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hand into the postpartum uterus is always followed by uterin irrigation of 4 litres of hot, steril, 2 percent acetic acid solution. If the membranes be found incomplete-they are always incomplete following Duncan separation-the retained membranes still adherent to the uterin wall are scoured off by the uterin douche. In this case the placenta was large, battledore, as is so often the case in placentae with low insertions, and had in addition two succenturiate placentae. The membranes were incomplete, about onethird remaining attacht to the uterin wall. These findings would readily explain a "right smart" postpartum hemorrhage. Our patient felt aggrieved because she did not go into collapse, but she did not know that she had

a

"hemorrhage," being saved the stage

fright.

The patient gave indications for a boxbandage, close watching of the pulse for hemorrhage, with ergot and strychnin for three days as prophylactics. Galactagogs were begun at once and a modified rest-cure instituted on the fifth day. The fundus, in its normal position at the level of the umbilicus following labor, involuted promptly, disappearing behind the pubis on the tenth day as in normal lying-in. This height of the fundus determins the day of getting up, irrespectiv of the number of days, the fundal height being charted every day by the JNO. J. GAYNOR.

nurse.

Eureka, Cal.

An Obstetric Case-Girl Babies Sometimes Urinate During Birth.

Editor MEDICAL WORLD:-The articles in the present issue on puerperal septicemia (pp. 46 and 47) strike me at a favorable time, as I am threatened with that condition in a Finlander's wife whom I delivered two days ago. The position was right occipito-posterior, and delivery was very difficult, being accomplisht with my trusty blades about the time that I was pretty near "all in" from fatigue.

There were no lacerations, tho the vagina was much bruised, capacious tho it was. The infant weighed 12 lbs, perfectly healthy. But now my trouble just began. After waiting a reasonable length of time I started after the placenta. The womb had no outline and I could not feel it thru the abdominal walls from the time of delivery. I had attended this woman once before with an adherent placenta and I saw I would probably meet with the same condition now. On introducing my hand (sterilized as well as the squalid circumstances would permit) out shot a big gob of clotted blood, followed by a furious hemorrhage. I found the placenta high up on the fundus, partly detacht. As rapidly as possible I separated the remainder, which was so firmly attacht that it came off piecemeal. After that the womb contracted and I had a rest. The flow was rather free but

not too profuse. I have been irrigating the womb with a solution of iodized phenol, which is my favorit antiseptic in obstetrics. It is composed of equal parts carbolic acid and tincture of iodin. I also took the precaution the next day of exploring the womb with a dull spiral St. Cyr curette, and was rewarded by getting out a shred of debris which would have been big enuf to cause trouble. Her pulse has been about 100 from time of delivery, tho temperature has not yet gone above 99°. Have also been administering quinin in small doses, which is an agent in which I have great faith. Inasmuch as these foreigners live in rather squalid surroundings and strict asepsis is very difficult to attain, I shall continue my douching, using my own syringe and my own granite iron vessels until the period of danger from infection is past.

There may be some who will take exceptions to instrumental delivery in presentations of this kind, preferring version; but a man has got to do the best he can. There was no one to help me but another Finn woman. The husband was hors de combat and professional help miles away. Furthermore, ignorant European peasants of the steerage emigrant variety are not good anesthetists. But I will say this to their credit: I have never lost a dollar in my dealings with them.

Regarding the case reported by Dr. Wheeler regarding the baby who didn't urinate until it was 48 hours old, I'll wager it was a boy. I have seen some 8 or 10 cases in the past few years of that kind, all boys. I have never known it in a girl; and here's one reason, altho theoretically it should apply to either sex: they often make water during the act of birth—about the time their heads hit the outer atmosphere and they begin to try to breathe. I've caught them in the act of urinating with all their might just as their bodies were emerging from the genital canal. J. D. THOMPSON. Winlock, Wash.

My Obstetric Routine.

Editor MEDICAL WORLD:-To provoke a discussion, I will say that I give f. e. ergot zj, strych. nit. gr. after thoro dilation of os in all my obstetric cases, and in a few cases have followed the above with gr. strych. an hour later when pains were deficient. I have had only the most satisfactory results and note the following advantages: Duration of labor is very much shortened; the pains are more tonic in character; the placenta more easily expelled, with less hemorrhage, and followed by less severe after pains; the child is rarely cyanosed, but on the other hand more vigorous and ready to inflate its lungs in the usual way, crying, by reason of the circulatory and respiratory stimulus of the strychnin. Will say further that I have

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A Little Irony and an Inquiry from Alaska. Editor MEDICAL WORLD:-I am 90 miles from consultation other than that afforded by my library and journals, of which I receive 11, and it is a pleasure to read the scholarly contributions from the profession at large, as found in THE WORLD especially.

