ing fleas, as her nice line of already penned mosquitos. Let us hear from some of the brethren regarding the possibilities of this tetanus germ being inoculated by the flea. Stason, La. J. SMITH, M.D. [Tetanus germs are found in the soil. We think your explanation of the cause in this case is correct; and it is the first mention that we have seen of the tetanus germ being carried by fleas.-ED.]

Adherent and Retained Placenta.- Signs of Pregnancy.-Moist Dressings vs. Dry

Dressings.-Cough Syrup.

Editor MEDICAL WORLD:-Regarding retained placenta, I find the following plan of service in differentiating between adherent and retained placenta: After birth of child keep hand on uterus; while uterus is round and smooth, placenta is still adherent; when contour is uneven, or when you can detect a flattening of one side, the placenta is detacht. All that is now necessary is to express it. I had a case when after waiting twenty-five minutes the placenta was still retained; uterus was flabby, strongly retroverted, and in such a position that the hand could not grasp fundus. Massage of no avail. Slapping a cold, wet towel over lower abdomen stimulated contraction and caused uterus to rise. Was then enabled to grasp fundus and express placenta. As a prophylactic against infection, especially where manual or instrumental interference has obtained, ergot in xx m. to 3j doses is excellent. It closes the gaping sinuses by contracting the muscular fibers, thereby preventing bleeding and formation of clots, and also hastens subinvolution.

In answer to W. Y. (page 168), if Johnson's sign is present, the woman is pregnant. This sign is present earlier than Hegar's, and consists of an intermittent softening and hardening of the vaginal cervix. It is present as early as the fourth week.

Dr. J. C. Johnson (page 169), will find that hot, moist dressings or compresses in septic conditions will give him better results than dry dressings or ointments. Hot dressings of a saturated solution of boric acid, 5 percent solution of echafolta, or 1 percent solution of aluminum acetate, are all excellent. Senn recommends the latter. A 1 percent solution of aluminum acetate can be cheaply made by dissolving 24 gms. of alum and 38 gms. of acetate of lead in one quart of water. Professor Senn substitutes this for dry dressings in "all wounds that are or may become infected."

If Dr. Vedder (page 171) will use difluordiphenyl ointment (antitussin) in whooping cough, he will find it almost a specific.

I wish to submit a formula of a cough syrup that I find palatable, stable, and efficient. I

Editor MEDICAL WORLD:-In the April WORLD, page 154, Dr. Jennett asks, “do you think there are such adhesions?" (placental). Your answer, "well rather," just expresses my views in the matter, having had several cases of the kind in my nearly fifty years of practise where I have been obliged to separate the placenta from the uterus by a sawing motion of the finger nails.

My object, however, in writing this is to detail one of my worst cases of the kind I ever had. Was called one night about midnight by a near neighboring practician (a German) who wisht assistance. On the way to his patient he said, "she," (a German woman) "had just been confined, and her womb had turned inside out and was then lying on the bed between her thighs."

I very naturally thought he might be mistaken. On arriving, the Doctor stept to the bedside of his patient, graspt the bed coverings and threw them across the foot-board, leaving his patient nude from waist down, and pointing said, "see."

I lookt and saw what appeared to be a large clot of blood between her thighs, just such as might be expected immediately after confinement. On closer examination, however, I found that the Doctor was right, and what made it much worse the placenta was very firmly attacht to the then outside of the uterus.

To break up the adhesions I was obliged to use much force with my finger nails, the blood gushing out freely the while. After thoroly cleansing I turned the womb back again, returning it to its natural position, after which she made an uneventful recovery, sitting up in bed on the fourth day, as probably no one but a German would have been able to do. Brooklyn, N. Y.

G. NICHOLS.

Not Twins, But a Case of Double Conception. Editor MEDICAL WORLD:-In April WORLD, page 152, Dr. K. Taylor, of W. Va., reports a case of "twin girls with " seperate placentas," and thinks it must be an exception to the rule, judging from an article he had seen in the November, 1903 issue, page 494 of this same journal, (written by myself). Now if the Doctor will read this article again carefully, he will find that the case of "twin girls he reports is not an exception, nor are they twins proper, but a double conception, altho of the same sex. Each was doubtless envelopt in a separate membrane and fed thru its own placenta, as he reports. The difference between this case of the Doctor's and a case of twins proper (which are always of the same sex) is this: The former will not be duplicates, while the latter will. The November article makes this plain, if carefully read. The last paragraph has it all in a nut-shell." T. E. REED, M.D.

