bandage, the eye made a good recovery. The secondary cataract, which remained after absorption of the lens had taken place, was subsequently operated upon by dissections with the effect to bring vision to 8. The result remained stationary.

CASE III. A ten year old girl received an injury to her left eye while playing with a penknife. When called, two hours after the accident, I found a longitudinal, gaping wound of the sclerotic, running from the insertion of the inferior rectus to and beyond the corneal border, with prolapse of iris. Irritative symptoms were but slight. Vision, as far as could be ascertained, was fair. I cut off the small protruding piece of iris, united the scleral wound by catgut sutures, without making the least traction, and covered the wound by conjunctival flaps. Under atropia and compressive bandage, my patient made a speedy recovery, with reestablishment of full sight. Background of the eye was normal. This favorable condition kept on for about eight months, when cyclitis developed, which ultimately led to total blindness.

CASE IV.-A 39-year old laborer came under my notice seven hours after he had suffered injury to his right eye, with the following condition: Penetrating wound of the lower lid in its inner third; lacerated wound of the sclerotic, running in an oblique direction from the caruncle to the lower margin of the cornea, with prolapse of iris and ciliary body; eyeball soft; conjunctiva chemotic; anterior chamber full of blood; only quantitative perception of light. I cut off the prolapse, and brought together the edges of the sclerotical wound by catgut sutures. The wound of the lower lid was stitched up with silk and silverwire sutures, and a monoculus applied to the eyeball. The after-treatment was out-door and irregular. The patient returned to his work the same day of the injury, and presented himself at irregular intervals only. But no reaction whatever took place, and the wounds closed very rapidly. The lens remained transparent until the second week, when opacity developed, which rapidly led to cataract. Quantitative perception of light and projection remained intact. There was no change in the condition during a further observation of two years.

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ON THE TREATMENT OF HA-
BITUAL CONSTIPATION.

THE

BY ALFRED S. GUBB, L R.C.P., M.R.C.S., Resident Medical Officer, French Hospital, London. HE treatment of habitual constipation is one of the most ordinary, and, at the same time, one of the most important and puzzling problems in clinical practice. It is the common fault of the greater proportion of the numerous remedies in the therapeutic arsenal, employed with this object that they either produce too rapid, too violent, or too drastic an effect; that they are either weakening in their after-result, or that they will not produce their characteristic effects through any lengthened period of time. One of the first and commonest impediments to the use of drugs in the treatment of habitual constipation, is that the use of aperients in such cases, even when effectively employed in the first instance is apt to produce a reactive effect in the opposite direction, and it is the commonest difficulty in the treatment of cases of the kind, that either medicines so potent need to be used as to cause injury by weakening the patient, or by depressing him so that, however successful the treatment may be in the beginning, it ceases to be effectual after a short time has elapsed, and often ends in producing results which are to be deprecated as more injurious than the conditions which the treatment was intended to remove. To overcome this difficulty many artful and ingenious combinations have been made. The number of aperient pills, the complicated products of the ingenuity of experienced practitioners, is endless, and there are very few physicians far advanced in life, who have not at their fingers' ends a series of complicated formulæ, in which remedies of the most diverse and often of the most opposite character, are harnessed to the pharmacological car, and made to pull in so many different directions that it is difficult to say to which element in the mixture the good or bad effect is to be attributed. The very number and complication of these specifics, and the varying and excessive popularity of the more heterogeneous compounds of empirical remedies, indicates at once the complexity of the problem, and the difficulty of its solution.

It is not surprising under these circumstances that of late years practitioners have looked more and more to those medicinal waters which nature

conclusions of other clinical observers that this water, which has been too little regarded in this country, has the especially valuable characteristic that, instead of its being necessary to administer it in increasing doses as the patient becomes accustomed to its imbibition, the dose may, within certain limits, be progressively diminished, and when left off it does not entail any tendency to constipation. With these facts before me, I have lately employed Friederichshall water in practice, and have used it somewhat extensively at the French Hospital, with results which seem to me so encouraging that I desire briefly to place on record some of the observations which I have made.

In one series of cases I employed it simply as a corrective of habitual constipation. I administered it in doses of from half a tumbler upwards, taken early in the morning, and combined with an equal proportion of hot water, this being the most effectual method of administering the water for this purpose. I used it largely for persons of both sexes, and it seemed to be especially advantageous as a mild laxa

There are also some Hungarian waters more or less extensively used, most of which belong to the same type, such as the Æsculap and the Victoria (Offner). All these waters owe their undoubted efficacy more especially to their richness in the aperient sulphates, and it appears from the results of clinical experience to be in excess of that which can be obtained by artificial compounds presumably of similar composition, to all of which, indeed, the objection stated above applies, viz., that their physiological and therapeutical activity becomes im-ative, exceedingly well fi.ted for all ordinary paired by continuing use.

