instrument

the forceps in the left lateral position without the patient's knowledge. He thought the possessed obvious advantages over Dr. Sawyer's excellent pelvic outlet forceps.

2.-PUERPERAL UTERUS AND ADNEXA.The pathological specimen was the uterus and adnexa, removed from the body of a patient who died at the Cook County Hospital on the third day of the puerperium. Dr. H. H. Frothingham, one of the resident obstriticians, had kindly placed the material at the speaker's disposal. The patient, thirty years old, multipara, was admitted to the hospital on the 13th of November, 1885, and gave a history of forceps delivery of a dead child, with perineal laceration, on the 11th of November. Temp. 103.4°F.; pulse, weak and rapid; respiration, shallow and frequent; tongue, dry and brown; pulmonary edema; rigors; profound prostration.

Abdominal tenderness, tympanites, dullness in both flanks; two tumors, the size of a hen's egg, on either side of the vulvar orifice; labia majora apparently gangrenous; recent perineal laceration; foul odor from vagina; complete cessation of lochial secretions.

The patient died soon after admission to the Hospital.

Autopsy. Both pleural cavities about half filled with sero purulent fluid and flakes of lymph; lungs edematous; pericardium contained three ounces of fluid similar to that within the pleuræ; endocardium apparently normal; myocardium soft and friable; no metastatic abscesses could be found. Peritoneal cavity contained about one gallon of seropurulent fluid with flakes of lymph. Intestines contracted, but no adhesions; liver enlarged, congested, giving evidence of fatty degeneration; spleen of normal size; kidneys, cortex, giving evidence of fatty degeneration; pelves injected and intensely hyperemic; peritoneum injected.

The uterus was of a size corresponding to the third day of the puerperium. The ring of Band was plainly demonstrable. The endometrium exhibited the pseudo-membranous necrosis, clearly described by Birch-Hirschfeld and other pathologists by the term endometritis diphtheritica. The mucous membrane of the vagina showed similar diphtheritic changes. Pus oozed through both Fallopian tubes. The left ovary and tube were intensely injected. Puerperal ulcers were visible on either side of the vulvar orifice. The tumors on either side of the vulvar orifice proved to be caused by hemorrhage into the perivaginal connective tissue, pudental hematomata. No examination for micro-organisms was made.

-Drs. W. H. Pancoast and J. V. Shoemaker, of Philadelphia, and Dr. W. C. Wile, of Connecticut, are in London. The interests of the Congress will not suffer, if they can help it.

-Dr. D. Bryson Delavan has been appointed Professor of Laryngology at the New York Polyclinic.

-The Society of Medical Jurisprudence and State Medicine, of New York, takes seven

"Whereases" and four "Resolveds" to sit down on Clark Bell, Esq., who "represented that he acted as the American delegate of the International Congress of Psychiatry and Neuro-Pathology." The crushing feature of the rebuke is its "muchness."

-An anatomical fact.-That Grover Cleveland can put his foot down with all his V toes out

stretched more emphatically than any of his pre

he should, in the matter of pension bills, the pen

decessors. The victims of his firmness feel that

shun.

-Patient.-Oh, doctor, can you tell me the character of this tumor on my lip and remove it for me?

Laconic M. D.-Certainly, I—cancer.

annual session at Quincy, Ills., this week. It is The Mississippi Valley Medical Society held its very gratifying to us to be able to report that the association is now in line, having adopted the Code of Ethics of the American Medical Association. Our readers will be presented with a full report of the proceedings at an early date.

-Recent numbers of the "Dublin Journal of Med. Science" and the "Boston Med. and Surg. Journal" have articles on "the therapeutic uses of Cus," commending it as a tenicide. The lat

ter journal says: "the native product, C. Americana, is said to attain a greater exuberance of development than its congeners of any other

clime !"

Yes, for downright, florid and gushing exuberance commend us to the wild western type of Cuss Americana.

