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In a recent communication to the Academy of Medicine of Paris, M. Regnier described a new method of producing analgesia for tooth extraction, which may some day supersede the use of cocaine, carbolic acid, or any of the present anæsthetics, all of which are more or less toxic, and involve an amount of risk out of proportion to the trifling operation of a tooth removal.

The method consists in the use of a high-frequency electric current applied to the tooth by means of a guttapercha cap lined with gold-leaf. The field of application of the electricity is thus limited to the tooth which it is intended to extract, and in it absolute insensibility is produced within a few minutes. The use of the current in this way is easy and harmless, and should this communication be verified by further observations, it would seem possible that the same method of producing analgesia might be extended to many other operations of minor surgery.

From recent German statistics it appears that whereas the number of legally qualified practitioners in Berlin is about 2,000, there are no fewer than 476 unqualified male and female persons who pretend, by one method or other, to cure the "ills to which flesh is heir," besides an indefinite number of others who ply their nefarious trade without the knowledge of the police authorities. As might be expected, these self-constituted exponents of the healing art are, with very few exceptions, persons with no education, but with blatant effrontery enough to claim for their methods and drugs miraculous powers, which it might well be thought would, to the large mass of the public, be enough to prove their utter worth lessness. It seems, however, to be a phase of human nature the world over that it is ready to accept the unauthenticated and incredible statements of every type of pretentious quack, even the most audacious, if only the virtues of his nostrums are widely enough advertised and loudly enough proclaimed. Germany is in this respect neither better nor worse than other countries; and though the statistics referred to focus the evil as it exists in Berlin, the same method of inquiry and numerical tabulation applied to every other great centre of population would but accentuate the deplorable gullibility of the general public in regard to matters pertaining to personal and public health. It is almost alarming to contemplate the result of a careful investigation into the question of quackery as it is practised—and profitably practised in the city of London. In every corner of this vast metropolis the self-constituted exponent of some form of infallible remunerative prosecutes his impudent but

cure

trade; for though the methods differ, there is little to choose between the broken-down, shabby-genteel professor who, from the lofty eminence of an up-turned beer barrel to a gaping crowd, vehemently bears personal witness to the unlimited curative powers of his fail-me-never pills, which for his love of humanity and out of gratitude for the good they have done to himself, he is willing to absolutely give away at the ridiculous price of sixpence or a shilling a box, and the correctlyattired, society-mannered proprietor or manager who presides over a sumptuous establishment in the West End, where by elaborated methods of electricity and massage, together with certain remedies the secret of whose preparation is, of course, known only to himself, the unfortunate victims of every variety of disease may, on paying a few guineas, count upon receiving early and permanent relief from miseries which are beyond the reach of the resources of legitimate medicine. And in many respects the West End establishments source of greater danger than the humble and illiterate vendor of pills and potions in the poorer parts of the city. Their systems of cure are generally concerned with methods of treatment that have their

are

a

legitimate use; high-frequency electric currents, superheated air, ozone, baths, massage, and endless other addenda of ordinary practice are pounced upon by these enterprising leeches of the true profession, and made the peg upon which are hung specious testimonies-which, by the way, are always unsolicited-from hopeless cases which have been cured, and suggestive promises which, alas! too often tempt the unwary and confiding sufferer from persistent or incurable disease, into the meshes thus carefully and suggestively provided for him. Unfortunately, moreover, the victim of this form of quackery is not always the malade imaginaire to whom if it does no good it can do no harm, and who, in the majority of cases, can afford to pay for these fanciful methods of management of a disease which has no existence but in the imaginings of a disordered nervous system; too often the alluring promises of restitution to health appeal to some poor sufferer from organic disease whose friends, in the vain hope of restoring him to vigour and usefulness, pinch themselves and deny to their families the ordinary necessities of existence that the "pound of flesh" may be paid which the extortionate Shylock of quackery demands as the ransom for the sick man's deliverance from the enemy which threatens his life. In these latter days the practice has gone even further than the kingdom of material things; it has invaded the spiritual world as well, and under the euphonious title of "Christian Science" a person called Mrs. Eddy and her disciples have had the audacity to carry the art and science of quackery in its most reprehensible form into the domain of sacred religion.

