tumour beyond the external parts, if necessary, by midwifery forceps or other means, and partially or completely invert the womb. The operator can then ascertain whether the tumour be pedunculated or imbedded in the wall of the womb. Should the latter mode of attachment be found, he recommends the investing membrane of the tumour, a little below its attachment, to be carefully cut through in a transverse direction, by long curved probe-pointed scissors, to such an extent as to allow of the tips of two or three fingers to be insinuated between the investing membrane and the tumour, and the process of enucleation to be completed by detaching the upper part of the tumour from the wall of the uterus, after which the remaining attachment of the investing membrane may be divided by the scissors, and the tumour removed. If the uterus should remain inverted, it must be immediately replaced by gentle but firm pressure, which may generally be done without difficulty, as the os uteri has been so long subject to distension that it will offer but little resistance. (Mr. T. P. Teale, p. 289.) MISCELLANEA. ASPHYXIA from Chloroform.-Artificial respiration, as recommended by M. Ricord, in cases where the fatal effects of this drug are manifesting themselves, cannot be too strongly insisted upon; but it must be well done, and steadily persevered in. In a case mentioned by Mr. Lowe, full eight minutes elapsed before the success of the treatment was made certain. (Mr. E. W. Lowe, p. 316.) In using artificial respiration in asphyxia from chloroform, it is very important to notice that the tongue should be drawn forward to ensure the free entrance of air to the lungs, as when the patient is laid on his back the tongue is particularly liable to fall back and close the orifice of the glottis. (Mr. E. R. Bickersteth, p. 314.) DISINFECTANT.-In Carlisle, on the suggestion of the Rev. Mr. Dew, of St. Cuthbert's church, great comfort has been found in introduciug a few shovelfuls of soot as a deodorizer in the removal of night soil and manure. (Dr. Elliot, p. 330.) FINGER, to remove a gold ring from.-First, polish the outer surface of the ring by means of a strip of linen and prepared chalk, then apply quicksilver to the whole surface of the ring; in the course of a few minutes, by means of gentle pressure made upon the ring, it will break in pieces. The mercury amalgamates with the gold, crystallizing it, and rendering it brittle as glass. (Dr. Castle, p. 321.) Wind closely and tightly round the finger, as far as the ring, a piece of wellsoaped twine; then, with the end of a needle or probe, force the end of the twine beneath the ring, and gradually unwind. The ring will come off with the twine. (Dr. Newnham, p. 321.) WHEY.-Receipts for the preparations of the different kinds of whey (which has long been employed as a curative agent in various aliments of a chronic character) will be found at p. 321. ASIATIC CHOLERA. PREVENTION-During the prevalence of cholera, persons in connexion with cholera patients should carefully wash their hands before taking food. The soiled linen should be immediately immersed in water as soon as it is removed. The greatest care should be taken that the water for drinking be not contaminated by cesspools, drains, or sewers. If suspected, it should be boiled and filtered. The provisions should be well washed with clean water, and, if possible, exposed to a temperature of at least 212° F. When a case of cholera appears in crowded neighbourhoods the healthy should be immediately removed, except those absolutely necessary to wait upon the sick. (Dr. J. Snow, p. 301.) CALOMEL TREATMENT.-Give grain-doses of calomel repeatedly, with one or two drops of laudanum with each dose, up to 24 or 30 drops, when it may be discontinued. Dr. Ayre speaks with the greatest praise of this simple mode of treatment. He says, that as soon as the secretion of the liver is restored a favourable change takes place. It would seem to be very difficult to salivate a patient in this disease. (Dr. J. Ayre, p. 301.) In collapse pursue the following treatment. Give 15 grains of sulphate of zinc, and 15 grains of ipecacuanha, and repeat the emetic in ten minutes. In about twenty minutes place upon the tongue 20 or 30 grains of calomel, and repeat from 2 to 10 grains or more, every ten, twenty, or thirty minutes, according to the severity of the symptoms. Give beef-tea'injections every half hour to support the strength. Allay vomiting or thirst by ice or very cold water, in teaspoonful doses, ad libitum. Avoid giving stimulants. When the stools contain bile continue small doses of calomel for a short time, then give 20 grains of rhubarb and 30 of sulphate of potash, in peppermint water, or a castor oil draught. Afterwards reduce the fever by salines; and lastly, restore the strength by quina, ammonia, &c. (Mr. F. W. Richardson, p. 303.) COUNTER-IRRITATION, CALOMEL, ASTRINGENTS, &c.-The author says he has tested the following plan of treatment in nearly all parts of the world. Turpentine epithegms, or mustard poultices, to be applied to the abdomen frequently. Give ten grains each of calomel and prepared chalk, in treacle, every hour, along with half an ounce of the following mixture: Take of compound powder of chalk with opium, powdered acacia, and white sugar, each two drachms; sesquicarbonate of ammonia, one and a half drachm; cajeput oil, twenty minims; tincture of catechu, three drachms; with camphor mixture, eight ounces. When the stools become feculent, substitute the following until the purging stops. Take of acetate of lead, half a drachm; Battley's sedative solution of opium, fourteen minims to one drachm; oil of cinnamon, four minims; tincture of ginger, three drachms; and infusion of quassia, eight ounces. An ounce may be given every two hours. (Mr. C. A. Chavasse, p. 304.) CROTON OIL.