stances incorporated in such ointments are not intended to be absorbed into the system and some of them are toxic when so absorbed, nor is there need of selecting a base with reference to its liability to become rancid, because its ingredients should maintain it sterile. As in other ointment bases the climate or temperature of the air will determine the substances of which the base is composed. Thus petrolatum, or lard with paraffin or wax, would best meet the indications as outlined.

Phenol is the drug most commonly used and in one to three per cent strength is efficient. Other preparations of phenol even more potent are cresol, one-half to one per cent, and creolin, one per cent. Boric acid is equally popular among physicians, but its antiseptic action is feeble. Its inefficiency as a germ destroyer is compensated for by a mild astringent action, which boric acid possesses, making it, therefore, a valuable application when a feeble antiseptic and astringent action is desired. The choice between petrolatum and lard in such an ointment would depend on the depth to which the action was desired. Beta-naphtol possesses antiseptic as well as stimulating properties and is of value in some. conditions, as in the mycoses of the skin.

Of marked efficiency, though but little used, is iodin. In the experiments of Post and Nicoll2 a one per cent solution of iodin and potassium iodid caused the death of all micro-organisms experimented on, such as the streptococcus, gonococcus, pneumococcus, and the typhoid bacillus, in less than one minute. Its stimulating effect also renders its antiseptic action more effective when applied to necrotic and decaying structures. Acid salicylic, cupric sulphate, and hydrargyrum are also used in this connection.

The penetrative, absorptive, also called diadermatic, ointments are employed either to act on the deep follicles of the derma, as in trichophytosis, to act on pathological conditions beneath the derma, or through the venous or lymphatic radicles to affect the system at large. The medicinal constituents vary according to the disease for which they are employed. Thus they may be either stimulating, parasitic, or constitutional. The base, therefore, should be selected which facilitates absorption, such as goose grease, lanolin and lard. The medicament should be in a state most readily passed through animal membrane. All palpable particles naturally should be

2. Post (W. E.) and Nicoll (H. K.): The Comparative Efficiency of Some Common Germicides; Jour. Am. Med. Assn., Nov. 5, 1910, p. 1635.

excluded from such a preparation and the most finely divided, impalpable substances should be incorporated evenly in the vehicle. The oleates of copper and mercury may be mentioned among the most efficient drugs when a local effect alone is desired. In mycotic diseases of the skin Jackson believes goose grease is the best of all vehicles.

Of the various mercurial ointments, the ammoniated is used for its local effect and is employed in the strength of five or ten per cent in a moderately impermeable base, excepting in some of the mycoses when a permeable base is needed. Mercurial ointment should contain as much of the salt as is consistent with deep penetration, which has been estimated at fifty per cent. The object in using this ointment is to introduce as much of the salt as possible into the deeper parts with the least amount of cutaneous irritation, from rubbing or otherwise. With some patients this form of medication is impracticable because of this reaction.

In conclusion something may be said in regard to the various preparations, most of which are "made in Germany," a few in France, to replace the time-honored ointments herein considered. The present writer has on several occasions been sufficiently captivated by the apparently disinterested enthusiasm of some clinical teachers to procure an ample supply of pastes, pencils, soap salves and mulls, but the results on continued use have, without exception, been disappointing.

It may be said, therefore, that the best results can not be obtained by stock formulæ, even when their exact composition is known, much less benefit can be expected from the numerous preparations of unknown or fictitious compounds offered to the physician with blaring announcements of their wonderful curative properties in the most diverse conditions. Again, the base must vary with the disease for which it is to be used, and the medicinal ingredients must vary even to a greater degree.

This need not hamper the work of the revisers of the forthcoming Pharmacopoeia; on the contrary, it should facilitate the work of properly grouping the various ointments according to their therapeutic use.-The Cleveland Medical Journal.

8. Jackson (George Thos.): Trans. Am. Derm. Assn., 1901.

HOWE'S AMPUTATION OF THE CERVIX UTERI.

BY O. C. WELBOURN, M. D., LOS ANGELES.

The writer had a personal acquaintance with Prof. A. J. Howe now deceased-and considers him a man of remarkable literary attainments and one unsurpassed in the art and science of the surgery of his day. For, notwithstanding the great gains recently made in surgical science, many of the methods. which he introduced and perfected have not been improved. And the object of this paper is to again emphasize to you as Eclectic physicians an operation devised by an Eclectic surgeon and given to the profession as such. This operation is without a parallel for simplicity of technic and beneficial results to the patient.

