Appendix.

One of the most eminent of London physicians, the late Dr. Palfrey, who had paid great attention to this matter, with a view to discover some definite protection for those women who are the subjects of distortion of the pelvis, and to whom labor often means death—while conversing with me on this subject pointed out the weak spot in the check most frequently recommended, and suggested by Dr. Knowlton, and he wrote me as follows:

"I must point out that the ordinary Higginson's syringe fitted with the common female tube is perforated at the extremity of the tube, and therefore is not to be trusted. The tube should be perforated with holes at the sides only, and so perforated as absolutely to secure a stream flowing in the reverse (backward) direction only. Higginson's syphon syringes are manufactured and sold by Messrs. Maw and Thompson, 7 to 12, Aldersgate Street, London, E.C., and 'I 'Higginson's syphon syringe with reverse current' is what should be asked for. These syringes may be obtained of all respectable chemists or druggists, and their price is from 3s. 6d. to 5s. each.

"Instead of a solution of alum or of sulphate of zinc being used, in the manner mentioned in the text, a dessert spoonful of a powder—composed of sulpho-carbolate of zinc, and dried sulphate of zinc, of each 1 ounce, alum 4 ounces—is recommended. Care must be taken that these drugs be reduced to a perfectly fine powder. The better plan is to dissolve the quantity of the powder just named in a few ounces of boiling water to ensure its perfect solution, to pour this solution when cool into a bottle, and keep it ready for use, adding the solution to a pint of tepid, or in hot weather cold, water at the time of using the syringe, and this is the quantity to be used on each occasion.

"As a matter of caution the solution must be kept from the reach of children or curious persons, and it is wise to label the bottle in which the solution is kept, 'Poison.' "

Dr. Palfrey informed me that in his own practice he continually recommended the use of this check to married women, and that it had been very largely and very successfully adopted.