vagina. After this date I did not visit her often, but gave her iron and quinine as a tonic, and advised her to remain in bed; but she improved so much she would sit up. My last examination was made April 14. The intestines were down in the pelvis, bound by bands of adhesion, and a knuckle presenting at the vulva; she is now able to walk from room to room, and some days out in the yard; she is costive most of the time.

The walls of the bladder were very much thickened, the last three months of her pregnancy she suffered from oedema of the feet and legs. She said there was frequently pus in her urine, but she thought nothing about it and never sought any treatment in this condition. She was allowed to go in labor with a distended bladder, not having passed ber urine for six hours; this no doubt caused the rupture; and continued pressure of the head, and later of the right shoulder against the anterior wall and pubic bones, with a stout negro woman trying to deliver her by traction upon the head for eight hours, bruised the anterior wall which produced the sloughing. I have the bladder in my office with the wall of the vagina yet attached. She has never had any symptoms of peritonitis, and complains of nothing now, except a heavy weight in the pelvis, and incontinence of urine. The ureters carry it into the vagina, and the disagreeableness of this makes her anxious to have something done. I read a report of the case before the Christian County Medical Society, and none of its members had ever heard of a similar case, and only one gave me any advice, and his was to let nature have the case. If any of your exchanges or many readers can, through the columns of your Journal, give me any information on the future treatment, by which I can prevent the continual dripping of urine from the vagina, I will be well paid for the report of the case, and my patient can live the remainder of her days' with more comfort to herself and family.

GLYCOSURIA.-Dr. H. Duncan, of Hamler, Ohio, reports the case of a retired practitioner suffering from glycosuria, who finds. the greatest benefit in the use of buckwheat flour. The sugar almost entire disappears from the urine, and other symptoms are removed when he uses this kind of flour.-Canada Practitioner.

THE DOCTOR'S MISTAKE.

BY "R. F. H."

(Respectfully Dedicated to Dr. “F.”)

Ned,

Von Sunday morning, so soon as I get out of bed,
My vife, mit sonie trepidation, say to me:
Better get your breakfast and after der doctor quick go;
For I must make you von leedle present to-day, you know.

Und vile der cook der breakfast vas making,

Der tree leetle boys mit noise vas waking,

Und I vas feed my horse, und der harness put on,

So after der breakfast I might be quick gone.

Vel,' I vent after der doctor, und invite him to the frolic,

Und he come, und talk to my vife, und say "too soon," you got colic.

Und den he say mit dot vise look he always put on,

"Next veek, I come back und bring you a leeddle son."

Und vile der doctor to his home vas go,

My vife's motder come over you know,

Und she know more about doctor's and vemen troubles,
Den most men und vemens know, added by doubles.

Und she say "Ned after dot doctor you go right avay,
Und tell him to come back here und stay,

For der troubles vill sure come about,

Und he must be here, und his business to look out."

Und ven der doctor vas come back der vas work to do,

For him, der nurse, und me too.

"Its a leetle gal" der doctor say

Selections.

THE INFLUENCE OF HIGH ALTITUDES UPON PULMONARY CONSUMPTION.-Dr. Austin Flint, so says Dr. J. M. Snow, in the N. Y. Med. Jour., June 13, 1885, states that he has seen but seventy-five cases of phthisis in which an arrest of the discase took place, and in most of these the improvement was for a short time. When we realize that one-seventh of all deaths are yearly attributed to this cause in the United States, and in Maine fifty per cent. of all deaths between twenty and forty years are from consumption, it behooves us, knowing this failure of the materia medica to cope with the disease, to give our attention to the modifying influence of climate upon chronic pulmonary disorders.

That climate is a potent agent in the prevention of phthisis is demonstrated by the fact that a region of comparative immunity from this disease is found in high altitudes. Consumption is very rare among the native population of New Mexico; and it is stated by Dr. Archibald Smith to be an exotic in the Peruvian Andes at an elevation of 6,500 feet. Küchenmeister and Lombard have estimated the altitude of approximate immunity in Switzerland at 4,000 feet, and at the equator at 9,000 feet. We may see the influence of altitude in our own country; that while the mortality in New York City is 20 per cent., at an elevation of 2,000 feet it is only 10 per cent.

