and expectorant.

In the full and bounding pulse, as a sedativ, I add about fifteen drops of a good tincture to half a tumblerful of water. Dose, a teaspoonful every half hour or hour, till the pulse softens and slows up; afterwards, every hour or two. In most cases I use tincture of ipecac and bryonia in very small doses, alternated with the veratrum. In the first stages of pneumonia the kidneys and bowels need attention, but this eternally physicking all thru the disease is no credit to any one. An oiled flannel well dusted with powdered lobelia and kept on the chest, with dry flannel on the outside, works well; or a liniment made of spts. turpentine, chloroform and sweet oil, equal parts, to be well rubbed into the chest three or four times in twenty-four hours, with the chest well covered with dry flannel or cotton. I use no poultices whatever in any case. Most of the nauseating expectorants I discarded years ago, as well as poultices. Of course, no one can lay down rules for all cases. Each pathological condition should be met with a knowledge of the indicated remedy or remedies.

Warren, N. H. F. L. GERALD, M.D.

Editor MEDICAL WORLD:-My trial subscription having expired, I hand you herewith $1 for a continuation thru 1903, believing THE WORLD to be the most practical periodical that reaches my office. I heartily indorse the discussion in Nov. and Dec. WORLDS in regard to the treatment of pneumonia, because it is something that I have had to deal with quite extensivly during the past two years, having passed thru an epidemic the past two winters. I have on my record book 87 cases, with 3 deaths. My mode of treatment is as follows:

First calomel to clean out; aconite or veratrum sufficient to open up the circulation and relieve the congestion, continuing this thru first stage or until I get the desired effect by reducing temperature and opening up circulation; in fact, until my patient rests. Then I give ammonia, preferably the arom. spts. and muriate combined, continuing this treatment, adding in the last stage strychnin and alcohol. These I use in large doses if demanded to tide my patient over the crisis. This, together with a nourishing diet, with the proper hygienic surroundings, has been satisfactory in my hands in dealing with pneumonia. Of course I give appropriate treatment for complica tions if any arise. Lanton, Mo.

H. A. THOMPSON, M. D.

Placenta Previa.-Pneumonia Without Fever. Editor MEDICAL WORLD:-Having read in the October number of your worthy magazine, page 419, an article written by Dr. Sims, on the I take pleasure in recording at this time a simsubject: "Central or Total Placenta Previa,' ilar experience of my own, but happily with a different termination.

It was my first case, as is this, Mr. Editor, my first attempt in writing for publication to your medical journal. Without further introduction I herewith give it you.

The husband of Mrs. K. came into my office on the evening of May 26, 1902. He informed me of his wife's pregnancy, and stated that she would doubtless be confined some time during the selfsame month, in case they had made "no mistake in their count."

On the evening of the above-mentioned office visitation, the wife had had suddenly a discharge of blood from the vagina, unaccompanied by pain or distress. The husband said the hemorrhage had ceast in a few minutes as suddenly as it had occurred. Further inquiry elicited the fact that this was the first occurrence of hemorrhage up to that date, altho the day of her confinement was supposedly so near at hand.

I instructed the husband to permit his wife to be alone at no time; to enjoin perfect quiet, and to phone me at once should there be a recurrence of the flow he had mentioned. With the above information, he left.

I heard no more of her condition until the following Friday night, five days after his first haste after me with an expression of anxiety visit, when Mr. K. again came, this time post on his face, saying his wife while sitting quietly on the porch had had another profuse discharge similar to the first, but more copious, and that he wisht me to see her forthwith.

We hurriedly reacht the bedside, where I found a multipara, aged 42 years, seemingly in perfect health, and feeling none the worse for the loss of blood she had just experienced, save a slight degree of vertigo.

After examination I exprest to them my convictions, outlined my proposed method of procedure, and privately informed the husband of the impending danger awaiting his wife, as well as telling him the unfavorable chances there were in saving the life of the child.