Surely the time has come when the profession should take strenuous measures to deal effectively with quackery of all sorts, and when the various legislative assemblies of the world should enact laws to better protect the art and science of Medicine and Surgery by the exemplary punishment of those who prey upon the ignorance and credulity of weak and often suffering humanity.

West Australia.

(FROM OUR OWN CORRESPONDENT).

Medico-Legal Cases-Enteric Fever in West AustraliaThe Australian Natives' Association and Friendly Societies.

In my former letter I made mention of the fact that the Medical Board of this State had obtained a conviction against a chemist for contravening the Medical Act by treating one of his customers for a so-called "cold in the eye." Unfortunately the evidence was not as strong as it might have been, and the conviction has been set aside in the Court of Appeal. I can only regret that the Medical Board proceeded to prosecute on such slender evidence, since other more glaring cases do occur frequently in our midst, evidence of which, however, it is very difficult to obtain.

Another interesting medico-legal case has within the last few days been also decided in the Court of Appeal. Unfortunately when the first case of plague occurred in this State, the regulations of the Central Board of Health were apparently not in good working order, and a technical trespass was committed by the Health authorities in dealing with the shop in which the first case of bubonic plague occurred. As the circumstances were those of extreme public danger, it is to be regretted that the judges have seen fit to allow the appeal and to give costs against the Health authorities. The zeal and

energy displayed by the Central Board of Health, and notably by the president, Dr. Black, at that period were no doubt responsible for the effectual stamping out of the epidemic and its non-recurrence this year in our midst. Perth, at the present time, is in a much improved sanitary state and comparatively free from all infectious diseases, and it will compare very favourably as regards its healthiness with the larger cities in the Eastern States. We are, I am glad to say, by our freedom from epidemics, and more especially that of enteric fever, disproving more and more every day the opinion which was freely expressed in the Eastern States, and is now still believed in firmly by many of their inhabitants, that this State of Western Australia generally, and the city of Perth more particularly, was, and is now, reeking with typhoid fever and other filth diseases. The population of this State is increasing rapidly again, and during the last four months over 7,000 persons have landed here in excess of those who have quitted our shores. Now, it must be evident to the intellectually-minded person that as fresh settlements are forming every day in both urban and rural districts, with in many cases a very easily polluted water supply from an archaic sanitary system, that outbreaks of typhoid fever must occur once a person suffering from that disease is introduced into any such locality. The condition of the only lunatic asylum in this State, viz.. at Fremantle, has long been a disgrace to any civilised race; and I am glad to find that the prospect of obtaining a modern institution, well planned and in a suitable site, is now within reasonable hope of attainment. The care of all lunatics, all indigent and aged people, must devolve upon the State, and it is the supreme and important duty of those in authority to see that no stone is left unturned to provide suitable and modern institutions wherein such unfortunates can be housed and efficiently treated. To my mind, it would be preferable to have one large accessible site on which a comprehensive scheme, with ample room for future extensions, could be carried out, and in which all those who are dependent upon the State for their housing or treatment could be placed.

Great activity is being displayed by the Australian Natives' Association and the other well-recognised friendly societies in all parts of West Australia, more especially in the larger towns, and their activity tends rather to the detriment of the medical practitioner. We recognise the necessity of the existence of a wellconducted friendly society, but we intend to prevent, if possible, any great extension of those pseudo-friendly societies, whose great aim appears to be the lowering of the ethical standard of the medical profession by the establishment of amalgamated clubs, or, in other words, "medical-aid" institutions of a most pronounced type. Let me again utter a warning to any newly-qualified and other medical brethren who seem to imagine that West Australia is a perfect medical elysium. Fees are much lower, living much dearer, and the comforts of life very few in most of the places from which these "specious" advertisements emanate, and it behoves all would-be applicants to exercise the greatest possible discrimination and judgment before applying for any one of such vacancies. The governing bodies of such medical sweating corporations express their intentions of obtaining practitioners from the "old country" should we obtain a sufficient boycott in the Eastern States.