Recent researches, and especially those of Professor Matthew Hay, of Professor von Mering, of Strasburg, and others, have shown that this defect in the natural solutions of the aperient sulphates is largely corrected when they are combined with the chlorides. The chlorides have been shown to be extremely effectual, not only in aiding diffusion changes, but also in stimulating intestinal action. These observations have caused renewed attention to be given to the clinical observations of the earlier physicians of this country and on the Continent, in the use of that which is, perhaps, the oldest and best known of the aperient mineral waters, viz., Friederichshall water. Von Mosler ascertained by careful clinical ob. servation and physiological experiment with Friederichshall water, that it not only has valuable and considerable laxative powers, but that it does not affect or disturb the general health, and that it increases the appetite. He found also that small doses do not diminish the weight of the body even when continually used, and that it has a remarkable effect in causing an increased secretion of urea. To the ordinary aperient effect of the sulphates, it adds a considerable power of promoting tissue change, and Sir Henry Thompson has confirmed the

cases, and this more particularly for persons of delicate constitution, for women, and for all other persons in whom the object is to produce an aperient effect, which should not be too drastic, nor productive of constitutional disturbance. It is often a great object to be able to produce a distinct laxative impression without disturbing the digestion or interfering with the ordinary daily occupation of patients engaged in business pursuits, and by no other means have I succeeded so well as with this particular water.

THE USE OF THe hypodermic
SYRINGE IN TYPHOID fever.

I

BY A. MARCY, M.D.

DESIRE to briefly call the attention of the profession to the use of this muchabused instrument in the treatment of typhoid fever. I say much-abused, because I have heard of those who refuse to use it for the relief of pain, because of a tendency in certain chronic cases for the patient to take the matter into his or her hands, and thus endanger their health and form a dangerous habit. Certain instrument makers in Philadelphia have remarked to me the frequency of its use by ladies suffering with neuralgia, whose sensitive nerves made

them frequently send needles to them to be sharpened, to lessen the pain of puncture, and thus betraying a habit which all right-minded physicians would strive to prevent. This only shows how easy it is for doctors to allow one of the most important means of relief to become an instrument of evil, by not keeping it under their own control.

With this introduction, I proceed to a fuller delineation of the subject in hand. Years ago I became impressed with the great advantage to be derived from this method of medication in all forms of collapse, or approaching collapse, having been impelled to use it in the cholera epidemic in 1866, when the depressing effect of the blood poison, whatever it may be, induced this condition without any correspond ing frequency in the number of discharges from the bowels or severe pains to make it. Indeed, as observed by myself, the depression came so suddenly and so completely, that in most instances the terrific cramps and numerous dejections of earlier epidemics, were frequently wanting. I suppose phenomena so universally observed by myself must have been common to those engaged in active practice at that time, and I can recall instances during that epidemic in which the hypodermic method of treatment not only brought relief to intense suffering, but tided the patient over the point of fatal collapse, and resulted in recovery. The experience of that period in the use of such drugs as morphia, strychnia, atropia, and chloral, induced me to look upon this method as one of the greatest importance in all cases where through sudden and violent depression of the nervous system, whether by blood poison, exhaustion, or shock of a traumatic origin, stomachic absorption had been impaired, in common with all the other vital functions.

and other evidences of prostration make one feel the necessity of using arterial and nervous stimulants by the mouth, I have often found great advantage from the use of the same remedies hypodermically twice in the twenty-four hours, in doses which would seem almost hazardous. I have frequently given from the sixteenth to the twentieth of a grain of strychnia night and morning in this way, while giving the same drug in other combinations by the mouth in the usual doses, and with the usual frequency. When the heart's action is uncommonly feeble, ten to fifteen minims of the tincture of digitalis should be given in addition every night and morning.

The advantages of the hypodermic method of medication in these cases is, first, to produce a sudden impression of an arousing character upon the nervous system, and through it upon the circulation. Second, to allow the digestive organs to proceed undisturbed with the functions of digestion and assimilation.