Middletown, Ohio.

Twins and Double Conceptions, Etc. Editor MEDICAL WORLD:-Dr. Taylor, on page 152, April WORLD, finds "twin girls with separate placentas. According to my views he found a double conception, and not twins. A few years ago I found twins (boy and girl) from one placenta. This is contrary to general teaching. We must dig or go beyond our teachers. The spermatozoa-the seed-is male or female. If a male sperm attacks an ovum -lives on it-until ovum is attacht to walls of womb, thereby becoming a physiological leech for a period of time, then expelled, becoming

a leech at breast, for another period, we have a male child. If a female sperm, we have a female. Should there be a male and female sperm attack and live on the same ovum, we have twins, male and female. Should there be two ovums and a sperm lives on each ovum, we may have two males or two females or male and female, but a double conception and not twins. Let those owning microscopes investigate along this line. According to Sturgis (Sexual Debility in Man) his microscopic plates show a difference, especially plate 7. hope some one will investigate and report.

I

In Dr. H. N. Jennett's case, page 154, I think the trouble wholly due to the intestinal tract. Genital tract not to blame. The case would have got along as well if not better without the cleaning out," "irrigation,"

etc.

Dr. John B. Lee, page 156 (puerperal convulsions), says: "Unless I previously learn better, I shall bleed the next similar case the first thing I do." I have had three cases; two I bled; they got well; one I did not bleed; she died. Owing to a law suit in which

Bleeding for Puerperal Convulsions. Editor MEDICAL WORLD:-I was much interested in Dr. Lee's article in April WORLD, page 156, on short cord and puerperal convulsions. In a practise of nearly forty-six years I have had my share of such cases. In the former it requires quick action on the part of the practician to save the child, and in the latter I have always been successful with free venesection, and fortunately have never lost a case. My first case was a primipara 18 years of age; bled her more than two quarts. She is alive and well today, and this was more than forty years ago. My last case was on the 17th ult., a primipara 17 years of age. Was called in consultation when she was in her fifth convulsion. The attending physician had been with her fifteen hours; had given large doses of bromid of potash and chloral, and hypoderimmense doses of chloral per rectum, and had mics of morphin and atropin; had given administered chloroform, etc. I suggested bleeding, which was immediately done, full one quart in quantity. No more spasms, and she was delivered of a live child the following morning. Mother and child at this writing

doing nicely. I hope Dr. Lee will not wait in

next case he has, to dilate and use forceps, etc., but resort to what I am satisfied is the only common sense treatment, viz., free venesection. H. W. CARPENTER, M.D.

Oneida, N. Y.

Possible Ectopic Gestation.

Editor MEDICAL WORLD:-In the April number of your excellent journal I suspect that Dr. J. R. Smith's case, on page 155, was one of ectopic gestation, and that the fetus was not in the womb at all. I had a similar case (and also in negress) in which the cranial and other large bones could be and were felt not only by myself but by several other practicians for several years-in fact, my case and his correspond in almost every particular. Aiken, S. C.

B. F. WYMAN.

Oil of cajuput is one of the most efficient of the carminativs. It is an excellent adjunct to other remedies in the flatulent dyspepsia of the aged. Combined with opium it is undoubtedly useful in diarrhea with choleraic symptoms. It has been also used as a rubefacient in muscular rheumatism and as a (local) parasiticide in ringworm. (Stevens.)

Diagnosis and Treatment of Gonorrhea in the Female.

Editor MEDICAL WORLD:-This is a subject on which we do not find sufficient data in our works on genito-urinary diseases and gynecology; it seems to be "disputed ground." Gonorrhea in the female differs in one essential point from that in the male, viz: that it is seldom an acute condition; and because of this, the cases are not seen in their incipiency, and we are liable to error in diagnosis and consequently in treatment.