When reading an article I often construct a mental picture of the author from his phraseology; and when in need of consultation reflect on the probable advice of that writer whose personality seems to best fit the exigency. Thus I should certainly recall Dr. Gaynor in a distocia caused by "presentation in Naegele's obliquity." However, in the technic of obstetric preparation practised by his nurse, I consider her procedure unsafe, incomplete, and in the light of modern bacteriology, unscientific. She should know that the hair follicles offer a favorable site for bacterial propagation; also that shaving a part allows those germs hidden beneath the epidermis to gain access to the surface. Hence she should have followed the shaving by applying a strong vesicant. After removing the cuticle, the base of each hair should be carefully cauterized, as should also the ducts leading to the glands in the vaginal mucosa. Such is the routine practise of the "head nurse in the lying-in department of my private hospital; " who, by the way, is merely a likely young squaw trained entirely by myself.

That these precautions are necessary, tho perhaps tedious, is evident from my records; never having had a case of puerperal infection in my 52 confinements covering 2 years, nor lost a mother or child.

But the purpose of this letter is not criticism, but inquiry. I should like to know if any of the "family" have had experience with Echimpanus Horrida, or devil's club, as it is commonly known. It is a plant growing profusely thruout the north Pacific coast country, but I cannot find it mentioned in my books. Any information on the above subject will be thankfully received. HARRY C. DeVighne.

Wrangell, Alaska.

"Dot Meester Parker,"

Ve haf a man in our profesh und hees name ees Meester Parker; He is write somedings in de Medic Vorld, dot I dell you vos some korkers.

He dinks he been a scientific, but dot ees all a choke;
Und ven I reads me vot he writes, I almost haf to croak.

Virst be dells us all aboudt dot Meester Markley's chob;
He says dot he didn't do id right, und dot he vas a slob;
I dink me dot if id had been hees case he vouldn't prag so vell;
Und dot if he had been in Markley's blace, he vould been scairt
like-(vell).

Und den he dells apoudt hees skeam for dishing oudt hees peels;
He puys dem by der pushel dot vill cure any eels;

He gits heem some of dese batent stuffs und soaks der label off, Und makes oudt like dey vas hees own, vich ees a great pig pluff.

Sthill, I dink me dey are goot for vot dey are indended;

I got me a pottle of dot wermifooge, und used as recommended;
Der vorms got on mine cabbages und vere hafing lots of fun
Dill I soaked dem mit dis wermifooge, und id kilt dem efry von.

He goes him in de country oudt to see von obstetric case;
Dis paby vork been hees long soot, you can see dot in hees face;
He is von great pig egsbert, vot helps dis vorld along;
In ofer nine hundred tousand cases nodings has efer yet gone

wrong.

Der poys vot reads der Medic Vorld get almost sick mit lafter, Ven dey read der rot dot Parker writes, und dey say he ees a grafter;

Den Meester Parker he gits mad, und dinks he'll cut a caper,
Ven he preaks hees nose to hurt hees face, by stopping yet der
baper.

He stays him mad a veek or two, und dinks dot ve vill cry,
Und dot der Medic Vorld vill go kerflunk if hees not in der pie;
Den von nice day he slips him pack with some real wit and humor,
Dot makes Pill Nigh look mighty seek, und Mark Twain such
a choner.
Dallas Center, la.
E. J. BUTTERfield, M.D.

Posture for Prevention of Albuminuria of Pregnancy.

