therapeutics, bnt enters the conflict contesting every inch of ground, determined at all hazards to purge it out, to narcotize it out, to neutralize it out, to poison it out, with strychnine and phosphorus. Reminds me of an instance related by Prof. Thos. L. Maddin, while attending lectures at the Vanderbilt University, Nashville, Tenn., in 1879. Said the professor: "While I was a student of medicine in 1849, Prof. Daniel Drake, on one occasion, while lecturing on the treatment of pneumonia, said: 'Gentlemen, if venesection does not cure your patient, nothing will. For instance, not long since, I was called to visit a patient, and found him the subject of pneumonia in the first stage, the proper stage for venesection to show its highest value. We bled for an effect, which is reached by placing the patient in a sitting posture. Its curative value in inflammation is not reached short of syncope. At 10 A. M., I bled

him twenty ounces,

with the best results. At 10 P. M. the pulse was again hard and incompressible. I bled him again twenty ounces, with the desired result of softening and slowing the pulse, removing the pain, promoting perspiration, and causing sleep. The next morning the pulse was full and hard. I bled him again twenty ounces with a good promise of aborting the pneumonia. At my visit in the evening I was surprised to find the pulse was again full, bounding and hard. With such a pulse, as a matter of course, I bled him twenty ounces, and, gentlemen, I give you my solemn word for it, he died, notwithstanding.""

As to the treatment, I do not administer anything to cure the fever. Hence the old Latin aphorism, medious curat sed natura sanat morbus (The doctor watches and cares for but it is nature that heals disease). I would, therefore, submit the following, which, in my opinion, comes nearer the demands of scientific medicine: Take care of the patient and the patient will take care of the disease (that is, nature in the patient will). Our duty in administering is to fulfill the best indications in strengthening and preserving the life of our patient. Studying the different modes of dying, and the means to avert same, by directing our therapeutics to the prevention of

asthenia and apnoea. Preventing all undue depletion, but stimulate with force-producing liquid food, as wine, whisky, or some form of alcohol. This saves tissue disintegration. Give ice and ice water to appease thirst and supply material for excretion and secretion. To know, comprehend, and provide for complication, and to address our methods to the patients, thereby enabling him or her with more endurance constitutionally until the equilibrium of health is reached through the recuperative powers of nature, thus learning the magisterial part that nature plays in disease, as well as health.

May the BRIEF continue to advance as it has during the past, and have many valuable contributors to its columns. W. M. BURTON, M. D.

New Roe, Ky.

Puerperal Septicemia Complicated with Phlegmasia Dolens.

Mrs. L., strong and plethoric, aged thirty-four, and the mother of four children, gave birth in due season to a fifth, a healthy male child, being attended during the latter confinement by a midwife. Case progressed well-in fact, so exceedingly well (according to the judgment of the midwife) that on the fourth day from delivery she had her patient up and dressed and partaking quite freely of such choice luxuries as canned salmon, sardines and boiled cabbage.

Like all calms, when a storm follows, the patient was seized with a violent chill in the evening, which continued at intervals during the night and following day. Midwife finally consenting, after a great deal of expostulation on part of husband and friends, to have the writer called in, in the evening-twenty-four hours after initial chill had occurred.

On examination the following conditions presented: Slightly lacerated perineum, left ankle joint swollen and inflamed, anorexia, great prostration, nausea and vomiting, profuse perspiration, fever and diarrhea. No tenderness over the region of the uterus, but an offensive discharge therefrom, limited in quantity and which soon entirely ceased. The mammary secretions also disappeared in a few days.

Great constitutional disturbance plainly indicated systemic infection of a grave character, while swollen crural veins, inflammation and oedema of the ankle joint, and other symptoms peculiar phlegmasia dolens were not wanting; together with the fact that patient had had a similar attack during the previous confinement.

After a few days, nausea and vomiting was controlled, but diarrhea was increased in intensity, while the inflammation in the foot had partially subsided, leaving a hemorrhagic extravasation on the outer aspect of the ankle. An enlargement of the right knee occurred, which, on manipulation, caused excruciating agony.

Discharges from the bowels were very profuse, averaging about one, perhaps, every hour, over which the most powerful astringents had but little control, and continued throughout her illness. Profuse perspirations came on at irregular intervals a very marked feature of puerperal septicæmia.

Pulmonary complication setting in, patient died on the twentieth day after chills made their appearance.

Have omitted to state that on first examination I found and removed a soiled night dress which I am constrained to believe patient had worn since being confined.

Absence of tenderness over the hypogastric region would preclude the decomposition of clots in the uterine cavity and more than likely infection originated by the lochia passing over a torn perineum, or from soiled linen or both, whichever or whatever may have been the cause of infection, too much censure could not be alleged against the inhuman manner subjected to by the patient by an ignorant old fossil whose brazen cheek would grace the diningroom of a cheap restaurant as "hash-slinger" to better perfection.

An antiseptic and supportive treatment failed to make but little impression in the case (septic infection being too deeply seated), yet, would not the patient's chances of life have been enhanced had treatment been commenced at an earlier period in the disease is one of interest to us as well as others of the profession placed in like circumstances?

