INFLAMMATION OF THE BREAST SIMULATING CANCER.-There not unfrequently occur cases of inflammation of the breast the diagnosis of which from cancer is extremely difficult. There may be a hard, doubtfully elastic swelling, with retracted nipple, no external sign of inflammation and no increase of heat. The nipple may be drawn in out of sight. In the diagnosis, a careful inquiry into the history of the case is important, and no opinion should be given until an exploratory puncture has been made. (Mr. T. Bryant, p. 223.) INTRA-UTERINE POLYPI.-The first thing necessary is of course to dilate the os and cervix uteri, so that the finger may explore the cavity of the womb. This is easily effected at one sitting, and without the foetor caused by the use of sponge, by means of a number of sea-tangle tents, used as follows: A No. 5 or 6 sea-tangle bougie is cut into pieces a little longer than the uterine cavity, and the ends rounded off and smoothed. The patient having been put into the semi-prone position, and a duck-bill speculum introduced, the anterior lip of the uterus is to be seized with a fine tenaculum and drawn downwards, and the pieces of tangle introduced one after another, so as to pack the cervix nteri with them. No force must be used in introducing them. The tents should not actually touch the fundus of the uterus, but nearly so. The intro"duction of a number of small tents is much easier than that of one large one, and the dilatation effected is more satisfactory. The polypus may then be seized with a vulsellum forceps, and the loop of a single wire ecraseur being passed over it, it can easily be removed. It is not at all necessary that the tumor should be cut off close to its uterine attachment. (Dr. G. H. Kidd, p. 205.) MEDICATED PESSARIES.-Cocoa butter is not a suitable vehicle for drugs intended to be administered in a pessary; for, independently of its causing an unpleasant greasy discharge from the vagina, it prevents the absorptive action of the vaginal walls acting on the drug used. An excellent vehicle is three parts of the soft soap of the B. P. to one part of powdered althea root. Pessaries prepared with this have a pleasant emollient action which is very grateful when anodynes are required. (Dr. A. Meadows, p. 218.) NEW DUCK-BILL SPECULUM FOR PRIVATE PRACTICE.--The advantages of Sims's duck-bill speculum are very manifest in all vaginal and uterine operations. The ordinary specula push the uterus away, and are of little service beyond affording an excellent view of the os and lips of the uterus, and of allowing the easy application of caustics or other remedies to these parts. They are of no use in operations on the vagina. There are, however, insuperable objections to Sims's speculum in private practice, such as its unwieldly size, and its requiring an assistant. Dr. Nott, of New York, describes a speculum invented by himself, which combines all the advantages of Sims's, with the portability of other specula. Like Sims's it admits of the uterus being hooked down to the orifice of the vagina if necessary. It is self-retaining, thus leaving both hands at liberty, and does not require the help of an assistant. It will be best understood by reference to the woodcuts at page 222. (Dr. J. C. Nott, p. 219.) OVARIOTOMY.-The Clamp.-During the twelve months, ending last October, Mr. S. Wells operated on thirty six cases of ovariotomy. In thirty of these he used the clamp, and all recovered; in the remaining six, other means were employed, and of these cases five died. Of these five, however, two would probably have died whatever mode of arresting hemorrhage from the pedicle had been employed. Still the superiority of the clamp seems sufficiently attested. It was not employed in all the cases, because in some the pedicle was too short. (Mr. T. S. Wells, p. 209.) POST-PARTUM HEMORRHAGE. In a case of very severe post-partum hemorrhage, in which no contraction whatever of the uterus could be obtained, and it was evident that death would soon ensue, the author pursued the following plan with success: He took a large sponge, and having washed it in cold water, squeezed it as much as possible, and introduced it into the womb; contraction immediately took place round the sponge, and a bandage having been applied over the abdomen the hemorrhage ceased. In about three days it was expelled into the vagina, whence it was withdrawn by a string which had been tied to it previously to its introduction. (Dr. F. E. Wilkinson, p. 199.) Injection of Perchloride of Iron.