ble size, and upon weighing it the next morn. ing, found it to "tip the scales" at twelve pounds, four ounces.

In the case just cited uterine inertia was doubtless the result of "too many births" coupled with this recent over-distension of the uterus. As the door of the womb was thrown wide open, uterine stimulants were in order; yet, regardless of their free administration, the uterus continued recalcitrant. Under ordinary circumstances a couple of drachms of good ergot will rarely fail, in the course of fifteen or twenty minutes, to rouse an unwilling womb to fairly vigorous action. Cimicifuga is also of great value in exciting uterine contractions, and not a few of the coal-tar products will often prove of great advantage. A finger or two cautiously introduced into the uterus often proves effectual in bringing on pains. If inertia persists after birth and bleeding occurs, it is required to grasp the placenta and take it away, after that our therapeutic measures may compel contraction. When hemorrhage continues, besides being liberal with the uterine stimulants, the fundus should be grasped in the hand and the womb forced, so to speak, into smaller bulk, a procedure resembling Crede's method of expelling the placenta.

J. HOBART EGBERT, M. D., PH. D. Southampton, Mass.

The re

A Case of Puerperal Sepsis. EDITOK MEDICAL WORLD:-On May 5th, Mrs. M. was delivered of a child. No physician being present, a neighbor lady superintended matters. As soon as the child was born she tied the cord and, in her own language, went "after the afterbirth." She pulled on the cord until it broke, and then tore it away by reaching her hand into the womb. peated floodings caused them to call me, and I found pieces of placenta all over the bed. By external manipulation I secured contractions, and by hypodermics of ether and brandy got reaction. As soon as she was sufficiently recovered, after disinfecting my hand, I removed a quantity of clots and shreds of placenta. This caused so much pain (and the family refused to have any anesthetic given) and faintness, that I was forced to desist. placed the lady in the most favorable condition, but in thirty-six hours fever developed, and its importance could not be overlooked. Septic matter had been carried into the womb by the midwife's hand. What was to be done? Authority is equally divided on intra-uterine irrigation-in fact, on irrigation at all. But after combating the fever with what I considered proper medicine, and using vaginal injections without benefit, and noting a con

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tinuation of the septic absorption, as manifested by progressive fever, chilly sensations, profuse cold perspiration, rapid heart action, weakness, and that peculiar ashy color of the face that always frightens me, I concluded that delay was criminal. With a double current female silver catheter, I injected hot water (that had been boiled). As soon as it returned clear then one pint of 1 to 4000 bichloride of mercury solution, and then a lot more clear hot water. This was attended by no pain, nor followed by any immediate improvement in the symptoms. Quinine in large doses was given, and all through the night stimulants, alcohol bathing and antifebrin were used. The next day a celebrated physician was called at my request from the city. He treated me with the greatest courtesy, but did not approve of intra-uterine injections, and forbade any more quinine. He advised salol, grains 22, and phenacetin, grains v, every four hours, as long as the fever lasted, and alcohol baths as long as sweating continued, plenty of food and air. In fact he advised not to use even the vaginal injection unless the odor was unendurable. I tried the case on these lines twenty-four hours with the effect of losing all that my quinine and irrigation had gained. The body was cold and clammy, with violent cold sweating while sleeping, and upon my own judgment, I returned to the quinine, grains v, four times during the day, and twice at night. Improveinjections were used daily, but no more intrament was noted from the first, and the vaginal uterine. Other medicine was brought to bear, such as nux vomica, sulphide of calcium, and later atropia to stop the constant clammy feet; also cactus as a heart tonic.

The

I take issue with the other doctor. I regard the quinine as absolutely necessary, and the sulphide of calcium certainly helped to neutralvaginal injection urgently demanded. ize the poison, but the doctor was right about the salol. in the blood, as I believe, it must find a wide If it is broken up into carbolic acid application. In conclusion I would say that my case is convalescing.