In conclusion, let me draw the attention of my confrères to the necessity of codifying the different Medical Acts at present in vogue in the States of the Commonwealth, so as to bring them into harmony and produce one comprehensive Medical Act which will apply to all the registration bodies in Australasia.

P.S. Since writing the above paragraphs, I have to notify that two cases of bubonic plague have occurred

in Fremantle, and I trust that the local health authorities will now grapple with the insanitary conditions well known to be present in that town.

THE TRAINING OF OBSTETRICAL NURSES.

(To the Editor of the Australasian Medical Gazette.) SIR,-The opposition to the Midwives Bill in England and to that proposed by Sir James Graham in this State was due to the belief that a class of registered but unqualified practitioners would be created, which would seriously affect not only the welfare of the general public but the pecuniary interests of the medical profession. But reflection has convinced me that the same end is being not less surely attained by the system which is at present in vogue at the various training schools for obstetrical nurses. Unless I am misinformed,

all the practical instruction at these places is given by the matron or head nurses, and all the ordinary labours are conducted by the same persons, the services of honorary medical staff being only called in if any complications arise. It seems that even lacerations of the perineum are dealt with by the nurse in charge. If this be so, then the whole trend of the teaching and example must go to show the pupils that an ordinary labour can be conducted without the presence of a doctor, and that, therefore, after they have completed their course they will be fully competent to have complete charge of any case, taking it for granted that they will be able to obtain the services of a doctor in case of need.

I have a suspicion that this procedure is becoming pretty general, and with the large number of obstetrical nurses being turned out every year it will probably become more so as the struggle for existence among them intensifies. I would suggest that all these training schools should have a resident medical officer, who would give the clinical instruction and supervise the Many of our young lady graduates would gladly welcome such a post, and their status as medical practitioners would duly impress the pupils.

cases.

I think the Australasian Trained Nurses' Association might move in the matter by refusing to recognise the certificates of those schools which had not a resident medical officer. I have little personal interest in this question, but nothing that affects the pockets of the medical profession is alien to me.

I am,

Sir, yours faithfully,

Macquarie Street, Sydney.

RICHARD ARTHUR.

MILITARY INTELLIGENCE.

COMMONWEALTH MILITARY FORCES.

VICTORIA.

CAPTAIN WILLIAM JOSEPH CROSS has resigned from the Victorian Rangers.

Lieutenant Walter Ernest Summons has resigned from the University Corps.

NEW ZEALAND

Surgeon-Captain Thomas Burns has resigned from the New Zealand Militia.

Surgeon-Captain Hugh Allan McCleland, of the Taranaki Rifle Volunteers, has been promoted to the rank of Surgeon-Major.

William Aloysius Conlon to be Surgeon-Captain New Zealand Volunteer Medical Staff.

THE BATTLE OF THE CLUBS.

REVIEW OF CURRENT MEDICAL LITERATURE.

Victoria.

THE Lodge Court Friar Tuck, A.O.F., is recognised as one of the strongest lodges in the district of Carlton. It has 306 members on its roll, and the amount paid in for medical expenses is £1 per annum for each member. It is pointed out that the court is not in a position to pay more than £1 per annum per member to its doctors and chemists without making special levies on the members. Some years ago it paid £1 per member to Dr. McInerney. Recently the amount paid was £1 3s per member, of which 8s went to the chemists and 15s to the doctors, but members objected to the latter figure on the ground that other lodges were paying only 13s, and others only 12s 6d, per annum per member.

At a special summoned meeting of the court it was therefore resolved that the doctors be given a month's notice to terminate the existing agreements. The doctors replied in a joint letter declining to accept less than the 15s per member they had been receiving. Matters were practically at a deadlock, when Dr. Lynch, a member of the Medical Defence Association, of which some of the court doctors were also members, agreed to see any of the lodge members professionally until such time as a permanent medical officer was elected. Dr. Lynch was subsequently unanimously appointed medical officer. Four other applicants were also elected, the whole agreeing to accept the reduced fee of 13s per annum per member. At the last meeting of the court the friends of the doctor to whom most of the trouble is attributed endeavoured to pass a resolution directing that a special meeting be held with the object of securing his reappointment, but the proposition was lost by 28 votes to 8.

