A Complicated Case in Obstetrics. February 5th, 10 P. M., was called to wait on Mrs. A. in confinement, multipara, thirteenth child. I was informed that she had had pains every day for a month, but became worse some four or five hours before my arrival. Pains or contractions seemed to be more of a cramp than natural labor pains, and were almost incessant.

The whole uterus, from outside examination, was as hard as a brickbat. On examination, per vagina, found left arm and right foot presenting, also prolapse of cord. Endeavored to convert into foot presentation, by pushing arm back and bringing down feet, but, when the attempt was made, found the most violent hour-glass contraction it has ever been my misfortune to meet with. It was impossible to reach the other foot through the contraction.

About this time, she went into a violent convulsion. I immediately sent for Dr. West to come to my assistance, and he arrived about 4 A. M. We put her under chloroform, and tried again to turn, but the anesthesia had no effect on the hour-glass contraction, and it was an undertaking harder than may be imagined. The right leg came down in front or on top of left. It, the left arm and cord, altogether, made it no small task. When we would allow her to come from under the influence of chloroform, she would have convulsions.

Finally, after long and persistent endeavors, we succeeded in getting the foetus turned, brought down both feet, and were congratulating ourselves on our success, when lo! a change in condition of patient.

Every muscle relaxed, breathing short and gasping, pulse imperceptible, and before a delivery could be effected she had crossed the Stygian River.

Of course, we did everything that had ever been recommended in works on obstetrics, and a great many more things that are not. We used remedies heard of and unheard of. We tried manipulations and experiments, known and unknown.

My opinion is, that immediate cause of death was concealed hemorrhage. After the child had been turned and drawn from the uterus, except the head, that hemorrhage set in and caused death.

The head was unusually large, and could not be drawn away without crushing, or use of instruments, and the family did not want it done after her death, and we used a winding sheet around lower extremities, and left child in that position-partly born and partly in

utero.

This, of course, is worth nothing to the many readers of the BRIEF, but it goes to show that sometimes one will meet a case in obstetrics where nature sets up all her powers to work against you, and generally carries things her way.

It is seldom, however, that we meet with a case of so many complications as this-abnormal presentation, prolapsed cord, puerperal convulsions, concealed hemorrhage. J. J. MORGAN, M. D. Dacusville, S. C.

Diagnosis and Treatment Wanted. Will some of the readers of the BRIEF diagnose the following described case:

On or about the 18th day of November, 1888, I delivered Mrs. of a healthy child, well developed and perfect in form, as far as I could see. The mother did well-labor lasting about six hours. About the fourth day after birth, a pustule appeared on the abdomen of the child, just above the connection of the cord with the abdomen, and under umbilicus, seated upon an inflamed base, which remained distinct. The inflammation spread to the surrounding tissues. It was filled with a yellowish, opalescent fluid, which, spreading, erupted, forming yellowish scabs and superficial ulceration, which extended to the umbilicus, the cord coming off about the seventh day from birth, which left an ulcer that continued to deepen and spread to the surrounding tissues, exhaling a cadaverous smell. Most of the bulle on the abdomen had healed, leaving cicatrices.

The last time I saw the case, the parents said the same kind of pustules were in the mouth and throat. The feeble condition of the child prevented me from making an examination. The child became so restless that the parents had to give it an opiate in the form of paregoric.

This is the fourth or fifth child these parents have lost, with the same disease, since 1874. None got well that were attacked in the same way. The parents are

healthy-no suspicion of syphilis in either. They have three living children, all in good health. I did not see the first case, but my partner did. I saw the second, when the ulcers had extended to the deep tissues of the abdomen, which resembled a case of phlegmonous erysipelas. The integument covering the abdomen was all destroyed, and the case lasted but a few days. The third ended the same way, so I was informed. The physician who attended that case attributed it to rapid labor (so I was informed). The fourth and last case is the one described in this article.

My treatment consisted of bismuth powdered on the parts to allay irritation, sulphate of zinc to change the condition of parts; afterwards, the solution of permanganate of potass. as a disinfectant. Internally, rhus and bromide of ammonium. J. R. JOHNSON, M. D. Cotton Gin, Tex.

