A WOMAN PHYSICIAN HONORED.

E are greatly pleased to be able to announce the honor bestowed upon Dr. Anita Newcomb McGee, of Washington, D. C., who is the first woman to be appointed as an officer of the United States Army, and is entitled to the rank of Second Lieutenant. She has the entire charge of the examination and assignment to duty of all the woman nurses of the U. S. Army.

The Woman's Medical Journal has had several articles of great merit from Dr. McGee, and in 1896 published a biographical sketch with potrait of this clever woman who even then, had attracted much attention by her brilliant professional career. Dr. McGee has not only honored herself, but all other women in the profession, and we rejoice doubly, therefore, that a woman has been recognized.

Dr. McGee is a woman of great personal magnetism and tact, as well as executive ability, and will not only win laurels for herself, but ably represent professional women.

OBSTETRICAL DEPARTMENT.

MALARIA IN THE PUERPERAL STATE.*

BY ELIZABETH CASSIDY, M. D., BURLINGTON, Iowa.

Tis not my purpose to give a prolonged dissertation on the general subject of malaria. The members of this society are doubtless familiar with the etiology, pathology, bacteriology, signs and symptoms of the disease. Malaria assumes some of its gravest as well as some of its mildest forms as a complication of other pathological conditions not malarial. It is malaria in the puerperal state to which I would call your attention in the report I have the honor to make at this time.

True malaria in the puerperal state, is rare; at least the diagnosis of malaria is not so commonly made as it used to be, partly on account of the improved hygienic conditions of our soil and the use of prophylactic measures, and also because malaria in the "lying in" so closely simulates sepsis. In times past, many cases of "child-bed fever" were miscalled malaria.

Before the use of the microscope came into scientific medicine as a means of diagnosis, it was impossible, or nearly so, to make a certain differential diagnosis between puerperal sepsis and malaria, in the incipiency of the disease. The presence of the plasmodia of malaria in the blood, is proof of the exisence of the disease; also by the best authorities, the exhibitions of the specific action of quinine is taken as positive evidence, from a clinical point of view. It seems to me I can do no better in the presentation of the subject, than to report in detail a case that came under my care only a few weeks ago.

May 9, 1898, Mrs. S., age 18 years, multipera, I was called to attend patient in labor, but found upon examination that labor had not begun and patient was suffering with a severe chill and abdominal pain. She gave an indefinite history of chilly sensations for a week, previous to my call. As the real cause of the patients symptoms seemed so marked, I gave gr of codeine and awaited developments. May 10, Patient was comfortable.

May 11, Patient had a hard chill. Temperature rose to

*Read before the Eastern Iowa District Medical Association, June 30, 1898.

102. Headache, vomiting and abdominal pain were markedly present. Treatment consisted of calomel, 2 gr and small doses of quinine every two hours, with 5 gr of antikamnia and codeine for pain.

May 12. Patient was comfortable.

May 13. Called again to attend patient in labor; examination showed no dilitation of the osuteri, no uterine contractions. Patient complained of pains in the back, tenderness over abdomen, especially in splenic area. Upon examination I found the spleen palpable, urinary examination showed her maturia. Patient complained of frequent and painful micturition. The temperature was slightly elevated. Treatment same as before with the addition of salines.

May 14. Patient had no elevation of temperature, rested little during the night. Urinary examination showed a diminution of quantity of blood. Labor began at 3 p. m. I saw patient at 6 p. m. Dilitation was rapid; vertex presented with position. Left ocipito anterior. Labor uninterupted, and in every way normal; delivery taking place at 9:30. There was a large quantity of anmiotic fluid present which was responsible for the great uterine distention. The placenta was delivered by Crede's method, and was of normal size and consistency. The cord was shortened by having a knot loose drawn. The child weighed 84 lbs. There was no laceration, and no hemorrhage, as the uterus was large and flabby. I gave 15 minims of ergotole to hasten contraction.

May 15. Patient rested well. Uterus fairly well contracted. Gave ergotole, 15 minims twice daily and quinine 2 gr every two hours.

