CLEIDOTOMY, or cutting through one or both clavicles, is one of the new de structive operations. It is indicated in impacted shoulders either in case of spas tic contraction or when the shoulders are abnormally developed and large. Thus, occasionally, after delivering the head, it is impossible to deliver the trunk because of a pair of enormous shoulders. The child promptly dies, and brute force would only succeed in rack ing frightful lesions of the genital tract. If now a pair of stout scissors are in troduced and the clavicles are deliber ately cut through, the chest instantly collapses, its diameter is diminished, and speedy delivery follows.
EauEra H. GRA:sins, SimosAux, New York.
PELLETIERINE.—Pelletierine, or punicine, is the alkaloid obtained from the root-bark of the pomegranate (Punica granatum, L ), or granatum, U. S. P. As found in the shops it consists of a mixture of pelletierine and isopelletie rine. It occurs as a colorless, oily liquid, of aromatic taste and odor, and is solu ble in 20 parts of water, and more solu Me in chloroform, alcohol, and ether. It readily forms salts with the acids, of which the tannate is most commonly used. The tannate occurs as a yellowish or grayish-brown, hygroscopical powder, having a slight astringent taste. It is soluble in SO parts of alcohol, in 700 parts of water, and in warm dilute acids. Tanret's pelletierine is a syrupy solution, sold in bottles, each containing one dose.
The officinal granatum is seldom used in the crude form. A decoction (4 to 16) in doses of 4 to 6 ounces, or fluid extract in doses of 1 to 2 drachms, is sometimes employed, but neither is of ficinal.
Physiological Action and Therapeu tics.—Pomegranate is a powerful astrin gent, and a decoction, flavored with aro matics, is useful in pharyngitis and as an injection in urethritis. Coronedi has found that pelletierine, in poisonous doses, paralyzes the peripheral ends of the motor nerves very much in the same way as curare does, without influencing contractility or destroying sensibility, and acts chiefly on the lower limbs, in which cramps may precede the loss of power. Pelletierine may also cause nau
sea and vomiting.
Autopsy made on a man, 34 years of age, NV110 had died in a comatose condi tion sonic hours after having taken a dose of 7 V, grains of sulphate of pel letierine. Strychnine poisoning was sus pected, but sulphate of pelletierine was found in the viscera. The patient was an epileptic, and epilepsy is personally considered contra-indication to the use of pelletierine. The sulphate of pel leticrine is much more dangerous than the tannate, and it is recommended to administer tannin at the same time as the sulphate of pelletierine. Crolas and Boyer (Lyon Med., July 3, '93).
A decoction of pomegranate was for merly used in serous diarrhoea and pro fuse sweats and in dysentery, but on ac count of its disagreeable taste and effect upon the stomach it is no longer used.
Dujardin-Beaumetz has successfully used pomegranate in 1I6niere's disease. According to Galezowski, pelleticrine is of service in paralysis of the third and sixth nerves.
The special use of this drug is for the destruction of tape-worms. In tropical countries the powdered bark is used in doses of '/, to 1 '/, drachms. The de coction (made by soaking 2 ounces of the bark in 2 pints of water for twenty-four hours, and then boiling down to a pint) is a nauseous dose, but generally effica cious; a wineglassful of this decoction is taken every hour until the whole pint is taken. Generally purging and vomiting follow, but, should purging not occur, castor-oil or other good purge should be used to expel the worm. A previous fast of twelve hours is necessary, whatever form of this drug is used.
Pelletierinc tannate is given in closes of 3 to 15 grains, in 1 ounce of water, followed in two hours by a brisk purge. As serious paralytic symptoms have en sued after the ingestion of 5 grains by a susceptible woman, not more than this amount should be given.