The secretary considers that other friendly societies are indebted to Court Friar Tuck for its successful efforts to prevent an organised attempt at "raising" (!) the medical fees.

Perhaps the profession in Carlton will consider that Court Friar Tuck has taken the lead in reducing medical fees, and that its medical officers who have consented to accept the reduction in fees will be deserving of professional and social ostracism.

Yersin's Curative for Plague.-The Acting Federal Prime Minister has received a despatch from the Secretary of State for the Colonies stating that it is proposed to manufacture Yersin's curative syrup for bubonic plague at the country branch of the Jenner Institute in England. £3,000 will be required to equip and work a new laboratory for two years. The local government boards of Great Britain have recommended that the Imperial authorities should subscribe two-thirds of £3,000, and the colonies which have suffered from the plague are now being appealed to to provide the balance. Hongkong has undertaken to vote £636 13s 4d of this £1,000, and Mr. Chamberlain suggests that the Commonwealth should become responsible for the £333 6s Sd still required. Mr. Deakin intends to consult the State Premiers on the subject.

At a meeting of the subscribers to the Dr. Way Memorial Fund on July 9th it was decided that all funds be handed over to the council of the Adelaide University for the endowment of a chair of gynæcology, to be called the Dr. Edward Willis Way Chair of Gynecology.

OBSTETRICS.

Three Symphysiotomies Upon One Patient.

L. Hirigoyen (Rev. mens de Gyn., Obst. et Ped. de Bordeaux, No. 10) reports three symphysiotomies upon the same patient, resulting in the birth of three living children. After the last operation no enlargement of the pelvis, fibrous induration, adhesions of neighbouring organs, or vascular dilatations near the symphysis were found.

Indications for Rapid Induction of Labour.

G. Fieux (Rev. mens de Gyn., et Ped. de Bordeaux, Nos. 8, 9, and 10) discusses the indications for rapid induction of labour. In the case of hæmorrhage, he limits it to accidental hæmorrhage, rarely employing it in that due to placenta prævia. As regards severe dyspnoea, the operation is not indicated if it be due to some mechanical condition, such as pneumonia, pleurisy, or ascitis, and in these cases treatment should be directed to the etiological condition. When of cardiac origin, medical measures should first be tried to relieve the heart, and, these failing, rapid induction of labour is favoured. Intrauterine putrefaction of the foetus, of course, demands the operation with rapidity. In eclampsia labour is usually initiated by the convulsions, and in the 10 per cent. of the cases in which this does not occur, rapidly induced labour not only produces no ill-effect, but often greatly improves the mother's condition. The foetal mortality of 80 per cent. in cases in which labour does not rapidly follow the convulsive attacks is reduced by the operation to 20 per cent. In cases of the apparent death of the mother near term, a Cæsarean section should only be done with all the usual precautions, as death has occasionally been found to be only apparent. If the foetus is in bad condition and the mother not so, partial dilatation of the cervix and insertion of Champetier de Ribes' bags may suffice; if not, rapid induction of labour is demanded. In cases of maternal anthrax he does not favour this operation, and in hydrophobia advises its use only after the onset of symptoms. He is uncertain as to the indications in tetanus. Among its contra-indications he includes a general sclerotic condition of the cervix, large fibroids, or cancer of the cervix or lower uterine segment.

Anæsthesia by Subarachnoid Injections of Cocaine in the Lumbar Region.

