August 17, 1872.] THE BRITISH MfEDICAL _JOURNAL. 183 presented as the facts in the case. Why, even in criminal cases, can- nexion with the pelvis, whilst it was at the same moment gently forced not we have such a supplementary jury sworn to examine nothing up with the palms of my hands formed into a cup-shape. This pressure whatever but the physical facts connected with the case? The wit- was continued steadily for some minutes in the direction of the outlet nesses may be examined by the lawyers; for they are clever at that, if of the pelvis, upwards and backwards, and, as it yielded, directly up. at nothing else. And the verdict of the supplementary jury should wards, when I had the gratification of finding it glide safely upwards be handed to the common jury as the only scientific evidence to be into the replaced vagina; by following it still up with the fingersjt was admitted. Such a plan would save justice gom the uncertainty whiclh pushed high in the pelvis. A full opiate was now administered. An is the greatest injury to which it is now exposed. A man now never assistant was placed to watch, with the hand on the perineUm; and knows whether he is to be hanged or not, which is a very unpleasant the patient fell into a profound sleep, and awoke, after some hours, thing. free from inconvenience. She was retained for some time perfectly The duties which the medical profession discharge to the public are quiet, with the hips slightly elevated, and went home well. At the at present but very imperfectly understood, and Iturn with special expiration of six weeks, she was delivered of a healthy living child, pleasure to those which they discharge to the sick, and especially to which appeared of about seven and a half months' development, and it the poor. The tongue of slander has never been able to say that any survived. large portion of the medical profession has ever neglected or deserted that CASE X. Acephalous Fctus; totally'raindess; acutely sensitie.- duty. The blessings of the poor are always their best and sometimes the A female child, otherwise fully formed and developed, was bom acepha. only reward they get for many hours of lonely toil. It is a consolation to lous-in fact, totally devoid of brain. It survived its birth one hour men working in the outskirts of civilisation in many parts of the and a half, breathing and crying loudly; the expirations were rather country, in remote villages and mountainous districts, where they have convulsive in their character. Its voice was very strong. It was acutely few companions of education around them, and are perhaps neg- sensitive to impressions made on the surface of the body, and moved lected by those supenorequalin society to themselves, toiling almost alone- its limbs. We could not satisfy ourselves whether it heard or saw. it is always a satisfaction to them to know that they are labouring in a It cried so much on inserting food in its mouth, that it was impossible to good cause, following the footsteps of Him who not only reclaimed ascertain whether it could perform the act of deglutition. In other cases the sinner from his evil ways, but also healed the sick. The records of acephalous fcetuses, we usually found a rudimentary portion of the of no profession can show so long a roll of obscure, able, and clever middle lobe of the brain; and they rartly survived beyond a few gasps, men, making, in quiet, great discoveries in science, in solitude doing if so much. The malformation is occasionall combined with spina much good, whose names are not known during life, and to many bifida and contortions of the limbs; but some, like this child, are fully -of whom statues to perpetuate their memories are now being erected developed-indeed, the shoulders were so much so, as to create a diffi- throughout England. Many an humble physician has thus worked, culty in their extraction. The post mzortem examination, in which I seen by no eye but that of the Great Master, and, at the close of his was assisted by the late Dr. Todd of King's College, presented no useful but neglected career, sees the shadow of the evening of life close feature worth recording, beyond what I have mentioned. upoin these labours, and may well exclaim, in the words of the great CASE XI. Spina B/iJda. -In June 1872, I was consulted about a child Italian poet who died among us in Englanid, far from his native land, four months old, reasonably well developed, healthy, and with every and forgotten by his country- prospect of continued vitality and health, save the existence of a head "Morte me darai fama e riposo." somewhat large, but with tardy development of the parietal and frontal "Death will give me fame and rest." bones, leaving the large fontanelle unossified, congenital dislocation of This is glorious language; still it is the voice of despair. the ankles forwards, and a spina bifida of the lumbar vertebr.e. This measured two inches in diameter, with a projecting polished mem- branous covering, enclosing an elastic fluctuating sac. In fact, there was a total absence of the integumentary, ligamentous, and bony AN ADDRESS covering of the spinal chord, the tllickened dura mater supplying their DELIVERED AT TIIE OPENING oF place. I exhiibit a model of this case. The child, a girl, shows quite as much evidence of mind and powers of observation as four THE SECTION OF MIDWIFERY. months' children generally do. My directions hitherto have been to A! the Anznual M.eetintg of/le Britishl Medcifical Associationj take every precaution to prevent the injury or rupture of the cyst. A chambered shield of gutta percha, lined with padded silk, is being inz b'irningta;n, August 1S72.