analogous to that of the sphincter of the bowel and bladder, whose physiological design is contraction. A rigid os uteri, therefore, is a natural process out of time, rather than a pathological one." "It is simply a misapplication of a natural force intended to accomplish an important end-delivery." To restrain this misapplication of force, and obtain a co-operation of all available force for the completion of labour, the profession has had recourse to various measures, but the one remedy which will most certainly effect this purpose is opium, and it is upon this agent that Dr. McElroy relies in the management of such

cases.

A propos of this subject, and of the remark just made about our partiality for new remedies, Dr. Agnew has, in the same journal, a paper on the use of gelseminum for dilatation of the cervix uteri in the non-puerperal state. He says he has found it successful in two or three cases where even very small instruments could not be introduced, and it appears from a note to this paper that Dr. R. S. Payne, U.S., had nearly two years ago found it to be of value in two cases of rigid os uteri and sphincter perinei. Whether, however, this opinion will be endorsed by the experience of other practitioners has still to be proved. (Medical Press and Circular, December 20, 1876.)

Quinine in the Treatment of Fissures of the Nipple. -Obstetric practitioners are much more in the habit of using quinine after child-birth than they were formerly, but we scarcely expected to hear that this agent would be found useful in the treatment of an affection which has always been regarded as more amenable to local than to constitutional remedies. Dr. Le Diberder, however, chief physician to the Lorient Hospital, is of opinion that the frequent failure of local treatment arises from the fact that this affection is only a manifestation of general disorder of the system. He says that the appearance of the fissures is soon followed by a general febrile state, of an intermittent nature, and during which the local affection is very likely to pass into engorgement of the breast, and even abscess. Accordingly, he thinks quinine will prove to be of the greatest service in those cases; and during a long experience of it he has always found that a cure was effected in from three to five days. He generally prescribed a dose of six grains early in the morning, and a similar dose about eleven o'clock A.M. Local treatment was considered of secondary importance, being confined chiefly to poultices and some simple wash or salve. (Ibid.)

Extracts from British and Foreign Journals.

Treatment of Chorea.-M. Hubert Guérin, of Paris, at the conclusion of a pamphlet, in which the causes, symptoms, and treatment of chorea are well given, makes the following observations. If consulted at the commencement of an attack of chorea, when it is so to speak in the acute stage, dry cupping should be applied to the vertebral column. Attention should then be paid to the cause, constipation, worms, dentition, disturbances of the menstrual functions, pregnancy, moral emotions, &c., and finally chloral or bromide of potassium should be prescribed with the object of calming the agitation when it is considerable; and the completion of the cure may be affected by the simultaneous employment of arseniate of soda, sulphur baths, and gymnastic exercises. (Pamphlet, 1876.)

Antagonism between Morphia and Atropia. - The following are the conclusions arrived at by Dr. Corona from his experiments :-(a) Atropia quickens respiration; morphia retards and modifies it. (b) Atropia produces convulsions in dogs and rabbits, but never sleep; morphia produces sleep and deep coma. (c) Atropia slows the heart's action; morphia quickens the movement of the heart. (d) While the heart's action is being diminished by atropia, the temperature remains stationary, or is slightly increased; during the acceleration of the heart's action by morphia, the temperature falls. (e) Dilatation of the pupil is the most marked symptom produced by atropia; with morphia the pupil may be dilated, stationary, or contracted. When atropia is injected in large doses into the circulation, dilatation does not occur, because both the circular and radiating fibres of the iris are paralysed. (ƒ) Atropia always produces vaso-motor paralysis; morphia never does so. (g) Atropia depresses reflex action, and always produces paralysis of the posterior part of the body in animals; morphia either leaves reflex action intact or sometimes exalts it. (h) On post-mortem examination, the lungs, liver, and system were normal after poisoning with atropia and morphia. The heart and large vessels were always full of blood, but it was coagulated

in poisoning by morphia, fluid and blackish in poisoning by atropia. The meninges were in both cases always congested, while the brain substance was constantly anæmic. The medulla oblongata and tubercula quadrigemina were never hyperemic, while their meningeal covering was always so. (2) As regards the toxic dose, there was very great variation both in regard to the age and race of the animal. The toxic dose of morphia was much less in dogs than in rabbits. Atropia was tolerated in large doses; it never proved fatal in rabbits in less than 50 centigrammes, except in young and very small animals. Dr. Corona makes the following remarks on the alleged antagonism of atropia and morphia :-Morphia in small doses removes the symptoms produced by atropia, and produces sleep. During morphia sleep, atropia, even in very large doses, does not alter the symptoms due to morphia, nor does it affect the sleep. When atropia was injected in small doses, at intervals of ten minutes, although the total quantity was large, its action was more rapidly extinguished by small doses of morphia than when atropia was injected in a dose of not less than 20 centigrammes. The injection of the two poisons into the veins showed that a much smaller dose was sufficient to produce rapid and grave poisoning; but even then the morphia produced its action instantaneously, and its symptoms always superseded those of atropia. The injection into the veins of large doses of atropia and very small doses of morphia was always followed by sleep; and the manifestation of the symptoms due to atropia were tardy. In all cases, after the disappearance of the symptoms due to morphia, those due to atropia appeared in intensity, proportionate to the largeness of the dose administered for the purpose of counteracting the symptoms due to morphia. Dr. Corona concludes from these results that a partial physiological antagonism between atropia and morphia may be recognized, but that the theory of a mutual therapeutic antagonism cannot be accepted. Morphia is available as an antidote in poisoning by atropia, but poisoning by the former drug may not be combated by the latter. (Giornale di Medicina Militaire, April and May, quoted by Edinburgh Med. Journal December, 1876.)

