Periodical Abortion.

I wish to give my experience in a case of periodical abortion, which illustrates a treatment that will prove the very best in all such cases.

A few years ago, I was visiting Dr. H. and accompanied him on his visits on one occasion. On our return, we were called as we were passing the house of Mr. L. We found Mrs. L. suffering from threatened abortion. From the fact that Dr. H. had been called five times at exactly the same date in her pregnancy, which was the fifth month, and in every case had failed completely to prevent the abortion, you may be sure he was not very sanguine of success this time..

Mr. L. was very anxious for an heir, and Dr. H. said to him, in a jocular way, “Mr. L., I suppose you would give any amount of money to be assured of bouncing baby?" Mr. L. told the doctor that if he would prevent this threatened abortion he would agree to pay him fifty dollars in cash, when the babe made its entrance into this world alive.

Dr. H. turned to me and said: "Dr. Kelly, here is your chance to take in that fifty dollars." Not thinking for a moment that I would accept the challenge. But, knowing the doctor had not used a remedy that I considered par excellence, I accepted, and at once had the patient go to bed. She was losing blood, and pains came regularly every few minutes. I put her on one-half grain of opii pulvis every hour, till four doses were taken, and then every two hours; also ten drops fluid ext. ergot every two hours.

I, in the meantime, used compresses wrung from cold water over the womb. I kept this up till next morning, having watched over her all night and encouraged her as best I could. When morning came, and my patient was quiet and hemorrhage had ceased, I really felt encouraged. I left off the ergot, but gave her one-half grain opii every three hours for the two following days, when I found every symptom gone that indicated abortion. I directed her to remain in bed for one week, and especially at every menstrual period to be quiet and take a dose of opii every day during that period.

When the proper time rolled around, Mrs. L. gave birth to a nine-pound boy,

and Mr. L. was happy-but not grateful, for I got only thirty dollars out of the promised fifty.

The only trouble with Dr. H. was that he had forgotten that opium was the sheet anchor in the treatment of abortion, and had used chloral hydrate and failed each time.

Dr. H. is a first-class physician, and had simply overlooked this recognized fact, for when we got home and looked up treatment on abortion, his own work on obstetrics said opium is the sheet anchor.

I shall be pleased to hear from others on this subject. J. D. KELLY, M. D. Severy, Kan.

Prevention of Conception.

Having seen something in the BRIEF of late on this subject, I wish briefly to express some of the views I hold on the same subject. These views are not original with me, but during the past fifteen or more years I have observed many facts that tended to prove their correctness, and none at variance with them. I merely state the theory, leaving the numerous readers of the BRIEF to prove or disprove it by the many facts that they may be able to bring together.

At the catamenial period, an ovum (sometimes more than one) is being produced in one of the ovaries, and at or near the cessation of the flow the ovum has usually reached the cavity of the uterus, where it remains attached near its point of entrance usually seven to twelve days, when, if not impregnated, it is detached and passed out of the uterus into the vagina, thence expelled from the system. The discharge of the ovum from the uterus is usually accompanied by slight pains of short duration, resembling those of the monthlies, and always, in the same person, about the same number of days after the cessation of the menstrual flow, seldom varying one day. The ovum is not discoverable by unaided vision, though a little thickened mucus, perhaps in the form of a clot, may be observed shortly after the discharge of the ovum.

From the time of the discharge of the ovum to the beginning of the next menses, impregnation can not occur. One day previous to the discharge of the ovum,

impregnation may occur. According to this theory, therefore, healthy women are liable to impregnation only about one-half of the time of their bearing period, not including times of pregnancy.

Not always are the pains accompanying the discharge of the ovum observable or noticed. They are generally slight, and probably often occur during sleep. Though many women have noticed these pains, which are sometimes quite severe, while not "unwell," perhaps but few have observed their regular recurrence. By a little self-study, however, a woman may learn when to expect them, and thus to know when her liability to impregnation ceases.

If the above opinions are not criticised too severely, I may have something to say about determining the sex of offspring before conception.

F. E. ASPINWALL, M. D.

Loudonville, N. Y.

Large Doses of Veratrum.

I notice, frequently, where men claim to have given (even to children) as much as ten drops of the tincture of veratrum, at the age of twelve years. Now, this is not only extremely hazardous, but perfectly useless, as spasms can be controled with moderate doses of the tinctures of lobelia and gelsemium, without any risk. And no man is justifiable in giving lethal doses of veratrum in any case of convulsions in children. Chloral hydrate, in medium doses, seldom fails to check spasms in children, or of females at confinement.

Dr. J. D. Blake reports (in the American Weekly, No. 20, 1874,) a death, resulting from three and four drops of Norwood's tincture of veratrum, given every two hours to a babe eleven months old.

