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While ichthyol in the acute form has acted like a charm it has not done well with chronic cases. Early in the case I use morphine freely, but later it is a dangerous screen and may conceal the need of a surgeon. DR. F. G. Greenfield.

Edinboro, Pa.

Various Topics.

Editor MEDICAL WORLD:-On page 397, November WORLD, is a quotation from Dr. Goodell in which he says he has never known a woman to become pregnant after having gonorrhea. If there is anything in medicine that I do know it is that women can and do have children after having gonorrhea. Three years ago I treated both husband and wife for gonorrhea. The woman's case was the most rebellious I think that

ever came under my notice. This year I

attended her in labor. She was delivered of a large, healthy boy. I never saw a mother and child do better than they did. Many similar cases could be cited if necessary. Strumpets frequently use means to prevent pregnancy or cause abortion or miscarriage. The fact that they seldom have children should not be charged to gonorrhea alone. We should not forget that such characters often have syphilis and this may account to some extent for the small number of children born to them.

Diet during the last weeks of pregnancy (page 395) may prevent the growth of the fetus. I have thought that it did in some cases I have observed. But the rule (if it may be called one) is not without exceptions. Long ago Dr. Rigin Thompson stated that epsom salts taken freely during the last two months of pregnancy would check the growth of the fetus. To this rule there are also exceptions.

The proposition for a permanent journal in the Latin language (page 370) is not likely to prove a grand success. Very few who read Latin at all read it well enough to "waste time" over it. The busy practitioner will have little to do with it. For the general practitioner one language is enough. The future medical historian will find enough and more than enough in his "own tongue wherein he was born" from which to gather abstracts and data. Physicians who have worried for many months over old cases of psoriasis will hail with joy the discovery of the "thyroid gland" cure for this troublesome disease (see page 370). Possibly some doctors will (like myself) lack faith in this treatment.

On page 369 the editors suggest that public funerals in cases, of death from contagious diseases should be abolished. This is right. In

deed, I have always thought public funerals, in towns and cities especially, and more especially during an epidemic or endemic, should be abolished. The tolling bell, or even conversation about a funeral, will seldom fail to make worse the patient who is dangerously ill. But the time will never come when the world will be free from contagious diseases. Like the poor, they are always with us. They originated de novo once, why not again? But it is in the power of men and governments or nations to do a vast amount of good in checking and preventing the ravages of not only contagious but all other diseases. It is the duty of the physician to do all in his power in that direction. Too often the advice and suggestions of phy sicians are unheeded, and legislatures are proverbily slow in enacting laws calculated to prevent disease.

CARROLL KENDRICK, M.D.

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Conduct of Labor. Cord Three Times
Around the Neck.

Editor MEDICAL WORLD:-As to conception in a female who previously had gonorrhea, I have an interesting case to report. A married woman in her fourth (4th) month of pregnancy contracted gonorrhea from her husband. She was subsequently delivered at full term of a healthy child, she having of course, recovered from her attack long before.

The child showed at no time any untoward symptoms, and after two years the woman is again pregnant.

The lack of conception in prostitutes appears to be owing more to an inflamed condition of the endometrium, which may be owing to any one or more of many causes rather than to the fact that gonorrhea may have been present in any particular case

I fully agree with Dr. Parker in his article on peritonitis following birth at any period of gestation.

In the first place be certain of the cleanliness and disinfection of every thing which may come into contact with the parturient canal. Also be sure that delivery is complete, not only of the fetus and membranes, but also of clot, and firm contraction secured.

Then cleanse the external parts thoroughly with disinfecting solutions and direct the process to be repeated at least twice a day, with a disinfected cloth covering the external genitals in the intervals, and leave the parturient canal, etc. strictly alone, and ill-recoveries from a truly natural event will be very much scarcer than at present.

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A Large and a Small Pair of Twins. Editor MEDICAL WORLD.-In November

WORLD Dr. L. Rupert, of Rupert, W, Va., reports a large pair of twins. I can get close to him.

On October 26, 1893, I was called to see Mrs. S. A., aged 30, at 4 o'clock a.m. Found ber in labor, and in two hours delivered her of twins, both boys, each a head presentation; one followed the other in half an hour, smallest first. One large placenta with two cords. They weighed 7 and 8 pounds. There was a good There was a good deal of hemorrhage, but the womb contracted well. I saw her the next day and she was doing nicely. I have attended her in several miscarriages. She would become pregnant and go two or three months, and once as long as five months- I then began treating her to avoid this and succeeded well; had no more trouble. She has four children. I did not see the case after the day following her confinement, but understood from her husband that she was doing well. I prescribed for constipation, and sent her a vaginal wash a few days after her confinement. Her husband said also that she had some pleuritic pains, but perhaps did not give this the weight he should have done, as she had had pleuritis a year or two ago, and did not request me to see her. I have seen somewhere that the symptoms of pleuritis sometimes follow labor when the true cause is in the uterus, and septicemia may develop when some of the symptems rather point to the pleura or diaphragm. She grew worse the last days of November and died on December 2-while her husband was away from home-a victim to blood poisoning, which might have been prevented had I seen her or known her condition in time, it being about five weeks after she was confined.

