of the organ are fixed by forceps, and the operation proper is commenced. With a long narrow-bladed bistoury a flap two, three, or four millimeters thick, according to the thickness of the tissue, is removed from the demicircumference of each lip. The mucus is thus abraded so as to form two excavations with their cavities opposed to each other; the mucus on the sides of the cervix is carefully preserved, as it is necessary for the regeneration of this tissue. The external orifice is widely opened, and the cavity of the cervix is stuffed with iodoform gauze. Dr. Bouilly has performed this operation forty times with only one faliure, and twice conception has taken place in women who had been sterile for a long time. As little hæmorrhages have taken place after operation was completed, the packing with the gauze should be carefully done.

RECTUM GONORRHOEA IN THE FEMALE.Dr. R. J. Nunn reports ("Southern Med. Rec.") the case of 18-year-old single nullipara who complained of a continual burning pain in the rectum, all the discharges from which were more or less purulent, and if solid were coated with pus. There was also an annoying tenesmus. These symptoms had existed for several days before her visit to Dr. Nunn, three days before which she had ardor urinæ, followed in two days by a vaginal discharge, or whites. There was no constitutional disturbance, but the facial expression of the patient showed marked evidence of suffering. Dr. Nunn regarded the case one of gonorhoea, although the social position of the patient was such that her regular medical attendant had not conceived it possible. The patient admitted the accuracy of the diagnosis, giving a date three weeks anterior to her visit as the only possible time for inoculation. Physical examination revealed much inflammation of the rectum, vagina, urethra, and mucous membrane. There was considerable endocervitis, with erosions of the os and endocervium ectropium. The disease had invaded the cervical endometrium, and probably soon would have extended into the body of the uterus and the fallopian tubes. Treatment was begun with the result that the condition of all accessible parts was ameliorated, and the more painful and annoying symptoms disappeared. In a month an intense peritonitis and salpingitis occurred, accompanied with a copious purulent discharge from the os, from which she made a good re

covery in ten days. The treatment followed was copious aseptic injections and douches, followed by injections of petrolatum liquidum into the rectum and urethra. The vagina was washed with petrolatum through a speculum, and tampons saturated with it were inserted and changed daily. The endometrium was treated with tents of cocoa butter. The progress of the case was satisfactory as to all accessible parts. The con

dition of the adnexa remains in doubt. Rapid relief of the rectal symptoms followed the injection of a couple of ounces of petrolatum, and continued from twelve to eighteen hours. The point of interest is the mode of accession, the disease first manifesting itself in the rectum, and its subsequent extension to the urethra, and lastly to the vagina. Implication of the rectum is exceedingly rare except in case of direct inoculation, which Dr. Nunn is confident, did not occur in his case.

ABNORMAL BIRTHS AND CEREBRAL DIS. ORDER.— Dr. Newmark concludes (“Pacific Med. Jour."): In children still-born or dying shortly after birth, congestion or oedema, and hæmorrhages are usually found in various important viscera. The hæmorrhages occur in cases delivered naturally or by version or by forceps; through normal and abnormal pelves, in primiparæ and multiparæ, with large and small children, in "easy" and difficult, rapid and prolonged labors. The hæmorrhages are, however, most frequent and most severe in children subjected to much pressure by the parturient canal, or instruments, or the hand of the attendant, especially when delivered by the lower extremity. Cerebral hemorrhage is more frequently found in still-born children delivered by the forceps than in those born by the breech, and in these latter more frequently than in those born naturally by the head. These hæmorrages and the accompanying injuries are in many cases the cause of the still-birth, and when not immediately fatal, may be followed by the gravest consequences. Premature rupture of the membranes, by artificial dilatation of the parturient canal (when necessary), by restricting the employment of version and other artificial manipulations to urgent cases, and by preferring cephalic to podalic version in cases suitable for the former. The use of the forceps should be absolutely limited to cases in which there exists some pressing danger to mother or child, and it should never be employed merely to shorten labor.

