make his suffering as easy as possible. He lived three or four hours, dying a horrible death, cursing everyone in sight.

Three or four months ago I was called to see a patient who had fallen astride a rock; he had bloody urine, later passed large amounts of pure blood; there was crepitus; slight deformity of tuber ischii; ecchymosis over the whole perineum; inability to stand; severe pelvic pain and severe shock. He was treated by me, and the case recovered nicely. I cite this case on account of the remarkable effects of the medicine that I injected into his urethra to control the hemorrhage from the bladder. His pulse was 72, the shock was considerable. I prepared and injected into the urethra two ounces of a 1-2000 solution of adrenalin chloride. No sooner was the injection made than the patient grasped his head with both hands, and yelled, "O, my head! O, my head! you have killed me!" His surface was covered with great beads of perspiration; his skin was as white as the paper on which I am reading; he was as blind as a bat; his pulse went up to 200 as near as I could count, and I certainly felt very apprehensive for a moment, for his condition was serious enough. These appalling symptoms left nearly as rapidly as they came; he was apparently all right in about five minutes, there was no further hemorrhage from the urethra, or any bad symptoms whatsoever.

Some five or six years ago I was called to see a young man who had sustained a severe squeeze between a mine car and the rib, or side of a breast. He had all the symptoms of a fractured pelvis, his bladder symptoms did not develop for ten or twelve hours after his injury, when it became apparent that he could not urinate. Sounds of the smallest caliber or filiaforms could not be passed; it was ascertained (under ether), that the borders of the ischium had been crushed inward and supra pubic cystotomy was decided upon and done right away. The bladder was distended to its utmost capacity and could not have stood the pressure much longer.

The whole subject of fractured pelvis has been covered so well by Dr. Wadhams, that any further remarks by me would seem superfluous.

CASE REPORTED.

BY DR. G. R. ANDREAS, WILKES-BARRE, PA.

READ APRIL 20, 1904.

October 12, 1898, at noon, was called to attend Mrs. L. in her seventh confinement. Her previous labors were varied. Some were exceedingly difficult and tedious, while others were easy and rapid, especially the sixth was very easy, according to the woman's statement.

I found a very roomy pelvis, with an antero-posterior diameter, a little less than what is expected in an otherwise normal or justo major pelvis. The os was not fully dilated, head at brim of pelvis, pains fairly good, and general conditions favorable.

6 P. M. Os fully dilated, pains good, head in same position. The pains from now on grew more violent, and came every few minutes, but head would not engage.

12 midnight. Administered an anesthetic, and applied the forceps, but after three or four vigorous efforts found that I counl not engage the head in this manner, so concluded that version was the proper next step. I had no difficulty to get a foot down, but as I was well exhausted by this time and had already sent for Dr. Dodson, waited and left him to complete the version. He had no trouble to deliver the body, but the head stuck. We tried the Wiegand-Martin method, forceps, and all the modifications we could think of but failed. We called in Dr. Gibson, and after repeated efforts and our united strength, we finally succeeded to deliver the head. The child, of course, was dead. Its head was not so very large, but the bones were rather solid.

The third stage was normal, and at 4 A. M. we left the patient with the womb well contracted and general condition promising.

7 A. M. Was called to see her, as she was vomiting blood. Found her with an anxious expression, rapid pulse and about every twenty minutes she vomited a few ounces of bright red blood. Directed her to swallow small pieces of ice, injected ergotol, and applied cold on region of stomach.

Noon. Seemed much improved, had not vomited since 8 A. M.

5 P. M. Expression again anxious, pulse small and although she had not vomited since 8 A. M., yet the signs were of rapid exsanguination. The vaginal discharge was about normal in the morning, but grew less towards night.

8 P. M. She died.

A post mortum was refused, but the undertaker told me that by turning her upon her side and pressing upon the abdomen the blood would rush from her mouth and nose. He thought it amounted to nearly a pailful he thus forced from her.

The patient undoubtedly died from gastric hemorrhage. There was no history of ulcer or other gastric trouble.

In my text books I do not find hematemesis mentioned as a possible complication of labor or the puerperal state, so I suspect this was rather a rare case.

