Treatment of Pneumonia. Editor MEDICAL WORLD:- How can a doctor who sees his pneumonia patients once in 24 or 36 hours give veratrum viride, aconite or atropin, to say nothing of nitroglycerin and strychnin? We need something better. As you know antimony is the great remedy in pneumonia, and with opium, potassium nitrate, calomel, digitalis, blistering, counter-irritations with a good diet and good nursing, we will have all we need in nine-tenths of the cases we have to treat. With this treatment we will lose very few cases, at least such has been my experience since 1858. I am delighted to see so many articles on pneumonia.

I think THE WORLD has done much for us in the treatment of typhoid fever, and should never grow less." Salem, Va.

J. L. STEARNES, M. D.

Obstetric Experience.

Editor MEDICAL WORLD:-Following is something of my experience in obstetrics. I have attended about 100 cases. This number including abortions and miscarriages of which there was fifteen, three under suspicious circumstances. Rapid

labor (two hours or less) ten cases; twins, three; labor lasting two days or more, 20. Breech presentation, one; face, one; second of occiput, ten; occipito-posterior, and rotated with or without assistance, ten; children of viable age dead or died soon after birth, six; placenta previa, three; one lateral and two central, mothers all saved but barely, and children all dead when born; eclampsia, one; os closed by adhesions necessary to break up before labor would progress, one; cases in which it would probably have been best to use forceps, eight; used forceps in none.

There were twenty or more cases of laceration of the perineum, usually not more than half way thru the perineal body, some deeper but none thru the anal sphincter. No doctor ever took more pains to prevent lacerations than I. Somehow doubts come into my mind, when I

hear a doctor say that he never has any lacerations or puerperal fever.

There were three cases of adherent placenta and twelve of retained placenta from lack of contraction or irregular contraction. Of postpartum hemorrhage, eight; fever lasting three days or more, fifteen; deaths during puerperal state, one; supposed to be from internal hemorrhage, during fourth week after delivery.

My rule when engaged to attend a case is to inquire after the general health, and insist that the woman take a sufficient amount of mild purgatives, stronger if necessary, to keep the bowels free. The liver being active, I usually have but little trouble with the kidneys. If there is a leukorrhea, I depend on injections of warm water and zinc sulfocarbolate. For the ill-defined pains that many suffer from during the latter weeks, large quantities of tea, made from blackhaw bark, uva ursi and squaw vine, any one by itself or all together but plenty of it, seems to have given me the best effects.

During labor I find more use for chloral than any other drug. It lessens the severity of the suffering in normal labor, and if there are colicky pains, or if there is severe headache as there is sometimes, it is the thing. I have seen it have the most happy effect when there was intense headache with a weak irregular pulse. Combined with potassium bromid it has a better effect in some cases, the potash seeming to hasten the labor. I have never had a postpartum hemorrhage when the patient had taken as much as a dram and a half of fluid extract of jaborandi during three or four hours before delivery. I am convinced that the more aseptically the case is managed the less liability there is of fever following, but there will be fever sometimes anyway.

I depend on the "classical" ergot to get uterine contraction after delivery, not before. Sometimes giving as much as six drams within two hours after delivery. Since I have adopted a routine of giving ten grains of sodium salicylate with half a grain of calcium sulfid, four times a day for a week, in addition to other precautions, I have less fever.

I use chloroform during the propulsive stage, but usually not to complete anesthesia, and this does wonders. It seems in most cases to hasten rather than retard the progress. Nearly all placentas will come away with but little trouble if you give them time. See that there is no

hemorrhage and let the patient rest from half an hour to six hours rather than use radical measures.

Much of this may appear crude to many of THE WORLD's readers, but it is the experience of a young doctor in a "rooral deestrick." H. C. SANDERS, M. D.

Stantonville, Tenn.

A Report of Obstetric Cases During 1898. Editor MEDICAL WORLD:-On page 145, April, 1898, number of THE WORLD, is a report of my obstetric experience for the year 1897. I will supplement that by giving a report of the same experience for 1898.

I delivered 49 full-term babies, all living-27 boys and 23 of the contrary sex and 2 premature, both being dead before delivery, if not before labor began. All of the cases, except two, were vertex presentation, one of these being a breech and the other being a face presentation, the last being one of the premature births.

