Dr. Branham drew attention to the fact that ergot causes danger to the child because it produces, not the normal contractions of the uterus, but tonic contractions. It is this faculty that makes it useful in the prevention of septicemia and post-partum hemorrhage.

Dr. Williams, in reply, said that he had guarded the point of the danger of ergot in cases in which there was a disproportion between the head of the child and the size of the pelvis. In regard to the unexpected difficulties that might cause dangerous delay in the delivery of the child by the forceps after ergot had been administered, he would refer to his own cases: out of seventy deliveries by forceps, there were only three cases in which such delay could have caused death. In one case, only Cæsarean section could have saved the child. It was large, and the sutures of the cranium were firmly united. An examination of the causes of death in the remaining two instances convinced him that ergot had not caused it. By administering ergot before delivery, time is given for its full physiological effect to take place by the time the child is expelled. He did not think the entire absence of post-partum hemorrhage in his cases since he adopted his present practice (in 1874-75) could have been accidental.

THE EFFICACY OF IODOFORM IN PREVENTING UTERINE COLIC AND PELVIC INFLAMMATION FOLLOWING THE INTRA-UTERINE APPLICATION OF NITRATE OF SILVER..

BY W. A. B. SELLMAN, M. D.

Mr. President and Gentlemen:

I propose to occupy your attention for a few minutes to make known my experience with these agents.

In the majority of the cases of inflammation of the endometrium, I have found the application of a solution of nitrate of silver, 80 gr. to the fld. oz., the most efficacious remedy that I have made use of. Its action has been decidedly an escharotic and alterative one, the application, as a rule, being followed by a free discharge from the inflamed surfaces, its repeated use being followed sooner or later either by a perfect cure or great relief. No other agent has given the same satisfaction in my hands, and I have never seen its use followed by stricture or closure of the uterine canal.

Up to a few months ago there has been one serious objection to its use. Very frequently my patients would suffer from severe attacks of uterine colic, coming on either immediately after or within the hour after treatment, and I have had cases of pelvic peritonitis and ovaritis to be brought about by its use. One case, which I will describe, is typical of the others.

I was called upon to treat Mrs. T., aged 30. Found the womb retroverted, with a unilateral laceration of cervix and chronic endometritis. She did not wish to wear a pessary at that time, so that I applied the silver solution on a cotton wrapped applicator, without replacing the uterus. Late in the evening I received a

message that she was suffering pain in left side. I called to see her; found great pain and decided sensitiveness over left ovary. Ordered poultices and 1 gr. of opium every 5 hours. The pain was much worse the following morning; there was acute inflammation left ovary; skin hot and dry; pulse 105. Ordered quinine and opium. The inflammation gradually increased until general peritonitis was developed; pain unbearable; compelled to give hypodermic injections of morphia; hot vaginal douches used twice a day. At the end of 7 days the inflammation was rapidly disappearing, and there was a serous bloody discharge.

The uterus has since been replaced, and she is wearing an Albert Smith pessary. I have made an application of the nitrate of silver since, but use the precaution of using the iodoform freely afterward. Have had no trouble.

In regard to uterine colic, up to the time that I commenced the use of iodoform, it was a common occurrence for my patients to suffer with this spasmodic affection after use of silver solution. One case I can recall, where the family thought that the patient would die before my attendance could be secured. By the use of opiates I soon gave relief.

Not wishing to be deprived of the nitrate of silver, as I consider it the most valuable agent in inflammatory conditions of the uterus, I began to ponder upon what I could use to prevent these unpleasant and dangerous results. I used belladonna, opium and hyoscyamus without effect. Knowing that iodoform does possess anæsthetic properties, I tried that, and the results have been very satisfactory, and as yet I have had no after trouble where the powder was freely applied. In congestive and inflammatory conditions of the uterus there exists, as a rule, a state of hyperæsthesia, and a nervous condition of the entire organism, and the application of the silver solution causes the cervical canal to contract, and prevents the excess of fluid from discharging into the vagina. I never have a case of uterine colic where the uterine canal is dilated and a free discharge is secured.

In regard to the cases of pelvic inflammation following the applications, it has appeared that the uterine contractions forced the excess of fluid into a patent Fallopian tube. Fortunately

none of my cases proved fatal, but they caused much solicitude and annoyance.

I make the application of the nitrate of silver solution on a cotton wrapped applicator, immediately following it with the powdered iodoform, applied in the same manner. Sometimes the contraction of the cervical canal is so sudden and violent that I am unable to pass the applicator the second time. Under these circumstances, I insert a suppository or uterine bougie (made by Mitchell, in Philadelphia), medicated or charged with the iodoform. I cover the cervix thoroughly with iodoform, and sometimes saturate a pledget of cotton with iodoform and vaseline, leaving a string attached. This I place against the cervix, and the patient removes it by means of the cord the following morning.

Hoping my experience will be of some benefit to my professional brethren, and trusting my future results will prove as satisfactory as the past, I leave the subject to your consideration.

Report of Section on Materia Medica.

REMEDIES AND THEIR PRESENT USE.

BY ARCHIBALD ATKINSON, M. D., OF BALTIMORE.

In calling the attention of the Faculty to the remedies herein mentioned, it is not the design of the reporter to embrace all the many therapeutic agents, which have been brought to the notice of the profession within the year, but simply to select such as have proved especially efficacious and worthy of trial and commendation.

SALICYLATE OF IRON is a purplish salt, resembling the hue imparted to the urine of patients who have taken either salicylic acid or the salicylate of sodium for some time, by adding a few drops of the solution of the chloride of iron, forming in fact, this very salt.

It seems to have done service in rheumatism after the heat and pain had yielded to the free use of the salicylate of sodium and the wine of colchicum.

This salt of iron is selected in the affection referred to for its therapeutic action, and in the hope of keeping up gently the effect of the salicylic acid, at the same time to secure the tonic effects of the iron in the anæmic condition attending conva lescence from a severe attack of rheumatism.

Being insoluble, the salt is preferably administered in capsules, as it forms an unsightly pill or powder. It possesses the advantages over the acid in not producing the dryness of throat, and in its freedom from causing nausea. It appears as good a chalybeate as the reduced iron, and does not produce the vas