It is not primarily a vaginitis, as is generally supposed, but a urethritis. The reason for this is that at the time of penetration the male and female urethra come in direct contact and here it is that inoculation occurs. The cervix uteri and vulva are generally attackt before the vagina.

The great majority of cases of urethritis in women are of gonorrheal origin, and whenever there is a discharge from the urethra, we should suspect gonorrhea, whether we find gonococci or not. She will come complaining of a burning, tingling sensation which is increast on urination. We may possibly obtain a history of the woman having "laid herself liable," but this is seldom.

As in the male, we must make a thoro examination of the parts. The most favorable time for making this examination is just before her monthly period; for at this time all secretions are increast. This, however, is necessary in obscure and subacute cases only when the discharge is very scanty. She should not void her urin just before an examination, as it would wash out any discharge that might be present.

On inspection we will find the meatus urethrae red, swollen, hot and painful to the touch. Slight pressure will reveal a muco

purulent secretion at the meatus. In this pus we generally find the gonococci; but should we fail, it does not follow that the case is not specific.

Now examin the vulva, vagina, etc. for any other places of localization. We will find the vulvo-vaginal glands on the inner aspect of the labiae majorae enlarged and the meatus of the duct surrounded by a red areola resembling an ordinary flea bite; this is called the gonorrheal macula. Pressure on the duct will cause an exudation of pus from the meatus. This condition of the vulvo-vaginal glands is very important in diagnosis, as it is the last sign to disappear in gonorrhea, and is therefore an important point in old and doubtful cases. In girls and young women we may have a vaginitis also, and the posterior wall is the one generally selected. The cervix and fornices may be affected, and the symptoms are those of ordinary inflammation, only exagger

ated. There will be some discharge, and the external os will be plugged with a thick, tenacious mucus which is hard to remove.

Treatment: Place the woman on a table, preferably in the knee-chest position, wash external genital organs and douche out the vagina with warm water and green soap. Now swab out vagina with cotton and steril water, being careful to get well between the folds of the mucous membrane; this will remove all excess of mucus. There will be some mucus that will remain in the external os; for this use a swab of cotton saturated with alcohol which will soften the plug of mucus, when it can be easily removed. Now wash all well with bichlorid solution 1-10,000 or 1-20,000. This puts the parts in a condition to receive local treatment. Now with a cotton swab apply protargol, 20 percent solution; apply this freely as there is no danger should any of it get into the uterus or bladder. This should be applied every other day, and in the meantime, boric acid, 3j to O of water should be used. Other drugs may be used in same way as protargol, e. g.: zinc chlorid, 2 percent solution; silver nitrate, 1 percent; chloral, 1 percent; permang. potass., grs. 5 to 3j; lead acetate, grs. 10 to j; copper sulf., grs. 2 to 3j; hydrogen dioxid and water, åå etc. Internally, such drugs as buchu, salol, copaiba, santal, etc. WM. M. JONES, M.D.

Hendersonville, N. C.

*Osteopathy-What is It?
No. I.

religion in its beauty we must approach it in Truly has it been said, if we would see any the spirit of one of its most devout adherents. This is equally true of any theory, philosophy, or science. Approach any subject in the spirit of antagonism or prejudice, and we thereby

shut ourselves out from whatever of beauty or truth it may possess. Those who peruse these articles on osteopathy with a desire to find whatever truth there is in them, will doubtless know more of the subject and see more of its possibilities than those who read only to criti

cize and ridicule.

When two facts seem contradictory, reject

*We have deliberately considered the matter of publishing a series of articles on osteopathy, if emanating from a reliable, respectable and able source. This article is the first of a series of 6. The writer is a graduate of the Hahnemann Medical College of Chicago, and the Registrar of that institution speaks well of him. We have seen the report of his examination before the Illinois examining board, which was very creditable. We have made inquiries of some of our subscribers in Peoria, as to his personal and professional character, and we have been able to learn nothing of him except what was in his favor. So we feel safe in presenting to our readers matter from his pen; and we believe that many of our readers would like to learn something of osteopathy from a reliable source.-ED.

