of a given size than it would be a smaller one. Artificial rotation may be effected at any point from brim to vulvar orifice, and should be if difficulty is met with. Instead of rotation being difficult upon the pelvic floor, nature usually accomplishes it at this point if she has not secured it higher up, and by effecting it lessens the dangers both to mother and child. Space will not permit an exposure of all the mechanical errors enunciated, but having started wrong his whole paper would be a comedy of errors if it were not for the fact that men will be deceived and women suffer and children die in consequence of it. Query No. 20.-I find that methods differ among practitioners in regard to removal of blood clots from the uterus after the placenta is expelled. Some of my acquaintances in the profession introduce the Manual hand to remove clots and others do not. removal is advocated on the grounds of cleanliness and lessening the probability of post-partum hemorrhage. What do you advise? 66 The introduction of the hand into the uterus is never proper unless called for by dire necessity. This is particularly true after the completion of the third stage of labor, glove for no membranes are present to the hand and the raw placental site is open to infection. Nor is it necessary, for clots may be expressed by compression of the fundus, or will be expelled by the next after-pain. Why, then, run the needless risk of infecting the uterus? If a large part of the placenta has been torn off and retained, it is necessary to effect its removal; but if doubt exists it is better practice to wait and watch for early As to post-partum hemorrhage, symptoms. the part played by clots has, I think, been greatly exaggerated. The relaxed and dilated uterus fills with clots, but the clots do not relax and dilate the uterus. The advice to turn out the clots is sound, but gives a false idea of the modus operandi of controlling the hemorrhage. While turning out the clots you reflexly stimulate the uterus to contract, and the uterine contraction results from the presence of the hand in the uterus, not from the removal of the clots. If the uterus contracts, either spontaneously or from friction of the fundus, the clots will be expelled. This is but one of hundreds of instances in obstetrics where an ill-expressed fact leads Never introduce the to subsequent errors. hand into the uterus after labor unless absolutely necessary. It is never necessary for The the simple purpose of removing clots. danger of infection, following this procedure, is tenfold greater than that attending version, for in version the vaginal and cervical mucosa 273 are intact, and the hand passes within the Query No. 21.-(By telephone.) Patient delivered What If she continued to feel well I would do nothing. The amount of lochial discharge varies greatly in different women. As a general proposition it may be stated that there is a certain relation between the lochial discharge and menstruation. Women who menstruate freely will have a free lochial discharge; those who have a scanty menstrual flow will have a more moderate lochia. If the discharge ceases, and there is no local or constitutional disturbance, let well enough alone. If the child has been dead some time before labor the bloody discharge will be of less amount, and of shorter duration, because the open mouths of uterine vessels have been occluded prior to the detachment of the placenta. The checking of the lochia, if accompanied by fever, should arouse suspicions of retention, but the mere checking of the lochia is of itself no reason for alarm. The modern view does not attach as much importance to the lochia in puerperal infection as was formerly ascribed to it. Query No. 22.-I have a patient six months pregnant who, during the second month, made several She is now very apattempts to induce abortion. prehensive lest there be some defect in the development of the child. What are the prospects of her having injured it? There are many superstitions encountered One of them is that in obstetric practice. children not wanted, or those whom the mother tried to get rid of, are apt to be mentally or physically defective. We have no statistics on the subject, but I can recall a large number of similar cases where the child was perfect. In an age when even nursery rhymes are being distorted to meet modern old woman who lived in a ideas, and the shoe" is supposed to have had so many children because she did'nt know what to do," deformity and imbecility would, I fear, be rapidly increasing in frequency if there was much reason for this woman's fears. If the ovum had been seriously injured she would probably have aborted. Hygiene. ROBERT MADDOX, M. D. [This department will aim to supply information