With this mixture the sick toe is to be moistened all over, and as much as possible of the liquid dropped into the fissure between the nail and flesh, and then the toe to be bandaged with a strip of linen about one and a half inches wide, and eight inches long. After the end coming next to the nail has been saturated thoroughly with the liquid, the balance of the strip is wrapped around the toe. The moistening of the inner end of the strip has to be repeated through the day four, or six, or ten times, and to be continued until a cure is effected. Generally the application causes no particular pain; if, though, there should be much sensitiveness, from six to twelve grains of morphine might be added.

Soon after the application of this remedy the swelling of the toe subsides, the excrescences, the proud flesh shrink, get black, as also the whole toe; the nail gets brown, soft, brittle, loses its stiffness, and ceases to press and dig into the flesh; the skin peels off, and out of the matrix a new, well-formed nail will be developed. If it is intended to effect a cure in a shorter time, and the patient is not afraid of some pain, it would answer to place a piece of lunar caustic, under a perforated plaster, on the diseased portion of the nail, which in a very few (five to ten) hours would remove the excrescences, when it would be necessary to remove the bandage. The first mentioned method, though, always was preferred by my patients.

ART. IV. Cephalic Version-A Case. Communicated to the Wisconsin Central Medical Association. By WM. CRANE, M.D., Cottage Grove, Wisconsin.

The following case having been one of peculiar interest to me, and supposing such communications, though in themselves of minor importance, may be acceptable to your association, I take the liberty to forward it to you, which I do by request of one of your members :

I was requested to attend Mrs. P., of this place, on the morning of June 9th. She had been in labor over twenty-four hours, under the care of a midwife, who informed me that the membranes were ruptured soon after her arrival the morning before. Her labor had been regular ever since.

On examination I found the right shoulder presenting, with the arm down, though flexed at the elbow, and enclosed in a fold of membrane. Part of the placenta was protruding at the vulva. The head was lodged in the left iliac fossa. The pains were excessive and nearly continuous, such as usually indicate the last stage of labor.

Under the impression that any effort at manipulation could not be successful while the parturient efforts were so strong, I gave her a full dose of morphine, and made firm but continuous pressure against the shoulder of the foetus. In about thirty minutes the uterine contractions relaxed, and the parturient efforts became regularly intermittent. During the absence of a pain, I succeeded in returning the shoulder and arm within the uterus, and at the same time permitted the placenta to be completely expelled. I now determined to make the effort to accomplish cephalic version, in accordance with the plan recently advised by a contributor to the Cincinnati Lancet and Observer, before proceeding to the common plan in such cases, of delivery by pedal version. Accordingly, with my finger against the shoulder of the foetus, I pushed it as high upward as possible, in order to give room for the head. to pass the brim of the pelvis. I was delighted, and, I must confess, somewhat surprised, to observe, during the next uterine contraction, the head, by a slight rotary motion, to assume the first position, and the fetus was delivered in about five minutes. It was of course dead, as the maternal circulation had been suspended for more than twenty-four hours. The recovery of the patient was rapid and uninterrupted.

I had intended to make some further suggestions with regard to cephalic version, but this narrative will suggest to any intelligent practitioner most that I could say on the subject. It seems to me, however, a matter that ought to engage the careful consideration of practitioners, as affording a more safe and less painful method than the one heretofore practiced; for if the effort should not be crowned with success, but little time is lost, and no impediment is added to the common plan adopted in such cases.

- Dr. Heath, a member of the association, communicated a case which had recently occurred under his care, which seemed to demand pedal version that in the effort to pass up his hand for the purpose of seeking the feet, the head of the foetus assumed

its position as in natural labor; and the process was completed with little delay. The position thus assumed by the head was unsought and unexpected by him, and was regarded simply as an anomalous phenomena, and such as would not be likely to be repeated, even by the most careful and well directed efforts of the practitioner.

ART. V.-Persulphate of Iron in a Case of Post-Partum Uterine Hæmorrhage. By GEORGE MENDENHALL, M.D., Cincinnati, O. On the 29th of September I was called to a case of uterine hæmorrhage, in consultation with Dr. H. E. Foote, who was in attendance on the case. Dr. John F. White was also associated with us in the consultation. Dr. F. informed us that the labor had progressed as usual, and that the placenta had been expelled into the vagina, by the contractions of the uterus, immediately following the expulsion of the child, and was at once removed. The uterus seemed to contract well, also, after the expulsion of the placenta. About ten minutes after delivery his attention was attracted to the pallor of his patient and upon examination, the distended uterus was found extending above the umbilicus. Friction over the fundus and body of the uterus was resorted to, and the hand was introduced into that organ. This was followed by a good degree of contraction, and the expulsion of coagula, but it soon again relaxed. Ice was introduced and the hand retained, notwithstanding which the haemorrhage continued. Ice was also applied externally. The pulse became almost imperceptible, and brandy was administered freely. Four hours after delivery, when I saw the patient, there was some little reaction, the hæmorrhage, however, continuing steadily, although lessened in quantity; and the uterus was in a very relaxed condition. - particularly in its anterior wall and neck.

