No one but a bungler ever gives opiates for headache. The doctrine of auto-toxemia, the need of elimination, the use of nutritives, general and local, and the growing preference of the medical profession for preventive and sanatory measures instead of drugs, have greatly reduced the legitimate field of this most dangerous of remedies. The laboratory examination of the urine opens a field that mostly richly repays investigation. and makes a man feel what a bungler he has been before availing himself of this means of diagnosis.

The approach of the summer warns us to furbish up our armor and prepare our weapons for the inevitable battle with that redoubtable antagonist, cholera infantum. It is discouraging to read the long lists of deaths from this cause in the health-office reports, when one believes that nearly all could have been saved if only the doctors knew! Thousands have adopted the theory and practice of intestinal antisepsis, but so many other thousands cling to their calomel, chalk, bismuth and the rest, just efficient enough to encourage one in continuing to rely on them, but failing in the bad

cases.

Of all the old therapeutics none is as worthy of retention as the neutral cordial, of rhubarb, hydrastis, ipecacuanha, soda and aromatics. Whatever can be done in the way of stimulating a flow of healthy intestinal fluids and washing out morbid matters from the intestinal canal this mixture will accomplish. Add to each dose five grains of sodium sulfocarbolate, and you have the best combination available for disinfecting the alimentary canal, and destroying any invading micro-organisms before they have had time to reproduce and damage the tissues to any great extent. A bottle of this mixture occupies a place in every family medicine chest that I control. My directions are to give a dose whenever the stools are offensive, and repeat every two to four hours until the stools are healthy in odor and in appearance. While the beneficent action of this remedy has cut me out of many a fee, I am well satisfied that it has brought me much more in credit and gratitude.

If the case does not improve I add the sulfocarbolate of soda, lime or zinc, according to the urgency of the symptoms. The latter is the most powerful and the most astringent, but quite frequently there is a need for lime that must not be overlookt. Fragility of the tissues, glandular enlargements, retarded development

of teeth or bones, the hemorrhagic tendency, obstinate catarrhs, all call for lime; and in meeting other indications the salts of lime should be substituted for those of soda or potash usually administered.

I would be failing in my duty if I were to ever write anything on this subject without adverting to the necessity of attending to the hygiene of the premises. Pardon me the repetition, but I still see doctors, better than myself, who forget this essential duty, while attending to everything else.

The diseases of children present us an open book, a primer in fact, where a few cardinal principles are demonstrated with the utmost simplicity. Later in life the problems become more complicated, the trails cross and recross with such complexity that they are bewildering. A man may acquire an enviable reputation as a child's doctor if he knows how to put in practice domestic hygiene, intestinal antisepsis, the rules governing digestion and indigestion, the management of respiratory catarrhs, and the therapeutic uses of heat, cold and quiet.

WILLIAM F. WAUGH, M. D. Ravenswood, Chicago.

Pulmonary Tubercular Pyrexia as Influenced by Rest.

Editor MEDICAL WORLD:-There is no detail of treatment of consumption that so taxes the physician's resources as the successful attempt to keep the fever at the lowest possible point. Nothing is so fatal to appetite and digestion, therefore to nutrition, as fever; or probably more correctly, prefebrile interpulmonary absorption, of which pyrexia is the most immediately observable sign.

The use of antipyretics of the coal-tar series and their analagous types are not to be thought of, for inasmuch as the fever is not due to an acute cause, the effects of drugs whose principal action is heat control have no power to attack the source of its production.

He who regards that part of the lung in which there is disorganization and breaking down of tubercle as a wound, and the resulting detritus as infective material, views the process in that light which leads to rational treatment.

For the clearer comprehension of the requirements and to trace the fever back to its primary cause, we are justified in taking cognizance of at least three separate elements of production, which may be

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briefly enumerated as that occurring in incipiency, and that which is operative from the period of the disorganizing tubercle to the time healing has taken place at its former site.

The fever of incipiency is due to inflammatory change around the forming tubercle, the consequence of the attempt to isolate the offending substance. The toxine elaborated by the bacillus is of no importance at this point of fever production.

When the crop of tubercles is fully formed, if there have developt no new areas of infection, and there is no breaking down of the fully formed tubercles the fever subsides. Should retrograde changes take place in the tubercles two new causes of fever production are inaugurated: First is the absorption of necrotic tissue substance, and second the toxines of a mixt germic infection.

In acute cases the principle that governs the use of any other organ during a period of acute congestion or inflammation is no less applicable when the same changes take place in the lungs.

As the fever in incipiency is principally reactive, its initial purpose may be greatly favored by keeping the patient in a state of perfect repose in the recumbent position during the period at which the fever is usually greatest.

