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Thoughts About Obstetrics. Editor MEDICAL WORLD:-I was very much impresst with an article in the March number, pp. 114, "Obstetric Experience," by H. C. Sanders, M. D. The doctor certainly has had an unusual experience. In the first place, it strikes me that the per cent. of abortions and premature births is high, and that I should look upon so high a per cent. with much more suspicion than does brother Sanders. He seems to look upon but three out of fifteen with any degree of suspicion. In rapid labor and twins, I find his experience much the same as mine. But tedious labors, lasting two days or more, twenty cases, or one in every five cases, seems much too high. Dr. Sanders did not state the cause of the delayed labor, neither did he say whether or no the patients were in active labor during all this time. Forty-eight Forty-eight hours or more seems a long time to allow

a

woman to suffer, unless the circumstances governing be entirely beyond control. I find the presentations found by Dr. Sanders are about in keeping with my own experience, but again, the number of still-births exceeds mine by 50 per cent. or perhaps more. The doctor has also encountered placenta previa three times in a hundred. It has never been my misfortune to meet with a single case. He has seen as many cases of eclampsia as I have-one. "Os closed by adhesions," none; eight cases in which it would probably have been best to use forceps." Why did he not use them?

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Forceps (next to chloroform) do more to relieve suffering than any other agent. I use them in 10 per cent. of my cases, and have the first bad result yet to obtain. It has long been a question with me whether a man could be justified in sitting idly by and see his patient suffer for hours when he has at his command an instrument so powerful for good when properly used.

Dr. Sanders has been fortunate in preventing rupture or the perineum in so large a proportion of cases. My experiMy experience has been that in all primiparæ we have rupture to a greater or lesser extent. While it is not at all uncommon in multiparæ, I have never yet had a rupture to involve the sphincter ani. I wish to add that these ruptures are not due to the use of forceps, as I have failed to notice any difference in cases where forceps have been used over those in which they were not used.

The cases of adhered placentæ, as set forth, are a very fair average. I think 83 per cent. a little high for retained placentæ from lack of proper contraction, etc. As is also his experience with postpartum hemorrhage, I have never met with

but about three cases that were in the least alarming.

I have never had a single death during the puerperal state, nor from its causes. Have seen but one typical case of puerperal fever in my own practice. I do not use any medication, prior to confinement, in more than perhaps 2 per cent. of my cases. During labor I find more use for chloroform than any other drug. This I use freely in the first stage. It aids greatly in dilating the os by its relaxing influence. In the second stage it lessens the suffering, and as the head sweeps the perineum, if possible I give it to complete anesthesia, thus enabling the mother to pass thru this awful ordeal without even knowing what has happened. The "classical ergot" I use only when absolutely indicated. I use it more before than after delivery.

I never allow a placenta (at full term) to remain six hours, very rarely more than half an hour. In abortion, I allow it to remain (if not expelled) unless untoward symptoms present themselves, when I proceed to the proper methods.

This article is not offered as a criticism of Dr. Sanders' article, but to show the wide difference in the experience of two men. The foregoing is based on about 600 cases. (I have not got a complete record of my cases.) I consider this a pretty fair showing. Can it be possible that I chanced to have only fortunate cases? I do not claim to be an expert accoucheur, but only an every-day Hoosier doctor, and, like brother Sanders, in a "rooral deestrick."

Andrews, Ind. J. C. BUCHER, M. D.

Possible Neoplastic Growth of the Cervical Region.

Editor MEDICAL WORLD:-Permit me to present the following case for consideration :

Mrs. B., age 24, has never had a child, of small stature, fair complexion, came of healthy parentage, menses regular and normal. About seven years ago the lymphatics under her left ear began to enlarge and kept growing until they reacht the size of a hickory nut before she applied to her family physician for treatment. She derived little or no benefit from the treat

ment given. The glands kept on enlarging until the neighboring glands became involved and took on the same slow process of enlargement until at this writing the entire lymphatics of neck and face are enormously enlarged, and seem to yield to no plan of treatment, either local or constitutional. There is no indication of suppuration, and but little tenderness. We have gone thru the entire family of iodids, electrolysis, cod-liver oil and other alteratives without any beneficial results. Have given Aulde's Nuclein a slight trial, but not a sufficient quantity to pass upon it as a curative remedy.

Outside of the lymphatic trouble her general condition is perfectly normal. She does her housework and takes plenty outdoor exercise.

Would there be any danger in vaccinating this patient?

Any suggestions will be very highly appreciated. D. C. DARNELL, M.D.

Grand Saline, Tex.

