The heart presented no structural lesions. There was no congestion of the lungs or bronchial tubes. The liver was very much congested and the great hepatic vessels leading into the ascending vena cava, and the cava itself were perfectly engorged with blood. The superior cava as well as the right auricle of the heart was also engorged with blood. There could, therefore, be no doubt as to the cause of her death. The clot had so plugged up the ventrical that the blood could not reach the lungs in sufficient quantities to sustain the wants of the system, and the flame of life was literally extinguished for want of blood.

In reflecting over this case, you will discover three things that may be regarded as diagnostic of heart clot.

First. The want of accordance between the pulse and heart in point of force; the first being very small, jerking and intermittent, while the latter was violent and persistent.

Second. The peculiarity of the respiration, and the distressing character of the dyspnoea. The most extreme case of pulmonary obstruction I ever met with could not rival it in intensity.

Third. The posture of the patient. I have for years observed verified it by post-mortem, that individuals suffering with heart clot of recent and sudden formation commonly seek a posture similar tomy patient. They almost instinctively turn upon their breast, and strive to get their head lower than the chest.

Cases like the one we have just described are pregnant with instruction. They teach the practitioner to be on his guard and use every instrumentality in his power to avert syncope in individuals attacked with sudden and profuse hemorrhage. Persons may, and do frequently die from excessive hemorrhage, but I believe more die from its sequels, and heart clot may be ranked as one among the chief.

In patients laboring under hemorrhage from miscarriage, it is bad practice to allow them to waste until the failing pulse, hurried breathing, cold and clammy skin, and blanched countenance, speak in language not to be misunderstood that she is on the verge of syncope. Every effort should be made to staunch the bleeding. It is true this is not always easily accomplished. But it should be attempted promptly, and our most reliable therapeutics should be employed at once. The tampon I regard the most efficient of all our instrumentalities in this case. Opium, ergot, acetate of lead, per-sulphate of iron and cold water, are

ood auxiliaries, but he who depends upon them exclusively, is leaning upon a broken reed, that will fail him when he most needs help.

ART. IV. Iodine an Antidote to Strychnine.

BY JAMES I. ROOKER, M. D., Castleton, Marion Co., Ind.

An article appeared in the Lancet, for June, (re-print), by Henry Wm. Fuller, M. D., Senior Physician to St. George's Hospital, entitled, Iodine an Antidote to Strychnine, and the Impropriety of Prescribing Quinine or Strychnine with Tincture of lodine.

The Dr. remarks: "In the course of my practice it has often occurred to me to prescribe a mixture containing quinine or strychnine, together with tincture of iodine," and have not been aware of any incongruity in the dispensing of it until last summer a chemist called my attention to the fact that it is impossible to dispense a mixture containing strychnine and tincture of iodine.

In whatever sequence the ingredients are mixed, I find that the whole of the strychnine is precipitated by the tincture of iodine. Indeed, so strong is the affinity between these two ingredients, that the two fluid drachms of tincture of iodine are capable of decomposing six fluid drachms of the liquor strychniæ, producing an insoluble compound of iodine and strychnine. "Now it is obvious that for medicinal purposes, a mixture in which such a precipitate occurs must be almost valueless. The patient not only loses the benefit of the quinine or strychnine, but of the iodine also. It is not unreasonable, therefore, to lay down as a rule, that tincture of iodine ought not to be perscribed in a mixture containing either of the above named alkaloids. Another question of practical importance arises out of this observation. May not a dilute solution of iodine be advantageously given in cases of poisoning by strychnine." Coming from so high authority the suggestion favorably impressd me, and, inasmuch, as I had been called a few times to administer to those suffering from strychnine poison, and finding all my efforts proved futile, induced me to institute a series of experiments on the lower animals. In order to further test its antidotal properties, I, therefore, procured three healthy pups, of the same age, twelve young rats, and two kittens. The two first experiments

were upon two pups. First took strychnine gr., water zij, tincture iodine, zi, at a dose for the first ten minutes. The only perceptible effect was frothing at the mouth, gnashing the teeth. whineing, and shaking the head. In fifteen minutes falls down, laborious respiration, heart's action increased. Twenty minutes, tetanic spasms-violent, gave 3i, tincture iodine diluted with water at a dose; thirty minutes no perceptable change for the better, in short geting worse, a touch or noise producing violent spasms; death threatened from asphyxia. Forty minutes, much worse; commenced the administration of chloroform by inhalation; breathing became regular; heart's action more quiet; appears as in a quiet sleep. As soon as the effect of the chloroform passes off, all the former symptoms return with the same violence. The only effect of the chloroform is palliative. I continued the administration of chloroform for three hours; it was then discontinued. Spasms returned at once with renewed force, and death came to its relief in a half an hour from asphyxia.

