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after me hurriedly saying that his wife was threatened with a convulsion. I armed myself hurriedly with what I thought would be needed and hurried to the house. I found my patient in the throes of the hardest convulsion I have ever had the misfortune to see; it lasted fully ten minutes. I at once began pumping Lloyd's veratrum into her, in 10 drop doses every 5 minutes. After using 3 doses I got her pulse down to 60. But worse than ever, she became intensly nauseated, and nothing I could use seemed to have the least effect on her nausea. Now, brethren, don't say, if I had done this, that or the other, I could have easily controled that nausea, for I did do them all. I had given already at the expiration of two and a half hours (as hard work as I ever did in my life) 3 hypo's of atropin. She would not get her breath sometimes for as long an interval as 60 seconds. I told her husband, who was a large muscular man, to hold her in his arms and every time she would hold her breath, to shake and squeeze her so as to force the air out of her lungs, so that when they expanded she would catch a breath. He kept this up for three hours on a stretch. I was fearful of poisoning her, but as a last resort decided to try one more hypo of atropin. In less than 10 seconds after I gave it to her, she began to breath more freely and regularly. I knew at once that there was a life snatched from the very jaws of death. Brethren, the lesson I learned (and I write this hoping that you will do the same) is never to give up as long as there is breath in the body.

I neglected to state that a fearful throbbing neuralgia of the fifth nerve would warn her of the approach of a convulsion about 5 minutes before.

A criticism of my treatment, if there should be any, will be received graciously. J. A. MELDON, M.D.

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in such a case, if the kidneys do not respond satisfactorily to appropriate treatment. Your self-congratulation was too soon, because you had not made yourself acquainted with the work of the kidneys. During those three hours of fearful suspense and anxiety during which time you and the husband workt so valiantly for the life of the patient, and with such gratifying results, your patient was evidently suffering with veratrum poisoning. The lesson to be drawn from this stage of the case is not "never to give up as long as there is breath in the body" (we should all know that), but not to give veratrum hypodermically so often as every 5 minutes. Puerperal convulsions seldom succeed one another so rapidiy as not to give reasonable time for the action of a remedy, particularly if hypodermically adminis tered (say about 15 minutes). Decide upon a reasonable dose for decisive effect, then give it time to act before repeating. You did not state the doses in which you administered the atropin. It would be interesting to know. "All's well that ends well"; and all the parties concerned in the above case are to be congratulated on the ending. It is the duty of all to submit cases to the most searching (but well meant) criticism. In this way we can help one another. We would like our readers to report more cases which end in death. They say that doctors' mistakes are put out of sight. They should be put upon record, to act as sign posts to point to dangerous places. The mistake of one should be a benefit to all, instead of a benefit to only the one who made it. -ED.]

Puerperal Convulsions.

Editor MEDICAL WORLD :-I notice reports of cases by Dr. F. G. Thomason, Aug. WORLD, page 324, advocating veratrum viride in puerperal convulsions, and claiming great success with that drug. In a practise extending over a good many years, and with attendance upon upwards of 3,000 cases of labor, I have, fortunately, not had many cases of that character to treat; but I should be sorry to place reliance on any particular drug, but endeavor rather to ascertain the cause of the convulsions. In my early days of practise one favorit theory was, the pressure of the fetus on the abdominal vessels; and of course, the remedy was to remove the child. But it was found that the convulsions recurred

after delivery. Albuminuria is, I think, now considered the chief cause of puerperal convulsions, and I should consider veratrum viride too depressing in such cases. In the patients under my care I have, when occurring during labor, expedited delivery, and when recurring, used purgativs and sedativs-largely bromids and opiates; with good results.

St. John, N. B. C. II. L. JOHNSTON, M.D., L.R.C.S. & L.M. Edin.

