day. Altogether I had every reason to congratulate myself on the results of the treatment, and the prompt response I invariably obtained from the remedies exhibited.

At the present writing, December 10th, over two months from the onset of the attack, he has entirely recovered, and within a week or two resumed his school duties. WM. C. SCHULTZE, M. D.

Marengo, Ia.

The Use of Ergot in Labor.

Note, in regard to the position of the writer in opposing the administration of ergot, until the uterus is evacuated, and the placental or third stage of labor is completed.

BY T. GRISWOLD COMSTOCK, A.M., M.D.

The following remarks are supplementary to the article that I published in the December number of the BRIEF. The aphorism, "Peritis in arte, credendum est," is, I think, acknowledged as true by the educated and scientific votaries of our profession; but I am well aware that some of your excellent contributors will regard the assertion of Pajot as dogmatic, that

"As long as the uterus contains anything, be it child, placenta, membranes or clots, never administer ergot. First, empty the uterus of its contents, and then give ergot."

The above quotation is a translation of Prof. Pajot's (of Paris) own words. We will now quote from Prof. Charpentier, adjunct professor at the faculty of medicine of Paris:

"1. Ergot is dangerous to the foetus." He also says: "its action is spasmodic, tetanic, maintaining the uterus in a constant state of tension, and may thus endanger the life of the foetus:" "2. Tetanic retractions of the uterus are not only dangerous to the child, but such an action may embarrass the obstetrist when called upon to make version, even, in some cases, rendering it impossible, except at the risk of rupturing the uterus." "3. Ergot given before the delivery of the placenta, may lead to retention of same, by causing retraction of the cervix, and the same is true of clots in the uterus."

Charpentier also adds, that "ergot administered in placenta prævia, is far inferior to the tampon." From a large ex

perience in such cases, we can fully endorse the above, although it is the practice of many practitioners in our country to give ergot in placenta prævia. In a recent instance of the kind, where the writer was called in consultation, ergot was given, and tetanic uterine contractions followed its use, after the delivery of a dead child.

The late Prof. Schroeder, in Germany, rejected the use of ergot before delivery, and says: "It causes spasmodic contractions of the uterus,and not normal pains." In his work upon obstetrics, in the treatment of placenta prævia, he does not even mention ergot. Finally, Charpentier says:

"Never give ergot until both child and placenta have been delivered,"

but he adds, however, as a possible exception,

"If inertia is present during labor, seeing that ergot is only allowable where the cervix is dilated, the presentation favorable, and the pelvis well-formed, it is much better to use the forceps."

Furthermore, Charpentier insists upon the rule as absolute, in case of hemorrhage due to inertia after delivery, to "give ergot only after the uterus has been emptied of clots."

We might quote many other authorities, as the literature upon this subject is vast; but we can make good our assertion upon the management of the placenta, that the best authorities among modern obstetrists do not give ergot until after the completion of the third stage.

In taking this position, we wish to say, that some very exceptional case might arise where it might be administered. Such authorities as Prof. Carl Braun, in Vienna, R. Barnes and Playfair, in London, Leishman, in Scotland, the late Dr. Albert Smith, of Philadelphia, together with a host of others in the profession of almost as high a standing, are opposed to the use of ergot until the completion of labor.

The object of this communication is only to show that we have good authority for the apparently radical position that we have taken in our article in the December number, in restricting the use of an agent that, in classical language, has been termed "pulvis ad partum," but in not a few instances has proved to be actually "pulvis ad mortem." After the

completion of labor, when we have a secondary puerperal hemorrhage, as the consequence of incomplete involution of the uterus, the administration of ergot is justifiable, and will be followed by good results.

507 N. Fourteenth Street, St. Louis.

Why is Eucalyptol Sometimes Disappointing?

BY WILLARD H. MORSE, M. D.

While it does not require to be defended, substantiated or explained away, I desire to say a word further concerning a remark which I made some time since, and which has cost me not a little pharmacal criticism. The remark was this: "Eucalyptol is of mechanical application, and-most of it-is of no other value."