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With this assurance, he gave me permission in all confidence "to do my best," and should occasion require it, he askt me to summon help.

On this visit at the home I tamponed the vagina, and continued so to do every thirty-six hours for a period of twenty-seven days. There was no account of further hemorrhage for ten days, when the patient, becoming tired of the rest treatment she was getting, took upon herself the responsibility of getting up to look after household duties. As a consequence, hemorrhage was provoked, but it proved to be slight. I learned afterward that she practised this procedure of "being up and down" until the time of her confinement, which was on the morning of June 22, 1902.

I was summoned about 6 a.m. on this date, with the understanding that labor was doubtless beginning. I started for the bedside fully realizing my responsibility. Upon arrival at the lying-in chamber, I found the patient having good expulsiv pains, with considerable flow of blood, tho not alarming. The tampon

had been partially discharged. Digital examination was made, and the os uteri was found to be dilated to the size of a half dollar. The fingers were thrust thru the opening, and the placenta torn loose along the margin surrounding the opening. A tampon was then inserted, and changed at intervals of twenty minutes. These were continued until 8 a.m., two hours after my arrival, when I dispatcht a messenger for Dr. B., to whom I had spoken relativ to the case, and had requested to be in readiness to help when summoned. He was with me within twenty minutes, and we soon had the patient anesthetized. The attempt was then made to apply the long forceps to the presenting head. This failing, no hesitancy was felt in performing version, and in short order a male child was brought forth, dead to be sure, but full grown and apparently of "good repute."

The placenta was next displaced. It was small sized and torn from center to circumference, which laceration, of course, occurred in process of attempted forceps application. After removal of placenta, the hand was quickly reinserted and firm pressure applied to cervix until contractions occurred. This phenomenon was soon manifest after an injection subcutaneously of Parke, Davis & Co.'s ergotin. The patient was then carefully examined, and conditions being favorable, we left her in apparent safety a few minutes after 9 a.m., three hours after the onset of labor.

In the subsequent visits nothing was detected worthy of note save an occasional rise of temperature. This, indeed, was slight except on one visit it went as high as 102° F. The patient

made an uninterrupted recovery. To-day she is attending her household duties, well and hearty.

A prominent gynecologist of this city, when the case was mentioned to him, made the assertion that he could have saved the life of both child and mother by an operation had he been called. He, by the way, advocates Cesarean section, without exception, for these conditions. May I ask on this occasion what is the judgment of THE WORLD relativ to this matter? My rule is to offer the mother, a known quantity, the greatest possible opportunity for recovery without risk more than needed, even at the sacrifice of the child, a decidedly unknown factor in the world.

Another new experience I will mention in this communication before closing, viz.: A case of lobar pneumonia without fever. This condition I witnest yesterday in consultation with one of the leading physicians of East Toledo.

The patient was a lady perhaps 37 years of age. She had been taken down with the abovementioned trouble one week previously. For two days, at the onset of the disease, I learned from the history of the case, she had a rise in temperature. At this, my only visit, the temperature was 98°, pulse 90, and respirations 20 per minute. There was also some little cyanosis, flusht cheek, very slight cough, with little expectoration, expression anxious, considerable stupor, and subsultus tendinum present. The lower and middle portion of right lung was the seat of the trouble. Consolidation was distinctly manifest. Without the chance of a doubt, the previously made diagnosis was correct.

Appreciating, Mr. Editor, the practical value of your paper during the past year, which has been my first but will not be my last, I herewith inclose one dollar for next year's subscription, and remain sincerely its friend.

