yes, six precious hours, given in my student days. Then it was: "this wound will heal by granulation; you must try, gentlemen, to keep the pus sweet; or, I should say, laudable." Now that the fear of pus with all its serious consequences has past, there is no part of the human body that cannot be invaded with safety and success. As time passes the surgeon will become more and more skillful, and the patients will have more confidence to choose an early operation, and we will see less cancer.

On the

In the old days we heard and read of scrofulous glands; today it is tuberculous disease of the glands. And this leads me to say that at least one-half of my surgical practise here is treating this disease. neck alone I have operated many hundred times. The neck seems to be a favorit place for the disease to develop. Here it is the very poor and the rich that are most afflicted; the former for lack of and poor food, the latter from over-indulgence, especially in the case of children who eat quantities of sugar colored with anilin dye, and the juice of sugar cane, eating at irregular times, and what is most pernicious, eating over-ripe bananas.

A famous Scottish surgeon in a recent article on the treatment of this disease said: "When in spite of the removal of the initial source of the irritation, in spite of change of air to the seaside or to high ground, of tonics, codliver oil, nutritious food, the injections of iodoform, etc., the tuberculous glands still go on increasing in size, it is advisable to remove them. And it is certainly most important to do this if possible before suppuration has supervened, and before longcontinued periadenitis has caused the glands to become firmly adherent to the structures amongst which they lie." I have quoted at length, for I quite agree with this advice. As a rule those who practise among the poor must treat this disease without long use of remedies; in many cases it is impossible for the patient to take a change of air, and cod liver oil and iodoform are expensiv. With them it is necessary to do something that will improve their health without delay. Some years ago I observed that on cutting open the glands that had been removed, almost without exception there was cheesy formation in the center. This, without doubt, would some time in the future break down and suppuration would ensue to the peril of the patient. I then advised the removal of all enlarged glands just as soon as they appear, or after three weeks' medication if there was no improvement. The operation is not difficult. The incision need be small, little or no scar results, and you have removed a source of irritation that would surely give trouble if not removed.

We have not the least difficulty to obtain the consent to an operation. In fact, they ex

pect it- would be offended if it were not done. "Why should I wait and have such an ugly scar extending from one ear to the other like my sister ?" It was true, for two years ago I removed 68 enlarged glands that took over an hour, so extensiv was the disease, and required careful dissecting. The improvement in her condition was markt, she gained 25 pounds in nine weeks. At one of the sessions of the recent meeting of the British Medical Association at Toronto, Canada, last summer, some of our leading American surgeons emphasized the importance of operating early if possible; if late, do the operation radically, removing the gland bearing fascia. This I think is most important; will prevent a return of the trouble at some future time.

Thanks to Dr. Russell, I sent for "Operative Surgery" by Dr. Binnie (P. Blakiston's Son & Co., pub.). Of the many of its class, I deem it the most valuable I have seen, especially for a busy man. What he tells

of "Excision of Cervical Tumors" is a most excellent guide for operation on the neck.

Mr. Editor, I congratulate you that some of the things you have so eloquently and persistently advocated in your Monthly Talks are coming your way, and others will come. The people are awaking from their long sleep. "Everything comes to him who will wait." May your shadow never grow less, as the Arabs say. Tripoli, Syria.

DR. IRA HARRIS.

[Glad to hear from our old friend again. "The family" would like to hear from him often. Let us not "wait" till "everything comes.' Waiting does not bring things our way. Rather, let us "hustle." In New Zealand the people got the blessings they now enjoy by working intelligently, determinedly and persistently. Let us do the same, but withal, let us work patiently. -ED.]

A Physio-Medicalist in the Obstetric Chamber.

Editor MEDICAL WORLD:-I wrote an article some time ago which ye Editor consigned to the waste basket. I hope this will meet a better fate, or a worse one and be sent to the furnace room.

I read your editorial in November edition in regard to Postpartum Hemorrhage and Its Treatment, and thought it might be of some interest to add a little of my experience to the really excellent treatment outlined therein.

I always try and avoid this grave complication by prophylactic treatment. In every case where I arrive before the child is born, or even afterward, if there is no hemorrhage, I give 5 drops of the tincture of arnica radix in water, repeat in fifteen minutes, and then follow with two drop doses at two hour or

three hour intervals, according to the bruised condition of the parturient canal-the more bruised and lacerated the more frequent the repetition. This fact is evident from the experience of all schools: that arnica greatly increases the watery excretion of the kidneys without a corresponding increase of thirst, and thus drains the blood of its watery element, making it thicker and greatly enhances its coagulability. Besides, who does not know of the relief of arnica in bruises of soft tissues?

