Fig. 4. After using five months without bandage.

Fig. 5.-After using five months without bandage. 1314 Olive St., St. Louis.

Diphtheritic Croup (?).

Is there a pathological condition that you can in truth call diphtheritic croup? We have had quite a number of fatal cases of diphtheria in our vicinity. The diphtheritic deposit seems to have extended into the larynx producing all symptoms of croup, which caused quite a discrepancy among our M. D.'s here. Some denying the term diphtheritic croup, claiming that it is simply diphtheria extending into the larynx, others say it is proper to name it diphtheritic croup. Again, others claim that it is diphtheria complicated with true or pseudomembranous croup, and that the terms pseudomembranous croup, true croup, diphtheritic croup may be used synonymously in these cases.

Will some of the many readers of the BRIEF, through its columns, give us their views on the above. Also best treatment

for diphtheria. D. M. BLOOM, M. D.

New Waterford, O.

Prompt Delivery of the Placenta. Owing to the fact that we gave up much space in previous editions to this subject, we are compelled to condense those contributions which came in late, and in consequence simply give the system adopted by the following contributors:

Dr. J. S. Haly, Napoleon, O., says: Early delivery is universally practiced in this locality. I favor early delivery. Dr. Jas. I. Philpot, Egger, Ark., says: I heartily endorse Dr. McCarty's mode. Dr. M. W. Gibson, Fancy Hill, N. C., says: Every physician should follow Crede's method. To introduce the hand into the uterine cavity to deliver the placenta, is barbarous.

Dr. W. F. Sharrer, Delphi, Ind., says: I advocate early delivery of the placenta strongly. I have practiced it for the past eighteen years, with the best results. I am also an advocate of the use of ergot judiciously.

Dr. M. H. Ragsdale, Glen Dale, Ind., says: I am in favor of early delivery of the placenta, but never introduce my hand into the cavity of the uterus.

Dr. F. M. Stratton, Metropolis, Ill., says: Every case of parturition should be allowed to proceed by the action of nature alone until it is evident that nature needs assistance. Insertion of the hand into the uterus is needed in but few cases.

Dr. J. B. Scott, Burton, Mo., says: Every doctor should act in accordance to the demands of the case.

Dr. O. S. Lovejoy, Haverhill, Mass., says: It is very doubtful practice to introduce the hand into the womb unless absolutely necessary, yet I always deliver the afterbirth as quickly as possible.

Dr. B. M. Miller, Shoal Creek, Ark., says: I was taught to wait on nature, and got in trouble by so doing. Now I don't wait.

Dr. G. R. Hagerman, Mendon, O., says: I deliver by Crede's method. When one says prompt delivery of the placenta is my way, he may mean in twenty minutes after the child has passed, which, in my judgment, is the best way-above all others laid down.

Dr. M. Hammond, Baltimore, Md., says: Immediate delivery has been my constant practice, and I have never had any trouble.

Dr. D. C. McCampbell, Harmontown, Miss., says: Many have been the anxious hours I have spent at the bedside, waiting for nature to do what I could and should have done in a few moments. I never hesitate to introduce the whole hand, if other methods fail.

Dr. S. F. Wehr, Belleville, Ill., says: Dr. McCarty gives good and plausible reasons, which I hold good.

Dr. C. H. Cass, Holton, Ind., says: I have had over 3000 cases. First make yourself master of your business, and then use good common sense; avoid haste or cowardly delay.

Dr. E. J. Burch, Cameron, Ill., says: I am happy to state that I fully approve of Dr. McCarty's method.

Dr. J. A. McIntyre, Kennedale, Tex., says: I usually wait from ten to thirty minutes; but prompt delivery is, at times, an actual necessity, even to introducing the hand into the uterus.

Dr. H. M. Banta, Udall, Kan., says: In a practice of twenty-five years, I have never had cause to regret my action in delivering the placenta as soon as possible.