on the subject of hygiene, general and personal, and on matters allied thereto. Our readers are invited to send to the address below any questions in reference to these subjects. Prompt and courteous answers will be given. Our readers must feel free to take advantage of this department at all times. Address: DR. ROBERT D. MADDOX, 1004 Yale Avenue, Cincinnati.] As to Sunshine. Dreadful sanitary advice as to sunshine is that found in the Dietetic and Hygienic Gazette of recent date. After quoting some authorities as to the desirability of sun exposure, the editor, Dr. J. W. Wainwright, of New York, says: "We are content to leave the wisdom of an abundance of sunshine for man, whether sick or well, to the judgment of all medical men as well as sanitarians and teachers of hygiene. Let us go out into the sunshine." A multitude of Philadelphia people took this deadly advice on July 19, 1907, and about 3,000 of them collapsed. The number of deaths will never be known. Incidentally, it might be remarked that this is not the best climate in the world for all of us, and the man who thinks he can expose himself to it is simply a fool. The medical profession is partly responsible for the terrible disaster during the Elks parade, for they have been long preaching the advantage of exposure to the sun's rays. Unlimited sunshine is advised, and Tyson says of the tuberculous: "The temptation to sit in cool, shady places should be resisted," and even Osler says they need "a maximum amount of sunshine." They surely got it on July 19, but they did not resist the desire for a cool, shady place very long. The above article, an editorial from American Medicine for August, 1907, is of extreme interest, though of questionable scientific value. On mature consideration, the "dreadful sanitary advice as to sunshine" found in the Dietetic and Hygienic Gazette is not so alarmingly dreadful after all; at least, not to an extent sufficient to cause a doubt of the profundity of Tyson, Osler, and others of equal attainments. It is an abstract statement, and as such a profound truth worthy of unceasing repetition. Moderation in all things is the keystone of applied hygiene, and the obvious necessity for ordinary preparation and precaution is always assumed. If Dr. Wainwright had been discussing the value of bathing as a hygienic measure, he probably would not have considered it essential to have made specific mention of the fact that the water should not be heated to the boiling point at the moment of immersion, that the bather should not be totally immersed for any considerable period of time, or that the removal of the clothing would greatly increase the efficiency of the bath as a cleansing agent. To doubt the sanitary and therapeutic value of sunshine simply because some of a Philadelphia multitude collapsed when subjected to the combined influence of direct solar rays, unusual physical exertion, undue mental excitement, and various other excesses, is a mental process equivalent to that of doubting the value of fire because of an occasional conflagration. To Detect Preservatives in Milk. QUERY NO. 4.-I would be glad to have some information regarding the preservatives ordinarily found in milk, and how they may be detected. A great deal is being said on this subject at present, and I feel that it is something I should know more about than I do. Any information you may give in your columns will be appreciated. C. S. D. The chemicals ordinarily added to milk as preservative agents are formaldehyde, salicylic acid, borax, and boric acid. Sodium carbonate, sodium bicarbonate, sodium fluoride, potassium chromate, and potassium dichromate are also occasionally used. If milk remains sweet after standing in a warm place for forty-eight hours, it is safe to assume that some preservative has been added. As this is a matter of considerable importance, the necessary qualitative analysis requires good technique and some laboratory experience. To detect added formaldehyde, place 10 c.c. of milk in an evaporating dish, and add 10 c.c. of hydrochloric acid and 1 c. c. of ferric chloride solution. Apply heat and stir well. If formaldehyde is present to the extent of 1 part in 100,000, the mixture will turn a pale violet color just before the boiling point is reached. To detect added salicylic acid, add sufficient hydrochloric acid to 100 c.c. of milk to coagulate, and filter. Add ether to the whey, shake, and evaporate without applying heat. If salicylic acid is present the residue will turn purple on the addition of one drop of neutral ferric chloride. To detect added borax or boric acid, add 10 c.c. of tincture of tumeric to 10 c.c. of milk, and evaporate to dryness. Slightly moisten the residue with dilute hydrochloric acid, and