome symptoms This case, by the way, narrowly escaped going will continue until the cervix is restored to its norto my partner, who is a uterine man, and who is mal state. These lateral lacerations always defavorably known among the laity as the inventor mand an operation. The mucous membrane of of a self-entering, self-retaining, back-action specu- the cervical canal is studded with glands and folllum. I do not think much of his instrument, how-icles and covered with pavement epithelium. The ever, as I have invented one of my own. It is rent in the cervix rubbing against the wall of the needless to say that the case progressed favorably, vagina sets up a constant source of irritation, and and I secured a good fee. It might just as well | abrades its exposed mucous membrane. have gone to Dr. W., but I did the best I could When a patient comes to you complaining of

A physician, thus mislead, applies nitrate of silver, or cauterizes the raw surface with nitric acid, or, perhaps, makes use of astringent suppositories, and very possibly the leucorrhoea disappears, the other symptoms improve and the woman goes away, considering herself cured, only to return in a short time with all her troubles upon her again. It is the commonest thing in the world for a prac-operation. Sims' speculum is the best instrument titioner, particularly a young one, to mistake laceration for erosion and to treat it accordingly, that is to mistreat it. I am not free myself from the same blunder.

that she was afraid to go out into the streets by herself. It was not until the lacerated cervix was stitched that the retroflexion began to disappear. You have no idea what a woman will go through when she wishes to have children, just about as much, in fact, as she will undergo when she has made up her mind not to have them.

This operation for laceration of the cervix is generally a most successful one. 'The hardest part of it all is the passing in of the sutures. A cervix which has been for a long time in such a condition offers one of the greatest obstacles to the passage of a needle to be met with in the whole range of uterine surgery. This cervix is just as tough as leather. I have, upon several occasions, found it almost impossible to pass needles through such tough tissue without bending, or, perhaps, breaking them in the attempt.

Prince, who first pointed out its value in this disease, but it has also a sedative, astringent, anti-spasmodic, and anti-diarrhoeic action, in addition to its local coagulating and antiseptic properties. If it only lessened pain by producing sleep, its action would be but transitory, whereas it is very persistent, being in reality a sedative to the brain and spinal cord as well as to the sympathetic system of nerves, and it is the latter system which is chiefly affected in dysentery. After the use of chloral it is found that the evacuations are lessened, while the flatus which is such a painful symptom in the disease, is diminished. In regard to the local action of hydrate of chloral it must be considered that one part is absorbed in the intestine, whilst another is passed on by peristaltic contractions into the cæcum and colon. After administration in a mucilaginous vehicle in doses of 2-3 grams, the peristaltic movements are at first increased, but then ensue diminished sensibility and movement. These phenomena are due to the stimulation and subsequent paralysis of the sympathetic, and it is in this way that the chloral lessens the pain in the bowels, and the secretion. If the administration be continued till recovery takes place, the chloral exhibits its properties of coagulatng albumen, destroying the organised ferment, and hastening cicatrisation. conclusion, Dr. Curci enumerates the other remedies employed in dysentery, and states his opinion that purgatives administered in the early stages of the disease alone approach in value to chloral hydrate. He condemns anti-phlogistic treatment, as well as that of opiates and astringents. He has There is a very valuable bit of advice which I known no good results obtained from the use of want to give you with regard to premature rupture ipecacuanha, the so-called radix antidysenterica, of the membranes, which, I said, was a potent since it only acts as an emetic, and is without effect cause of laceration of the cervix. When the wom- upon the other processes of the disease. Il Raan in labor is a multipara, you may generally rup-cogliatore Medico, Nos. 15-18, 1878. Med. chir. ture the membranes with impunity, after a fair dila- Rundschau, May, 1879.)-Practitioner. tation of the os. But in the case of a primipara you must not rupture them until after full dilatation has taken place.-Hospital Gazette.

Let me, to revert a minute, call your attention in passing to the very powerful influence which a disordered womb has upon its possessor's brains. My former patient, to whom I made brief reference a few moments since, was made utterly wretched by the laceration. Nervous, easily frightened, unable to sleep at night-in fact almost insane. The operation restored her health of mind and body completely.

Be very careful not to denude the whole surface of each lip, but to leave a spot in the middle of each untouched, otherwise the cervical canal would be wholly closed. I have been in the habit of calling this undenuded portion my "room for repentance," as the painter would put it.

HYDRATE OF CHLORAL IN DYSENTERY.-Dr. Curci finds that chloral hydrate is serviceable in the diarrhoea of typhoid. He has therefore employed it during an epidemic of dysentery in seventeen cases, always with the best results. At first it was administered in combination with potassium chlorate, but afterwards the latter drug was omitted, and the chloral was given alone in a mess of barley gruel, either by the mouth to the extent of 1-3 grams per diem for an adult, or as an enema (10 grams in 2,000 grams of gruel being sufficient for ten enemata). When given by the mouth it is found advisable to administer some slight purgative beforehand to prepare the bowels for the reception of the remedy. Hydrate of chloral is not only a soporific remedy for dysentery, as was supposed by Dr.