Dr. Edwin W. Hunter, Chicago, Ill., says: I am sorry to see that there are so many rash enough to insert the hand into the uterus. I regard the delivery by nature a physiological process.

Dr. W. C. Taylor, Gillsburg, Miss., says: After a short interval of rest, I proceed to deliver the placenta. I seldom give ergot.

Dr. J. S. Smith, McHenry, Ky., says: I deliver according to Playfair, and will continue until I find an adherent placenta, when I will feel justified in introducing my hand.

Dr. James M. Hole, Salem, Ò., says: I use no rashness, neglect or seeming haste to deliver the placenta.

Dr. J. M. Buzzell, Portland, Me., says: If you have an adherent placenta, you will be obliged to introduce your hand and take it away as soon as possible.

Dr. C. E. C. S. Thiesen, East Portland, Ore., says: For an inexperienced man, prompt delivery would be advisable. I never introduce the whole hand.

Dr. V. D. Lockhart, Homer, Ga., says: Every case must rest upon its merits. The delivery of the placenta is but a natural process.

Dr. J. B. Ramsey, Ramsey, La., says; I give ergot when necessary, and wait until cord ceases to beat, then deliver the placenta.

Dr. T. J. Fritz, Cowden, Ill., says: Mr. Editor, it is always in order to move that the debate do now cease. So, I move that the controversy over the "immediate delivery" of the placenta do now cease, and the valuable pages of our BRIEF be filled with other matter. Will add, however, that if we will carefully study Playfair's system of midwifery, and be governed thereby, we will not greatly err. Cowden, Ill.

T. J. FRITZ, M. D.

Can a Woman Conceive after Having Had Gonorrhea?

I find on page 469, December BRIEF, the following question: "Can a woman conceive after having had gonorrhea?" I was not a little surprised at reading the interrogatory, from the fact that such things happen so often in practice. I have in mind two well-marked cases of gonorrhea happening in my practice. One suffered for nearly two months before fully recovering, and has since given birth to three healthy offspring. I know whereof I affirm in this case. Its contagious nature, and other circumstances and facts, convince me that my diagnosis was correct. I answer that gonorrhea does not interfere with females (nor males) conceiving, after being cured of the malady. Cowden, Ill. T. J. FRITZ, M. D.

In response to the query in the December BRIEF: "Can a woman conceive after having had gonorrhea?" I will say that I can answer that question in the affirmative, and will say that in the summer of 1876 I treated a married lady, and her husband also, for gonorrhea, and since that time the woman has conceived and given birth to five children; four of them are now living, one dead. And I can also mention other cases that are living monuments that gonorrhea is not a positive, permanent preventive to conception. W. H. S. CRABB, M. D.

White Run, Ky.

In December BRIEF, page 469, is the question: "Can a woman conceive after having had gonorrhea?"

I say yes. I attended a woman with gonorrhea in February and March, 1886,

and in a little over a year after I ceased treating her she gave birth to a child. A. C. FOSTER, M. D.

Blue Mound, Ill.

In compliance with request of the readers of the BRIEF in regard to women conceiving after having had gonorrhea, I will say that I know of a case in my practice of a woman having had gonorrhea and is now about eight months pregnant. E. J. BURCH, M. D.

Cameron, Ill.

"Can a woman conceive after having had gonorrhea?"-MEDICAL BRIEF, December, page 469.

Assuredly. Why not? Miss -, aged eighteen, among my first calls, had a blooming case." At twenty, married a Baptist preacher; settled down in Virginia; eight children.

Mrs. widow, fell from grace journeying to St. Louis in sleeping car; beautiful case-twenty-five dollars' worth. Married second time, and had twins eleven months after.

Could give many more cases, but the two mentioned will answer.

Every country doctor knows that gonorrhea will not prevent conception. JAS. WARD SCOTT, M. D.

Darlington, Md.