DEAR DOCTOR TAYLOR:-For the benefit of suffering humanity and the poor doctors particularly, who strive to find some remedy that will save their patients from puerperal convulsions, I would recommend to the doctors to give each pregnant patient, after the fifth month, a little piece of advice, in place of medicin. Explain to them the cause of albuminuria in pregnancy-caused by the congestion of the kidney, produced by the enlarged uterus pressing on the iliac arteries and vena cava (veins of and from the legs), producing swelling of the feet, ankles, and legs, causing constipation, bladder trouble, headache, backache, etc. To avoid all this they must NOT wear corsets after the fifth month, and always spend five minutes every morning in the knee chest position, ten minutes in the forenoon, and ten minutes in the afternoon, and stay in the knee chest position for ten or fifteen minutes on going to bed, and then slip a pillow under the hips and go to sleep on her side. Doctors, this is simple, but stop and reason a little. RICHARD B. STEWART. Warren, Pa.

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Editor MEDICAL WORLD: For some time I have been interested in the subject of exfoliativ endometritis, and I was very glad to see Dr. Mershon's article in the February WORLD (pages 73 and 74), with the editorial comment, as I had been able to find practically nothing on the subject in other medical literature. Dr. Mershon's article shows that I am not the only doctor who has troubles. Besides searching text books, I have askt a number of physicians about the matter, some of whom were men of wide experience, and I have found but one practician who ever had a case or who knew anything about the subject. This man stated that the few cases he had seen had all developed either cancer or fibroid later, but whether or not this was anything more than a coincidence, I cannot say.

In the past three years I have had three cases, all in married women who had borne

children. Two were suffering from climateric metrorrhagia and the third was a young woman whom I thought, at first, was miscarrying. All passed clots as large as or a little larger than a good sized hand, which were inclosed in a membrane. In the first case, a woman who was doing her house work, they would unexpectedly drop on the floor half a dozen times a day with a dull thud-as the novelists say. I advised immediate curetment in each case, and was refused because I would not promise an absolute cure. So I had to do the next best thing. I considered the first necessity was to stop the hemorrhage, as all three were very weak and anemic from loss of blood; and to do this I lookt to drugs like ipecac, sabina, china, hamamelis, secale, and trillium. After a few doses of the one indicated, usually one of the first three, the hemorrhage stopt in each case.

Case 2, which is of special interest, had been under various physicians for over seven months, having daily hemorrhages with these large clots. She was so weak and anemic as to be unable to raise the head from the pillow. She suffered intense and constant nausea during the flowing, which, very peculiarly, came only in the night. Position had no effect whatever. She never flowed by day, but as soon as evening came the flow would commence and continue until morning. I could not account for this peculiarity in any way, but I found that coccus cacti (cochineal) had this symptom very markt in its pathogenesis, so I gave her coccus cacti in alternation with ipecac. The hemorrhage ceast soon after midnight. She had a slight flow the following night, and except for a moderate menstrual flow at the regular periods, has had no hemorrhage whatever to the present time. She recently went to another city for a visit. After stopping the hemorrhage I considered it my next duty to get directly after the endometrium, and this is where the "next best" method applied.

I have the druggist make the following in tablets which I believe are practically the same as the "uterin wafers" sold under various trade names, as they act exactly the same way.

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specific for that intractible disease: ordinary, uncomplicated endometritis.

In the meantime I gave the appropriate treatment for the anemia and built up the general health in every way possible.

I believe the principles of treatment outlined in THE WORLD are correct. The above outlined methods have been entirely successful in these three cases.

Some one has asked for the formula of campho-phenique. It can be made as follows: Carbolic acid 30 parts, camphor 60 parts, and alcohol 10 parts. There is a U. 8. P. formula of 1 part alcohol and 2 of camphor. Either makes what is to all practical purposes the preparation sold under the name of camphophenique. It is a very valuable agent, being the strongest antiseptic imaginable and entirely free from the usual caustic effect of carbolic acid alone. Poured into a fresh wound, it thoroly disinfects and at the same time so anasthetizes the tissues that they may be sewed with practically no pain. It is a very valuable throat swab in tonsillitis and even diphtheria. A few drops in the ear makes one of the very best palliativs for earache.

Can some one tell me what "Jo-He" is? It is a middle west preparation for rheumatism. It is sometimes called "rock oil." There is one for external, and another for internal use. Chico, Cal. H. A. WATTS, M.D.