We

neither, but look for a third fact that will reconcile the two. This we are apt not to do. If we are allopaths and know that opium will cure diarrhea, we are apt to think it can be of no service in constipation. If we are homeopaths and know that croton oil is curativ in certain forms of diarrhea, we are apt to deny its usefulness in all cases of constipation. should reject neither of these facts, but should look for a third fact that will reconcile them. Likewise, if we are an advocate of drug therapeutics, and know that both opium and croton oil are of service in both diarrhea and constipation, we cannot deny the ability of the osteopath to cure these same conditions by methods peculiar to his system, until by repeated trials we have demonstrated that such cannot be done. I am not ready to say that diarrhea, constipation, and many other conditions may not be cured by antipathy, allopathy, homeopathy, osteopathy, hydrotherapy, electrotherapy, or even by Christian science. The thing for us as therapeutists to do is to search for the third fact that will reconcile these seeming contradictions, and to determin, if possible, to what class of cases and patients each of these therapeutic measures is best adapted. These facts can be determined only by clinical experience, and until the results of such are at hand it were wise to not become dogmatic. We should not forget that "I do not believe" is as dogmatic as "I do believe."

When I assert and attempt to prove by logical deduction from recognized anatomical and physiological facts that all pathological conditions of a curable nature may be favorably influenced by osteopathic methods, and even tho ample clinical experience by competent observers confirm these deductions, it by no means follows that these same results may not be obtained by other therapeutic measures.

66

With these introductory remarks, I will define osteopathy not as A system of quack medicin in which diseases are treated by manipulating the bones," as given by Dorland in his medical dictionary, but as a science and art of treating diseases mechanically, by readjustment of tissues to their normal relations and by stimulation and inhibition of nerves and nerve centers.

To the recognized methods of treating the grosser osseous lesions such as fractures and dislocations, osteopathy adds little either in theory or technique, altho the correction of such lesions being mechanical are a legitimate part of this system. To minor and operativ surgery osteopathy adds little tho often curing, without resorting to operativ measures, certain conditions that are considered surgical. It is to the pre-operativ stage of so called surgical

cases, and to that great class of diseases that fall within the province of the physician, that osteopathy brings new diagnostic and therapeutic measures productiv of such satisfactory results to both patient and physician. What

are these new diagnostic and therapeutic measures, and how are such results obtained? A review of a few anatomical and physiological facts will enable us to give a more concise and intelligent answer to these questions.

Gerrish gives the following as the origin and distribution of the spinal nerves, taking them "as the type on which cranial nerves also are planned. They originate in the spinal cord by two roots, an interior or efferent root and a posterior or afferent one. After emerging from the cord these roots unite forming a mixt nerve. This mixt nerve passes out thru the intervertebral foramen, after which it gives off a recurrent branch, which receives fibers from the sympathetic system, and re-enters the spinal canal supplying the vertebrae, their articular surfaces, ligaments, blood vessels and meninges. The tissues supplied by this recurrent branch makes its importance out of proportion to its size. After the recurrent branch is given off, the spinal nerve divides into a dorsal and ventral division, each of which receives communicating branches from the sympathetics. The dorsal division passes backward and supplies the posterior spinal muscles, the integument and other tissues in that region. The ventral division passes forward and supplies muscles, integument, and other tissues in the anterior part of body, and thru plexuses sends branches to the internal viscera and tissues. Thus the three divisions of the spinal nerve arise from the same nerve center or centers in the cord, each receives sympathetic fibers, and each innervates separate and distinct areas and tissues. So intricate and complete is this nervous association of the various parts of the body that Kellogg says that every area of the skin periphery is associated thru the nerve center which supplies it with nerve filaments, with some special visceral periphery or vascular area. Hilton shows the same nervous connection between internal and external tissues when he says, "the same trunks of nerves whose branches supply the group of muscles moving a joint, furnish also a distribution of nerves to the skin over the insertion of the same muscles, and the interior of the joint receives its nerves from the This is equally true of other tissues on the surface of the body; they are all associated thru some nerve center with some internal structure.

same source.