Mr. Lawson Tait did the world a kindness when he told a physician "The causes of your septic inoculations are found under your finger

nails."

Criticism of this case is invited.

OLD SUBSCRIBER.

Some Thoughts at Random. EDITOR MEDICAL WORLD:--The present (June) number of your progressive, spicy and ever welcome journal is brimful of useful and entertaning facts, highly beneficial to the busy physician. It is the medium for the interchange of the views of many thousand phys

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icians every month, thus making a grand medical association. It is a fact worthy of note that its humblest contributor is treated with kindness and respect and his contribution is free from harsh criticism. In the great "Forceps Battle" every one who has written has been treated with courtesy. In reference to the use of the forceps, Dr. Tureaud's experience is a deadner against the necessity for their frequent use, and he is certainly duly and truly prepared and every way qualified" to give an opinion in the momentous question. A man fifty-one years at the bedside without meeting with a single forceps case has been unusually fortunate. I really think that cases requiring instrumental aid are few and far between. We rarely meet in this country a case of dystocia from any cause. A warm climate may have some influence, but in all things let us be conservative.

Several have written against the use of blisters in the treatment of pneumonitis. One, "that it obstructs thoracic exploration." This need be no serious objection, for in the sputa we have abundant means of aid to diagnosis. I feel sure that I have been fairly successful in my treatment of this formidable disease, and I always blister early.

I can't agree with Prof. Parvin that "To cohabit with the pregnant wife is both unwise and immoral." I rather regard it as a wise provision of Nature that we may enjoy marital pleasure through the entire period without injury to the wife or the unborn child. Thousands do it without injury, and facts are worth more than theories, though I admit that too frequent intercourse, especially in the early months, is injurious.

I have noticed several communications in reference to the removal of the placenta. I never wait long. Immediately after the birth of the child I give one or more drachms of fluid extract of ergot, and then practice Crede's method of gentle expression of the uterus, making no traction on the cord. I always ask the woman to bear down. If I fail in this method I gently introduce the right hand (well oiled) and surround the placenta, and bring it slowly away. If too high to encompass with the hand I hook one or two fingers into its meshes and gently get it low enough to surround with the hand. I have never failed to get a retained placenta. Be sure to get all the membranes; a clean delivery and you need have no fears of puerperal septicemia.

Will Dr. Tureaud tell us about knots in the funis? Has he ever found one? I never have. It may be possible, but so rare as not to be recognized as the cause of total death. Bradford, Ark. J. G. ALLEN, M. D.

A Powder for Tonsilitis.-Strong Coffee to Increase Labor Pains.

EDITOR MEDICAL WORLD :—Guaiac, aconite, warm fomentations and the various domestic remedies frequently. fail us in aborting an attack of tonsilitis. We stand by with lancet in hand, patiently waiting for the abscess to point, (that is, unless the case is a personai one-there is but little patience then).

The following formula, given me by my preceptor, is, I think, an original one with him. In his hands it is as nearly a specific as things go in medicine. Since using it I have only had one case of lancing in eleven cases of tonsilitis:

R Tannic acid.. Subsulphate iron. Acetate of lead. Morphine.....

...aa...

.gr. v .gr.j M. Rub to very fine powder and apply to affected parts by means of an insufflator, as often as necessary.

The above quantity will make at least twenty applications. The action is astringent. The morphine is a direct sedative. This is excellent in chronic hypertrophy of the tonsil. Apply once daily for one month.

Probably nine-tenths of the readers of this journal are familiar with the good effects obtained by the administration of very strong and very hot coffee, without either sugar or cream, in those cases of labor where the pains are weak and far between. To those who have not tried it it will be a revelation. Besides the good it does the patient it helps occupy those dear friends, the old ladies, who know so much more than we about midwifery, and who encourage (?) the patient before our arrival with reminiscenses of the "times they had." Let them prepare the coffee and keep it

hot in another room.