If I further discover that the labor is slow, the pains "aggravating" rather than expulsiv, and the presentation right with the os dilated, I administer a hot infusion in sweetened water of the following: myrica compound 3 parts, caulophyllum thal. 1 part, cypripedium pub. part, trillium sessile,

part. Dose a teaspoonful. If the os is undilated, I add a few drops of lobelia inflata. Myrica compound is a physio-medical preparation composed of the following ingredients: bayberry bark 32 parts, ginger 16 parts, hemlock bark 16 parts, cloves 2 parts, capsicum 2 parts. It is a stimulating, astringing tonic of very strong power.

When

this power is directed toward the uterus by caulophyllum it becomes one of the most powerful parturients I have ever known. Cypripedium is a relaxing nervine, quieting irritability, and trillium has a decided influence over hemorrhages, especially uterin, so much so that it is popularly called "birth root."

I repeat this dose every few minutes until one or the other condition follows: i. e., the pains are stimulated to perfectly healthy expulsiv efforts, or else are entirely quieted down. It does the latter if nature is not ready for expulsion; and I frequently have cases go a week, and one went three weeks, after this administration, and then had rapid and perfectly normal deliveries without the least sign of postpartum hemorrhage following.

If I find the woman in hemorrhage, the quickest acting remedy I have ever used and one giving the greatest satisfaction is oil of erigeron in 10 drop doses on a lump of sugar. This is a short acting remedy, but will hold for arnica and the hot infusion of the prescription above to follow it. I could not improve upon the mechanical means suggested in the article from the pen of the Editor. The only difference is that I try paragraph 6 in the place of paragraph 3 with this difference: that I pack the uterus with sterilized gauze (which I always carry in a separate compartment of my obstetric case) wrung out of just as hot water as I can stand. I renew these at frequent intervals.

I have had better results from the administration of very small doses of quinin in the after-effects of hemorrhage of any kind than any other treatment from a medicinal standpoint. DR. C.; Ill.

Editor MEDICAL WORLD:-I am one of the new subscribers to THE WORLD, and I have been watching with no little interest some of the reports of cases, and especially criticisms, of some of your subscribers, such as Dr. Parker made in regard to Dr. Markley's case, which struck me as a severe arraignment. I note in the Nov. issue Dr. Parker describes his treatment of what he evidently considered a very complicated case of labor. On his arrival he found a stout primipara in the first stage of labor, os lying back on rectum and closed. He proceeded to take things easy, which any of us would do, especially if there were no other calls to make at that time. At the end of six hours he found os dilated so he could introduce his finger, which he did, and pulled forward for a time. He said the membranes had ruptured (too early). I agree with him, but it would only delay labor for a short while. He then used the dilator for a short while, with some little benefit. I think he did just what he should not have done. There is no excuse for using a dilator when labor is progressing, even tho slowly, unless some urgent symptoms call for immediate delivery; and from his paper you see there was nothing of this kind. I find you can easily dilate with your fingers after you can get one introduced; at the same time, if the woman is tired and nervous (which this one did not seem to be) you can give her 30 grs. of bromid potass. and chloral 10 grs., and let her rest and sleep; and I am pretty sure after a few hours you would find your patient pretty strong and new pains starting, softer os, and a pretty quick delivery without instruments. I am not criticising, however, the use of instruments in this case, but I do criticise his using dirty instruments, as he did. I would as soon examin a woman immediately after walking in the room without washing my hands or preparing in any way, as to use instruments without boiling them thoroly, except in case of emergency where it was impossible to regard asepsis.

The Almighty was with the woman; and her fine resisting power against infection, being a strong, healthy woman in good condition, it was no fault of Dr. Parker's that she was not infected. He did his best to infect her and failed. No doubt the lard was all right if it was gotten out clean from the can; but I prefer to lubricate with germi

(Continued beyond Yearly Index. Raise staples with a pocket knife, lift Yearly Index out, and bind in front or back of volume, as desired. On account of the unusual size of the index this year, we omit the title page and blank page on opposit side of same leaf. As practically all who bind WORLD use the WORLD Binder (only 35 cents each, or three for $1), a sepa rate title page is not needed, and is seldom used. However, if as many as 100 of our subscribers request a separate title page, we will supply it without extra cost.)

cidal soap containing 1 percent of mercuric iodid.