Veratrum Viride as a Sedative. What abnormal condition of the system would seem to indicate the use of veratrum viride? It is, unquestionably, those inflammatory diseases, whether general or local, which are attended with very high arterial action. By this we do not mean to say that all diseases attended with inflammation should be treated with veratrum; as it is true that we do not always benefit a patient in proportion to the degree in which we may diminish the number of pulsations of his heart per minute. As a certain frequency is necessary for the healing process in inflammation, and an excitement is also necessary to expel morbid poisons from the system, as in scarlatina and typhoid fever, and the rapid pulse and nervous excitement in some inflammations may be of such a character as to be borne without interference, after which supervene a period of depression; and if given beyond this point this remedy may add to the depression and diminish the chances of recovery.

Veratrum viride, however, has this advantage, in such cases, over digitalis that it is more rapidly expelled, or thrown off, from the system. And, unlike digitalis, it is not cumulative in its action and may be safely continued.

Of the different class of diseases in which Norwood's Tincture is indicated, pneumonia ranks among the most important; and here, certainly, it has proved of the greatest advantage. With it, we may reduce both pulse and respiration to any desirable limit, by giving from two to four or six drops every three or four hours, or until nausea is produced. And we find it often favorable without the nausea, then we give the same from four to six hours, or discontinue. Let us imagine the blood in the body rushing through the vessels of the pulmonary and general circulation at railroad speed, at the rate of 120 to 140 pulsations per minute. Assuming that two fluid ounces are expelled at every pulsation, at this rate the whole amount must pass through the heart in one and a-half to two minutes.

Now, in acute pneumonia, where the capacity of the lung is greatly diminished, and the demand for activity is correspondingly increased, an increased quantity of blood must be constantly poured into the tender and inflamed lungs, so that every respiration gives the patient increased pain, and every pulsation adds new suffering, and the patient finally sinks beyond all hopes. Unless we have wisely given Norwood's Tineture, so as to get entire control of the circulation, and, in some degree, the respiration, why the disease is to go on to its final end.

The great benefit we have derived from the use of the tincture is this: the impulse and amount of blood forced into the lungs was greatly diminished, thus affording some degree of rest, as is most favorable for a quick resolution of the disease; and all this is done without the loss of a single ounce of blood.

The same may be said in regard to pleurisy, in which the inflammation is confined to the lining membrane of the lungs and chest. In this way, Dr. Norwood's tincture, no doubt, has done much to do away with the lancet.

CARL SEMELROTH, M. D. Mount Lebanon, N.Y.

What is Calomel?

There has been considerable discussion, through the BRIEF, on the calomel question, which I have read with much interest, and wonder why so many advocate its use if they understood the chemical preparation of the drug.

I will give the preparation of calomel, as I understand it, by chemistry, as it may influence some one to discard its use as a remedy for diseases.

First, what is calomel? Ans. Mercury and chlorine. What is mercury and chlorine? Ans. Mercury is quicksilver, and chlorine is a combination of muriatic acid and black oxide of manganese.

When chlorine is brought into contact with quicksilver, at common temperature, a combination takes place between them, amounting to one proportion of each, forming a protochloride of the metal. This, however, is not the common method of preparing calomel; the two constituents being more conveniently combined in their proper proportions, by mixing the bichloride of this metal with an additional quantity of mercury. The bichloride of mercury contains, as its name signifies, two proportions of chlorine and one of the metal. This compound is known under the name of corrosive sublimate. It contains mercury 200, and chlorine 72 parts by weight.

When this salt is triturated with mercury, the metal absorbs a part of the chlorine, and the whole is converted into a protochloride or calomel. The proportions are 172 parts, or one equivalent of the corrosive sublimate, and 100 parts, or one equivalent of the mercury. When these equivalents are mixed in a mortar, and then sublimed by heat, 36 parts, or one proportion of the chlorine is transferred from the bichloride to the metallic mercury, thus converting the whole into 272 parts of protochloride of mercury or calomel.

Corrosive sublimate is one of the most active and virulent of all metallic poisons, and in doses of only a few grains, occasions the most agonizing symptoms, which commonly end in death. But calomel is a milder poison. The chemical difference between these two substances is, that the calomel is a compound of one atom of chlorine combined with one of

mercury, while corrosive sublimate consists of two atoms of the first and one of the metal.

