Imaginary Pregnancy in a Forty-eightYear-Old Multipara.

Krummacher (Centralb. f. Gyn.) tells of an interesting case in his practice, in which the mother of five children, a woman of forty-eight years, after several months of amenorrhea associated with an increase in the size of her abdomen, firmly believed herself pregnant. Fetal movements were felt after four months. On examination these movements were found to be due to the spasmodic contractions of the left rectus muscle. The contractions were distinctly felt and somewhat painful to the patient. Although at first doubting the statements of her physician that she was not pregnant, the patient consented to visit a sea bath resort and the hydro

therapeutic measures at this place relieved the muscular twitching and convinced her of her mistake.

Contra-Indications Against Breast-Feeding.

Bouquet (Bull. gen. de ther, rev. Zentralbl. f. Gyn.). According to the experience of the author every mother who suffers from a cardiac lesion, even if it is completely compensated, should be prohibited from nursing her baby. The same is true for mothers who have an albuminuria caused by nephritis. One of the most important contra-indications is tuberculosis. The resistance of the nursing mother is reduced and the child is in danger of receiving with the milk either

tubercle bacilli, or at least tubercular toxins. Breast-feeding must be stopped in cases of acute infectious diseases of the mother, such as typhus, erysipelas or measles. The necessity of a discontinuance is obvious in cases of lymphangitis, abscess formation or malignant tumors in the breast. It is more difficult to decide on the advisability of breast-feeding in cases of chronic intoxications. Alcoholic mothers seem to transmit through the milk substances which become responsible for disturbances of the intestinal tract or the nervous system. This deleterious effect upon the nursing child is more pronounced in chronic trade poisoning, e. g., with mercury, lead or arsenic. In another group of cases nursing must be discontinued on account of persistent anomalies in the chemical constitution of the milk.

Mitral Stenosis and Pregnancy. French and Hicks (British Journal of Obstetrics and Gynecology) analyzed the obstetric histories of 300 women, over 20 of whom had mitral stenosis with or without other lesions. The cases were not selected but were taken consecutively from the records of Guy's Hospital. They found that

1. Comparatively few are sterile.

2. They are not especially liable to abort.

3. The majority bear children well.

4. When heart failure develops in relation to pregnancy it is very often not with the first pregnancy, but after several pregnancies.

5. The treatment should be the same as for a non-pregnant patient with mitral

stenosis.

6. It is not just absolutely to veto marriage in all women with mitral stenosis. The dogmatic "No" of G. Jellett and of Porak is unjustifiable. It is right that the physician should make clear to the contracting couple, or to their near relatives, the risk run. He should use his discretion, and distinguish between one case and another. The risk should not be minimized but it should not be exag. gerated. Whether the woman marry or not, it is likely that she will not reach old age.

She should not have successive children rapidly. But if she has survived the age of twenty with good cardiac compensation, the likelihood that pregnancy will

accelerate the time of heart failure does not seem to be so great as has been declared in text-books.

Streptococcic Puerperal Infection.

W. Zangemeister and H. Meissl (Zeitschr. f. Geb. u. Gynak.) made extensive bacteriological investigations on fifty different streptococcus cultures obtained from various sources with a view to testing their pathogenicity, virulence against immunized animals, etc. Their results corroborate in general the findings of Natvig, inasmuch as they were able to show that all the streptococci examined belonged to a common parent. In particular they could show the identity with the true streptococcus pyogenes of a number of saprophytic streptocooci found in lochial discharges. From this, two important practical points can be deduced. In the first place, the possibility of an infection through such streptococci as are for the time being merely saprophytes; secondly, the possibility of immunizing against all sorts of streptococci. The fact that, at least for certain animals, it was possible to protect against all forms of streptococci by the use of two different and distinct sera, that of Aronson and that of the Rochester Farbwerke, is evidence in favor of this view. Both sera were, it is true, made with the use of several streptococcus stems, were thus polyvalent, yet were nevertheless able to protect against a great many, in fact all the various sorts of streptococci that were injected into mice.

Treatment of Puerperal Fever With AntiStreptococcus Serum.

Ed. Martin (Berl. Klin. Woch., July 16, 1906) considers the two new forms of treatment for puerperal sepsis that have come into vogue during the last few years, ligation of the vessels or total extirpation of the uterus, and the use of serum injections. The operative procedures are possible only in hospitals, while the serum can be easily employed by every practitioner. The author has employed the serum of Menzer in the following manner: As soon as the rectal temperature exceeds 38.5°, the secretion of the uterus is examined microscopically. If no gonococci are found, 20 c.c. of serum are given at once. If the temperatue still remains above 38° on the

following day, another dose of 20 c.c. is given, and, if necessary, a third one on the day after. If the fever persists beyond the sixth day, another course of injections of 20 c.c. each is given for three days. No cases were treated where there was an extension of the process to the tubes, parametrium, or along the veins. The action of the serum was on the whole very favor. able, since the patients treated did not have such high fever and were not sick for so long a time as those who did not receive any serum. Two patients died despite the use of the serum, but these suffered from an exceptionally severe form of sepsis. Bad after-effects were not seen, and the slight eruption which occasionally developed disappeared in a short time. The largest amount injected was 120 c.c.

