On Turning by External Manipulation. By Dr. SPENGLER.

As this operation can only be performed before the liquor amnii has been discharged, Dr. Spengler observes that the opportunity of effecting it seldom falls to the lot of the private practitioner in Germany; but in midwifery establishments it is more easily resorted to, and Ritgen states that he seldom now employs other means. Dr. Spengler was called to the present case, occurring in a robust woman, on account of a hemorrhage after a fall, which, however, had ceased on his arrival. She was at full time. On examining the abdomen, he found it wanting in the usual roundness, and the integuments being relaxed, he was able on the right side to feel the lower parts of the child, and on the left a firm round body, which he concluded was the head. The os uteri was sufficiently open to admit the point of the finger, and its lips were thick and yielding; no presenting part could be felt. The sounds of the child's heart were inaudible, nor had the mother felt it move since the morning. The placenta-murmur was plainly heard at the left side. Believing he had diagnosed a cross-birth, the author proceeded to endeavour to rectify the position. The woman was laid on her left side, and a small firm cushion placed under the child's head. During a pain, with one hand applied to the child's head externally, and the other towards its breech, he endeavoured to direct the one down towards the brim of the pelvis, while he raised the other upwards. Little success at first attended these efforts, and the woman was unable to lie any longer on her left side. After two or three hours' manipulation, the patient sometimes lying on her back and sometimes on her side, with the cushion pressing on the child's head, some movement was at last impressed upon the infant's extremities; and after a while the bag of waters could be felt pressing against the os uteri, having a hard body behind it. The pains were slack, and on account of the thickness of the membranes these were not easily ruptured. After the discharge of the waters, the pains continued too slight, and the author having no more ergot, resorted to a practice which we have more than once found useful under similar circumstances. He says that it occurred to him, that as plugging the vagina may be employed successfully in the artificial induction of premature labour, the same mode of inducing uterine action might here prove available; wherefore, he filled it with sponge and charpie, and in a very short time very active pains came on, expelling a dead child. The woman resumed her household affairs in a week.-Neue Zeitschrift für Geburtskunde, xxv, 187, 170.

Puerperal Tetanus. By Dr. AUBINAIS.

DR. AUBINAIS, of Nantes, relates three cases of this affection which have come under his observation, believing that it has not received sufficient attention from writers upon obstetrics. The exciting cause of the disease is almost always the suppression of the lochia, or of profuse sweating during the milk-fever, by wet or cold, and hence probably the reason why it is so much more common in rural than in civic districts. In the first case, the milk-fever was high on the fourth day, when the woman (æt. 30) crossed a wet floor, while the skin was covered with sweat, with naked feet. She was soon seized with prolonged shivering, abdominal pain, and suppression of the lochia, and gradually the tetanic condition, commencing with difficult deglutition, markedly prevailed, inducing a slight degree of emprosthotonos. She died seven days after the symptoms began. In the second case, a poor woman, æt. 28, having suffered from an attack of eclampsia, for which she was bled, was delivered a few days after of a seven months' child. She went on very well until the fifth day, when, having drank a large quantity of cold water, she was seized with shivering, followed by trismus and difficult deglutition, which went on to complete tetanus. On account of her enfeebled state, blisters were alone resorted to, the lochia being also restored by warm baths. The spasmodic symptoms did not give way for twenty days, and forty elapsed before she was quite restored. In the third case, the woman (æt. 34) likewise, while in a state of perspiration, exposed herself to wet and cold four days after confinement, with the effect of suppressing

the lochia. The tetanic symptoms did not appear until twenty-four hours after this, but then became strongly developed, and obstinately resisted the most active antiphlogistic treatment until the tenth day, when they began to give way. She was bled six times, 100 leeches were applied, and musk and valerian were afterwards given.-Rev. Méd.-Chir., V, pp. 149-59.

MATERIA MEDICA AND THERAPEUTICS.

On Large Doses of Sub-nitrate of Bismuth in Gastro-Intestinal Affections.
By M. MONNERET.

M. MONNERET states that he has been for some years engaged in experimenting upon the medicinal qualities of this substance, and that he finds that, given in far larger doses than are supposed to be permissible, it is of the greatest value in gastro-intestinal affections, especially those attended with fluxes.

