water against the cervical part of the uterus requires to be done night and morning, and usually on the "fourth or fifth day" labour supervenes,-a process easy, irksome, and often failing.

Cohen's and Simpson's injections of warm water into the cervix uteri, to detach the membranes, though successful, are open to the same objections as Kiwisch's. Professor Simpson says "the injection may be repeated twice a day or oftener," "but the repetition of the injection sometimes becomes irksome to the mother as well as the accoucheur."

Of Simpson's other method, viz., the separation of the membranes by the introduction of a sound or bougie, easy as it is to the patient, we are told, "in all cases a single introduction of the bougie will by no means suffice; like the tents and douching, it requires, in most instances, to be repeated more than once." Besides, there is danger of rupturing the membranes in the rotation of the bougie or sound.

Professor Lazarewitch, from experiments, has concluded that the fundus uteri is thickest, is most supplied with sentient nerves, and therefore is most irritable. On these grounds he is of opinion that if any condition of the uterus can be brought about which is similar to that which occurs at the full term of pregnancy (when labour sets in), such a condition will induce labour. It is well-known that at the full term, when labour sets in, there is a separation of the ovum from the uterus. The membranes that hitherto were adherent become detached more and more till delivery takes place. On this account Professor Lazarewitch directs that premature separation of the membranes should be produced at that part of the uterus which is most sensitive, viz., the fundus and body, and this is accomplished by the injection of a stream of warm water between the membranes and the uterine wall, up towards the fundus uteri. The instrument he employs is a metal syringe to which is attached an elastic canula, with a wire in it. The syringe being filled, the canula is passed well up between the membranes and uterine walls. Six ounces of warm water is to be steadily injected, taking great care that no air be introduced. The stream is directed towards the fundus, separating the membranes as it advances. That the water reaches high up is known by the

expression of the patient who feels it rushing up above the navel. Of course it is necessary to diagnose the position of the placenta, in case artificial separation of the placenta should result and an awkward complication ensue. He states that the nearer the water goes to the fundus, and the greater the separation of the membranes, the sooner labour takes place. Professor Lazarewitch's narration of cases in the vol. of Obstetrical Transactions (London) for 1867 is exceedingly good and satisfactory. These cases are 12 in number.

In the cases narrated by myself, the apparatus used was very simple, and the whole operation took from five to ten minutes. The apparatus consists of an ordinary india-rubber enema syringe, with central ball and valves; the bone rectum-piece being removed, a gum-elastic canula, with one opening at the end, and without a wire, of No. 10 size, is substituted. The directions for operating are-Place the patient on her left side, with the pelvis near the edge of the bed on which she lies; put a basin containing a couple of quarts of warm water (80° to 90°) conveniently and immediately below, to catch the water which flows away, and serve at the same time for injecting. Fill the syringe, by placing both extremities in the water, squeeze the ball two or three times, till all air is expelled, and then put a small piece of bees wax softened in the water, into the mouth of the canula, (in the water) so as to prevent any of the water from running out, when the canula end is removed for introduction into the uterus. The canula can now be passed up for six or eight inches into the uterus anteriorly or posteriorly, as the case may be, and the injection commenced. Of course, it is obvious that the other end of the syringe must on no account be removed from the water, else air would pass into it and be injected. The injection is carried on till about a pint or pint and half of the water is injected; the water first injected usually returns immediately, and is caught by the basin-the rest remains in utero for a few minutes, and gradually comes away with a slight discharge of mucus and blood. It is advisable for the patient to rest for half-an-hour or so, to allow the water to drain gradually away; after that, she can get up and go about her household duties.

VOL. I., No. 2.-NEW SERIES.

M

Labour sets in directly in some cases, and in others as late as twenty-five hours after.

CASE I.-Mrs. H., aged 28.-Delivered twice before by craniotomy, on account of pelvic deformity, caused by a large exostosis at the promontory of the sacrum. Antero-posterior diameter at brim 23 in. Being pregnant with her third child, on 19th October, 1865, when she was in her 7 month, one pint of warm water was injected well up into the uterus posteriorly. Patient said that she felt the water running up above navel. The operation took about 10 minutes. A little mucus came away with the return of the first water. Within half-an-hour, and before she had left her bed, labour pains set in, and 401 hours after injection she was delivered of a living child. The child lived for a year, and died of measles.

Mother made a good and rapid recovery.

CASE II.-Mrs M., aet. 35.-Being pregnant with her eleventh child, was injected on 4th December, 1866. Labour did not set in till 25 hours after injection; it then was so rapid that (being a footling presentation) the feet and body of the child. were born some time before I could get to the house. The child was extracted with some difficulty dead; death produced by pressure on the funis. She made a good and rapid recovery.

