TWO DEATHS.

With deep regret we learn of the massacre of Dr. Marietta Hatfield, at Rolofunk, Sierra Leone, Africa. Dr. Hatfield was a graduate of the Cincinnati Woman's Medical College and for a time practiced in Toledo, Ohio, where she had many friends.

Dr. Archibald, another woman physician, also suffered leath in the same manner at the same place. They were missionaries of the United Brethren Church.

Women Physicians. This country is surely the Mecca of the woman doctor. Here they thrive and are an acknowledged factor in the medical profession. In 1870 there were 527 women doctors in America; now there are 4,500. Nearly all the specialties of medicine are represented in their number. It is true without doubt that in every town of 10,000 or more inhabitants, one or more women can find a field for practice; and indeed it would seem that the harvest is ready and waiting for them, inasmuch as inany women not only prefer, but demand their services merely because of their prejudice and assumed modesty.

Sanmetto in Cystitis, Prostatitis and Irritable Bladder.-I have been using Sanmetto in my practice for two or three years. I have used it in a good many cases of cystitis, prostatis and in all cases of irritable bladder, with the most gratifying results. R. T. HOCKER, M. D. Arlington, Ky.

Ex-Pres. So. Western Ky. Med. Ass'n.

It is said that the determination of the Army and Navy officials not to enlist any woman nurses for war service has been given up, and that Dr. Anita Newcomb McGee, of Washington, D. C., has been charged with the selection of all the war-nurses for the Government during its present conflict.

It is the desire of G. W. Flavell & Bro., Philadelphia, Pa., to extend their appreciation to the medical profession for their continued favors for their line of goods, by stating that there will be no advance in prices for goods on account of any stamp war tax.

The Woman's Medical Journal.

VOL. VII.

AUGUST, 1898.

NO. 8.

AN UNUSUAL CAUSE OF FEVER IN THE PUERPERIUM.-REPORT OF A CASE.

Dr. Frances Horton Lee.

ARCH 17th, '98, I was called to attend Mrs. M., in her fifth confinement. She gave the history of a long first and short second stage of labor in the previous confinements. She further stated that each confinement had been attended by "chills and fever," beginning the fourth or fifth day. The present labor progressed favorably during first stage, in the second there was arrest of progress. Duration of labor-1st stage some twelve hours; second stage four hours. Dilitation of os normal and complete, with spontaneous rupture of the membranes. Arrest of progress of the before coming head occurred and I completed the delivery easily with the forceps, at the outlet. A short cord, 35 cm's was wound about the neck, and accounted for the arrest of progress. Labor completed, I left my patient feeling quite well. At my visit in the afternoon of the same day found the temperature and pulse normal, which continued so until the fifth day. Bowels were free, appetite good and the milk established, without any rise of temperature up to this time. On the afternoon of the fifth day I was hastily called to the patient, who had been having chills since morning. I found her temperature 103.5° F; expression of countenance anxious, abdomen slightly distended and tender; patient complained of headache.

I was alarmed at the serious turn things had taken and began to inquire as to the cause.

In reviewing my management of the case, I could find

nothing probably due to faulty tecknique, as I had observed all the precautions necessary to an antiseptic and aseptic conduct of the case. Since the confinement, the husband, a drinking man, I had noticed was surly and glum. I divined that he in all probability could explain matters.

Putting the question directly, I found the patient had been submitted to sexual intercourse on the night of the third day, and morning and night of the fourth day, three times in thirty-six hours. Evening of the fifth day, temperature 104 3-5° F., pulse 140. On the seventh day temperature had dropped to 102° F., pulse 120. Patient began to improve from this on and was dismissed on the thirteenth day after confinement, convalescent but weak.

TREATMENT:-Viginal douches three times a day; colonnic flush of normal salt-sol. daily with strychnine and quinine, with morphia for pain, and a sharp reprimand for the husband (?). The patient stated that she had been submitted to intercourse on the third and fourth days after each confinement-the "chills and fever" following.

QUESTION: Is the physician always guilty of conveying the infection to a lying-in patient? If this patient had died who would have been held responsible? The physician, of

course.

PYOMETRA-REPORT OF CASE.