Arnold W. W. Lea (Journal of Obstetrics and Gynæcology of British Empire, January, 1902) contributes a very excellent and exhaustive paper on this subject, with reference to its use in obstetrics and gynecology. The literature of the subject is reviewed. The details of the method of Tuffier (who has done so much to bring this method forward) are briefly as follows:-The injection is made between the lamina of the fourth and fifth lumbar vertebræ. For this purpose a needle sufficiently long and firm to penetrate the tissues is required. Tuffier's needle is four inches long, and is best made of platinum with an iridium point. The point of the needle must be short, to avoid injury to nerve structures. The skin is made thoroughly aseptic. The patient is placed in the sitting posture, with the back well arched forward. In this position the maximum amount of separation between the lamina of the vertebræ is obtained. The spine of the fourth

lumbar vertebræ is now sought for and clearly identified, This is usually easy to do, but in stout patients, or if the spinous process is not well developed, a line joining the highest points of the iliac crests, which crosses the level of the fourth lumbar spine, may be adopted as a guide, and will be found to be reliable. The needle is now inserted one centimetre below and outside the spinous process, and directed vertically downwards and slightly inwards. It will enter the interval between the lamina of the fourth and fifth lumbar vertebræ, and penetrate the subarachnoid space, as is shown by the escape of clear cerebro-spinal fluid through the needle. An ordinary Pravaz syringe is now attached to the needle, and one centimetre of a 2% solution of hydrochlorate of cocaine (grain) is very slowly injected. The needle is now withdrawn, and the minute puncture sealed by collodion. The strictest antiseptic precautions must be observed. It is essential that the cocaine solution be freshly made. Difficulty may arise from several factors. (1.) The needle may impinge on the bony lamina, or in cases of deformity of the vertebræ or ankylosis it may be impossible to enter the subarachnoid space. (2.) The needle may be apparently in the subarachnoid space, but as yet no fluid appears. This may be due to the point being entangled in the membranes, or the needle may have penetrated too deeply. A slight movement of rotation or withdrawal is usually sufficient to cause the fluid to run freely. (3.) Blood may appear at the end of the needle, due to injury to a vein. The needle must then be withdrawn and a fresh puncture made. The analgesia commences almost immediately, and is usually complete in five to ten minutes. In rare cases fifteen to twenty minutes may be required. The extent of the analgesia shows great variations, but it may be relied upon up to the level of the umbilicus, and usually there is complete cutaneous anesthesia up to the ensiform cartilage. The duration of the analgesia is also somewhat uncertain. Usually it continues for an hour or a little more. It may, however, last for thirty minutes only, or up to three and a half hours. During analgesia the patient has a feeling of "malaise," respiratory anxiety, and weight at the epigastrium. Nausea occurs in 30% of cases. In a considerable proportion this is succeeded by vomiting. The pulse is quickened and the tension lowered. After analgesia the patient usually feels very comfortable. Slight sickness may continne. Headache, which may be severe, comes on six to eight hours after the injection. A rise of temperature, accompanied sometimes by a chill, or even a shiver, occurs in about half these cases within a few hours of the operation. It is usually slight, it subsides rapidly, and is of no special significance. The cause of this rise of temperature is obscure. If during the operation there is evidence of cardiac depression or respiratory difficulty, injections of strychnine should be given. Fowler, of New York, gives a full dose of strychnine before the operation Certain details add much to the comfort of operating upon a conscious patient. Thus it is well to put cotton wool in the ears, and to place a handkerchief over the eyes of the patient. She should also be reassured at intervals during the operation. Silence should as far as possible be enjoined. This method of anaesthesia is not suitable for hysterical women, in whom the simple sensation of contact may suggest painful sensations. Cases of heart disease or anteriosclerosis bear it well (Tuffier). Clinical experience has shown that the contractions of the uterus continue Dupaigne regularly under the influence of cocaine. found that the uterine contractions were increased in force and frequency, and considered that the duration of labour was distinctly lessened. If the dose of 1 centigramme (grain) be not exceeded, the injection

in each case.

is without influence on the condition of the fœtus. The definite influence of cocaine on the uterine contractions limits its sphere of usefulness in obstetric practice, as when complete muscular relaxation is required for podalic version or other intra-uterine manipulations. Gueniot, in a communication to the Academy of Medicine of Paris on January 22nd, 1901, lays down the following conditions as contra-indicating its use in labour: (1) Disease of the heart or great vessels, (2) chronic disease of the respiratory organs. (3) chronic affections of the central nervous system, (4) the absence of facilities for securing complete asepsis. The same writer admits the following conditions as suitable for the use of cocaine: (1) Any obstetrical operation requiring anethesia, with the exception of those in which it is necessary to introduce the hand into the uterine cavity; (2) excessive pain during labour; (3) prolonged labour owing to feeble or irregular contractions of the uterus in the absence of any obstruction; (4) in conditions tending to hæmorrhage, such as uterine inertia, placenta prævia, etc.