I have carefully lookt for the similarity between Dr. Parker's and Dr. Markley's cases. I find one (Dr. Markley's) a serious case of confinement; the other (Dr. Parker's) a simple, uncomplicated case of slow labor, being a primipara, large and strong, only needing a little time and patience.

There is not a subscriber to your journal that has not had many cases like the above. Martinsville, Va. W. W. VEST.

A Childless Wife's Appeal. Editor WORLD:-My husband, a physician, takes THE WORLD and we both read it with interest. The piece, "A Neglected Doctor's Wife", page 456, Nov. WORLD, was exceptionally interesting, and so identical with my own case I decided to write. I am 30 years old, been married 7 years, weigh 150 pounds, and the picture of health. Have not spent a sick day in bed in 15 years.

I had a miscarriage at close of my first year of married life in early stage of pregnancy, but have been unable to become pregnant again. My husband has long since exhausted his supply of information on me, as have five other doctors, and he sent me to a noted doctor on women's diseases at Chicago, all to no avail. I suffer no pain at menstruation and have no female trouble of any kind except slight catarrah of cervix, which the doctors thought of minor importance. Will some doctor who has had experience in a case of my description, or who has any information which might lead to the desired result, write me personally or thru THE WORLD? Í assure you it will be thankfully received. It seems strange how some women use every conceivable means to prevent conception, and others use as untiring efforts to become pregnant, and yet both fail.

To my Ark. sister who has so many aches and pains, and over whom I stand a better show because of my good health, I want to say, don't let any one encourage you, in your desire to become pregnant, by saying "you are young yet"; nor let me entirely discourage you by my experience. But I have tried doctors and doctors, uterin tonics, womb dilators, suppositories, and every conceivable thing for 5 years, and would give all I possess for a dear baby of my own, to clasp it to my heart and experience that love that only a mother knows. But after days of weeping I have become reconciled to the fact that "God is wise and all is for the best." A WISCONSIN DOCTOR'S WIFE. [Here is the anguish of a true woman's heart. Naturally the lady does not wish her name printed, but she asks us to forward to her any letters that may come for her.-ED.]

491

Disappearance of Fetus in Utero. Editor MEDICAL WORLD:-I have had a most peculiar case. Mother, a primipara, had every symptom of pregnancy: supprest menses, morning sickness, etc. About the sixth or eighth week she had troubles and exposure enuf, as I thought, to make any woman miscarry, but it didn't seem to affect her. At four and one-half months she miscarried, passing the placenta only; no flatus. The placenta was small in size, seemed about two months and perfect in shape. What became of the child? Did it die in utero, and was it taken up in the amnionic fluid after this excitement at about the sixth or eighth week? if not, what became of it? Several years ago I saw a placenta that was retained in utero for three months after a miscar

riage, and it did not show the least sign of decomposition when removed with the curet. I would like to know if any of the "family" every had any such experience.

GABRIEL F. THORNHILL, M.D.

Paris, Texas.

Postpartum Hemorrhage.

Editor WORLD:-If you will permit me, I would like to add something along the line of your admirable editorial in Nov. issue, pages 428-429, on postpartum hemorrhage. It is said, "a cat may look at a king;" and so I suppose an ordinary doctor may criticise an editor.

My criticism, if so it may be called, is simply a rearrangement of your advice. First, I would suggest that you place paragraph 6 directly after 1 and 2, or use the advice contained in it in connection with 1 and 2. A good workable fountain douche should be the most important item of the obstetrician's armamentarium. It should be sterilized and with proper nozzle, preferably of glass, wrapt in a steril towel and never be left out of the obstetric bag for an instant. It is more important than the forceps, which are used much more frequently than they should be. In cases of emergency it can be used without resterilizing, but where time permits it should be resterilized always, and made ready for action in the third stage of labor.

The first thing an obstetrician should do when called to a case of labor is to make sure that there is plenty of sterilized water available, both hot and cold; then he can make the temperature of solution to suit the case. Steril hot water introduced into the uterin cavity with clean instruments and clean hands can do no harm, and in connection with internal and external massage will meet more cases of postpartum hemorrhage than any other expedient. 90 percent of the cases of sepsis in obstetric cases are due entirely to the laziness or carelessness of the accoucher; for there is no home so poverty-stricken that will not afford abun

dance of steril water, boiled in a frying pan if necessary.

