allow Dr. Huber to remove the afterbirth; was not fully conscious; began to mutter; would sit up in bed and squirm around on the but tocks; throw herself down again upon the bed; would thrash the arms around like a windmill; would moan piteously, and continue to thrash around on the bed, now turning her head toward the foot of the bed and then almost immediately reversing toward the head of the bed. It was endeavored to arouse her to consciousness, to recognize her husband, children or friends, but to no purpose. She gradually sank; the thrashing about on the bed became more feeble; the pulse left the wrist and respiration became less and less. The Doctor and I recognized that as soon as she got quiet she would die. She died without ever regaining any degree of consciousness. The afterbirth was not delivered. The second babe was born dead and the right humerus was broken at or near the shoulder. I am certain I did not break it myself. There was some considerable flattening of the arch of the pubes, and the most prominent sacral promontory I ever had anything to do with. Why, it was what might be called a shelving projection of the sacrum. This was a most heart-rending case. We were powerless to save either the mother or second babe. The mother was a stout, robust woman and this was her fourth pregnancy.

I need not point out to physicians the lesson here taught. The husband's mother had "taken care" of several cases of labor and everything had gone well, but here in an unexpected hour fatality loomed up in her path. "I will laugh, sayeth the Lord, in the day of your calamity;" but this was no laughing matter to the helpless physicians and to the sorrowing young husband and to the consciencestricken old woman who had essayed to do that which the law prohibited her from doing. Will these doctors who are howling against the laws enacted to prevent such incompetents from "taking care" of women and to protect the lives of confiding puerperae continue to say that they are solely in the interest of "a few self-seeking political doctors"? Oh, come off! J. J. CONNER, M.D.

Pana, Ill., Dec. 10, 1905.

Puerperal Convulsions. Editor MEDICAL WORLD:-The article of Dr. Paul F. Ela in the December WORLD, page 489, calls to mind some similar cases in my experience, and his reckless use of morphin in those cases induces me to state how I managed them. The first case I ever saw occurred in the summer of 1856. Mrs. P. Sullivan was a stout, young, married woman, whose husband was a track laborer on the railroad. He left his home at six o'clock in the morning, and

did not return till night, consequently she was left alone all day, except when a neighbor happened to call. About the middle of the afternoon one day a lady called and found Mrs. Sullivan lying on the floor, senseless and having almost continuous convulsions. No one of course knew how long she had been in that condition, as no one had seen her since her husband left her in the morning. I saw her first about 4 o'clock p. m.; found her on the bed where the women who had collected placed her. She was scarcely out of one convulsion till another appeared, and was utterly senseless all the time. The first thing I did was to take a full quart of blood from the arm; this checkt the spasm; then I gave ten grains of calomel with half a teaspoonful of sodium bi-carbonate. Made an examination, and found that the labor was making some progress. I did not interfere, leaving the case to nature. Then I made a mixture of Epsom salt and cream of tartar, equal parts, and gave all we could get into her stomach, which was not very much because of her senseless condition. In two hours another terrible convulsion came, and again a large quantity of blood was taken. This ended the spasms, but she lay perfectly motionless and comatose till a pain would come (which was about every half hour), when she became terribly agitated, and it required three or four strong persons to keep her on the bed, but she did not seem to know what she was doing at any time. This continued till four o'clock the next morning, when a dead girl baby was born.

Till this time no medicin was given except as above stated, but now I began to give quinin, as every one in this region at that time was full of malaria, and it was necessary to give quinin in every sort of case. I continued the above named mixture to keep the bowels well relaxt. She still remained perfectly comatose for twenty-four hours after the completion of labor, when semiconsciousness appeared; but for three days from this time she was utterly insane, then gradually regained her senses and made a good recovery, and was in bed but one week.

Have seen a number of cases since that time and have made it a rule to bleed in every case when the convulsion came before the completion of labor, and never give morphin or opium in any form till after the termination of labor, and not then unless the mind is clear between convulsions.

Was called to a lady who had been in the care of an old midwife for forty-eight hours and should have been delivered hours before, and would have been had she had proper attention. Found nothing serious the matter, but the woman much exhausted. Soon delivered

a babe with the forceps; then found another, which followed in a very short time. The patient seemed all right, and I was about to leave, when a violent convulsion seized her. I at once gave her a hypodermic of one-third of a grain of morphin, which was all that was necessary; no trouble followed, and she with the babies got on all right.