[This case presents many characteristics of a neoplastic alteration of the glandular structure of the region involved, which may soon develop malignancy. It is not advisable to treat too much before forming a conclusive diagnosis, and this is impossible to make without inspection and a very close observation. We should ad. vise sending the patient to some hospital for diagnosis, and would not venture to express an opinion upon the data afforded. We do not think that vaccination would be contraindicated so long as evidences of malignancy have not developt, but it is always well to have the person vaccinated in the best possible physical condition. ED.]

Puerperal Eclampsia.

Editor MEDICAL WORLD:-I was called February 4, '99, near midnight, to Mrs. M., age 22 years; primipara. Messenger said the lady was having fits. On arriving I made a digital examination, and found a rigid os and no dilatation at all. She was having a convulsion about every fifteen minutes; very severe. I administered chloroform, gave a hypodermic of morph. sul., gr., atropin 1-150 gr., and sent for counsel. Dr. T. C. Dollens, of Trinity Springs, Ind., arrived that afternoon at 4 o'clock, and on consultation we put her on tr. veratrum viride (Norwood's), one-half teaspoonful every ree hours, and bromidia (Battle's), tea

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spoonful every three hours, alternately with the veratrum viride, with directions to double the dose of veratrum viride in case convulsions continued. On my return the next day, about noon, her husband informed me that he had doubled the dose three consecutive doses. She was lying semi-conscious, with occasionally, every thirty minutes, a light convulsion. I continued the treatment, adding acetate of potash and buchu as a diuretic, and calomel, podophyllin and jalap as a cathartic, giving her on this visit an injection of onehalf gallon of warm soap suds high up in her bowels. On returning the second day, found her resting well, passing urine copiously and bowels having moved four or five times copiously. I lessened the dose of veratrum viride and bromidia, but continued the diuretics and cathartics. On the third day she was entirely rational, but I kept up the veratrum viride and bromidia in fifteen drop doses alternately every four hours for about four days, and also the diuretic, but changed my cathartic to cream tartar, podophyllin and jalap every night at bed-time. Kept up diuretics and cathartics until March 30. '99, when I was called in haste, messenger stating that the lady was suffering intensely. On examination. I found a very rigid os and scarcely any dilatation, but pains regular and bearing down in character. Gave chloral and gelsemium; also kept os completely bathed in a belladonna ointment, and kept worrying along with her until April 1st, when Dr. Dollens was again called in.

We decided to continue the treatment and wait, and on the morning of April 2d I was called again, and this time I successfully delivered a 64pound girl. Both mother and child doing well. I am thoroly convinced of the merits of veratrum viride in puerperal eclampsia, but I also push diuretics and cathartics (not laxatives).

My favorite diet in this condition is skimmed sweet milk, with a little limewater added. Have the patient drink freely of it.

Success to THE WORLD, one of my monthly consulters, each number being worth the subscription price for, the entire year. B. C. WRIGHT, M. D. Indian Springs, Ind.

WORLD for four years for $3.

WORLD one year and Dr. Waugh's book, $5. You need them both.

Don't neglect to send all notes on treatment. They will be of value to somebody.

An Easy Cure for Fistula, etc. Editor MEDICAL WORLD:-My experience with a scrotum filled with knotty cords and varicose veins and a discharging fistula in ani after ten years of annoyance and in which I secured a complete and permanent cure of both within 60 days without the knife or medicine may be useful to some member of the profession, hence I give it as it is very simple and can be performed by anyone with ordinary intelligence.

First place a permanent band or belt around the waist, supported by straps over the shoulders to keep the belt in the proper place. Then fasten to this belt behind a cloth about six inches wide; bring this cloth between the legs and up in front, leaving a hole for the penis to protrude but not the scrotum. Pass this cloth under and over the belt and fasten firmly. Place a wad of cotton or a cotton ball that it will rest firmly upon the rectum and be held there tight by this cloth. This must be done so that, no matter what the position day or night, there will always be a firm pressure upon the rectum and the scrotum will be held firmly up in place.

At stool this cloth must be unfastened and removed in front and the rectum

washed clean and then the cloth replaced.

By this method there was but little trouble or inconvenience, and cure resulted in 60 days. The knotty cords and varicose veins had disappeared and the fistula was well. Two years have passt and no return of the trouble and manhood restored. OLD PHYSICIAN.

Three Aged Physicians.

Editor MEDICAL WORLD:-Joseph Weeks, M. D., of Mechanicsburg, Henry Co., Indiana, Daniel H. Stafford, M. D., of New Castle, Henry Co., Indiana, and R. H. Homer, M. D., of Knightstown, Henry Co., Indiana, graduated about the same time in a Cincinnati, O., College, and are all in active practice in Henry County, Ind. The youngest of the three will be 80 years old in a very few months, and all now enjoying good health.

How is this for Henry County? Is there such a thing in any other county in the United States? R. H. HOMER, M. D.

Knightstown, Ind.