redry. If either borax or boric acid is present the pink or red residue will turn green or greenish-blue on the addition of a drop of ammonia water. Registration of Births. The registration of births is an economic necessity, if for no other reason than that the State requires children to attend school until of a certain age, and that this age cannot be legally determined unless the birth of the child has been recorded. Therapeutics. E. S. M'KEE, M. D. Sweating Scrotum. For excessive sweating of the scrotum accompanied by an odor use a mixture of a half an ounce of formaldehyde to a pint of water and wash frequently. The solution may be increased till the sponging of the scrotum with pure formaldehyde can be tolerated, if necessary, though these stronger solutions are not often required. If there are any lesions from scratching, the stronger solutions should not be used. If desirable, use a powder after this application, consisting of orris root 30.00, salicylic acid 8.00, boric acid 30.00. This will protract the stringent effect. The Therapeutics of Chewing Gum. The great American habit of bolting meals seems to be counteracted in a measure by chewing-gum. A meal insufficiently masticated lacks of the salivary amylolitic aid to gastric digestion. Chewing gum results in a supplementary insalivation within the stomach from swallowing the saliva poured out by reason of chewing gum. Though repulsive in the extreme, especially on the street, it not only aids digestion, but also aids indirectly by cleansing the teeth, thus keeping them in good order and preserving digestion. Thus it seems that we cannot scientifically oppose this digusting habit. Creosote Carbonate in the Pneumonia of Children. A. Fletcher (Canada Lancet) says this remedy is supposed to be carried into the bloodstream unchanged and conveyed to the cells of the lungs to be excreted. The breath is soon loaded with its odor, and the skin aids in its excretion. The drug is brought into direct contact with the tissues in which the pneumococcus is developing. The dose for a new-born infant is one minim per hour. The adult dose is seven to fifteen minims every two, three or four hours. It may be given dropped on a lump of sugar. No gastric disturbances follow its administration. It is claimed that this treatment will reduce the death-rate from 25 to 5 per cent. Hydrogen Peroxide to Abort a Cold. The inhalation of the vapors of hydrogen peroxide is recommended by Maget in La Presse Medicale. These inhalations are repeated four or five times, and continued for five minutes at a sitting. The liquid must be in a boiling condition. If this be done over night the patient will awaken in the morning free from every symptom of a cold. If the nostrils are plugged up with a secretion apply adrenalin solution (1-10,000) a few minutes before the inhalation to clear the nasal passages. The treatment is excellent in chronic catarrh if persisted in. Boric Acid as an Eye-Wash. A saturated solution of boracic acid at the normal temperature is just about equal in density to that of the tears or a salt solution of 14-1,000, or one and a half times that of the blood-plasm. Being thus isotonic with the tears, it forms an ideal medium with which to cleanse the delicate epithelium of the cornea and conjunctiva. To Remove Freckles. Take of pure iodine 24.00, potassium iodide 12.00, glycerine 12.00, rose water 120.00. Paint this on the freckles and after twenty minutes remove the iodine stains with a mixture of three ounces of hyposulphite of soda to a quart of water. In mixing the first solution dissolve the iodine in a small part of the rose water to which has been added a drachm of glycerine. Rub together and add the iodine gradually, rubbing until in solution. Then add the rest of the prescription. Lecithin. A very easy method of preparing this remedy is as follows: Yolk of egg, raw, 300.00; distilled water, 60.00. Beat together and pass through a strainer and add glycerine, pure, 300.00; sodium chloride, 8.00; cherry laurel water, 10.00; syrup lemon, 100.00; rum, 50.00. M. S.