Have used veratrum viride in some cases with good effect, and since the introduction of the bromids and chloral hydrate, have used them quite extensivly with satisfactory results. Chloroform is all right to modify the spasms, but it don't cure the patient. My formula for the bromids and chloral is: Potass. brom. 3 3, chloral hyd. 3 2, camphor water q. s. f3 4. Mix. Sig. Give a tablespoonful in water as required.

I have never seen but one woman die with puerperal convulsions, and I shall always believe she would have recovered if she had been properly bled.

Was called in consultation; found the case like several others I had seen-no worse; had been having spasms frequently for ten hours. I advised bleeding at once, but the attending physician and friends objected and the woman died.

To repeat, I say bleed in all cases when the fit comes before the termination of labor, and after, if the wasting has not been very free and if the patient remains comatose. I have sometimes bled the third time and have never had occasion to regret it. I believe the Epsom salt and cream of tartar mixture an excellent adjuvant, given to free the bowels thoroly, and it undoubtedly has a good effect on the kidneys. L. L. SILVERTHORN.

Charleston, Ill.

Treatment of Eclampsia. Editor MEDICAL WORLD:-Every pregnant woman whose urin gives the slightest indication of albumin should be immediately put upon an exclusiv milk diet. This regimen is the preventiv treatment par excellence of eclampsia.

When a patient attackt by eclampsia is vigorous and cyanotic, bleeding from four to five hundred centigrams is indicated, and should be followed by the administration of chloral. She should be put upon a milk diet as soon as possible.

When the patient is delicate, the cyanosis less markt, the convulsions less frequent, chloral alone may be sufficient.

Labor should be allowed to begin spontaneously, and to pursue its natural course whenever possible. If the contractions are insufficient, delivery may be accomplisht by version or by the forceps, if the child is living; if dead, by cephalotripsy, basiotripsy or cranioclasis.

Interference should be postponed until the parts are completely dilated, so that the operation may be performed without injury to the mother.

Labor should be induced in those cases only in which medical treatment has completely failed. Incisions of the cervix for the purpose of inducing labor, should never be attempted.

Eclampsia depends upon the association of two elements: Toxemia and heightened reflexes. Many cases in which reflex influences are the preponderating cause are relieved by delivery; others suffer from genuin toxemia, and die in spite of all treatment.

There is another class between these two in which treatment may be very efficacious. Unfortunately the symptoms are not easily differentiated. Chloroform is an important remedy when the convulsions are caused by reflex action; but its prolonged use may be dangerous when they are due to toxemia. Light, noise and cutaneous irritation should be avoided, and blisters, leeches, and bleeding are not recommended by some.

Milk is a great preventiv, and a curativ when the danger of convulsions is not imminent. As soon as the presence of albumin is recognized, milk diet should be instituted and maintained until after delivery, even when the symptom does not persist. Albuminuria is but a danger signal, and the danger may remain. after the signal disappears.

St. Meinrad, Ind.

N. A. JAMES, M.D.

Faulty Treatment of Pneumonia. Editor MEDICAL WORLD:-I have just finisht reading THE WORLD for November. This issue of THE WORLD has caused me to think. What a help it is to one of us little fellows to get a journal once a month that sets us thinking and helps us to think. I am now 52 years of age, have practised 30 years, hoping all that time that I should some day be a doctor; but I am yet a student. Several pages of the November WORLD are devoted to pneumonia, a very interesting subject to me. It seems that

no age, or sex, or environment, is exempt from this dreadful scourge. I am unable to give statistics as to deaths or recoveries from this disease for two reasons: First, I have kept no record of my cases; second, I may have been mistaken as to some of the cases being pneumonia. I am sometimes called to see a patient, find face flusht, respiration hurried, fever high, intense pain in one, sometimes both sides of the chest, tongue coated, urin scanty and highly colored, and troublesome cough. Began with a severe chill or rigor. At this time there is some resonance in all parts of the lungs, tho I hear crepitant rales. Expectoration principally mucus, tough, ropy, and tena

Treat Bill Perkins, Not Pneumonia. Editor MEDICAL WORLD:-Rarely do two physicians use the same therapeutic methods in the treatment of pneumonia. Dr. Bogart, page 484, and Dr. Kemper, page 485, December WORLD, treat pneumonia in about the same way. This is the eclectic method of treating the disease.

Dr. Whitman, page 483, treats his patients in an entirely different manner. He uses homeopathic remedies in low dilution. Now, the question arises in the mind of the layman, how can pneumonia be treated scientifically in such diverse ways? If Bill Perkins is sick, and his sickness is named pneumonia, shall we treat pneumonia or Bill Perkins? The scientific therapeutist will answer, treat the condition that you find, regardless of any arbitrary name which may be applied to it. Fit your drugs as therapeutic measures to Bill Perkins and his condition as you visit him from time to time, and change your drugs or other treatment as Bill Perkins' condition changes. It goes without saying, that the close observing physician will see that the conditions of the patient, Bill Perkins, require different treatment during the first, second, and third stages of pneumonia; therefore, Bill Perkins must be treated, and incidentally his pneumonia.

