retentive metal splint to be reapplied, and ports from Chihuahua, Mexico, the following the hand and fingers bandaged to it. Should case: On the 11th of September, 1877, atthe immediate extension produce much pain tended a Mexican woman in her seventh the splint may be removed and readjusted at labor, which lasted sixteen hours, and was any time. (4) Extension to be kept up by perfectly natural. On the 13th of Septemthe splint worn continuously night and day ber, at midnight, she had a chill, followed by for two or three weeks, but the splint and a fever and severe pains in the lower part of bandage to be changed every two or three the abdomen, with difficult micturition. days. After this the extension splint is to Fever, pain and difficult urination continued, be worn at night only for an additional three and at the expiration of three weeks a tumor or four weeks, free motion being encouraged could be made out by external palpation during the day. Relapse of the contraction above the pelvic brim, but was too high to be is now to a great extent guarded against by felt, either by vaginal or rectal touch, though the plan of dividing all the contracted bands repeated attempts to do so were made. On of fascia by as many punctures as may be the 1st of November the abscess ruptured necessary, and also by the adoption of the into the rectum, and a few days after into method of immediate extension. If partial the bladder. The discharge by the rectum relapses should occur, any bands that may continued two months, and from the bladder have escaped division, or any which may four months. She got out of bed on the since have become prominent by the exten- 16th of March, 1878. The menstrual flow sion may be divided subcutaneously and the returned in April, and was very profuse durdisposition to recontraction prevented at an ing the first two periods. Since then she early stage. This contrasts very favorably has been in good health. This case was of with the relapsed cases after open wound necessity left to nature. It was slow and which, from the nature of the cicatricial con- tedious in its course, and may be considered traction, are incapable of further relief. remarkable from the fact that Thomas, quoting from Nonat, says: "That when the collection" of pus in pelvic cellulitis " opens into the intestine and bladder, death is inevitable."

Obstetrics.

UTERUS TORN OUT BY A MIDWIFE.-M. Schwartz (Archiv. für Gynækologie) tells of a shocking case in which a midwife, by great violence during the process of labor, seems to have torn away what she describes as the "rest of the afterbirth," but which, when

FORCEPS OR VERSION, WHICH ?—There are few practitioners but are occasionally troubled to answer the above inquiry, satis

examined by the physician, proved to be the factorily and promptly. Dr. Barker (Med.

whole of the uterus. The ovaries and fallopian tubes remained in the abdomen. The uterus is preserved at Halle. The woman recovered in fifteen days, and has since enjoyed good health.

FISSURED NIPPLES NEW METHOD OF TREATMENT.-Dr. King (St. Louis Courier of Medicine, Dec., 1879,) recommends the application to fissured nipples of a solution of gutta percha in benzine or bi-sulphide of carbon. He paints this solution all over the nipple, except the apertures of the milk ¦ ducts. It remains on two or three days, and usually the parts are entirely healed. Occasionally it needs to be re-applied. It is sug gested that the cement used by cobblers in mending shoes, by what they term "seamless patch," would answer the above indication.

PELVIC CELLULITIS.-F. Paschal, M. D., (Gaillard's Medical Journal, Dec., 1879,) re

Record, Jan. 17, 1880,) suggests that the vital condition of the patient is an important element entering into the decision of this question. (1) In that form of contraction of the superior strait called the oblique oval of Naegle's, the forceps should not be used, but we should always resort to version. (2) In that class of cases in which the contraction is at the inferior strait, with a straight sacrum instead of the normal curvature, narrowness of the sub-pubic arch, etc., we should never resort to forceps, but always select version, if we have the opportunity, to make the election by a sufficiently early examination. (3) In face presentation we should never resort to forceps when the head is above the superior strait and not engaged.

Diseases of women.

CONDITIONS OF THE SYSTEM FAVORING DEATH BEFORE AND AFTER THE OPERATION FOR OVARIOTOMY.-Dr. Bogeman (Re

sistent support of the vital forces, leaving the fever to take care of itself.

