tion on my part need only reach the surface of consciousness.

The first case was in a multipara; her third confinement. I was called about nine p. m. to make the eight mile drive. Labor was well advanced and the woman apparently in normal condition. In an hour I delivered her of a well developt child. After its removal, while preparing to deliver the afterbirth, I was surprised by my fingers encountering the feet of a second child, and directly after this, I was still more, and terribly surprised to see the woman, without having given any premonitory indications, go into one of these awful convulsions. This occurred not long after my entrance on the practical and independent study of medicin―i. e. the beginning of practise; and you may believe I was overwhelmingly imprest with the feeling that a tremendous task and fearful responsibility may pounce upon the doctor at any moment, be he beginner or one near the close of his career. How I longed for the complacent assurance and universal knowledge of our obstetrical professor as he calmly and eloquently developt the plan of procedure in the most difficult cases. But action-prompt action devolved upon me, regardless of how I felt about it. Fortunately my patient's uterin contractions continued regular and strong, and I was enabled to quickly deliver the second child, also living, tho small, and the placentae as well. This being the first duty, it was also the first step in treatment. I hoped that with an empty uterus the convulsions would cease, or at least become less strong and frequent. Bit sadly was I disappointed; regularly, and as severe as the first spasm, every fifteen minutes came on another. I had given the husband a "chlorformed" napkin, with instructions as to mild use, and when labor was finisht the patient was fairly under the anesthetic influence. I then gave grain morph. and r atrop. hyp. and followed this with 20 grains each of chloral and bromid pot. per rectum, keeping up gentle use of chloroform. But convulsions succeeded one after another almost precisely to the second of each fifteen minute interval' I had not at this time seen veratrum so highly extoled in this trouble as it has since been, and so failed to use it. I repeated the morph. and atrop. until I had given one grain of the former and of the latter. Also doubled the dose of chloral and bromid with all

minor means I could think of to control these awful attacks. But all my efforts were without avail in mitigating in the slightest degree either the severity or frequency of the convulsions. When the twelfth attack came it was as long, as horrible to see and as close to the preceding one as before.

At this time came my friend and associate, Dr. Rogers, whom I had sent for to aid me. During the years of my study, bleeding was in its worst repute; and my mind was imbued with repugnance to this old time measure, used once for nearly everything and now almost entirely tabooed. Having been overdone, it was at this time underdone. So when Dr. Rogers, who was an older man, whose earliest experience recurred to the closing years of the vogue for bleeding, suggested that we bleed this patient, I hesitated. But the woman would surely soon die at any rate, so we concluded that the abstraction of eight ounces of blood could not much hasten the event, and in the absence of amelioration from all other therapeutics, was justifiable. So I took this amount of the "life-fluid" from the patient's arm. When the next time for the spasm came, what was our immense relief that it did not occur! Minute after minute, in tensest dread we waited, fearing yet hoping. The second fifteen minute space went by without an attack. In short there was not another convulsion after the bleeding. But the poor patient had been too much exhausted by those which for over three hours had so fearfully rackt her, and in spite of all our efforts to stimulate her thru the period of depression, she gradually grew weaker and died before sunrise.

Does some one say; "your bleeding did it!" I think there will not be many practical meh's voices to that effect. This patient died from exhaustion of nerve force, used up by the violent convulsions. Would she have lived had I bled sooner? I think so, but God only knows.

Both children lived and partially compensated the bereaved husband by growing to be a bright and lovely pair (boy and girl) of children, at six years of age when I last saw them.

My next case came three years later, in a primipara. A robust young woman, in active labor when I arrived, her os about half dilated, when a most terrific convulsion came as suddenly and unexpectedly as if a bomb shell had exploded in the

room. I let labor take care of itself and deprived her of about twelve oz. of blood. I then helpt dilation and delivered with forceps a very large child. There was but the one convulsion. Later examination of urin showed abundance of albumin. Gave cathartics freely and then tr. chlor. iron. She got up on the eighth day as well

as ever.

My third case came in about a year after the preceding, and was almost a repetition of it, excepting that the woman had had a convulsion when messenger was sent for me from three miles away. Here, also, labor was progressing well, and when a convulsion had come, which her husband said was the fourth, there being no contraindication, I immediately bled the patient; and as in the preceding cases there was an end of convulsions. The rest of the case was uneventful, and recovery was complete.

