-Dr. Jules Felix, of Brussels, finding a great number of inconveniences attending the ordinary caustics in use, proposes the following paste as a substitute, which is said to answer a most excellent purpose:

The following is the formula of the paste: Powdered starch 37 grams, wheat flour 112 grams, bichloride of mercury 1 gram, dried chloride of zinc 110 grams, pure iodol 10 grams, croton-chloral 10 grams, bromide of camphor 10 grams, crystallized carbolic acid 10 grams; all to be mixed up in a glass mortar, the ingredients being well pulverized separately, and gradually add to the whole the quantity of distilled water necessary to obtain a homogeneous paste, which keeps in a perfect state of preservation for an indefinite time. When required to be used the quantity necessary should be pressed in the hand previously moistened, and the paste could then be pressed into any shape or form.

-French duels, which have long been held up to ridicule, owing to the lack of danger attending them, have been deprived of still another element of danger by the practice of the duelists of dipping their swords in an antiseptic solution before the deadly combat.

with an uneven floor of a dark green or yellow, | dirty color, in a person known to be under the influence of syphilis in its later stages, such an ulcer we generally consider to be a syphilitic one.— H. G. Klotz, in N. Y. Med. Jour.

THE DOCTOR.

The doctor is a useful man,
Constructed on a noble plan;

He's sometimes fat and sometimes lean,
And sometimes just half way between,
But none confers more blessings than
The doctor.

The doctor goes and lingers where
Men's moanings fright the fetid air;
Where'er he can he gives relief
To sickness, and as well to grief.
Ah, ill could we poor mortals spare
The doctor.

He may some stately palace own,
All silk inside and outside stone;

But still in counting human woes,
Like some base-burner stove he goes,
And never sleeps-so far as known—
The doctor.

We may not know him when this shell
Of clay befits the spirit well;

But when the spirit doth protest
Against the clay that both invest,
Our grief in confidence we tell
The doctor.

The doctor is a generous man,
But people cheat him when they can;

They have their health restored on trust,
And pay him something when they must,
And swear no bill is bigger than
The doctor's.

---Nat. Drug.

--Russian experimenters have reached the conclusion that the use of tobacco lessens the assimilonged. The digestion and assimilation of polation of nitrogenous matter. Digestion is protassium iodide is accelerated by smoking. The influence of tobacco is most marked at the beginning of its use.

---Fourteen of the immigrants who arrived on the steamship "Alesia," a fortnight ago, have died of cholera at the hospital on Swinburne's Island, and there are still ten cases under treatment.

-An ordinance has recently been put in force at Paris which provides for a corps of physicians for the theatre, one of whom must be present dur

birth of her child. He found the perineum had been torn, the injury extending into the rectum. Dr. Hewitt refused to operate upon the case when he learned that an action for damages had been commenced by the patient and her husband. Dr. Hewitt expressed the opinion that as to the forceps being used at the proper time, no opinion could be given unless after examination of the condition at the time; it was for the practitioner to judge of that. His further testimony was corroborative of the correctness and skill of Mr. Hill's management of the case. The learned judge in summing up the case observed that medical practitioners were expected to bring to bear a reasonable degree of skill and care, otherwise they became liable.

The evidence showed that Chapman had quarreled with the defendant, Jeffries, and his testimony was impeached. Three medical men, witnesses for the defence, alleged that it was impossible for them to say, unless present at the time of labor, whether instruments were properly used or not; and that to form a judgment on this point the state of the patient must be known and considered The judge virtually instructed the jury to bring in a verdict for the defendant which was accordingly rendered as follows: "For the defendant, but we think there was not sufficient medical supervision over the nurse in the after-treatment."

It was shown by the evidence that Mr. Hills had failed to inspect the perineal wound and had left its attention to a nurse. As he resigned the case on the fourth day into Chapman's hands, one may question whether the subsequent neglect was not as much attributable to Chapman as to Hills.

