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head of which was flat like a pancake. The body had started to decay, and had a foul odor. When five months' pregnant Mrs. Z. fell over a woodpile, which fall I think crusht the child's head from side to side, and flattened it as described. There was only one placenta. Under careful aseptic treatment, Mrs. Z. made a prompt recovery.

FRIEDE VAN DALSEM, M.D. Hudson, South Dakota.

Short Cord.-Puerperal Convulsions. Editor MEDICAL WORLD:-I was called, November 15, 1903, to attend Mrs. S. in her second confinement. Labor was normal. Cord measured just 13 inches.

At about 6 a. m. November 18, 1903, I was called to see Mrs. H., a primipara, who was expecting to be confined within the next week. She was in bed, in no pain, very cheerful, but blind. She had suddenly turned blind while attending to breakfast. She could not discern light. I soon gave her pot. brom. grs. xx and chloral hyd. grs. x. The expected puerperal convulsions and unconsciousness soon came on. Gave morphin sulf. gr. ss and atropin sulf. gr. hypodermically, and repeatedly gave enemas of double the amount of bromid and chloral without the desired result. About 12 m. called in Drs. D. and G. We decided, after dilating os a little, to deliver with forceps. Gave her chloroform and about two hours hard work, turn about, resulted in a prolapst cord, dead baby and lacerated perineum. After repairing the perineum the doctors left. After the effect of the chloroform had passed away the convulsions returned. I repeated the enema and hypodermic as I thought best. Near 8:45, p. m. I invited my guest and preceptor, Dr. N. of Ala., to see the case. She had a hard convulsion at 9 p. m. I suggested bleeding. Dr. N. thought it the thing to do. Drew about five gills of blood and repeated the hypodermic of morphin and atropin. No. more convulsions. Conscious next morning. Uneventful recovery.

Unless I previously learn better, I shall bleed the next similar case the first thing I do. Since this case my preceptor informs me that he was called to see a lady who had had twenty-five convulsions. After taking about a quart of blood she had a light convulsion. He took another quart and she had no more. Chattanooga, Tenn. JOHN B. LEE, M.D.

Editor MEDICAL WORLD:-Inclosed please find my check for $3 for four years' subscription to THE WORLD, a jo rnal that I certainly prize above any other. Your business advice to the doctors is worth $3 of itself. You are doing a great service to physicians. I most highly appreciate your valuable services. Richmond, Ky. J. A. GWYNN, M.D

Hysteria and the "New Woman." Editor MEDICAL WORLD:-Will the new woman have hysterics? Is this form of nervous disease less common than ten years ago? Physicians with whom I have spoken regarding this matter, think so. It seems so to me.

In looking at the etiology of this disease, it is evident that the predisposing and exciting causes are not as potent as formerly. Women are more self-reliant. They have better mental and physical development, and more hygienic surroundings. No great social or political teaching of Christian science may have had an question is agitating the public mind. The

influence in this matter. Grinnell, Iowa.

E. C. BLISS, M.D.

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Help Wanted in Damage Suit. Editor MEDICAL WORLD:-Aug. 6th, 1903, Dr. Little called me to assist him in the delivery of Mrs. C., he having refused to go into the case without another doctor, as she was in the last stage of Bright's disease. The urin showed 50 percent albumin. She had general dropsy, and had been tapt twice in the peritoneal cavity and six times in the limbs, three weeks before confinement. At this time there was general dropsy. I found the lady unable to lie down or turn in any way; she had not walkt for some time. The first child was born dead, but in good condition; the placenta caine away in a perfectly normal way. Fiftythree hours later we delivered her of another dead baby in good condition. The membranes were intact all the time, and were ruptured by myself fifteen minutes before the child was born. It was simply a case of delay between the births. Ten days later she died of uremia. The other doctor and I have been sued for $5,000. Have also been indicted for manslaughter. The civil suit has been tried once, and the jury hung 10 to 2, in our favor. The manslaughter case is to be tried, also the civil suit again. There are many other facts of interest that I will not report for fear of taking up too much space.

