East Bernstadt, Ky.

[Query: Would this case have been reported if death had taken place? Do doctors bury their mistakes (or their failures) and blazon their successes? Let us have

the cases that end in death, as well as those that end in recovery.-ED.]

The Cause of Puerperal Convulsions. A New Theory.

6

Editor MEDICAL WORLD:-On page 471, November WORLD, the Editor says: "Your work and your contributions to the chats' should be thoroly up to date. The progressiv doctor never gets too old to be a student." Now, I am surely not too young to be a student, and I will not only come up to date, but will go a little ahead of it.

I was in advance when I stated that diphtheritic membranes could not develop in the light;and that in abdominal sections for the cure of peritonitis the light should be allowed to fall on the peritoneum, where it will act as a disinfectant.

Now I will take the lead again and say what causes puerperal convulsions. There is a constant breaking down and building up of tissues. The broken down tissues have to be eliminated. The broken down tisses of the nervous system are eliminated principally by the kidneys, and if they are unable to perform this the poisonous material will irritate and poison the nervous system, causing hysteria, convulsions or insanity, according to individual susceptibility. The spinal cord and the nerves originating from it are poisoned by this effete material, and revolt against it. Any spinal sedativ, like veratrum viride, will be borne in very large doses-larger than

Rupture of the Perineum by the Shoulders.— Tobacco Heart.

Editor MEDICAL WORLD:-The last few issues of THE WORLD have had several good articles on the perineum in labor. All, however, refer only to danger from the head. My own experience leads me to believe that the shoulders deserve more attention than they get, and that many of the worst lacerations are produced by them. One case in my own practise within the last few months: very hard labor, and 10 lbs. of naked baby. After several hours of intensely hard bearing down pains with no perceptible progress, I administered chloroform and applied the forceps. I watcht the head pass slowly over the perineum without injury. It was several minutes before the shoulders came, and as I knew the perineum was sound when the head past over it, I made no further examination after the second and third stages were completed. It afterward developt that she had a bad laceration, and it is our present arrangement that I shall repair it in January, 1902. He was a great broad shouldered boy, and the shoulders did the "devilment." The forceps had nothing to do with it.

Another case still more recently in the practise of a brother practitioner. Patient very fleshy, 28, primipara, and nervous. Had been in hard labor for several hours

without progress. I was called to assist. Chloroform was given to complete anesthesia, and forceps applied in the superior strait by my colleag. It was the hardest case I ever saw; for one hour we kept her under complete anesthesia "spelling" each other at the forceps. Finally he succeeded in making the delivery. The head past over the sound perineum, and seeing signs of life in the child, he attempted to hasten the passage of the shoulders, when the perineum gave away, to, tho not thru, the sphincter. She was too much prostrated for immediate repair, so we deferred it until the next day. In a couple of

hours convulsions developt, but were controled in a day or two, and at the end of a week mother and child were both doing as well as the average. In this case the forceps saved both mother and child, for there was not the slightest probability that a natural birth could have occurred, even if there had been no convulsions. The woman would have died from exhaustion. Had the convulsions come on before the forceps were applied, she would almost surely have died before delivery could have been accomplisht. Further, the forceps could not be blamed for the rupture except on the ground that, had they not been applied the head would never have reacht the perineum. Of course repair at the time was out of the question, and the Doctor expects to repair at least one perineum in 1902. I give these two cases to illustrate especially two points: 1st, when the head is born the danger to the perineum is not yet over. 2nd, if forceps are used, the fact that there is an injury is not proof that the forceps are to blame.

In President McKinley's case, I think that too little importance has been attacht to this element: It is asserted by some who ought to know (tho denied by others -evidently to shield the President) that he smokt fifteen to twenty strong Havana cigars per day. What would one expect in a man nearly 60 years of age, fat, sedentary life, great mental strain, mental activity and worry for years with no exercise of a nature to develop vital physical energy, and a system saturated from tobacco smoking? If the case were an ordinary man, would we not at once say, tobacco heart? A. W. MITCHELL, M.D. Georgetown, O.

Don't Deliver too Rapidly.-Typhoid Fever

Aborted.

