fine forceps, and in raising it this peeled off very easily, and the separation was completed by another incision round the lower edge. (Mr. Haynes Walton, p. 364.)

LACHRYMAL SAc, Injection of.-Mr. Obre has brought into notice an injenious invention for injecting the lachrymal sac. A small silver canula is attached to a vulcanized India-rubber bag the size of a nut. The canula being introduced into the meatus, a slight pressure on the bag propels the fluid. A drawing of this apparatus will be found at page 368.

TARSAL TUMOUR.-Whenever this tumour takes an outward direction, divide it on the outside, squeeze out the contents, and pull the cyst away with a pair of forceps. If the incision is made horizontally, and the edges brought accurately together, there will be no scar. (Mr. Haynes Walton, p. 367.)

MIDWIFERY AND THE DISEASES OF WOMEN.

-ANEMIA.-In Chlorotic Anemia especially, give the saccharine carbonate of iron and manganese. This preparation is much more powerful than the simple carbonate of iron. In the chronic anemia of children, the extract of bullock's blood, in doses from 9j. to 3j., may be given with great benefit. In infantile anemia we may give 15 grains of this extract with three grains of the above double salt with great advantage. (Dr. S. T. Speer, Med. Times & Gazette, Dec. 10, 1853, p. 598.)

CANCER UTERI, Hemorrhage from. To arrest bleeding from cancerous growths from the neck of the womb, give injections at five minutes' interval, of a solution of the perchloride of iron, 15 parts to 250 of water. (M. Remilly, p. 436.)

CARCINOMA UTERI.-To relieve the excruciating pain, apply the vapour of chloroform to the os uteri by means of Dr. Hardy's 'anaesthetic douche'. (Dr. S. L. Hardy, p. 404.)

GALVANISM in Obstetric cases.-A continual current is by no means so effectual as repeated shocks; these rarely fail to excite muscular contractions, for this stimulus acts directly on muscular fibre. The discs of the apparatus may be covered with thin flannel, and applied on either side of the uterus, the flannel being moistened with water. This plan is equally effectual as the application of the discs to the spine and the cerix uteri. (Dr. R. Barnes, p. 385.) HEMORRHAGE, during Labour.-In cases of hemorrhage before the birth of the child, apply the poles of the galvanic battery to the sides of the uterus. (Dr. R. Barnes, p. 382.)

From the Navel of new-born Children.-The best plan is (as cauterants usually fail) to secure the three vessels of the cord, by pulling the navel knot forwards, and passing around it a ligature with the help of hare-lip pins. (M. Roger, p. 454.)

HYDATIDS. For the expulsion of hydatid growths from the uterus, apply galvanism. (Dr. R. Barnes, p. 384.)

LACTEAL SECRETION.-The stimulating influence of galvanism is well worthy of a trial, to arouse the activity of the mammary gland. (Dr. R. Barnes, p. 385.)

OVARIAN TUMOURS, Excision of.-The length of the incision should be regulated by the size and character of the tumour. The length should be such, that the solid part of the tumour should be extracted entire. The pedicle should be transfixed with a nævus needle, carrying a whip-cord ligature, and tying on each side as closely as possible. The ligatures should not be left in the peritoneal cavity, nor should the stump slough off in it, therefore the pedicle should be well drawn forward so as to project above the wound, and the ligature attached to the hare-lip pins, with which the lower line of the incision is closed. It is of the greatest consequence to ascertain before operating whether there are any adhesions which will prevent extraction. These generally occur in about one-third of the cases. We may judge whether there be or not, by ascertaining if the patient has been liable to peritonitis, and if the tumour does not change its position on a deep inspiration and expiration, and by alterations of position. If adhesions are suspected, it is better to make a small exploratory opening, and examine the connections of the tumour by the finger or hand. (Mr. J. E. Erichsen, p. 433.)