Second pup, gave Sulph Strychnia, gr., water, zij; attacked with the peculiar spasms in five minutes. Twenty-five minutes, gave tinct iodine zi, in water. Thirty-five minutes, still geting worse, chloroform administered for three hours, when discontinued death followed in twenty minutes.

Post-mortem examination twelve hours after death in each case. First pup-Stomach full of indigested milk; mucus membrane healthy; could not detect with starch any trace of iodine, or of strychnine, by the taste, gall bladder ruptured; right heart contained dark blood, with fibrinous clot; left empty; no further examination made. Second pup-Same condition, except gall bladder entire, but empty.

Third Experiment.-Pup-Gave sulph strychnia, gr., water, 3ij; attacked with tetanic spasms in two minutes; left to itself; died in two hours apparently from exhaustion and asphyxia.

Fourth Experiment.-Twelve young rats-Gave Hall's Solution Strychniæ, ten drops to the first six: the other six, same amount strychnia containing equal amount tinct iodine; all died in one hour.

Fifth Experiment.-Two kittens, same age-First, took zi, Hall's Sol. Second-Hall's Sol. 3i, tincture iodine, zi, water, zi; administered to both at once. Both died in two hours, in violent spasms.

REMARKS.-These experiments were roughly made by one not accustomed to it. Still they go so far to show the inertness of iodine as an antidotal to strychnine poison. But I do think that no intelligent physician, called to treat a case of this kind, would be so blind as not to see the indication for chloroform.

ART. V.-A Case of Triplet Birth.

BY S. M. RYKER, M. D., Lebanon, Ind.

I was called on the morning of the 11th Feb., 1868, to visit Mrs. W, aged 35, sanguine temperament, who was in labor with her second child, but who added, before the labor was completed, three children to her family. I am not induced to report the case on account of anything remarkable in either the case itself, or the treatment adopted; but simply to report a case of triplets. The head of the first child presented favorably, and the os uteri and soft parts being well relaxed, it was born in twenty minutes after my arrival, the Tuniculus Umbilicalis being wrapped around the neck. The breech of the second child presented, but was delivered in fifteen minutes after the first-cord around the chest. The head of the third one presented, was delivered by the second pain after the second child was born-cord around the neck. Upon examination, per vaginam, found but one placenta large, and adhered at all points to the fundus of the uterus. Feeling assured that it could not be expelled by the natural efforts of the uterus, I cautiously introduced my hand into that organ, and with the fingers pulled it off from its adhesions, and delivered it at once. A little friction over the region of the uterus arrested all hemorrhage, and the lady had a "good getting up," without a single untoward symptom, and was, in four weeks, attending to her household duties. The children-two male, and one female -are all doing finely, and weighed at birth, respectively, six and a half, seven. and eight pounds.

ART. VI.-Case of Suppression of the Menses of Ten Months Duration, from Imperforate Os Tinca, Complicated with Retroorsion.

BY J. A. EASTMAN, M. D., Brownsburg, Ind.

I was requested by Dr. T. A. Graham, to see Mrs. Maged 38, June 30th, 1868, suffering from severe bearing pains simulating thoso of labor, for the past three days, and was informed by the Doctor, that he had attended her in labor about one year previous, and that the labor not progressing properly, after eight hours another physician was called, and delivery effected by the forceps-the child being dead. Vaginitis followed resulting in a very large vesico-vaginal fistula. Nothing more was heard from the case, except that she had consulted several doctors as to the propriety of an operation, none having been performed. On reaching the case, she expressed herself, that she felt as if each approaching pain were approaching death. On further inquiry into the history of the case, I learned that she had had similar pains about six weeks from her last labor, and that they had increased at every monthly period since. Health very much broken down; bowels costive; urine passing in quantity whenever she made any decided effort at stool, jarred the pelvis by stepping, getting out of bed, etc.; hypogastric region slightly enlarged with fluctuation. On passing the finger per vaginam, it came in contact with a tumor filling up the vulva and pelvis. The parts being intolerant of further manipulations, I gave a brisk purgative, and left her until the bowels should be moved, there having been no action in six days. When I returned, accompanied by Dr. Graham, we found that the bowels. had moved, but no cessation of recurring pains. We placed the patient on her back, administered chloroform, and proceeded to decide whether we had to deal with a bladder prolapsed through the fistula, a polypoid tumor, or retroverted uterus, distended with menstrual fluid, and filling the entire pelvis. Passing the finger into the vagina up to the fistula, and a catheter into the urethra, I found the bladder in its proper place, except that the tumor crowded it slightly upward. When I withdrew my finger a quantity of urine followed. I then passed two fingers up on the left side of the tumor, and could feel what had, at some time, been the os, and soon determined that the uterus was distended as large as it should be with a fœtus at four months, retroverted and so twisted as to place the os in the left iliac fossa. I readily