On November 10, about two weeks after I delivered Mrs. S. A., I was called to Mrs. W. S., age about 32, in labor, but as I was not at home Dr. S. was called, who reached there in the early morning, one baby being born before he got there. After eight hours the other was born. I was ealled when they were two weeks old to see them, as one of them was thought to be dying, as they had given it a large dose of tincture of opium and camphor to quiet it. They were very much jaundiced, but that is disappearing; are doing well now. They are females, and weighed 4 and 5 pounds when F. W. B

born.

[We can only express our regretful criticism of the manner in which the first case was allowed to die without proper attention. The husband was certainly to blame if being at all able to pay for medical services, he requested the physician to cease calling before the mother was well. However, there are many so unfortunate that they must limit their expenses for medical attention to only that which seems to be urgently necessary, needing all their income for supplying the other necessities of life. In such a case if the physician undertakes an obstetrical case it is incumbent upon him to keep the patient under his own observation until she has properly recovered from the puerperal condition.-ED.]

Kneeling Posture in Labor.

Editor MEDICAL WORLD:-Dr. J. A. White wants some one's experience with labor in a kneeling position. I have for many years, when labor was slow and I didn't think it necessary to use the forceps, requested my patient to get on her knees in the bed and, when the head of the child got about one-quarter through the labia, I would have them laid back in their usual position. While in the kneeling position the child gravitates toward the outer world, and I sit at the back of patient with my hand against the labia merely to stop a sudden exit of the child. I have something for the woman to lean on or some one to support her while in this position.

I never keep my patient in this position any longer than to get the head partly through the labia. However, I believe it would be a good way to deliver, for, instead of the child dragging over the perineum it would be over the pubis. J. H. STANLEY, M.D.

Beardstown, Tenn.

Editor MEDICAL WORLD.-"The Physician as a Business Man" reached me several days since, and I am very much plea-ed with it. Such a book should be read by every member of the protes-ion, and I am sure there would be more harmony and success attending them through life. S. J. SUMMERS, M.D. Haigler, S. C.

Answer to Drs. Harry Brown, P. B. Hardy and J. W. Shemwell. Quiz in Relation to Cystitis. Editor MEDICAL WORLD:-I will try to answer a few of the quizzes and then I wish THE WORLD to solve a question for me.

Dr. Harry Brown's case, page 358, October, Dr. P. B. Hardy's, page 394 and Dr. J. W. Shemwell's, page 394, November, are all from one and the same cause, inflammation along the spine. Internal remedies are useless as curative treatment. Of course, keep the digestive organs in good condition, build up the general health as far as possible. To relieve the pain in a severe attack allow the patient to inhale chloric or sulphuric ether just sufficient to relieve the pain but not to full anesthesia.

For the curative treatment begin at the base of the skull and make firm pressure along the spinous processes and then over the transverse processes on either side of the spinal column down to the coccyx and locate the tender spots which indicate the points of inflammation along the spinal cord and roots of the spinal nerves.

Now blister and blister, yes, use the good old Spanish flies, over every tender point, one after another, and repeat them until you have taken the soreness all out of the spine, or as nearly so as possible, and your patients will be well in proportion as the same is removed.

Don't let them lift or do any kind of work, walking or riding, that will jar or in any way strain the spine.

Dr. Hardy's patient has some very tender spots over the transverse processes of the tenth, eleventh and twelfth dorsal and probably first and second lumber vertebræ. This gives reflex pain over the region of the ovaries and possibly though the sympathetic nerves-real ovarian neuralgia, but the blisters over the above named regions will benefit and cure if persisted

in.

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This works admirably as a topical application. Let's hear through THE WORLD how they progress.

The help I want is for a case of cystitis of fifteen or sixteen years standing in a woman, married, aged forty-seven, menstruates every two to four months now, who has been confined to her bed for that length of time.

The symptoms are as follows: Severe pain and discomfort about the bladder and urethra all the time. She is obliged to pass water every fifteen to fifty minutes, day and night. Urine contains mucus and blood, sticks to the bottom of the chamber and has an offensive odor. Upon examination there is much tenderness over the region of the bladder. By vaginal examination the urethra was very sore, and the neck of the bladder is exquisitely tender.

