ing to be felt in the utero-rectal pouch, though there is tenderness of the uterus. She takes food and brandy well. The wound is cicatrized well; the sutures all out; the pedicle. is nearly all removed. To-day (the eighth after operation) the pulse is 112, and temperature normal. On the third day she had a rather severe pleurodynia of the right side, just such as she had suffered ten days prior to operation. It was entirely relieved in twelve hours. There was no cough and the ausculatory sounds were normal, excepting a slight prolongation of the expiratory murmur, and a little, not well marked, dulness at the apex of the right lung.

Dr. Logan reported the case of a lady who had been subject to attacks of hæmorrhoids. Was consulted for painful defæcation. Made rectal examination; found thickened mucous membrane; no fissure or ulcer. Made forcible extension of the sphincter muscle and gave opiate. She was relieved temporarily, but the distress returned in a week. Pushing the investigation further, he discovered a mass of impacted fæces quite high up. This was broken down and brought away, with prompt and entire relief. Inquiry elicited the fact that the patient had been for a time in the habit of eating ground-peas, which was probably the cause of the fæcal impaction.

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Dr. Woodhull reported the case of a woman of forty, with phthisical tendency. Menses had ceased for two years. good deal of gastric irritability and daily rejection of food from the stomach for three years. He suspected a uterine trouble was at the bottom of the gastric irritability. Inquired into the state of the uterus. She had had some such trouble some years ago-not conscious of any now. He reasoned that uterine irritability might exhaust the ganglionic system of nerves and thus induce the want of tone in the stomach; he therefore put her upon one drop of wine of ipecac. every hour. Under this treatment the vomiting ceased and the appetite increased very markedly. He thought the sequence of the improvement upon the treatment very striking. He has had favorable observation of the use of the one drop dose of the wine of ipecac. in the nausea of pregnancy.

Dr. Flewellyn had observed in the treatment of dysentery that ipecac. was often salutatory, but had observed that when he had good effect from the ipecac, there was always catharsis, and suggests the inquiry whether there was not catharsis in Dr. Woodhull's case.

Dr. Woodhull replied there was not.

Dr. Battey called attention to the plan of breaking up impacted fæces in the female by bringing the mass between the firm wall of the sacrum and the two fingers passed high up into the vagina. He thinks this expedient new; it certainly is original with himself; but it is hazardous to claim anything as absolutely original at the present day. The mass by this method is easily broken up in most cases, and the disintegrated masses are pushed out at the anus into a napkin. By this method we may overcome the very great repugnance of ladies to rectal manipulations, as well as avoid the disgusting fæcal odor which clings so tenaciously to the hands of the operator.

Dr. Logan said the method was certainly new to him, and he should try it when another suitable case offered. He thought, however, in the case he had reported, the impacted mass was so firm and hard that there would be danger of injury to the rectovaginal wall in the adoption of the expedient of Dr. Battey.

Dr. Connally related a case of fæcal impaction of long standing remedied by mechanical removal. The mass was larger than the double fist, and of the consistency of stiff putty. Adjourned.

Our Exchanges.

SPORADIC MALIGNANT CHOLERA.-Dr. Willis Alston, of Littleton, N. C., reports, New York Medical Journal, February, 1875, a case resembling malignant cholera generated de novo in an isolated village. The patient was a young man of nineteen, who, on the day before the attack, "walked four miles in the hot sun, with a looseness of the bowels, and bathed in a mill-pond while he was warm and perspiring. He bathed in another pond of stagnant water soon afterward. In this pool of dirty, slimy water he played about two hours, under a burning sun, and it is likely also that he swallowed some of the dirty water; he came out, and walked home in the afternoon; soon after getting home he purchased a large quantity of blue plums, unripe, and ate as many as he wanted; slept in a close, unventilated, dirty room adjoining

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his father's store, and was taken violently ill after midnight," 18th July, 1873. The symptoms were identical with those of a patient with Asiatic cholera, and he died in thirty hours. Dr. Alston observes: "Taking the above case upon its symptoms alone, without going into the origin or exciting cause, we would necessarily be compelled to recognize the disease to which they point. and with such data I am forced to the conclusion that I was dealing with cholera." He says that there was "for the past two or three summers a good deal of diarrhoea and dysentery" in the village. 1873 was a cholera year, when "people are more liable to have simple and choleraic diarrhoeas, which all the authorities say if let alone are likely to terminate in cholera, especially so if they have great exciting causes as were present in the case above described." "After the death of this young man, two men were taken severely with (as I took it) cholerine or choleraic diarrhoea." They recovered, and the disease did not spread.

Taken in connection with the paper of Dr. E. M. Estrazulas, in the American Journal of the Medical Sciences for July, 1873, upon spontaneous epidemic cholera in Paraguay, it looks as though the accepted theory that that disease must be imported as a preliminary to every outbreak, may, like some other medical doctrines, require revision if not alteration.

