He may relieve the neuralgic pains of dysmenorrhoea. In a certain per cent. of cases, these are dependent upon a stenosed canal, when a No. 20 olive tipped bougie, carrying 10 m. a. of negative galvanism, will speedily dilate the stricture and relieve the patient. When the cause is congestion, the same current applied to cervix and upper vagina by a dilating electrode, will effectively attain the same end. So complete is this relief that I have seen more than one woman fall asleep in the operating room during the application.

He may use electricity in cases of suspended animation of newlyborn infants. It is far better than artificial' respiration effected by the doctor's mouth, and much more agreeable. I think that the best way to apply faradism here is through the medium of a warm bath. One pole may be plunged into the water and the other touched to the skin above the surface.

In this desultory way, gentlemen, I have endeavored to suggest a few of the many things that a general practitioner may do with electricity, and do well with nothing more than his two instruments and half a dozen electrodes. The list is but a small one, but to extend it in this presence is needless. I have said nothing of electro-surgery nor of electricity in gynecology, not only because there are others present more competent than I to speak upon those subjects, but because I believe that success in both is dependent upon a degree of expertness in manipulation, and an amount of knowledge of electro-physics that no general practitioner will be willing to give sufficient time to attain.

What he may not do, his own sense and a fair amount of experience will teach him, and what knowledge remains after his experimenting is done, will be likely to imbue him with respect for the science of electro-therapeutics, and for the men who devote themselves to its advancement in the face of factious and determined opposition.

SUDDEN DEATH FROM PULMONARY THROMBOSIS AND

EMBOLISM DURING PREGNANCY.

BY O. W. PHELPS, M. D., BELLOWS FALLS, Vt.
Now West Warren, Mass.

REPORT OF A CASE.

Cases of extreme rarity, though interesting, are not usually the most profitable as subjects for a paper; but those of comparatively rare occurrence, though well understood by the profession, are liable to be forgotten or slip the mind of the active practitioner, and hence he is liable to make a mistake in diagnosis to his own mortification, and perhaps the injury of his patient when treatment is based upon such diagnosis. But in cases of sudden death, like the one I am about to report, it is only the physician's reputation that suffers, as his patient has gone beyond his power to torment e'er he reaches the bedside, and his only office is to assure the sorrowing friends that there was no help for their loved one; but, one explanation of the cause or the mode of this sudden and rude severing of all earthly ties is asked and expected.

Usually the common and popular snap diagnosis of heart disease or apoplexy satisfies all demands, but occasionally some enquiring mind insists on a more definite explanation of their bereavement, or they realize that the symptoms do not agree with their preconceived ideas of these diseases; then it is, we are put to our wit's end for an answer, and again we may be called before life is extinct, and when we shall need all the presence of mind we are possessed of, and the accumulated knowledge of the profession will be none too much if we are to be of service to our patient.

Among the internal causes of sudden death which will come to our mind are:

Sixth.

Heart clot.

(a) Extravasation and effusion of blood at the base of the brain, from disease and rupture of the arteries. (b) Large hemorrhages into the substance of the brain, from the same causes. (e) Embolism, constituting apoplexy.

Seventh. A somewhat similar factor to the last, but affecting an entirely different organ. Thrombosis and embolism of the pulmonary

artery, first explained by Virchow, and exemplified by the case I am about to report :

CASE. April 17th, 1891, Mrs. A—, age 35; married about ten years; has three children, ages respectively 8, 4, and 11⁄2 years; she has lost one child between the last two; at present time is about 8% or 9 months pregnant (against her wishes). At about the seventh month rather suddenly she was seized with pain in the left leg, followed by swelling below the knee; this became very painful so it was with difficulty she could get about the house, and lasted between two and three weeks, when it disappeared about as suddenly as it came, without treatment other than rubbing with linament and the use of an elastic abdominal supporter, as suggested by myself, as I was in the house soon after this pain began, to see the husband. It was casually spoken of but no consultation asked or expected. I did not see her again alive. The swelling did not wholly disappear, and it had been remarked by neighbors, for a few weeks, that she was more pale than usual.

The following is from the local paper: At about 7.30 o'clock on Friday morning, April 17th, 1891, Mrs. A- —, wife of a prominent local dentist, dropped unconscious while busily engaged in her domestic duties of the morning.

She had come down stairs with a lamp and water glasses in her hand and had reached the door which opens into the sitting room, when she fell backwards. No one saw her fall but her son, who had passed her room while she was dressing, and gone up stairs to his room, soon came down and found his mother prostrate in the hall. He immediately called his father, who was working in the garden, who reached the side of his wife in a few seconds. He worked over his wife and got her to breathing rather artificially for about ten minutes. In about twelve minutes from the time Mrs. A- was discovered, Dr. Whitman

reached the house, but the heart-beat had ceased.

