inflammation, and by the constant presence of parasitic fungi or bacteria.

Mycosis Axillaris.-A brown discolouration of a portion of the skin in the axilla, and desquamation of the epidermis are described by Dr. Payne under the above name, and are considered by him to be due to the settlement of a colony of micro-organisms, which found a suitable soil in the warm moist situation.

Salt in the Treatment of Skin Diseases.-Dr. Brooke, in the Medical Chronicle for May, quotes Dr. Piffard's experience of the effect of sea-water and salt brine baths on the normal and diseased skin. Sea salt contains 95 per cent of sodium chloride, with small quantities of magnesium chloride and sulphate, and calcium and sodium sulphates, which makes its solutions like sea-water slightly glutinous and causes the skin to feel sticky. The presence of iodine and bromine is doubtful, Dr. Piffard finds sea-water baths useful in chronic eczema, sluggish psoriasis, furunculosis, pruiginous affections, and strumous diseases. The bathing should be continued for some months, and if this cannot be done at the sea-side, sea salt baths should be used at home. These should be prepared by mixing from one to fifty pounds of common salt with twenty-five gallons of water at a temperature of 95° to 97° F. The immersion should last from fifteen He also recommends the use of a bath containing ten pounds of salt in cases of subacute eczema. Pathogeny of Urticaria.-Dr. Unna divides urticarial eruptions into the following four forms :—

to twenty minutes.

1. Universal predisposition due to cerebral causes.

A. Urticaria traumatica.

B. Urticaria communis, chronica et acuta.

c. Urticaria factitia.

2. Local predisposition due to peripheral causes.

D. Urticaria pigmentosa.

He produced some urticarial wheals by the use of nettles, excised them, and found no migratory cells, as in healthy skin. To explain the formation of wheals he suggested the existence

O spasm in the large veins of the skin, which are provided with muscles, whereby a stasis takes place in the lymphatic circulation of the skin.

The pathological appearance of the wheal, he says, coincides with a perverse innervation of the vasomotors, that is such an one as leads to spasm of the veins, with or without slight narrowing of the arterial blood vessels. No paresis follows upon a primary contraction. The wheals are in the beginning always red, and always and in all forms of urticaria there is present a paresis, an enlargement of all the blood vessels, arterial as well as venous; but in those predisposed to urticaria the small veins of the skin contract

does not result, but a wheal.

anæmia, however,

OBSTETRICS.

BY A. HARVEY, M.B.

On the Temperature during the Puerperal period.-A committee of the Esculapian Society appointed last year to investigate this subject has issued a report through Dr. J. W. Hunt. The results briefly are—that in 70 per cent. of all cases the temperature never exceeded 100°, while in 43 per cent. it was practically normal. The highest temperature occurred almost always during the first five days, but between these there was little difference in the frequency of its incidence; it was slightly most frequent on the 1st day (this probably from neurotic causes), then in order on the 3rd, 4th, 5th. 2nd. In cases where laceration occurred the average temperature was slightly higher, but the rise was in no way proportionate to the length of the tear. After the use of the forceps in no case did it remain quite normal, but it was never high. In three cases of retained placenta it remained normal, in one it was high. The occurrence of after pains had no effect upon the temperature curve. The highest temperatures were due to neurotic conditions, e.g., "acute domestic infelicity."

The influence of Ergot on Involution of the Uterus.-A discussion upon this subject was introduced at the February Meeting of the Obstetrical Society, by Drs. Herman and Fowler. In their cases the criterion adopted was the height of the uterus above the pubes upon successive days of the lying-in in two series of cases, (1) where ergot was administered systematically for 14 days, and (2) where one dose was administered and no more, the result was that the uterus diminished more rapidly in the first than in the second class of cases; with regard to the cessation of the lochia there was no appreciable difference. Dr. Boxall had made similar series of experiments and found that ergot tends to prevent the formation and hasten the expulsion of clots, diminishes the frequency, intensity and duration of after pains-has no appreciable effect on the cessation of the lochia. Dr. Dakin did not accept the criterion as trustworthy; his results had been contrary. He found that with a single dose of ergot the uterus sank to the brim in 9'2 days, with three days of ergot in 12'3. That with one dose the lochia lasted 9.8 days, with three days use of the drug the duration was 113 days. That in the ergotised cases there was less after-pain, but more clots, which however ceased on the 6th day, while in the unergotised cases they lasted till the 10th.