[This is a very unusual case of coincidental longevity and we hope all three of the doctors mentioned "will live long and prosper." Is the Fountain of Youth located in the Hoosier State?- ED.]

Atropin in Pneumonia.

Editor MEDICAL WORLD:-I had a case of pneumonia in a child six months old. The child was blue, cyanotic, and in articulo mortis. I gave 1-30 of a grain of atropin hypodermically over the heart and in ten minutes the cyanosis had disappeared. I then gave the child white of egg, brandy and water, and a little sugar every half-hour for twelve hours. child recovered. I would like to know whether any of your readers have had experience with atropin as a respiratory stimulant, and whether Jas. Milner Fothergil's statement that children bear large doses of belladonna is proved in practice. New York. ARTHUR A. COTTEW, M. D.

The

A Case in Practice.-Endarteritis With Sequel of Senile Gangrene.

Editor MEDICAL WORLD:-February 7 I was called to see James N., aged 71, whom I found with a temperature of 98°. The right foot and leg half way to the knee was as black as a boot and shrunken and shriveled to half its normal size. The live portion, about half way from the knee down to the ankle was a swollen and

slufing mass, and stinking worse than

valerianic acid. I at once took in the situation and informed the patient and friends that the only recourse would be an amputation, at the same time informing the friends that the chances for recovery were slim even if the operation would be done.

The previous history of the case revealed that some time in September last the man had a paralytic stroke of the right side, which affected his mental faculties. After treatment the paralysis and mind were both improved in a corresponding degree. About this time as his mind and appetite began to improve the friends began to notice that his feet began to swell, he began to complain of pain in these extremities, and in a few days after the foot began to turn black and shrivel. Physicians to whom they went for medicine informed them that it was "bone gangrene and so the case ran on for days and weeks until, about December 15, the line of demarkation began to assert itself and active slufing began.

I took the case February 7 and immediately put the patient on strychnin arseniate (Abbott's granules) five per diem, and in. structed the attendants to give him a lib. eral and nutritious diet. I told the friend

that if left to my judgment I would put the patient in the best possible shape by building up the system and then amputate. Death was inevitable in the case if left in that condition; yet even at the advanced age of 71 with a tainted condition of the system and a probable endarteritis as the prime cause of the gangrene, with an amputation of that slufing limb I thought there was more chance for recovery than to leave the morbid mass to taint the entire body.

My

February 20 I amputated the limb as close to the knee as I could without opening the joint, one and a half inches below, just missing the fibular attachment with the saw. We found the arteries very hard to tie, as by the least tension upon them their walls would tear like rotten leather. assistant put the knots as far up on the arteries as he could by pushing back the tissues, and then we snapt on hemostatic forceps, and left them on to serve in drainage facility as well. We laid in a 4-inch drainage tube with the exit to the outer angle of the flap. February 26 we deemed it advisable to dress the stump; we found in the place where the hemostatics were left considerable pus. The drainage-tube was quite free of any accumulation. With slight tension the forceps came away bringing the torn end of the artery. The pus was laudable (of the Bliss variety). Tho we had made as near as we could an aseptic operation the stump lacked "union by first intention" by several degrees.

From this time on the patient grew steadily worse. Tho his temperature had not exceeded above 101, showing slight traumatism, brain symptoms ensued and appetite failed. Heretofore he had eaten well and relisht his food. The bowels became irregular, but the urine remained normal in quantity and appearance.

On my visiting the patient March 1 I found his condition absolutely hopeless, and from this date and until March 14, he took no nourishment but whisky and water. The reasoning faculties were becoming less and less each day and the vital spark was fast smouldering away. March 7 I found that he was bereft of his mental faculties, had a temperature of 95°, voided his urine in bed and the peristaltic action of bowels was lost. I, however, persisted in the use of strychnin arseniate granules as long as he could swallow and I attribute to this agent the extending of his days. Thru these days of decline of the vital forces the plastic deposits were carried on

almost to perfection in the stump, and in consideration of the restricted and defective circulation these processes were perfect tho they were slow. Only one spot on the flap showed any signs of mortification and it was removed on the tenth day and did not reappear again. The stump healed nicely up to the day of death.

My opinion is that this was a typical case of endarteritis, with the sequel of senile gangrene. The caliber of the arteries was so diminisht that the flow of blood thru their channels was obstructed, especially at some point above the foot and of course mortification took place. The brain lesion was also from the same cause, and the brain was anemic from the lack of blood supply.

The reader is referred to Bartholow in reference to this malady, also to Wyeth's Surgery, which has an exhaustive article on the subject.-Did we do our duty ? Persia, Iowa. DR. F. M. HILL.

Perineorraphy, Etc.