I wish to hear from all who have had any experience with delay between the birth of

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We, the undersigned physicians of Assumption, Illinois, do hereby mutually promise and agree among ourselves and to each other, to be governed in our practise in the following rules, and charge for our professional services the prices and rates as publisht below, viz. :

FIRST-That we will not bid for pauper practise. SECOND-That we will not attend the paupers, nor do the eleemosynary or public practise at a less rate than the regularly establisht and recognized Fee Bill of Assumption.

THIRD That in the distribution of the pauper practise of Assumption, no one particular physician shall be favored in such practise by the public authorities, but the patient shall have the privilege of choosing his own physician.

RATES.

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Extra patients in the same family, each Mileage-day; $1.50 first mile, 75 cents

each additional mile.

Mileage-night; $2.00 first mile, $1.00 each additional mile.

Obstetrics, uncomplicated-within three miles

Detained services in obstetrics more than five hours, $1.00 per hour extra Delivery by turning, forceps or perforation Subsequent visits in town for the first

three days, to be included in the charge unless complications render unusual attention necessary. Subsequent visits in the country, the same as in other cases.

Attendance on small-pox, per visit, mile

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Minor surgical operations, like opening abscesses, dressing bruised fingers, bleeding, cupping, the formation of issues, and introduction of setons 1.00 to Dressing injuries of greater extent or danger, including the ligation or acupression of arteries in wounds of little importance, the amputation of a toe or finger, circumcision, the removal of the tonsils, the uvula, curetage, etc..

5.00

5.00 to 25.00

Dressing large or dangerous wounds, requiring the closure of important arteries, to arrest hemorrhage, adjusting fractures and dislocations involving difficulties, the operation for hemorrhoids, for hydrocele, for harelip and strabismus, paracentesis, amputation of the breast, castration, the removal of tumors not involving great difficulties, staphylorrhaphy, laryngotomy, iridectomy,

amputation or extraction of the eye, $25.00 to $100.00 Amputation of the arm, leg, foot or hand, 50.00 to 100.00 Capital operation, including the larger

amputations, resections and exsections, the removal of the parotid gland, trephining, ovariotomy, herniotomy, lithotomy, celiotomy, the more difficult plastic operations, the reduction of dislocations which have resisted previous attempts, the adjustments of oblique fractures of the thigh, and those involving the neck of the femur or the knee joint, compound and comminuted fractures of the larger bones and joints, extraction of cataract and the formation of artificial pupil Administering chloroform or ether Subsequent attendance the same as in other cases

$100.00 and upwards 5.00 to 10.00

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Wholesome Criticism is Better than Praise. Editor MEDICAL WORLD:-I inclose you my check to pay for four years' subscription to THE WORLD, and for "The Story of New Zealand." Now a word concerning THE WORLD. I like it and I do not like it, begging your pardon. I love to read it because so many medical men from all over the country express their belief and opinion in its pages, and from all of that we get a great assortment of experiences, all of great value to us fellows doing hard work in the field. I do not like it because it contains so much "trash stuff' at times. Of course I realize that such an expression is not the most pleasant thing in the world for the Editor to hear, and may even provoke a feeling of resentment; still, I feel as tho he would like to know with what esteem we receive his journal. I mean by "trash stuff" such articles that convey so little idea of the real condition of instances upon which information is desired, and which are signed with the names of men who claim the protection of social and medical laws because they prefix their names with "Dr." I mean by "trash stuff" such articles in which the writer of the article attempts to relate some extraordinary experience, and flatly fails to convey even the most salient features of his tussle. I mean by "trash stuff" such stuff written by some medical man, in which he lauds to the skies some prescription composed of from four to six ingredients, and where he

extols its virtues for a certain named disease. I mean by "trash stuff" such articles in which the writer relates stereotyped treatment for a specified disease, pneumonia, for instance. Any medical man of any community who wishes to impart the impression that he is a strictly scientific fellow, and has nothing better than calomel, salts, Dover's powder, poultices, strychnin, digitalis, and alcohol to offer to his medical confreres for every case of pneumonia, and makes that his routine, should not be given a page of any editor's journal.

