4th. The diet, while the absorbing powers are yet active, should consist of beef-tea thickened with isinglass or arrowroot. By being thickened, irritation of the stomach by it is much lessened, and small quantities may be retained in spite of vomiting. Stimulants purs et simples should never be given, but mingled with food they may be administered in small quantities—thus, a teaspoonful of brandy with a wine-glassful of milk and the white of an egg may be given every three or four hours.

II. TRUE ASIATIC CHOLERA-COLLAPSE.

Supposing that the fore-mentioned means have been tried, and yet the special symptoms of cholera set in-supposing coldness and cramps and the signs of incipient collapse occur—what are the indications?

The cause, I firmly believe, is an union of the poison with the sympathetic. It may be that the system is so overburdened that nothing can lift the load; but what plan of treatment offers the best chance?

1. Counter-irritation of the Epigastrium.-I have often seen the value of heat employed to the epigastrium in relieving the symptoms of collapse. I have employed it in cases of chloroform administration wherein there have been signs of syncope. Derivation from the solar plexus seems à priori likely to do good. What is the best form of counter-irritation in these cases? The carbonic acid, which is close at hand, offers itself. Let it be rubbed over the pit of the stomach for a short time by means of a piece of flannel. Dry cupping to this region may be applied with advantage. Subsequently to the counter-irritation, warmth by means of hot water bottles or hot salt bags should be applied.

2. Keep the Patient in perfect Rest.-The stomach should be spared fruitless efforts to exhibit nourishment. It is true that in collapse the powers of absorption are not annihilated; but it must be remembered that absorption is, in fact, a mechanical act (dialysis), and that though mere absorption may take place in this way, still vital transmutation is necessary to make the absorbed material of any avail for nutrition; and this assimilating power is wanting. No medicine and no food should be

Cases have occurred in which symptoms of collapse have happened without previous warning, and have continued with fearful rapidity until death. A few days ago a man was observed to fall down in the street. He was taken to an hospital, and died almost immediately. At the post-mortem examination the appearances peculiar to cholera were noticed in the intestinal canal, and there was no other lesion to account for death.

given by the stomach, but enemata of warm water may be administered with the hope, not of supplying heat, but of diluting the thickened blood. The best way of administering the enema is by using a siphon tube proceeding from a vessel placed at a convenient height, or the douche enema, made for me by Messrs. Francis, Upper-street, Islington. By this means a continuous and equable flow is maintained, and the saltatory jet and the frequent mess of an ordinary enema-syringe are avoided.

It has been proposed to transfuse blood or a fluid analogous to it into the veins, and in some instances this practice has met with at least a temporary success. The warm fluid dilutes the thickened contents of the venous system, promotes a flow in the capillaries, then reaches the minute contracted arteries, and distends them. Motion is renewed, and motion is life. It is at first sight very strange that two such opposite courses as transfusion and venesection should have been of equal benefit. But if we consider that the symptoms are due as well to diminished arterial supply as to retention of products which should be excreted, as well to arterial anæmia as to venous engorgement, we may understand the cause. The veins in the case of bleeding being lightened of their load, the excretory products which had narcotized the system being in part removed, respiration and aëration return, and the column of blood moves. In a patient suffering from syncope, motion of the blood is of the first importance for reanimation. If we tilt the feet, so as to allow the column of blood to fall back upon the heart, the failing circulation is rapidly restored. Again, in cases of threatened death from suffocation, it is only when the current of blood is set in motion that the symptoms of danger pass off. In a case of collapse, in which the arteries are nearly empty and the veins over-full, motion of the blood can only be induced in two ways-either by venesection, which allows an escape from the distended right side of the heart, or by forcing a stream à tergo from a vein. Either or both these means may be tentatively employed, but neither should be adopted unless other means are found to fail.

If there be any mode of relaxing the contraction of the arteries, this should be tried. I should think a fair trial should be given to inhalation of chloroform. This procedure has been known to relieve the cramps and to induce at least a temporary reaction. Combined with local warmth to the epigastrium and warm injections of the bowel, it may be yet more successful, and it certainly deserves a fair and careful trial. —Medical Times and Gazette.

Midwifery and Diseases of Women and Children.

CASES OF POSTURAL TREATMENT IN PROLAPSE OF THE FUNIS. By ROBERT DYCE, M.D., F.R.S. Edin., Professor of Midwifery, University of

Aberdeen.

As the two following cases were so eminently successful in this but too fatal complication of labour to the child by this method of treatment, I send them for publication.

The first case was conducted by Dr. Thomas Milne, then a student attending my class in this University, and which most opportunely took place shortly after treating of this method. He reports as follows: "Mrs. W., aged 27, second pregnancy; a healthy, rather stout, but well-made woman. When I first saw her she had been in labour for

three hours. The membranes had ruptured some time before. The os uteri was fully dilated. The head presented naturally, and was partially through the brim, and hanging in the vagina, and projecting beyond the external parts, was a loop of the funis; it was pulsating feebly, which ceased during every pain. The pains were regular, and recurring about every ten or twelve minutes. I endeavoured to push up the cord in the interval of the pain, with the patient lying in the usual obstetric position, but failed; when remembering what you recently, in the course of lectures, had been describing of the success attending the 'postural method' as proposed by Dr. Thomas, of New York, I at once placed the patient on her elbows and knees, with the head and shoulders lower than the pelvis. I now pressed the head of the child a little up, and then steadily endeavoured to push up the cord; it passed away most readily, but during the next pain it came down as before. I again, in the interval of pain, put it up, but the next pain brought it down. The third time I passed my whole hand into the vagina, and carried the cord beyond the head; when the pain came on, I could only feel it with the tip of my finger, and when the pain left, the funis had slipped beyond my reach, and did not again return. The patient was kept in the same position until the child's head was fairly in the cavity of the pelvis and nearly touching the perinæum. I then allowed her to take the usual position, and in about two hours the child was born alive, though rather feeble. Both mother and child have since done well."