Toledo, Ohio. V. O. MOORE, B.S., M.D. [Your lady patient undoubtedly erred as to the proper date for her confinement. Was there any dilatation of the os uteri at your first visit? When she was "on the porch" at the time of her second hemorrhage she was hardly obeying your instructions implicitly when you had enjoined perfect quiet. Tamponing every thirty-six hours for hemorrhage when there was no hemorrhage was hardly warranted, and it is strange that it did not provoke an abortion. (If it had, you would probably have gotten early engagement of the smaller sized head, and would possibly have saved the child; but no one could have known that for certain.) conducted the case well when you finally got at it. The assertions of your specialist friend are not supported by authority; ask him to show you any references advising such pro

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cedure (unless it may be in certain very exceptional cases, such as you did not have). Your treatment of the case was more rational than his proposition. We cannot but wonder how many Cesarean sections he has performed for such conditions, and the record as to mortality.

Pneumonia is occasionlly noted in the first few days without great elevation of temperature, but such cases are rare and are generally accompanied by the gravest symtomatology along other lines.

You made a success out of an ugly case; but that is what you are there for; keep it up. You write a good letter; give a record of some other cases, but omit all but the essentials.-ED.]

Try the Old Remedies First.

Editor MEDICAL WORLD:-Being a young man, only in my second year of practise, I naturally feel somewhat like the little boy who they say "ought to be seen and not heard." However, in the short time I have been privileged to practise, I feel that I have learned one lesson, at least, which may prove of value to other young practicians, if not to some of the older ones, and that is, do not become so lost in the spirit of advancement as to forget the value of old remedies which have been tried over and over again and not found wanting. Nearly every day some sample is received either thru the mail or by visiting salesman, and we are askt to try them all, in their various indications. Now when we are called to a case, and let us take catarrhal dysentery for an example; shall we remember the kind advice of the salesman, go and hunt up our sample with a long name, and which is sure (?) to cure dysentery? And when this one fails, hunt up another and continue our experi

ment? or shall we resort to the old reliable remedies, and leave our patient feeling that we are doing our best-that we are on a sure foundation, and need only resort to experi

ment when the establisht methods have failed?

It is not just to our patients who have placed their trust in us, to start them off on a line of samples of new preparations of which we know absolutely nothing, except that we hear Dr. A. cured a case in twenty-four hours with that remedy, and Dr. B. buys it in five gallon lots, etc. Stick to the good old U. S. Pharmacopeia, and when that fails it may be well enuf to test the merits of the much-lauded secret nostrums. H. D. HOPKINS, M.D.

Jericho Center, Vt.

Your "Monthly Talks" are highly esteemed by me, but did you know that it is quite difficult for some doctors to think? "Labor and Finance," by B. S. Heath, is one book all doctors should read. -W. S. H., Texas.

Adrenalin as a Hemostatic. Editor MEDICAL WORLD: - CASE I.B. K., age 13 years, typhoid fever with hemorrhage from the fauces; moderate; gave adrenalin in 10 drop doses, in i dr. of normal salt solution every two hours; two doses relieved the hemorrhage completely, but it returned in three or four days, when two more doses relieved it completely and permanently.

CASE 2.-M. S., age 45 years; typhoid fever with profuse hemorrhage from the stomach. Ordered 15 min. of adrenalin in I dr. normal salt solution every two hours until i dr. of the adrenalin should be taken. No more hemorrhage after the second dose.

CASE 3.-Mrs. B., age 40 years, renal degeneration with hematurea of long standing. Gave adrenalin in 15 min. doses in the salt solution every three hours; increased the dose to 25 min. every two hours until one or two oz. were taken. Only slight improvement. Combined the adrenalin with normal liquid ergot. No change in her condition when the case passed out of my hands.

CASE 4-Negress, age 50 years, subject to nose-bleed, applied to me in her last attack. Put her on 15 min. doses of adrenalin in normal salt solution every two hours. No more bleeding after two doses were taken, but continued the medicin for two days at longer intervals-say three times a day; no return of the trouble; now two months since last attack.

CASE 5-Mrs. S., age 30 years; following typhoid fever she was attackt with profuse hemoptosis; very profuse, coughing up a dram every fifteen or twenty minutes until she had discharged some eight or ten oz. Prescribed adrenalin in 20 min. doses in half oz. of normal salt solution

every two hours until four doses should be taken, then every three or four hours until perfect relief was obtained, which occurred in twenty-four hours.