THE LINEA FUSCA IN CHILDREN.-Dr. Adsersen of Copenhagen ("Jour. of Cut. and Genito-Ur. Ds.") has examined two hundred children with regard to the existence of the pigmented abdominal line reaching up from the pubes towards the navel, and which is regarded as characteristic of the first pregnancy. Of these 105 were girls, ninety-five boys, of fourteen days to thirteen and a half years. Out of these children 128 had the characteristic linea fusca or pigmented median abdominal line of pregnancy. Of these seventy-six were girls and fifty-two boys. Its frequency increased with age. In half of them the color was quite pronounced, and in the other only indistinct. Brunettes seemed more predisposed than blondes, though not especially. In eight of the children the line reached above the umbilicus, and in some even up to the ensiform cartilage. Deviations to the right or left of the median line, as Schoenberg has described in adults, were observed in several. Adsersen concludes that this line of pigmentation is not to be included in the characteristic signs of pregnancy, as besides being found in children it may be observed in diseases of the genital tract, as for example, in uterine myomata. A suitable condition of the patient's soil is essential to the propagation and perpetuation of inflammatory pneumonia upon the urinary tract-after microbic invasion. This condition, intensified, by traumatism and physical weakness, notably of the degenerative variety, is most intense when there is vesical distention with atony, and when the ureters are dilated and the kidneys involved in the changes incident to tention below-namely, atrophy, and sclerosis above, with or without surface catarrh. Under these circumstances surgical pyelonephritis is most likely to declare itself as a result of microbic infection from below (occasionally from above)-in the course of suppurgative disease or after operative interference. Asepsis, antisepsis, and sterilization of urine are ends to be aimed at in genito-urinary surgery-but, like all other geatest goods, not yet attained in perfection. Much, however, can be done by local means in a prophylactic and curative way, little by internal medication, and possibly as much or more than by any other means by flushing the urinary passages with natural mineral waters.

SURGERY AND OPERATIVE GYNECOLOGY. LARGE HERNIE IN BOYS.-Dr. Szuman holds ("Therap. Gaz.") that as soon as a congenital hernia shows signs of increasing opera

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tion should be undertaken, especially when the retention apparatus is not efficient. He operated on a child aged two years, with a scrotal tumor hanging to the knees. He dissected the neck of the hernial sac from the surrounding structures of the cord, freeing this sac to the external ring. A ligature was then placed as deeply as possible and the wound was tamponed with iodoform gauze. Two years later the child came under observation; the cure was found to be perfect. A second child operated on was fourteen months old. Four and a half years later the cure was found to be permanent. The third child was three months old when operated on. Eight years later the cure was perfect. The fourth child had a colossal double scrotal hernia. In these operations free dissection of the neck of the hernia was extremely difficult. The dissection should always be begun high up, since here it is easier. When it cannot be completed in the lower part of the scrotum, as is often the case in congenital hernia, this portion is cut off and drained.

CEREBRAL INJURY BY CONTRA-COUP.—Dr. F. J. Allen ("Birmingham Med. Rev.") states that when the skull is struck forcibly at a particular region-say, the occipital-the comparatively rigid cranium is driven, as a whole, away from the point of impact (forwards in this case); but the brain, owing to its softness, lags behind, and tends to flatten itself against the cranial wall on the struck side (occipital). This may cause direct injury. But the cranial wall here supports the brain-substance, and distributes the force of the blow over a wide area, rendering the injury less acute. The chief injury occurs on the opposite side (frontal), where the lagging brain tends to move away from the cranial wall, and receives no support from it. At the center of the unsupported surface there is a point from which the soft brain-substance is tending to depart in all directions in the act of flattening itself. At this point of greatest strain the rupture will ocAfter the first rupture waves of oscillation will occur, and these may increase the injury. If detachment of the dura mater can be caused by contre-coup, as some observers have affirmed, it should be the result of exhaust or suction at the moment when the brain recedes from the inner surface of the cranium. This so-called contre-coup detachment of the dura mater is said to occur only in the squamous region, where the dura mater is not so strongly attached to the bone as in other regions.

cur.

AMERICAN JOURNAL OF INSANITY.

[To the Editor:] I have the honor to announce that the "American Journal of Insanity," which has been edited and published at the Utica State Hospital for the past fifty years, has lately been sold to the "American Medico-Psychological Association," of which society it will henceforth be the accredited organ. The journal will be edited ad interim by a publication committee consisting of Dr. Edward Cowles, president of the association, Boston, Mass.; Dr. Henry M. Hurd, secretary of the association, Johns Hopkins Hospital, Baltimore, Md.; and Dr. Richard Dewey, Chicago, Ill., with the last named gentleman in immediate editorial charge. Until further notice it will be published in Chicago, Ill. Bespeaking for the "Journal," under its new and favorable auspices, your generous encouragement and support, and thanking you, as exeditor, for innumerable courtesies in the past, G. ALDER BLUMER, M. D.