We were instructed by our alma mater, during college days, that a chill following delivery (except that caused by childbirth-withdrawal of heat from the mother suddenly) was indicative of some grave disorder and should receive prompt attention. Yet ignorant midwives do not comprehend the gravity of a case of this nature and are always loath to have a physician summoned for the simple reason that their ignorance becomes exposed and the practice they are endeavoring to "steal" suddenly slips from their grasp.

The BRIEF comes to us enlarged and improved, and a source of great comfort in medical literature. May it ever increase in size as well as prosperity. A. L. SAYLOR, M.D.

North Powder, Ore.

Removal of the Remains of a Fœtus per Anum.

In renewing my subscription to the BRIEF, I thought I would send you something in addition, which may be of interest to some of your numerous subscribers.

I feel a lively interest in the BRIEF, not only as a source of valuable information, but as a pleasant means of social intercourse between the members of the divine art.

On the morning of April 19th, 1864, I was called on to see a negro woman, about thirty-five years of age, thought to be laboring under chronic dysentery. I found her feeble, very much emaciated, and confined to her bed. Upon enquiring into the case, all the information elicited was that she had been laboring for several months with chronic disease of the bowels; frequent discharges from the bowels of blood and purulent matter, mixed with the feces. Of the previous treatment of the case, they were ignorant. From the facts before me, I worked upon it as a case of chronic disease of the large intestines.

Treatment.-Stimulants and anodynes, with milk toddy, etc. On the 21st, ordered a small dose of ol. ricini, together with the anodyne. On 22d, was called in great haste to see her. The oil had acted partially, and the rectum was nearly occluded by some substance. Upon intro

ducing the finger into the rectum, I detected what I took to be a piece of carious bone; from its shape and position, I took it to be the coccyx of the woman in a necrosed condition. It was removed with some difficulty.

Further examination detected a mass of bones lodged in the rectum. I introduced the index and middle fingers of the left hand into the rectum, dilating it as much as possible (fortunately the sphincter and soft parts surrounding yielded, as the vagina in labor) and with a delicate pair of forceps in the right hand, to my utter astonishment I extracted what I recognized as the parietal bone of a foetus, and, continuing the operation, extracted another parietal, the os frontis, the occiput, the clavicles, femora, etc., until the greater part of the most compact bones of the skeleton were removed. This process was facilitated by injecting water up the rectum.

After the operation, I learned for the first time that she thought she had been pregnant the year before, but not giving birth to a child, she supposed herself mistaken.

Upon making inquiries as to her former life, etc., I learned she was thirty-five years old; had given birth to five children previously, with as little inconvenience as most mothers. The year before this time (1863) she thought she was pregnant. Pregnancy advanced as usual, with nothing to distinguish it from gestation generally. September was her ninth month of gestation, and during the month she was taken with the usual premonitory symptoms of labor pains and slight discharge from the vagina. She thought labor was progressing, though the pains were not severe at any time. This condition lasted several days, and then all symptoms of labor subsided; the abdominal enlargement gradually diminished; health only tolerable; dysenteric symptoms came on about two months before I saw her, which was the 19th of April, 1864, about seven months from the time she had expected labor to

come on.

After the removal of the bones, she recovered rapidly. The bones indicated full development of the foetus, from their size and compactness, and the mother told me she thought she felt the motions

of the fœtus during gestation, as in ordinary pregnancy.

The woman lived about nine years after this time (1864), menstruated regularly for several years, enjoying good health until a short time before her death; was never pregnant after the removal of the foetal remains.

After the operation, I examined the rectum to discover if there was any communication with any other part, but could not detect one, nor was fecal matter at any time voided through the vagina, indicating communication of uterus or vagina with the rectum.

My opinion is, it was a case of extrauterine pregnancy; it progressed to maturity in a membrane extemporized by nature for its support, delivery being impossible per vias naturales. The foetus died; adhesion took place between the sack which contained it and the bowel, nature made an opening, and the bones were voided per rectum.

If this be true, how was the foetus nourished? Where was the placental attachment? What was the communication with the mother? JNO. LEWIS, M. D. King William C. H,Va.

Insomnia of Alcoholism.

Dr. Fuss, No. 57 Rue Conscience, Antwerp, Belgium, says: I tried Bromidia (Battle) on a poor alcoholic, having cirrhosis of the liver, and troubled with a cruel insomnia. Chloral, given in doses of forty-five grains, had given only imperfect results.

Two teaspoonfuls of Bromidia procured for the patient a complete and refreshing sleep.

I have recommended it to several, who have also found it very successful. But the case to which I have alluded is certainly a very remarkable one. I have also tried the preparation on myself. I find that sleep is preceded by a very pleasant sensation of repose, I have no dreams, and I awake with a clear head and a general feeling of comfort. On the whole, I believe that the preparation is destined to render very important service.

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A Diagnosis Wanted.

I was called to see Mr. C., aged eighteen years, Dec. 11th, 1888; found patient had been dead about thirty minutes when I arrived, and parents very anxious to know cause of death.