* adapted to prevent the possibility of accidental injury; and I have By EVORY KENNEDY, AI.D., it in contemplation to try a plastic operation when the age, promise Late Master of the Dublin Lying-in Hospital; President of Lhe Section. of enduring life, and condition of the child justify it. It would be extremely gratifying to me to have the suggestionis of my conIfreius with CASE VIII. The I Vitoole Circle oft/t Os Ulte-i thrown offnaitLbouz.- reference to the future dealing with,this remarkable case; more especi- A patient in her third labour, which was somewhat violent, had sliglht ally of those who have met with similar cases in their practice. How hbemorrhage. The head was well engaged in the pelvis, and some long have they been known to survive, and how they were treated? fleshy mass was found to protrude from the vulva. The pains increas- CASE XIII. IVesieo-vagi;zal Fistula cured ly twisted Sututre.-On ing, a complete circular riing, about three-eighths of an inch thick by August 12tli, 1837, 1I. Byrne, aged 25, was sent from the country suf- an inch in breadth, escaped, which, on examination, proved to be the fering from vesico-vaginal fistula. The opening was longitudinal, about detached os uteri in its entirety. The labour proceeded rapidly. There five lines long, with considerable loss of substance. It was about three was very little Ineniorrhage; and the patient made a favourab!e re- inches from the urethral orifice. The bowels were well freed. She was covery, the lochial discharge continuing longer and being more offeni- placed on the abdomen on the edge of a table, with a bolster inter. sive than usual. Of the after-history of this case, and whether she bore posed. My four curved beak-tractors were introduced, and, her limbs more clhildren, I am ignorant. being held fast by assistants, I pared the edges of the fistula with a scalpel, cutting on an ebony spatula; and, having introduced three short CASE IX. Proci/tteitt of Gravi(d Lters in the Sixth AMonthi !fPrqg- twisted nancy, retduced successfully: Living Chlild six l kit s after- Rt>luctioal.- needles into the wounded edges, drew them together with a MI. B. was admitted inito hospital April 4th, 1838, with the extraor. sutulre. A perforated shot was now squeezed on the end of each needle, dinary displacement of the gravid uterus exhibited in this drawing. an elastic catheter introduced into the bladder, and the patient was on of placed lying on her abdomen, on bolsters stitched together longitudinally. She considered herself just entering the sixth montlh preg- She was retained in this position, and closely watched day and night, nancy, and had suffered for some time from bearing dowin anid pelvic from had by a relay of nurses, who never left her. The urine flowed freely distress. The tumour, now perceptible, protruded suddenly beyond the urethra into a bladder attached to the catheter. Her bowels were the parts the day before admission. It appeared larger than a pint mug, the polished, dry, and red, with the os uteri enlarged, but not patulous; washed out by lavement. Not a drop of urine escaped from vagina. rather as perceive; mucus, with The sutures were cut out on the fifth day, and the needles removed, puckered, you plugged witlh yellow and wlhen the union was complete. She left the hospital in a fortnight per. -several ulcers, as if the effect of abrasion, on the most pendulous part fectly well. I had the advantage of the assistance of my late colleague, surrounding the os. The ulcers were touched with solid nitrate of the distinguislhed surgeon Mr. Abralham Collis, in this case; and I can- silver. The patient was placed on her back with the pelvis elevated by not easily forget the gratification he evinced when he made a final exa. pillows. The protrusion was smeared well with hog's lard ; and then the the protruding tumour was gently but steadily embraced with both my mination of the bladder before the patient left the hospital, nor all significant manner in which he answered my inquiry whether he could hands, and pressed with the points of the fingers round at its con- find any hole. "No, doctor; I can't find a hole, unless I make one"; of bis shoulders, with 8 Concluded from page 163 of last number. and added, with a peculiarly expressive shrug 184 fTHE BRITISH MEDICAL 7OURNAL. [August 17, 1872. = I which those who knew hiin were famiiar, " I am sure you don't wish enced before or since. Our attention was called by the chloroformist me to do that." to our patient, who lay with her head over the edge of the table, her CAsz xIv. Ieso-vaginal Fisitda treated by C'autery.