In

PERICARDIAL EFFUSION-FLUID WITHDRAWN BY ASPIRATOR.--The following interesting case under the care of Dr. McCall Anderson is reported in the Glasgow Med. Four. Sept. '79. H. H. aged 17, millworker, was admitted 22nd July, 1879, complaining of severe cough and general dropsy, most marked in the legs. The cough has troubled him for some years, and is always worst in winter; during the last four winters he has had several very severe attacks of hæmoptysis.

When admitted, he breathed with difficulty, his face had a livid hue, and the attacks of coughing were frequent and violent. On examining the chest there was found to be marked aulness of the left side anteriorly. The dulness extended 2 inches to the right of the middle line, and round into the left lateral region; it reached upwards nearly to the clavicle, beneath which, however, there was a limited area of clear percussion. The lateral limits of the dulness were much less at the upper than at

the lower part of the chest. Behind, percussion
was clear, except towards the base where there
was some dulness. The left side of the chest was
decidedly fuller than the right, and over the area
of dulness there was a bulging of the intercostal
spaces. Harsh sonorous râles were heard all over
the chest on both sides. The heart sounds were
normal, but seemed distant and muffled The
act position of the heart could not be made out,
and the apex-beat could not be felt. The pulse
was rapid, very small, and thready.

granulations became greenish, and the foetid oder returned. I then tried an ointment of iodoform, according to the formula used by Dr. Tantum for prurigo, ie., iodoform 3i, to 3i of ointment. I spread a thin layer of the ointment on a piece of lint cut to the size and shape of the ulcer; this I placed on the ulcer, and over it a layer of carex-bolised tow-as an antiseptic precaution — then bandaged the leg firmly, and left my patient for a week without re-dressing, and to my satisfaction, at the end of the week found the ulcer in a nice healing condition. Since then, I have continued the treatment with very satisfactory results. I have also tried it in other cases with like results.

Urine contained a trace of albumen and bile. Patient was ordered a cough mixture and a diuretic.

The diagnosis made was pericardial effusion, with probably slight pleuritic effusion at the left base.

BLEACHING Sponges without injuring the texture may be done very nicely by first soaking them in a solution of muriatic acid made by adding a pint of acid to a gallon of water. This dissolves out the limestone, shells, etc. After this rinse thoroughly, and immerse the sponges in a solution of permanganate of potassa containing an ounce of the latter to a gallon of water. Wring out the sponges, and put them into a solution made from one pound of hyposulphite of soda, one gallon of water, and one ounce of muriatic acid. This will bleach immediately, after which they should be well washed with water to remove all traces of acid, etc.

As the patient was not improving, a consultation was held on 30th July, at which the diagnosis made was confirmed, and it was resolved to remove the fluid by means of the aspirator. The The spot selected for puncture was in the fifth intercostal space and about an inch to the right of the nipple line. A medium sized trocar and canula connected with the aspirator was used, and 38 oz. of a light straw coloured fluid withdrawn. When the instrument was first introduced, it was evidently not in contact with the heart, but during the latter part of the operation the cardiac impulses distinctly affected the canula. Immediately after the operation patient's breathing became CHLORAL IN DIPHTHERIA.-Rokitansky, of Innsdecidedly less laboured, and very soon after there bruck, has used a 50 per cent. solution of chloral was a marked improvement in his appearance, as a local application to the membrane, by hairwhich, previous to the operation, was character-pencil, every half hour. Pain is seldom severe, istically cyanotic. On examining the chest on the but salivation is intense. In an hour and a half following day, the area of dulness was found to be pieces of membrane come away on the brush; and considerably diminished, the diminution being at the end of two to four days the surface of most marked at the upper part, and to the right. wound has granulated. As the surface improves The heart sounds were now very distinct and in appearance the solution is gradually diluted. nearer the surface. The pulse was much stronger From Morrell Mackenzie's monograph on Diphand more regular, though still frequent. theria, it appears that chloral-syrup, 25 grains to the ounce, ranks high in his esteem as a local application: "it rapidly gets rid of the fetor, and it is beautiful to see the membrane loosen and come away, leaving a healthy surface underneath."

What the final result in this case may be it is impossible to state, though no doubt can exist as to the great improvement which has resulted from the operation.