Dr. Bogart gives a mixture of veratrum viride gtt. v-x, bryonia gtt. viij-x, and asclepias tub. 3 ss-3j, in water 3iv. The specific medicins of the above represent 1 grain of the crude drug to the minim. The specific indication for veratrum v. is a full bounding pulse-i. e., sthenic condition. Indication for bryonia: pain or stitch in the side, worse on movement; that is, inflammation of serous membranes.

v.

Dr. Kemper uses aconite instead of veratrum

This is the remedy for asthenic inflammation, indicated by the frequent small pulse; but it should be remembered that neither veratrum nor aconite should be given when there is a weak pulse.

Dr. Whitman uses aconite in the first stage, followed by bryonia. In the second stage, phosforus.

Phosforus is indicated by a sensation of weight on the chest, frothy or blood streakt sputa. Sulfur is indicated in delayed resolution, or pus formation.

Dr. Whitman says: "Let the heart alone." This pre-supposes that the patient has been under treatment from the beginning. If the heart is failing, and the physician not called until the lung is solidified, what heart remedies should be given? The modern text-book mentions among the prominent remedies which influence the heart, digitalis and nitroglycerin.

The indications for digitalis are:

a pulse of

low tension; intermittent pulse with cyanosis; i. e., relaxation of the vessels-dilatation. Digitalis is a very slow acting remedy, and is therefore not a remedy to be depended on in an emergency, being absorbed slowly, and requiring from 12 or 14 to 36 hours in order to get the characteristic effect of the drug. Nitroglycerin is indicated by a high tension pulse; i. e., it relaxes the capillaries and arterioles. Its action is opposed to digitalis.

In pneumonia we have an obstruction in the lungs, requiring the heart to perform an extra amount of work, plus septicemia, from absorption of toxins. The nerve centers are profoundly deprest by the toxic poisoning. The physiological heart remedy would be strychnin or capsicum or both; and for the septic condition, an antiseptic which would be eliminated largely by the lungs. Creasote carbonate is one of the new remedies of this nature. older practicians used the iodids of potassium or ammonium.

The

The older physicians used the jacket poultice. An old physician who had years of experience told me that he had many times witnest the beneficial effect of the jacket poultice, the solidified lung softening, and resolution commencing in from 12 to 24 hours after the application of the poultice. In my own case the hot poultice felt very grateful, and relieved the pain and discomfort, yet I realize that the poultice would kill a patient with feeble circulation thru the lungs.

Dr. Reed uses hot water bottles around the body and ice over the lungs and head. This treatment might do in selected cases. I should select a patient whose power of reaction is first class.

Then again, the treatment of a pneumonia patient in the high altitude of Colorado might differ from that of a patient in a low altitude.

Brethren, "Let us have the conclusion of the whole matter:" Study your patients, study your materia medica, and fit your treatment to the individual patient. Bill Perkins may have pneumonia on Wednesday, and he may have pneumonia on the following Sunday, but his condition may require diametrically opposit treatment; therefore, there is no treatment for pneumonia. Bill Perkins must be treated. Ipswich, Mass.

WM. H. RUSSELL, M.D.

Never attempt to reduce a Colles' fracture without administering an anesthetic. Nearly all cases of deformity following such fractures are due to failure to properly break up the impaction before attempting to secure alignment and apposition of the fragments. Short anesthesia gives ample time to do the adjusting thoroly and completely, and with all opportunity for satisfying oneself as to the accuracy of his work. Once a Colles' fracture is properly reduced, it is very easily retained in position, and any difficulty in retaining the apposition should at once arouse suspicion that the fracture is not properly reduced.

Homeopathy and "Regular" Medicin Compared in the Treatment of Pneumonia. THE WORLD:-In an editorial, page 433, on Pneumonia, you say:

"Altho the disease has been known for so long, and despite the familiarity of every physician with its manifestations, it has, as yet, defied the efforts of clinicians and bacteriologists. We are apparently little nearer its mastery than we were decades ago, and it is certain that our therapeutics, in this connection, must be conceded to be purely empirical, or at best only symptomatic, ***. Indeed, when the knowledge of the profession is summed up, the result is very unsatisfactory. We have absolutely no drug or method in which we can place any reliance in its power to influence favorably, either the septic condition or the process in the lungs."