I had been five years in this city when my last and recent case occurred. For this I had been engaged from the beginning of pregnancy. The woman was young, well nourisht, and except for having the neuralgic diathesis, healthy. She was a primipara, but had had several miscarriages. During the early months of pregnancy the urin showed nothing abnormal. After the fifth month of the term I had heard nothing from her, and was beginning to think that perhaps the people had changed their minds about the doctor they wanted, which is a more frequent experience in the city than in the country. Then, at about the end of the eighth month her husband came in, just to report how well she had been doing. I told him that the next time he came, which was to be in a few days, he should bring a sample of her urin. But this time was not to come, for on the next day I received a telephone message to call on her, as she was supposed to be in labor. Thinking that it was probably a case of false pains I did not go as thoroly prepared as usual. I found the patient, however, in regular labor with pains almost incessant, and she very nervous. In less than an hour a living child was born; and, as in my first case, immediately after she was seized by a severe convulsion. I had not a lance with me and there was not a sharp pen knife in the house; so as the natural flow of blood was abundant, I concluded to complete labor and then, if necessary, to send for a lancet. After the removal of

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afterbirth she had a second spasm. gave gr. morph. hyp. and 30 grs. each chloral and bromid by the rectum. her third convulsion her husband askt that I have assistance called, and in the unprepared state I was, I was not unwilling. I felt sure that with the advent of counsel, veratrum would probably come along, and after the laudation of this remedy I had seen since my Kansas experiences, I was inclined to try it in this case. As expected, the Doctor proposed veratrum viride, and I acquiesced. The patient was in a semi-conscious state between convulsions, so was able to swallow the first dose of 12 minims. Another attack coming on soon after, Dr. M―injected 10 minims. There was then no convulsion for half an hour, and the Doctor being very busy, left. The patient continued very nervous, and as she seemed to be approaching another outbreak, and as the pulse had not yet been much reduced, I gave another hyp. inj. of 8 minims. There were no more convulsions, but she remained unconscious or partially waked to a confused mental state for a number of hours. The pulse had gone from 120 at beginning of attack to 48 in an hour after the last injection. Wretched vomiting soon set in, which recurred at short intervals for a couple of hours. The patient had a nervous, restless night, with mental confusion until morning. She has made a good recovery however, and probably a good share in the successful management of the convulsions is attributable to Norwood's tr. ver. vir.

I have already taken up so much of your space that I shall not take more by elaborating my conclusions on these cases. There are several morals scattered thruout for me, and perhaps for others. As most of us are prone to be governed by our personal experiences, can you blame me for saying that I shall still bleed such patients should my execrable fortune pursue me by placing any more of them in my hands? Dayton, O. Jos. WERTHNER, M.D.

Method of Relaxing the Perineum. Editor MEDICAL WORLD:-In the September WORLD, page 360, I see remarks on the care of the perineum to prevent laceration. For some years I have had no serious trouble in that line, as I have followed a method which I believe will produce almost complete relaxation in the most rigid. Try it. When the uterus is

on

completely dilated, the head descended well onto the floor of perineum, introduce the three middle fingers of the right hand with the dorsum upward; let the middle finger make slight pressure on the oncoming head, the other two, one right the other on left side, make firm pressure outward (sideways) and downward on the perineum with each "pain" or uterin contraction. Between pains," hold what relaxation you have gained. I have yet to see the perineum that will not yield, and become soft, and the outlet become perfectly relaxt. Should the hand become crampt or tired out, have a solution of bichlorid at hand, take the hand away and immediately cleanse it, rest three or four minutes, when you can continue the pressure. Missoula, Montana.

E. A. CRAIN, M.D.

that would hold a quart. The livers in many had tuberculous abscesses. But the farmer and his family and his hired help were and are today healthy, and certainly they must have taken into their systems millions and millions of the tubercle bacilli. There are hundreds of cases in this State like the above.

Don't believe for a moment that homeopaths are fools, or ignorant, either. I have counseled with them many times. One of my very best neighboring practitioners is a homeopath. They do take a great deal of pains in selecting their remedies in relation to their "provings,' and they are careful about diet, nursing, hygiene, etc., but don't be fooled by believing that they give the infinitesimals all the time. I had charge of a lady who was injured in a carriage accident, and accompanied her to her home in Worcester, Mass., where her homeopathic family

Examining the Spine.

Editor MEDICAL WORLD:-I believe with Dr. Hammond (p. 364, September WORLD) that increast experience leads to decrease in use of forceps.

When every particle of placenta, membranes and clots are aseptically removed there is no reason why there should be very much lochia.

The only lacerated perineum that I have had for a long time occurred in a primipara aged 32, in January, 1901, and I was surely to blame for it. The labor was progressing quietly, and I was carefully pressing my hand against the perineum as each pain came on, just to keep track of the advancing head, when suddenly there came without warning a tremendous contraction, coupled with the voluntary efforts of the woman (who was on her back, limbs well drawn up and spread wide apart), and the child was simply shot out, down almost to the mother's feet; and of course the perineum was badly lacerated. Had I been more carefully on my guard, and held back the advancing head and allowed the vulva plenty of time to dilate, there is no reason for believing the perineum would have been lacerated.