The passive respiratory movement, and even the more quiet circulation, allow the more perfect formation of the inflammatory barrier.

In the second condition, or when degenerative changes are going on, a temperature above 99 5 F., or certainly 100 F., is an indication for absolute rest.

The increast activity of the circulation favors in greater degree the absorption of the morbid products from the diseased surface.

The need of less oxygen in repose greatly reduces the breathing rate and prevents the enfeeblement of tissue that is the result of immoderate exercise.

My rule is to make frequent temperature observations while the patient is unrestricted, about every two hours during the day. After a study of the temperature for two or three days the temperature chart will indicate very closely the hour when the daily rise may be expected.

When once the time has been found, the patient should be sent to bed at least one hour, and better two, before the time for the rise. Hot-water bags should be applied o the extremities and the patient kept

perfectly quiet until an hour after the time when the fever usually declines.

Usually it is found that the rise of temperature, which is greatly diminisht by the rest, gradually comes on later each day, and the time of intermission much sooner, until a certain point is reacht in the length of the febrile period which depends on individual causes.

By perfect rest in bed is meant what is said: no reading, conversation nor company is allowed during this period, for the more absolute the bodily and mental repose, the greater will be the degree of success.

Under this treatment I have the temperature range drop to normal when previously very high, in a very few days when the case is not too advanced. When the maximum is not much over a 100 F. a fall to normal may be expected in from two to four days, if the general management is what it should be. Louis F. HIGH, M.D. Danville, Va.

The Puerperium.

Editor MEDICAL WORLD:-It is impossible to give a definit time a woman should remain in bed after parturition. Some patients are able to assume the upright position on the seventh day, and others are at the end of a fortnight. We should be guided by the involution of the uterus. The uterus should be sufficiently contracted so that the fundus should be about one and a half inches above the pubic bone before the upright position is allowed, altho it takes from six to eight weeks for the uterus to resume its normal size.

If a woman is granted the upright position too early, the uterus being heavy and now more yielding, sinks in the pelvis, draws down the weakened broad ligaments which were separated by the enlarged uterus, thus interfering with the broad ligaments, ovaries and oviducts returning to their normal position in the pelvis.

A woman should not remain in the dorsal position except a few hours after delivery to rest, and then only at intervals, as it produces a retroposition of the uterus, of which I have had several cases, a retroposed uterus which is nearly always attended with adhesions, and in my experience, has caused more pain and suffering in women than in many cases of prolapst uterus. The patient should be advised to turn from side to side as frequently as she wishes; she may also remain in the dorsal position at intervals,

but she should not remain in the same position continuously.

The Indian woman who, immediately after labor, straps her new-born to her back and resumes her journey, has her different roots and herbs for the pains and aches peculiar to her sex. Shall we continually advocate the barbarous custom of some savage tribe or uncivilized race?

Sepsis is more frequently found among the well-to-do than among the poorer classes. Cleanliness is sought, but not antiseptically, and therefore more harm is done than good. The water used in giving vaginal douches is taken from the hot water tank, or boiling water is cooled with cold unboiled water. The germs in this water affect the abrasions or bruises in the vagina, which occur in nearly all confinements. A syringe or vaginal douch among many of the poor is unknown. Many of the poor are compelled to perform their household duties early in the puerperium, but many of them silently suffer the penalty.

I have had several poor patients, some who have a partial and others a complete prolapsus of the uterus, which I believe is due to improper care during the puerperium. I have a patient thirty-three years of age with a laceration of the perineum and a prolapsus of the third degree; that is, the whole uterus is outside of the vulva. She does several washings a week, and has been in this condition for more than a year. She says that she cannot stop work for an operation. She complains less than many with a smaller lesion. I have at present a patient who has had a complete prolapsus for six years, and she continues to perform her household duties.

That the poorer classes, as a rule, make a more satisfactory recovery than do the women of the richer classes, is untrue; they only bear more suffering silently.

To recapitulate: The time every par turient woman should remain in bed should be determined by the involution of the uterus. If possible, any laceration of tissue should be immediately repaired. Cleanliness should be obtained with aseptic or non-irritating antiseptic solutions. Williamsport, Pa. E. N. RITTER.

Bro. C. F. Taylor:-I enclose $4.00 (four dollars) in P. O. money order, for which send me THE MEDICAL WORLD for 1899, 1900, 1901 and 1902, and three Binders for THE WORLD. I've just received the Jan., Feb., March and April numbers for 1899. Many, many thanks. This is my second 4 years' subscription for THE WORLD. You are just right. I like all of your views. Yours for right and humanity, B. F. Johnson, M. D., Stockdale, Texas.

