natural conclusion. Mr. Tait mentions four deaths from this cause in Queen Charlotte's Hospital, as verified by post mortem examinations, and says that "these cases during life were all regarded as puerperal fever." Saenger comes forward with two cases which have come to his knowledge in which the overdistended tubes burst and discharged pus into the abdominal cavity, with death on the fourth day after confinement in one case, and on the twenty-first day in the second case. Who can doubt that, in the light of our present surgical knowledge, if these cases had been recognized and operated on, the women fined to bed for several months. She has never been well since that time; has been constantly losing flesh, suffered from pain, and has generally felt wretched, not able to work half the time. I was called to attend her on the 31st of March last, and found her suffering with peritonitis, of which she had been getting gradually worse for the past three or four weeks. An examination disclosed a pyosalpinx firmly bound down and extremely tender. I made an abdominal incision, and removed a large and densely adherent tube and ovary, both filled with pus, from the right side. Recovery was uninterrupted, and she has been relieved not only from her peritonitis but from all her old sufferings. The last time I saw her she told me she was feeling more and more like herself, and was fast regaining her former weight. The only regret I have in either of these cases is that I did not remove both appendages. The case Mamie P., has recently had an inflammatory attack in the remaining tube, from which she has recovered, but I am afraid the time will come when another operation will be required. I think where pus is found that both sides should be removed always, whether one side is apparently healthy or not, the patient being willing, of course. would have all survived? The day has passed, I hope, in which we will allow a women to die of pus in her abdomen without at least proposing an abdominal section, not merely as a last resort, but as an early means of relief and safety. It is by no means to be held that because a parturient women has an inflammation of her tubes, she is to be rashly submitted to the knife of the surgeon. I have, within the past few months, seen a woman who presented an elevated temperature, with anorexia, restless nights, and other general symptoms, and whose tubes, on examination, I found enlarged and painful. Under careful treatment this local trouble all subsided, and with it the general symptoms disappeared, and the patient made a satisfactory recovery. These mild cases, however, often go on to a chronic condition, when unrecognized and neglected, and the woman eventually falls into the surgeon's hands to be relieved of a pus-tube, and then generally gets the credit of having had a gonorrhea at some period of her life, or else drags out a misera-practice in which the salpingitis had a prior ble existence until she dies of her trouble, or some other disease puts an end to her suffering. The following case fairly illustrates this: Maggie F., æt., 31, married thirteen years, has had one miscarriage and five children. Had always had good health until her last confinement, six or seven years ago. At this time she had a slow and tedious "get up." Her physician told her that she had "an inflammation in her stomach." She was con Whether or not this disease arises de novo, or, having already existed from other causes, has simply a new inflammation added by the puerperal condition, must be determined by careful investigation in each case: Hecker, as early as 1878, mentions two cases in which an old pyosalpinx was lit up by the puerperal state, and Saenger adds another from his own existence. In the case of Mamie P., the patient was apparently perfectly well up to the time of her last confinement, but the adhesions were of such a firm character that it is safe to presume that there was an old inflammatory trouble prior to this time. It is impossible to imagine the formation of such organized bands in so short a space of time. At her first confinement she had "an inflammation in her stomach" and that was the probably beginning of her trouble. She un doubtedly has had tubal disease ever since (probable pyosalpinx) and has not suffered enough inconvenience from it to seek advice. This is often the history of these women; they complain of pain and general ill-health, loss of flesh, anorexia, and sleepless nights, etc., but oftentimes they do not even suspect the real origin of all their trouble. The result in the case of this particular patient is a valuable lesson of the dangers of such neglect, and is an additional reason why the disease should always be removed when recog nized. Of course, the possible contagion of gonorrhea can never be eliminated excepting by a microscopical examination. In both my