What a remedy to be administered to suffering humanity for the cure of diseases; filling their system with a deadly poison to counteract a less poison; and this is the remedy given by the old school in nearly all diseases as far back as the renowned Paracelsus, which was about the year 1523. And many physicians at the present day advocate its use. Why do they still adhere to that old method of treatment of the dark ages? Can they not see that calomel does more harm than good? Its poisonous action has been. closely studied.

Among the earlier symptoms of the action of mercury are an increase of the salivary secretion, an alteration of its quality, fetor of the breath, swollen tongue, soreness and loosening of the teeth, sponginess of the gums, swelling of the parotid, sublingual and submaxillary glands, aching of the jaws and teeth, with general muscular soreness and aching of the limbs, etc.

Bartholow says: Any considerable quantity of mercury, administered a sufficient time, will affect the quality and composition of the blood; the red globules are diminished, the fibrin loses its plasticity, the proportion of water is increased, and various effete material, whose nature is unknown, accumulate. Mercury is deposited in all the textures, interferes with the normal nutritive process, and is found in all the secretions and excretions.

A marked degree of anæmia, loss of flesh, muscular weakness, intractable ulceration of the skin, loss of hair, eczema, a foul breath, diarrhea, the stools being very fetid, are the characteristic symptoms of the action of mercury on the solids and fluids of the body.

Dr. Gunn, in his treatment on disease, speaking of calomel, says: Though we have occasionally spoken of calomel, as well as that other preparation of mercury, the Blue Pill, in connection with the treatment of disease and the formation of medical preparations, yet we do not recommend their use, at least internally, in any case whatever. Indeed, we advise one and all not to use them. There is no necessity for it, whatever. Discov

eries and experience of late years have amply demonstrated that we have in the vegetable kingdom herbs, roots, barks and remedies sufficient for all the diseases to which man is subject, of far more efficacy than the mercurial and other mineral preparations, and free from any of their deleterious effects.

As the attention of the BRIEF readers has been called to such authors as Fothgill, Potter, Ringer, Wood and other eminent writers, I will not give a repetition of the same. P. C. SMITH, M. D. Orrington, Me.

Important Notice to Physicians Regarding the Census of 1890. DEPARTMENT OF THE INTERIOR, CENSUS OFFICE,

WASHINGTON, D. C., May 1, 1889.

To the Medical Profession:

The various medical associations and the medical profession will be glad to learn that Dr. John S. Billings, Surgeon U. S. Army, has consented to take charge of the Report on the Mortality and Vital Statistics of the United States, as returned by the Eleventh Census.

As the United States has no system of registration of vital statistics, such as is relied upon by other civilized nations for the purpose of ascertaining the actual movement of population, our census affords the only opportunity of obtaining near an approximate estimate of the birth and death rates of much the larger part of the country, which is entirely unprovided with any satisfactory system of State and municipal registration.

In view of this, the Census Office, during the month of May this year, will issue to the medical profession throughout the country "Physicians' Registers," for the purpose of obtaining more accurate returns of deaths than it is possible for the enumerators to make. It is earnestly hoped that physicians in every part of the country will co-operate with the Census Office in this important work. The record should be kept from June 1, 1889, to May 31, 1890. Nearly 26,000 of these registration books were filled up and returned to the office in 1880, and nearly all of them used for statistical purposes. It is hoped that double this number will be obtained for the Eleventh Census.

Physicians not receiving Registers, can obtain them by sending their names and addresses to the Census Office, and, with the Register, an official envelope, which requires no stamp, will be provided for their return to Washington.

If all medical and surgical practitioners throughout the country will lend their aid, the mortality and vital statistics of the Eleventh Census will be more comprehensive and complete than they have ever been. Every physician should take a personal pride in having this report as full and accurate as it is possible to make it.

It is hereby promised that all information obtained through this source shall be held strictly confidential.

ROBERT P. PORTER,

Superintendent of Census.

Ulcerated Sore Leg.