On careful examination, I found the patient had evidently died without a struggle; he had complained of severe pain in left breast the evening and night previous to death at 7:30 A. M., had attended school the day previous to death, and had engaged in a game of jumping, at noon.

The parents informed me that a very short time before his death he complained of severe pain in left breast, and became suddenly unconscious and made an effort to vomit, raising his head from pillow over edge of bed, he spit out a mouthful or two of mucus and saliva, laying him back on pillow, he expired in a few minutes; there was no perceptible pulse in wrist after laying him back on pillow.

There was no pain in head, no marked change in appearance of eyes, no difficulty in breathing except a slight smothering the evening previous to death.

My diagnosis was rupture of heart. Am I right?

I will be glad to hear from some of the readers on this case.

Have taken the BRIEF for several years and can not do without it. Cynthiana, Ind. J. E. GUDGEL, M.D.

Clinical Thermometers.

In the Sept. 1888, MEDICAL BRIEF, I noticed a communication over the signature of S. W. Walker, M.D., Baldwyn, Miss., in which he asks how he may know which of all the advertised clinical thermometers were reliable and how he could, be assured of their reliability. On Sept. 18th, 1888, I wrote Dr. Walker that I would furnish him with a thoroughly seasoned thermometer with absolutely indestructible index and Yale Observatory certificate of accuracy and would guarantee the reliability of this thermometer until it was broken. I have not been honored with a reply from Dr. Walker but am still willing to submit my thermometers to the most critical A. WEINHAGEN.

examination.

New York.

Venesection, as Practiced Sixty Years Ago, by my Preceptor, Dr. J. M. Dill, of Edisto Island, S. C., With Some Dots.

I bled

In 1826, I took a seat with Dr. Dill in his gig, to see some cases of pneumonia. He stopped on a large plantation and after examining the sick in their respective houses, he drove on to the next plantation, leaving me to bleed some. eight cases. Dill's instruction was to bleed until the patient could draw a long breath, or until there was a decided improvement in the pulse. A blister was placed over the seat of pain, the patient was put on a decoction of seneka made as follows: One ounce seneka, half ounce liquorice root, two grains ant. et pot. tart.

The roots were bruised and put in one pint and one half of water, boiled over a slow fire down to one pint. Dose-a tablespoonful every two hours. The case was now treated for symptoms.

I never knew Dill to bleed a second time in pneumonia. He was successful; seldom lost a case of pleurisy or pneumonia and no sequelæ.

In 1833 I went West and located in Lowndes Co., Ala. Within a short distance of me were three." Thomsonian" or "Steam Doctors," as they were called. That practice was in favor with the people. They were violently opposed to venesection and calomel. I had but few calls for some time; finally, several brought me into notice.

No. 1.-A. L., aged seventy years, at 9 A. M., seated upright in bed, had slept rone during the night; could not lie down for cough and pain in side; bled him copiously and cupped him-went for him in such a business-like way that he made no objection. I left him lying down, soon went to sleep, and made a quick recovery.

No. 2.-Mrs. J. L., fever, had taken an emetic (lobelia) the day before. I bled her and gave quinine. She missed her fever and had no return.

No. 3.-Mrs. J., at 11 A. M., in labor with her first child; convulsions. I sent for Dr. W. (a regular M. D.). We bled her copiously. Late in the afternoon, she had gotten through, when her mother entered the room, wringing her hands and crying out "they have killed

my child-they have bled her to death." She roused up the next morning and made a safe recovery.

I had no lack of business any more that season.

In 1834, I removed to Wilcox Co., Ala., where I remained fifteen years. Did a large practice. My books of reference on practice of medicine were Thomas and Watson. Watson, in his lecture on pneumonia, says: "I am far from desiring you to believe that bleeding is the only expedient required, but certainly the amount of the best experience, ancient and modern, is strongly in favor of its free, and I might almost say, its prodigal employment. Very lately, one most distinguished French writer, M. Louis, has endeavored to show that venesection has not much control over the progress or event of pneumonia. I advert to hls opinion on the subject merely to caution you against being misled by it."

Thomas, on pneumonia, says: "If a large amount of blood is abstracted at the onset, the disease is suddenly corrected, and will often, in the course of a few hours, be converted from a most violent pneumonia into a simple catarrh, but if the result is not so fortunate, the symptoms will become milder and more manageable. If bleeding has been too long deferred, or not largely employed at first, the disease generally proves violent, tedious, untractable, and often fatal."

"I bled once in a chill" (Armstrong). I bled in all cases of inflammation and threatened congestion. I bled for effect, not quantity. I bled with my fingers on the pulse. Many times I have stopped the bleeding before an ounce had flowed. Then again, in an oppressed pulse, the blood has trickled down the arm, increasing in strength and frequency to a full stream.

I bled once in strangulated inguinal hernia. After several hours of ineffectual efforts to reduce it, I opened a vein in each arm and made the patient stand upright. There was no trouble after he fainted. In three days this man was doing his task in the field as usual.

I bled successfully in habitual abortion; bled just before the menstrual period.