The same question is discussed by Dr. Blanc in a paper in the Annales de Gynécologie, March, 1888. The conclusion which he considers his experiments amply justify is that ergotin when administered during the first five to ten days of the puerperal period, so far from exerting a favourable influence on uterine involution, actually interferes with the process, as tested by external measurement combined with internal.

The Relative Frequency and Causes of Fatal Positions.— Schäublin (Archiv. für Gyn., B. 32, H. 2) considers that gravitation causes occipital presentation; that lax abdominal walls. permit the child's back to turn to the mother's right side more frequently in multiparæ than in primiparæ, and that in contracted pelvis the uterus shapes itself to accommodate the

foetus.

Also that contracted pelvis is the most frequent cause of anomalous positions.

Craniotomy and its Alternatives.—One of the most important contributions to the discussion of this question is a series of papers by the staff of the Dresden Maternity, edited by Leopold, and based upon nearly six thousand cases treated at that institution during a space of three years. In these cases labour was induced prematurely in seventy-six with the result that 78.9 per cent. of the children were born alive, and the maternal mortality was 2.2 per cent. Version followed by extraction was the method adopted in eighty-three cases; here the maternal deaths were four, but of these only one was traceable to the operation, while the infant mortality was 31 per. cent. Out of seventy-one cases where craniotomy was performed the maternal mortality was nil. In the cases treated by modified Cæsarean section the percentage of children born alive was eighty-seven, the maternal death-rate 8.6 per cent., half the deaths being due to other causes. Leopold sums up that although the time is not ripe for the substitution of Cæsarean section for craniotomy, yet, when a living child is desired and alternatives are not possible, it is justifiable, provided that patient be strong, not far advanced in labour, and that the foetal heart sounds are normal. That the induction of premature labour is within certain limits decidedly the best course; but with a pelvis contracted beyond these limits, and in cases where the period for induction has passed, that craniotomy is on the whole to be preferred to section, even where the child is living, offering, as it does even now decidedly the best chance for the mother.

Writing upon the same subject, Strauch records a series of cases of induced labour, with a view to the estimation of the comparative value of this operation and the Cæsarean section. The maternal mortality (in twenty-eight cases) was nil, the infant mortality 55 per cent. Comparing these figures with a mortality in the modified Cæsarean operation of 118 per cent. for mothers and 8 per cent. for children, Strauch considers that the Cæsarean operation should be more frequently performed

where the indication is only relative. His infant mortality, however, in the cases of prematurely induced labour was unusually high.

On the Detection during Labour of Coiling of the Cord round the Neck of the Fatus.-Dr. Turquand (Annales de Gynécologie, 1888, T. 360) considers that in occipito-posterior presentations if the head refuses to rotate, and, when artificially rotated, glides back to its former position, there is a strong presumption that the neck is encircled by coils of the cord. Turquand considers this sign as of the more importance in that the usual presumptive evidence of the presence of coils, length of labour and the umbilical souffle, is either valueless or absent in occipito-posterior positions.

THERAPEUTICS.

BY ARTHUR FOXWELL, B.A., M.B. CANTAB.

On the Treatment of Phthisis by Ogygen and Ozonised Oxygen. The patients inhaled the gas by means of a Clover's Nitrous Oxide Inhaler. Three inhaled pure oxygen for daily periods of five to fifteen minutes for a week to a month. They were all third stage cases: the inhalations never caused coughing, there was a general feeling of lightness and brightness after each inhalation and in two the pulse and respiration were temporarily slowed. Oxygenated water alone or with milk was found to lessen gastric irritability. Ozone. When this was obtained from air all the patients complained of cough and a sense of irritation; but when it was formed from pure oxygen the general effects were sleepiness, increased appetite for next meal, pulse and respiration unchanged, no irritation, no headache, no change in the amount of bacilli in the sputum. Dr. Ransome concludes (1) that pure oxygen can be inhaled continuously for at least fifteen minutes without the slightest harm resulting; (2) pure ozonised oxygen may be breathed, to the extent of 2,000 to 4,000 cub. ins., not only without harm, but even with apparent benefit. (3) The ozone lessened the number of the bacilli in the sputum in two cases, and in the third the expectoration was diminished and the disease quiescent, whilst the general