or chronic, marks on Ovariotomy, page 6) gives this as inflammation, whether acute follows: (1) The conditions of the system through all its stages, by continuous, perfavoring the idiopathic development of ovarian growths expose both ovaries alike to the attack, but oftentimes these growths are inHODGE PESSARY-ITS VALUE.-Dr. E. II. duced without such previous conditions of Trenholme (London Obstet. Jour., Dec. '79), the system, through dislocation or imprison- from his experience and study of the Hodge ment of one or the other, or of both ovaries pessary, concludes: (1) Variously modified in a state of hyperæmia or anæmia. (2) The it is an efficient and most adinirable instrumorbid processes underlying the development ment for sustaining a retro-dislocated uterus, of ovarian growths, in whatsoever way pro-and that to any desired elevation in the duced, soon lead to disturbance of innerva- pelvis. (2) Even a large pessary, filling and tion and nutrition of the entire system, and distending the vagina and taking pressure on thus cause gradual impoverishment of the the floor of the pelvis, can be worn with blood-general anemia. (3) The general comfort and ultimate curative results by the anemia arising from the development of proper use of the postural treatment, together ovarian growths is always pernicious, and with the inflation of the vagina by elevating the stages of growth and development ordin- the floor of the pelvis while in that position. arily recognized only represent so many de- (3) The curative forces operating upon the grees of advancement toward a fatal termin- uterus are resultants of (a) the elevating ation, which certainly comes sooner or later power of the pessary; (b) the resisting force unless checked by the resources of surgical of the sacrum; (c) the weight of the uterus, art. (4) The general anæmia accompany- now so high up as to gravitate forward and ing ovarian growths is usually attended in downward, and (d) the pressure of the abthe earlier stages with a well preserved out-dominal viscera. (4) The vices of flexion ward appearance of the body; but such adi and position being overcome, a permanent pose symmetry, associated as it is with de- recovery may be looked for with certainty ficiency of red blood globules, betokens dys- in from six months to a year from commencecrasia rather than robust health. (5) The ment of treatment. general anæmia of ovarian growths when attended with emaciation, as in the latter stages, is pernicious in the highest degree, owing to the rapidly increasing abstraction of important elements from the blood, and to other functional disturbances arising from mechanical pressure. (6) Inflammatory affections, whether of idiopatic or traumatic origin, occurring in any stage of the general anæmia attending ovarian growths, tend to flow down the tube attached to the caualways to low and persistent forms. The at-tery, and patient, operator and assistants Or a little extra air tending fever, be it due or not to the intro- might be set on fire. forced into the bottle when too full might duction of a pyrogenic, phlogogenic, pyogenic or septigenic material into the blood, lift the benzine into the tube by atmospheric is almost, if not always, in a corresponding pressure and cause the same accident. (2) degree asthenic in type. (7) The seemingly necessary corollary from the foregoing is the operator's clothing or placed in his that the surgeon should strive to counteract pocket. If so attached to his person, he, in the evil tendencies of the general anaemia of ovarian growths; to husband and strengthen the powers of the system during its progress; to remove the morbid growth as experience justifies before or as soon after the emacia- bag for heating the knife in the right hand This assistant, under tion appears as the diagnosis can be deter- of the same assistant. mined; to avoid all depletory or depressing no circumstances, should be allowed to leave influences; and to treat the accompanying his post for any other work. His only duty

CAU

PAQUELIN'S THERMO - CAUTERY TIONS IN ITS USE.-Dr. Wilson (Trans. Maryland Med. Society, 1879), from considerable experience in the use of the above named cautery, gives the following cautions: (1) The benzine bottle should never be more than two-thirds full. If too full the slightest tilt of the bottle would cause the benzine

The benzine bottle should never be hung to

the act of bending forward, might tilt the bottle so as to cause a like accident, although very little benzine was in use. (3) The ben. zine bottle should be held securely in the left hand of a trained assistant, and the rubber

Laryngology.

is to take care of the benzine and watch closely the point of the knife so as to keep PHLYCTENULAR INFLAMMATIONS OF VOCAL it at the proper temperature. (4) The blade CORDS.--Dr. Rudolf Meyer (Berlin Klin. of the knife should never be heated too hot, Woch.-Cincinnati Clinic,) describes cases a dull, red heat is best, and this redness from which it appears that phlyctenular inshould never extend above one-third the flammation of the vocal cords is an acute blade. (5) If the knife is too hot we cut no affection which cones on in otherwise healthy better, lose more blood, and are in danger of persons, is accompanied by slight febrile bending and injuring the blade, and of burn- symptoms, results in a few days in small ing up the platinum gauze within the blade, circumscribed epithelial cloudings, with very thus rendering the knife worthless. (6) superficial inflammation in the vicinity, which When we are done using a knife it should be is usually accompanied by herpetic erupheated a little extra hot and, while so, quickly tions in other localities, and which disappear separated from the wooden handle. By so in 8 to 14 days, without leaving any traces doing no carbon deposit will take place in of its presence. Active treatment will the knife, and it will be in perfect order for rarely be found necessary. The favorable future use. (7) In all operations with the prognosis will only be confirmed by laryngothermo-cautery within the vagina, four assist-scopic discovery of laryngeal phlyctenulæ. One to give chloroform, The initial fever, the accompanying herpetic one to work the cautery, one to hand the in- eruption, the characteristic laryngoscopic struments and hold the knife when the oper- appearances are sufficient to guard against a ator desires to be relieved of it, and a fourth diagnosis of syphilitic laryngitis. to held Sim's speculum.

ants are essential:

Pathology.