I love to read a fellow who has a definit idea to convey, and who is specific in the therapeutic field; who can and does give the condition of his patient, and who gives his remedy not because it has been recommended for a certain named disease, but because there is present in the case a particular condition which will be relieved by a particular remedy.

Does it not look like a pity to hear some physician go deeply into the study of his case, so far as concerns pathology, diagnosis, etc., and then when it comes to treatment, to absolutely fail to show where he attempts anything definit outside of a stereotyped routine?

THE MEDICAL WORLD gives us many valuable contributions by able men; to read and study them proves a source of great satisfaction and profit. The extraordinary good qualities of these more than make good the shortcomings of those I have just condemned, and it is for this reason that I am willing to read THE WORLD Several years more. Respectfully yours,

J. S. NIEDERKORN.

Versailles, Ohio. [Frank, manly and respectful criticism is better than praise. We like it and always welcome it, when given in the proper spirit. Instead of receiving the above with "resentment," perhaps the Doctor will be surprised to see it publisht, with these remarks. We hope that he will give to "the family," from his own pen, something that is worth reading. We think he can do it, and we will expect him to do it. In the meantime, he may be taken up by some who consider that the remedies he mentions, if used skilfully, are quite enuf to use in pneumonia. Some of the best practicians use few remedies, but use them skilfully, and for definit purposes.-ED.]

Editor MEDICAL WORLD:-About two years ago I reported a case of bed wetting and askt for help. I got some very good and wholesome instruction. A cure was effected by having the boy's eyes examined and fitted by a good oculist, as instructed by a reader of THE WORLD. N. H. BAKER. Gillette, Wyo.

Nursing in the Country.

The following very clear and pertinent remarks are from a doctor's daughter (whose father, however, we regret to state, has recently died). These lines are so apt that they deserve a place in these columns:

Dr. W. C. Abbott, in his article on pneumonia in March WORLD, says the first step is to "move the patient into a clean, light, airy room." Suppose he were here in the Ozarks, where the family all eat, sleep and live in one room, or the patient is in a stuffy 8 x 10 bed room that opens into the living room, and has an extra bed in it, where two other adults sleep at night, and the "nurses" (?) under no consideration will permit one whiff of fresh air, lest the patient "catch cold."

Country doctors who have to depend upon the neighbors, friends and the relativs, to do the nursing, can not insist too strongly on having the medicin given strictly as directed. I have seen the medicins passed around to be tasted and "analyzed," and compared with what Dr. Blank gave Johnny when he had mona," and the dose reduced or increast just as Dr. Blank had directed in his treatment; and the symptoms studied and compared to those given in the family doctor book, which father said are a curse to the people and the bane of the doctor.

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I am not speaking at random, for the case was my brother, who was very, very ill with pneumonia away from home, and I never removed my clothes or scarcely ate or slept for eleven days and nights, and we came near losing him thru the other nurses tampering with the medicins and knowing too much about medicin, learned from patent medicin advertisements and the family doctor book.

The people need to be educated along these lines, and the doctors could do it by means of the press; not by writing learned essays on "How to Nurse the Sick," but give a few instances that have resulted fatally, from not following the instructions; then offset that by a few cases where the patient's life was saved by the prompt action of the nurse, or at least the doctor's work was supplemented in the saving of it. Fowler, Mo. (MISS) ANNIE HOFFARTH.

Diagnosis Wanted for Epidemic Eruptiv Dis

ease.

Editor MEDICAL WORLD:-There has been an eruptiv disease prevailing in this section for the past two months or more, and as the doctors cannot or do not agree as to the diagnosis of it; I want to give you the symptoms of a case I had recently, and ask you or the WORLD readers to kindly give your opinion of same.

