It upon the anterior wall, and exerts a a proceeding would be found somewhat awkward, for I am of the opinion that the accoucheur can have better control of the uterus with one hand than with two. It now remains to consider the complications of the third stage. Adherent placenta is fortunately seldom encountered, and even when we do meet with it it is rarely pathological. Placental adhesion is usually the result of uterine atony, and occurs in women that have given birth to a large number of children. But there may be adhesions due to previous disease, as placentitis, inflammation of the uterus, or there may be "fibrous degeneration of The method which I am in the the elements which normally unite the habit of employing to deliver the uterus and placenta" (Parvin). When placenta is a modification of the so- we have to deal with a case of adherent called Crede's method. In the first placenta we should endeavor to stimuplace I do not resort to any preliminary late the uterus to active contraction by frictions of the uterus. After waiting friction and pressure, and thus cause ten or fifteen minutes I press the four expulsion, if we can. Failing by these fingers vertically downward behind the means to deliver the placenta, we must fundus, allowing the ball of the thumb introduce the hand and detach it. But to rest on the anterior surface of the it must be borne in mind that the introuterus. I do not carry my fingers duction of the hand into the uterine down on to the posterior wall as recom- cavity is an operation fraught with mended by Parvin, but allow the ends some danger, hence it should not be of them to rise against the lower part resorted to hastily. If hemorrhage of the fundus. Moreover, I do not occurs, and its occurrence is inevitable wait for contraction to occur, for I have if there is a partial detachment of the found that the maneuvre which I em- placenta, then we have not a moment ploy invariably induces efficient uterine to waste on expectant measures. The contraction. With the hand grasping hand, thoroughly disinfected, must be the uterus in the manner above de- carried into the uterus and the placental scribed, I exert firm, but intermittent | mass detached and withdrawn. Hourpressure; at the same time I seize the cord and make it tense, and when I feel the placenta loosen its attachment, make gentle traction. Thus, by expression, aided by moderate traction, is the after birth made to descend into the vagina. As soon as it comes within reach I seize it with my fingers, and giving it a few turns so as to twist the membranes into a rope, extract it. glass contraction is a complication rarely met with now-a-days. When this condition of the uterus is present, it will usually be found to be due to the injudicious use of ergot. This drug induces a general tonic contraction which separates the interior of the organ into two cavities, the dividing line being the internal os. In this condition of affairs, if there be no hemorrhage, we may wait until relaxation takes place, aiding it meanwhile by the rectal injection of laudanum or chloral. In a paper recently read before the Cincinnati Obstetrical Society, Dr. W. D. Porter recommended the application The placenta having been delivered, of both hands to the uterus in order to it is a good routine practice to administer exert pressure. I cannot see myself a full dose of ergot as a preventative of what advantage is gained by using both hemorrhage and as a means of lessening hands. Indeed, I should think that such | after-pains. THE PIONEERS IN OPHTHAL- Travers published a work on eye disfamous in his day as an oculist. Dr. MIC PRACTICE DURING THE EARLY PART OF THE PRESENT CENTURY. BY FRANCIS DOWLING, M.D., CINCINNATI, Member of the American Medical Association, etc. NO. VII. In England about the first labors that appeared in the field of ophthalmology during the early years of this century were a series of essays on the pathological anatomy of the eye, written by Dr. James Wardrop. They were published in two volumes in Edinburg in 1808. Dr. Wardrop was a pupil of the famous Alex. Monro, and first began practice in Edinburg. In 1827 he went to London, where he opened a surgical hospital. In 1837 he was made Professor of Surgery in the Hunterian School of Medicine in the latter city. John Cunningham Saunders was was born in Loviston, in Devon, in 1773. He was a teacher of anatomy in St. Thomas' Hospital, and practiced as a physician in London. Dr. Saunders had in preparation a work on eye