Ophthalmology.

TOBACCO-EFFECTS OF ITS USE UPON CHIL- ENLARGEMENT OF OPHTHALMOSCOPIC IMDREN.-M. Decaisne (Brit. Med. Jour., Jan. AGES.-Dr. E. Landolt (Brit. Med. Jour., 3, 1880,) states that of thirty young people January 3d, 1880), from an exact study of observed, twenty-seven present noticeable this subject, makes the following deduceffects of tobacco upon the body. Even its tions: (1) In an emmetropic eye when exrestricted use by children often leads to a amined with the upright image, the enlargechange in the blood, and sometimes to chlo- ment is twenty fold. (2) The degree of enrotic anæmia, paleness of the face, emaci- largement is less for a hypermetropic and ation, morbid sounds in the carotid arteries; more for a myopic eye, and that in proporpalpitation and intermittence of the heart, tion to the degree of the ametropia. (3) The diminution of the normal quantity of the enlargement is less in the hypermetropia of blood corpuscles, difficulty of digestion, etc. curvature than in axial hypermetropia. (4) The ordinary treatment of anæmia and of The enlargement is more considerable in the chlorotic anæmia produced no effect in general myopia of curvature than in axial myopia. whilst the habit continued. Young people If it were possible to place the correcting who smoke show generally a certain slug- glass at thirteen millimetres from the corgishness of intelligence and a more or less nea of the observed eye and of the observpronounced taste for strong drinks. In er's eye, the enlargement of the upright children who cease to smoke, and who are image becomes in all cases of axial ametronot affected by any organic lesion, the dis- pia the same as in emmetropia. orders of the economy which have just been mentioned disappear, often very quickly, and almost always without leaving any trace. The effects of tobacco smoking in women very closely resembled those observed in children.

recommendations of the committee appointed It is reported from Memphis that all the by the National Board of Health are being

carried out.

THE teetotalers of England expended, WANTED FOR CASH. during the past year, for the support of their

A Physician's Practice, with or without small views, the large sum of £19,878, 1s. 11d. Drug Store. Address particulars to The propagandism of their principles is cer

tainly rather expensive.

J. HUMBOLD,

Elizabeth City, North Carolina.

I

No. 10.

It seems to be always communicated by a poison in the mouth of some animal. The dog is the great propagator of it. In countries where there are wolves and foxes, they, too, are equally liable with the dog, and they are said to run into the habitations of people to bite them; at any rate, they seem to lose their wildness and to mingle with men. most all the domestic animals can have it— the hog and the cow, if they are bitten.

Al

HAVE now to occupy your attention with one or two diseases that are not perhaps natural to man, but are communicated to him. The first of these is hydropho- The poison seems to be chiefly concentratbia. We have a history of hydrophobia ed in the saliva, and it has no effect upon any running back to 350 years before the com- person unless the skin is broken where it is mencement of the Christian era. Aristotle applied. It is true that there are two or spoke of it. He spoke of it being commu- three records of persons getting hydrophonicated by dogs and wolves and foxes to bia from dissecting animals that had had the other animals, and was particular to say that disease, and it was then found, after they beall animals were liable to the disease if they came affected, that they had some cuts or were bitten by a rabid creature, except man. scratches on the finger, something to break He knew of no man that had ever had it. the cuticle. There is another fact that is But in the time of Augustus Cæsar, Julius asserted, and I am very much inclined to lived and wrote, and he described some in- think it is true from what I know about it, stances in which hydrophobia had been com- and that is that dogs which are to have hymunicated to man, and from that time until drophobia can communicate the disease by now it has been a doubt in the minds of licking the hands of their master if there is some of the profession whether the disease any cut or scratch upon his hand, and afterwas really communicated to man. Some wards show the symptoms of hydrophobia. have said, "O, it is fear! it is imagination!" In other words, the disease has a latent Well, fear will kill sometimes, but it kills period. This has been said to extend over quickly; it does not kill through a series of three years, but I do not believe it. For symptoms such as I am going to describe to example, a negro boy that was waiter in one you as attending hydrophobia. Fear will of the houses here, on Fourth avenue, two kill; joy will kill in certain instances, but I or three years ago, had hydrophobia. I saw do not think imagination ever destroys him two or three times with the attending anybody. However that may be, a person physician, and the report to me was that he has but to see one or two cases of hydropho- had had a bite from a dog six years before. bia, and find how exactly in the line of each I had inquired into the question of long dorfollows the other, and witness the terrible death, to be fully aware that hydrophobia is a stern and terrible reality. It does not occur frequently in man, but every year, indeed, almost every week, we hear of it from some region of the country as a disease that has been fatal to man,