Camphor and Carbolic Acid Combined. Editor MEDICAL WORLD:-I notice on page 67 of February WORLD that Dr. S. D. Stuteville, of Grandview, Ind., asks for the formula for campho-phenique. I would suggest to the doctor that he try my way of using camphor and carbolic acid. I take a pound of each of the best quality; take a large mouth bottle that will hold a quart, or a fruit jar, and crumble the gum with my fingers in small enuf chunks to put in bottle or fruit jar, and pour the melted carbolic acid on it and set it aside a few hours, and it is ready for use. I sometimes filter or strain thru cotton. I have had an experience of daily use of this combination for nineteen years. I use it in dressing all open wounds, in accidental or emergency surgery, sometimes first dressing in full strength and later with different proportions of oil. It is a local anesthetic as well as a disinfectant. My patrons keep it on hand in ointment for dressing little scratches. You notice I use no alcohol in preparing it. B. S. LOUTHAN. Sutherland, Iowa.

Campho-Phenol.

Gum camphor 3ij. Carbolic acid cryst. pure 3j. Melt acid and pour on the camphor. For dispensing, add to this an equal part sweet oil. J. W. MOORE. Mexico, Ind.

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Auto Experience. Editor MEDICAL WORLD:-In 1904 I wrote a short article on the motor cycle for physicians. It surely served me well, but some time ago I graduated from its use, and have since run a R. E. O. run-about, to my supreme satisfaction; and may I add, financial encouragement, for I find it costs only about what a team costs. The two are quite equal; and in saving time for the busy physician they are not to be compared. I do up my driving in the a.m., and have my office hours undisturbed, which I could not do without the machine.

In regard to repairs: I've now run about four thousand miles, and because of extra bad roads during the winter I must now get my rear tires recovered, which will cost $10 each. I've worn out one chain and sprocket, costing me $8. That is practically my whole repair list.

During the cold weather I use alcohol and water for cooling, and do not drain my radiator at all. The automobile has not yet reacht perfection, but I trust my "R. E. Ó." anywhere except in mud holes. I've never been stranded so that I could not get home. I could not go back to the old way again, tho I keep my team for rainy days and bad roads. Gothenburg, Neb. WM. J. BIRKOFER.

Automobiles Again.

Editor MEDICAL WORLD:-In response to many personal requests for conclusions based upon my somewhat extended experience as a physician in the use of automobiles on country roads, I will give a few concrete ideas which may be depended upon as safe guides for any physician who is thinking of buying an automobile for country work.

Seventy percent of all delays and troubles on the road are due to the use of pneumatic tires. You cannot depend certainly on getting quickly to your patient and back to your office in an automobile if you use pneumatic tires.

The principal evidence of durability is good workmanship. All burrs should be held in place by thin washers and cotter pins. Any burr or bolt which can be turned off with the fingers after being started with the wrench is an evidence of poor or careless workmanship. These are small points, but I

have found them to be good general indications of proper workmanship.

The four-cycle (cylinder?) gasoline, aircooled, positivly lubricated engine, with both valves mechanically operated, gives the best motiv power so far discovered.

The power needed for practical use should be one horse power for each seventy-five pounds of gross weight.

The running gear should be either ball or roller bearings.

Wheels should not be over thirty-two inches in diameter for best results.

Two first-class kerosene-burning lamps are ample for light; do not waste money on acetylene gas lamps.

Tire chains are a necessity; always have them with you.

A ten or twelve horse power light runabout with long wheel base, solid rubber tires, and most all of the weight on the rear axle, will give best all-around service for a country doctor.

I do not know of any automobile now made which combines all of the essential points that I have mentioned. The manufacturers cater almost exclusively to the trade that demands luxury instead of utility.

The doctor who places any dependence upon testimonials as found in automobile catalogs will soon realize that they are about the same "breed of cats" as patent medicin testimonials. A. D. HARD.

Marshall, Minn.

Editor MEDICAL WORLD:-Just a word on automobiles. I save time. Have never been delayed except to replace a link in chain. The expense of gasoline, oil, and other incidentals have cost me about half the amount to keep my team.

Donnybrook, N. Dak. JOSEPH ROGERS.

Antikamnia Sales Reduced.

Editor MEDICAL WORLD:-I have a personal friend who is the bookkeeper for probably the largest drug jobbers in my city. The other day I askt him about the amount of antikamnia business his concern handles, and to my gratification he told me that the business has fallen to less than of what it was 3 years ago, at which time the firm bought from $300 to $500 worth of antikamnia a month. He is also satisfied that no other jobber in the city has gotten any of their antikamnia business away from them; the antikamnia sales have simply been reduced. The doctors' eyes are probably being opened to the true facts, and are cutting antikamnia out of their prescriptions. I could give you the name of the bookkeeper, and also of the firm, but as I consider this information as confidential, I wish to omit the names, and if you publish this kindly omit the city also. I will sign myself as GRATIFIED.