Utica, N. Y. HYDRASTININE HYDROCHLORATE, according to Dr. H. C. Wood ("Univ. Med. Mag.") is a heart tonic and will prove a valuable remedy in cases of cardiac weakness, and certainly should be tried with this object. It is a much safer remedy than hydrastine, as even in toxic dose it does not directly depress the heart. Its influence as a calmative depressant of the brain and spinal cord, conjoined with the stimulant action upon the heart and arterioles, should render it a very valuable remedy in cases of general feebleness and lack of circulatory power, occurring in hysterical women and men; and when to these powers are added the extraordinary influence it possesses over the uterus, its probable importance grows. In all forms of menorrhagia, whether due to simple atony, to fibroids, or even more severe organic disease, hydrastinine is a very valuable remedy.

His own experience accords with much that has been determined in finding that it is distinctly more powerful than ergot. The arrest of the hæmorrhage is usually so prompt that it hardly can be due simply to vascular contraction; and there seems little reasonable doubt that the alkaloid is a powerful ecbolic. It is notorious that ergot frequently fails to act, while Archangelsky found that in pregnant animals hydras

tinine invariably induces pronounced rhythmic contractions of the uterus. Moreover, Faber, as the result of a number of trials upon women, states that, given hypodermically during labor, hydrastinine very notably increases the force and length of the uterine contractions, causing a spasm which affects all portions of the organ, and is similar in character to that provoked by ergot; in some of the cases there was uterine tetanus, lasting as long as fifteen minutes. Faber also asserts that distinct contractions can be produced in the unimpregnated uterus.

PIPERAZIN.-Dr. John Gordon concludes anent piperazin-schering ("Brit. Med. Jour."): Piperazin is not wholly oxidized in the body, and may be detected in the urine of those to whom it is exhibited. Piperazin in solution of 1 per cent in normal urine, when kept in contact at a temperature of 39°C. (body temperature) for a given time, has the property of dissolving to a great extent fragment of uric acid calculus. That the stronger the solution of piperazin in urine (up to 7.5 per cent) the earlier did the solvent action begin and the more rapid was the completion. That, notwithstanding this, with the stronger solutions of piperazin in urine the rate of solubility was not so markedly rapid over the weaker solutions as might be expected. That the solvent action of piperazin in similar circumstances was greater than any other of the substances that were employed, viz: borax, lithium citrate, sodium carbonate, and potassium citrate. That piperazin, in weak and strong solutions in urine, converted the undissolved portion of the calculus into a soft granular or pulpy condition. That neither borax, lithium citrate, sodium carbonate, nor potassium citrate in similar circumstances rendered the fragment of calulus soft or pulpy.

CERIUM OXALATE IN THERAPY.-"Food," remarks that "from the fact that cerium oxalate proves a satisfactory remedy in most cases where silver nitrate is generally employed, and that it is, moreover, a tonic and sedative that may be administered freely without discoloration of the skin, it would seem as if this drug were worthy of a thorough trial in the treatment of epilepsy, chorea, and allied convulsive diseases." The "Medical Age" is of the same opinion.

ALABAMA.-Dr. S. F. Johnston of Lauderdale died July 3.

CALIFORNIA.

Dr. S. S. Kahn has been appointed San Francisco city physician.

COLORADO.-The state board has licensed Drs. Frank A. Pruitt, George Atcheson, F. Milton Friend, Earl H. Fish, Thomas E. Evans, E. Mildred Wood, James M. Woodruff, James G. Hopkins, Chauncy E. Tennant, Wilbur W. Bulette, Leander P. Kapp, Hattie Bedortha, James F. Kearns, Alfred Richardson, Catherine P. Hayden, George P. Powell, Rufus L. Robinson, Vivian R. Pennoch, Oscar C. Huffman, Reed D. Burnham, James T. Muir, Sarah J. Fearing, Frank G. Jones, Evaline M. Maguire, Carlton M. Maguire, Elsie R. Schmitz, Seymour T. Jarecki, Frank Embery, Benjamin L. Jefferson, Daniel McSweegan, Caroline H. Marsh, Gottlieb Schick, Joseph E. Milligan, Martha F. Miller, H. W. Rover, A. R. Timmerman, H. G. Anderson, William D. Lewis, J. T. Ball, R. J. Pease, W. L. Schenck. Officers of the board elected were Dr. C. N. Hart of Denver, president, and Dr. J. N. Hall of Denver, secretary. -Dr. T. J. Melvin of Sagnache has been appointed pension examiner.