The case is of value to obstetricians for several reasons.

1. It demonstrates the damnable and disgusting cussedness of some members of our profession. This one Chapman on the face of the testimony shows how low and contemptible human nature can stoop. With no personal knowledge of the immediate accouchment he brazenly under oath informs the jury

that the forceps were the cause of the damage by not being properly used.

2. The claim of the plaintiff denying the right of the defendant to employ a substitute, especially one less skilled.

The claim is a just one and should be laid down with emphasis. The responsibility as a matter of law and equity should lie with the party engaged to do the work. If the engaged party sees fit to transfer the work to a substitute, well and good, but no responsibility to the party for whom the work is done, can be placed by the plaintiff upon the substitute.

The duty of the substitute to his superior is certainly here manifest, and in this case Hills should not have used the forceps without a consultation with his superior. The consent of the plaintiff in this case is of no value either on the question of using the substitute or the substitute using the forceps. The plaintiff is not competent to judge.

3.

Whether the use of the forceps should have any plan in the action for damages. The forceps should have no more special weight than the use of any other remedy for assistance. If carelessly used, that is without due knowledge and caution, the ground for legal action is good. But to say, because the patient was assisted by the forceps and the perineum was torn into the sphincter that therefore the use of the forceps is a good or just legal ground for suit is sheer nonsense. The point made by three of the witnesses that the state of the patient must be known and considered, is truly gratifying to one who has had any observation on lacerated perineums. A case of this character serves to reveal the importance of discipline among medical men and careful attention to our patients after delivery as well as before and during.

ANTIPYRIN IN PREGNANCY.

Cheron reports the case of a young woman seven months advanced in pregnancy, who was attacked by typhoid fever. Antipyrin was given to reduce a temperature of 108° F. in two doses of seven and a half grains each,

at intervals of five hours. The temperature fell rapidly to 94.1° F., attended by cramps, difficulty of speech, obscured sight, and general intellectual oppression. Heat and diffusible stimulants were required to rescue the patient from this condition. The remedy was again tried in six grains given in eight doses, at intervals of three hours; the collapse repeated itself. Still smaller doses were without either good or bad effects.

THE SIGNIFICANCE OF THE RETENTION OF THE MEMBRANES AFTER LABOR.

The importance to be attached to the retention in the uterus of portions of membrane after the completion of the third stage of labor has been variously estimated by different obstetricians; some-e. g., Winckel, Dorn, Ahlfeld and Gräfe-holding that grave dangers are to be apprehended when this occurs; while others as Olshausen, Credé, Fisher and Cohn (who has reported two cases in which nearly the whole membrane had been retained for five days without causing any pyrexiabelieving that little or no danger of hemorrhage, septicemia, or other puerperal mischief is caused by the retention of even considerable portions of the membrane. An explanation of this divergence of view has recently been attempted by Professor Lazarevitch iu the opening article of the new Russian Obstetrical and Gynecological Journal. His explanation is founded on the fact, unrecognized by most obstetricians, that the "membranes," even at the full term, are composed of and more or less separable into three distinct layers, representing the chorion, the decidua and the amnion. Their strength has been investigated by Poppel, Duncan and Ribemont, and the amnion showed by them to be much tougher than the chorion in conjunction with the decidua. Professor Lazarevitch has also made a number of researches on the subject by means of an apparatus consisting of two rings covered with India-rubber, between which the membrane to be examined was stretched, the resisting force being estimated by means of a wooden hemisphere on