May 16. Patient had a violent chill lasting two hours, during the night. Saw patient at 8 a. m.; temperature 102, pulse 96. Patient complained of headache and abdominal pain. Lochia was normal in odor and amount. Countenance dull and listless; face flushed and tongue coated. There was a perceptible odor to the breath. I ordered quinine 8 gr three times a day. Gave lysol, double, with mercurial lacoweed by salines; at 8 p. m. temperature was 105, abdomen tender and sympathetic; repeated lysol douche.

May 17. Morning temperature 99 45; evening temperature 100 4-5; pulse 84. Patient had vomited and was still suffering with abdominal pain and tenderness. Lochia was

normal, and uterus contracted but tender. Treatment consisted of lysol douche, twice daily and in the evening intra uterine douche. Quinine as before with increase to 10 gr three times a day. I ordered hot turpentine stoupes and flax seed poultices for abdomen and salines every hour in small doses.

May 18. Morning temperature 100 4-5; evening temp. 104; symptoms unchanged from previous day; same treatment continued.

May 19. Morning temp. 99 4-5; evening temp. 103; treatment same.

May 20. Temperature normal and all active symptoms had subsided. I saw the patient last on May 23; temperature pulse and lochia were normal. The cause of the febril disturbance is a question worthy of our most careful consideration. It is better to be on the side of right and safety than to be misled by any previous history, or symptoms that might mark the real condition, so I determined to treat the case, primarily as one of puerperal sepsis, not resting on the possibility of the disturbance being due to a malarial origin. To my mind whether the complication was due to malarial organisms, was immaterial as compared with the pos sibility of an infection which has deprived many a home of the care of a mother.

In summing up the case, the points of most interest to me were the chills and fever before delivery; the haematuria, which may have been a puerperal nephrates aggravated by malarial poison, the chill following labor on the third day, with continuous fever, lasting six days, exacerbation occuring every seventy-four hours-remittent in type. If I were to argue the question pro and con, as to the cause of the febrile disturbance in this case, I should say that in favor of malaria, is the history of the case. Patient gave a history of having had ague two years before, and at intervals of twenty-four hours, for two weeks previous to labor. The patient's appearance was not one of true sepsis. Profound prostration was absent, the features were not pinched, but instead, were full and flushed. The enlarged and tender spleen was characteristic of malaria and lastly the gradual decline of the fever under heavy dosage of quinine.

In favor of puerperal sepsis is the chill, occurring on

the third day. The tenderness and lympany over the abdomen, and the yielding of the infection to the antiseptic treatment. Tenderness and sympathy may have been caused by malaria, as intestinal symptoms are often present in the remittent type of the disease. Uterine tenderness might have been due to great distention, and on account of the enlargement of the internal organs, with blood in consequence of the fever. Dr. Mary Tuttle saw the case with me on the third day after the chill, and was of the opinion that the case was not one of sepsis. Since the patient's recovery from the lying-in state, she has consulted me for malaria.

ABSTRACT.

OBSERVATIONS IN THE STUDY OF AN EARLY PLACENTA. By E. H. ROOT, M. D., CHICAGO, ILLINOIS.

AXIMILIAN HERZOG, (Am. Gyn. and Obs Jour. April 1898,) reports observations made in a study of an early placenta in situ, obtained from the living Age of placenta from nine to ten weeks. Cuts of microscopic sections illustrate the text of the essay. In giving a short review of the report, "facts either not observed by other investigation of the subject, or facts noted previously but not yet confirmed on details" in which the essayist differs from other well-known writers upon the placenta are briefly recapitulated.

1. "In the amnion, near the insertion of the cord, there are found small cavities contained between two layers of amnioted mesoderm. It is possible that these small cavities are due to a reduplication of the amnion occurring at a very early stage of its foundation.

2. The chorionic epithelium, and that of the villi, presents itself in two very distinct layers, each of characteristic, differentiating features. The Langhans' 'Zellschicht' has been found in a single cell layer only, nowhere as a double or a triple layer. The epithelium does not possess a basement membrane.

3. Plasmodial (syncytail) buds springing from charion and villi are very abundantly found. Plasmodical islands in the inter villous spaces do not exist; what appears as such are buds sparated from their basis by the direction of the cut of the knife.

4. Kastchencko's 'Zellknoten' are likewise not at all islands floating in the inter villous space, but decidual and