GYNECOLOGY.

Instrumental Perforation of the Uterus.

Wilmer Krusen (Amer. Med.) discusses briefly the accidental perforation during operative procedure. The uterus may be accidentally perforated by the sound, dilator, bougie, tent, or curette; or it may occur in the attempt to procure abortion by many other instruments and unusual appliances such as may be conveniently at the hands of the abortionist. There are certain conditions of the organ which favour such injury and render it more liable to occur. When the body of the uterus is the site of a carcinoma, the organ is more fragile, and the effort to obtain material for microscopic examination may prove disastrous. Atrophy, anæmia, and tuberculosis are the usual causes of abnormal fragility of the uterus. An abnormal condition of the uterine muscle may be attributed to frequently recurring pregnancies in which there is a very brief time between successive labours. Any attempt to explore or curette the uterus immediately after labour or abortion, when the uterus is subinvoluted, must be made with unusual care because of the softened condition of the uterine muscle. A failure to recognise by careful bimanual examination the position of the uterus when it is either acutely anteflexed or retroflexed may lead to injury because the operator fails to properly direct his instrument. The point of the instrument making pressure upon the cervical wall near the flexure produces rupture. No one should attempt intrauterine manipulation until he is competent to diagnose the uterine position, and the presence or absence of disease of the appendages. Much harm is done by the unwise dilatation and curettement of the uterus in cases of lateral disease. Proximity to the menstrual period, when the uterus is much congested and softened, may contribute in a high degree to the possibility of uterine injury.

The perforation may be either partial or complete; partial when the mucosa and muscular coat of the uterus are involved without injury to the serous covering; complete when the instrument passes through the three coats and enters the peritoneal cavity. The injury may be cervical or fundal,

The result of such injury may be :

(1.) Infection: If unclean instruments have been passed through an unclean canal, there is the possibility of septic material being carried directly into the peritoneal cavity.

(2.) Hæmorrhage: The amount of blood lost de-
pending upon the position and extent of the
injury and the contractile power of the uterus.
(3.) Visceral injury may occur, as when the intes-
tine or omentum is injured by the instrument
or drawn into the uterine or vaginal canal.
(4.) There is the danger of the introduction of toxic
material into the peritoneal cavity when
chemical antiseptics are employed. Whenever
there is a possibility of uterine injury, irriga-
tion should not be practised, or, at least, only
saline solution employed.

(5.) Pelvic peritonitis may result.

When simple perforation of the uterus has occurred under aseptic conditions, without marked symptoms of shock or visceral injury, no operative interference is indicated. In all cases in which there is visceral complication, cœliotomy should be immediately performed, and the injury repaired.

Ovarian Transplantation.

William R. Nicholson (Univ. Penn. Med. Bull., Jan.), in summing up the work which has been reported on this subject up to the present time, states that it is possible to transplant ovaries either homo or heteroplastically, and that pregnancy will follow in a small proportion of cases; that there is without doubt an influence inherent in the ovaries, beyond the mere process of ovulation, which is very important for the development of the genitalia and also for their conservation. All the evidence adduced tends to strengthen the position held by the so-called conservative school, that the whole ovary, or at least a portion of it, should be left where possible.

Pigmentation of the Linea Alba.