cases, although the trouble seemed very clearly to have arisen at the time of confinement, yet the chances of gonorrheal infection both before and after pregnancy are not to be denied; however, in lieu of a microscopical examination, the chances are all in favor of a purely puerperal origin. But whatever the source, the results are the same, and it is only by prompt measures we may hope to save some of these cases. It is no longer surprising that even under the most careful antiseptic treatment of the uterus, vagina, and person of the patient as well as the person of the attendants that still patients are lost from septic poison. This disease has been recognized and operated on at least four times in Philadelphia; one case was operated on just two weeks previous to mine, by Dr. Longaker, in which a pyosalpinx was removed, the patient dying on the second day. I may state here that this operation was delayed three or four days after an abdominal section had been urged. Dr. Joseph Price has since operated twice, and in one case found more than a quart of pus in the abdominal cavity; the case, unfortunately, came into his hands too late, and the patient survived only two days. These cases, though few in number, certainly teach us that the work done in this direction is encouraging, and although a large percentage of the patients have died, it only warns us of the extreme importance of an early diagnosis and prompt surgical interference. It becomes our imperative duty in every case of post-puerperal trouble to make a thorough investigation on the appearance of the first symptoms, and should a fulness be found on either or both sides of the uterus, accompanied with pain on touch and with constitutional symptoms of gravity, there should be no hesitation as to the course to pursue. This being secured, our present high mortality of one woman out of every hundred delivered in large cities, as recently stated in a statistical paper on lying-in charities in the United States, must be very largely di minished and the fatal results now surrounding our parturient women must become infinitely less. WEEKLY MEDICAL REVIEW, EDITED BY THE MEDICAL PRESS AND LIBRARY ASSOCIATION. Contributions for publication should be sent to Dr. B. J. Primm, 3136 Olive Street. All remittances and communications pertaining to Advertisements or Subscriptions should be addressed to J. H. CHAMBERS, 914 LOCUST Street, St. Louis, Mo. SATURDAY, JULY 16, 1887. COCAINE IN SURGERY. It is frequently the case that the administration of an anesthetic is as formidable a procedure to the patient, as the performance of the operation itself, and its after-results very distressing. With a view of obviating these difficulties, cocaine, as soon as its anesthetic properties became known, was largely experimented with in minor operations, and found to answer an excellent purpose. Of the many virtues claimed for this drug at its introduction, this, its local anesthetic power, has remained as an established fact. Prof. W. F. Grube extensively uses it in his surgical clinic as an anesthetic in cases of removal of superficial new growths, such as sarcomata, lipomata, etc.; the results of the observations made there are as follows: 1. An injection of five centigrammes of cocaine is sufficient to produce complete anesthesia of an area measuring from four to six square centimetres. 3. Anesthesia is complete in five to seven minutes, and lasts from twenty to thirty minutes. 3. Tactile sensibility is preserved, but only to a very slight degree. 4. Artificial local anemia, produced by pressure with a drainagetube or otherwise, seems to intensify the anesthetic effect. 5. The dose used varied between one centigramme (a syringeful of a 1 per cent. solution), and two decigrammes (four syringefuls of a 5 per cent. solution), but those most often employed were five centigrammes and one decigramme. As a rule, the doses up to twelve centigrammes did not produce any general effects; but in a nervous woman, aged 38, with sarcoma of the parotid gland, eight centigrammes gave rise to formication and numbness over the body, paleness of the face, giddiness, weakness of the pulse, dryness of the mouth and pharynx, difficulty of swallowing, dyspnea, oppression in the chest, and vomiting. In a strong peasant, aged 45, with dry gangrene of two phalanges, one decigramme produced only dryness of the mouth; twelve centigrammes caused only a slight acceleration of the pulse; fifteen centigrammes produced, in from ten to twenty minutes, acceleration and weakening of the pulse, dryness of the mouth, sometimes giddiness and pallor, and once a condition resembling syncope. A dose of two decigrammes, in an anemic girl, aged 13, in whom the os calcis was scooped for caries, gave rise, in fifteen minutes, to dilatation of the pupils, and on the next day to headache and general malaise. 