I originally wrote this in the course of a narrative of an experience, which if not precisely bitter, was at least vexatious. With profoundest faith in Bartholow, I had sought confidently to cure chronic catarrh of the bladder with a remedy of which the Philadelphia professor had written that he had found none more effective. And there was not the least therapeutical effect. Instead of a howl to the effect that "all men are liars," I paraphrased matters by exclaiming in the anguish of the occasion, "Woe is me, because that in these days the pharmacist bringeth forth preparations in which none can enjoy confidence!" I sought another preparation of the volatile oil of the eucalyptus, and it failed me. I tried three others, and it was the sixth specimen that proved efficacious. Before this happy issue was obtained an engineer met me, and inquired as to what I thought of eucalyptus for removing the crust from the inside of boilers-an application recently vaunted highly. I told him that if the trouble with his boiler was at all like catarrh of the bladder, I had nothing to say. In a moment of generosity I put the five discarded specimens in one bottle, and gave them to him with the injunction to empty them into his boiler, and report progress later. He did so, and three days later went on a strike. His successor observed as he drew off the water a week after

wards, that "Joe, ter all appearance, seems ter 've used that 'ar b'iler fur a urinal!"

In those days I made the remark to which I refer, which-being interpreted -is, "Much of the eucalyptol in the market is of no use medicinally, though perforce of use mechanically." This the manufacturing pharmacist is not disposed to relish, inasmuch as it is pharmacal gospel that no matter who manufactures an essential oil, or how it is manufactured, it always turns out uniform in character. However true this may be of certain other of the essential oils, it is not the case with eucalyptol.

There are at least two reasons for this, of which the first is of most importance. They are, (1) that there are several species of the eucalpytus, only one of which has leaves of eucalpytol value; and (2) that the peculiar process of manufacture is all too frequently slighted. The latter reason is one too apt to obtain, and is too remotely removed from novelty to require consideration here. A word to the first reason:

There are about 135 distinct species of eucalyptus, native of Australasia. Of these the E. globulus is (as the U. S. Dispensatory says) "the most important," but not the most hardy, common or beautiful. There grow one hundred or more of the E. amygdalina, E. piperita, and several other species, to one of the E. globulus. Now, as all poppies yield opium in some quality and quantity, and our dependence is only on the papaver somniferum, so all eucalypti yield eucalyptol, but in the leaves of none but the E. globulus (and perhaps the E. coriacea) is it of that fixed quality demanded. But as the Turk and the Chinaman will cut other poppies than the one by which the goddess of sleep is won't to swear, so the Australasian is as unscrupulous, in using a bushel of the other eucalypti leaves to a pint of those of the E. globulus. It is false to urge that the essential oil of the other species is equal to that of the one. In proof: Though the eucalyptus has been introduced into the Argentine Republic successfully for several years, the E. globulus is not as plentifully found in the plantations as some of its sister species. The Buenos Ayres pharmacists send to England for their

eucalyptol, and all because that they can not obtain the oil from the common E. peperita.

I submit that the true eucalyptol is that obtained from the leaves of the E. globulus; that the oil obtained from the other eucalypti is more or less inert; that much of the eucalyptol in the market is a mixed product from the several species, some of it containing none of the oil of the E. globulus leaves; that some of these mixed specimens are adulterated with a terebinthinous oil of the wood, with alcohol, turpentine, or some fixed oil; and that the essential oil of the E. globulus leaves (the true eucalyptol) is alone of medicinal value.

The false oils are not only inert, but they prove their usurpation of an honorable name by failing to respond to the scientific tests, and by plain evidencing of adulteration. The oil distilled in this country is practically useless, as the bulk of the imported leaves are other than those of the E. globulus, and because, (even if unmixed) the dry leaves yield a very small percentage of oil, and the temptation to adulteration is strong.

My deductions as to the reasons for the failure with eucalyptol were at first purely theoretical. Later, supplementing it by an elaborate chemical study of eucalyptus leaves, I obtained full substantiation from a letter from a leading physician of Victoria. I quote my correspondent:

"The eucalyptol from the laboratory of Sander & Sons of Sandhurst (Victoria) the only kind accounted reliable here, is derived solely from the leaves of the blue gum trees, E. globulus. With it we never fail to do all that we seek, and it is that alone which we refer to as Eucalyptol-a pure volatile eucalypti extract."

It was with a bottle of this antipodal preparation (accompanying this letter) that I achieved the success in the treatment of catarrh of the bladder. The specimens found inert then and since were some of those accounted as leading in our drug market.