A lump of ice carried into the uterin cavity, tho not steril, is sometimes an expedient that has been used when hot water is not quickly available.

Packing the uterin cavity is an expedient that is seldom necessary, but one which the accoucher should always be prepared to perform, and there is seldom necessity for doing it with anything but aseptic material. Purchase gauze in 100-yard bolts, fold up 5 to 10 yards of it, cut in hand breadth widths (double), wrap in strong cotton cloth or sized paper, mark on wrapper with indelible pencil, "uterin gauze," steam thoroly in any kind of boiler, and dry. Carry one or two of these packages always in the obstetric bag. Resterilize whenever you think it necessary. One can sterilize enuf gauze at one time to furnish all of his surgical bags and keep a reserve supply in a tight sterilized tin can. Gauze prepared in this way is preferable in every way for all kinds of surgical work. It requires less handling, and is eminently safer than any kind of stock package.

In the old days cases of postpartum hemorrhage were ascribed to some idiosyncrasy of the patient; but with a better understanding of the pathology of obstetric conditions, many cases can be premised and prepared for. Probably most cases are due either to a condition similar to the one described by Dr. Blakely; i. e., prolonged labor with its resultant exhaustion, collapse and lowered tone of the vessels; or to lateral implantation of the placenta (partial placenta previa). The latter condition frequently is not diagnosed until labor sets in, and often not then; but in many cases could be if the physician were carefully observant. In either the former or latter condition, one would sooner think of leaving his forceps home than the douche bag, which should be hanging at the foot of the bed ready for action the instant the infant has been delivered.

It is in the cases of lateral implantation that gauze packing is most frequently indicated, and it should be done thoroly. It makes little difference what sort

of

medicament, if any, is used, if the packing is thoroly done; and it takes a much larger amount of material than one would ordinarily suppose. Vaginal packing, it is needless to say, is absolutely useless in these cases and more than dangerous, as it gives a sense of security which does not exist. One might just as well put a tourniquet on the great toe to stop a hemorrhage in the groin.

For anemia following cases of shock and collapse from loss of blood, instead of one pint of saline sol. I would say give two quarts or a gallon of normal saline per rectum, if the patient can hold it, at temp. of 110°.

Paragraph 2. Think a little more about

that nitroglycerin. Almost all authorities are agreed that nitroglycerin in shock and collapse from hemorrhage is not only useless but dangerous. They may or may not be right. Be careful with your digitalis; don't expect an immediate effect from your strych., and add to your list as immediate accellerators hypodermics of camphor gr. viiss in steril oil m xx, adrenalin, brandy, and ammonia. Give adrenalin if possible in normal saline solution intravenously.

This is already overly long, but I would like to add one more paragraph: Don't use your obstetric bag for a general operating and dressing receptacle. Have a good large bag, large enuf to accommodate everything you are likely to need in any emergency, and use it for nothing else; repack it and clean it whenever necessary.

Gallup, N. M.

W. H. BURR.

[The Editor is not infallible. Whenever your views are different from his, or opposed to his, don't hesitate to express them. Wisdom comes from counsel from many sources.-ED.]

A subscriber upon returning from an all night battle with postpartum hemorrhage pickt up Nov. WORLD and read our editorial on that subject on pages 428 and 429. He writes that he would have been glad to have given $2 for that article 24 hours earlier.

Rock Candy Syrup.-Ergot in Labor. Editor MEDICAL WORLD:-In regard to the syrup problem, which I see discust in THE WORLD: I made my syrup for years by the cold (percolation) process, but some time ago I found that any wholesale druggist was glad to sell me pure rock-candy syrup for sixty cents a gallon, and I find it much more satisfactory than any that I could make. In regard to the case of Dr. Blakeley (page 440, November WORLD), it would be interesting to know what results he expected from a large dose of ergot when he found "A very large head firmly wedged in the pelvic outlet." It seems to me that about the only result he could expect would be a ruptured uterus. It seems to me that it was decidedly the wrong thing to do, altho I would guess that the uterus was ruptured when he arrived, and that the death was caused by the ignorance of the midwife. "It is easy to criticise." NEBRASKA.

Simple Way to Make Simple Syrup. Editor MEDICAL WORLD:-I have seen a number of answers to the query on how to make simple syrup, but I have a simpler method than any given and good enuf for all practical purposes. Fill your bottle twothirds full of granulated sugar and add enuf cold water to fill the bottle. Shake occasionally and you will have a saturated solution and one that will keep indefinitly. From time to time add either water or sugar as

Geneva, Pa.