I was poisoned by some weed, probably the poison ivy, in the Spring. Acetate of lead and other stand-bys only appeared to increase the irritation. Finally I tried sulpho calcine. The result was excellent, although it was two weeks before I got rid of the stain.

Swan Pond, W. Va. E. L. STRODE, M. D.

An Interesting Case of Internal Parasites. EDITOR MEDICAL WORLD:-On the evening of the 24th of November last I was called to see the 18 months child of Mr. Maloney, who had been in convulsions for a short time. I found him in a comatose condition. Soon after my arrival he was again taken with convulsions and continued to have them at short intervals until about 7 a. m. They were about the usual character that we see in children of that age. I prescribed a warm bath, calomel cathartic, bromide and

gelsemium. Upon visiting him next day I found his head and neck drawn backward, the muscles of the back rigid. He was quite deaf, had strabsimus, twitchings of the face and extremities, face flushed, pulse quick and hard, temperature 1041⁄2 in axilla. Consciousness partially lost. I continued the same treatment and applied blister to nape of neck. These symptoms continued with but very little change for two or three days. When the patient began to cough he had hurried respira

The physical signs all showed capillary bronchitis. At about this time the head symptoms began to improve, the bronchial trouble being the most prominent for about six days. I gave carbonate of ammonia, whiskey and a few doses of antifebrine. He was then taken with very obstinate vomiting, diarrhea and tympanitis, the latter symptoms remaining most marked for about four or five days.

Prognosis very unfavorable. I looked for crape on the door at every visit. I gave our usual remedies to control vomiting, diarrhea, etc., and applied turpentine stupes to abdomen. After a sickness of about twelve days with the above described symptoms the father came to my office, bringing a bottle containg hundreds of little white worms, different from any that I had ever seen, which he stated that the child had recently vomited, stating also that these were but a small part. After placing one under the microscope and making some research, I visited the patient, and while I was present he again vomited up some milk and it seemed to be literally alive with worms, which crawled out of the vomited matter up the sides of the wash dish and out of the child's mouth. He again vomited in a few hours with the same results. Neither before nor since have any entozoa been seen in connection with the case. Soon after this the patient commenced convalescing and made a rapid recovery. The points of interest in this case are: 1st. The varying set of symptoms; 2nd. The diagnosis and cause of sickness; 3rd. What kind of worms are they? In reply to the last question I will say that a microscopic specimen was sent to Dr. Leidy, Philadelphia, and he, being unable to determine definitely, suggested that we send a specimen to Prof. Riley, Government Entomologist, Washington. He says they are Dipterous Larvæ, and thinks that the female fly must have deposited her living larvæ in the mouth of the child while it was sleeping. Cortland, N. Y. A. J. WHITE, M. D.

The Faith Cure. EDITOR MEDICAL WORLD:-In reference to Father Mollinger, there are quite a number who have made a pilgrimage to his shrine dur

ing the past year. I will give you seven casesthat I have knowledge of.

Mrs. K., age about 20, deafness.
Rob. F., age about 22, deafness.
J. L., age about 20, epilepsy.

Mrs. A. G., age about 51, deafness and partial blindness, the result of an injury of twenty or more years.

J. B., age about 30, epilepsy.

T. McG., age about 24, epilepsy.

Miss K, age about 23, morbus coxarius, causing luxation of the femur.

These all were there at different times during the year, and not one of them has been benefitted in the least.

EDITOR MEDICAL WORLD:-There seems to be considerable opposition to my treatment of pneumonia. Well, I will say to Dr. Patton that if he will come into this section and practice next winter, I will prove to his entire satisfaction that pneumonia is a strictly bilious disease, and as for morphine, whereas I always combine it with atropine, yet even this combination is very pernicious in this disease, seeming to check the whole secretory apparatus. I refer him to Fothergill's Handbook of Treatment, sect. 77, p. 212, for the pernicious action of morphine in diseases of the chest.