By Lillian G. Towslee, M. D., Cleveland.

Assistant to the Chair of Gynecology in the College of Physicians and Surgeons: Gynecologist to the Cleveland General Hospital Dispensary.

T

N the text-books on Gynecolgy if pyometra is mentioned at all, it is simply defined. It is rarely met with and more rarely diagnosed. There are probably

many interesting cases that have never come to light. It may very easily mislead one and be mistaken for cancer, as it so closely resembles advanced uterine cancer. Women who have passed the menopause are subject to senile endometritis due to retrograde changes in the glands of the endometrium, and if there is a stenosis of the cervical canal, this secretion is pent up and the uterus becomes filled with pus which causes sepsis, and the out

ward appearances greatly resemble those of malignant disease, as the following case illustrates.

I was called in the latter part of December, 1895, to see Mrs. E., aged 64, for three years a widow. She had been an invalid for six months; she was now in bed and had been so for several days, with pelvic peritonitis. Her morning temperature was 102, pulse 120, and she was very sensitive over the lower abdominal region. Her general appearance denoted malignant disease; she was emaciated and her skin was exceedingly yellow. After taking a careful history of the case, I found nothing unusual in her menstrual history except that labors had been very severe. She had had three children and the menopause occurred at the age of 54, ten years ago. Her general health previous to the past six months was usually good, yet she was never a robust woman. She exerienced no difficulty at the change of life. She had a "show of blood"in August, 1895, for the first time since the change, and another one week before I saw her. This was all the discharge she had before I examined her. It was impossible to make a satisfactory vaginal examination on account of the great tenderness and distension of the abdoman, so I ordered hot applications and gave salines and liquid diet until the temperature fell and tenderness subsided, which was in a few days; then I made a vaginal examination: The vaginal vault had undergone atrophit changes, the cervix being short and lacerated, and the lips everted, very hard, and eroded. The body of the uterus was very much enlarged and unsymmetical, and extended half way to the umbilicus. On a careful introduction of the sound the uterus measured five and one-half inches, and a slight purulent oozing followed the withdrawal of the instrument. I did not like the appearance of affairs, fearing an epithelioma of the cervix and possibly a myoma of the body of the uterus which was degenerating. I advised giving my patient an anesthetic and dilating and carefully curetting the uterus, intending to have the scrapings examined microscopically for diagnostic purposes. I feared it was too late for a radical operation (if there were cancer) but hoped by thus clearing up the diag

Her consent was

nosis to give my patient a better chance. given for me to curet but she would not take a general anesthetic, nor could she be persuaded. I decided to do the curetting without it, expecting to abandon the operation, and then to arrange for an anesthetizer. After making the necessary vaginal toilet, I introduced my uterine dilator with considerable difficulty, and no sooner had it passed the internal os than the pus began to pour out of the uterine eavity at a tremendous rate, until over a quart of the most offensive pus imaginable flowed out of the uterus. The odor was so rank that one assistant was obliged to leave the room, and I was nauseated myself. I decided at once not to curet as I did not wish to make a fresh wound in a uterus already septic, so I washed out the cavity with bichlorid solution and packed with iodoform gauze and put my patient to bed, deciding to curet later, which I did in one week, scraping out a large amount of granulating tissue and cutting a small piece out of the cervix for microscopic examination. The patient endured the operation well without an anesthetic, but she is a woman of remarkable will-power. There was no rise in the temperature and the patient improved steadily for six weeks, when, the former symptoms reappearing, I again introduced the dilator and about six ounces of pus were discharged. I was obliged to wash out the uterus from time to time when pus had accumulated, this treatment being kept up for ten months. After keeping her under observation for six months longer, the case was dismissed last April at which time the uterus measured two and one-half inches. The patient's general condition steadily improved, so that at the time she was dismissed she was able to attend to her domestic duties. The scrapings were examined by Dr. Ohlmacher. No cancer cells were found; only inflammatory tissue.

Thomas asserts that the construction and atrophy of the cervix take place more rapidly than do the similar processes in the corpus uteri. Such a process may be followed by atresia and stenosis of the cervical canal while the glands of the endometrium are still pouring out their secretion. This