-Honor Lattan jaw fallen, and to all appearance dead. There was no respiration; no was admitted in May 1836 with a vesico-vaginal fistula an inch and a pulse at the wrist; no action of the heart. I took out my watch, in half from the meatus, transversely oval, with the edges thinned off, and order to take care that attempts to restore animation should be conti- large enough to admit the point of the little finger. She suffered from nued for a sufficient time before desisting, but without a hope that they constant escape of urine ever since her first of two labours in the could be attended with success. Experience in resuscitation of infants country, which lasted for seventy-two hours. The vulva was excoriated, had led me to expect little from forcible inflation of the lungs by in- red, tumid, and tender, with gritty deposit. Lead-poultices and the serting a tube into the trachea, but much from a continuous and per- use of the catheter were had recourse to for some days; and then she sistent imitation of the act of respiration by regular pressure on the was placed on the abdomen on the table, the tractors were introduced, elastic ribs of the subject-producing, as nearly as possible, the systole and the button actual cautery applied to the stricture surrounding the and diastole of the lungs and chest-frame, as observed in nature. aperture. After this, she was slung from the bedposts in a sheet, lying Without a moment's delay, I sprang upon the high table, so as to upon the abdomen, with the catheter introduced. This operation was command the prostrate woman; and, kneeling across her, placed a repeated at intervals, at first of five days, and subsequently at intervals spread hand over the lower ribs, and kept up an artificial respiratory of eight or ten days; and.she left on the 26th of July, able to retain her action in the lungs of about twenty pressures in the minute. In the urine for two hours, and only disturbed twice at night. The edges were meantime, all the available means of resuscitation were most assidu- again touched on the iith of August; and, on the 30th, she described ously carried out by my friend Dr. Ringland and his assistants. Fric- herself as free from inconvenience, retaining her urine regularly for three tion and sinapisms were applied to the arms, legs, and surface. As hours through the day, and being even able to go on often without re- speedily as buckets of warm water could be procured, her hands, feet, lieving the bladder more than three times in the day and twice at night. and limbs were immersed in it These efforts were persisted in, whilst The spot remaining ununited was reduced to a smaU pin-hole, such as minute after minute was anxiously counted, with not the slightest evi- you see represented in this drawing of Bridget Byrne, a case somewhat dence of restored vitality. At length, our souls absolutely sickened milarly treated, and with similar results. with disappointment, and, I may add, all hope having fled, we were, CASE XV. Vesico- Vagintal Fistula treated by Cautery and Pessary.- at the expiration of twenty-two minutes, repaid for our exertions by a Mary Cathcart (November 1837) suffered from a slough of the vesico- convulsive gasp. Nearly a minute took place before a second occurred. vaginal septum in her first labour in the country. The fistula was Then they recurred at half-minute intervals; and eventually the natural small, circular, about two inches and a half from the meatus, and breathing became established, and the artificial respiration was desisted rather to the right side. This was considerably diminished by one from. Sickness now set in. She was unable to assist in the involun- application of the actual cautery a month after her third delivery; but, tary efforts to discharge the stomach. The food blocked up the as this was followed by peritonitis, it was determined not to repeat any cesophagus and postenor fauces; but, by drawing the head and neck operation. A cast model of the vagina, made of dentist's wax, was over the edge of the table, and giving her the advantage of gravity taken. This was done by introducing the soft wax, with a tape for whilst the finger was passed into the cesophagus, the obstructing food extraction imbedded in its centre, through a speculum partially intro- and mucus were removed, and respiration was established. A second duced. A caoutchouc mould was made from this, which fitted the collapse ensued after a few minutes, consequent on the evacuation of vagina accurately, and was worn constantly as a pessary. The result the uterus; but after this she recovered without a check. A curious of this simple contrivance, to use the words of my then clinical clerk, circumstance, in a psychological point of viewv, should not be omitted. copied from his report, was, that "she experienced much comfort, be- When she recovered her sensibility and powers of perception and mg enabled by its use to retain her urine to a convenient length of speecb, within a few minutes after respirtion was re-established, look- time, and evacuate the contents of the bladder at pleasure, without ing steadfastly at one of the physicians present, she asked slowly and withdrawing the instrument." I should, however, mention that I have with some effort, "Is