-We insist that the time has now come when that girl who was sent out on a sea voyage by the "Medical Age," given a dose of pills inducing a catharsis so effective as to include icebergs in her passages, should be given—a rest. The voyage was commenced in the last months of winter, the dose and the Arctic effect soon followed, and now in these broiling days of July we trust our

ex

of Medicine, June 17th:

Dr. Taliaferro spoke of the evil results of higher education of women. He denounced in unmeasured terms the "pressure" system of education in our fashionable boarding-schools and female colleges. He said that the present birth-rate, when compared to that of olden times, shows a degeneracy of the constitution of women of the present day. He thought that physical culture was a first consideration, and that, as a girl approached womanhood, she needed all her energy for the development of certain organs and the exercise of their natural physiological functions. If, at this period, her energy is devoted to the development of her intellect, the consequences are, imperfectly developed ovaries, dysmenorrhea, hysteria, physical impairment and perhaps insanity. He thought that it was the duty of the physician to make his influence felt upon this question among the families who were under his charge. He further claimed that the girl who wins the prize is an invalid, the girl who stands first in the class is an invalid, and that highly intellectual women are not fit for matrimony-that higher education is damaging to women, damaging to humanity.— (Atlanta Med. and Surg. Journal.)

Our girls should be put back to first principles -taught how to be good housewives and mothers. The hothouse culture of the present day is partly responsible for the broken health of our women, and very largely accountable for the number of unmarried females and divorced wives. Sensible men either want a wife who is clinging, affectionate, healthy and homeloving, or none at all.

As we approach, "culture" greets us and demonstrates to us that she has little love for a home, with happy children gathered around, but she rather prefers loneliness and high art.

-It cost $36.95 to govern a New Yorker; $7.40 to control an inhabitant of London; $7.35 of Berlin, and $5.40 a citizen of Paris. That is what the municipal government of each city costs, per capita. Are New Yorkers so comparatively refractory? "Independent Practitioner."

London is governed by Englishmen, Berlin by Germans, and Paris by Frenchmen, and they are properly economical, but New York indulges in the luxury of being governed by a class who are prating most loudly of the beauties of home rule. Such government comes high, but then New York must have it.

Do of collapse by such continuous purgation. not keep the poor lass crossing the Atlantic every month and furnish_the “Age's” joke for the century, and, at the same time, have her, as Puck would say, contributing to Monthly," even if it is only an iceberg.

the

"Atlantic

-- A correspondent to the "Medical Record” suggests that physicians should always have their cards engraved with the "M. D." after their name, rather than the prefix "Dr." to the name. The abbreviation "Dr." does not distinguish whether a man be a physician, dentist, veterinary, lawyer or divine, all of whom have the legal sanction, and the first three the sanction of custom, for the use of the term "Doctor." When the degree of M. D. is conferred it becomes as a part of one's name, as the John or Thomas given at the baptismal font.--"Southern Practitioner.”

We would wish to remark that the M. D. on the

cards might be made to indicate to certain kinds of patients "money down." To some of us the "Dr." after the name expresses the painful facts in the case.

Now

--Denver some time ago had a craze on roller skating--a good deal of noise, plenty of dust, a few broken limbs, two large rinks-finis. we have "mind-healers"-a few hysterical women benefitted, a few pockets well filled, the golden opportunity of saving many useful lives frittered away, thousands of lies told, ignorance personified and riding in carriages, curses of the victimized, the triumph of science, the mind healer overwhelmed and buried under the accumulations resulting from a rupture healed "in the mind." Finale.-"Denver Med. Times."

St. Louis some time ago had a similar craze-a good deal of noise, plenty of dust, several large rinks, some broken doctors-finis.

-Dr. W. B. Slater, in "The Lancet," describes the case of a working girl who had delirium tremens caused by chewing tea leaves. She had acquired the habit while working in a factory, and when she was deprived of the tea she was in a condition analogous to that of a confirmed inebriate when deprived of alcohol. The delirium_tremens were well marked and characteristic.-"Independent Practitioner."

Respectfully referred to the W. C. T. U. Alas! Alas! Only to think that a lass (!) should have delirium tremens, who was a tea-totaler.

LOST TENDON REFLEX NOT AN INVARIABLE SIGN OF TABES. TABES PRESENT WITH THE CHARACTERISTIC KNEE PHENOMENON ABSENT.