The Doctor seems to think a blister scarcely worth while in pneumonia. Why, my dear Doctor, if you will succeed in this part of the world in convincing even the laity of a remedy that will take its place your fortune would soon enable you to retire from the practice. say emphatically, and hundreds of intelligent: physicians will bear me out in it, that a pneumonia, allowed to run into the third stage in this debilitating climate, without a blister, is almost certain death.

I will

You cannot treat South Carolina pneumonias in the swamps of Arkansas!

I reiterate that pneumonia, or parenchymatous inflammation of the lung, is no more selflimited than is gastritis, peritonitis, cerebritis, nephritis, etc. Do not all inflammations have these same stages of inflammation?

And if the physician sits around in this country, and talks iodine instead of cantharidal cerate, and theorizes over the various pneumonic phenomena, he will be replaced by another physician. I do not call every local engorgement of lung pneumonia; but when I meet with a genuine progressive case of it I find that I have a hand full, and have my skill and ingenuity tried to its utmost.

I do not use "Antifebrine" but I find acetanilide C. P. (ac. acet. et aniline) to be a

wonder worker in aiding the antipyretic effects of quinine.

It is needless for me to add my praise to Norwood's verat. viride in pneumonia, tho' I believe we could do a great deal more good with it if we could see our cases earlier. Next season I will do my utmost to make an early alterative impression on my pneumonia subjects with hydrarg chlo. mite.

If any of THE WORLD'S Subscribers have a case of mastitis on hand let them try an Alcock's porus plaster. I have had it to 'set back' a mastitis after suppuration was well advanced

In case I have a walking worm subject I give the following with first class results:

Salines in Peritonitis. Editor MEDICAL WORLD:—I see that some of the medical brethren are inclined to treat peritonitis with saline cathartics and that you are decidedly in favor of that treatment. I gave that a fair trial once-or, rather, the child's mother did. A little girl nine years old was seized with intense pain in the bowels. My diagnosis was idiopathic peritonitis and should have begun the opium treatment at once, but the mother's universal hobby and treatment was salts, and it was useless for me to oppose her. If the child had died, she would have thought that salts would have saved her; if she had had a protracted illness she would have thought salts would have cured her quickly. She gave salts, the bowels were moved, but the great pain almost killed the patient as the mother admitted. I then treated her with morphine, giving her just enough to keep her free from pain; she would frequently call for it when she felt pain coming on. Her bowels did not move for nine days, and moved then without medicine. The neighbors were clamorous for the bowels to be moved, but I had the confidence of the family and was master of the situation. She recovered. Dr. Alonzo Clark related in his lectures that he kept the bowels confined longer than that and then let them move of their own accord. I think it probable that had a full dose of opium been given instead of the salts, and repeated if necessary, the attack might have been cut short and I would have doubted the correctness of my diagnosis.

I give the readers of THE WORLD a case I

had in Military Hospital in which my diagnosis was perforation of the intestine in typhoid fever. I was in the hospital at the time and was attracted by his cries. I gave him two drachms of laudanum at once, following it up with smaller doses. The result was so good that I sometimes doubted the correctness of my diagnosis. Had I the case now I would inject morphine hypodermically-I had never used morphine in that manner thenand give laudanum by the mouth. I had a case recently in which my diagnosis was perforation of the intestine in typhoid fever. I did not see her till four or five hours had elapsed. The result was my patient died.

I must cling to the opium treatment of peritonitis until you can give me very good results from your saline aperients. If an aperient is used I should combine it with an opiate, and have the patient fully under the influence of opium when the bowels moved. I would use the sulphate of magnesia in preference to any other aperient. Let me caution against large enemas where you have soreness, inflammation or adhesions in the abdomen. You may excite great pain, and have prostration, collapse and failure of the heart. I have known this. If an enema is used it should be warm water, and but a small quantity at first. I am more afraid of cathartics than Dr. Park is.