I have been a reader of the BRIEF for a number of years. Am sixty-five years old, and have been engaged in active practice for twenty-seven years. Have had a vast experience in the treatment of all classes of venereal diseases. I, therefore, wish to give the result of my experience in regard to the question in the December BRIEF: "Can a woman conceive after having had gonorrhea?”

About three years ago, Sarah A., a stout, healthy woman, contracted gonorrhea-as malignant a case as I ever sawand three months after the patient was discharged, she conceived, and, in due time, brought forth a child at full term. I am convinced that gonorrhea is not a certain preventive to conception.

Hoping that this may conduce to the further elucidation of this subject and the maintenance of truth, I close with best wishes to the BRIEF and its many thousands of readers. Rosine, Ky.

M. W. DUVALL, M. D.

Acute Rheumatism.

BY I. J. M. GOSS, A. M., M. D.

This form of inflammation is attended with active fever, with the local inflammation and tumefaction of the joints. When the case presents local tumefaction, with but slight general fever, then it is of a subacute type. And in cases with local pains, stiffness, and impaired motion of the joints, without fever, the cases are called chronic rheumatism. If the pain is in the muscles, it is called myalgia. And if the nerves or their sheaths are affected, it is called neuralgic rheumatism. If it follows syphilis it is called syphilitic rheumatism. And if it follows gonorrhea, it is called gonorrheal rheumatism. And it is named according to its locality, as lumbago, in the lumbar region, and sciatic rheumatism when in the sciatic region, etc.

But these names lead to confusion in the minds of the people, and in the minds of young physicians, and it is better just to divide the disease into acute and chronic rheumatism.

ETIOLOGY.-The causes of rheumatism, in all its grades may be divided into exciting and predisposing. The predisposing causes are such external influences as may lessen cutaneous elimination and transpiration, as cold, wet weather, getting the feet wet or damp, and a hereditary tendency to this disease. These causes favor the rapid accumulation of lactic acid and the lactates in the blood. The chief exciting cause of the local peculiarity of this disease is an excess of such acids in the system as is capable of producing this specific form of inflammation in fibrous tissues of the body. In this disease, the blood and the several secretions have almost always been found to contain more or less acidity, and not to yield to remedies until this state is counteracted, either by alkalies, or remedies that prevent the formation of acids in the blood. The lactic acid is generally found to be in excess, but other acids, as fruit acids, produce this disease.

I had a case of acute rheumatism some time ago, which the patient brought on by eating very sour apples, and I soon relieved it by an alkaline treatment, and the patient reproduced it in a few days

by sour apples again. Rheumatism does certainly stand in a certain relationship to lactic acid. It accumulates in the blood when glycogen is given off into the circulation, and converted back again into sugar; and the sugar broken up into lactic acid, which uniting with alkalies, forms lactates. B. W. Richardson produced endocarditis on dogs by injecting lactic acid into the peritoneum, this is proof sufficient. Dr. B. Foster found that acute rheumatism followed the administration of medical doses of lactic acid. I have observed the same, in several instances.

When acute rheumatism affects the heart, it is very apt to prove fatal, if not quickly relieved. This affection may be distinguished by its migratory character and the absence of suppuration. From acute and chronic synovitis, periostitis and gout, or pyæmia, by the two first named diseases being fixed, and their not moving about from one part to another, and are generally attended with effusion of serum into the synoval sac, and perostitis comes on the shafts of the bones, between the articular extremities. And from the others it is not difficult to distinguish rheumatism.