The Thèse de Paris, 1901, of R. Lehman (Presse méd., November 30) shows that pigmentation of the linea alba occurs under other conditions than pregnancy. He found it in about 30% of the little girls in one of the hospitals. In these cases it is usually pale yellow, sometimes darker, and generally associated with chronic constipation or other intestinal lesion, such as typhoid, general or localised tuberculosis, or the approach of puberty. In men it occurs under the same circumstances. It is always between the umbilicus and pubes in girls, appearing before the first menstruation, and persisting if the function is not regularly established, and always suggests the occurrence of amenorrhoea, dysmenorrhoea, menorrhagia, &c. Tumours of the genitals cause this pigmentation only when they cause amenorrhoea or dysmenorrhoea. The writer considers a dark line pathognomonic of pregnancy. He believes that a line of sufficient length, breadth, and intensity conclusively proves, without other examination, that the woman has recently been pregnant. In the nullipara after puberty it nearly always indicates the existence of amenorrhoea or dysmenorrhoea, while in a little girl it points to the near approach of puberty and the first menstruation.

Early Diagnosis of Carcinoma of the Uterus.

Abel (Arch. für Gyn., Bd. lxiv., H. 2) claims that he has discovered a valuable diagnostic point between carcinoma arising from the squamous epithelium of the cervix and benign growths from the same cells. His illustrations show the presence of elastic fibres between the

cancer cells as well as around the cell nests, while in the normal epithelium or in benign growths, such as condylomata acuminata and tuberculous lesions, these fibres stop at the edge of the epithelium, and are not found between the individual cells.

Shortening the Round Ligaments through the Vagina.

C. J. Bucura (Zeitschr. für Geb. und Gyn., Bd. xlvi., H. 2) warmly defends this operation as it is performed by Wertheim. Of 86 cases so treated, only two had recurrence of the retroversion at the time of discharge, and these were complicated cases. Seven had since had normal labours; three had aborted; three were pregnant and comfortable at the time of writing. Of 48 cases in which this operation only was done, 10 had recurrences. While vaginofixation and Alexander's operation give better results, the former may cause complications during subsequent pregnancies and the latter sometimes hernia.

OPHTHALMOLOGY.

Older and Newer Mydriatics, Myotics, and Anæsthetics.

In the March number of the Archives of Ophthalmology H. Schultz has an article under the above heading. The mydriatics discussed are atropine, daturine, duboisine, hyoscyamine, hyoscine, scopalamine, atroscine, homatropine, gelsemine, ephedrine, mydrine (a mixture of homatropine and ephedrine), euphthalmine and mydrol. The myotics are physostigmine or eserine, pilocarpine and arecaline. The anaesthetics are cocaine, apomorphine, benzoltropine, stenocarpine, toad-poison, strophanthine, erytropleine, tropacocaine, eucaine, holocaine, anæsine and suprarenal extract. So far none of the newer agents appear likely to displace atropine, homatropine, eserine or pilocarpine for general purposes. Cocaine, however, has formidable rivals in tropacocaine and holocaine, both of which are less irritating than cocaine, have no action on the corneal epithelium, and little or no effect on pupil, accommodation or tension, and both can be sterilised by boiling, and keep well. Holocaine, in 1% solution, is also powerfully antiseptic.

In the same number Macklin writes on the cycloplegia and mydriatic action of atroscin and I-scopalamine (which are probably identical in nature). He advocates their use (in oily solution) for the following reasons(1) only one application is required; (2) more rapid and certain action of the drug. Mydriasis begins in 10 minutes, and is complete in 20; cycloplegia begins in 20 minutes, and is complete in about 50 (average); power of accommodation returns in about 5 days. Schultz thinks, however, there is no reason for replacing atropine by scopalamine generally. Solutions stronger than are not to be employed, since they may have a toxic effect.

Treatment of Suppurative Keratitis.

In the Recueil d'Optalmologie, Perrin concludes his observations on his series of 32 experiments on animals, of injections of antiseptics into the anterior chamber in cases of suppurative keratitis (especially those due to staphylococcus) with iritis, hypopion or iridochoroditis, and is so impressed with his results that he announces his intention of employing the method in man. recommends cyanide of mercury 1-5000. He says injections into the anterior chamber are less painful, and more rapid and certain in their action than subconjunctival injections.

He

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