6. Inhalation of amyl nitrite (one, two, or three drops on a piece of cotton-wool) seems to be the best physiological antidote to cocaine; its action manifests itself very rapidly after a few whiffs. 7. The osseous system, even in its superficial parts, is very incompletely anesthetized by cocaine. 8. Cocaine has no influence on the process of healing. 9. Cocainisation presents many advantages compared with other local anesthetic agents; the chief ones being rapidity of action, ease of application, harmlessness in regard to the tissues with which the drug comes in contact, and convenience for use in regions which are inaccessible, or nearly so, to other local anesthetics. Cocaine will supercede chloroform in many cases, as in cardiac or pulmonary disease, etc., or where the use of chloroform is difficult owing to the position of the patient-for example, that a la vache in operating for hemorrhoids, etc. Professor Grube and Dr. Barsky have lately tried with success a combination of cocaine with morphine, as recently recommended by Professor Schnitzler. A REMEDY FOR RINGWORM. Dr. J. Hutchinson in the Brit. Med. Jour., strongly recommends the tincture of sieges beckia orientalis for ringworm. It is free from the objections of greasiness and pain on application, which attend the use of ointments. He speaks of the drug in the following terms: Siegesbeckia orientalis is a shrub, the green parts of which have quite a reputation in the Mauritius. For internal administration a syrup is prepared by pounding the green plant, adding sugar, and straining. This syrup is considered a powerful alterative, and is given in syphilis, gout, scurvy, scrofula, etc. For external use a poultice is made of the bruised leaves, and applied to gangrenous and sloughing sores with marked healing effect. By the enterprise of Messrs. Thos. Christy and Co.,London,the plant has been introduced into England and placed within the reach of medical men here. From them I received a supply of the tincture, and have been prescribing it with varying degrees of success in dif ferent diseases. It is, however, to its value in treating the several varities of tinea that I now wish to draw attention. I have used it in fifteen cases of ringworm; of these, eight were cases of tinea circinata, four of tinea sycosis, two of tinea tonsurans, and one of tinea versicolor. The site of the eight cases of tinea circinata was in six of them upon the neck, and in two upon the calf of the leg. None of the patients called upon me till the disease was well developed, when the red, raised, circular, bounding edge, and the pale central area with its branny desquamation, left little doubt of the diagnosis. The four patients who were afflicted with tinea sycosis all blamed a "foul shave" for their ailment. In all of them the disease was upon the chin, and presented the characteristic fig-like appearance. The two cases of tinea tonsurans showed the roundness of the diseased patches, the scaly eruption, and the brittleness of the hairs peculiar to that form of the trouble. The one case of tinea versicolor was also typical. My prescription in all of them was the same, namely, equal parts of tincture of siegesbeckia and glycerine, and this I ordered to be well rubbed into the affected area night and morning. The drug appears to act both as a stimulant and a parasiticide, and the method of cure was for the diseased patch to become broken up into a number of smaller patches, with sound skin intervening. These smaller patches became again broken up till they disappeared altogether, and in their place was left a red blush, as if the part had been struck a smart tap with a cane. This redness, however, only remained for a day or two. The two cases of tinea tonsurans were the most stubborn to give way, but even in their cases more frequent applications, and continuing the treatment over a longer period, brought about the result desired, and that, too, without resorting to epilation. COCAINE IN LOCAL ANESTHESIA. In the course of an address on dermatology, delivered by Dr. Henry J. Reynolds, the method of producing local anesthesia with the aid of electricity, is spoken of as follows: Knowing that cocaine was not well absorbed by the skin, and therefore did not produce much of an anesthetic effect, Dr. Wagner, of Vienna, was led to make experiments for the purpose of ascertaining a method by which a better absorption and anesthesia of the skin might be produced. Basing his theory upon the established princi ple in electro-physics that fluids move from the positive to the negative pole in a galvanic current, he saturated the positive electrode with a cocaine solution,applied it the skin,and applied the negative pole a short distance from the positive. As the result seemed satisfactory, he made a number of similar exper iments in the clinic of Billroth to determine the value of the method in