Treatment. One of the essential means of eradication of rheumatic inflammation from the tissues, is to neutralize the excess of acidity of the blood. For this purpose, the benzoate of lithia stands pre-eminent. The carbonate of lithia also is a very positive anti-rheumatic. The benzoate of ammonia has also done good service for me. And if the fever is high I alternate the above remedies with aconite, one drop every two hours until the circulation is controlled. These alkalies should be given until the urine is decidedly alkaline by test. Carbonate of lithia or the benzoate of lithia, in doses of five to ten grains, will soon produce this effect, if given every two hours. This lessens the plasticity of the blood, and prevents exudation taking place in the heart, or in the inflamed structures. As soon as the blood is rendered alkaline, salicylic acid should be given in doses of five to eight grains, every three hours, to sedate the sensory and excito-motor nervous system, and moderate the temperature, which it will do as an antipyretic. It is one of the most direct reme

dies to relieve the attack after the acid is neutralized in the blood. It should always be given, dissolved in dulc. spts. of nitre, and in alternation to the alkalies, not with them, as they change its chemical character. I have relieved all the symptoms of rheumatism, in many cases, in from three to five days, with the above treatment. After the disease is relieved, that state of the digestive organs, upon which the acid condition of the blood originates, must be corrected. Digestion must be improved by the use of hydrastis, nux vomica, or cimicifuga. For as long as fermentation takes place in excess in the stomach, so long the patient will be liable to this disease. Marietta, Ga.

Effect of Quinine on the Bones.

The inquiry of Dr. N. Otis, October BRIEF, p. 401, is severely criticised by Dr. Palmer in November BRIEF, p. 449, and by Dr. Crabb on next page.

I do not suppose Dr. Otis entertained "the old fogy notion," that quinine directly settled on the bones, and let Dr. Palmer be assured that quinine gets nearer the bones in effect than the moon. Quinine may be given as a tonic in necrosis with safety when indicated. In some forms of our southern fevers, quinine is about the only remedy needed. In others it is absolutely injurious, yea poisonous.

Two years ago I was called to Mr. S., a creole, who had a violent chill and fever for two days in succession and was expecting another in two hours. I gave at once ten grains quinine and five grains calomel and a sinapism applied over stomach, bowels, thighs, legs, back, nape of neck, in succession, so as to keep up the impression. Quinine repeated in two hours and then in half doses that day and next morning. No more chills or fever.

Last year a boy of ten years was in the same condition, expecting third chill; red, pointed tongue. I stated that quinine would probably bring on a chill, hence I gave ten drops spirits turpentine, applied a fly blister for half hour, kept him wrapped up and warmth applied and he had no chill. Epigastric soreness-hence the blister. Might not have

had a chill, you say. Well, I have had extensive experience in these two forms of fever and could illustrate by numerous remarkable cases.

"Old fogy" learned a lesson from the late Prof. B. W. Dudley of Lexington, which he has found of incalculable benefit, even to the present day. Dudley was called to see Mr. L., a bricklayer, in consultation for trephining. Mr. L. had previously had a fall. Comatose, fever, dry hot skin, coated dry tongue. "Gentlemen," said he, "let's give calomel and ipecac in small and repeated doses and wait for correction of secretions and relaxation." We saw Mr. L. plying his trade and he was not trephined.

Common malarial fever was epidemic here last year-mild but extensive. C. M., by advice, took an ounce of quinine and solution of strychnine, arsenic and quinine in quantity for three weeks. Fever every night during this period. Being called, I prescribed half grain calomel and six grains quinine nightly until cured. Recovery was rapid, with no other remedy except, perhaps, half ounce of castor oil and ten or twenty drops of spts. turpentine.

More remarkable cases of last year could be given to illustrate the fearful abuse of quinine. Dr. Dudley recommended correcting the secretions before giving quinine. A fine young man of first course fell a victim to this error in Alabama, under my observation, and many more could no doubt be given.

Now, suppose C. M. had a sliver through his foot, injuring, perhaps, the periosteum. The general depravity was aggravated by quinine.

In strictly malarial fever, if I give calomel at night I almost invariably give quinine with it, if there is no contra-indication. How often have we put an end to mammary and other diseases by the use of calomel and quinine judiciously used.

A girl had a large swelling on the thigh giving intolerable pain, chill and fever; treated it as such. Up next day, and neglected treatment, and next day had a return with greater violence of local and general symptoms. If quinine alone had been pushed in this case, in all probability a frightful abscess may have resulted.