CONNECTICUT.-Dr. F. S. Quackenbos of Hartford died July 1.

DAKOTA, SOUTH.—Dr. J. Stensgaard has located in Dell Rapids and Dr. Torrance of Keithsburg Ill., at Deadwood.

GEORGIA. Dr. W. H. Marr of Maryland died June 29.

ILLINOIS.-Dr. Wait has located at Kappa.-The state board has licensed Drs. C. G. Buford, W. H. Bradley, C. E. Stockert, Martha A. Winegar, and W. Kincaid, Chicago; A. C. Eakin, Shirland; H. A. S. Hartley, Keokuk, Iowa; M. C. Moore, Vincennes, Ind.; W. F. Reynolds, El Dara; Nellie M. Conkling, Manito; H. H. Jones, Peoria; B. H. Fortuondo, Belleville, and A. A. Wilson, Auburn Park; P. D. Carper, Esrreger, E. E. Rohrerbaugh, Dion Thomas, M. A. Reddle, L. F. Scott, T. Nokamun, Elenore, Chicago; John Egert, Crossdale; W. H. Elder, Bloomington; J. S. Niven, Leland; J. H. Sams, Wheatland; C. H. Hamilton, Hillsboro; H. W. Daniels, Alpa; J. H. Close, Buffalo Prairie; H. R. Cledhill, Jerseyville; E. S. Lucas, Peoria; William H. West, Waterford, Pa.; J. L. Hayes, Baldwin; W. P. Schierding, Palatine; Thomas Faith, L. Ganson, William J. Butler, L. Haecker. S. K. Sessons, A. L. Brown, J. H. McVay, Chicago.-Dr. Chapen of Melvin has been appointed assistant in Jacksonville insane-hospital. Dr. T. E. Freeman of Oberlin, Ohio, has located at

Oregon.-Chicago—“Dr.” McCandless is a graduate of the Chicago Physio-Medical College, the successor of the Chicago Physio-Medical Institute, which, prior to 1891, had been conducting a medical school. He made an application to the state board for a certificate April 27, 1893, and on December 16, 1893, the application was refused. McCandless claimed to have complied with all the rules of the board. The evidence, however, showed that his education prior to his course of medical study comprised only a common school education, and that he was not a graduate of a scientific or literary college, as set down in the rules of the state board of health. Since the hearing of the case he produced a teacher's certificate from a private school in the north of Ireland. In deciding the case Judge Windes said: "It does not appear that any examination was ever held by the officers of the college to which the relator was admitted, except a mere conversation. That the college waived this examination will not avail McCandless, as it was a rule of the state board that this examination should be made. It is admitted that the institute was recognized by the board as being a college of good standing, but the evidence does not show that the board has ever recognized the Physio-Medical College as being a college of good standing. By an investigation a committee of the board determined that the college was not a college of good standing. The relator claims that this action deprived him of a property right without due process of law. In this investigation by the board I do not think, however, that the proper action was taken. The evidence shows that the college never had a hearing before the full board, neither was it notified that an investigation was to be made. I think that the board went beyond its power in this regard, but as the relator has not complied with the rules of the board, the be denied. Dr. Alex Thummler writ will committed suicide June 28.-Dr. A. Church has removed his residence to 4927 Madison avenue.— Dr. Sidney Sawyer died July 12 at the age of 84.Drs. J. H. Apperson of Bourbon and John Lowry of Flora died recently.-Dr. W. A. Barker ot Waukegan died July 6.

INDIANA-Dr. B. S. Hunt has located at Winchester. Dr G. W. Poyneer of Fort Wayne died July 4, Dr. E. M. Smith of Calloway July 15, and Dr. E. Newland of New Albany July 14.-Dr. A. C. Farron died at Worthington.

INDIAN TERRITORY.-Dr. J. K. Hiestand of Ordmore died June 28.

IOWA.-Dr. F. Joerger of Lowden died July 12, Dr. W. R. Smith of Sioux City July 1, and Dr. C.