The position taken and demonstrated by the reporter in 1879 and '80 (vide Trans. Missouri State Med. Ass'n June, 1879; St. Louis Med. and Surg. Jour. February, 1879; and Alienist and Neurologist, Jan, 1880), that the patellar tendon reflex (knee phenomenon) was sometimes absent in other conditions than posterior spinal sclerosis, and even absent occasionally in conditions of apparrent health, and could not sometimes be elicited in true tabes dorsalis, is now confirmed by one of the original promulgators of this ordinarily valuable diagnostic sign. Westphal has himself at a recent meeting of the Berlin Society for Psychiatry and Nervous Diseases, referred to some cases in which the knee phenomenon remained intact up to a short time preceding death, and Bernhardt has added confirmation from his own clinical experience of this fact.

this phenomenon in cerebellar and medulla oblongata disease and in cerebro-spinal meningitis, and M. Déjerine, at a recent meeting of the Paris Biological Society, read notes on a case of suppression of reflex action of the patella, with the cord remaining intact; also the posterior roots. It is well known that in a normal condition absence of reflex action in

the patella very rarely happens, but is impor tant as a symptom of sclerosis of the posterior columns at its onset. Nevertheless, it may be met with independently of any alteration of the spinal cord and the posterior roots. M. Déjerine has observed the following instance. The patient was tuberculous, reflex action in the patella was absent in both knees; he was in M. Déjerine's wards during ten months and it was not observed. There was no motor

nor sensory disturbance. At the necropsy, lesions characteristic of pulmonary tuberculosis were very evident. The cord and its membrånes, and the anterior and posterior roots, appeared normal to the naked eye. Microscopic examination of the posterior roots in the lumbar region proved them to be normal. In some interesting abstracts in the July number of the Alienist and Neurologist, the English reader will find interesting abstracts from reports in Neurologisches Centralblatt of the discussions of the Berliner Gesellschaft fuer Psychiatrie und Nervenheilkunde of March 8 and May 10 of the present year.

Westphal himself now maintains that he never meant to confine the sign to tabes dorsalis exclusively, but it will be remembered by our readers how tenaciously he has all along asserted that if the knee phenomenon was absent and no other sign was present he

should believe that tabes was present, and would later appear demonstrable by other indubitable signs.

The sign has not the special and exclusive diagnostic significance hitherto so generally claimed for it, though, it must be conceded, it is of great associate value; and, while the later progress in medical discovery of the confirmation of the position taken relative to this sign by the neurologists of this country, (especially Hamilton, Baumeter, Seguin Jewell, L. C. Gray and myself) divests it of absolute pathognomonic significance, it is always true progress to reach the real value of a symptom.

THE CORRELATION OF CENTRAL NERVOUS

ATROPHY AND IMPAIRED OR LOST PE

RIPHERAL FUNCTION.

Dr. Joseph Wigglesworth, of London, reates in the Journal of Mental Science for April the case of a female epileptic, æt. 56, died Sept. 18, 1884 of catarrhal ulceration of the large intestine, who, when only four years of age, met with an accident which necessitated amputation of the left upper extremity. The section had been made about the middle third of the left upper arm, so that a small stump was left, which was partially movable. For a period, therefore, of fifty-two years this patient was deficient in the movements and impressions connected with the left arm and hand, and it was consequently to be expected that the cerebral centre in correspondence with this region would exhibit some amount of defective development.

The convolutions of the motor area of the cerebrum were, therefore, submitted to close scrutiny, with the following result: The right and left ascending frontal convolutions were equally developed throughout, but the right ascending parietal convolution presented a notable diminution in size as compared with the left. For the first three-fourths inch (measuring from the median fissure of the cerebrum) the two convolutions were nearly equal in size, the right being, indeed, a trifle broader, but for the next two inches the right gyrus was about half the breadth of the left,

this proportion being observed until just before the termination of the convulution, when they again become nearly equal. The exact measurements in sixteenths of an inch were as follows:

Right..

Left.

5-16 6-16 5-16 10-16

..6-16 15-16 12-16 9-16 10-16 11-16 These measurements were taken from the

brain immediately after its removal from the cranium. We may, therefore, say that the right ascending parietal convolution in its lower three-fourths was half the size of the corresponding convolution on the opposite side. No other convolution presented any abnormality.

It is right to observe here that the patient was not a dement, but between her fits, which were not very frequent, she was quite rational. Her brain as a whole weighed 1,240 grammes, and the convolutions were well formed.