Instruments were used nine times, five cases being primiparæ, whose ages were from 23 to 36 years, and four being multiparæ, the oldest being 42 years and this being her fourteenth living child, the twelfth having been delivered with instruments by myself.

One of the primiparæ, aged 26, had been "bloated" she said for several years, but as I had never seen her before, and there had been no analysis made of her urine, I am not able to say to what this "bloating" was due.

When I was called, she was in active labor; her head was aching and face flusht and pulse full and throbbing. Her hands, face and lower limbs were very considerably swollen. Fearing convulsions, I gave chloral and potassium bromid, in anticipation, and they came not, neither did the baby. After giving Nature a fair show, and finding her inadequate to the task, I had the patient placed in proper position and delivered her easily and quickly with instruments. But now came the difficulty which resulted in her death-the only death from confinement occurring in my practice during the year, and the only one that has ever occurred where I had used instruments. The placenta was adherent thru its entire extent. Just here, I wish to say, I have been unfortunate enuf to see three such cases, except that in this case the placental tissue was much firmer than I have ever seen placental tissue before or since. It seems to me that the

best comparison I could make would be to say it was about the firmness of tender raw beef.

The illustrations in the books, with the description of peeling the placenta off from the interior of the uterus, make the process seem very plain and easy; but, from experience, I am sure that it is nothing like so easy as one might imagine from looking at the illustration and reading the description. Brethren, have you ever tried it, and if so, don't you agree with me? By the sense of touch, when the placental tissues are as firm as the uterine tissues and the two are so blended together that you cannot tell which is which, the peeling process is not only difficult, but sometimes utterly impossible.

This was the state of affairs in this case. I removed all I could without doing any harm, washed her inside and out with a bichlorid solution, tested her urine and found it loaded with albumin, put her on supportive treatment, and washed her out every day with a bichlorid solution, each day getting a little more of the placenta ; but, in spite of this, septic fever set in, and she died five days after confinement.

Could a fatal termination of this case have been averted had it been possible for her to have had the advantage of a modern hospital? I think not, when we take in consideration the condition of her kidneys and the placental complications.

Some of your readers may be ready to say, "Oh, you have used instruments entirely too often;"-nine times in 51 cases, or once to every 5 cases on an average. Well, it does look rather often, especially to the man who has been practising forty years and never used them in his life; still the cases, in my opinion, demanded it and I used them. By doing so, I am sure I did no harm and some good, caused no more pain than there would have been without them and saved much suffering, lost no life on account of their use, but no doubt saved some lives, both to mothers and babies.

Instruments are like chloroform, powerful-to do good when properly used to do harm in the hands of the ignorant. Anything that is powerful to do good is also powerful to do harm if not properly used. The idea of leaving things to Nature is all right when Nature is competent to do the work, but when she is not, then brush away the old adage, "avoid meddlesome midwifery," and do something-anything that needs doing, and don't fear violating

that old precept which could never be twisted into an excuse for "do-nothingism."

If Nature should have her course, why have a doctor at all? That simple fact shows that we don't propose to always leave things to Nature. Show a sensible woman an easier, quicker and safer or even as safe a way to pass thru the suffering of an accouchement, and she will take it, tho that way leads by forceps and chloroform. Chloroform and instruments, with asepsis, are saving lives to mothers and babiessaving suffering and apprehension to mothers, saving time and anxiety to doctors in a degree that was little dreamed of a decade ago. Still we have the old fogies with us who believe in leaving a poor, suffering woman to Nature, denying her the relief which it is possible to give by the two first and disregarding the dangers of neglecting the other. Still we have a few amongst the laity who will prefer good old Doctor

to an up-to-date doctor.

Possibly, we have a few who would prefer to travel in the discarded stage-coach to a modern palace-car. The difference is as markt, tho not so plain to all.

G. G. THORNTON, M. D.

Gravel Switch, Ky. Painful and Tedious Labors-A Suggestion. Editor MEDICAL WORLD:-I deem it my duty to report my experience in two obstetric cases which were decidedly out of the ordinary.

CASE I.-Mrs. S.- had given birth to nine children; four of these were stillborn after very tedious labors. Twice turning in utero had to be performed before. labor could be completed; twice forceps had to be used; once craniotomy had to be resorted to in order to save the woman's life; and all the labors were tedious and prolonged.