Dr. Denison, of Denver, has placed the altitude of comparative immunity at 6,000 feet; the vital statistics of Denver in four years and a half show but fourteen deaths from phthisis originating in the State.

Damp, ill-drained land, cold, humid air, sudden changes of temperature, lack of sunlight, anti-hygienic surroundings, all contribute to depress the general health, and to occasion the fearful prevalence of phthisis in low-lying districts and in large

cities. When in search of a climate for the prevention or cure of consumption, dryness of air and soil, and the invigorating influences of sunlight, must be among the deciding factors.

When we learn that the difference between the annual precipitation of rain and melted snow at Denver, 5,300 feet above the sea, is 14.77 inches as compared with New York, where it is 42.70 inches, we can appreciate one of the causes of large cities presenting such large phthisical mortalities. Constant humidity of earth and air predisposes most strongly to the development of phthisis; dryness of soil and atmosphere gives to the inhabitants of high plateaux comparative exemption from disorders of the respiratory tract. Laennec mentions a locality where the dampness of the soil was of such a character that two-thirds of the resident population died of phthisis.

The effect of light is to stimulate respiration, and to the consumptive, whose hope of life depends upon the amount of sunlight and out-door exercise he can obtain, the value of a climate like, say, Colorado, may be appreciated when we contract its 320 sunny days annually with Boston, where one-third of the year is cloudy.

The atmosphere becomes cooler in proportion to the elevation above the sea, 1° lower for every 200 feet; physiologically heat is opposed to stimulation of the nervous centers, its influence upon respiration is also depressing.

Dr. Parkes shows that the number of respirations in the tropics is about 13 to the minute, in England it is 16. The value of a cool climate in arresting incipient phthisis is well known.-The Medical and Surgical Reporter.

TREATMENT OF CHOLERA.-In the College and Clinical Record, June 1, 1885, Professor Da Costa is reported as expressing the following views on this subject in a lecture delivered at Jefferson Medical College:

Prophylaxis. Since filth of all kinds leads to a rapid production of the germs, the locality should be rid of the same.

The

dejecta and cesspools should be disinfected. Inspect the source of water supply, since the germs can obtain easy access to wells. Drink only filtered water. Speedy burial of the dead should be urged. No change in diet is necessary. Live as usual. Better avoid stimulus in the prophylactic treatment. Among the disinfectants to be used are corrosive sublimate, zinc chloride, cupric sulphate, iron sulphate and permanganate of potassium.

Internal Treatment.-Must check the early diarrhoea if you desire to be successful, for, in most cases, if you stop this you put an end to the disease. For this purpose the most valuable are sulphuric acid in combination with tr. opii deod., with aq. menth. pip. In India the acetate of lead, grs. iv, with pulv. opii, gr. j, at once with the diarrhoeal outbreak, and continue every three hours until it checks the discharges. If the above cannot check the diarrhoea, use capsicum, gr. j, with opium and camphor.

Second Stage. Here we have cramps, vomiting and purging. Now, stop the use of fluids; allow but little ice in the mouth. This is a point of great importance. As little food as possible. Stimulus in small amounts, but frequently repeated. Mustard to the epigastrium. Administer ever hour or two:

If stomach does not retain the opium, give it hypodermically; but, if possible, give it by mouth, since it appears to have a local effect. To relieve the cramps, use chloral subcutaneously, in large amounts. When reaction has set in, allow fluids to wash out the kidneys. If he has not reacted, and is not doing well under opiates, try calomel, especially in cases in which the secretions have been arrested by opium. Give at first gr. v. to gr. x, then order gr. every hour or so. When the pulse is sluggish, the temperature below normal, use friction and a hot bath. In this the stage of collapse, stimulus will not be absorbed or it would be of utility, though brandy or whisky might be tried hypodermatically.

Caffeine, gr. iss.-gr. ij, hypod., stimulates the heart's action. If still the patient fails and the veins are swollen, etc., resort to