-Give one or two drops of croton oil on a small piece of sugar, and repeat it every two or three hours if the vomiting and purging continue. At the same time, apply hot bricks or bags of hot sand to the feet. The action of this remedy in this disease is not clear, but it certainly does not act as a purgative. (Dr. Hancox, Lancet,' Oct. 8, 1853) · QUININE.--Of all remedies hitherto tried as a palliative, with the exception perhaps of opium, there is none more deserving of further trial than quinine. (Ed. • Med. Times and Gazette,' p. 409.) SULPHUR.-In the ordinary diarrhoea preceding cholera give a quarter of the following mixture every two or three hours: Twenty grains each of precipitated sulphur and sesquicarbonate of soda, two drachms of tincture of lavender, and six ounces of water. Hot fluids and vegetables should be avoided. If the disease has advanced to vomiting give the remedy every quarter of an hour until it stays upon the stomach. If diarrhoea has preceded the treatment by some days, give five or ten minims of tincture of opium with each dose. (Mr. J. Grove, p. 304.) SULPHURIC ACID.-Dr. Fuller sums up his experience as to the value of sulphuric acid as follows: In Asiatic cholera, given in 3 ss. doses of the dilute acid, he says it exercises a most favourable influence. In bilious diarrhoea he believes it to have little or no effect, but in epidemic or autumnal diarrhoea and in more decided choleraic diarrhoea he has never known it to fail. To render it a certain and effectual remedy the above dose should be given every twenty minutes. (Dr. H. W. Fuller, p. 305.) "MAXWELL'S REMEDY."-Give one scruple of sesquicarbonate of soda with three grains of opium, in a bolus, washed down with another scruple of soda, in a wineglassful of water, as hot as the patient can swallow it. Repeat it in the evening, with two grains of opium if necessary, and afterwards give it in diminished doses. (Dr. Maxwell, p. 307.) DECOCTION OF CATECHU, &C.-When the cholera broke out in the 37th regiment, at Colombo, in Ceylon, in 1847, after trial of various systems of treatment, the most successful plan was found to be strong decoction of catechu administered both by the mouth, combined with laudanum, and by enemata (to the amount of two wash hand basinfuls) conjoined with laudanum, turpentine, ether, ammonia, &c., according to the circumstances of the case, and the condition of the patient. The intense pain in the epigastrium, and the vomiting, are best relieved by applying hot spirits of turpentine to the stomach, and iced drinks, especially champagne. Excess of stimulants is fraught with great danger. The inhalation of ether was tried, but with questionable success. In some cases, however, a remarkable restoration of enticular warmth took place, and increased fulness and force of pulse. (Mr. A. J. J. Chitty, p. 309.) SALINE INJECTIONS.-As the saline constituents of the blood in cholera are greatly diminished, keep ready for solution the following powder: Chloride of sodium, three ounces; phosphate of soda, one ounce; carbonate of soda, one ounce and a half; sulphate of soda, half an ounce. This powder should be dissolved in water until the fluid has a specific gravity of 1030, and then heated to 98° F. It is then ready for injection into the blood. (Dr. G. O. Rees, p. 308.) CHLOROFORM INHALATION.-Mr. G. H. Heath strongly recommends the inhalation of chloroform to keep the stomach quiet until some powerful anti-emetic medicine has had time to affect the system, and relates a case in which it appeared to be very effective. (p. 310.) EXTERNAL STIMULANTS.-Mr. T. M. Greenhow recommends a plan of producing external stimulation, which, though not quite so formidable as the application of the actual cautery, and which he says is often resorted to in India, is yet a sufficiently formidable operation. It is a brandy blister; a linen rag dipped in brandy is applied to the abdomen and ignited, vesication may follow, though it does not invariably. If needful, repeat it; the part to which it is applied may be varied. (p. 311.) COLD WATER AFFUSION, OR DOUCHE.-In India, in 1845, cholera was treated as follows. The patient was placed in a hip bath and water poured over him, while hospital attendants rubbed the limbs and trunk. This was continued until he shivered or felt chilly. He was then placed in bed and dry rubbed. If he relapsed, as they often do when the warnith of surface returns, the process was repeated. Generally the first operation was successful; it rarely needed beyond three or four repetitions. Little internal medicine is needed, except cold water. The beneficial effects of this douche plan are believed to arise from the stimulation given to the respiratory, and secondarily, thereby to the circulatory functions. The author of this paper considers the premonitory diarrhoea to be neither part nor parcel of the disease. (Mr. E. M. Macpherson, p. 311.) INDEX TO PART XXVIII. Albers, Dr., on typhlolithiasis and typhlostenosis Albuminuria associated with acute renal disease, Dr. Johnson on of the metatarsal bones, Dr. Edwards on Anæsthesia, danger of continuing inhalation after producing Anchylosis, Dr. Hingston on the treatment of of the knee, M. Langenbeck's treatment of 66 unetur of external iliac cured by galvano puncture Aphonia, Dr. Bennett on the treatment of Arsenic, its use in the treatment of snake-bite M. Pravaz's method of obliterating Artery, posterior tibial, case of false aneurism of subclavian, chloride of zinc paste in aneurism of Mr. Clement's operation for in the ascending colon dilatation of the os uteri membrana tympani, Mr. Toynbee's PAGE 202 37 134 124 248 156 316 322 320 79 160 161 172 170 173 171 326 96 317 168 171 172 173 191 194 197 200 259 257 on heart-diseases in relation to rheumatism and albuminuria 33 Bickersteth, Mr. E. R., on the mode of death from chloroform, Bonnet, M., his case of subclavian aneurism treated by chloride of zinc Bowman, Mr. W, on the use of two needles at once in operations on the eye 173 61 256 Brainard, Dr. D., his case of erectile tumour of the orbit 174 Bright and Bernard, on the physiology and disease of the |