-In desperate cases of post-partum hemorrhage, where kneading, compression, ergot, cold in every form, have failed, there is no better plan of treatment than that of injecting the uterus with a solution of perchloride of iron. A very convenient preparation is the liquor ferri perchloridi fortiori of the British Pharmacopoeia. Half a pint of this should be diluted with a pint and a half of boiling water and put into a deep small basin. It must be injected into the uterus by means of a syringe and a uterine tube about nine inches long. The author says, "I have hardly ever known any more hemorrhage to occur after one injection." (Dr. R. Barnes, p. 200.) PROLAPSUS UTERI.-Operation.-A case of prolapsus uteri was lately operated upon successfully at the Middlesex Hospital in this manner: An elliptical piece of the mucous membrane of the vagina about three inches and a half in length by two in breadth, from the vesical wall of the vagina. The cut margins were brought together by means of two silver wire sutures. Fourteen days afterwards rather more than an inch of the mucous membrane of the posterior and lateral walls of the vagina, including the cutaneous margin of the fourchette, was removed by a horse-shoe shaped incision. The denuded surfaces were brought together by quilled sutures, as in operation for ruptured perineum. (Mr. Norton, p. 204.) SICKNESS OF PREGNANCY.-Carbolic Acid.-Give drop-doses of the crystallized carbolic acid, liquefied by heat, and diffused in half an ounce of thin mucilage, three times a day. It will be found to act very satisfactorily, not only in the sickness of pregnancy, but in chronic cases of vomiting unconnected with pregnancy. (Mr. E. Garraway, p. 198.) Hypodermic Injection of Morphia. In intractable cases of vomiting of pregnancy inject morphia subcutaneously. A most interesting case illustrating the benefit of this plan of treatment is given. (Mr. J. Harrison, p. 255.) UTERINE SPECULUM.-Reflecting Mirror.-Dr. Sedgwick recommends as an improvement on the uterine speculum, the adaptation to it of a reflecting mirror about three inches and a half in diameter, and of five inches focal length. This is attached to the speculum by a jointed arm. The advantages of this are, the light can be concentrated on the part to be examined without much alteration of the patient's position in bed, and the illuinination obtained is itself better. It was made by Weiss and Son. (Dr. L. W. Sedgwick, p. 248.) VESICO-VAGINAL FISTULA.-The author proposes the plan of splitting the edges of the fistulous opening, so as to form two flaps, one vesical and the other vaginal. When the edges are brought together the split edges open out, and apply themselves against each other, giving a wide surface of contact. The edges are to be brought together with quill sutures. It is always necessary that the incision of the margins should pass well through any tough cicatricial tissue and reach sound areolar tissue. (Dr. M. H. Collis, p. 215.) MISCELLANEA. ARTIFICIAL RESPIRATION.-One of the convenient galvanic batteries now made by Stöhrer and others should always be at hand when chloroform is being administered, or at places where death by drowning is liable to occur, in order that a Faradaic current may be at once applied to the phrenic nerves where they pass over the scaleni muscles. There is no more effectual means of procuring artificial respiration than this. (Mr. Carter, p. 241.) Pacini's Plan of Artificial Respiration. The following plan of artificial respiration is that of Pacini, of Naples. Place the patient on his back on a table or bed, and let the operator have his abdomen against the head of the patient, and place his hands in the axillæ, on the dorsal aspect, and then pull the shoulders towards him with an upward movement at the same time. The shoulders should then be relaxed, then the former movement, and so on alternately. The air sometimes makes a loud noise when it passes the larynx. (Dr. E. P. Bain, p. 240.) DISINFECTION WITH CARBOLIC ACID VAPOUR.-The employment of carbolic acid vapour as a disinfectant is recommended in cholera or fever hospitals. The acid should be placed in a small porcelain dish which is to be floated in a larger vessel of hot water, and the heat of the latter is to be maintained by means of a gas jet, or similar means. (Dr. J. B. Russell, p. 228.) IMPROVED SYRInge-pipe for Hypodermic InJECTION.-A gold syringe-pipe may with advantage be fitted with a solid steel spear-point. By this means we avoid the liability to corrode, which is characteristic of steel needles, and at the same time are enabled to pierce the skin with ease. (Dr. T. Buzzard, p. 227.) LEAD POISONING.-Sulphates and Iodides.