that Jesus Christ?' Where was her soul during since several times repeated this plan, using the cautery in preference that period of suspended animation? It might be surmised that this to the ligature, or where this was objected to; and it has generally case would shake one's confidence in chloroform. WVith me, it had an enabled the patient to retain her urine for some time. It has, how- entirely contrary effect, as it proved the power-perhaps I shoutld say ever, not always been attended with the same amount of success. In the capability-of restoring vitality suspended by its use under circum- fact, it is more adapted to very small fistulous apertures, or to those stances apparently hopeless. that have been reduced by the use of the cautery CASE XVII. Fallfront: Window in the Seventh Month of Gesation.- CASE XVI. Total Occitusiont oJ Vagina: Operation : Ani,nation sits- In January 1834, I was called to see a woman in Beresford Street, who pendedfor upwards oftwenty-two Minutes bi C'hloroforrn.-Some years had fallen from a window three storeys high, whilst stretching clothes ago, Dr. Ringland and I were called upon to operate in a case of a on a rope line made fast to a projecting pole. She not only fell about lady with total occlusion of the vagina. The examination could only thirty feet, but, her hip striking a small wooden baluster that protected be made through the rectum. The anterior and posterior walls of the the area, the baluster gave way, and she was precipitated about severn vagina were united almost throughout their whole length. There was feet lower into the area. This woman was in the seventh month of a sense of fluctuation perceptible on pressing the hnger high up into the pregnancy. I found her still suffering from the shock, with a small bowel. A tumid fulness was perceptible over the pubes, to about quick pulse, very anxious countenance, the surface and extremities the extent of a six months' pregnancy. The bladder and rectum cold; but, with the exception of a contusion on the hip and some slight were emptied; and the patient was placed on her back, on a high abrasions on her hands, she had received no apparent injury. As she couch, with the limbs flexed and hel by assistants, as in lithotomy. was in very poor circumstances, I had her carefully carried into one of The patient was with some little difficulty brought under the influence the surgical wards of the Richmond Hospital. A full anodyne was of chloroform. I had commenced the operation, when she struggled so administered, and she awoke, after some hours' sleep, without any in- that I was obliged to desist, and assist in bringing her completely under jury or ailment save the contusion and abrasions referredto. After its influence, before again commencing. A catheter was introduced resting in hospital for a few days, she left quite well. In the course of into the bladder, and the dissection was proceeded with, cutting and a fortnight, she made a voyage from Dublin to Liverpool, and suffered separating the adherent tissues with the blade and handle of the scalpel from sea-sickness. She returned and was admitted into the Dublin alternately; now introducing the finger into the rectum, and again feel- Lying-in Hospital. At the end of her ninth month, she had an easylabour ing through the anterior wall for the catheter, to avoid approaching too of a living child, and recovered without a clheck. Sir Astley Cooper closely to either cavity-a scarcely appreciable divergence in either might well say, in reference to the patient who died from diffulse in- direction being fraught with misery to our patient for life. From the flammation following the scratch of a pin, and the recovery after per- difficulties and risk attending the operation, it was necessarily a tedious foration of the thorax with a gig-shaft, " Gentlemen, yoivwill tllus per- one; "rapidity" in such an operation being a convertible term for ceive there are some cases that you cannot cure, wvhilst there are others " destruction". At length, after cutting for three inches upwards, and that you cannot kill." dissecting a new vaginal canal throughout this extent a of by dividing CASE XVIII. Arin sing Tzz''lve M31onths after Dzdiz'4' /a Daitl Child. layer condensed structure not more than the sixth of an inch in -Mary Kenny, aged 22, had had a still-born child ninie imionths after thickness, we had the gratification of coming to a small pouch at the marriage, computed to have been a month dead. She secreted milk upper part of the vagina, which communicated with the distended freely, and continued to have milk in her breasts for a monitlh after uterus, and from which poured a quantity of grumous retained strual men- delivery. At the expiration of a year, she took a relative's child to fluid. Having thoroughly enlarged the opening at the upper dry nurse. She had the child to sleep with her, and applied it to her part, so as to correspond with the dimensions of the canal throughout, I breasts in the night. On the following morning, she noticed her got up from the operation to receive a shock such as I never experi- chemise stained with milk that had escaped from the nipples. Sbe August 