THE VALUE OF CREOSOTE CARBONATE IN PNEUMONIA

BY DR. C. P. STACKHOUSE, WILKES-BARRE, PA.

READ MAY 4, 1904.

In presenting this paper, it is my desire to call attention to the value of the Carbonate of Creosote in the treatment of lobar and broncho-pneumonia, and to give in a general way the result of my experience with it.

Creosote carbonate is formed by the combination of beechwood creosote and carbonic acid. Creosotal is creosote carbonate freed from certain impurities.

Dr. I. L. Van Zandt, of Fort Worth, Texas, (1) began the use of creosote in pneumonia in January, 1894, but its carbonate was first used in France by Dr. Cassonte, physician-in-chief to Marseilles Hospitals.

Favorable reports have been made by Prof. Andrew H. Smith (2), Dr. Leonard Weber (10), and Dr. W. H. Thompson (11), of New York; Dr. J. A. Gracey (3), of Texas; Dr. Charles F. Stokes (5), of the United States Navy; Dr. Cum

mings (9), of Texas; Dr. Frieser (6), Dr. Meitner (7), Dr. Elberson (8), of Germany, and others.

Although containing 90 per cent, of pure creosote, creosotal is not irritating to the mucous membranes and is practically non toxic. It separates in the bowel into creosote and carbonic acid and is excreted by the lungs, kidneys and skin. Any excess is excreted by the bowel without irritation.

"Its absorption in the intestines is a slow and continuous process, whilst elimination takes place with rapidity and can be demonstrated in the breath and urine one hour after its ingestion" (4).

To properly understand its action it is necessary to understand the existing pathological condition and Dr. Andrew H. Smith, of New York, has pictured it as follows (2):

"The chief menace to life is

First. Infection of the system by toxin formed in the lung. Second. The embarrassment of the lungs from the exudation in the air-cells.

From the first, arise a host of manifestations dependent upon toxemia; from the second, we have the ever-present danger of failure of the right heart."

"The occurrence of the chill is a certain indication that a considerable amount of toxin has already been formed in the lung and has been taken into the general circulation. As the disease progresses one after the other of the air-cells is shut off and in each one of these the germ culture must be allowed to go on. The young newly formed cocci are the most virulent, as has been proved by laboratory cultures, and it is in the half-filled cells in which the blood is still flowing that these cocci are present in large numbers and hence it is never too late to begin treatment."

"The problem before us is first of all to arrest or inhibit the growth of the pneumococcus. It should be remembered that the life of the organism is short, not exceeding ten or twelve days in artificial cultures, and that this is one of the most sensitive of all germs."

"If we can impregnate the blood sufficiently with a substance

inimical to the growth of the pneumococcus there is a chance of forestalling the local process."

"The local process is always a spreading one so that it seems perfectly feasible to prevent the spread of it to other cells than those first invaded."

"The carbonate of creosote has been found to saturate the blood readily without irritating the stomach and without giving rise to poisonous or other untoward effects."

He also calls especial attention to the double circulation in the lung which seems to him the most important of all the facts connected with the subject.

Dr. Meinter, of Germany, says (7):

"By means of the large doses of the non-poisonous remedy that could be administered, the tissue fluids of the organism were saturated with creosote. There is thus a constant creosote diffusion through the bronchial mucosa, which is in many cases the seat of the disease, and the air spaces are filled with a creosoted and disinfected air."

Dr. Leonard Weber, of New York, says (10):

"It must be conceded, I believe, that neither to the antipyritic or bactericidal qualities of creosotal is to be accorded this remarkable and beneficial influence upon pneumonia, a fact which so far as my experience goes is never accompanied by any symptoms of depression or disturbance of the gastro-intestinal tract. It is reasonable to say that its action must be anti-dotal to the pneumonia toxins."

"The most important effect of the creosote treatment is the surprising fall of temperature in a few hours after its administration is begun; it becomes normal in two days or sooner."

"With this the general condition improves, the pulse becomes better, the breathing quieter, the cough is lessened, the thirst ceases and the dryness of the mouth and lips disappears. Then the tongue cleans, the appetite returns, the entire course of the disease is cut short and convalescence is about abrogated. Under creosote treatment I have never seen that weakness followed by a slow convalescence." Meitner (7).