I introduced my left hand into the uterus, and made pressure exteriorly with the right, which produced little or no contraction, and the hemorrhage was not checked. Ice was resorted to again, internally, without any other than temporary results. If the introduction of the hand had any effect, it was rather to increase the hæmorrhage, because it irritated the uterus and dis

turbed the coagula, without any success in inducing uterine contractions. Ergot, and a saturated solution of the persulphate of iron were sent for. The ergot arrived first, and was administered with little or no apparent effect, as we supposed on account of the extreme prostration of the patient; and it was not thought best to wait longer for its action. With the hand in the vagina and partly in the uterus, a catheter was introduced to the uterine fundus, and about three ounces of the saturated solution of the persulphate of iron injected through it into that organ. The hand was retained for a few minutes, so as to retain as far as possible the solution in contact with the inner surface of the uterus. It produced no pain, and increased the contractions of the uterus but very slightly. The blood in the uterus and vagina were coagulated in a manner that can only be produced by this preparation of iron. The hand was withdrawn, and watch kept over the condition of the uterus and the discharges from the vagina. From that moment not another drop of fresh blood was discharged from the uterus and vagina. The patient was bandaged, reaction came on, and she recovered without an unpleasant symptom.

For the next forty-eight hours the discharge consisted entirely of the disintegrated blood, which had no doubt been in the vagina and uterus prior to the injection. This was succeeded by, and intermixed with, a serous or sero-mucous discharge, tinged in color by the persulphate, which gradually became of the natural color that the lochia assumes upon the cessation of the presence of the red globules of the blood. After the injection there was not at any time a particle of fresh blood, or a tinge of it, in the lochia.

In the great majority of cases of post-partum hæmorrhages a resort to this article is unnecessary: ergot, friction, and the introduction of the hand into the vagina and uterus, and clearing out the accumulated clots contained therein, will be sufficient to induce a reliable contraction of the uterus. In some cases, of which this was one, these remedies are not sufficient to check the hæmorrhage, and other means become necessary. Where there is extreme prostration, ergot sometimes fails to produce contractions; in other cases we may fail in getting a reliable article, while in others it may not be retained on the stomach; and again, when everything is favorable to its use, its action may not be suffi

ciently quick. The steady loss of the vital current may produce death before we can expect its effects to be produced. In such cases, a prompt and reliable remedy is demanded; and we have it, I have no doubt, in the persulphate of iron. Its use in this case was suggested from having seen its beneficial effects in a case of hæmorrhage from chronic inversion; in which case it was repeatedly applied as the hæmorrhage recurred, with entire success in preventing further flow at the time. It never produced any inflammation, soreness, or other inconvenience. The value of a remedy having the powerful astringent properties that this has, without any caustic or other irritating properties, can not but be appreciated. It would seem to be applicable in post-partum hæmorrhages where there is great relaxation of the uterus; in cases of hæmorrhage accompanying abortion in the early months, and in excessive menorrhagia.

I have used the diluted tincture of iodine, to which hydriodate of potassa had been added, to prevent the precipitation of iodine, in cases of menorrhagia, with great success; but I have no doubt but that this article would be equally or more efficacious, and with less risk of producing pain or other difficulty. How far it may be found useful as an injection in uterine leucorrhoea, diluted to suit the case, I can not say. It would certainly be safer in every respect than the nitrate of silver.

ART. VI.—Dr. Fisher's Case. BY JOHN DELAMATER, M.D., Professor of General Pathology, Midwifery, etc., in Western Reserve College, Cleveland, Ohio.

[Continued.]

Our inquiry will be simplified by a recurrence to the leading conclusions at which we have previously arrived, which I, therefore, take liberty to do.

It has been assumed that the causes of inversion are of a twofold nature: 1st. Predisposing or preparatory certain conditions of the uterus of a nature to favor and facilitate the change; and 2d. Exciting or efficient causes, being those agencies by means of which the inversion is immediately induced.

The conditions of the organ predisposing to or favoring the VOL. III., No. 11.-44.