I believe Dr. Koch is correct in saying that bovine tuberculosis is not communicable to man. A farmer a mile from my place had forty of his cattle killed in 1899 by a veterinarian sent by the State. Many of them were 66 rotten 99 with tuberculosis. I saw some of their lungs that had cavities

gr.

called. I assisted them in the operation, which was very skilfully done by this homeopathic surgeon, the homeopathic family physician giving chloroform. After the operation was over they gave morphin, with a hypodermic syringe, just as you or I would. I protested, saying that was almost a dangerous dose, and said I had been giving 1-16 gr. tablets that have workt like a charm. Then, said I, how does gr. of morphin harmonize with your 6, 10, 30 and even 50 potencies? They laft and said, we give medicin when it is necessary, as well as you; it is only a few cranks now that use above the 3x.

Dr. Cushman's case (page 391, Sept. WORLD) is probably reflex trouble, either from the spine or the genital organs. Examin her spine by making firm pressure on the spine from the base of the skull down to the coccyx. Press firmly over the spinous and over transverse processes, and if you find any sore points, put a fly blister on that place, and repeat if necessary. believe the soreness over the liver was reflex neuralgia from a sore point between the shoulders.

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Dr. Loope's (page 394, Sept. WORLD) patient probably has soreness at the base of the skull, or between the atlas and axis. Press firmly over the root of the occipital nerve, on the affected side, and if you find soreness, put on a good blister or use massage with a menthol ointment. Ninetenths of the cases of dizziness are caused

by soreness either at the base of the brain or in the cervical region, or possibly as low as the third or fourth dorsal vertebra. Too little attention is paid to the spine. Many obscure cases of dyspepsia, obstinate vomiting, etc., can be located in the spine, and if properly treated can be cured. J. C. CAMPBELL, M.D. Albany, Vt.

The Professional Dead Beat. Editor MEDICAL WORLD:-Who is he? how are we to know him? and how to manage him? are questions of great importance to our profession; and in my estimation these questions have not received the attention from the profession which their importance entitles them to. He may present himself in many ways, and always under the best disguise possible to himself; and without his previous history (which can only be furnisht by a brother doctor) we may not be able to recognize him when brought face to face with him, until from sad experience we learn that his case is hopeless after he has workt us early and late, in season and out of season, and now that we will work no more for him for nothing he casts us off and seeks other pastures, which if not more verdant, are sufficiently so for him and his purposes. He may be a good, clever (and this usually means good-fornothing) poor fellow who comes to you and says that he has learned of your fame, of your wonderful success as a baby doctor, or as a fever doctor, or as a pneumonia doctor, or as the kind of doctor which he just then stands especially in need of; and that he wishes your services, as his wife don't want any body but you. He may tell you how much sickness he has had in his family, and what a hard time he has, and what big bills he has paid your neighbor, and what poor luck Doctor So-and-so has had in his family; or it may be he will tell you that Dr. Blank has been attending his wife now for ever so many weeks, and that every dose of medicin she takes seems to make her worse, and that he and she have decided to make a change, and that he wants you to go right away as quickly as you can get there. You go and he pays you the cash for your visit. He tells you of many good things which he says he has heard said about you (which he may or may not have heard), and you congratulate yourself upon being so lucky as to add

such a good fellow to your list of customers. You make another visit, and he happens not to have the necessary "change." You make another and another visit with the same state of affairs regarding the "change," and you "charge it" and "charge it" until you become so accustomed to charging that you never think of anything else but charging. And you fail to collect it for so long that it has become "second nature" to you to let him run on and on, until finally some dark rainy or cold night, just as you have retired for the night to get much needed rest and sleep, some one knocks at your door, or perchance hello's at your front gate, or calls you by telephone to go from four to ten miles thru rain and mud or snow and ice to see his wife or baby, who has been sick for a week but can't wait till morning for a doctor. You are tired and sleepy and your sense of hearing and appreciation is somewhat dulled; you ask who it is, and the response informs you that he is none other than your old case of "sevenyear-itch," figuratively speaking. You decide at once not to go without the cash, and as he has been accustomed not to have it on former occasions he happens not to have it now; and your friend of these many years is lost to you forever. He owes you a long and big bill and forthwith he proceeds to settle same, not with cash, but by the use of his vile tongue in saying all manner of hard things against you that he may know or may imagin. He will delight to entertain his listeners with a narration of all the mistakes which you have ever made or which by any manner he could make them believe you have made. If you have ever lost a case of typhoid fever, pneumonia, scarlet fever, diphtheria or any of the other common diseases which will sometimes terminate fatally in spite of all any of us can do, he is sure to have learned the fact, and this he will roll as a sweet morsel under his tongue and magnify all the facts bearing against you and your management of the case in every way possible. This he will always do in the presence of some of the friends of a patient who is at that time under your care. He does this for the two-fold purpose of settling with you, and as pay for the doctor whom he now calls his family physician, being really more against you than a real appreciation of the other man's services. These fellows will do more talking against you