Antero-posterior diameter of pelvis at the brim, 2 inches, caused by ricketty projection of the sacral promontory and lateral narrowing; pelvis cordiform. She was delivered by forceps in her first six confinements, and in the other four by craniotomy.

CASE III. Mrs B., aet. 37.-Had been three times delivered by craniotomy-on the last occasion by myself. Being now 7 months gone with child, on 18th December, 1868, I injected 1 pints of warm water, posteriorly. Some blood came away mixed with the first water. She felt the water above the navel, and distending her. In 3 hours labour set in, gradually increasing till the 20th at 10 P.M., when I was sent for on account of rupture of the membranes. I found the os fully dilated above the brim of the pelvis; the presenting part of the child was the breech. Pains very active every few minutes. At 2 A.M. (21st) there was no advance of the breech. I passed my

hand into the vagina and upwards, with the intention of bringing down a leg. I could not reach further than the middle of the child's thighs, between which I found the head tightly wedged, the child being doubled round like a ball, and the uterus firmly contracted. I failed to bring down a leg. I then withdrew my hand and waited half-an-hour, and made a second attempt; in this I also failed. Patient now becoming exhausted, anxious, and semi-delirious, I sent for Dr Hall Davis. We put the patient under chloroform. Dr Davis passed his hand as I had done, with the same intention and like failure. He then passed a blunt hook, and by dint of fracturing the thighs, brought down the legs. He found it also necessary to fracture the arms to get them down through the pelvic brim. After using great force the child was extracted dead. Mother made a good and rapid

recovery.

Pelvis cordiform, extremely narrow.

The other cases being so much like the preceding I give only the bare notes.

CASE IV.-Mrs W., third child-1 pints injected at 7 months. In 2 hours labour set in, and terminated in 24. Child dead. Mother did well. Pelvis cordiform from rickets.

CASE V.-Mrs D., seventh child-Delivered by ergot three times, with dead children. 1 pints injected. A curious result followed, which is extremely interesting. In 24 hours the os uteri was completely dilated without a pain. A second injection was administered, and in 7 hours a dead child was born. Mother did well. Exostosis on sacral promontory.

CASE VI.-Mrs P.-At 7 months 1 pints injected. In 3 hours labour set in, and ended in 96. Child alive. Mother did well. Sacral exostosis. Fourth child.

In Professor Lazarewitch's 12 cases labour set in immediately, or soon in all of them. The most speedy case ended in 33 hours, and the longest in 36. Nine children were born alive, three dead. In 5 cases only was there contracted pelvis, and only in one was the antero-posterior diameter of the pelvic brim under 3 inches. In the 5 cases one child was born dead, and in that case the antero-posterior diameter was 23 inches. In only two cases did he require to inject twice. In one case the mother

died, but post mortem examination shewed extensive cystic disease and atrophy of the kidneys, &c.

Now, if we compare the results of these cases-15 inductions with one injection, and 3 with two only, with the results of the other methods, we cannot but be struck with the remarkable saving of time and trouble to the patient and practitioner.

In the cases narrated by me there was extreme pelvic deformity in all the mothers. From such one would look forward to extreme danger to the children, yet two out of six were born alive, while the mothers, saved from the dire risks of craniotomy, all did well.

In none of the cases was any discomfort given to the mothers by the operation; indeed, they were surprised at its ease and rapidity-the operator alike being saved much time and trouble.

Contrasting the results, I conclude that this method of Professor Lazarewitch's is by far the most certain, most agreeable to the patient, and least irksome to the medical attendant.

In conclusion, if we can do at once-at one operation, by a justifiable process, with as little discomfort to the patient and as much safety to her and the child, that which would take by any other process, several operations alike irksome to patient and operator, we have conferred a great boon upon our patients, and gained for ourselves an immense advantage.

VI.-TWO CASES OF CONGENITAL MALFORMATION OF THE EYE. By GEORGE RAINY, M.D., Lecturer on the Eye in the University of Glasgow; Surgeon to the Glasgow Eye Infirmary.

I.-CONGENITAL OPACITY OF BOTH CORNEAE.

HENRY G., aged eight days, was brought to the Glasgow Eye Infirmary on the 3rd April, 1867. Both corneae were pretty densely nebulous throughout, and somewhat prominent. The opacity of the right cornea was rather greater than that of the left. There was no appearance indicative of recent inflammation, with the exception of a little hyperæmia of the tarsal conjunctivae. The child was a good deal affected with icterus infantum. In all other respects he seemed to be healthy. The mother was said never to have had a miscarriage, nor to have lost any children, and she has two others who are reported to be quite healthy.