these micro-organisms.

The cocci gave no marked pathogenic effects. The bacillus caused rapid death of the animal, or grave general symptoms, accompanied with albuminuria. An albuminuric, having bacilli in her urine, gave, by inoculation of her blood, cocci, sometimes in chains and of the same appearance as those the author has found in eclampsia.

He examined the urine and blood of three eclamptic women, always finding what he describes as a lengthened coccus, or better still, a short bacillus. Inoculation of a female rabbit with the blood of an eclamptic caused anuria and prostration. After two other inoculations albumi

nuria ensued.

In the box in which several inoculated rabbits had been kept and in which two had died, he placed a healthy pregnant rabbit. This animal took sick and miscarried a dead litter. Another, treated in like manner, shared a similar fate. A non-gravid rabbit placed in the cage promptly succumbed. A rabbit, pregnant for eighteen days, inoculated with the blood of another eclamptic died in ten or twelve hours with intense convulsive phenomena after giving birth to one or two dead little ones. Another gravid animal, inoculated with a very small quantity of a bouillon-culture, showed only general symptoms of little gravity, but attended with intense albuminuria and premature birth.

[Readers of the JOURNAL, having cases of puerperal eclampsia in their practice, may make important contributions to the further study of this subject by sending samples of blood from such patients, properly collected and sealed, to Dr. Bolton, at the Hoagland Laboratory.-ED.]

THE DIAGNOSIS OF PLACENTA PREVIA BY PALPATION OF THE ABDOMEN.

Dr. H. R. Spencer (Trans. Obs. Soc., Lond. -Am. Journ. Obs., Sept., 1889). In seven cases of placenta prævia the location of the placenta upon the anterior wall of the lower segment was clearly made out by abdominal palpation. In two of these the placenta could not at the time be felt by the vagina. In the remaining four cases abdominal palpation showed that the placenta was not attached to the anterior wall.

The diagnostic signs as given by Dr. Spencer are as follows: In head-presentation with placenta prævia the head cannot be felt where the placenta is situated; may be distinctly felt where the placenta is absent. The placenta, when in front, may itself be felt as an elastic sponge-like mass which keeps the fingers off the head. The edge may be made out having the shape of a segment of a circle. Within the circle all is obscure to the touch; outside the circle the head or other part of the child is plainly felt.

Impulses to the head are obscured where the placenta overlies it, elsewhere are distinct. Combined abdominal and vaginal examination give similar signs.

DIETETICS AS A SUBSTITUTE FOR ARTIFICIAL PREMATURE LABOR.

Prochownick (Arch. d'obstet. et de gyn., Oct., 1889) comments upon the unsatisfactory results of premature labor, so far as concerns the child. The high mortality of infants prematurely born has led him to seek a substitute. This he appears to have found in the old and abandoned practice of restricted diet. He reports in detail three successful cases which he treated, during the last few weeks of gestation, with a dietetic treatment entirely analogous to that of diabetes.

In his first case, perforation, version and premature labor had been successively employed in previous births. The dietetic regimen was pursued for two months before her last accouchment. The result was a small living child, whose cranial vault, though hard, was still plastic, The child remained healthy and grew rapidly.

His second case was a dwarfed and scoliotic woman whose first delivery was by cephalotripsy, the second by difficult version, the child dying in four hours, the third by premature labor, the child. dying at the fifth week. In the fourth pregnancy the author placed the patient on the restricted diet during the last five or six weeks. The child was a male and at birth weighed little more than two-thirds the usual weight. It however presented all the signs of maturity so far as regards the diameters of the head. It lived and throve.

The third case was a secundipara whose first child had been sacrificed by craniotomy. She was placed on the dietetic treatment for four and a half weeks and was delivered at term of an undersized child which lived.

MANAGEMENT OF OCCIPITO-POSTERIOR POSITIONS.

Bataillard (Arch. d'obstet. et de gyn., Oct., 1889). In tedious labor, with occipito-posterior position, B. thinks the imperfect flexion and consequent failure to rotate are due to detention of the occiput by the neck of the uterus or, after complete dilatation, by the caput succedaneum. He advises waiting for two hours after full dilatation, in the absence of emergency. Tarnier's method of reduction should not be attempted till the head is well flexed. He holds that a good forceps seizure is always possible in these cases, though denied by most authors. To accomplish this he passes the guiding hand wholly within the vagina and alongside the head. Cautious attempts may be made with this hand to promote flexion, but must not be pushed too far. The second blade should be carried well back against the posterior

wall of the pelvis till the handle may be easily depressed for locking. The first traction generally determines complete flexion and partial rotation of the head. We infer that he uses the Tarnier instrument.

THE PORRO OPERATION.

J. Price (Annals Gyn., Oct., 1889). The Porro operation has the following advantages over the Cæsarian section: The danger from the succulent uterus with its incision is removed, hæmorrhage is absent, the operation is more rapid, the technique simpler. The uterine suture is unreliable owing to the instability of the uterine tissue during involution. Possible leakage and peritonitis are inevitable dangers. On the other hand, the écraseur adapts itself to the shrinking stump and, more important still, the stump is extraperitoneal. The Porro operation should give better results than ordinary hysterectomy for the following reasons: 1. Absence of adhesions. 2. No implication of any important viscus and therefore less hæmorrhage. shock.

3. Less The ethical objection to the Porro operation, Dr. Price thinks, does not hold. The woman is not to be regarded simply as a propagating organism. Other relations to family and friends are as important as her procreative power.