The Diagnosis and Treatment of Accidental Hemorrhage.

Wright (American Journal of Obstetrics) summarizes as follows:

1. Making a diagnosis in many cases of concealed accidental hemorrhage is generally difficult, sometimes impossible, before delivery.

2. The so-called important symptomsanemia and distension of the uterus-are not present in a large proportion of such

cases.

3. The serious condition in most cases is shock from traumatism, and not collapse from loss of blood.

4. The diagnosis of the combined internal and external accidental hemorrhage is more readily made, but the amount and effect of the blood within the uterus are often difficult to ascertain.

5. Even in such cases shock from traumatism is sometimes the predominating element; on the other hand, collapse from loss of blood, whether retained within the uterus or flowing externally, is sometimes the important factor.

6. In all cases where shock from traumatism is the main condition, or the predominating element, the most urgent requirement is proper treatment of such shock, and not emptying the uterus.

7. In a large proportion of cases of the combined internal and external hemorrhage, the introduction of the vaginal plug, with the application of an abdominal binder, appears to be a very safe and effectual plan of treatment.

8. In a small proportion of cases, especially during labor, puncture of the membranes is beneficial.

9. Any form of accouchement forcé, which includes forcible dilatation of a rigid cervix, is never justifiable.

10. The best operative procedure would appear to be some form of vaginal section; but its field is limited, and not accurately defined.

Operation for Puerperal Pyemia. Archibald Cuff (British Journal of Ob stetrics and Gynecology) reports a case, the seventh successful operation so far recorded. The woman was confined by a midwife. Fever developed two days later, assuming a pyemic character within three weeks. The maximum temperature was 105.6°, the pulse 132.

Examination revealed a moderately firm mass, apparently in the right broad ligament, about the thickness of three fingers, and extending from the uterus to the pelvic wall. It was not firmly fixed. The abdomen was opened in the fourth week. The mass in the broad ligament was found to consist solely of thrombosed veins.

The peritoneum was reflected and the vessels tied on either side. The ovarian vein, which also was thrombosed, was ligated just below its junction with the vena cava. None of the vessels was resected.

The highest temperature after operation was 100.2°, and there were no rigors. Slight sweats continued for several days. Recovery was prompt and complete.

The writer observes that in no reported case has abscess developed at the site of the infected veins after ligation.

Passage of the Anthrax Bacillus from
Mother to Fetus.

Santi Sirena (Arch. p. le Sc. Med. Rev.). The bacillus of anthrax in pregnant rabbits has been observed to pass into the amniotic fluid and into the fetus itself. Alterations are produced in the chorion and in the uterus itself, and consist in hyperemia, a dilatation of the vessels, extravasation of blood and infiltration. The placenta contains a large number of bacilli within the veins of the serotina and in the intervillous spaces. It has been shown that the bacilli pass from the mother to the fetus by way of the placental vessels.

NEW SERIES VOL. LVIII.

WHOLE VOLUME LXXXXVII.

From whatever point of view the early history of Cincinnati is regarded, the figure of Dr. Daniel Drake stands out conspicuously. If we look at the growth of the little community, in his sketches of "Early Cincinnati," we find a faithful and entertaining picture of the expanding settlement. If we seek the origin of its educational institutions, Dr. Drake's name appears as founder or supporter. Among the original organizers of canals and railroads his was an important influence. "He was at once merchant, physician, author, writer and lecturer."

His activity in many spheres of usefulness in which he made himself conspicuous has been forgotten, and he is best known. to-day as pre-eminent in his chosen profession as a successful practitioner -a pioneer investigator and a prolific writer. His Diseases of the Mississippi Valley is a monument to his energy, activity and powers of observation. Whoever looks into the early medical history of Cincinnati must turn to his pages, and I here wish to express my obligation to Dr. Drake's writings, and also to an interesting history of medicine in Cincinnati by Dr. P. S. Conner, which appeared in a "History of Cincinnati in 1881."

Dr. Drake did not figure as a surgeon. His work was almost entirely devoted to internal medicine-unless one considers as surgical his work in the Eye Infirmary, which he founded. He cannot, therefore, figure conspicuously in a toast to the early surgeons of Cincinnati. His name, however, comes always prominently to mind

whenever we look at the early medical history of our

town.