Eclampsia and Veratrum.

Editor MEDICAL WORLD:-The following extract from notes of a recent case of eclampsia may be of value because of the definit and prompt action of medicines. used.

Patient, age 21, primipara, 8 months pregnant, severe headache for twenty-four hours preceding the attack, six convulsions in all, only one taking place subsequent to treatment being instituted: chloral, bromid and veratrum per rectum, croton oil by mouth, chloroform inhalation. As the room was cold and drafty, it was impossible to secure diaphoresis. No improvement; labor induced and completed in 6 hours.

After delivery, patient was quiet and apparently comatose. Waited some hours to allow effects of chloroform to disappear, but condition became worse.

At 4.30 a. m. Pulse 156, hard and tense, the body vibrating at each heart beat. Respiration 46 and stertorous. Face

flusht. Conjunctivæ insensitive. Pupils contracted. Patient absolutely unconscious and could not be roused. Injected per rectum :

Con

7.15. Pulse 110, respiration 28. 8.00. Pulse 110, respiration 28. junctiva sensitive. Swallowed water. 9.00. Bowels moved. 9.30 used catheter. 10.00. Pulse 92, respiration 22. Quiet natural sleep.

There is a point in connection with eclampsia to which, I think, too little attention is given in the text books: The importance of careful after-treatment, extending, it may be, over months. Patients are very apt to regard themselves as well, as soon as they get around the house.

They should be directed to report at intervals and the urine examined till all traces of albumen have disappeared. Until then the patient should be kept largely, if not entirely, on a milk diet, together with such medicinal and other treatment as may be indicated. R. S. THORNTON, M. B., C. M. Deloraine, Manitoba.

人!

Recumbency After Childbirth.

Editor MEDICAL WORLD:-This recumbency question depends altogether upon the strength, constitution and habits of the patient. An obstetrician should always keep his patient on the "safe side." Generally speaking, a woman is not a horse, neither in strength, custom nor habits. Farmers who breed colts all believe in allowing the mother of such colt to rest, some as long as nine days. A mare, generally, is in heat and will conceive on the ninth day after the birth of its colt. This would indicate that the womb of the mare is in a fairly normal condition by that time. But a cow, a sow and most other female animals of fairly large proportion, and undergoing a four to eleven months' gestation, is not in a receiving or conceiving condition until at least a month or longer after the birth of its last offspring.

There is perhaps no animal given so much to the recumbent position as man. This is due to the fact that he is upright (at least in position, if not always in transactions), and hence the womb of a woman, being heavy immediately after birth, needs the recumbent position for at least nine to fourteen days, particularly if it is true that it requires forty days for a woman's womb to return to its normal condition. I never advise a woman to leave her bed until after the ninth or tenth day. I say ninth because I think it is the shortest time for the safety of the woman.

It is true that a woman who has given birth to a child should not be sick, but be better able to get up and go about her work, for she is relieved of a burden, an annoyance and an inconvenience. The whole process, from beginning to end, was a normal and not an abnormal one. The enlargement of the womb, its surroundings and the mammary glands had simply undergone a physiologic hypertrophy, and not one of inflammation; ergo, there should be no reason for the recumbent position. This is simply a fair way of reasoning without proof for its accuracy.

We know, by practical experience, that any organ undergoing a physiologic hypertrophy is much more liable to inflammation during such a stage than at any other time in its history. We also know that the stomach, kidneys, liver, temper, heart and other things suffer with some women during gestation, while others claim that they never felt better.

From such a histy we learn that there is a danger line, and no practitioner has a

right to overstep it, danger or no danger ahead. In fact, no pregnant woman should be left to herself during her term, but should frequently consult her physician, who should be competent to know whether she needs treatment or not.

Many years ago I met a man and his wife tramping in January. The woman told me that she would be confined that day. I told her that she might be up yet for two weeks. She said: "No, for I feel as if everything was going to drop out below." Two weeks later I met her, still tramping, but with a bundle on her arms. I stopt and said: "Hello! have you got your baby on your arms?" She smiled and said: "Yes; I just got it last night at seven o'clock in Mr. W's sheds." I said: "I would not be surprised if it would kill you." She smiled and said: "Oh, that's nothing." The husband answered: "Yes, some people said to-day she must be made of iron and steel." I met her at 11 a.m., when she had traveled a distance of seven miles thru snow up to her ankles. Some years later I again met her and she said she had had two children since the time mentioned. On one occasion she was attended by an old midwife who gave her infusion of ergot, which nearly killed her. The next time she drank a pint of whisky, "which did her a d- sight more good than a physician or an old midwife." No recumbency in

her case.