Editor MEDICAL WORLD:-The following brief notes are relative to my experience with the new local anesthetic, eucain. CASE 1. March 27, 1898, I was hastily summoned to see a Mrs. R.; sanguine plethoric temperament, aged 37, a primipara. I had been called to her a week before, when she expected to be confined, but when the "fullness of time" came it was a precipitous labor, and as I lived six miles distant, I could not get there in time. She was attended by an old lady, who, as soon as the placenta was delivered, found the perineum ruptured clear to the anus. She informed the husband and patient of the condition and I was sent for and an examination confirmed the midwife's diagnosis. As they desired an operation immediately, I washt out sponges with a mercuric chlorid solution1:2000. The vagina was doucht with the same, and all parts rendered aseptic as nearly as possible. I plugged the vagina with a sponge, then with a hypodermic I injected in each external labium one fluid dram of four per cent. eucain solution. In two minutes complete anesthesia was produced. I introduced a perineal needle deep enough to catch all parts needed for continuity; used asepticised silk thread. Taking several stitches I approximated the parts and dresst them with iodoform. The urine was drawn with a catheter, and the bowels were locked with opii pulvis for five days, then opened with small

doses of olive oil. The thighs were kept together with a broad bandage, so as to keep the parts continuously approximated. Healing by first intention ensued and 10 days after the stitches were removed and patient dismisst. The eucain (B) did not sicken the patient; there was no acceleration of the pulse or rise in temperature; and to cap the climax, no pain.

CASE 2. A young man came to my office a few days ago suffering much from having the cortex of a large cane or reed thrust thru the ball of the third finger of the left hand. The offending substance was onequarter of an inch long and one-eighth inch broad, coming thru enough to elevate the root of the finger-nail. I injected 15 minims of a two per cent. solution of eucain (B) in the posterior part of the finger. In one and three-quarter minutes anesthesia was complete. With a sharp bistoury I incised down to the cane and with sequestrum forceps removed it. The patient said I could have cut his finger off and he would not have known it.

Referring to Case 1, I will say that the full results of an immediate operation cannot be fully exhibited unless the obstetrician fully understands the anatomy of the parts he is to operate on, and learns how to approximate divided surfaces by sutures carried up to the highest point at which solution of continuity has occurred. He must bear in mind the shape and dimensions of the body he is about to restore, remembering that the shape is that of a triangle, with the apex above and the base below. As to the time of operating, I prefer immediate operation; some do not. Harreldsville, Ky. J. S. TATUM, M. D.

"A Doctor's Wife" wishes to ask "the WORLD family" the following questions:

Can conception occur during menstruation? What effect does intercourse during menstruation have on the female? By what means can the menstrual flow be increast without the use of drugs? What drugs are most effective to produce an increase in the menstrual flow?

The Morphin Habit.

Editor MEDICAL WORLD:-As the morphin habit, or disease, more properly speaking, is becoming so prevalent, and since preventative medicine is one of the foremost subjects of the profession to-day, it seems not out of order to present some views on this subject. To an ordinary ob

server it might seem there is no necessity for any great demonstration on this subject, but when I say there are over 30,000 people in Chicago alone using some form of an opiate, and who have a drug-habit firmly fixed upon them, and that these habits exist in every other city in the United States in about the same proportion to population, it seems there is immediate demand of agitation of the subject, that further spread may be prevented if possible.

Some of the brightest men in the medical profession, who once held high positions and had remunerative practices, who knew perfectly well the action of the drug and the danger ahead, are victims to-day, earning barely sufficient to buy the morphin required to support them. No person is exempt from sickness, and in my experience in treating this class of cases for the past five years, over 90 per cent. have contracted the habit during some sickness, not even dreaming of such a thing until too late. One patient whom I now recall, was caught by using a muchadvertised nervine. When he first began using it he thought it a regular elixir of life, but soon found to his sorrow he could not live without it, and was finally advised by his physician to use morphin, as it was very much cheaper. Many of the much-advertised much-advertised patent medicines are made to sell, and the opiate they contain is the winning attraction. Another frequent source of contracting the habit, and especially is this the case among professional men, is that of taking morphin to quiet nervousness produced by liquor. When a drug-fiend attempts to stop the use of the drug there is at first a restlessness or indescribable nervousness which can only be realized by having seen or experienced. This nervousness seems to keep on increasing until the patient becomes really frantic, sometimes even to reaching a stage of insanity. The features become pincht, the hair disheveled, and the patient writhes in agony from aches and pains. Cold sweats break out, the patient complaining of a feeling of icewater running down the back, and oftentimes the night-clothes are dripping with this cold perspiration. From this the patient gradually sinks to a stage of complete exhaustion, and death sometimes ends the scene. Such is a perfect description of a case I was called to witness only one year ago, where all opiates were taken from a habitue of several years' standing,

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