PELVIC VISCERA, Prolapsus of.—In these cases, with lacerated perineum, the object must be to remove the actions of the sphincter ani and the levatores ani, by removing their points of attachment to the coccyx. Mr. Hilton describes his plan of operating in these cases as follows:-A narrow sharp-pointed knife was introduced through the skin on one side of the point or free extremity of the coccyx, about half or three-quarters of an inch from its end; it was then passed into the pelvis between the concave surface of the coccyx and the rectum, special care being taken not to puncture the intestine. The cutting edge of the knife was now made to sweep over the sides and ends of the coccyx, so as to separate from it the coccygeal attachments of the sphincter and levatores ani. The knife was then withdrawn through the same small opening by which it had been introduced, scarcely any blood escaped at the wound, but a compress of lint, supported by adhesive plaster, was applied over it to keep the parts quiet and to intercept the flow of blood. (Mr. J. Hilton, p. 401.)

POLYPUS UTERI.-Sometimes a polypus can be reached by the fingers easily, and separated from its attachments, particularly when flabby or putrid. Introduce two fingers of the left hand into the os uteri, to feel for the neck of the polypus, and gently but firmly tear it from the surface to which it is attached. It is obvious that whenever the fingers or hand can be used for such a purpose in the womb, it is always preferable to instruments. (Dr. F. H. Ramsbotham, p. 441.)

Sometimes the ligature is used, at other times excision, or torsion; occasionally biborate of soda given in large doses for several days will cause its expulsion. (Dr. Tyler Smith, Mr. Canney, Mr. Hodgson, and Dr. Copland, p. 442.)

Galvanism applied to the uterus has brought these growths into view where ergot had failed. (Dr. R. Barnes, p. 384.)

PREMATURE LABOUR, Induction of by Galvanism.-In a case where it was necessary to induce premature labour for half an hour on the 23rd of Jan., the poles of the galvanic battery were applied on either side of the uterus. The womb became contracted. On the 24th and 26th the application was continued one hour, and on the evening of the 27th slight pains came on. On the morning of the 28th they had increased, and at 9 a.m. the child was born. Galvanism is more valuable than ergot in these cases, because if any unforeseen obstacle occur to the birth of the child, rupture of the uterus might be induced. Besides, if the case were prolonged, there is some danger, from the number of doses required, of producing ergotism in the mother. (Dr. R. Barnes, p. 380.)

By Ergot of Rye. In a large number of cases the following prescription proved successful in inducing premature labour: B. Secale cornut. pulv. 3iij.; aquæ ferventis 3vj.; infunde per semihoram in vasa leviter clauso, et cola. B. Infusi supra prescripti 3vss.; acid. sulph. dil. 3ss.; syrupi Zij.; tinct. card. co. 3ij. Misce, sumat partem quartam 4tis horis. The doses required varied from three to thirty. (Dr. F. H. Ramsbotham, p. 396.)

PUERPERAL CONVULSIONS.-Administer chloroform in 3ss. doses, and keep up its full effect according to the power of the paroxysms. This treatment was quite successful in a case related by Mr. Andrew Bolton. Morphia had been given previously, but without any good effect. (p. 412.)

TURNING. Nothing so much facilitates the turning of the child when the parts have become wedged, as the inhalation of chloroform. (Dr. Snow, p. 392.)

UTERINE CATARRH AND INTERNAL METRITIS.-A sound symptom to judge by in this disease, is, that lateral pressure all down to the neck of the womb gives considerable pain. Dr. E. J. Tilt recommends the application of the tincture of iodine to the inside and outside of the neck of the womb in such cases. The second application may take place ten days after the first, and then repeat it every four or five days, if necessary, for three months. The uterine mucus should be first cleared away. The best injections in such cases is 3j. of the acetate of lead and one pint of decoction of poppy heads. As a remedy, five to ten grains of ergot of rye, given three or four times, proved as useful as any. (Dr. E. J. Tilt, pp. 416, 421.)

UTERUS, inaction of from Chloroform.-Apply the stimulus of galvanism. (Dr. R. Barnes, p. 384.)

MISCELLANEA.

CHLORIDE OF ZINC.-To prevent this caustic from running, mix it with plaster of Paris, in proportions to suit the case in hand. (Mr. Cock, Med. Times and Gazette, May 13, 1854, p. 487.)