An Interesting Correspondence. PORT ESSINGTON, B. C., CANADA, January 14, 1907. Editor MEDICAL WORLD:-I inclose herewith copies of three self-explanatory letters which you may use in any way you think best in the public interest.

I have been a subscriber for THE MEDICAL WORLD for the last twelve years, and I consider it an able exponent of what is best for the doctor in business, ethics, and medicin. Yours sincerely, T. A. WILSON.

PORT ESSINGTON, B. C., November 20th, '06. The Canada Lancet, 15 Wellington Street, E., Toronto, Ont.:

DEAR SIRS:-Please discontinue the Canada Lancet to my address as above, after the expiration of my subscription in December, 1906.

I am discontinuing all medical journals and literary magazines, for next year, containing antikamnia advertisements, and it is for this reason that I reluctantly erase the Canada Lancet from my subscription list for 1907. Yours truly, T. A. WILSON.

TORONTO, ONT., Dec. 11th, 1906. T. A. Wilson, Esq., M.D., C.M., Port Essington, B. C.:

DEAR SIR-I am in receipt of your favor of Nov. 20th and regret exceedingly that you are cancelling your subscription to the Canada Lancet. We had always lookt upon antikamnia as quite a legitimate advertisement. As a matter of fact the writer, when ill with la grippe some two years ago, had antikamnia tablets prescribed by one of the leading physicians here in Toronto, and I must confess they gave a good deal of relief.

I trust that you will reconsider the matter, as we do not wish to lose so valuable a subscriber as yourself. Yours sincerely,

(Signed) T. H. BEST, Managing Director.

PORT ESSINGTON, B. C., January 14, 1907. T. H. Best, Esq., Managing Director, Canada Lancet, Toronto, Ont.:

DEAR SIR-In reply to your letter of the 11th ultimo, I beg leave to say that I will not renew my subscription for the Canada Lancet until its disagreeable features, such as the antikamnia advertisements, are eliminated.

The medical profession generally do not recognize any prescriber of secret proprietary preparations and quack nostrums as a leading physician, even tho he should live in Toronto and prescribe them for the Managing Director" of the Canada Lancet. T. A. WILSON.

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Yours truly,

Treatment for Incipient Uterin Cancer.—“Airless Cushion Tire."

Editor WORLD:-Some two and a half years ago I was visited in my office by a lady who informed me that her daughter-in-law, Mrs. S., who had been married two years and had one child, six months old, was suffering with a kidney trouble, perhaps gravel, and from her history of the case I made a prescription and told her to report in a week.

She returned at the end of the week informing me that Mrs. S. was no better. I told her that I was not willing to risk my reputation on her diagnosis and must see Mrs. S., or she must see another doctor. They lived some twenty miles in the country. In a few days Mrs. S. came in.

After getting a personal history of the case from her, I proceeded to make a special examination. On the anterior lip of the cervix I saw a dark red nodule about the size of a

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I had her to return in a week and repeated the injection. The second week I could see some improvement, and the painful micturition ceased. She came every Saturday until the ninth injection. I dismissed her entirely well, and no return up to this writing. I learned that her mother died, some ten years ago, with uterin cancer. I did not make a microscopical examination in this case. The improvement began with the first treatment, and I was proud of her recovery. Doctor, you might try the sp. med. thuja in the next case of incipient cancer you may have.

I notice Dr. Oscar Myers' article on the automobile vs. horses, page 493 of the last December WORLD, in which he complains of pneumatic rubber tires. Dr. J. W. Carhart, of this city, has invented and applied for a patent on the "Airless Cushion Tire," which has all the good qualities demanded by autoists of today, and gives promise of a wonderful future. It needs no pumping, does not puncture, does not go flat, does not wear out, neither slips nor skids, and as to price, is within the reach of every one who is able to own an auto. He has had them in use on his steam auto for nearly two years, running them over the roughest roads, and has had no trouble whatever with them, and is now better pleased with them than at first. The wear thus far is inappreciable.

I relieved a case very much like Dr. A. G. Anderson's, on page 499, December WORLD, with the following:

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