WORLD:-Inclosed

The Auto vs. Horses. Editor MEDICAL please find $1 for what I consider the best medical paper publisht. You have the happy faculty of printing what most physicians want to see, and will read without yawning their heads off. I have just stopt my subscription to the A. M. A. Journal, for I find you have about all they have, and thank heaven, the meat of the subject is given shorn of the trimmings.

In answer to Dr. Suess (Nov. WORLD, page 447), I would say, get an automobile by all means and enjoy your drives. I am now running my second, and since giving up horses (6 months) I have not had the pleasure (?) of a drive behind one. I have had the usual troubles, but think they are no worse than with horses. The roads here are atrocious, and hence think I have given the auto a fair trial. If a man is mechanical, he will have no troubles which he cannot attend to himself. However, the man who cannot distinguish between a sprocket and a buzz saw would be wise to fan the flies off Dobbin's back until he can hire some one who can look after his machine; for machines are surely neurasthenic at times, and a slight misadjustment will mean ignominy unless one can "figure" out the trouble. Personally I would not go back to the horse way for any consideration. Long drives have no terrors for me now, for they are accomplisht so quickly and with so much comfort that they become a pleasure. My machine is 1822 h. p., weighs 1800 pounds, and is convertible. I have a buggy top fitted, and drive it mostly as a single seated rig. It climbs hills splendidly, and has gotten me quite a number of calls simply because people know I will be on hand before the others have found their stable boy.

The expense has been less than keeping a horse and man. I anticipate the greatest item will be tires; and while on this topic would like to caution any of the credulous against buying the Majestic tire, which is advertised as being just as good as the other makes of tires and fully guaranteed. Neither of these statements is true. I bought one of these tires and found at the end of 350 miles that it was entirely worn thru, and the makers refused absolutely to replace it, or allow anything for repairs; hence this tire is a complete loss. The reputable tire makers get a little more for their tires, but their products are worth the difference, and they make replacements and repairs free of charge if the fault is theirs, charging only for mileage on a 5000-mile basis. Economy is filth in the tire question.

493

Are you bored with my ramblings? If so, don't spare my feelings but drop this in the basket. Thought some of the awakened would like to hear of the experience of others, and as numbers seem to be looking to the auto as the future means of transit, dared hope my little say might be of interest to them.

It is my opinion that many of Dr. Markley's critics would do well to examin for the beam in their own eyes before they make so bold as to test his refraction. The milk of human kindness is something most of us like to have brought to our own doors, but which we hesitate to dispense until it is quite sour. OSCAR NORTHWAY-MEYER, M.D.

Monticello, N. Y.

The Success Automobile Again. Editor MEDICAL WORLD:-Having an interest with another in the purchase of a Success Automobile, my attention was called by a physician to Dr. Van Noppen's letter concerning it in your valuable publication. Our experience with it has been practically the same as his, except he has been more fortunate, having got his money back. The Success Automobile Manfg. Co. of St. Louis should certainly restrict their auto to certain sections of the country, for at its present stage it is practically useless except on solid, smooth, principally level, streets or roads.

Canonsburg, Pa. JOHN MCKNIGHT.

Opposes Dr. Parker's Plan.-The Dignity of the Medical Profession.

Editor MEDICAL WORLD:-During the last few months I have read with some interest the methods of Dr. H. J. Parker, and Dr. Parker's prescriptions. I have with patience read all of them, and fear it is not purely to help some young brother in getting up his combinations for his prescriptions, but there seems to be too much advice which is not at all elevating to the dignity of the medical profession.

I cannot too highly indorse the article by Dr. C. L. Sherman, Oct. WORLD, page 389, for I think he hit the nail squarely on the head at every blow. We cannot too strongly urge the physician to uphold the dignity of the profession, and not fix the price of his fees by the size of the bottle.

The physician cannot afford to have any but the best results obtainable in each case; and to do this each case cannot be properly treated without a thoro examination. With nothing short of this can we hope to make a clear-cut diagnosis, which is essential to proper treatment. To accomplish this latter we must consider the special peculiarities in a given case and select our treatment, hygienic, dietetic, or medicinal, to best suit these peculiar tendencies.

In the medicinal treatment of each case we should select the drugs indicated for the con