Editor MEDICAL WORLD:-It is not enuf to use chloroform and instruments "cautiously." You must also be very sure that they are indicated. I use chloroform just enuf to take the edge off the pains. I do not want my patients to be unconscious, because I want their help; chloroform pusht to unconsciousness predisposes to postpartum hemorrhage; so do forceps too early applied. Given a fully dilated os, it does not yet follow that the uterus is ready to be emptied. It is much greater misery to see your patient collapse from hemorrhage than to hear her moan

ing. Forceps are indicated, if I remember Lusk rightly, when the uterin contractions fail to move the head, or when the patient shows signs of exhaustion, or, of course, in accidents like convulsions. I maintain that in the average case uterus should have contracted and retracted for at least five or six hours before it is wise to apply forceps; and even then I do not deliver the placenta for one half to one hour later, in order to stimulate retraction. With such precautions I have avoided postpartum postpartum hemorrhage in women who always "flowed terribly ́ ́ in previous labors.

Dr. E. T. Lewis asks whether typhoid can be aborted? Assuredly it can. I have aborted five cases this fall, and more than that number last year. To be sure, I did not in any case go bug hunting; i. e., I did not make a laboratory test, but the clinical picture was complete in every case, and one of them was myself. All were treated with castor oil or saline laxativ to secure one or two free movements a day. W-A. intestinal antiseptic tablets (i. e., sulfocarbolates of calcium, sodium and zinc) every three hours until smell and appearance of dejecta were normal; diet and rest (except in my own case, for I attended to my practise all the time) and but few had to go to bed. All of them were up and about in one week, and ready to go to work by the tenth day. Error in diagnosis? I do not think so. We have plenty of typhoid here, and I have had my share of cases. If the clinical picture is there, if the patient feels ill and weak, he wants to get well whether the bacillus is found or not; and my treatment, which I have used in severe cases as well as in mild ones, and which I have found to be almost a specific, has been successful in every case without exception. Roselle, Ill.

H. J. ACHARD, M.D.

Chlorine Water in Typhoid. Editor MEDICAL WORLD:-I have derived so much benefit from reading your valuable journal that I feel I should send in "my mite" with the hope of benefitting some other tho wiser brother. I have found, after a thoro trial, that chlorin water in typhoid fever is the nearest approach to a specific of anything I have ever used. I consider it (when used in conjunction with the Brandt baths) superior to any, and all other treatment.

Also, I wish to state that during an epi

sas

How to Meet Mean Competition. Editor MEDICAL WORLD:-Your editorial in September WORLD on Physicians' Fees, and your advice to keep them up to a reasonable amount, strikes a responsiv chord in my heart. To strengthen some wavering brother, let me tell a little incident that happened years ago in my own experience. In the good year 1890 I was practising on the line between Connecticut and Massachusetts, when, without the slightest fault on my part, I got into a controversy with a young physician in a neighboring town a dozen miles away. Hesassed" me in a letter, and I replied that while his remarks did not affect me any more than the bark of a little yellow dog would disturb the serenity of the silvery moon, yet if he repeated his " sing" I would move right into his little bailiwick, so we could fight at closer range. He, taking my threat as a bluff, did "sass" me again, and within a month my shingle was hanging on the next house but one to his, without him having the slightest intimation of my coming. Of course he was thunderstruck; and, having the moral support of the "tin-god" of the village (the mill-owner), he made his brags that I was to be starved out in short order. Besides running around to every house and on every crossroad to revile and blackguard me, he also let it be known that from that day his fees were just one half of the usual charge; so he charged only fifty cents per visit, and ten or fifteen cents per mile for travel. Having already had ten years experience and good friends to advise me, I shut my mouth tight as far as my competitor was concerned-shut it tight. To be sure it was hard, awfully hard, to have those "dear friends" (blast them), found everywhere, who are so willing to run with tales to and fro among the different doctors, to come and tell you that this or that was said, and yet not reply; but I succeeded.

To

Regarding fees:-The regular charges used to be a dollar per visit and twentyfive cents per mile (I even charged thirty

seven and one-half cents), and when any patient sought to reduce my charges by quoting what Dr.-charged or would have charged under the same circumstances, I simply told him that as far as I knew all men sought to get a renumeration somewhat near an equivalent to their service; and if a doctor charged twentyfive cents, or even ten cents per visit, no doubt he was the best judge as to the value of his work; and further, that I considered my services worth two dollars per visit, which I would charge if the patient was "rich," which, of course, they

The "Germ of Truth" in Irregular Medical Cults.