THE MANAGEMENT OF DELIRIRUM.-Dr. J. M. Fothergill (Practitioner, Dec., 1874,) after discussing the psychical treatment of delirium, makes the following points as to its physical treatment. That form that marks commencing fevers in children scarcely calls for treatment, being a mere symptomatic affair. In delirium tremens, if the pulse be full, bounding and incompressible, a good dose of opium with antimony is indicated. But if the pulse be small, compressible and very quick, when sleep is kept off by that irritability which is associated with commencing exhaustion in nerve structures, full doses of opium are dangerous. Perhaps death here results from the effect of the opium upon the cardiac ganglia. In such cases half-ounce doses of tincture of digitalis have been given with good effect. Bromide of potassium with a vegetable narcotic might be combined with the .digitalis.

In sustained pyretic conditions, if there be considerable vas cular excitement and heat of head, opiates are inadmissible.

Chloral in fifteen-grain hourly doses until a drachm is taken, acting as it does upon the vascular system as well as upon the nerve centres, is better. Subcutaneous injections, of a strength not exceeding ten grains to the ounce, will often be useful in typhoid, non-absorbing conditions.

High temperature usually affects intelligence, and the local and general application of cold is of service. There is a form of delirium, which is more properly cerebral exhaustion, met with after the acute pyretic stage is over. Where there is persistent watchfulness without much vascular excitement, where delirium remains after a cerebral inflammation has been subdued, or where the sensorium is excited without heat of scalp or much throbbing of the arteries of the head, opium or chloral, or opium and chloral, are indicated.

CEREBRO-SPINAL FEVER.-Dr. J. B. Hamilton, U. S. Army, reports (New York Medical Journal, February, 1875,) the details. of eleven cases of cerebro-spinal meningitis, of a very severe type, among those occurring in his private practice in Illinois in the winter of 1873-4. He does not believe that it is an inflammation, but regards it as a zymotic disease, with the fever and localized inflammation dependent upon miasmatic poison. He asserts that: "In the beginning the skin is always dry; the secretions throughout the body are arrested; * *the patient often dies from retention in the blood of excrementitious material. When the excreting organs are at once overpowered by the malarial poison introduced from without, the patient dies suddenly, a victim to chemical forces generated within his own body. No treatment will be of any avail which does not have elimination for its primary object." So far as general treatment can be outlined he recommends the following: For the first day or two, B. Ext. ergot. fl. f3j., sp. ammon. arom., fij. A teaspoonful in a little water every four hours. B. Potass. acetat., 3xij., aquæ camph., f3vj. A tablespoonful every two hours until diuresis is produced. Additionally he uses the warm bath followed by wrapping in flannel or rubbing with dry mustard every three, four or six hours, and employs stimulants, if necessary, from the As the symptoms ameliorate the ergot mixture may be diminished in frequency, and at the third or fourth day discontinued. Then large doses of quinine may be useful and a more stimulating diuretic may be substituted. In his cases the sequela responded best to potassic iodide.

ABSORPTION BY THE SKIN.-"A correspondent calls our attention to the fact that while the survivors of the Cospatrick suffered agonies of thirst in their boat, the two men from the La Plata, who were actually in the water up to their waists nearly all the time of their three days' exposure on their damaged raft, felt no thirst and no hunger. Only when the sight of the Dutch vessel-their rescuer-made them feverish with hope and excitement did they begin to find their throats grow parched. Does not a plunge into the sea relieve thirst? our correspondent asks. And he gives his own experience as a swimmer in a seaport town, when he was young, in testimony that it does produce that effect. The water entering the pores relieves the parched-up palate; and, perhaps, as he puts it, a filtration takes place in the process, which gets rid of the presence of the saline matter. The theory is affirmed with great precision, we remember, by one of George Sand's heroes-not a high authority, certainly, on medical o: scientific questions; but the experiences of a hero of romance, if only they are adapted from anybody's actual life, are as good, s far, as those of Hippocrates or Huxley. George Sand's hero take, a bath for the purpose of quenching unusual thirst, and avers that it is the best and surest way of allaying pangs which the drinking even of fresh water would only aggravate. The question ought to be very easily settled, and the only wonderful thing about it is, that, if the belief of our correspondent and the French romancist's hero be correct, there should ever have been any question at all. We fear that if so ready and simple a remedy was also sure, it could hardly have failed long ago to find universal recognition. The thirst which is caused by mere heat would be naturally assuaged by a plunge into the water; but the thirst which is born of exposure, exhaustion and want of food 14 perhaps not so easily conquered or cured. Still there is something in the fact of the singular contrast presented by the two instances our correspondent has noticed, and the one striking difference in the conditions, which perhaps our philosophy might think it worth while to find out."

The above is from the London Daily News, under the heading A Hint to Shipwrecked Mariners, and is of interest to the profession as well as to the laity. That the skin is a valuable absorbing agent is unquestionable. (See Flint, Physiology, ii., pp. 451-5.) Life has occasionally been sustained in infants by milk baths. The promulgation of information like this among the people is a part of our duty as public health-conservators.