Veratrum being one of our most powerful vascular depressants, due to a direct effect of the drug upon the heart muscle, and to the stimulation of the cardiac inhibitory nerves, it should not be given in large doses. If it was not that veratrum contains rubijervine, giving it emeto-cathartic effect, it would usually prove fatal in large doses; but if it fails to produce emesis, then it is apt to prove fatal in lethal doses.

Toxical Effects.-Great muscular weakness, frequent vomiting, and great depression follow large doses, and, if repeated, the pulse becomes extremely rapid and very small, the skin cold and clammy, giddiness takes place, the vision is lost, and the patient becomes unconscious. In large doses, veratrum has but little action on the voluntary muscles, or on the motor nerves, but it greatly irritates the motor centres in the brain, causing convulsions; hence, in large doses, tends to produce, instead of curing, convulsions. (See Potter's Materia Medica.)

Brunton says (see page 894 of his Materia Medica) that garvine from veratrum lessens the functions of the spinal cord, and the medulla, especially the vasomotor centre, and of the cardiac ganglia, and at the same time it irritates the motor centres in the brain, producing convulsions (instead of curing them).

Respiration ceases before the heart ceases to beat in cases of poisoning, and death takes place from asphyxia. Voluntary muscles and motor nerves are but little, if at all, affected, says Brunton.

Judiciously used, veratrum controls the heart's action, reducing its frequency to 30 or 40 beats, in some cases. This action is due, probably, by stimulating the inhibitory branch of the cardiac portion of the pneumogastric nerve. Small doses are not only exempt from danger, but act with certainty, repeated every two hours, or say one drop hourly.

I. J. M. Goss, A.M., M.D.

Typhoid or typhus, like enteric fever, abdominal typhus, eleo-typhus, continued fever, pythogenic fever, are common names applied to an acute, self-limited affection characterized by a peculiar crop of eruptions on the abdomen and other lesions of the abdominal viscera, such as ulceration of Peyer's patches, softening of the mesenteric glands, enlargement of the spleen, etc., with complications of all the organs that are essential to life.

Causation. The cause of typhoid fever is not well understood. The origin of the typhoid germ has thus far baffled the skill of all investigators, to a certain extent. Many have spent much time and labor to find out from what source the poison is produced. It seems, from our best authorities, that it is not produced merely by decomposition of the various animal matter, but it is essential that the typhoid germ be present. Typhoid fever is endemic and never prevails epidemical, and is communicable only by the introduction of the germ into the system through some medium such as water and raw articles of food.

Symptoms.-There is no definite knowledge of the period of incubation. It is probably from one to three weeks. When one member of a family is stricken down with typhoid fever, it is impossible to tell whether the next one of the family, should another member be attacked,contracted the disease from the first source, or from the poison developed in the fæcal matter of the one already suffering with the fever. Therefore, it is difficult to fix an exact date of exposure, and the period of incubation is not definitely known. The invasion is insidious. One of the first symptoms is pain in the back, severe headache, chilly sensation along the spinal column, weakness of the muscular system, loss of appetite and general depression of the entire nervous system.

A typical case comes on gradually from the very onset of the attack. Usually there is a tired feeling and uneasiness complained of, which is accompanied by an increase in temperature. The thermometer placed in the axilla, registers 100 or 1019 F., and the tongue

is coated with a white fur, and often stained with bile and has a yellowish hue. At the end of the second week the tongue is heavily coated, dry and cracked. The end is generally red and pointed with a narrow red strip on each side, clean about one-half of its length on the sides, and has the appearance of raw beef. Though in some cases, the tongue is clean from the very onset of the fever and is glazed-which is always a grave sign.

The second and third week sordes collect on the teeth, and there is a tendency to sleep all the time. The sleep is not natural, but a kind of stupor from which they are easily aroused when called or touched. Other symptoms are too numerous to mention in this article.

Diagnosis.-In forming a correct diagnosis of typhoid fever, as well as any other affection, we should take into consideration all the symptoms that go to make up the clinical history of a case of typhoid fever.

There are four important things to be noted, viz.: the morning and evening temperature, the appearance of the tongue, the abdominal symptoms, the disturbance of the nervous system. In a goodly number of cases the febrile symptoms gradually develop, though in a few cases it comes on abruptly with a severe chill, and the temperature rises at once to 102° or 103° F., and the subject is suddenly seized with fits of deliriousness which is accompanied with photophobia and mental aberration. In a typical case the temperature is a little above normal in early morn, and gradually rises to 1021 to 1031°, and continues so until the end of the first week. Though, throughout the entire course of the disease, there is a morning remission and evening exacerbation as a common thing. The tongue plays an important part in the diagnosis and is probably the next in diagnostic value to the continued febrile state, and the morning remission and evening exacerbation. The aspect of the tongue is as follows: In a typical case it is almost always pointed and red on the tip and edges, the center is coated and has a frosty look, light-colored, moist; but in the second and third week it becomes dry and dark and cracked in the center and bleeds.