The second case of funis presentation was further complicated with placenta prævia.

Mrs. M., during her fifth pregnancy, in the latter months had three several sudden discharges of blood from the vagina-the first time during the night, the second time when dressing in the morning, and the third

time also in the morning the day before her confinement; on all occasions the discharge stopped suddenly, and proceeded from no accident or cause on her part. The symptoms were suspicious of placental presentation, but as she wanted a good many weeks from her full time by her own calculation, and more especially as the loss of blood had produced no particular constitutional disturbance, I risked the uncertainty by not making any examination. When summoned on the night of her confinement (twelve hours after the last flooding), I was fully prepared for the announcement that the flooding had returned; but on inquiry I was rejoiced to learn that the waters and not blood had come off-in fact, there was not a stain upon her linen-and that the liquor amnii had been discharged. On now making an examination, I was met by the funis, not merely a loop, but a mass which the hand could scarcely grasp. She had then no pain, but she had had during the evening some weak and distant indications of uterine action. The funis was very tense, and pulsated strongly; the head could be felt through the os, which was open to the size of half-a-crown, and very dilatable. Tha external parts were also relaxed. I endeavoured to return the funis while she lay on her left side, but as fast as one portion passed up, another came down, Determining to try the "postural method," she was placed on her knees and elbows, the pillows being removed, when, with the slightest possible pressure, the whole mass of funis passed at once into the uterus. I observed also in this, as on the subsequent attempts, that there was no tenseness of the funis, as if the present position had removed some cause of pressure or obstruction, but when in the ordinary obstetric position the cord was tense and resilient when touched. Finding that on withdrawing my hand prolapse immediately took place, I determined to induce pain, hoping that the descent of the head would prevent its return. I gave her at intervals of ten minutes three several doses of a full teaspoonful of Battley's liquor secalis. Strong pains followed the last dose. The postural treatment was then resumed, and the funis as readily replaced in the in. terval of pain as before, with the exception of a small knuckle, which seemed adhering near the cervix. The next pain brought it partially down, but on a third attempt, my hand being entirely within the vagina, the funis was passed beyond the head, which was now descending, and retained there with great ease. In another pain it slipped bepond my reach, and gave no further trouble but still the little knuckle-like portion remained, and which I now discovered to be the placental extremity of the cord and the mass of placenta itself attached closely to the cervix. The patient was now allowed to take the ordinary position, and the child was born in fifteen minutes, strong and healthy.

This plan of treatment was originally proposed by Dr. Gaillard Thomas, of New York, in a paper published in the New York Medical Journal for March, 1858, and, although several years have elapsed since that time, the method proposed does not seem either sufficiently known, or, if known, is not appreciated, by the Profession. It seems very clear from the numerous methods proposed to remedy this complication, that no one of them can be depended upon for saving the child, as even in the ablest hands the mortality is fearfully great. Churchill states that practically the mortality is greater than in any other order of labour, more than half of the children in which the funis was prolapsed being lost. Collins lost 73 out of 97 cases, Clark 49 out of 66. I might extend this catalogue, but the fact is so universally admitted, whatever plan is adopted, that it will be unnecessary. Any suggestion, therefore, that holds out a prospect of greater success than has hitherto been attained is deserving of more attention from the Profession. The few published cases scarcely warrant a comparison being made between the result of the postural treatment and the numerous old methods. I feel, however, assured that when it shall come to be more generally known and recognised by the Profession, the rate of mortality will be very materially lessened; besides this, the facility with which it may be accomplished is greatly in its favour, while the entire absence of all danger either to mother or child is a mutter of supreme importance. Dr. Thomas's rules are few and simple, and are applicable equally to cases where the membranes are entire as well as where they have been ruptured.

First, if the membranes are entire and the cord detected, he at once places the woman in position, and trusts to this for its return into the uterus, and uses no manual assistance.

Secondly, if the waters have escaped and left the funis below the head, he places the woman in position and pushes it up with the hand, then induces pain either by friction, or better by ergot, and if the presenting part soould so occupy the pelvis as to prevent its return by the hand, he uses a gum elastic catheter and tape as a porte-cordon; and I would thirdly suggest, from the experience of the two reported cases, that the whole hand should be introduced into the vagina, and if the head interferes, push it up and carry the cord beyond the head, having previously induced pain by ergot.

He believes the cause of the persistence of the accident whatever may have first produced it) to be mainly the slippery nature of the cord, and, secondly, the inclined plane offered by the uterus by which to roll out of its cavity; and his principle of treatment is to invert this plane, thus turning not only this plane, but the lubricity of the cord to our advan