Editor MEDICAL WORLD:-A St. Louis medical journal informs us that all the "paths and isms" that have struggled into life, "one and all contain germs of truth, or they would have died-'died in the bornin'" Now, it may be objected to this "Brief" argument that the premises are not verified, and the conclusion not irresistible. Josh Billings once experimented, for the good of humanity, by swallowing samples of all the cathartic pills on the market. Like Josh, I have been experimenting, but along another line. I bave been searching for those "germs of truth." The old rustic's simile of the hen that moved a ton of dung and found a grain of wheat holds good in my case. I have waded thru a ton of " metaphysical" litererature. I have read "magnetic" and

psychic" journals. I have pried into the "occult secrets" of the "orient" and "occident." I have perused that blatant and blasphemous travesty on healing and religion publisht by Chicago's second or third edition of Elijah. I have pondered over the preposterous mush of Boston's female Messiah. I have reflected over the loudmouthed pretensions of the absent treatment impostor. I have studied the" dy namic force of thought" and the "law of mental currents." I have examined the

delusions and hallucinations of opium and hashish fiends under the title of "spirit phenomena." I am familiar with the mysterious arts" of the "necromancer" whose secrets you could not investigate and live unless you purchased them as directed. I did not follow directions but still live. In my anxiety to discover that "germ of truth" I descended in folly low enuf to read the puerile rhetoric of the osteopath and the crazy logic of the homeopath. I understand the theory and practise of fortune telling, palmistry, clairvoyance and astrology. I have investigated telepathy, hypnotism, demonology, et cetera, ad infinitum. But after floundering thru these quagmires of imbecility and mendacity I have discovered the "germ of truth"-the great law upon which depends all the success that the followers of these cults have. I presume I might develop, pad and expand this "germ" into a "mail course," copyright it and sell it as an "oriental, occult, psychic system," or something of that kind, but for ethical reasons, I shall not. Here it is Jolly a man and he feels better. J. A. MULNIX, M.D. Daws, Iowa. [The Editor is not a homeopath, but he objects to this large, respectable and educated body of men being clast with the above mentioned. Yet it is the systems or the literature of the systemsand not the men, that the Doctor mentions above. Progressiv homeopaths agree that much of their literature sadly needs "weeding out." Dr. S E. Chapman, now of Chicago, the able champion of homeopathy, says in November WORLD, page 473, below middle of first column: "Upon its face, homeopathy is the most tremendous humbug ever perpetrated upon suffering humanity." He says this, we understand, of the literature, the logic, of homeopathy. But he confidently invites We do not us to the test of actual trial. understand that homeopaths, as a class, do any more "jollying" than regular practitioners.-ED.]

Tonsillitis. Comparativ Statistics. Editor MEDICAL WORLD:-A discussion of tonsilitis is timely this time of year. The only treatment I have found successful is as follows: magnesia sulf. to copious evacuation, 5 grains quinin t. i. d.. and 1 or 2 tablets of protonuclein every 3 hours. This will abort an oncoming attack (premonitory symptoms, objectiv and subjectiv

are unmistakable), and will quickly cure a well developt Relief is prompt. Prophylaxis: keep feet warm and dry, don't wrap throat except lightly. Have tried the usual remedies as laid down in text books: tr. chlor. iron, chlorate of potassium, nitrate of silver, tr. guaiac, etc. all without the slightest benefit except in very few cases.

In re homeopathy vs. regular school, I present a few facts. Dr. Routh of London has collected statistics of the Vienna hospitals and is corroborated by an independent party, Sir William Wilde, an eminent Dublin oculist who says: "I am bound to say that the cases I saw treated in the Vienna Homeopathic Hospital were fully as acute and virulent as those that have come under my observation elsewhere." Dr. Routh's statistics reveal these startling contrasts: Name of Disease.

Pneumonia Pleurisy Peritonitis Dysentery

Homeo. Deaths. Per cent.

57

3.4

4.

3.

Regular School Deaths. Per cent

24.

13.

13.

22.

Here is a comparison of the five Massstate hospitals for the insane (year not given):