mancy of the poison before, and felt persuaded that no such continuance of the period could be, and I cross-questioned the boy. His mind was clear. He said he had had a bite at Orange about six weeks before he got sick. So I think it will turn out in every case that the period of incubation will

be limited to about two months; the maximum period being about two months. I have never seen a case in which the period of incubation exceeded two months.

with what they are doing, or what they are thinking about; they have their minds diverted from their proper business by this feeling of restlessness, and when this bas continued a certain length of time, comes the characteristic sign, difficulty in swallowing fluids, or swallowing anything for that matter.

The question has been raised whether a man affected with hydrophobia can communicate the disease to another human being. There is no record of any such communica- The disease has its name from the fear of Other tion, but I have no manner of doubt that he water-hydrophobia, fear of water. could communicate it just as a hog could, or persons experience for the first sign of the the cow even. A cow is quite as mild as a disease this difficulty in swallowing, a little human being, and, strange enough, they have stiffness in the lower jaw, a little contraction the disposition to bite when they get hydro- of the muscles of the lower jaw and of the phobia. That the poison is active in man neck, and some stiffness of the neck; and has been proved by the retro-inoculation, then a difficulty in drinking water. that is, the dog has produced the disease in difficulty comes to be in a little time an imman, and the saliva of man, when he is affect- possibility. You direct a person in whom ed of the disease, has been used for inoculating the dog, and the dog has had the disease regularly and died of it.

this disease is confirmed to take a drink of water (he is thirsty enough to take it at any time), he will look very sober, he will look at the glass for sometime, he will take it in his hand, and with a firm resolution to overcome

all resistance, he takes it into his mouth, and away it goes. It does not go down the throat. There is a spasm there that prevents it from passing down the throat.

The place most dangerous to be bitten is the face or hands, for the reason that they are generally not covered by anything, and there is nothing to wipe off, so to speak, the poison from the teeth. In hundreds of cases-indeed, I myself have known almost a The mind is, in the majority of cases, clear hundred, at any rate it would be safe to say fifty cases-persons have been bitten on until the last few hours, and then the patient their legs by dogs that were supposed to may be delirious or unconscious. I say unbe rabid, and nothing has come of it. The conscious. If he is so, the secretion from clothes that first meet the teeth are gener- the mouth, as the disease advances, becomes ally not all cut, and though the skin may be very abundant and is viscid; will flow out of abraded, or even injured to a considerable his mouth, or it will flow backward into his extent, still the clothing really has been be- throat, depending upon the position he occutween the poison and the injury, and they pies. seem to wipe off, as I said before, the poi- I said his mind is clear, but it is excited. son in such a way that it does not affect the Everything the patient does is done with an person. These are the general considerations unnatural degree of suddenness. His words that it seems to me worth while to state be- are snapped out so that they are sometimes fore giving the symptoms of the disease it- called barking. Then, in other ca es, the self. You understand that the period of in- cough is quite barking, for he has an almost cubation, or the period of dormancy, is not incessant shallow cough, and spits with alfixed definitely. There are no two authori- most every cough some of this viscid mucus. ties that agree upon it from their own obser- If you look in his throat you will find the vation, but, as I said before, I think it will fauces, including the tonsils and hanging never be found longer than two months if palate, swollen and red, and you can almost accurate information can be obtained upon it. see the secretion coming from them. These After inoculation it is developed in a few two things, a viscid secretion and a constant days. spitting taken together, and the impossibility of swallowing water, are the characteristic signs of the disease.

The symptoms of the disease are well marked when they are fully established. They are quite uncertain and vague in the Two years ago-three years ago it may beginning. As for example, some have for be--a gentleman in Hartford, a professor in their first symptoms a feeling of discomfort one of their institutions, died of symptoms and unrest--a restlessness and an impatience that were clearly those of hydrophobia.