17, 1872.] THE BRIYISH MEDICAL .70VRNAL. continued nursing the child regularly for seven months. The child relieve it from the pressure, when the labour progressed. In minor was satisfied, and throve remarkably well. Her catamenia, which had cases this is all that is necessary, but in more severe cases I have de- continued regularly from the time of her confinement, ceased, and did rived benefit from punctures. In Quinlan'scase, now exhibited, atten- not return whilst she nursed. The child died of dentition when seven tion was called to what was supposed by the pupil on duty to be a months old; and two years afterwards, when this case was noted, polypus connected with the upper and anterior part of vagina. The a milky fluid could be drawn from the breasts. -} head was at this time escaping the os, and pressed the tumour against CASE XIX. Obstinate Procidentia of Uter-us cured bl' Actual Cauterj'. the pubes. At noon, the head descended very little, but was forcing -Mary Burke, aged 6o, a widow with six children, had obstinate pro- the tumour down before it. Two fingers were steadily kept against cidentia of the uterus, ancd could not retain any form of pessary. She it during and in the interval of the pains, and the head descended to suffered much distress; her general health was deranged; she was dys- rest between the ischia, where it remained stationary, withlout making peptic, and had lumbar pains. She was confined to the horizontal the turn into the hollow of the sacrum for ten hours. The painsbe- position, with the hips well raised, for a fortnight. The ulcers healed. came slack; there was no want of room; andthe fretal heart was audible. The uterus was placed in sitt, and astringent injections were used. I passed up the lever and brought down a living male child. This The actual cautery was then applied about an inch and a half from the woman went out well and returned at a subsequent period, when the vulva round the surface of the vagina for the extent of about half an projecting growth was removed by curved scissors which I had con- inch. My clinical clerk, who was somewhat of the Gil Blas school, in structed for the purpose. criticising his master, adds that the old woman was so indignant at CASE XXIV. Suddien and unaccountable Deatlh on Fifth Day after this operation, which, for obvious reasons, it was deemed more con- Labour.-Mary Caulfield, aged 30, was deliveredApril i4th, I837, after siderate not to explain beforehand, that she left the hospital in a fit of a labour of ten hours. Her recovery was favourable. She was up for indignation, because a hot iron had been applied to her inside, as she a short time on the igth, apparently well, when she suddenly ex- said, without saying, "With your leave, or by your leave." She claimed, " What ails me? Oh, my God !" andalmost immediately ex- eventually permitted the treatment to be followed up by the applica- pired. After the most careful post miortem examination, there was not tion of nitrate of silver; and the report is thus continued by my clinical anything found that could account for death. In a case of sudden death critic. At the expiration of two months, she was able to go about occurring some months previously in hospital, a dissecting aneurism of again. The uterus was in sitie; and she had derived much benefit the aorta was found that had opened into the pericardium. It is quite to her general health and condition, and a distressing pain, descending possible that a lesion might have existed in Caulfield's case also, that down the front of the thigh, from which she had constantly suffered, escaped detection; but every tissue in the body was examined most had disappeared. The cicatrix formed by the eschar prevented the carefully, especially the respiratory, circulatory, and cerebral systems, descent of the os. He adds, however, this caustic comment on my and nothing abnormal could be detected. operation: " She certainly got a regular touching up." CASE XXV. Funis Prolapsed: Lonzg Forceps: Advantage ofStethioscope. CASE XX. Procidentia Vesictr treated by Vaginal 2T'ould.-In February -Biddy B. had her second labour in November 1837. The funis was 1839, Catherine Sullivan was admitted with complete procidentia of prolapsed, with rupture of the membranes. The os was fully dilated, the bladder, the result of a tedious and instrumental delivery of her and the head entering the brim of the pelvis. I replacedthe funis within nrst child. She bad had two pregnancies, and suffered from pro. the uterus, and retained it in situt by pieces of sponge pressed up in the lapsus; but the protrusion occurred suddenly, about two years before posterior and right side of the pelvis, where the funis had descended. admission, whilst she was lifting a feather-bed. She was treated by a This practice I had frequently before adopted with great advantage. variety of pessaries, and the actual cautery was applied to the interior However, on applying the stethoscope, the action of the fcetal heart, of the vagina; but the protrusion recurred despite of all. She was that had been previously audible, became indistinct, and eventually 'kept for some time in the horizontal posture. A