CASE 6.-O. B., age 30 years; bloody dysentery. Prescribed adrenalin every two hours in normal salt solution. Continued for twenty-four hours. No effect. Then ordered i dr. mixt with thin starch-water as an injection. Immediate relief, had to repeat the injection every twelve or fifteen hours for two days, after which no return of the hemorrhage.

CASES 7 and 8.-Mrs. B. and Mrs. W. B., two cases of hemorrhage following abortions at six and eight weeks. Prescribed adrenalin in 20 min. doses every three hours.

Both cases perfectly relieved in twenty-four and thirty-six hours.

In none of these cases did I use the medicin locally save the one of bloody dysentery. Have recently prescribed the medicin in another case of hemoptisis and one of bloody dysentery from which I have had no report; should the report be unfavorable, will inform you if desired.

I have used P. D. & Co.'s preparation only. While I do not claim adrenalin to be a specific, it has acted beautifully in my hands. THOS. B. HOPKINS, M. D.

Lafayette, La.

[Yes, we want unfavorable as well as favorable reports.—ED.]

Another Remarkable Record.-A Novel Passport Thru the Golden Gate.

Editor MEDICAL WORLD:-In reading of the remarkable record of Dr. J. W. Birney, of Des Arc, Arkansas, in the December WORLD, page 531, I thought of another record, equally as remarkable, and in some respects perhaps more so. I was born in the year 1843, the first day of the week, first day of the month and first day of the year. I am the seventh son of the family and my birth day comes on Sunday every seventh year. Am now sixty years of age; have been in the activ practise of medicin thirtyfive years; never lost but eight weeks altogether from practise, and part of that time was spent in a post-graduate course, the balance of the time in sickness. Have delivered over one thousand children; never had but two lacerated perineums; never used forceps but three times; never lost a woman in confinement. Many a hard battle in sickness have I fought; many a night have I stood by the bed side of a sick child, and when the victory was gained, on dismissing the patient, I have almost heard from the invisable, "well done thou good and faithful servant."

Inclosed please find three dollars for subscription to THE WORLD, one of the best journals of medicin that comes to my office. On account of the Editor's political views, and the sound medical literature it contains, I have requested my family, when time with me is no more, and I have shuffled off this mortal coil and been placed in my coffin, to place in my folded hands a copy of THE MEDICAL WORLD, for I think I would have no trouble in entering the Golden Gate with such a passport to present to St. Peter. You of the WORLD family, do you think that

I will have any trouble with St. Peter with such a passport?

Trusting that you all have had a merry Christmas, and that the New Year will bring you success in every laudable undertaking, I am very respectfully yours.

W. G. HENDRIX, M. D.

New London. Ralls County, Missouri. [These glorious old records are grand incentivs to the younger men. The improvement that the younger men should make, now that facilities and opportunities are so much better than formerly, is this: Don't make all of your life a work day; take a short vacation every year, besides attending your local, state, and perhaps National medical societies; and once in several years make your vacation longer, during which time take a post graduate course. Don't be afraid of losing patronage. The people flock to a man who is enterprising and progressiv.—ED.]

Spontaneous Cure of Joint Trouble.-An Unusually Large Fetus.

Editor MEDICAL WORLD:-I was called to see a small child about a year old, who they said had its knee out of place. When I arrived I found the child asleep. On examination I found that the knee could be thrown out of place by slight pressure, and the child did not wake; so I began to inquire and found out that the child had never walkt, but was trying to walk and fell and hurt his knee, and its mother noticed its knee out of place. I then examined the other knee and found it in the same condition; on examining the hips I found them in the same condition also. Everything seemed normal about the child but the ligaments of the lower limbs, and they were relaxt or so abnormally long that they would let the knees and hip joints be slipt from their place, and cause but little or no pain. Consulted my text-books and could not find any case of the kind. I could not find anything that would cause such a condition. The child had a terrible temper, and would become almost comatose from madness some times, so I began treatment on the tonic and alterative plan, giving elix. iron, quin. and strych. and other things when required. He began to improve soon, and one year later I could find nothing wrong with the child. He can run about anywhere, seems to have plenty of strength and is as activ as any child of his age. I don't know that my treatment cured the child, but he came thru in that irregular way. This