Ten years ago, driving along on a Friday morning in the month of April, a young German came running and askt me to come down into a field where his young wife had given birth to a baby. I found her sitting against a tree with a babe between her limbs. It had been born half an hour. I tied and cut the cord, wrapt the child in a shawl, took away the placenta and covered it over with stones. We walked nearly a fourth of a mile to a house, she and her husband carrying their baggage and I the child. There we drest the infant, and she remained on a lounge until in the afternoon, when they started for a farmer's barn over a mile away. There they remained until the Monday morning following, when they proceeded on their journey. These are exceptional cases, but it shows that a healthy woman can endure much.

I have attended many women during labor who were strong enuf to get up and do their work the next day, but who remained in bed to comply with the "old

custom" and my advice. It is not the getting up early, but how they get up and how they exert themselves. A woman who has much of a lochial discharge or almost a flooding should be in the recumbent position by all means. Women with much afterpain should keep quiet. Hard contractions often stir up mild inflammations which may become serious.

A moderately tight abdominal bandage is of great importance. It keeps the uterus in place and supports the abdominal walls. The diet of the lying-in woman is another important consideration. When a woman is healthy and no untoward symptoms, I say, "eat what you relish, but not too much at a time." Those who have trouble with swollen mammary glands are more or less restricted. Drink their customary drink, but not too much cold water at one time. If a woman eats a big dinner of sauer krout, fat pork, potatoes and many other things at 12 m., is confined at one or two o'clock p.m., and is not killed nor sick, why should she be if she would eat the same some hours afterwards in moderate quantity? I remember the time when women had to eat soup sparingly for three or four days and nothing more. I tried to drive the idea out of their heads, but it took a long time to accomplish it.

A woman who has suffered a laceration of the os or of the perineum, or both, should be restricted in her diet and kept in the recumbent position until all these troubles are over. If an obstetrician is not concerned to know what has and what has not happened to his patient, he should at least enjoin recumbency for his patient for ten days.

A womb that has conceived is undergoing a change, and the practitioner is cautioned against the use of certain drugs, and the patient against improper exercise. This admonition indicates danger, after the womb has expelled its contents and is on its retreat, and when the mammae are being called to functional activity. This sudden change also affects the nervous system, hence we enjoin caution, which is best obtained by recumbency, rest and avoidance of unnecessary or undue exposure. Hence, we conclude that recumbency, not always essential in every case, is the safest for all lying-in women. Eshbach, Pa.

FRANK R. BRUNNER.

L. 8. Holcomb, M. D., of Maysville, Ark., while sending $1.35 for renewal and Binder, makes some very interesting remarks (too long to quote in full), in which he says: "The best and most reliable political journalism of this country is not found in the partisan press.'

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Recumbency After Child-Birth." Editor MEDICAL WORLD: -It would seem that there should be but one answer to the question: "Should a woman rest after childbirth?" The uterus is enlarged; the viscera having been forced out of their usual position, return to their place. Rest is necessary to readjust to the normal condition. But there should be no confinement to one position in bed, either on back or side. Also the woman should get up on the chamber to evacuate the bladder and bowels, so as to, by gravity, get rid of clots, etc., which may be retained in the womb. This last I enjoin in case of severe, protracted after-pains, as I have noted that they often cease after getting up over the chamber. Nine days is my order to remain in same room, but not in bed all the time. In 30 years (and over 600 cases), I have had two perineums badly ruptured, both of which were sewed up and "lookt as well as ever." Both had children afterward without any tear. One was 19, one 33; primaparas. It is a little curious that we hear so much about what other nations, civilized and savage, do in these cases. The most complete record of observation and experience is that of the Jews, recorded in the old testament; and the woman was not allowed out of the house under 40 days. This is reasonable and right.

I find the most troublesome cases I have are those who will try and be "smart,' disobey orders, and are out and about in a few days at their work. Usually they are broken down in health and strength at 40 years of age, with much trouble all the time.

As to the forceps, I have seen two cases in which I would have used them had they been handy; but the baby was in sight long before the messenger, sent for them, came back. I have never owned a pair of forceps, but have had a pair used once, by my confrere, on a negro of 12 years, who could not give birth to the child. weighed twelve pounds-born dead from puncture of skull. I use chloroform, preceded by chloral hydrate, 5 to 15 grains, in 5 grain doses, as then less of the chloroform is required and the spasmodic stage is avoided.

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I use no ergot before or after, but I use tincture or fluid extract of mistletoe first, last and all the time. A teaspoon dose of mistletoe tr., or a wineglass of the infusion. with 5-grain quinin, will make things lively. Also it may be given without the quinin to aid the first stages of