Simple Diarrhea. It is especially in the diarrhoea of infants, resulting from imperfect lactation, that he has found it so very useful, large doses curing such in a few days. So, too, after weaning, and the injudicious diet so often adopted, the bismuth, in doses of three teaspoonfuls a day, soon removes all symptoms of disordered digestion, especially the serous diarrhoea so often produced in these cases. Simple diarrhoea is of much rarer occurrence in the adult; still, examples are met with in which we cannot attribute it to either phlegmasia or ulceration of the intestines, as in the granular disease of the kidneys, in chlorotic women, in women become anæmic from cancerous degeneration of the uterus, and in some cases of chronic disease of the heart, or in commencing phthisis. Those cases in which the diarrhoea is serous, and results from an atonic state of the gastro-intestinal membranes, best yield to this medicine. It should be given in gradually increasing quantities from two drachms to twelve or more per diem.

Diarrhea symptomatic of Intestinal Lesion. In spite of the presence of symptoms indicative of inflammatory action, the author has frequently administered the bismuth to children with great success. So, too, he has found it very useful in some subjects of phthisis suffering from obstinate colliquative diarrhoea, and even in the diarrhoea of typhoid fever, when the intestinal canal was certainly the seat of very numerous ulcerations. In this last case its utility is not very permanent; but it has the advantage of inducing the tolerance of articles of diet or medicine, which without it would be rejected.

Cholerine. The frequency with which gastro-intestinal disturbance precedes true cholera is well known, and the desirability of its suppression is evident; and to this end large doses of bismuth succeed better than any other means. It is most suitable in the cases in which with the diarrhoea there are nausea, vomiting, gastralgia, colicky pains, borborygmi, and anorexia. The cases are innumerable, in which the author has been enabled rapidly to relieve these symptoms without any aid from opium, by giving eight or ten drachms per diem. The only inconvenience resulting, is a certain amount of constipation.

Gastralgia. Various observers have already admitted the great utility of this substance, both in idiopathic gastralgia and in the forms dependent upon hysteria, hypochondriasis, chlorosis, &c. &c.; but it has frequently failed in the hands of others, by being given in doses of two or three scruples per diem, in place of twelve or fifteen drachms; and it is taken with such ease, that the patients voluntarily continue its employment after the pain has ceased, until the gastro-intestinal functions are thoroughly re-established. The idiopathic forms of gastralgia, so often met with in sedentary or literary persons, and in those suffering from depressing emotions, or from abuse of alcohol or coffee, are those which are most successfully combated. It has often, too, enabled the stomach to bear those tonic aliments, whose slow and painful digestion, accompanied by cephalalgia, drowsiness, and pain in the back and limbs, is so often observed in chloro-anæmic patients. This

medicine only produces a temporary relief in gastralgia, dependent upon organic disease of the stomach, except when this viscus secretes a large quantity of acid fluid.

Vomiting. Vomiting may depend upon a simple gastric neurosis, and then the bismuth can be very usefully employed. It is also useful in the vomiting of pregnancy, and that accompanying dysmenorrhoea; but its efficacy is less certain than in affections of the gastro-intestinal tube, and is never so great as when diarrhoea, colic, and flatus are present. From whatever cause pain manifests itself during digestion, we may relieve it by mixing the sub-nitrate freely with the articles of food.

Administration and action. It should be given in powder, and best so with the first spoonful of broth or gruel. It excites no disgust, especially if placed between two bits of bread soaked in broth. Children take it readily with milk or ptisans. The author has never given less than from two to three drachms per diem, nor more than twenty, and he has never observed the slightest inconvenience from these large doses; and it is his custom to give it to the children in his hospital by spoonfuls or tablespoonfuls, without observing more exactitude, so innocuous is it. So imperfectly is this fact known, that the chemists hesitate in preparing his prescriptions in which these large doses are ordered. The author cannot conceive why this substance was ever set down as an irritant poison, as he has never found the slightest irritation from the largest doses given to either the healthy or the sick; and post-mortem examination proves that, beyond patches of black discoloration, it produces no effect on the mucous membrane, the consistence of this remaining quite normal. The action of the substance on the canal seems to be quite negative, that is to say, the anormal symptoms for which it was prescribed quickly disappear. Great attention has failed also to detect any marked effect upon any other part of the system. Perhaps the urine is somewhat increased, and the pulse becomes slower, but this is probably due to the relief of the gastro-intestinal affection. The action of bismuth is then purely a local one; and this local action, so far from being an irritant one, as so commonly stated, diminishes the activity of the phenomena of which the mucous membrane is the seat. It is not to be supposed, however, that this inert substance can act actively and directly upon the canal, as a soluble body after absorption does do; and it is probable that it acts merely as an inert body, just as charcoal might do, mechanically protecting the over-excited secretory organs and papilla of the nerves from the too immediate contact of the fluids, and especially of aliments. By its mechanical apposition, it limits the amount of exhalation. The allegation of its antispasmodic properties has solely arisen from observing the diminution of the symptoms, without considering whether this might not arise negatively from the preservation of the gastro-intestinal surface from the causes of irritation. In this way we might call darkness an antispasmodic, because it allows the repose of the retina, and the subdual of the irritation which gives rise to photophobia.-Gazette Médicale, Nos. 15, 16.