Easy Method of Cleansing the Middle Ear of Infants. -Dr. Martin F. Coomes, of Louisville, states that he finds the syringe affords a very imperfect means, and the Eustachian catheter is as a rule interdicted in infants and children under five and six years of age. Therefore, after many unsuccessful attempts by Politzer's method, he tried a plan, the execution of which is simple, effectual, and easily accomplished. If the child is too young to stand, or is unruly, it should be placed in the arms of a nurse or assistant, on its back, inclined at an angle of forty

134 EXTRACTS FROM BRITISH AND FOREIGN JOURNALS.

five degrees. The nozzle of a suitable air-bag is placed in the nose just as described in Politzer's method. The surgeon is now in readiness, with the air-bag in one hand, while the other retains its nozzle in position, and at the same time closes the meatus of the opposite side. A teaspoonful of water or milk is put into the child's mouth, which compels it to swallow; and just at the time the act of deglutition is performed the air-bag must be forcibly compressed. In this way the infant's middle ear can be cleansed as thoroughly and easily as an adult's. There is no danger in the operation. The only precaution necessary is to see that the child has no foreign body or substance in its mouth, which might be blown into the trachea, If the whole teaspoonful of liquid that is put into the child's mouth should be forced into the larynx, it would do no harm. The slight strangulation that occurs in those cases amounts to nothing; in fact, its occurrence is very rare. This method of inflating and cleansing the middle ear of infants has the following advantages :-(1) The assurance of success in every case where the Eustachian tubes are pervious, and in a normal condition; (2) The ease and rapidity with which it can be accomplished; (3) It is applicable to a class of patients who will not permit the use of the Eustachian catheter, and who are unable to understand what is necessary on their part for the execution of Politzer's method, viz., a certain class of deaf-mutes and insane persons. (The Cincinnati and Medical News, March, 1876).

A New Method of Treating External Aneurism.-Dr. Walter Reid, R.N., gives the details of a case of popliteal aneurism which he successfully treated with Esmarch's bandage. He had already tried flexion and Carte's tourniquet, but, these means failing, he proposed to try the elastic bandage. It was passed very lightly over the tumour, and carried as high as the junction of the lower and middle thirds of the thigh. After fifty minutes, the patient having complained of severe pain above the seat of the constriction, a Carte's compressor was applied to the femoral at the pelvic brim, and the elastic tubing removed. The compressor was used as a precaution to prevent the blood-current through the main artery from breaking down and washing away the newly-formed clot which it was expected had formed in the sac. When the compressor was stopped a few minutes afterwards, no pulsation could be detected in the aneurism. The cure was complete. (The Dublin Journal of Med. Science, December 1st, 1876.)

Department of Public Health.

NINE PROPOSITIONS BEARING ON THE ETIOLOGY AND PROPHYLAXIS OF CHOLERA, DEDUCED FROM THE OFFICIAL REPORTS OF THE CHOLERA-EPIDEMIC IN EAST INDIA AND NORTH AMERICA.

BY DR. MAX VON PETTENKOFER.

Professor of Hygiene in the University of Munich.

I.

The Indian Report.-The reports of the Sanatory Commissioner with the Government of India, Dr. James Cuningham, on the presence of cholera in its proper home, with additions by Dr. Bryden, Dr. Douglas Cunningham and Dr. Lewis, have been published for twelve years. These Indian reports stand pre-eminent in the literature of cholera, on account of the extensive observations on which they are based and the strict method on which they were conducted, and have the advantage that they do not regard the facts in the light of modern views, or give only what is in accordance with the knowledge of the day, but consider cholera in the widest possible sense as an epidemic, and adduce a number of facts which are opposed to the prevailing views.

James Cuningham long delayed to draw any positive conclusions; these, however, appeared in a definite form in 1872, and differ considerably from those which are still generally accepted by physicians throughout the world. In his tenth annual report, 1873, Cuningham has summed up his views in the following nine propositions:

"1. That if human intercourse play any part in the dissemination of cholera, it must be a very secondary part.

"2. That the facts of individual outbreaks, and especially the remarkable immunity of the attendants, are altogether opposed