Forceps in Labor. Editor MEDICAL WORLD: In July WORLD, page 275, I see an article by Dr. Thompson in regard to the use of forceps and chloroform in obstetric cases. I wish

to add my voice to his, to the end that more of our poor women may be relieved of much unnecessary agony in childbirth. I know many men of good repute, who will calmly lie down, with instructions to be called if wanted, when the head has fully dilated the neck and is only stopt from coming into the world by being wedged back slightly by the pubic bone. Apply forceps, rotate ever so little with slight, steady traction, and it will be born in one minute. Leave it alone and nature will deliver it in a few hours. With forceps the woman will be bright and strong, Left to nature she will be exhausted, and nine times out of ten, will have a flabby, relaxt uterus, with more or less hemor

rhage. I do not believe it is good policy to give chloroform to complete anesthesia, but sufficient to quiet while the forceps are placed and traction begins, then let the patient come out from its influence and assist. Of course this is for ordinary cases. Missoula, Mont. E. A CRAIN, M.D.

Increase of Experience Leads to Decrease in use of Forceps.

Editor MEDICAL WORLD: Fourteen years ago I used the forceps in nearly 60 per cent. of my cases. In the past two years, having learned as I believe the better way, I have found indications for their use in not above 20 per cent. of confinements attended. I never fail to take both chloroform and forceps when I am called, but as increase in experience adds to my success, I fail to find those indications for the use of the latter nearly as frequently as in years gone by.

Out of upwards of 800 confinements I have had four cases of placenta previa, two partial and two complete (all four in

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Editor MEDICAL WORLD: - Do you believe that hemorrhage following labor in which quinin is given is caused by the quinin? or the condition (inertia) that necessitates the use of it? Would it not be a good idea to follow with strychnin and ergot until the womb is contracted thoroly? It seems to me that when it is necessary to give quinin to assist labor there is a condition of the uterus that needs after treatment.

Washington, La. L. LAZARO, M.D.

[Several subscribers have exprest their views on this question in recent issues. Let us have a fuller expression. This question should have been settled long ago. The routine administration of quinin in labor, which seems to be practist by many, is to be condemned. No drug should be given until it is clearly indicated. Uterin inertia during labor should suggest suitable post partum treatment to prevent hemorrhage.-ED.]

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Editor MEDICAL WORLD:-Referring to Dr. M. A. Dunn's letter in the July WORLD, page 265, on the subject of malarial hematuria and its treatment, I believe that the elimination of the poisonous products of malarial organisms thru the bowels and kidneys, ie very essential indeed, and is of prime importance in treatment, whether quinin is given or not. In treating malarial hematuria it is absolutely necessary to determin whether the malarial organism is activ, as it most probably is in acute malarial subjects; or whether its activity is spent, which is most probably the case in chronic malarial subjects. It is my practise to give quinin where there is any probability of remaining active malarial organisms; but where the condition is more of a toxemia due to the spent activity of the organisms, quinin should be discarded. As a general rule, where the fever is of an intermittent type, or even remittent, with characteristic symptoms of chills, quinin should be given. On the other hand, remittent fever with slight variation in temperature range is not benefitted by quinin, but yields to laxativ doses of sodium hyposulfite. This result is probably due to disengaged free sulfurous acid in the blood, and this agent is antagonistic to and destroys the microorganisms which are the real cause of the disease, and thus arrests corpuscular disintegration.

The first question that confronts us in the treatment of malarial hematuria is, shall we give quinin or shall we withhold it? The advice of Bastanelli is, if hematuria occurs during a malarial paroxysm, and the malarial parasites are present, quinin should be given, even intravenously if urgency of the symptoms demand. If parasites are not found in the blood, quinin should not be given.

My rule is, treat the patient, rather than follow a set way of treating the name of any disease. GEO. L. MORGAN, M.D. Turtle Bayou, Texas.

[You say, give quinin to kill the parasites, if the living microorganisms are present. Then you say, if living parasites are not present, don't give quinin, but give hyposulfite of soda, which sets sulfurtagonistic to and destroys the microorganisms!" ous acid free in the blood, which is "anYour therapeutics may be good, but your explanation is not clear.-ED.]