During her tenth pregnancy Mrs. S took liquor sedans, a teaspoonful three times a day, for several months, up to the day of her confinement, and the result was remarkable indeed. The labor was in every way a normal one, and the woman blesses liquor sedans.

CASE II.-Mrs. Khad given birth to three children. I attended her in the three labors. The first and second were very tedious labors, and the third a most difficult one. Forceps were used in the three labors.

During the fourth pregnancy, the woman took liquor sedans, a teaspoonful three

times a day, for a number of months, taking it up to the very day of her confine

ment.

The labor was normal, easy, and the patient was delighted with the result, due to her faithful use of the medicine.

Two cases in which this medicine proved of such remarkable benefit mean something, and the reason I report the cases is, if possible, to induce other practitioners to give the remedy a trial in similar cases -cases that are difficult on account of some defect in the uterus itself, rather than cases that turn out unfavorably on account of systematic diseases, such as kidney troubles. Jasper, Indiana. DR. E. J. KEMPF.

A Case of Superfetation.

Editor MEDICAL WORLD:-The following case seems to me sufficiently extraordinary to bring to the attention of your readers:

I was called in haste recently to attend a confinement case, arriving at 9 p. m. The head of the fetus presenting seemed unusually small, and the pains seemed located at an unusual height in the abdomen. The child was born at 11 o'clock, and presented the appearance of a sixmonths' fetus, but was living, however. Another head was presenting, and this child was delivered in about a half-hour, the second pain pushing it at least six inches from the vagina. The first thing attracting my attention was that it was heavily veiled." The placenta was delivered simultaneously with the last fetus.

Examination showed the last-born fetus to be no more than a four-months' one. Both children were given immediate attention, but the second lived only a few seconds, while the first-born survived three hours.

The mother stated that two months after the first cessation of her menses they again appeared, and she was sick as usual, having intercourse very near this time. Undoubted evidence from the appearance of the children convince me this is a case of superfetation. Can anyone give me additional information on this subject? O. H. FRANKS, M. D.

Seabrook, Kansas.

[The best authority upon cases of such unusual interest to the profession is "Curiosities and Anomalies of Medicine," by Drs. George M. Gould and Walter M. Pyle, of this city, who cite a number of

Editor MEDICAL WORLD:-To the inquiries of Dr. Bordner and Dr. Gore, page 77, February WORLD, I would answer that I have recently used iodid lime (Nicholls) prepared by Billings, Clapp & Co., in two cases of croup, with the happiest results. While I cannot make any predictions as what success will attend my use of it in the future, or land it as an unfailing specific, I must admit that I was highly pleased with it in these two cases. I gave it according to directions on nal ounce package, viz

origi

igr. x 3 iv

M. Sig. Shake and give teaspoonful every half-hour until relieved.

I will say, however, that Igave in each case, at intervals of one hour, a tablet composed of calomel, 1-5 gr., ipecac, 1-10 gr., sodium bicarb., 1 gr. till bowels moved freely.

Dr. Matchette, page 73, while entirely too radical in his views on the use of the clinical thermometer, demonstrates very forcibly the urgent need of more care being exercised for the protection from infectious diseases through this medium. usually keep several thermometers, and leave one with the patient having such diseases as typhoid fever, diphtheria, etc., and when I visit him I use his thermometer, not the one in my pocket.

I

Regarding obstretic work, I am convinced that there is no other line of work coming within the domain of the physician that is so completely surrounded with mystery and "hoodoism" as that of obstetrics, especially in the rural districts, and sometimes we are surprised to meet it in some of the more cultured circles.

I have been criticised for taking a pair of scissors and clipping a hole in the cloth for dressing the cord, the wise old granny shaking her head and reminding me that it should be burned thru with a red-hot iron. There are to-day scores of old women and midwives who think that the only proper method for the expulsion of the placenta is for the parturient woman

to blow into a long-necked bottle, never dreaming that it is the contraction of the abdominal muscles and downward pressure of the diaphragm that produces its expulsion, and that a cough or sneeze would do as well.

Many otherwise good physicians still oppose the use of the warm vaginal douche after labor. In all normal cases I like it for two reasons: It promotes rest and recuperation, relieves the parts of the accumulated debris, which, being disposed of, prevents, in a great measure, the liability of infection by the reabsorption of this putrefying animal matter. In normal cases I order a half-gallon water given three times daily, with fountain syringe, and use no antiseptic whatever. I always instruct the nurse to dip the vaginal tube in

boiling water just before inserting.