Kirk, in his Physiology, says: "One of the chief functions of nerve cells appears to be the power of sending out impulses to the periphery

along efferent nerves in response to impulses reaching them thru afferent nerves." In fact, we may say that all the socalled involuntary bodily functions are the result of this reflex activity. Afferent impulses pass to their center, are transformed and sent out as efferent impulses (trophic, secretory, inhibitory, or motor) along efferent nerves arising from the same center. If the afferent impulse is sufficiently strong, the corresponding center of the opposit side of the cord is likewise affected and a bilateral reflex results. If still stronger, other centers are involved until all the muscles of the body are thrown into activity. Kirk further states that muscular contractions produced by reflex activity are often more sustained than those produced by direct stimulation of the motor nerves themselves.

As we have seen, efferent fibers from a nerve center pass in three principal divisions, consequently impulses reflected from this center will pass in these three directions, and the tissues supplied by these three nerve divisions will be affected regardless of the route by which the exciting afferent impulse is conveyed to this particular center. Abnormal impulses from a diseased viscus pass to the associated center or centers, and other abnormal impulses are reflected out, not alone over the fibers passing back to this viscus, but also over the other fibers passing from the center or centers, which fibers, as shown, supply tissues in other parts of the body. As a result of such reflexes, abnormalities or secondary lesions are set up in these other tissues. Regardless of the location of the primary trouble, the tissues in and along the spinal column will be particularly affected, as two of the three nerve divisions mentioned supply these parts, sending branches to the vertebra, the vertebral articulations, the muscles moving them, the skin over these tissues, as well as the meninges of the cord. These secondary lesions may take the form of congestion, inflammation, increast or decreast functional activity, with resultant muscular, ligamentous, or fascial contractions or relaxations, trophic changes, etc., the resulting lesions depending on the tissues afflicted and the nature of the primary lesion. Congestion and inflammation with soreness and tissue contractions are more markt in recent cases, while contractures, relaxations, trophic changes, and bony subluxations are prominent in chronic conditions.

Unless these impulses are of sufficient strength to affect the corresponding centers on the opposit side of the cord, these reflex secondary lesions will be confined to that side of the body from which the afferent impulses

arose.

Lesions similar to those just described as

secondary to visceral abnormalities may result primarily from traumatic or other causes, in which case the viscus will be affected secondarily. A recent case illustrates well this fact. A patient in whom repeated analyses of the urin had shown nothing abnormal received a severe sprain of the back about the eleventh dorsal; urinary symptoms developt and albumin was found in the urin for about two months, or until the lesion produced by the sprain was removed by appropriate treatment. The albumin then disappeared and has not since returned.

Abnormal conditions along the spine, especially areas of tenderness, as associated with internal disorders, have been observed by others than osteopaths. The lame back with uterin and kidney trouble, and the pain under the right scapula indicativ of hepatic disorders, are known even to the laity. DaCosta in his surgery says of gastric ulcer: "The pain is very violent in the abdomen and also passes to the back, being located between the eighth and ninth lumbar vertebrae" (he evidently means dorsal instead of lumbar). Hilton, in his "Rest and Pain" notes the frequent association of sore spots along the spine and many internal disorders. He seems not to have determined the exact pathology at these points in many cases; but only to have concluded from the pain and tenderness that some abnormality existed there. Absolute rest in bed was his chief treatment, and by this means he succeeded in curing many cases after ordinary methods by other physicians had signally failed.

Perhaps no more concise and convincing consideration of this subject has come from a medical source than that given us by the late Dr. Hammond. In his treatise on diseases of the nervous system, and more particularly in his monograph on "Spinal Irritation," he gives the results and conclusions arrived at from his personal examination and treatment of one thousand cases, with nearly as many from other eminent observers. His observations may be summed up as follows: (1) That areas of tenderness along the spine are common, and to use his own words, those who refuse to believe it "must necessarily belong to one of the following categories: Their experience must have been very limited and therefore they cannot see, or they must have been endowed either with restricted powers of observation or with minds so constituted as to cause them wilfully to close their eyes to the facts that they did not care to see." (2) That the patients in many cases are unaware of the existence of these areas of sensitivness until called to their attention by an examination. (3) That this sensitivness may be seated in the muscular, cartilaginous, liga