Malarial Hematuria.

Dr. W. C. Sterling, of Sulfur Springs, Tex., endorses our view that only those who have had cases of this disease should write about it. His first experience with this malady was in 1888, when he had ten cases, which he treated with quinin, losing only two, one of which was moribund when first called. He says:

"I have interviewed something like fifty physicians of Texas who have treated several hundred cases, and all, with the exception of two, gave quinin, and those two didn't give any rational reason why quinin should not be given; and did not give any systematic plan of treatment in the different types of the disease." He also says as follows:

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'Why should a physician give quinin in all the other types of malarial fever, and not give it in this form of the disease, when the cause is just the same? The plasmodium malarial in the blood of a malarial patient don't turn to something else because the patient has a hemorrhage from the kidneys. Malarial hematuria is not a new disease, but only a complication of malarial fever, just as a hemorrhage in typhoid fever is a complication.

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"We never have malarial hematuria except in those who have been exposed to malaria for several months. We hardly ever see a case only in the fall months. have seen and treated between thirty and forty cases of malarial hematuria, and they composed all the different types ofthe disease. I will give the plan of treatment which has been employed in my practise. The mortality has not been over fifteen per cent.

"First To secure cinchonism as early as possible, quinin should be given in large doses by the mouth, or rectum, or the bisulfate of quinin hypodermically as demanded by the urgency of the symptoms.

"Second: Prompt purgation with calomel and soda, given in two or three grain doses every two hours, dry on tongue until catharsis has been produced. "Third: Hypodermic injection of morphin and atropin, when necessary to allay the incessant vomiting, and strychnin for the fagging heart.

"Fourth We should see that the kidneys and skin are doing their work. In the event of arrest of renal secretions, cupping over the lumbar region; among diuretics, we have nothing better than bitartrate of potassium.

"Special attention should be given to the patient's nutrition. From the fact that we have to deal with a case of blood poisoning, caused by the toxic effect of the malaria, makes it important that we should see that the patient is nourisht."

A Chill Season" Dream.

Editor MEDICAL WORLD:-Seated in my office some time ago, listening to the downpour of rain, such a rain as you see nowhere except in this country in the rainy season, I was meditating on the unpaid bills of my patrons and trying to devise in my mind a plan to better my financial condition. I became drowsy and leaning over against the table and wall I pickt up a late journal and thought I would divert my troubled mind from its condition. Opening the journal I first saw this heading of an article: "Mosquitoes Effect ually Destroyed; No More Malarial Microbes."

The door being open, in walkt a nice looking gentleman, with his hat in one hand and a large maroon colored grip in the other. "I am Mr. Smith," said he, "of the U. S. Health Department, and learning of your excellence as a man and your ability as a physician, also your political affiliation, I have made haste to call on you before the actual results of our work are made known to the medical profession in this and other cities of this section. My mission is to destroy all the mosquitoes in this State and so destroy all the malarial germs; and then you medical men will be out of a job. But Doctor, I think that I can have the department employ you at $300 per month and expenses for several years to watch the ponds and lagoons of this part of the State, keeping the undevelopt mosquitoes from ever coming to to maturity." While talking he was taking

his apparatus from the grip and preparing to demonstrate just how, as he said, every M.D. in the malarial districts was going to lose his job and have to "run cattle" or "grub palmetto roots," for a living.

"Give me a glass of water," he said. On receiving it he applied his microscope and said, "uh, hu! just as I told you. There they are. Enuf to kill a whole family. Look," he said, handing me the glass. I did see several small wigglers in the water, but they didn't look so dangerous to me. "Why," said he, "we will have no more intermittent, re-mittent, pernicious remittent, dengue, or yellow fever in this country. Let me show you," he said, as he took the glass and with a long needle to a small syringe injected a drop or two of kerosene oil in the glass. "Now look again." I lookt and sure enuf the little fellows were looking like the picture of the rats on the "ruff on rats" advertisements.