diseases when he suddenly died on the 10th of February, 1810. The work was, however, subsequently published through the assistance of his pupils, Stevenson and Adams. John Stevenson was a pupil of Saunders. He was Surgeon to the Royal Institute for Cataract Diseases, and was also teacher of ophthalmology in a private dispensary established by himself. He was not much known in ophthalmic literature, but he was a very able practitioner. Benjamin Gibson was Surgeon to the Manchester Infirmary, and enjoyed quite a reputation as an eye surgeon. He wrote some essays entitled "Practical Observations on the Formation of the Artificial Pupil," which were published in London in 1811. Benjamin Travers was made Physician to the London Eye Infirmary in 1810, and also Professor of Surgery to the St. Thomas Hospital, and was quite eases in London in 1820 which was illustrated with beautiful colored plates. His constant endeavors were to place ophthalmology on as firm a scientific basis as was surgery in his day in England. John Vetch was an army surgeon, and was Chief Physician to the Ophthalmic Military Hospital. Dr. Vetch published a small work on eye diseases. He also wrote an account of the ophthalmia which appeared in England after the return of the army from Egypt, the so-called Ophthalmia Egyptica. It was published in London in 1807, and was the first accurate account given in England of that very troublesome malady. William Adams was a pupil of Saunders. He was Physician to the Greenwich Hospital, and was an oculist of great renown in England. He was the author of a series of monographs on ectropion, a treatise on artificial pupil, cataract, etc., published in London from 1812 to 1819. John Henry Wishart was born in England in 1793. He was a pupil of Scarpa, and served as Professor in the Royal Infirmary in Edinburg. the author of a great many articles on various subjects pertaining to eye diseases, which were published in the Edinburg Medical and Surgical fournal from 1813 to 1823. Geo. James Guthrie was Professor of Anatomy and Surgery in the College of Surgeons. He was also Surgeon to the Westminster Hospital and to the Westminster Eye Infirmary. Dr. Guthrie was one of the most famous teachers and practitioners in England during his time. He published a work on operative surgery which appeared in London in 1823. He was also the author of several monographs on operations for the formation of artificial pupil in cataract extractions, etc. These appeared from 1820 to 1834. William Mackenzie was born in Glasgow in 1791. He studied eye diseases, under Beer, and practiced first in London, and then removed to Scotland. He was made Professor of Ophthalmo logy in the Ophthalmic Institution in I William Lawrence was born in 1785. In 1814 he was a colleague of Traver's, as physician to the London Eye Infirmary. He was also Surgeon to the St. Bartholomew's Hospital, and Professor of Anatomy and Surgery in the College of Surgeons. He died in 1867. Dr. Lawrence shared honors with Mackenzie as being the ablest oculist of his day in England. He wrote a work on eye diseases which ran through eight editions. It was published in London from 1834 to 1842. John Henry Green was Professor of Anatomy and Surgery in the College of Surgeons. He was also Surgeon to St. Thomas Hospital, and was the author of a work on eye diseases. of Arthur Jacob was Professor Anatomy and Surgery in Dublin. He was also Surgeon to St. Patrick's Hospital, Director of the Infirmary for Eye and Skin Diseases, and was one of the ablest oculists in Ireland during his day. Dr. Jacob was the author of a great many articles on subjects pertaining to ophthalmology, which appeared mostly in the Dublin medical journals. The principal of these are: An article on the treatment of corneal opacities by means of local applications of nitrate of silver or acetate of lead solutions. An article on lachrymal fistula, paralysis of the ocular muscles, etc. Richard Middlemore was Surgeon and Teacher of Ophthalmology in the Royal Eye Infirmary of Birmingham. He was also the author of a work on ophthalmology, which appeared in two volumes in London in 1835. He was also the author of a large number of articles on eye diseases, which were published in various medical journals. Frederick Tyrrell was a nephew and a pupil of Sir Astley Cooper. He was Professor of Surgery and Ophthalmology in St. Thomas Hospital and in the London Eye Infirmary. He died in 1843. He was the author of a practical work on diseases of