Regarding Dr. Newlon's case, on page 65, I would just remark that the location of the hairpin might arouse the suspicion that it was not "swallowed" according to the orthodox method.

As this is my first contribution to THE WORLD, I will close, lest I become tedious; and if this does not land in the wastebasket, I may write again.

W. M. WHEELER, M. D. Gray Summit, Mo.

[No danger of such practical notes from practice becoming tedious. What is wanted in medical journals is not fine writing, but the jewels of experience. Obstetricians are, in many instances, deprecating the use of the douche before or after labor, claiming that the vagina is naturally antiseptic thru its secretions and bacteria, and that the douche is likely to carry infection in rather than prevent it. Have you thought of this point, Doctor?-ED.]

Brown lodid of Lime.

Editor MEDICAL WORLD:-I notice in February WORLD a call for information regarding the iodid of lime and, being in possession of a few facts, gladly furnish

them.

This salt is a dark brown amorphous powder of powerful iodin taste and smell; it is unofficial and so far as I am able to determine, is not mentioned in any standard work on materia medica or chemistry. This is not the calcium iodid mentioned in the secondary list of the United States dispensatory. The latter is a pearlywhite crystalline salt when pure, while the brown iodid of lime is a dark-brown preparation. It is made by Billings, Clapp

& Co., Boston, who furnish the following information concerning it:

"Iodid of lime is a chemical compound discovered by James R. Nichols, of Boston, in 1855. It is a preparation entirely distinct from the iodid of lime of commerce. The latter is a stable salt of calcium and iodin, of light color and very little therapeutic value. Iodid of lime is an unstable combination of these two elements, of a very dark brown color with a large excess of iodin."

This drug has been heralded abroad as a sovereign remedy for membranous croup or croup of any character, for the last year or two. The first mention I ever saw of it was in the Medical Council of Philadelphia, and it was made by Dr. Lawrence of Kansas, in February, 1897. He quotes a letter from Dr. Beebe, and Dr. Beebe had a letter in the Medical Summary of March, 1894, in which he praises this drug as a specific in croup. Dr. Beebe in his letter to Dr. Lawrence says: "I have never lost a case of croup under this treatment, altho I have used it for 25 years. According to my belief, every death which occurs from membranous croup could be averted by this treatment if employed within a reasonable time. I have never known it to fail when it had a fair chance."

The iodin appears to be the true remedy in this combination. The drug is used as follows: Measure out 10 grains and dissolve it in four ounces of water; let the superfluous lime fall to the bottom of the container and administer one or two teaspoonfuls every 15, 30 or 60 minutes, according to age or severity, until the dry, hoarse cough is succeeded by the moist form, then give less frequently until the child is out of danger. Don't shake the mixture. Keep in the dark.

Dr. Gore in the February WORLD, asks for the formula of this compound. The manufacturers will probably retain this secret; they say it is made by a special process of manufacture, but don't tell what it is.

I desire to state that my experience is that this remedy is a "dead shot" in this trouble and that I have several clients who keep the remedy in solution at their homes ready for any emergency. may be done if care is taken not to expose it to the light.

This

The use of this drug in croup does not appear to be in its infancy. Why not have a symposium on it? Mosheim, Tenn.

M. G. PRICE.

La Grippe-A New Theory. Editor MEDICAL WORLD:-Little or no literature of la grippe was in possession of the profession when it swept in upon us, and only the thoughtful investigators could successfully handle it. It was, and now is, by many classt as a disease of the respiratory organs, but my investigations have convinced me that this classification is a mistake. I do not mean that the respiratory organs piratory organs are not involved, but that it is a disease of the central nervous system-of the brain and spinal cord. I mean that, as in diphtheria, the influence of the poison is exerted specifically against the brain and cord; and we believe the cord must be always more or less anemic to make an attack of la grippe possible. The poison exerted against the cord directly causes a degeneration or waste of the spinal nerve cells, thus impairing the functions of every organ under control of the nervous system. Hence we find the following symptoms: Great soreness of muscles, especially of the lower limbs, one or both sides; an affection of the muscles of the face, causing an annoying squinting and often preventing the adjustment of vision to different distances; dizziness or vertigo; irregular, irritable and very