surgical practice. He found that by keeping the positive electrode saturated with a sufficiently strong solu tion, and allowing the current to run in the manner described for a short time, incisions could be made in the skin without producing any pain. His results and the descrip. tion of the method were presented to the So ciety of Physicians of Vienna at their meeting, Feb. 5, 1886. In regard to this method, I may say, that I have personally made a number of experiments with a view to ascertaining its merits, which I intend to publish soon in the form of a paper on that subject, but which would occupy too much time were I to repeat them in this paper. I will merely say that in my hands the matter is a success, and in my opinion one of the most useful discoveries that has been made in dermatology during the year 1886. In my experience, in the operation for the removal of superfluous hairs by electrolysis, and in other minor operations on the skin, the patient need experience absolutely no pain whatever. SOCIETY PROCEEDINGS. ST. LOUIS MEDICAL SOCIETY. Stated Meeting June 4, 1887. S. Pollak, M. D. in the chair. F. D. Mooney, M. D. Secretary. DR. F. J. Lutz presented a specimem.-I have a specimen which is interesting from the fact that it is such an extremely rare about which I can find nothing in the literature at my command. one, deal, and the external portion of the calvarium was pushed off from the internal layer, as can be seen at a portion of the skull where it is translucent. It was pushed upwards towards the sagittal suture, and subsequently The enlarged, more than the internal one. dimensions are, in the antero posterior diameter, 3 inches; in the lateral diameter 3 inches. Cavity of the tumor is of an inch thick,and in it are the remnants of what I take to be coagulated blood. It is quite natural that it should be mistaken for a hematoma; no doubt there existed a hematoma also. It had nothing to do with the death of the child; and no forceps was used in this case. DR. H. C. DALTON.-I have here a very beautiful specimen of a clot which was withdrawn from the pulmonary artery and its branches, of a man who died of phthisis. DR. HULBERT.--In connection with the subject of extra-uterine pregnancy, I will relate the history of a case which was under my observation. No one had a positive opinion on this question of diagnosis except one of my assistants, Dr. Mary McLean, who was fully satisfied of the correctness of the diagnosis of extra-uterine pregnancy. Lizzie S. t. 31, married, housewife; mother of three children, last one seven years old. No miscarriages. Character of labor normal. Weight in health 125 lbs., present weight 110 lbs. Duration of present illness since July 1884. Menopause very regular and painless. Last menses in June 1884, only a show in July. Patient for eight or ten months previous to her illness was under a severe and debilitating strain in nursing her sick brother. She also has had much domestic trouble. I have the right parietal bone of a child which lived to be about six weeks old and then was found dead in bed. The history of the delivery is this. It is the second child, the first being born dead, because her pelvis was very narrow. When this baby was born,it States that in June, 1884, she was taken was found to have a large tumor, on the right sick after having been doing more work than side of the head, covering the right parietal usual, with severe pain in the front of her bone. The physician in attendance pro- chest, on a line with the eighth rib, which nounced it a hematoma and said that in the finally extended all over the chest. This atcourse of time it would disappear. No treat tack was at night after lying in a draft. ment was instituted, and the tumor did grow Had fever and took morphine; was sick about smaller, but did not disappear. On removing a week. A day or two previous to this the scalp I found the tumor as presented here. attack, while lifting a bucket of coal, she I found that it was hard, osseous, and a small felt something that "pulled away," as she exquantity of serous liquid came out of the open-pressed it. She was compelled to lie down ing. I then removed it together with the adjoining bony parts. The tumor is com posed of two layers of the skull; the inner side of the calvarium is smooth and presents no abnormal appearance. The tumor is formed mainly of the external layer of the skull, the cavity being the diploe. It was formed in this way: The pelvis being a narrow one, the head was compressed a great on account of the pain and distress about. the womb. Recovery from this accident was only partially good. She became of the opinion that she was pregnant, in July 1884, latter part of month, her reason for this opinion was that she only had a show; her menses ceased until about April 12, 1885, a period of about nine months, when, after running a sewing |