The condition noted in this case is strikingly in harmony both with previously recorded cases of a similar nature and with the results of experimental investigation.

A case was reported by Dr. Gowers in which congenital absence of the left hand was associated with a marked diminution in size of the right ascending parietal convolution as compared with the left. "At their origin at the longitudinal fissure for the first inch of their extent they were nearly equal in size, and continued nearly equal for the upper one and onehalf inches. In the next (middle) two inches there was a very marked difference, the right being a narrow single convolution and the left broad and depressed by a slight secondary sulcus.

The lowest extremities of the two convolutions were equal in size."

Another very similar case is recorded by Dr. Bastian and Mr. Horsley. In this case there was a congenital defect of the left upper limb, which was shorter and much slighter than that of the right side, and the left hand was small

and abortive. The right ascending parietal convolution in its middle three-fifths was much smaller than the region on the left side.

It will be noted that in both these cases the atrophy was limited to the middle area of the convolution, the upper and lower ends being equal in size, which conditions also existed in the case before us, although here the diminution in size occupied a somewhat larger area of the convolution, in correspondence, doubt less, with the greater extent of the defect in the limb. It is just this middle area of the ascending parietal convolution in which Ferrier has localized, by experimental investigation, "the centres of movement of the hand and wrist."

It would be an interesting inquiry whether minute measurements in perfectly normal individuals might not give a slight preponderance in size of the left ascending parietal convolution over the right, in accordance with the greater complexity of movement of the right hand in the great majority of individuals.

QUEBRACHO IN MELANCHOLIA.

Dr. Kiernan (Am. Lancet, Feb'y, 1886), says that in melancholia, stuporous insanity, and in certain phases of depression which mark other psychoses, the cerebral disease seems (to use Clouston's words) to exert an inhibitory action on cardio-motor innervation, causing the pulse to be small, the arterial tone low, and the capillary circulation very weak indeed, and in many cases there are very decided thoracic symptoms accompanied by mental distress resembling attacks of suffocation accompanied by "precordial fright," as it has been termed. For these reasons quebracho would seem to be indicated in melancholia and the psychoses mentioned. While aware of the theoretical basis for the use of quebracho in psychoses named, his attention was especially attracted to its value in a case of what seemed to be melancholia with the facies, capillary circulation, and emotional depression well marked. The patient, a woman, had phthisis, and had been deserted by her husband. She ran down

rapidly, and at one time seemed almost moribund from dyspnea. To relieve this, quebracho in half drachm doses, every two hours, was given with very beneficial results on the dyspnea not only, but also on the patient's mental condition. She seemed to markedly rally from her depression, and the facies and depression of melancholia disappeared, but an insanity of manner made its appearance, and it was found, on careful investigation, the patient had systematized delusions of grandeur for several years before being suspected of any mental disease, and that, therefore, the melancholia was a complication of a pre-ex isting paranoia which had not been suspected. Guided by the results in this case, quebracho was given in ten cases of melancholia accompanied by precordial pain, with decidedly beneficial results. He is of opinion, from these cases, that in melancholia this drug will prove of decided value, especially in the atonic types. For stuporous insanity it has always given beneficial results, and has, in at least two cases, initiated a recovery.

BOLDO AS AN HYPNOTIC.

The tincture and wine of boldo were used in medicine, when subsequently boldine, an alkaloid, was isolated by Verue and Bourguin. (Brit. Med. Journal, December 12, 1885). In 1884, M. Chapoteaut extracted a substance, which, submitted to reagents, behaved as a glucoside. It was first tested on dogs, and afterwards on patients in M. Magnan's wards. Doses of two, four, six and eight grams were given in draughts, capsules or in rectal injections. It is a powerful narcotic, not producing any disagreeable results. A patient at the St. Anne Insane Hospital, who passed sleepless nights in great distress and excitement, produced by her hallucinations, slept soundly when she took two grams of boldo. This was discontinued during ten days. Her old sufferings returned. She implored to have the capsules given to her again, and then passed tranquil nights. Dr. Juranville describes ten similar cases. This substance is a hypnotic, producing repose similar to natural sleep. There is an absence of anesthesia; less