cast of the vagina could not be detected. My long forceps were immediately applied, was taken in wax, with the bladder restored to its natural position. A and a healthy child was extracted, in which the respiration was speedily plaster of Paris mould was made from it; and in this a cautchouc in- established. strument was moulded. This she wore with great comfort and conve- CASE XXVI. Procidentia of Uterus and Vagina during Labour; zoith nience. It should be mentioned that the difficulties in this case were retainied Placenta: Replacement : Recovery. -The last case to which I added to by the existence of a growth supposed to be an exostosis, shall call your attention is one represented in this drawing, and which springing from the interior of the sacrum, and encroaching on the tells its own tale. The patient was sent into hospital as you see her, inlet of the pelvis. delivered by an ignorant midwife, after a labour of a few hours, with CASE XXI. Inversion of Bladder-, wit/ Procidentia, th;-ozuZzh the `esico- procidentia of the vagina. The funis was hanging out; the vagina Vacginal Septum.-J. S., aged 50, suffered from lesion of the vagino- lacerated at its superior part ; the uterus was close to the external parts. vesical wall in labour, to such an extent that the bladder protruded and the placenta retained within it and adherent. There was little beyond the vaginal aperture to the extent of a small cricket-ball. The haemorrhage, or she could not have reached the hospital alive. Reac- loss of substance was such that no operation could possibly be under- tion was established, and the uterus and vagina were restored to their taken, and the intolerance of pres,ure was so great that no attempt natural position. The hand was slowly introduced into the uterus, and at reduction or support of the bladder in situ, as in the former cases, the placenta detached and removed. Fortunately, the laceration, which could be made or tolerated. A shield of tin was adapted to prevent was flap-shaped, did not extend to the deep-seated tissues or bladder, friction, but"Its advantages were not very great. and she recovered slowly but completely. She was retained for a long CASE XXII. Procidentia of Uterus and Bladder, with Ever-sion of lat- time in the recumbent posture ; and the vagina and uterus kept their te;-from Sloughiing of Vesico- Vaginal Wall.-This case was also the position without requiring artificial support. result of a tedious and instrumental labour. The patient had been a miserable and hopeless sufferer for years. Nothing could be attempted, OF SARCINOUS VOMITING. not even reduction within the vagina, with any hope of advantage. TREATMENT A tin shield was adapted, as in the previous case, to preserve the sen- IN the JOURNAL for July 20th, in the account of Dr. Murchison's sitive parts from friction. The ulcerations on the utero-vaginal wall, clinic, a case of sarcinous vomiting with organic disease of the stomach which you perceive in this drawing, were healed by the application of is given, in which all the gastric symptoms, together with the vomiting, caustics, and she was discharged to wear out her life of misery and were relieved by kreasote and morphia. I can speak highly of the torture. value of kreasote in these cases. Some three years ago, in a case of Whether the ingenuity of our operating surgeons will ever arrive, narrowing of the pylorus, with dilatation of the stomach and sarcinous by adaptation of a plastic operation or otherwise, at any means of curing vomiting, occurring in a young woman, I tried carbolic acid, chloride these apparently hopeless cases, is problematical. One comfort is, that of sodium, and other remedies, in vain. Kreasote gave the most the earlier use of instruments would appear to render these incurable marked relief; the distension of the stomach, the vomiting, and the cases less frequent ; certainly we do not meet them as we did when sarcinous fermentation, all abating very considerably under its use. I the rule was to leave Nature day after day to her unassisted efforts. was much struck with the result at the time; and, although I am fully CASE XXIII. I]Vpertrophy of Lips of Ut'rus.-I formerly described aware that single instances of this kind have but little value as evidence some cases of this affection occurring in the unimpregnated uterus, of therapeutic effect-for I believe, with MIr. Stuart Alill, that " re- with operations for their removal. The drawing now exhibited shows covery from a disease is an event to wvhich, in every case, many influ- this condition in the impregnated organ. It is, no doubt, a cause of ences must concur"-I nevertheless veniture to publish the formula I tedious labour, and, when the lips of the uterus are cauight by the head employed: Rx Sodme hicarb. gr. x; tinct. lupuli Tt xx; sp. chloroforrri against the pubes, retards its progress. My case-books show several in- Ir, xv; misturx kreasoti 3j. Misce. To be taken three times a day. stances where delay was referable to this cause, and in which the head JAMFS SAWYER, M.B.Lond., remained stationary until the tumid lip was pressed steadily up so as to Physician to the Queen's Hospital, Birmingham,