In regard to Drs. Hodge and Tate's case in June BRIEF, would say that the treatment par excellence, for ulcerated sore leg, is to get one of Martin's rubber bandages, and to have patient wash his limb, night and morning, drying it thoroughly, and placing on his limb a cotton hose, commencing at the toes with this bandage, applying as you would any other bandage, making equitable pressure throughout the limb as high up as the knee, not allowing the bandage to remain on too long, until patient gets used to it; it need not be worn during the night.

Keep patient as quiet as possible, having him to keep his limb elevated on a chair while sitting.

Regulate blood with tonics, etc., and your patient will recover.

The dear old BRIEF, out of seven medical journals that visit my office, you occupy the top shelf.

WILLIS B. CAUBLE, M. D.

Sidell, Ills. Reply to Dr. Wilson in June Brief. In reply to the request of Dr. A. H. Wilson, Huber, Tex., as to best treatment of case described by him in the BRIEF for June, page 265, would be the use of the knife, and it can not be done too

soon.

Am greatly pleased with the BRIEF. Chicago, Ill. J. L. S. HALL, M. D.

Typho-Malarial Fever-Ulcerated

Leg.

Dr. Broadstreet wishes a good treatment for typho-malarial fever. We have many cases of that peculiar combination of symptoms, which, for lack of a name is called typho-malarial fever. This fever being self-limited we can not cut it short, as it generally runs twenty-one days.

Knowing it to be of malarial origin, I give quinine from the first. I am careful about giving cathartics as there is danger of the bowels being attacked, which enhances the danger greatly. For the first two weeks I give :

M. Sig.: Two to three drops three times per day.

Treat symptoms as they arise. My particular attention being paid to cleanliness. Where there is no bowel trouble the temperature rarely runs above 102°, and in such cases, outside of bathing or sponging, I use no antipyretic, but give the best of supporting treatment from the start, giving my patient a half gallon of sweet milk every twenty-four hours, in case he relishes it; otherwise, I alternate with beef tea, chicken soup, etc. Stimulation comes in at the proper time, as the strength of the patient indicates.

This treatment has been eminently successful in my practice. I have had cases which began as typho-malarial and terminated in the worst form of ty

phoid. Of course, in such cases, we

would treat it as typhoid fever.

Drs. Hodge and Tate wish a treatment for ulcerated sore leg. I treated an indolent ulcer a few years ago, after having tried every known method, by placing a cantharides blister over its surface, leaving it on thirteen hours, by which time false granulations were completely destroyed, and followed it by iodoform ointment, and my success was complete. I think, if you will apply the blister until false granulations are well destroyed a healthy surface is exposed, and apply the following, you will cure your ulcer:

Give us the Truth.

In the June BRIEF, Dr. Pike, in speaking upon the treatment of pleurisy and pneumonia, says he has often been called upon to bleed, but declined, and demonstrated the superiority of other remedies in speedily allaying inflammation. But, at the same time, the doctor fails to tell us what those remedies are. Like the modern infidel who labors to convince the world that Christianity is a farce and that our hope of heaven is a delusion, takes away all our anticipations of a blissful eternity, and leaves us nothing upon which to base our comfort. Surely any man who has treated hundreds of cases of pneumonia and only lost two cases, must be in possession of a plan of treatment which is unknown to the rank and file of the medical profession of today.

Again, the doctor tells us to "restore secretion and equalize the circulation and the patient has none too much blood." Very well, but by what means? Yes, it is the truth we are after; give it to us, please.

Now, Dr. Pike, is not the old adage a true one that the "truth is always found between the extremes?" From the tone of the beginning of your article I judge that my medical training and alma mater is the same as yours, and yet observation has taught me that there are occasional cases in which venesection affords from quick relief and an early recovery, the two maladies spoken of.

The kind of patients so relieved are those who are of full habit, plethoric, with a full bounding pulse. Let us not exclude everything from the practice of the healing art, and at the same time cry out for the truth. Experience, as practitioners holding on to such a theory will place us, now and then, in a false position.

Now, as to that powerful and potent drug about which there is so much controversy I mean calomel. As physicians, who claim to be ever ready to accept the truth and apply it in practice, where is the consistency of ruling mercury out of its legitimate sphere, simply because its indiscriminate and injudicious use has wrought much harm?

I agree with you, Dr. P., that disease is not a "big animal to be knocked out with