When Graves & Stokes began treating peritonitis from perforation of the intestine in typhoid fever with opium, we are told that they had a patient that was doing very well, but the bowels had not moved for several days. They thought this would not do; they opened the bowels and lost the patient. They had another patient in the same condition and allowed the bowels to remain confined several days longer; the patient was doing well, but they thought it would not do to let the bowels be confined longer. They gave something to open the bowels and lost this patient also. Then they learned the important lesson to let the bowels alone.

I

been a hard drinker-in fact, was under the influence when it happened. To my mind there was but one chance to save life, namely, immediate amputation, which I performed. had charge of the case for forty-four days, and during this time a great many complications occurred, which I was able to combat by using means learned from various sources, which I give for what they are worth, in the hope they may be of use to others.

The patient rallied well from the ether, but soon began to sink. I gave him dosimetric granules of arsenite of strychnine every ten to twenty minutes, and cactina every half hour. These were followed all night, and, while he seemed to be dying several times, they brought him through. I will say that these were the only medicines I could give. Brandy, ammonia, Hoffman's anodyne, &c., were instantly vomited.

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The next morning fever developed, for which I gave antifebrin, but I did not like its action; so in the afternoon I commenced on dosimetric granules of aconitine and veratrine, one of each every half hour, and one of digitaline every hour. But few doses were needed, and fifteen grains of sulfonal gave sleep.

The next morning I gave six granules of hydroferrocyanide of quinine every hour for three doses, and the fever seemed to be controlled. This was used as needed for fever. After some days the kidneys failed to eliminate and symptoms of uremic poisoning developed, for which one-third grain of calomel with soda were given every hour, and tincture of digitalis, ten drops, every four hours. This worked nicely. (Calomel in small doses is a grand glandular stimulant). Later drowsiness, from imperfect cerebral circulation, developed, which was quickly relieved by giving belladonna as recommended by Prof. Scudder, one-third of a drop every half to one hour. The tongue became coated with a dirty white coat, and the eclectic remedy, sulphite of soda, dr. iii in a pint of water, all to be taken during the day, soon cleared it. Now the deep red tongue called for muriatic acid, enough in water to make a pleasant sour drink, and take ad libitum. From the very minute that the stomach could be gotten in order old-fashioned tincture of iron, quinine and nux vomica was given three times a day, and when the pulse got weak, as it often did, I gave cactina. The stump was suspended in an anterior splint, irrigated twice daily with bichloride solution 1 to 4000, and dressed with iodoform gauze. Senuel abscesses

were opened and thoroughly washed. For food, milk and raw egg, beef meal, beef peptonoids, extract of beef, beef juice, chicken stew, raw oysters, ale and porter, and I had

The Use of Sanguinaria Canadensis as an
Emmenagogue.

EDITOR MEDICAL WORLD:-My mode of administering is to commence a fortnight before the expected return of the menses, and give teaspoonful doses of the tincture three times per day, and a tablespoonful on going to bed (preceded by a warm pedeluvium, or, in bad cases, a semicupium). If the secretion is not restored at the time, I remit the use of the remedy for a fortnight, and proceed as before. In the meantime I make use of such hygienic treatment and regulations as the general indications may demand. These, of course, are not uniform in all cases, but are governed by all the various circumstances and conditions that regulate us in the treatment of any other disease. When the full effect of the remedy is produced, it is characterized by slight nausea, pain in the loins, extending through the hypogastric and iliac regions, as well as down the thighs. The symptoms sometimes manifest themselves once or twice, before the discharge is completely established. The sanguinaria canadensis is an appropriate stimulus to the uterus when in an abnormal condition. least such has been my experience for a series of years. To it as an efficient remedy in dysmenorrhea I would respectfully call the attention of the profession, feeling assured that, should it answer their expectations as it has met mine, it will prove a much safer remedy to use in general practice than the tincture of antacrida, or many other prescriptions (polypharmaceutical) that are so soon superceded by others of like doubtful efficiency, and of equal liability to deteriorate.

At

Give it a fair trial, and give me the result of your experience, that I may be confirmed in,