Mr. P., a young man 18 years of age, came to my office for treatment on February 5th, stating that he had had severe pain in head and back for two days. I found on examination that he had a temperature of 103° F., and pulse of 110. I prescribed for him, and told him to go home and go to bed. The next day he sent for me, stating that the symptoms were no better; suffering intense pain in head and back with high fever. I could not get to see him that day, but saw him on the following day, and found him with temperature of 102°, pulse 110; secretions generally inactiv, pains somewhat relieved (due as I supposed to the anodynes he had taken). I noticed a few small red spots on the side of his face near the chin;

at the same time his mother remarkt that while rubbing his back with camphor the night before to relieve the pain she felt some bumps; on further examination I found a half dozen

or more small hard papules on back and upper part of chest. On February 8th I found him with temperature of 99%, pulse 66, pain relieved, kidneys acting freely (up to this time they had been very inactiv), and almost the whole cutaneous surface covered with those elevated hard papules. On February 9th, temperature 99°, pulse 60. February 12th, temperature 98°, pulse 60, patient feeling fairly comfortable, with papules larger. On the apex of each was a vesicle filled with serum; the most of the older ones were deprest in the center. February 14th, I found temperature 100°, pulse 84, patient more restless, with an areola of redness around the base of each papule, while the serum in the vesicles was more turbid. February 15th, temperature 982, pulse 60; some of the pustules are becoming dry and falling off, and the face not so badly swollen. February 18th, temperature and pulse normal. February 22nd, temperature and pulse normal, scabs nearly all off and patient feeling comfortable and has a good appetite.

Now, my diagnosis of this case was smallpox, which I think was almost a typical case, tho the large majority of the cases are not so bad, the eruption not so great, and the secondary fever does not appear in a good many cases. My treatment in the early part of the disease was calomel to stimulate the secretions, and anodynes to relieve pain. When suppuration commenced, I gave calcium sulfid in 1 gr. doses 3 times a day, and applied 3 percent car

bolized oil to relieve the stinging and itching that he complained of at this stage. J.D. GROOM, M.D.

Maxton, N. C.

[There are many things to be taken into consideration which can be done only on the spot. What effect has vaccination on this epidemic? Has it been tried? Is it contagious? If so, have you noticed any difference between the vaccinated and unvaccinated in regard to susceptibility? You say this is one of the worst cases. True, it suggests small-pox in a mild form, but have you thought of chickenpox in a severe form? This thought is not considered as carefully as it should be under such circumstances. Read up on chickenpox and make careful comparison with your cases, and at the same time realize that chickenpox is sometimes quite a severe disease. A number of epidemics that were first thought to be a mild form of small-pox have been discovered to be a severe form of chicken-pox, and your patient above described strongly suggests this diagnosis. With this suggestion, and by carefully reading up the subject and examining your patients with this possibility in mind, you can doubtless reach a decision. It may be small-pox, but we give you the above suggestion. Have our readers anything to say ?-ED.]

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Erysipelas.

Editor MEDICAL WORLD:-I desire to report a case of erysipelas ambulans, and my experience with the streptolytic serum. Patient, a man aged 50, usual health good, was attackt December 30, the disease beginning about the nose and rapidly spreading over the face, head and neck; then more gradually continuing its course until the entire body had been covered down to the knees. Temperature ranged from 102° to 105°, pulse rapid and weak, delirium in the early stage. On the tenth day pneumonia was strongly threatened. Activ measures, however, aborted this.

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Treatment: Nourishing diet, tinct. iron, quin., strych. and echinacea; locally I used ichthyol, tinct. iodin, tinct. mur. iron and other usual applications. Under this treatment the disease would occasionally seem to be checkt, only for the inflammation to return with renewed energy. On the twenty-eighth day of the disease I injected two bulbs, 20 cc., of streptolytic serum in the twenty-four hours; waited twenty-four hours longer, saw no change whatever. I then injected at one time four bulbs, 40 cc.; at the end of twenty-four hours more found patient no better; at this time I used two more bulbs, 20 cc. In twelve hours' time the temperature fell from 103° to below normal; patient was greatly prostrated and cold, requiring heat and activ stimulation for

two hours before any reaction. The temperature was soon normal and remained so for several days. The inflammation was completely controled. Meantime patient had complained of aching pains in the joints, which seemed to grow worse. At the end of the week what appeared to be a violent case of inflammatory rheumatism set up, with symptoms closely resembling lockjaw accompanying. Rheumatic treatment was used, which entirely relieved these symptoms in two weeks. The patient is just now, at the end of ten weeks, able to be out, and is convalescing very nicely.