-The two chief remedies for lead poisoning are the sulphates and iodides. The former render the lead inert, by reducing it to its most insoluble form, and the latter eliminate it after rendering it as soluble as possible. The lead is eliminated as an iodide of lead and potassium, which is very soluble. The sulphates are most suitable for the treatment of acute cases, the iodides for chronic. As good a formula as any for the administration of sulphates is the following: Magnesiæ sulphatis 3 ij., acidi sulphurici diluti mx., tinctura hyoscami mxx., aquæ mentha piperita 3j., ter die. (Dr. E. Clapton, p. 242.) SNAKE-BITES.-Dr. Halford's Remedy.-Professor Halford's remedy for snake-bites is attracting a good deal of attention in Australia. A solution of ammonia is made of the strength of one part of strongest liquor ammoniæ to two parts of distilled water, and of this an ordinary hypodermic syringeful is injected into a vein. For this purpose an incision inust be made through the skin, and the superficial radial vein exposed. The point of the syringe inust be introduced through the coats of the vein. This has been tried upon animals, with great success, and once in the human subject. "The beneficial effect was immediate. From an almost pulseless state, and from a stupor verging on death the patient speedily became conscious." (p. 245.) INDEX TO VOL. LIX. Accidental hemorrhage, Dr. Calthorp on its diagnosis from placenta prævia 66 and its preparations, Dr. Ringer on the therapeutic action of Acupressure and torsion, Mr. Forster on Alcoholic stimulation, Dr. Gairdner on its limits in acute disease Alexander, Mr. W., on the use of Calabar bean in acute traumatic tetanus Alkaline treatment of rheumatic fever, Dr. Dickinson on the treatment of rheumatic fever, Mr. Fleischmann on the Amputation of the joints, Mr. Brodhurst on on a proposed modification of Teale's mode of Anchylosis, partial, on the treatment of Aneurism, popliteal, Dr. Watson's treatment by compression 125 sponge-tents, Dr. Bryant on the preparation of Aneurisms, surgical, Mr. Porter's artery compressor for Anstie, Dr. F. E., on muriate of ammonia as a remedy for some nervous disorders 48 on the treatment of epileptiform neuralgia Antiphlogistic, Dr. Wilks on the use of aconite as an แ 66 system, Prof. Lister on ligature of arteries on the 62 34 40 109 216 101 system of treatment in surgery, Prof. Lister on 108 Apoplexy with hemiplegia, treated by application of cold and heat to the spine respiration, Mr. Carter on application of Faradaic current to produce 241 Arteries, Prof. Lister on ligature of, on the antiseptic system Artery compressor for some surgical aneurisms, Mr. Porter's Asthma, Dr. Salter on its treatment by belladonna spasmodic, of children, use of bromide of potassium in Atropine, on the subcutaneous injection of Bain, Dr. W. P., his mode of inducing artifical respiration แ on expelling foreign bodies from the nose on the local treatment of diseases of the throat Barnes, Dr. R., on improved methods of inducing and accelerating labour Beardsley, Mr. A., on the prophylaxis of scarlet fever Mr. Harrison on its use in diseases of the bladder and urethra 125 89 91 228 240 147 260 161 144 145 194 200 212 25 89 99 100 132 Bone, M. Sedillot's operation of évidement, or gouging out diseased Bromide of potassium, Dr. Turnbull on its use in some nervous affections Bromism produced by excessive use of bromide of potassium Brunton, Dr. J., his improved mode of injecting air into the Eustachian tubes. Bryant, Mr. T., on some cases of inflammation of the breast simulating cancer on the treatment of suppurating joints by free incisions Bumstead, Dr. F. J., on the treatment of urethral stricture Buzzard, Dr. T., his improved syringe-pipe for hypodermic injection PAGE. 134 166 131 142 52 91 250 55 250 63 182 216 223 114 255 210 166 227 212 Calthorp, Dr. E., on the diagnosis of accidental hemorrhage from placenta prævia 198 bean, Mr. Alexander on its use in acute traumatic tetanus Cancer, Dr. Marsden on its treatment by arsenical mucilage Mr. Bryant on inflammation of the breast simulating Carbolic acid, Dr. Keith on its use in scarlatina, measles, and small-pox Chapman, Dr. J., his cases of paralysis treated with cold and heat to the spine Chorea, Dr. Douglas on the use of Indian hemp in 66 Dr. Wilks on the treatment of Compound fracture, Prof. Lister's antiseptic treatment of Compression in the treatment of sprains, Dr. Higgins on Constipation, habitual, Dr. Crighton on the use of tincture of colocynth in Coote, Mr. H., on the use of ether-spray in the treatment of hemorrhoids Dr. Pavy on the alleged efficacy of peroxide of hydrogen in Dickinson, Dr. W. H., on effects of remedies on uncomplicated acute rheumatism. 41 its use in disease of the heart Disinfection, Salt's new vaporizer for carbolic acid 6: with carbolic acid vapour, Dr. Russell on 252 70 67 42 223 26 142 229 228 187 177 178 180 236 38 236 74 66 64 242 159 84 163 154 215 111 122 231 124 164 81 231 97 182 201 57 97 95 98 38 25 80 229 228 |