The following is clipt from the Dallas (Texas)

News:

"Chicago, Ill., Jan. 28th. Drug treatment is useless in cases of pneumonia. The medical profession, so - far as medicins are concerned, can be of no assistance in the fight against this disease. The sooner the profession will acknowledge this to the public, and set to work to discover some specific to save pneumonia patients, the better for all concerned. This startling statement by Dr. Arthur D. Regan, who stands high in the profession, has stirred up the members of the Chicago Medical Society at their meeting. Several physicians sprang to their feet to protest against the arraignment. All had to admit, however, that there is no definit remedy known, and they based their protests solely on the contention that they might influence the patient favorably by easing him somewhat, and by the moral effect of their presence."

Here's what homeopathic authorities say. Fisher's Diseases of Children, page 663:

"If there be a disease in which the results of the homeopathic treatment as compared with the old school treatment are satisfactory, that disease is pneumonia. Osler is responsible for the statement that pneumonia is a self-limited disease, and runs its course, uninfluenced in any way by medicin. It can neither be aborted, nor cut short by any known means at our command. This statement is so exactly in variance with the testimony of homeopathic physicians whose word is considered equally as reliable with that of Osler, or any other old school authority, that we are justified in making the statement that homeopathy is far superior as a system of medicin, in this as in many other diseases in which the helplessness of the old school is freely acknowledged. For the clinical

course of pneumonia clearly shows that many, even severe cases, that seem to threaten disastrously, may terminate favorably, and it is a fact, that the ordinary case of pneumonia can be modified and abbreviated in almost every instance if proper medication be applied early. Just why this disease should be abandoned to its unrestricted and natural course is not understood."

Raue, Special Pathology, page 383, says: "The mean or average time which it takes pneumonia to run its course, if it is not interfered with by medicin, is as above stated, twenty-five days. But this average may, by judicious treatment, be considerably shortened, for pneumonia can be arrested in each of its stages."

Jousset, Practise of Medicin, page 786:

"The various treatments disturb this natural course and increase or diminish the duration of the disease." Arndt, Practise of Medicin, page 1007:

* the indicated remedy, selected upon homeopathic principles, does, nevertheless, cut short, and modify the course of pneumonia, reduce the gravity of the complications, and materially lessen the death

rate."

This comparison of ideas of both schools is

given without comment, to show the WORLD family that there is a better way.

Paris, Texas. G. F. THORNHILL, M.D. [Homeopaths treat the patient, and not the disease—that is, they treat symptomatically. When all doctors treat the patient ill with pneumonia rather than pneumonia, the results will be better.-ED.]

"Brains" vs. "Mud" in Chest Cases.

I

Editor MEDICAL WORLD:-I believe the use of the glycerinized clay poultice by physicians is more from fashion or habit than from a fixt belief in its therapeutic value. I have never used it on my own person except as a dressing for boils; the boils did not improve. The application was unsatisfactory, and a poultice of linseed was substituted with markt benefit. have sometimes prescribed glycerinized clay for my patients, but have never been able to satisfy myself that it was superior to any old poultice of domestic manufacture. I should, perhaps, make an exception that in inflamed and tender joints an application of the glycerinized clay has given better results than any other external treatment.

In colds, congestion of lungs, pneumonia, etc., an application of hot glycerin or camphorated oil to the chest and covered with a cotton jacket or pad of light material will generally prove useful, and may well be employed. The strongest claims for the glycerinized clay are that it depletes the tissues, is a protectiv, and does not have to be renewed often.

I have never been able to satisfy myself to what extent it depletes, if, indeed, it does so to any appreciable extent. It is evident that the evaporation is greater than the extraction of moisture from the tissues, or the poultice would not dry at all. Some of its disadvantages are that it is sticky, dirty, ar d nasty, and is removed only with great difficulty before it dries; and when dry it crumbles ard gets scattered over the bed and floor. It is too compact and too thoroly excludes the air from the skin. Its tendency is to sodden and debilitate rather than give the desired stimulation to the tissues. The poultice is too heavy. A case seen recently will illustrate: A child aged 2 years, ill with pneumonia, 52 respirations per minute, lying on its back, with a half pound of glycerinized clay spread over its chest; poultice to be renewed as soon as it would peel off. This was the fifth day of the disease, and the poultice had been on from the start. Now, suppose we do a little figuring. The little baby's chest muscles were lifting 26 pounds of dead weight every minute; 1.560 pounds per hour, and 37,440 pounds per day-as much as an able bodied man will move with a scoopshovel in a working day. Allowing the posi