The conditions requiring this operation are: A stellate laceration of the external os uteri, and a follicular cervicitis, the former usually causing the latter. The technic is as follows:

After the patient has had twenty-four hours preparation, she is brought into the operating room, anesthetized and placed in a lithotomy position. A weighted duck-bill speculum is introduced to retract the perineum and expose the cervix. A curettage is usually required, after which the posterior lip of the cervix is seized with a vulsellum forceps and the uterus drawn down towards the vulva. With a pair of long-handle, sharp-point, curved-on-the-flat scissors, the posterior lip is severed at its junction to the vagina. Then the vulsellum is shifted to the anterior lip, which is exercised in a like manner. The severed surface now appears cup-shaped, with the cervical canal in the center. There is free bleeding, which is usually controlled by a compressing sponge. Sometimes there is marked uterine arteriosclerosis and it is necessary to place a ligature about both circular arteries. No attempt is made to suture the wound or close it in any manner. It will readily heal by granulation, and at the end of two weeks the os is surprisingly virgin-like in its appearThe patient gains rapidly in health and strength and is soon able to resume her customary duties. As the internal os is not disturbed, impregnation and gestation will proceed in a normal manner.

ance.

This operation is so simple that the tyro can easily perform it. Moreover, the results will be fully as satisfactory as the most elaborate method performed by an expert.-California Eclectic Medical Journal.

OLIVE OIL IN POST-OPERATIVE NAUSEA.

BY CLARENCE REGINALD HYDE, A. M., M. D.,
BROOKLYN, N. Y.

The use of olive oil to lessen and even control post-operative nausea has not merited the attention of surgeons that its success warrants. For over a year in my operative work it has been employed after ether anesthesia, and with such positive results that I am confident more surgeons would make use of this simple method were they cognizant of its efficacy.

The technic is as follows: Just as the patient is beginning to return to consciousness (that is, roll the head from side to side, slowly open the eyes, and moan), two ounces of ordinary olive oil are administered by the mouth from a cup. The patient must be sufficiently out of the ether to understand the command to drink. the oil, which is then swallowed without any difficulty. It is of interest to note that after regaining consciousness, the patient does not even recollect taking the oil. Usually within five minutes after the oil has been given there is free and copious vomiting, which in the large majority of cases concludes with gastric disturbance. The vomited material consists of large amounts of ether-saturated mucus, free oil, and occasionally some bile. The nurse who gives the oil should be instructed to have at hand a basin and towels, and to remain by the bedside of the patient, as the vomiting which is initiated very soon after the ingestion of the oil is explosive and projectile in character. This precaution is imperative, as some patients will vomit with such a violent expulsive effort as to soil the floor for some distance around the bed. Rarely does a second vomiting attack occur, and within a short time the patient is resting comfortably, so far as the stomach is concerned, and free from nausea or retching. If the oil is not vomited, as sometimes happens, the same effect is obtained; the patient does not vomit. As to the theory, I can only surmise that the oil goes into solution with the ether-saturated mucus in the stomach, stimulating a marked and increasing peristaltic wave which terminates in the act of vomiting. The absolute success of the method depends on the correct time of administration. The oil must be given when the patient is semi-conscious and can understand the command "to drink." If given before this particular time, the patient can not swallow. If given after the return to the conscious state, when the

patient is then nauseated or vomiting, the oil will be refused, as the sufferer is too stomach sick, and will be made more so by the sight and odor of the oil. Both these exceptions were noted during our earlier experience. It is admitted that some ether subjects may not vomit, or vomit but once and with nothing done to relieve their stomachs, but these are exceptions rather than the general rule.

The method insures a quick, rapid stomach cleansing, usually terminating with this one performance, and is urged as a substitute for gastric lavage on the operating table before the patient is returned to the recovery room or bed. It is a fact well known to hospital surgeons that many ward patients who have experienced the distressing sequelae of ether anesthesia are later violently nauseated by the sight of another patient recovering from the effects of ether. The disagreeable sounds of the patient's continued attempts at retching, combined with the penetrating smell of the ether fumes, many times nauseates the convalescent. The use of olive oil with its one vomiting act precludes any such repetition. It controls nausea and vomiting, thus easing the patient. It minimizes the pain, which is increased by the effort of vomiting. It relieves the strain upon the abdominal sutures and, most important, lessens the tension on intra-abdominal and other important ligated vessels.

The method has been tried out in over one hundred personal cases, and only in first few were any failures noted, due, as was afterwards recognized, to faulty time of giving. With the interested assistance of one nurse and the house surgeon, the procedure, in my cases, has been so intelligently systematized that no failures have been reported for months. At this point I would like to state that as we can not remain by the bedside of our patients till they begin to come out of the anesthetic, the giving of the oil must be intrusted to the nurse, to whom the most explicit directions should be given. An indifferent nurse may spoil the whole program, which means a continuance of the vomiting and no practical results gained. The many who have, at my suggestion, made use of the oil, have in most instances reported success, depending on whether their positive orders were faithfully executed. I am not aware that this use of olive oil has been employed in any other metropolitan hospital, nor is any originality claimed. I have demonstrated the idea before sections of students, showing them when to give the oil, and giving them ocular evidence of the vomiting occurring within a few minutes after its ingestion. Not once has this demon