I think Consul Griffin at Auckland, N. Z., will furnish samples from the market there, and I trust that my assertion will gain proof in some such way.

Pure eucalyptol will curably affect the

maladies for which we make it a custom to prescribe it. (See Bartholow, Schmidt, Ringer, Wood, Keller, Gubler, Maclean, Mosler, Hazard, Schulz, Gimbert and other authorities, for particular therapy.) The impure oil-made so by some one or other of the reasons to which I have referred-will disappoint, as a rule. Where the evidence as to the utility of the drug is contradictory, it will be found to be the invariable fact that we h: ve sought to obtain legitimate ends fi m illegitimate means.

Westfield, N. J.

Epilepsy.

Dr. R. C. Bogle, of Midland, Tenn., again asks for assistance, by advice, in the treatment of epilepsy. The doctor has something by which he may find plenty of advice, but finding relief is not so sure. I will give him a few ideas which may be of use to him. Judging from his treatment his pathological and etiological views are perhaps such as I have long considered incorrect. Formerly it was common to consider this disease of centric origin, that is, having its seat or origin in the nerve centres; and although this idea is perhaps not so prevalent now, yet much of the practice would indicate that belief.

Epilepsy is peripheral in its origin and the brain is affected secondarily, the convulsions arising from reflex action. Let us look at some of the causes. Heredity is credited with much to do in the production of epilepsy, and while there is no doubt that a peculiar constitution or predisposition is necessary to the development of the disease, that constitution may exist in children whose parentage may never have been affected. The constitution consists in peculiarities of the nervous system. Lead poisoning, venereal excesses, masturbation, worms, sympathy, intemperance and various other things have been noted as particular causes. But in those subject to the disease there is no cause so common as that state of irritation of the digestive organs caused by improper eating and drinking in both quantity and quality, and especially by the use of such articles as strongly affect the nervous system, such as tea, coffee, tobacco, alcohols, beverages, etc. The irritated organs, through the

afferent nerves send impressions to the nerve centers whence they are reflected in the production of the convulsive action.

The irritation caused by worms, masturbation, the menstrual period, etc., combining with the irritation of the digestive organs, will give greater force to the reflex action and greater severity to the convulsions.

In treatment it is useless to address remedies directly to the nervous system to produce sedation; all sources of irritation must be removed. Look to the feeding of children; take away all pies, cakes, candies, and indigestible and stimulating food and drinks of all kinds; feed them on plain, simple, nourishing diet. With adults take away the tobacco, tea, coffee, alcoholic beverages, and reduce them to the same kind of diet; inquire about secret habits, menstruation, etc., and see that all sources of irritation are removed; examine every organ and see if it is performing its functions; look out for worms even in adults. A gentleman came to me four years ago and told me he had for some time past become subject to "fits;" had tried several doctors and received no benefit and was growing worse. I stopped his coffee and tobacco, treated him for worms, of which I removed a large quantity, and he has never had another "fit."

The nerve centres seem to store up the irritative impressions sent to them from the periphery till they overflow; then an explosion occurs in the form of the convulsions; and the frequency or violence will depend on the susceptibility of the nervous system, or the strength of the irritation; if the irritation be periodical, as with the menses, the attack may be periodical. In such cases the reproductive organs must have special attention. Bathing, massage, attention to the bowels and restricted diet should be carefully carried out shortly before expected attacks, to remove irritation and carry off surplus electricity. All bad habits must be removed. A youth of seventeen applied to me for treatment and on strict inquiry informed me that he had practiced masturbation for several years and the disease had existed since he began the practice. During a year I succeeded in apparently removing the disease, but after he fell from under

my care and observation, it returned and he died. His errors were masturbation and use of tobacco, both of which I placed him under the strictest promises to abstain from; he returned to the tobacco, I learned, and I suppose the other practice. It must be remembered that these practices are sometimes begun very young; at ten years and often much under that age.

There is no special treatment for the disease; remove all bad habits and sources of irritation, and correct the general health with any remedy that may be indicated, and place no confidence in special remedies. Counter impressions will direct the attacks; sickness will arrest them.

When the disease has progressed far enough for the irritation to produce centric changes, that is, organic changes in nerve centres, as will eventually occur, cure is almost hopeless; but even then, if not too far gone, persistence may repair the lesions. In treatment the greatest dependence must be placed on keeping the stomach and bowels in a healthy condition. F. M. STRATTON, M. D.

