lung;" and, later on, speaking of "An engorged condition of lung?" Without an excess of blood in the lung we cannot have pneumonia, and yet I acknowledge that such excess is not the primal cause of pneumonia; it is a result. I bleed to avoid the result, and thus hold the inflammation in abeyance; for when we bleed we remove-not the cause, not the effect-but that which feeds the inflammation. Again: "Pneumonia is a self-limited disease; and no treatment with which the medical profession is acquainted has ever been known to shorten or cure the disease." Is it possible that after all our boasted modern skill in the treatment and cure of disease, we are like the augurs of ancient Rome, and it has become a matter of surprise that one physician can look another in the face without laughing? My article was intended to recall to the minds of the physicians of to-day the "lost art" of blood-letting in acute inflammatory diseases, and was particularly called forth by an editorial on page 398, November WORLD, entitled "Pneumonia." Venesection, it is true, did much mischief in the years agone, when it was the sheetanchor of many of the doctors of the old régime, when they bled promiscuously for all diseases. Yet I still hold fast to my motto: "Keep blood from your skirts by judicious blood-letting," in all acute inflammatory dis

eases.

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Since writing my December article I have treated four serious cases of pneumonia, all of whom were out of bed and well inside of eight days from the date of the chill. I will give exact notes as taken down daily in the worst

case:

Joseph S., aged 29, married, a carpenter, is a member of a brass band; blows a brass horn. The band played for an out-door ox-roast on the night of November 27, 1888; walked home five miles after midnight; had a severe chill next morning. I was called to see him in the evening of the 28th; found him suffering with a dull heavy pain, and a feeling of pressure in right side, with an annoying, unsatisfactory cough, that would scarce allow him to speak, expectorating a glary, tenacious mucus, that was streaked with blood; at times it was very bloody. The sense of oppression was so great that he thought he could not live an hour. Temperature, 1052°; pulse, 120, hard, sharp and full. Auscultation showed marked crepitant râle, and percussion a dullness over entire right lung. I at once called for a basin and bandages, and abstracted twenty ounces of blood from the arm. I bled not for quantity, but for effect, with the patient in a recumbent position, with head slightly elevated. He dropped back "in a faint." I removed the

M et sig. A tablespoonful every three hours, or until he would become nauseated.

Nov. 29th. I called to see him at 9 A. M., and found him comfortable; had slight nausea after taking a tablespoonful of his medicine just prior to my arrival; pulse 88, temperature 10020, very slight loose cough, sputa still discolored by dark coffee colored streaks-not bright red fresh blood, as shown by his sputa the previous evening, perspiring freely. He asked to be allowed to eat a roast potato. I granted his request and added toast and a soft boiled egg to his bill of fare. Continued the medicine by reducing the dose to a teaspoonful, and to be taken every two hours.

Nov. 30th. Cough very slight, more expectoration, no discoloration of sputa, temperature 990, pulse 78, skin moist, wants to eat more, asks to be allowed to sit up in bed. I grant his requests and withdraw the medicine and give him quinia sulph. grs. iij every five hours, as a tonic.

Dec. 1st. Temperature and pulse normal, free expectoration, with not much cough, tongue clean. Asks to be allowed to get out of bed, and sit in an easy chair; begins to think he is well.

Dec. 2d. Find my patient sitting at a table and eating, seems to enjoy it, and says: "Doctor, there is nothing the matter with me." After advising his remaining within doors a week longer, I dismissed the case, and just one week later I met him a mile from home, looking somewhat bleached, but in perfect health.

Pneumonia is a self-limiting disease, as are most other diseases, if left to their own sweet will; but the great trouble is that under the sustaining or expectant treatment of to-day, death fixes the limit much too often in preumonia, and when the patient, after lying in bed from three to four weeks, proves that his constitution is stronger than the disease, and fins the limit of the disease, he finds himself an invalid for as many weeks, almost, as my above case was days. The history of the above case is that of most cases of pneumonia, treated by the rational method, and yet I do

not pretend to say that I treat all cases as heroically as this one. I give it as an outline of my general practice in cases of pneumonia and pleuritis. It was a bad case, and, as the boys would I went for it." I incline to the say, opinion that "milk and water" would not have cured a case like mine. I do hope I will not be constrained to ask space in your columns again on this subject. I have said more than I intended to say; but would advise Dr. Middleton to note carefully the article on page 32, January number, by Dr. Brunner of Eshbach, Pa. WM. B. BIGLER, M. D.