Of the utility of bismuth in smaller doses in gastric affections we have almost daily proof; but the doses we are in the habit of employing are so very much smaller than those recommended by M. Monneret, that their beneficial action can scarcely be explained upon the mechanical theory he advocates, which is, however, admirably suited to the explanation of the modus operandi of the very large doses he employs. As somewhat confirmatory of his view, we may mention that M. Belloc, in a recent communication to the Académie, makes mention of the very great benefit derivable from the employment of charcoal prepared from poplar shoots, in gastro-intestinal affections. It rapidly subdues pain, facilitates digestion, excites the appetite, and enables medicines that the alimentary caual would not otherwise tolerate to be easily borne.-Sec Rev. Méd.-Chir., t. v, pp. 75-86.

On Aconite. By M. TEISSIER.

M. TEISSIER has undertaken a prolonged series of researches in order to establish, if possible, the therapeutical value of this substance, and especially its anodyne and its antiphlogistic power. The existence of the former is incontestable, but it differs from opium in giving relief, not as that does to all descriptions of pain, but only to certain kinds of it. This speciality of the action of aconite is one of its characteristics, its anodyne property being only in fact a secondary one. Its principal, and in some measure specific, action is exerted upon the skin, eliminating through its vessels injurious principles, and restoring the natural functions when these have been disturbed. Thus aconite is a very appropriate remedy in diseases induced by chills, or when morbid principles are detained in the cutaneous tissues, as in the exanthemata; and M. Teissier has especially derived benefit from its anodyne properties in diseases of a rheumatic or catarrhal origin. The antiphlogistic power of the substance is quite subordinated to the influence exerted by it upon the skin, and is especially observed in individuals of a nervous or lymphatic temperament, and those predisposed to rheumatic and cutaneous affections; and in such it is beneficial in lumbago, angina and bronchitis, influenza, rheumatism, especially when recent and not very acute, &c. M. Teissier prefers the tincture, to obtain the anodyne effect of which he rapidly increases the dose from 10 or 20 drops to 1 or 2 drachms per diem.-Revue Médicale, 1849, t. i, p. 333.

Concealing the Taste of Fish-oil.

Now that the swallowing cod-liver oil bids fair to become the fashionable mania of the day, it may be as well to state the simple and effectual means communicated by M. Fredericq, of disguising its abominable taste. This merely consists in masticating a morsel of dried orange-peel just before and just after swallowing the dose. -Rev. Méd.-Chir., t. v, p. 114.

Collodion in Bed-sores.

AIR-CUSHIONS and water-beds are not obtainable by the poor, and it has been the practice to protect parts subjected to injurious pressure either by powdering them with some inert substance, or covering them with diachylon. The first of these measures is of little use, and the other does more harm than good, as by softening the tissues to which it is applied, it only renders them more susceptible to the influence of pressure, especially if the leather on which it is spread gets into folds. Collodion adheres far more closely than diachylon, and is quite exempt from moisture; and in the cases in which it has been tried in the French hospitals, has answered well.-Gazette des Hôpitaux, 1849, No. 38.

Removal of Stains of Nitrate of Silver.

ACCIDENT first led M. Martinenq to the observation, which he has since repeatedly confirmed, that the stains produced by nitrate of silver on linen, &c., may be readily removed by wetting the linen in a solution of bichloride of mercury (1 part to 31), rubbing it well, and then washing it in cold water.-L'Union Médicale, 1849, No. 15.

BOOKS RECEIVED FOR REVIEW.

The Retrospective Address on Diseases of the Chest, delivered at the Meeting of the Prov. Med. and Surg. Association, Derby, 1847. By Edward J. Shearman, M.D. Worcester, 1848. 8vo, pp. 47. With Four Plates.

Report on the Epidemic Cholera as it has appeared in the Territories subject to the Presi

dency of Fort St. George. Abridged from the
Original Report, printed at Madras in 1824. By
William Scot, Surgeon and Secretary to the
Medical Board. London, 1849. 8vo, pp. 212.
On the Cryptogamous Origin of Malarious and
Epidemic Fevers. By J. K. Mitchell, A.M., M.D.
Philadelphia, 1849. 12mo, pp. 137.