the eye and their treatment, which was published in two volumes in London in 1840. John Walker, physician and teacher. of ophthalmology in Manchester, was the author of a short work entitled 66 The Principles of Ophthalmic Surgery,' which appeared in London in 1837. In this treatise the author endeavors to place the specialty of ophthalmology on a physiological basis. Robert Wilde, Surgeon to St. Mark's Hospital in Dublin, was the last of the great oculists of this period in England. Dr. Wilde was the author of an interesting paper on the Vienna School of Ophthalmology, which was published in the Dublin Journal of Medical Science, of November, 1841. He was also the author of later articles strabismus and entropion operations. [TO BE CONCLUDED.] The Symptoms of Hip Joint on Dr. A. M. Phelps (New England Medical Monthly) concludes that the important early symptoms of hip joint diseases occur in the following order: 1. Limiting of motion. 2. Deformity with apparent lengthening or real shortening. 3. Limp. 4. Atrophy (in bone disease). 5. Pain in knee (with absence of knee joint disease). 6. Pain on joint pressure. 7. Night cries in absence of other joint disease. 8. Flattening of buttock with change in gluteal fold. 9. Heat. 10. Swelling.-Philadelphia Polyclinic. Society Reports. ACADEMY OF MEDICINE. OFFICIAL REPORT. Meeting of February 27, 1893. The President, G. A. FACKLER, M.D., in the Chair. T. V. FITZPATRICK, M.D., Secretary. DR. W. E. KIELY presented a Specimen of Chronic Interstitial The patient from whom this specimen was taken lacked fourteen days of being sixteen years old. His father died about eight years ago, presumably of tuberculosis, and a sister more recently of tuberculosis. The patient was a messenger in the Post Office. I first saw the case seventy-two hours before his death. The history of the case is as follows: Late in October he presented some symptoms of indigestion with headache, for which he consulted a physician who prescribed for him. In a week or ten days later he discovered some difficulty in reading the address on packages or letters, and for this ocular defect he consulted Dr. Buckner, an oculist, who pronounced the trouble of vision to be dependent upon disease of the kidneys. The day prior to my first visit the patient was seized at the table while eating with a convulsion, which lasted some time. The next day he was taken with another convulsion, when I was sent for. The case was so typical that I recognized in a moment that there was some lesion of the kidney. The urine was characteristic of a scirrhotic kidney, pale, clear, and a very low specific gravity, and by volume about 7 per cent. of albumen of that granular variety which takes a long time to settle in the tube. The pulse was hard and bounding. He passed into a comatose condition and died in seventy-two hours from the time I first saw him. The age of the patient is very interesting. I have not been able to find a similar condition of things existing at so early an age. It will be noticed that in some portions of the kidney the cortex is. very much reduced. The right kidney is the smaller. The destruction is not so great in the left kidney, but there is considerable connective tissue which is very dense. On one side the capsule is adherent, as you see that in attempting to separate it the cortex was torn. The liver was perfectly normal. Meeting of March 20, 1893. The President, G. A. FACKLER, M.D., in the Chair. T. V. FITZPATRICK, M.D., Secretary. DR. G. A. FACKLER read a paper bearing above title. Owing to the fact that it is a compound of a number of hydrocarbons, 75 per cent. of which belong to the benzol series, which, by mutual stimulation of their antiseptic powers, established its title as a superior antiseptic, and owing to the fact that the chemical construction of some of the component parts demonstrate their inocuousness as general poisons, and the removal of other undesirable effects by the addition of alkalies and resins, creolin can be employed with confidence in its therapeutic potency and without fear of evil consequences resulting from possible. absorption. Bacteriological investigation has proven it to be a more powerful antiseptic and antizymotic than the majority of such agents employed at the present time. Clinical observation furnishes abundant evidence to substantiate these statements of the bacteriologist. It forms a complete emulsion with water, and with water, and for ordinary purposes can be employed in a 1 to 2 per