It is not my purpose to speak in this paper of the wonderful results seen in actual collapse, whether of traumatic or other origin, as my design has been to bear testimony to the therapeutic value of this method of medication in typhoid fever. But I will only add that the same general principles of treatment have given me the greatest satisfaction in many, many instances of that kind. It will not be amiss to state here that there is no necessity to be too timid in regard to dose. From the sixteenth to the thirty-second of a grain of strychnia can be given twice daily, at intervals of ten to twelve hours, according to the severity of symptoms, and temperament and age of the patient; and while remembering the usefulness of the hypodermic method of administration, not by any means to lose sight of the usual and Now, every one knows who has had any ex-general plan of treatment as each case may perience in typhoid fever, that at some period of the disease, either through the various complications that may arise in the course of the disease, or perhaps by the exhausting effects of long-continued high temperatures, say from the fourteenth to the eighteenth day, there is apt to be more or less disposition to collapse of the nervous and circulatory systems. I know of no way in which this can be met more readily and successfully than by the administration hypodermatically of strychnia alone or in combination with digitalis.

require.

The writer feels confident that he has seen life saved many times when death appeared almost inevitable, by assisting the general plan of treatment in this way.

THE City of Paris has lately appointed a lady as medical examiner of girls throughout the local schools. It will be her business to see that the girls are not overworked, and that they get through their studies under sanitary condi

Even earlier in the disease, when subsultus tions.

PESSARIES IN THE TREATMENT theory the pessary worked on was the mos

OF UTERINE DISPLACEMENTS.

A

BY J. R. JACKSON, M.D.

nearly correct of any in use; and they then asked me if the instrument was used much in America, and what our American doctors thought of the pessary and the theory of application. I must confess I was a little ashamed to tell them I did not know what American phy

got out of it by saying, "The instrument was quite a new one, and had not been thoroughly tested yet, but the physicians who had used it thought very well indeed of it." My attention being thus drawn to this pessary, I have given it a thorough trial since coming home, and have been able to hold the uterus in place with it in cases where I had utterly failed with all other kinds. The theory of Dr. Herrick, the inventor of this pessary, is that all forms of retro displacements are but different degrees of prolapse, excepting, of course, accidental displacene87from falls or other injuries where the uterus is suddenly thrown into a retro position. But all cases which come on as the result of weakening of the natural supports of the uterus, such as laceration of the perineum, want of tonicity of the vaginal walls, or but involution of the uterus, where that organ is too heavy for the weakened vagina and ligaments to hold it in position, both he and Professor Fitzgibbon, in the article before referred to, claim, are but cases of prolapse originally. The results obtained here by myself and others in the use of this pessary, and the experience in London and Paris of capable men, surely point to the truth of the theory advanced by the in

BOUT two years ago I read an article in a medical journal, written by Dr. Fitzgibbon, of London, England, on the above subject. In that article he especially recom-sicians thought of an American pessary, so I mended Dr. Herrick's pessary, and his theory of treating displacements of the uterus. At the time of reading his article, I thought perhaps the writer was unduly carried away with a to him new thing. Still I was quite favorably impressed after reading his paper, for the theory looked to me as being nearly correct. That theory, as I remember it, was that all displacements of the uterus backward were always preceded by prolapse, and that the uterus in descending simply followed the different pelvic straits; and when the prolapsed uterus was in or at the lower strait, the fundus of the organ must be in a condition of retro-version, as the os must be somewhat higher than the fundus at that point. Every physician will, I think, agree with me, that the os, if it protrudes at the vulva, must be somewhat elevated in order to follow the curve of the pelvic cavity. If this point is conceded, then the theory seems rather plausible. The article before mentioned claimed that to overcome such displacements the uterus must be elevated to its normal height and held there; also that the pessary should make pressure against the anterior portion of the uterine neck instead of against the posterior of either the neck or fundus; in other words, the pessary should push the uterine neck upward and backward toward the hollow; or, better still, the promontory of the sacrum; and, if the pessary held the uterine neck in that position, the fundus must stay forward towards the bladder, or the laws of gravity be reversed. Soon after reading Professor Fitzgibbon's article I went abroad, visiting the colleges and hospitals of London and Paris while away. To my surprise I found quite a number of these pessaries in use in both places. Of course, there were other American pessaries in use there, such as Hodge's, Cutter's, Thomas's, and others, but, I think, quite as many of Herrick's as of either of the others. I asked some of the physicians using them how long they had been in use there, to which they replied "only a year or two," and gave as their reason for preferring them, that they thought the

ventor.

Foreigners are not apt to take up any new thing originating in this country, unless they have exceptionally strong evidence of its utility, and I am free to confess that it was their notice and indorsement that first led me to fully recognize the merits of instrument and theory.

I could give the history of fifty cases treated by this plan and with this pessary with the most happy results, where many other pessaries of the most approved make had failed, both in my hands and in the hands of other physicians, but each case would be but a repetition of the other.

I will simply say in conclusion, that I do not know either Dr. Herrick or Professor Fitzgib bon, and have not the slightest interest in them or the pessary in question, but I simply write this article to call the attention of the medical