which weights were placed, which the membrane was made to support, more weights being added until it gave way. These observations showed that the integrity of the ovum depends almost entirely on the amnion. During labor some separation of the membranes from one another usually occurs, and this is especially the case when the chorion, split or torn below, maintains a close connection with the decidua and the decidua with the uterine wall; the progress of the labor also separates the amnion from the chorion. Roemer explains the separation of the membranes from one another by their unequal elasticity, and Professor Lazarevitch declares that the chorion, being less elastic as well as more easily torn than the amnion, is frequently ruptured in several different places, some portions coming away attached to the amnion, and some being left behind attached to the uterus. The causes of retention of the chorion with the decidua are (1) the presence of villi on the chorion; (2) extravasation of blood on the decidua, with consequent formation of fibrous adhesions; and (3) adhesions in consequence of endometritis and choritis. The amnion. may be retained in consequence of—(1) occasionally occurring adhesions between it and the chorion and decidua; (2) early rupture and escape of all or part of the liquor amnii; (3) a low attachment of the placenta or placenta previa; (4) intra-uterine manipulations; (5) anteversion of the uterus after the birth of the child; (6) exceptional weakness or thinness of the amnion. Retention of the decidua (which is formed from the uterine mucons membrane, not from the ovum) is, as a rule, of little moment, though it is perfectly possible for endometritis decidualis to occur, and for the retained portions of the decidua to serve for the development of micro-organisms intro. duced from without. Shreds of the chorion, if retained either by themselves or together with the decidua, do little harm, as they rapidly undergo a chemical and mechanical destruction, and are carried away with the lochia. The amnion, when retained, is much more liable to become the developing gronnd

of

Dr. Samuel C. Busey Washing ton, says this term is applied to the prolapse of the bladder into the vaginal passage. The prolapse may be partial or complete. It may occur anteriorly or laterally. It is well known that distention of the bladder frequently complicates labor, but the subject of cystocolpocele has not received much attention. It is a rare accident, and, when present, often overlooked. The author had been able to find six reported cases of cystocol pocele complicating pregnancy. Where the distended bladder can be detected externally, there is no difficulty, but where the prolapse is into the vagina, many of the cases are doubtless regarded as cases of threatened abortion. The speaker reported the following case occurring in his practice:

November 24, 1886, he was called to see a woman in the ninth month of pregnancy. It was thought that labor had commenced. The pains occurred at short intervals. The finger in the vagina at once came in contact with a distended pouch. The os could not be felt, and no presenting part could be discovered. It was learned that no urine had been passed since the previous day. With the fingers of one hand in the vagina, while percussion was made above the pubes, distinct pulsation was observed. It was then concluded that the case was one of distended bladder, prolapsed into the vagina. The patient was then assisted by the nurse to the commode, and passed a large quantity of urine. The tumor at once disappeared, the cervix could be reached, and labor had not begun. In this case, vesical tenesmus was not present.

The cause of this affection is not known. It occurs in multiparous women who have to work hard. In most of the cases there has been presentation of the head. The condition is usually accompanied with pains somewhat like those of labor, but unaccompanied with any progress toward expulsion of the fetus. In some cases there is complete retention of urine, with frequent desire to empty the bladder. More frequently, there is a scanty dis charge of urine, with vesical tenesmus. If the prolapse is partial and the organ empty, a firm, hard mass, marked with rigor, will be found. If the bladder is completely prolapsed, or partially or incompletely filled with urine, there is an absence of internal serum above the pubes, and a tumor will be felt in the vagina, completely closing the vaginal canal. The finger can be swept over the lat eral and anterior portions of the tumor, but not in front. Where the prolapse is anterior, labor cannot be completed until the urine is removed. The only certain sign of this affection is the discharge of urine through the urethra, and the subsidence of the swelling.

DISCUSSION. Dr. William Goodell, of Philadelphia, said I have met with two cases of this condition, one a few days before labor, and the other during labor. In the first case, the nurse sent for me on account of peculiar symptoms. I found a body as large as the child's head, and as hard. There was severe vesical tenesmus. I could not pass the finger behind the tumor, and there was no evidence of an os uteri. Further examination showed the swelling to be due to the distended bladder. A catheter was readily introduced, and relieved the swelling. There was no return of the trouble. The other example of this con