Springvale, Pa.

Confirmation of Coal Oil in Intussusception. Editor MEDICAL WORLD:

I have had two cases of intussusception of bowels since Dr. Whitney's communication in the September WORLD. The first, an old lady, aged eighty years, suffered for two days with, what she supposed, colic, before sending for me. I diagnosed obstruction and tried the usual remedies-large enemas of warm water, the shoulders dependent; injection of air until the abdomen was tympanitic-all to no purpose. Finally, when stercoraceous vomiting set in, I determined to try the coal oil as described by Dr. W. In six hours a large fecal stool, followed by many others. The patient being so old and very feeble she succumbed to the shock and died the third day afterwards.

The second case was that of a boy four years old. Had been having acute colicky pains for several days; his father told me his "stomach" was much swollen. No stools for several days, when he had given him some "Stewart's worm mixture," which, his parents said, brought seventy-five worms. After that the pain and constipation began. I used no other remedy but the coal oil (4 oz.), which in a few hours gave copious feculent stools. No further trouble, but a slight diarrhea. Friendship, Md.

GEO. W. P., M. D.

Grind thoroughly together and put into sixty capsules, of two grains each.

Sig. Give one capsule after each meal until all are taken.

If, during the time of taking, an aching paroxysm comes on at evening for two or three days, you had better poise the patient over these spells by thoroughly quinining him for two or three days; but at the same time go on with the capsules. In a very stubborn case, you may have to renew your prescription once, but never more than one time. Try this with the chlorotic girl who has no enjoyments in life for want of health, and in doing so you make to yourself a name that will be envied by your brother doctors:

Editor MEDICAL WORLD:

In reading my medical journals, I have long been impressed with the fact that there is a lack of conservatism, on the part of many contributors, in advocating too freely new treatment without sufficiently testing the same. I have noticed in some instances, physicians re-, porting the therapeutic virtues of drugs in certain maladies, after but a single trial. The result is a large number prescribe them in similar cases, only to find them deficient of the properties ascribed, and the patients suffer the consequences. Again, there are others who intuitively, or otherwise, believe from a limited experience that certain treatment is effective, and recommend it to the fraternity with a view of them giving it a trial, whereupon numbers of patients become the victims of a mass of experimentors. To obviate such an objectionable course, we should thoroughly test our proposed remedies, that we may be certain of their reliability, before publishing. I am not one to discountenance the use of a new remedy, when I have reason to believe it to be of service; but I don't think it advisable to discard the time honored remedies, and go into raptures of en

thusiasm over some whose therapeutic powers are still sub judice.

I would say to Dr. Younger, page 82, that I have had considerable experience in such cases as he describes, and found no remedy so effective, in relieving pain and making a cure, as the hypodermic injection of morphine and atropine into the seat of pain. Not a single case has developed the morphine habit, and it has been exhibted in this way three times during the night in one-fourth grain doses. Since the attacks are periodical, I have found it sometimes advantageous to give it about the time the pain is expected to begin, when it will be aborted. I wish you would try this treatment in a systematic manner for a month or more, doctors, and then report.

The best remedy I use for constipation (Dr. Gentry, page 82) is cascara sagrada in sufficient doses, three times a day, to move the bowels once. Sometims I combine it with nux vomica and belladonna. It is also very servicible in hemorrhoids, which are often complicating cases of constipation.

I like THE WORLD very much, and think the index, by Dr. House, its crowning effort. Kingman, Me. R. J. LOVE, M. D.

For Gall Stones. Editor MEDICAL WORLD:

In your journal for February, 1889, page 56, Dr. R. D. Ramey asks for a good prescription for dissolving gall stones. I will send him, through your columns, a treatment I have used for more than two years with good results:

R Sodii phosphatis ... .grs. xx to xxx Sig. At one dose, in a cup of hot water, one-half hour before each meal. The dose can be reduced if it should cause too free catharsis.

In connection with the above give:

An Interesting New Drug.

Editor MEDICAL WORLD:

Thinking that a few lines to your many and widely diffused readers, concerning an interesting drug, might be acceptable, I pen this communication.