"Yes sir, Doc.," said Mr. Smith, "if you want the job of looking after the skeeters of this country instead of working yourself to death over these Florida fevers, I can get the appointment for you. "Thank you, Colonel," said I, wanting to take him by the hand.

"Yes, said he, "I take this instrument and with these tubes that look like fish lines to you, I inject or shoot the petroleum into the bottom of the lakes and ponds and destroy all the young mosquitoes and the unhatched eggs, and so destroy the germ that is supporting all the families of the medical profession in this country; and also it will ruin all the medicin companies that are making chill tonics both tasteless and untasteless, and all the ague cures and all the malarial upsetters and all the Cuban chill cures; and hundreds of girls who are now living from weaving mosquito bars." "Just look at that glass again, Doc.," as he handed me the glass of water and the microscope, “and see how those eggs have burst and all their vitality gone."

I was getting very nervous over the matter, and as I reacht for the glass my hand trembled and down went the glass with a crash and I started from my chair. "Hello Doc." said Mr. A——. .. Sleep here now? Want you to go to my house at once. Willie is very sick; seems to have colic. "

"What a dream I've had," said I to myself, rubbing my eyes.

"Wish you'd hurry, Doc.," said Mr. A.,

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"Willie is very sick. I live at No. 87
street.
Jumping on my wheel, which was at
my door, I was soon at the designated
place. Before I entered the house I heard
the screams of the mother, half a dozen
children and several neighbor women.
Willie was rolling and tossing about and
seemed to be in great agony.

I made what inquiry I could and lookt at his tongue while he was crying. Tried to feel his pulse and feel his stomach and bowels. Found that his stomach was swollen, and askt the mother what he had been eating to-day. "Nothing at all," she said.

"What did you have for dinner," I

askt.

"We had boiled peas; but Willie only ate one teaspoonful, and I masht them up myself. He sat in his little high chair right by me, and I tried to get him to eat

some more.

While Mrs. A--was talking, I was getting my hypo. syringe ready with a grain of apomorphin dissolved, which I at once emptied into Willie's thigh.

Then

The noise kept up for about 5 or 10 minutes, when Willie turned pale around the mouth and was very quiet. such vomiting and such a rattling of peas on the floor! I think there was fully a quart of half cookt peas, and they fell to the floor and rolled around like shot that had been spilled-not a one of them masht.

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How to Frame a "Sheep-Skin." Editor MEDICAL WORLD:-In reply to Dr. H. R. Taylor's query "how to frame a sheep-skin," allow me to respond: Never do or say an unmanly or unprofessional thing and your sheep-skin will be framed in pure gold.

A short time after my graduation from college the same question was suggested to my mind because of the wrinkled state of my diploma, and as I had workt hard. for years to possess it, and as it was to me a "thing of beauty" and will be "a joy forever," I put on my thinking cap to find a means for its preservation. A frame having a generous proportion of space between the flange surface and the plane of the back was selected, and two pieces of ordinary window glass of a size a little larger than the diploma were secured. The diploma was allowed to remain for a number of days under pressure to obliterate the wrinkles, and then carefully placed between the two pieces of glass, placing all in the frame, and making pressure from behind by means of a strong piece of board about twice the thickness of the ordinary backing, and secured in proper position by wire nails. My diploma has hung for over two years and is in good condition.

THE MEDICAL WORLD is to me an inter"My God!" said Mrs. A——. "Testing and welcome visitor, and many clipdidn't think we had that many peas for pings from its numbers have found their dinner; and how this poor child got them way to my medical scrap book. I cannot I don't know." refrain from complimenting the Editor for the possession of the spirit of fairness regarding homeopathy. I belive he and his interesting journal will be sources of great good to those who seek for the truth.

After emptying his stomach Willie became very quiet, and so did the balance of the family.

I gave Mr. A--this:

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