cent. mixture; 2 to 100 boric acid will be found equal, as a dry dressing, to iodoform; 2 to 10 per cent. with vaselin will be an ointment applicable wherever the application of an antiseptic or aseptic salve is indicated. Internally creolin acts as a gastro-intestinal disinfectant. Enormous doses are required to cause toxic symptoms. DISCUSSION. DR. LEONARD FREEMAN: There seems to be one or two theoretical objections to the use of creolin in old granulating or suppurating wounds at least. The micro-organisms get down among the cells and granulations, and in order to reach them it is better to employ some substance which will remove at least the outer covers of cells. Carbolic acid in 5 per cent. solution does this and creolin does not, according to the paper which has just been read. Creolin would seem not to be well fitted for the sterilization of instruments; it would be very difficult to find a small instrument, such as a needle, in so opaque a solution. DR. SETH EVANS: Another objection to the use of creolin is that you cannot hold onto the ordinary smooth nickle-plated instruments, for they become quite slippery. When you cannot hold onto the instruments, and must wrap them with gauze, you will wish you had not heard of crenolin(e), creolin, I mean. DR. C. A. L. REED: My attention was called some years ago to the method by which a celebrated specialist in rectal disease (who has lost his identity with the profession, but who is still successful in that department) was in the habit of treating deep fistula, i.c., by making a saturated solution of carbolic acid in neatsfoot oil, wrapping a probe with a piece of gauze saturated in this solution, and passing this into the fistula. In this way the escharotic properties of the carbolic acid were overcome to a great extent, and it was found the oil as a vehicle permitted more ready entrance into the interstices, in which were found the pus-formers. In answer to the criticism by Dr. Freeman, it appears to me creolin might be combined with similar satisfactory results, and I would ask the essayist if this is not the case. I ask this because -although I have given no attention whatever to creolin-I have in hand a case in which it has occurred to me to use it. DR. EDWIN RICKETTS: Sir Joseph Lister was the first surgeon to espouse the cause of carbolic acid as an antiseptic. In an article recently published in the British Medi cal Journal he says he has experimented with a number of antiseptics, as bichloride of mercury, etc., and that he has now given all those up and returned to the use of carbolic acid alone. I merely speak of this in connection with the paper read to show that the "wheel" turns backward sometimes. Sir Joseph has found nothing equal to carbolic acid, 2 per cent., in which to keep clean surgical instruments and for an antiseptic in surgical operations. DR. T. V. FITZPATRICK: The very unsatisfactory effect which occasionally follows the use of peroxide of hydrogen, which is probably due to the excess of hydrochloric acid, which some specimens contain, has led me recently to look for a remedy which would contain all the antiseptic properties of peroxide of hydrogen. Some three or four weeks ago I employed a 1 per cent. mixture of creolin in several cases of suppurative middle ear disease, and have been gratified with the results. The discharges have diminished, and where the discharge was offensive this unpleasant feature was completely corrected in a few hours. In regard to its powers in correcting the offensive odor of discharges, I recall a case of mastoiditis where the discharge was extremely offensive. A solution of creolin (2 per cent.) corrected it promply. DR. FACKLER (concluding): If we are to take evidence from any one as to the value of an antiseptic, we must take evidence from the bacteri ologists, and, if we can positively demonstrate that creolin, when it comes in contact with micro-organisms, has a more effectual action than carbolic acid, why is carbolic acid superior to creolin? The escharotic action, which has been referred to by Dr. Freeman (for the going down and eating must be due to this action), if valuable, would suggest the use of such acids as nitric acid. The antiseptic power is not due to the escharotic action, but because it is a benzol derivative. The action of chloral would be like carbolic acid, but the effects are changed by the introduction of an alcohol radical. As to the instruments, they have adopted in England, Germany and France, a peculiar per |