During the night before, she had been kept awake most of the night by the baby, who had a severe bronchitis, and the Doctor also not being well, she had taken the entire care of the baby, although it was unusually hard for her, and she was very tired. At about 6.30 o'clock, the Doctor took the baby down stairs, leaving his wife to rest, the last he saw her alive."

Autopsy, April 18th, conducted by Doctors Whitman, Albee and myself. The thorax was opened, and the lungs found normal in appearance, collapsed, the diaphragm being crowded up by the gravid uterus. The abdominal cavity so far as examined, was found normal; the uterus was opened and found to contain a well developed female fœtus. The heart being sought was found normal and in systole, it was dissected from its place and taken out. In severing the arteries and veins considerable blood rushed out; nothing abnormal was how

ever found, until the pulmonary artery was cut, when a large semiorganized clot slipped out. This clot evidently filled the whole length of the artery from the valves to the first division; the distal or pulmonary end appeared to be a recent clot and solid, while the cardiac end was more fully organized, and on closer examination found to be tubular. Sudden death from pulmonary embolism during the puerperal state is not uncommon, and also in some other conditions supposed to favor the coagulation of the blood in the viens; but during gestation few cases have been reported.

Dr. J. S. Billings, of the United States Army, informs me that there is no case reported in their library at Washington that corresponds precisely to this. The nearest to it is, perhaps, one that is reported by Dr. Smith in the Association Medical Journal, London, 1853, page 441, in which a lady aged 20, near the end of her second pregnancy, while laying in bed dressed, suddenly cried out and died suddenly On examination, forty hours after death, the pulmonary vein was found to contain a cylindrical coagulum, the outer layer of which was free from red corpuscles.

Dr. Billings further adds: There are of course a large number of cases of pulmonary embolism reported, some of which are connected with simple local thrombosis in the lower extremities; but I have not the time, at present, to examine these cases in detail, and can only say that I do not remember having seen an account of any such case occurring in the latter months of pregnancy.

I had intended to include in this paper some reported cases of pulmonary embolism, and suggestions from authors; but have not been able to give it the necessary time, hence I close with a few words of theory or suggestions which may lay me open to criticism, and I hope may draw out discussion.

Pulmonary embolism as we all know is not an unusual result of the breaking up of a thrombus of the illiac or femoral vein, the fragments of which form the primary obstruction.

But in this case I believe there was a thrombus of one of these veins which broke up or disappeared about the time the lameness was reliev ed, leaving no other symptoms that were observed at the time; but it seems to me possible, and perhaps probable, that a fragment of the clot was carried along and lodged just behind the semilunar valves of the pulmonary artery: the ebbing or retarding of the current at this place a each beat of the heart would favor this result, and this fragment might thus form the nucleus for the secondary thrombus, which was thus seve ral weeks in forming and becoming semiorganized, lining the whole interior of the artery and narrowing its passage, and the sudden death may have been caused by the final loosening of the whole thrombus, or a portion of it, or even the forming of new additional clots, either of which might plug the whole artery.

INDIGESTION AND ITS RELATIONS TO DISEASE.
BY DR. C. W. PECK, BRANDON.

In the discussion of the question, indigestion, and its relations to disease, it is first necessary that we have well defined ideas on the subject of indigestion.

Indigestion is defined by Dunglison as a state of the stomach in which its functions are disturbed, without the presence of other diseases, or when, if other diseases are present, they are of but minor importance. He goes on to some length to point out the symptoms of indigestion, which are not especially relevant at this time. My own idea of indigestion is, that it is a physiological disturbance of the whole or a part of the digestive apparatus, whether it be in the stomach, directly after a meal, or a torpid condition of the colon with constipation in consequence of a changed condition of the secretions-the mostfrequent cause of this so common a malady.

To study indigestion in its broadest sense we must study it in its relations to the other systems, the nervous, the reproductive, the circulatory, the muscular, and the respiratory. The influence which a disturbance in one of these systems exerts over the others can scarcely be realized, even when carefully studied. Examples of this kind are constantly being brought out by specialists, where the correction of a single nerve strain of the eye regenerates the whole being, and brings order out of chaos.

On the same general principles the general practitioner should carefully study the almost daily digestive disturbances arising among a certain class of his patients. It is a well recognized fact that the act of digestion calls into use almost the entire organic nervous system, and that a failure on the part of the nervous system to perform its work normally, during this act, causes a poisoning of the blood and nervous centres, changing largely the quantity and quality of the excretions, especially the most important one, the urine. It is only when we realize that the large majority of neuralgias, rheumatisms, and nearly all inflammatory actions, as well as the long list of so-called summer diarrhoeas, are primarily due, largely, to indigestion, from one cause or another; and our inability to cope successfully with any of this multitude of ailments without first correcting the indigestion, if it exists, that we recognize the fact that good digestion is the sine qua non to health and strength. I said indigestion was a physiological derangement of the whole or part of the digestive apparatus. Among the various organs in this system I think most importance has been attributed to the stomach, which I believe is a mistake. The stomach is not long-suffering, but is a prompt