The first surgeons were the army surgeons. "It was the custom," says Dr. Drake, "of these gentlemen not merely to give gratuitous attendance on the people, for which many of them are held in grateful remembrance by the aged, but also to furnish medicine fromthe army hospital chests through a period when none were imported from the East."

Conspicuous among these was Dr. Richard Allison, Surgeon General to Harmar, St. Clair and Wayne. Preserved in the list of the army surgeons are the names: John Carmichael, Joseph Phillips, John Eliot, Joseph Strong, John Sellman, Dr. Adams and William Henry Harrison, who had taken a course of medicine at the University of Virginia and at Philadelphia, and who, although he came to Fort Washington as a military ensign, often gave advice in cases of sickness.

In the earliest list of Cincinnati doctors in the growing town by the banks of the Ohio we have the names of Burnet, Morrell, Hole, McClure, Cramer and Goforth, an eccentric genius "who wore a wig and carried a gold-headed cane."

In these early days all physicians practiced more or less surgery, and their services were doubtless often called for in the back-woods town for gunshot and arrow wounds, and other injuries and accidents. No name has come down to us prominent in surgery, and no mention of any surgical work of importance has been recorded in these early days.

The first mention we have of a surgeon as such was on the organization of the Medical College of Ohio, in 1819, when Dr. Jesse Smith occupied the chair of Anatomy and Surgery. The fact that the first surgeon in the college came from abroad would seem to confirm the opinion that there were none among the home doctors who were conspicuous as surgeons. The only notable event to which Dr. Smith's name is connected is certainly not surgical in character. The new school had hardly started when he and his colleague, Dr. Bohrer, united and expelled Dr. Drake, who was the real founder of the school.

The position of Professor of Surgery in the medical college must have given prominence to its occupants in the community, all the more from the fact that the faculty formed the staff of the Commercial Hospital, organized at the same time with a grant of $10,000 from the State; so that the Professor of Surgery was the surgeon to this hospital. We find in the list of professors of surgery Jesse Smith, Coleman Rodgers, John Godman, Jedediah Cobb, James Stoughton, and Alban G. Smith, the last named having occupied the chair from 1833 to 1837. During this period the college in Cincinnati suffered by comparison with the Transylvania School in Lexington, where Dr. Dudley, the surgeon, has left a lasting name for himself as a lithotomist, and no man in Cincinnati could compare with him in reputation. None of the names above mentioned have left any record of conspicuous surgical work.

The decade from 1830 to 1840-in which Cincinnati developed from a town of some twenty-four thousand inhabitants to one of forty-six thousand-was important in its surgical annals from the appearance of three men who have all left names famous in the surgical world-Samuel D. Gross, Willard Parker and Reuben D. Musseyand with these three names the real surgical history of Cincinnati begins.

The first and most distinguished of these, Dr. Samuel D. Gross, was born near Easton, Pa., July 8, 1805. His early education was obtained at the Wilkesbarre Academy and the Lawrence High School. At nineteen he entered the office of Dr. Joseph K. Swift, and afterwards matriculated in the Jefferson Medical College and became a private student of Dr. G. B.

McClellan. He first settled in Philadelphia, translated several French medical books, but did not succeed in obtaining much of a practice. In 1833 he obtained the position of Demonstrator of Anatomy in the Medical College of Ohio through the influence of Dr. Eberli, who had come out from Philadelphia a few years earlier.

His success was immediate, and during the first year he made in practice fifteen hundred dollars besides his college fees. In 1835 he became the Professor of Pathological Anatomy in the Medical Department of the Cincinnati College, which had just been founded, and continued with it until it suspended in 1839. It was during these years that he laid the foundation for his work on pathological anatomy.

In his autobiography he says:

"After my appointment to the chair of Pathological Anatomy I commenced at once a course of study to aid me in the discharge of my official duties. Indeed, I may say I abandoned myself almost wholly for the first few years to the illustration of my department. I bought all the medical books I could find, and my medical friends did all they could to throw post-mortems in my way. A field was then afforded me for the study of much morbid structure which I most gladly and thoroughly worked up.

"It was my custom to make the dissections as complete as possible, spending often upwards of two hours upon each case, and carrying away with me the more interesting specimens for the future and minute inspection. After a careful and sometimes protracted examination, of which full notes were taken, the specimens were macerated and then preserved in alcohol, In this way I laid the foundation of a museum of pathological anatomy, which, when the college was broken up, contained a large number of valuable specimens.

"It was from these dissections, from an elaborate course of reading and from numerous visits to the pork-houses and slaughter-houses of Cincinnati that I derived the knowledge upon which I founded my work on pathological anatomy, issued in 1839. The work was illustrated by numerous wood-cuts and several colored engravings. As far as I know, mine was the first attempt ever made in the country, or, indeed, in the English