IODOFORM IN THE TREATMENT OF CHRONIC ULCER. Dr. Evans, Glasgow Med. Four. gives the following. On entering the room occupied by an old man, whom I was one night called to see for a sudden illness, I was quite overcome by a most offensive and fœtid odor, which, I found on enquiry, was caused by "a bad leg" of 30 years' standing. On asking to see it, I was shown a large irregular sloughing ulcer in a most horrible condition. I washed it with a solution of carbolic acid (1-20), then dressed with a solution (1-40). This I did daily for about a fortnight, and the ulcer became perfectly sweet and healthy looking; but if left for a single day without dressing, the

In a case of stone occurring in a man about twenty-two years old, Dr. Bigelow recently removed, in one hour and seventeen minutes, a calculus, of which two fragments weighed 720 grains. There was no blood in the urine during the operation, nor any unfavorable indication afterwards; the patient rapidly convalescing. The calculus was phosphatic, but quite hard, having a small lithic nucleus. It measured 24 inches, and could not be grasped by a Thompson's lithotrite. It was crushed by Dr. Bigelow's lithotrite, and aspirated through a tube of the diameter of 30 French. This is, with one exception, the largest stone yet removed by the new method.-Boston Med. Journal.

THE CANADA LANCET.

A Monthly Journal of Medical and Surgical Science

Issued Promptly on the First of each Month.

Communications solicited on all Medical and Scientific subjects, and also Reports of Cases occurring in practice. Advertisements inserted on the most liberal

terms. All Letters and Communications to be addressed to the "Editor Canada Lancet," Toronto.

and who are not, or who can judge whether instrumental aid is demanded. The forceps is not so harmless as enthusiasts would have us believe."

Dr. K. then proceeds to quote in support of his position, from several eminent obstetric writers. He, however, in our opinion, falls into a serious inadvertence, when he appeals to obstetric statistics; for whether in this department of medicine, or any

AGENTS. DAWSON BROS., Montreal; J. & A. MCMILLAN, St. John. other, what theory or practice so ever, has not

N.B.; GEO. STREET & Co., 30 Cornhill, London, Eng.; M. H. MAH-
LER, 16 Rue de la Grange Bateliere, Paris.

TORONTO, NOVEMBER 1, 1879.

RABIES GYNECOLOGICA.

found support in this refugium periclitantium? How often have common sense and rational judgment been driven from the field by the figure columns of medical statisticians! We shall never forget one illustrious instance of this form of argument, when an official noodle proved to his own satisfaction,

The St. Louis Medical aud Surgical Fournal that a certain large public institution enjoyed better for August contains a paper read before the Med- health, and had a lower mortality, when it was ical Society of that city, on 5th July, by Thomas densely crowded, than when the inmates had more Kennard, M.D., entitled "The use and abuse of liberal cubic space. Even supposing that this pethe Obstetrical Forceps," under the admonitory dantic figure-head had collated his figures correctly motto, "In medio tutissimus ibis." Dr. K. appears and honestly, and that they appeared to sustain his to have designed this paper as a counterblast, or position, could any man of sound mind assent to remonstrance, against the new-fangled doctrine of his doctrine? certain forcipologists, who advocate the early and Dr. Kennard, in his repugnance to the abuse of frequent employment of the forceps, with the dou- instrumental interference, has, we apprehend, overble view of economising their own time and that looked one very important fact, from which, we of their parturient patients. A member of the so- are convinced, the advocates of frequent recourse ciety, in a paper previously read, had stated that to the forceps adventitiously derive their main suphe used the forceps, on an average, once in every port. It is simply this, that the forceps does least three cases of labor. Another member, less adven- harm when least needed; and as in the very large turous, said he used the forceps only once in seven majority of cases of all labors, the powers of nacases. Our space does not permit the full repro- ture are quite adequate to the safe, and generally duction of Dr. K.'s argument, which is both full facile, expulsion of the child, it is quite evident and forcible. We offer the following short passage that as neither defective pelvic capacity, nor abas a mere specimen :— normal rigidity of the soft parts, retards the labor, "Dr. Maughs says that the forceps can be ap- the introduction of the forceps and the subsequent plied and take up absolutely no space. Every in- manipulation, must be much easier, and attended strument or solid body must necessarily occupy with less risk to both mother and child, than when space. Then how can such an assertion be sus- the conditions are the opposite of these. We can tained? He means, perhaps, that it compresses then well understand that a practitioner who emthe fœtal head to make room; but the foetal head ploys the forceps in every third, or every seventh cannot be compressed much without injury. It case, will be able to show a far more dazzling promay be changed slightly in shape by the forceps. portion of successful issues, than one who has reEvery person acknowledges that the forceps in un- course to instrumental aid only when he finds it skilled hands is a dangerous instrument. All obste- indispensable. But is this an adequate justification tricians admit that contusions, lacerations, inflam- of the practice? If so the surgeon who amputates mations, sloughing, and death to both the mother a limb, which by patience and skill he could have and the child, may follow its injudicious or unskil- saved, is not guilty of malpractice; though it is ful use. The difficulty is to know who are skilled not to be denied that he may, by his sawbones im