Metropolis, Ill.

Chronic Dysentery.

I have under my treatment a case of chronic dysentery of six or eight years standing. The patient is a lady aged about forty, and her illness dates from her last confinement, since which time she has not menstruated. Her tongue is clean and her appetite good, and while she is very weak and much emaciated, she still has strength to sit up an hour or so each day. I have now had her under treatment more than a year; but at best my treatment has proved only palliative. I have used minute doses of mercury combined with opium; and in various combinations, opiates, vegetable and mineral astringents, the mineral acids, iron, nux vomica, ipecac, bismuth, pepsin, lactopeptine, etc., etc. I have also tried to diet her, but find this impossible as she is too poor to get such articles of diet as she should have. I will be glad if some of my brother practitioners will give, through the columns of the BRIEF, a course of treatment that will prove curative. HUGH T. CAFFEY, M. D.

Jemison, Ala.

The Afterbirth of Units, Twins and

Triplets.

If the reader would consult what I said on pp. 333 and 399, XV. Vol. BRIEF, and add it to what I say now, he would have still more facts regarding the afterbirth.

The two yolks of a double-yolked egg may sometimes develop into individuals of the same sex, or opposite gender, and be within the same membranes, and the placenta will be blended and the two cords will be inserted in it very close together, and sometimes will be intertwined for a short distance.

Usually, in the case of triplets, two placenta are blended, and sometimes all three, and sometimes all three are separate.

There is usually more amniotic fluid accompanying a boy than a girl, also the placenta is smaller and the cord longer, and oftener prolapsed. The reason the placenta connected with the girl is larger and more expanded, is because the ovum which grows to be a male is fecundated while in the fallopian tube or ovary, consequently, it attaches itself to the fundus of the uterus as soon as it has entered the uterus, where it does not have as much room to expand and grow as does the placenta which accompanies the female child, which is ordinarily situated nearer the center of the uterus, where it has more room to expand; and, it being larger and more expansive, the mother would, on an average, flow more and longer than after the birth of a male.

Usually, in case of twins, when one is a boy and the other a girl, the boy is born first, because he is usually accompanied with the most water and is the heaviest, consequently, he would sink lowest and engage first; and if one of them is presenting right and the other wrong, the boy would be right and the girl wrong, for the larger head and shoulders of the boy would cause him to present head first, while the larger hips of the girl would be more likely to cause her to present crosswise, or breech or lower extremities first. If the first one born is a boy, the probabilities are that the second one born will also be a boy, because twins are usually of the same gender; and if a girl is born first, the probabilities are still greater the next will be a girl, for, if

there had been a boy in the case, he would have been born first.

A large majority of extra-uterine conceptions are males, because a large majority of ova impregnated while in the fallopian tubes or ovara grow to be males, consequently, many of them cohere to the fallopian tubes and grow to be males, while a large majority of ova impregnated while in the uterus grow to be females. Boys are usually conceived shortly before the courses, and girls shortly after. Boys proceed from ova impregnated while immature; girls from ova impregnated while mature.

In a majority of placenta prævia cases, the offspring are females, because, as I have said, the ovum which grows to be a female is probably fecundated while within the uterus; it therefore seems that it is more liable to form an attachment to the neck of the uterus than if it had been fecundated while within the ovary or fallopian tube. In this latter case, I should expect that the semen had so impregnated it with growing and attaching powers that it would fasten to the uterus as soon as it reached its cavity, and thus it would not be so liable to reach the cervix uteri as if it had been fecundated at a later period, when it had advanced much nearer the cervix without much attaching powers.

My observations for thirty-seven years have strengthened my belief in the foregoing theories and facts. I was and am the first to present the most of them to the public. SILAS HUBBARD, M. D. Hudson, Ill.

Diagnosis and Treatment Wanted.

Will some of the many readers of the BRIEF give me diagnosis and treatment for the following case?

Lady, twenty-six years of age, mother of three children, aged, respectively, six, four and one. She commenced complaining of a vaginal swelling and a burning sensation. Face swells. Her appetite and digestion are very poor. Vagina swollen and very sensitive. No family history. Can find no syphilitic symp

toms.

I have tried a carbolic wash and one of boracic acid with no apparent effect. Billings, Mo. T. F. NOBLITT, M. D.