-Dose two tablespoonfuls three times a day. To Prevent Urethral Fever. D. A. Freudenberg relates in Klinische Therapeutische Wochenschrift how, for the last four years, he has been using camphoric acid in powder in doses of one gramme three times a day, and also immediately before catheterization, and has had a complete absence of urethral fever following the use of the catheter. The remedy, however, disturbs the stomach very much. Prickly Heat. A very good remedy is a mixture of alcohol, chloroform and ether, equal parts, and menthol 1-10 per cent. Alcohol alone is good also equal parts of alcohol and spirits of camphor. Frequent changes of underclothes and repeated bathing are good combined with. avoidance of stimulating food and alcoholic drinks. Book Reviews. American Practice of Surgery: A Complete System of the Science and Art of Surgery by Representative Surgeons of the United States and Canada. Editors: JOSEPH D. BRYANT, M.D., and ALBERT H. BUCK, M.D. Complete in eight volumes. Illustrated. Volume II. Muslin binding, pp. 778. Price, $7.00. New York: William Wood & Co. The second volume of this valuable system of surgery presents the same high qualities that were noted in Volume I. The illustrations are profuse and excellent. Part VI, the opening chapter of the volume, includes leprosy, plague, glanders, anthrax, actinomycosis, mycetoma and scurvy. Rare diseases are discussed at too great length for a work of this sort, but the descriptions are good and will be valuable for reference. ease. Part VII includes tuberculosis and syphilis. The general discussion of tuberculosis from the surgical viewpoint is filled with points of vital importance, and gives an excellent basis for reasoning in this disThe subject of syphilis is ably discussed from the viewpoint of a disease that "requires a surgeon's diagnosis, but rarely a surgeon's treatment." The general discussion of the disease is given in too much detail for a work on surgery, but the general principles and special indications for treatment are very thoroughly and very properly presented. Part VII deals with abscess, ulceration, gangrene, surgical diseases of the skin, muscle, tendons, bursæ, connective tissue, nerves and lymphatic system. The section on abscess and ulceration furnishes a complete review of the most accepted views on these subjects, while the section on gangreene is particularly good. The latter section deals with all gangrenous diseases, including emphysematous gangrene, gangrene of lung, intestine and other viscera. The section on surgery of diseases of the skin deals with many important subjects, which are too often passed over slightly by the surgeon, yet are of vast importance to the patient. All skin lesions that may have a diagnostic or operative significance to the surgeon are discussed in this section. The disease of muscles, and tendon sutures are described in detail, while tenosynovitis and bursitis are wisely given a position of importance. Disease and wounds of nerves are very ably discussed and operative measures are very accurately described in detail. Traumatic neuroses, cerebro-spastic palsy, progressive muscular atrophy, occupation palsy, and joint neuroses are also described. Tuberculosis of glands of the neck very properly occupies a major place in the discussion on surgical diseases of the lymphatics, and is thoroughly discussed from every view-point. Part IX, dealing with surgical disease caused by intense heat and intense cold and of electric shock, would seem very inadequate indeed. Part X, on simple and complicated wounds, including gun-shot wounds, forms a most excellent Materia Medica, Therapeutics, Pharmocology and Pharmacognosy: Including Medical Pharmacy, Prescription Writing, and Medical Latin. A Manual for Students and Practitioners. By WILLIAM SCHELIF, Ph. G., M.D., Demonstrator of Medical Pharmacy in the Medical Department of the University of Pennsylvania. Series edited by Bern B. Gallaucht, Instructor in Surgery, College of Physicians and Surgeons, New York. Third edition, revised and enlarged, 470 pages. Lea Brothers & Company, Philadelphia and New York Much might be said pro and con as to the value to the medical profession of such a work as this; there is no doubt but that a short, concise statement of the principles of the materia medica and of their therapeutic value is desired by many readers who lacked the time or inclination to make an exhaustive study of these subjects; likewise, the student is more concerned and interested in learning of well-established facts than in reading of new theories, even though they be clearly stated. On the other hand, the tendency and also the danger of this class of book is to give to the students much that is old and shop-worn, with the result that he must re-learn more or less of what he has mastered. 