Finally, the Porro skilfully performed gives the patient a better chance for life than the classical operation.

TREATMENT OF POST-PARTUM HÆMORRHAGE.

Misrachi (Arch. d'obstet. et de gyn., Oct., 1889) considers the hot intra-uterine douche too slow and advocates the use of a special curette and écouvillonnage. He uses a large curette with a serrated edge. As an auxiliary hæmostatic he prefers equal parts of glycerine and tinct.iodin., or of glycerine and lactic acid or creolin to the glycerocarbolic mixture of Doleris. The lactic acid and creolin mixtures he believes to possess remarkable hæmostatic powers. In the event of persistent hæmorrhage or sepsis he places in the uterus a large stick wet with lactic acid, leaving it there for one or two minutes. douche he uses only in case the foregoing measures fail.

PRACTICE OF MEDICINE.

BY HENRY CONKLING, M. D.

SENILE HEART.

The hot

Balfour (Edinburgh Med. J., Sept., 1889) writes that there are certain. affections of the myocardium, due to senile change, that are not usually discoverable during life. Such changes may be included under the terms pigmentary involution. fatty degeneration, aneurism and rupture

of the heart. There is, however, a senile heart presenting certain abnormal symptoms and signs. The causes producing the condition result from (1) changed relation in size and amplitude of the blood vessels, causing increased arterial tension and slowing of the pulse rate. In advanced life the elastic arteries tend to become rigid tubes, causing an extra strain in the heart; a dilation of the aorta and large arteries follow. Loss of arterial elasticity causes an intermittent capillary circulation to take the place of the normal flow. This causes a condition of obsolescence to ensue.

2. Relative proportiou between aorta and pulmonary artery changes. The aorta becomes the larger of the two. This causes a diminished pressure through the lungs with a resulting imperfect æration and gradually increasing venosity of the blood.

3. Senile dilatation results from the increase of the intra arterial blood pressure. The rigid coronary arteries, causing lack of nutrition, aid in promoting this change.

Mauifestations.-The earliest symptoms of the development of senile heart are those depending upon weakness of the myocardium, with manifestations of nervous irritation. The author includes them all under the head of cardiac erethism. This is marked by rapid or irregular cardiac action. A few fluttering beats disturb the regularity of the pulsation. This may be followed by a choking sensation in midsternum, pallor of the face, a tendency to syncope, and a momentary loss of power in the lower limbs.

In certain cases, rapid action alone may be present. This is called tachycardia. This condition may pass away or give rise to new forms of cardiac action. These may

be:

1. Action continually small, rapid and feeble-Embyocardia.
2. Rapidity with extreme irregularity-delirium cordis.

Attacks of what is called "fluttering of the heart" occur in these cases, and are really tremor cordis. They may occur without warning and cease quite suddenly. A number of short, sharp and usually incomplete systolics rapidly follow one another, causing a tremulous. sensation about the heart; the pulse is small and sometimes not perceptible.

In a few cases the dilated senile heart is accompanied by a slow pulse. This may be when the heart beats are double the rate of the pulse, or be in itself a true bradycardia.

The changes in the cardiac muscle and the blood vessels alter the character of the cardiac sounds. When the aorta has lost its elasticity it expands abnormally before each succeeding blood wave, and the weight of the excess of blood in its ascending portion closes the aortic

valves and with unusual force, causing an accentuated sound. The greater state of tension to which the valves are thrown may terminate in separation of the segments of the valves, with regurgitation between. them. If the aorta becomes dilated, a systolic murmur may be heard at the base.

When physical examination reveals a more forcible impulse at the lower end of the sternum than in the normal position of the apex beat, with changes in the area of dulness, and accentuated second sounds in one whose arteries are atherosed and show a high degree of intraarterial blood pressure, there is indication of a heart dilating under permanent causes.

[It is interesting to note that in the original paper from which the above analysis was made the statement is given that an intermittent pulse is rarely found in the senile heart. This statement, with the author's views on the intermittent pulse, as a single factor, published elsewhere, is additional testimony to the theory that this condition means but little, and is in no wise a dangerous element.]

WEIGHTS IN TYPHOID FEVER.

Cochin (Cochin Hosp. Rep.) gives the result of certain observations upon the weight of a series of typhoid fever patients. From these observations it would seem that there was a daily uniform loss, varying in different persons. The existence, in ætiology, of a relation between loss of weight and the amount of food consumed by the patient is denied. The cause of the emaciation is considered to be the long continued elevation of temperature, especially as the losses in nitrogen and weight seem to bear a close relation to the degree of elevation. This view of the etiology is not strictly adhered to, however, as the statement is made that complications increase the loss in weight, and that the loss in weight will give information as to the action of nutritive substances in fever cases. Gain in weight is considered as a sign of convalescence and as an aid in prognosis.

ACIDS IN THE STOMACH.

Jaworski (Centralblatt f. Med. 1889) gives the following conclusions as to the use of acids: 1. They precipitate mucus. 2. Increase the cellular elements of the gastric oontents. 3. Cause effusion of bile into stomach. 4. Stimulate secretion of pepsin but have no influence in increasing the amount of hydrochloric acid. 5. In moderate amount their long continued use produces gastric disturbance. 6. In large amount derangement of function and diminution of gastric juice. may result.

The difference in action between alkalies and acids is also given. The former dissolve mucus and decompose pepsin; the latter precipitate mucus and increase pepsin.