COD-LIVER OIL.-1. When too nauseous for the patient, give it floating on some bitter menstruum, in coffee, ginger wine, infusion of quassia, or, better still, in a solution of quinine, with a drachm of the tincture of orange peel, or give it in very hot milk, or smear the mouth well with marmalade or black currant preserve, and having thus absorbed the attention of the gustatory nerve, immediately swallow the oil. 2. When the oil excites sickness. Prepare the stomach by hydrocyanic acid and bismuth three times a day. Give first a little dry biscuit or bread crumb, and then float the oil on the coldest spring water, and give it immediately; give it in the recumbent posture, an hour or two before getting up or after going to bed. 3. When the oil cannot be digested, the following is useful: B. Rad. rhæi Ziij.; rad. zingiberis 3ij.; rad. gentian. Žiss.; sodæ carbon. 3iij. aquæ lb. viij. The roots to be cut into small pieces; the infusion to be made with cold water, and to stand twelve hours. Take a wine glassful thrice a day for a week before beginning the oil, and then give it with the oil. (Med. Times and Gazette, May 13, 1854, p. 487.)

Substitute for Cod-Liver Oil.—Cocoa nut oil seems to possess the same valuable properties as cod-liver oil, and in some cases was efficacious where the latter had been useless. (Dr. T. Thompson, p. 116.)

IODINE. The topical application of this remedy is becoming very general in London. The following is the formula: B. Iodinii 3j., sp. vini rect. 3j.; ft. solutio. It is better to keep this some time before using. It should be applied in glandular affections beyond and around the enlarged parts, so that the absorbed fluid may be carried through the gland by the lymphatic vessels. It is used topically, 1st, in pleuritic and neuralgic stitches; 2nd, to the throat in cases of aphonia or hoarseness; 3rd, to the mucous lining of the throat itself in cases of congestion and of enlargement of the tonsils; 4th, around the external parts of the eye, in cases of strumous inflammation; 5th, in all forms of periostitis, whether syphilitic or strumous; 6th, in glandular affections as above mentioned; 7th, as injections into cysts and cavities of abscesses, provoking adhesive, but not suppurative inflammation, as in hydrocele. (Med. T. and Gaz., April 8, 1854, p. 347.)

OPIUM.-Nausea from. To counteract the nausea from opium, combine with it 30 minims of dilute sulphuric acid. The nausea from hydrochlorate of morphia, is best controlled by dilute hydrochloric acid. (Dr. J. Williams, Lancet, Nov. 19, 1853, p. 497.)

POISONING, By Lead.-Iodide of potassium in doses of 10 grains acts as a curative agent in lead poisoning, by converting the lead into a more soluble form, which can be readily taken up by the blood. It acts more rapidly in conjunction with galvanism. (Dr. J. R. Nicholson, Lancet, Jan. 14, 1854, p. 42.)

In a case of aggravated paralysis from lead poisoning, but in which there was absence of colic, the following prescription was completely successful: Iodide of potassium, 5 grains; liquor of potassium drachm; peppermint water, 1 ounces; three times a day. As the recovery progressed, it was observed that the blue margin of the gums gradually disappeared. (Dr. R. H. Goolden, Lancet, Dec. 3, 1853, p. 252.)

:

By Opium.-Belladonna has been found useful in poisoning by opium. When the patient is comatose and other remedies fail, try the following tincture of belladonna, six drachms in five and a half ounces of water. Take an ounce of this every half-hour, till the coma begins to disappear, or till the pupils dilate. In another severe case, one ounce of the tincture of belladonna was given at once, in three ounces of water; in half-an-hour two drachms morǝ were given. (Dr. Anderson, Monthly Journal, April, 1854, p. 377.)

POTASSA FUSA. To prevent this from deliquescing, mix two parts with one part of lime. Cylinders of this may be made nearly as manageable as nitrate of silver. (Dr. Bennet, Lancet, May 6, 1854, p. 497.)