The abdominal symptoms are tenderness over the region of the stomach, spleen and liver, and the tenderness gradually develops over the entire abdominal region. The nervous phenomena are too numerous to mention. Suffice it to say, the entire nervous system is more or less disturbed, though after the middle of the second week there is very little pain complained of, as a common thing. The diagnosis is clear in the majority of cases before the eruption on the abdomen appears, which is about the eighth day; in some cases there is no eruption.

Of other diagnostic symptoms, are looseness of the bowels, the characteristic clay-colored stool. It should be carefully discriminated from acute tuberculosis, pyæmia, septicæmia, and the essential fevers, and other continued febrile affections.

Prognosis.-Predicting the termination of a case of typhoid fever is a very uncertain thing, there are so many complications that may come up. If the temperature runs low the first two weeks and there are no complications, as a general thing the prognosis is favorable. On the other hand, if the temperature ranges very high at the end of the second week and great prostration, the prognosis is unfavorable. It is impossible to tell how a case will end. In a mild case some complication may suddenly come up and carry the patient off. The diagnosis. should be guarded.

Treatment.-Typhoid fever being a self-limited disease, there is no therapeutical agent that will abort it, but we believe that the disease can be very much modified by the judicious use of remedial agents at the proper time. I will not mention any remedy in this article that I have not had personal experience with in the treatment of typhoid fever. The most essential thing in the treatment of a typhoid patient is to reduce the temperature, and this is best accomplished by two therapeutical agents, namely: cold water and sulphate of quinine.

The modes of applying cold water to the surface of a fever patient is cold bath, wet pack, sponging, etc. All of these are highly praised by different authors. My rule is to sponge the patient every

half hour or hour, when the thermometer in the axilla registers 103° F., and continue until there is a reduction in the temperature. After the use of the sponge bath, if there is any manifestation of cold or chilliness, alcoholic stimulants are indicated, in moderate quantities. The cold water treatment should be continued as long as the temperature is above 103° F., provided there is no complication that contra-indicates its use. Such as intestinal hemorrhage, etc. I have often seen marked benefit from the combined use of the above agents.

If there is any objection to the use of cold water, the sulphate of quinine may be employed alone in ten to fifteen grain doses every two hours until three doses have been taken. I generally commence at four o'clock in the morning, and give one dose at four, six and eight, and there is a perceivable reduction in the temperature, as a general thing.

Should the salts of cinchona produce cinchonism, or any nervousness, that can readily be counteracted by bromide of potassium or sodium, in ten to twenty grain doses of either of the salts every two hours.

In the first week of the fever the secretions and excretions should be looked after, more especially the secretions of the liver. If the bowels are constipated I give some saline purgative-epsom salts is as good as any, in doses of one or more drachms every four hours, until the bowels act. Should the bowels act too freely after giving a purgative, they must be held in check with powdered opium.

And, if I have any reason to believe that the liver is engorged, I never hesitate to give calomel. It seems to me to clear the alimentary canal of all the effete matter better than any other purgative, and causes less depression than any of the vegetable cholagogues. Calomel, or any other drastic purgative, should be used with great caution. It is best to give the calomel in broken doses, from three to ten grains, divided into three parts, and given every two hours.

The kidneys should be active at all stages of the disease, and especially the quality of urine should be observed. If the urine is scanty and high colored, spirits of nitre may be given, in combina

tion with acetate of potash, one-half drachm of the former and fifteen grains of the latter. Buchu, in the form of the fluid extract, may be added to the above prescription. In some cases catheterization is necessary when there is suppression of the urine.

Turpentine is also useful in cases where the kidneys are involved, and is a beneficial adjunct in the treatment of typhoid patients. The oil is the preparation to use, though the spirits is preferred by some practitioners, Either may be given in doses of five to fifteen drops in mucilage of gum acacia, every four or six hours. The indications for its use, are: dry tongue, parched lips and great thirst.

When the breath is fetid, carbolic acid and iodine are valuable therapeutical agents.

In cases where cold water and the sulphate of quinine fails to reduce the temperature, tincture of aconite, gelsemium and digitalis should be employed, and their effect carefully watched. To quiet the delirium, the bromide should be brought into play. The writer has more than once seen the tincture of digitalis quiet them after the bromide and opium had utterly failed, in doses of fifteen drops, every two hours. When great tenderness of the bowels and much pain is complained of, or if there is tympanitic condition of the bowels, turpentine stupes will be found of much service. The complications should be treated rationally as they come up.

One thing of importance in the treatment of typhoid patients: That is, use as little medicine as possible. It often happens that you will have to give a placebo to satisfy the family.

To husband the strength of patients, through all the stages of the disease, is very essential in all cases, as the mode of death is by asthenia in the majority of cases.

The above is merely an outline of the treatment I employ. No two cases needs the same therapeutical interference. Close attention to diet, nursing and hygiene will accomplish as much towards the patient's welfare as drugs.

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Fourth.-Prevents exposure of the person and lessens the chance of taking cold.

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