This is my first use of the streptolytic serum, and whether these unpleasant complications were due to the large amount (80 cc.) of serum used or not, I am unable to say. I should be pleased to hear from others who have had experience with the serum in the treatment of this disease. B. DECATUR SMITH, M.D.

Cincinnati, O.

Ninth and Baymiller Sts.

Did the Chickens Have Erysipelas? Editor MEDICAL WORLD:-Inclosed find P. O. order for $3, to pay for four years' subscription to your valuable journal. Not long since, a lady patient of mine developt a very classical case of erysipelas. She had been

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visiting her brother who has a large flock of poultry, and some of the fowls were suffering from what poultrymen call "swelled head." The sick chickens had been doctored by smearing plain vaseline on their heads. ing her visit, my patient developt an acute coryza, and took some of the chicken's vaseline to smear over the bridge of her nose, hoping to thus relieve some of the disagreeable full feeling in her head. The coryza got better, but about five days later erysipelas developt. The eruption and swelling commenced on the bridge of the nose and spread over the entire face and scalp. Now, Mr. Editor, the interesting question is, did those chickens have erysipelas?

Point Arena, Cal. D. A. MARSAN, M.D.

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We find that our criticism of Dr. Waugh's article, page 121, March WORLD, was not just to him. He gave the case, "An instance, an illustration of the point he made in the first part of his article, viz., the widespread lack of accuracy in diagnosis. If the case is read in that light only, we see that it is a good illustration; and he writes that this only was his intention. So he did not fall into the very error that he pointed out, as we supposed.

If the old "fly blister" were employed more frequently in cases of chronic sciatica and lumbago, we would see fewer cripples. Use but small blisters, and apply them frequently.

Gained a Minute, Lost a Month. Editor MEDICAL WORLD:-Inclosed find P. O. money order for $3 for which please continue THE WORLD four years. Four weeks ago I sustained a fractured clavicle as a result of my horse falling on the rough, frozen ground. This is my first accident in six years' country practise, and would like to say to the brethren that there is truth in the old axiom, "When you want to go fast, go slow;" for in my effort to gain a minute I have lost a month.

Physicians are liable for malpractise to their patients, corporations for injuries to its employes, and yet the country doctor has neither recourse nor sympathy from his patients when injured in their behalf, which to me suggests the organization of a Physicians' Mutual Benefit Association. Let's hear from THE World. J. MORSE GRiffin.

Millville, Mo.

[Such associations are usually local, and perhaps better so, for then the management can be simpler, and there are less chances for dishonesty. For example, there is a physicians' benefit association connected with the Philadelphia County Medical Society. However, it pays death benefits only, I think, and not illness nor accident benefits.-ED.]

Simplified Method for Giving a Hot Vaginal Douche.

Editor MEDICAL WORLD:-It is often necessary to prescribe hot water as a vaginal douche, and it is not often given in a very efficient manner. As a general thing women use the douche sitting on a vessel. The different textbooks describe how it should be done, but it is very seldom that we can get our patients to use two to five gallons of hot water. I have a plan which I have never seen described or recommended in medical journals by which as good results can be obtained with the ordinary two quart fountain syringe as with the more elaborate douche-can or irrigating apparatus. It is used as follows: Either lying with hips on an ordinary bedpan or lying across the bed with feet on chairs and hips over the edge of bed, a rubber sheet or several folds of newspaper being utilized to conduct the water into a tub as described in works on gynecology, two quarts of very hot water can be made to answer the same purpose as several gallons under the old plan. The difference is simply this: Have the water in the fountain syringe considerably hotter than with the ordinary douche-can, then before inserting the nozle of the syringe into the vagina, insert a sponge or several sponges or a strip of gauze up near the uterus, large enuf to distend the vaginal folds slightly, then insert the nozzle back of the sponge or packing. Next, have the cut-off or stop-cock well under control and let the hot water into the vagina

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