66 The drugs are grouped under such headings as Antispasmodics," "Anesthetics," etc., and excellent judgment is used in placing the drugs according to their proper classification. The student who wishes to study remedies having similar action could hardly do better than to follow this system. As regards the subject-matter, as might be expected from this type of book, the sins are more of omission than of commission. Thus, in the treatment of phenol poisoning there is no mention made of alcohol, and but four lines are given to the subject of adrenalin, which heads a list of what are termed "New Remedies." It is doubtless true that no book is so poor but that in it one may find something of value, and no book so good but that it may be open to criticism. Be that as it may, this work can hardly be played in either classification. OBITUARY. R. S. Dr. Arthur Clay Blain, of Brunswick, Ga., di1 August 28 of nephritis, aged forty. Dr. George H. Cannon, of Albany, Ind., die August 28. The cause was said to be an obstruction of the bowels. He was fifty-five years of age. Dr. L. C. Bunker, eighty-six years old, died at Greensburg, Ind., August 27. He joined the Second Illinois Infantry and served under General Taylor ir Mexico. In 1845 he began the study of medicine, attended a course of lectures at Rush Medical College, but was graduated in 1852 at the Eclectic Medical College, Cincinnati. He removed to Greens burg in 1865. He retired from practice in 1897. Mrs. J. L., aged thirty, general health good, although not robust. Five years ago bore her first child. This labor was tedious, although the position was normal and was terminated by forceps, the instruments being applied after the head had entered the pelvic cavity. This delivery was very skillfully made by Dr. Gillespie. The mother made a prompt and uninterrupted recovery. The child weighed eight and a half pounds at birth. The head was large. The difficulty in this case was due to the excess of the sacro-vertebral angle. Her second delivery occurred, two years later, was in every way quite normal, and only about six hours in duration. This child weighed eight pounds and had a smaller bead than the first. On March 3, 1907, Mrs. L. entered Christ Hospital in anticipation of her third accouchement. For several weeks previous she had been under a severe physical and nervous strain by reason of the very serious illness of the oldest child. The abdomen was very large, spherical in outline, and the fetal parts were not very readily outlined, from which it was inferred that there was an excess of amniotic liquor. This was confirmed when, upon vaginal examination, the head, which was resting upon the pelvic brim, was found to be very readily lifted up and moved from side to side. The os was slightly dilated, the cervix rather flaccid. Her calculated time was March 6. There were some feeble pains on the 5th. During the 6th there were definite pains of the first stage, but not severe. When examined in the morning the head was found resting upon the pelvic brim in the first position, the os dilated to the size of a silver quarter. When seen in the evening she was having severe labor pains, which had begun late in the afternoon. On making the vaginal examination I was much surprised when the examining finger could not reach the head, which had been so easily outlined in the morning examination. External pal pation discovered the head lying well over in the left flank. The vertex position had changed to a transverse one. What was the wise course to pursue? To proceed immediately to make podalic version, or by manipulation to restore the vertex position, wait for the head to descend and then attempt to deliver by forceps? When the uterine contraction relaxed there was no difficulty in pushing the head back into position over the brim. There was in this case especial reason for making every effort for saving the life of the child consistent with the safety of the mother because her first child had died two days after she came to the hospital. lespie to my assistance. amount of amniotic fluid I called Dr. GilFrom the large present and from the fact that the child had so easily changed its position, it was fair to assume that the head was not unusually large, and that it would therefore enter the brim and be delivered without difficulty if it could be held over the brim until vigorous contractions should fully dilate the cervix. If this could be accomplished it would be a safer procedure for both mother and child than version, while version would be still practicable if this plan did not succeed. As the mother's condition was perfectly good there was no reason for haste. It was found quite easy, by external manipulation, to bring the head over the brim and to maintain it there by the application of a pad and binder. During the night moderate contractions occurred at intervals. At 4:30 A. M. the membranes ruptured, a large amount of amniotic fluid escaping. During this day, March 7, and the following night the patient's condition continued good. Pains of moderate severity occurred from time to time. The cervix was gradually dilating. The pad and binder were kept on. On the morning of the 8th the head was still above the brim, the cervix fairly well dilated. Further delay was considered inadvisable. Under thorough anti * Read before the Cincinnati Obstetrical Society, April 18, 1907. |