The drug in question grows in southern Arizona, northern Mexico, and other places. It is recognized as the Jatropha Macrorhiza (Benth.) and is known amongst the Mexicans by the name of Jicomia. It is related to the Jatropha Purgans of South America and other tropical countries. The root of the Jatropha Macrorhiza, from which a fluid extract may be prepared, is the part used. It is highly purgative, also emetic in too free doses. The root closely resembles another of an edi

soda, or of borax soap. These alkaline preparations help to restore the albuminous tissues to a normal condition, and afford almost instantaneous relief from pain of burns. Carbolic acid in a five per cent. aqueous solution would be more nearly ready for use if water was not easily obtainable.

I should also have as much pure water as whiskey in my case. Such are some of the suggestions I desire to add to Dr. Shimwell's article. GEO. F. WATERS.

8 Beacon St., Boston, Mass.

Retained Placenta.

Editor MEDICAL WORLD:

In the January issue, page 36, of your very highly prized journal is an article from the pen of Dr. J. M. Proctor, supplemented and amplified by one from Dr. John G. Meachem in Feb. issue, page 68, to the dictum of which I and, beyond doubt, the great majority of our profession cannot by any means subscribe.

Before issuing his dictum, the Dr., at the beginning of his article, very naively says: "Dr. Coleman seems to think that the placenta is in some way fastened to the uterus." Most assuredly is it "fastened" (attached) to the uterus; yes, so much so that it sometimes requires the combined aid of nature and art to remove it. As well might we doubt the attachment of the apple to its parent twig as to question the relation between uterus and pla

centa.

Although belonging, the one to the animal kingdom, and the other to the vegetable kingdom, still there is some analogy between the two-placenta and apple-in some respects. The placenta, attached to the uterus, grows, develops and matures, after which it is, as a rule, but not invariably, cast off. So with the apple. Both, however, sometimes require more than mere nature in their removal; that is, if they are to be removed in their proper time.

Now for the "dictum" spoken of. It is no less sweeping an assertion than this: "Never go after the placenta." (!) (Proctor), and, "Its necessity can scarcely ever exist." (Meachem.)

Now, in view of the light of some of my experience, the above assertion is certainly a bold, a sweeping and yes, I must say it-a pernicious one; one which, if implicitly followed, is not only mischievous, but will actually carry untold misery in its wake to many a family over the land.

Let me give but a partial pen-picture of a case from actual practice, exaggerating nothing. I have been called to a woman who expected

soon to be confined, but hardly at the time I was sent for. The distance there is fully seven miles or more. When I got there I was informed that not very long after the messenger had started, and probably before he reached my office, the woman was confined-child born. Then there was complete inertia of the womb.

When I arrived at the bed-side, the following condition of things was found: A blanched appearance; a feeble, frequent and almost imperceptible pulse; a relaxed and perspiring skin; parched mouth and purple lips; momentary blindness; cold extremities, and gasping, sighing breathing. The abdomen was found tumid, the placenta retained, the uterus inert and filled up with coagulated blood and still the bleeding continued, while the bed was literally drenched with blood.

Everything indicated an impending dissolution; in fact, the woman herself said she was dying. Here, if ever, there was an appalling case, one that tries men's souls and which would (paradoxical as it may seem) unnerve the strongest heart and hand if it were not for the very gravity of the situation itself.

A crisis is at hand; a precious human life is in the balance ! Shall we temporize until the flickering spark of life is fully extinguished or shall we, by any means at our command, attempt to speedily rekindle that spark? I say, if you wish to save your patient, do not wait a moment, but act-act speedily. Here seconds are golden; minutes but silver.

Give ergot (brandy and opium if need be), try Crede's method of exciting the womb to action; but not long, for time now is too precious. Failing in this to accomplish the desired result, then gently and kindly, yet firmly, introduce your hand into the organ and remove the placenta, together with any clotted blood contained.

In doing this, you will generally succeed in arousing the uterus from its atonic condition; if not, then introduce a sponge, saturated with pure cider vinegar, and express it. This will very generally have the desired effect at once; but, should it fail, from lack of proper application, then inject one or more uterine syringefuls into the womb and you will be surprised at the rapidity and certainty of its action. water may likewise be used.

Hot

I should have remarked, that before passing the hand into the womb it should be washed scrupulously clean and be made aseptic with bi-chloride of mercury solution, carbolic acid, or any other good antiseptic. If this is done there need be no fear of puerperal septicemia.

I am by no means in favor of forcibly removing the placenta simply to gain time-to