child was a quarter Pottawotamie Indian. I was called to see a primipara about five o'clock in the evening. They told me that the waters had broken about noon. On making an examination I found a prolapst cord and a head presentation, with very feeble pains. By manipulating I got the cord above the head; the pains were light all night. The next day they became harder and the head descended to the true pelvis and there it stopt., I applied forceps but could not cause the head to advance by traction on them for an hour or more, so I decided to perform some operation. It was ten miles to another doctor, and I did not know if he would come, as there was a "northerner" that day. I decided to perforate the head, which I did with a scalpel, and washt the brains away and collapst the head with the forceps; then the head was born, but the shoulders caused some trouble; however, by traction and good pains the child was expelled. It weighed twenty-two pounds. Its mother's weight is 110 pounds. There were no injuries to the mother, and she made an uninterrupted recovery. She thinks she carried it ten months. I am open for instruction on this case, but hope I will never have another one like it. W. A. BALL.

Editor MEDICAL WORLD:-The case of which I wrote, and which appeared on page 453 of October WORLD, is still on my hands. The child has been having fever now for six months or more. As stated before, has never been confined to bed. Since article was written a swelling was noticed near occipital protuberance, but has since disappeared. Gave iodin. Now I have the child on preparations of cod liver oil. Has begun to eat solid foods without deleterious effects; is increasing in weight and strength every day; cheeks are rosy; still the fever continues; remains at 998°; some times there is no fever, especially in mornings.

It cannot, in my opinion, be miliary tuberculosis, for the effects of this would be quicker and more markt. There are symptoms, however, indicating the existence of tuberculosis of some portion unknown to

me.

"Worms," as suggested by Dr. C. A. Button, of Holland, N. Y., are excluded by proof of treatment for such to no effect.

I thank those of the fraternity heartily who were so kind in writing private letters to me, and advice given was carefully considered.

Now what is your prognosis? Will the child continue to improve, or will he succumb to some other disease? We know him to be very susceptible in his now condition. Furman, Ala. PHILIP V. SPEIR.

[Miliary tuberculosis is not always, nor necessarily, rapid in its course, particularly when treatment is given to stay its progress. The fact that the child is gaining in weight and strength is an encouraging sign. As long as you can continue this, you have prospect for recovery. ED.]

Psychology and Suggestion.

Editor MEDICAL WORLD:-In the July number of the WORLD, page 281, you say in regard to the treatment of a certain patient: "He was treated abominably from first to last. When he comes to his senses, if he ever does, he will have much reason for cursing the medical profession. He came for bread and he received a stone. The first need of that man was a high ideal. Without this his course was sure to be hellward, as it has been. Could he find no physician who would tell him that he must become a normal man in head and heart before he could become a normal man in body? *** When will doctors learn that 'giving medicin 'is the least of their duties, and that giving instruction in the highest, best and fullest living is their first and largest duty ?" In the September WORLd, page 388, in his very instructiv article upon the chemistry of uric acid and its allied compounds, Dr. Heysinger says: "In these afflictions there is often a large field for suggestiv and non-suggestiv mental treatment. Only those skilled in this great, and soon to be overwhelming branch of medical science, can use it directly, but all physicians can and do habitually use it indirectly. That is what makes the difference between a true physician and a shoveler-in of drugs and chemicals-a sort of professional coal-heaver, or mechanical engineer at best. The neglect of this world-wide field has opened the door to Christian Science, with all its perversions and facts, and until our profession again takes up its heaven-appointed work on the mind, the master, as well as the frame, the slave, of