Eighteen months ago, when I first began treating this case, I dilated the urethra thoroughly and expected to cure the case as I had in several others apparently like this one, but the dilatation only afforded temporary relief. I then educated her to use a glass catheter which gives the most relief. I washed out the bladder, using sulpho-carbolate of zinc and golden seal and various other things at different times. Internally, carbonate of lithia has done the best of all the remedies used except hyoscyamine to relieve spasms of the bladder and urethera. I should like to hear what THE WORLD readers will advise. J. C. CAMPBELL, M.D.

Albany, Vermont.

Hystero-Epilepsy.

Editor MEDICAL WORLD:- I read with interest Dr. Waugh's comments upon the case reported to your journal by myself on page 394.

It may be of interest to Dr. Waugh to learn that we do live "in the backwoods" and that the case

of hystero-epilepsy was relieved of both hyper-
esthesia and convulsive siezures by forty grains
of quinine given in four doses during twelve
hours and repeated on the seventh day.
Britton, Mich.

P. B. HARDY, M.D.
Pemphigus.

REPLY TO J. D. MCDONOUGH, M.D. Editor MEDICAL WORLD:-The case re

ported in December MEDICAL WORLD, page 428, I diagnose as pemphigus, caused by a vitiated state of the system. I had a case in July-a young man with both arms completely covered with scales and scabs from the elbow to the wrist; fiery red under scabs of yellow; when a child he was covered from head to foot, with a mass of sores, but the disease seemed to be cured when he was six years old. When he came to me he had a good head of hair, said he

slept well, ate well and had no trouble with his digestion. I found his pulse very slow and weak, about forty-five and his tongue pale. His age was thirty and he was not married. He had various sores on his limbs, whenever he bruised or scratched them. His arms had been in this condition for over six months, and he had been treated by the local physician of the place where he resided, but he said that he was growing worse instead of better. I told him that the cure would be very slow, that he would not see much improvement under three months. My mode of treatment was as follows: In the first place wash the sores in strong salt water with a soft sponge every night and morning; then apply a cerate which I him The gave cerate was one per cent. of yellow oxide of mercury in purified lard. For an alterative I gave him:

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This was mixed in a pint of syrup and a teaspoonful taken night and morning, enough to produce two operations a day.

To build up the whole system I gave McArthur's hypophosphites, a dessertspoonful after each meal.

The first month there was but little improvement in the sores, except that the fiery red of

the skin seemed less. The second month the scales and scabs began to come off and new skin began to form. The third month the arms began to look natural and, as the new skin formed, no scars were left and the disease appeared to be cured. I had him continue this treatment two months longer so as to keep his blood in a good condition, and to all outward appearance he is cured.

DR. L. M. HOLMES.

46 Union Park, Boston, Mass.

Treatment of Dysentery.

Editor MEDICAL WORLD:-In your November issue I notice "yarrow for dysentery." As I have had numerous occasions, especially this autumn, to observe the disease in both adults and the young, and have used yarrow as a tea in some, allow me to detail my procedure, describing at the same time the character of the disease as displayed in this locality, directly bordering on the sea and supplied with a temperate climate, good drainage and air currents.

In nearly all cases I found, when called early, constipation, anorexia, fever and headache, followed in the young by nervous phenomena, quite often convulsions, and in the old nausea and emesis. It was my practice when constipation existed to prescribe minute doses of calomel and soda, and as the case would go on

with profuse diarrhea, after which, as a rule, the pyretic symptoms would ameliorate, I would resort to a compound powder of lactopeptin, bismuth and salol, in doing which, I bear in mind the possible complication of enteric fever. Dieting, of course, was rigidly observed, but as regards injections of starchy water, etc., the tenesmus and anal irritation proved so great that I simply ordered one or two enemas of warm water to clear the bowels of old fecal matter and let this part rest at that. In adults I almost universally prescribed after the calomel aperient the following:

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Fever and eclampsia were combatted by acetanilid and cold cloths.

In cases both of adults and children I universally prescribed for the thirst, which, of course, was always present in greater or lesser degree, tea made out of one ounce of yarrow to one pint of boiling water and allowed to cool somewhat.

This taken freely and mixed with a little sugar seemed agreeable and has no doubt acted well. I believe that a mild case of dysentery would do well with dieting, rest and some such tea to assuage thirst and balance the waste of fluids per rectum.

EMIL WESCHCKE, Ph.G. M.D. Pt. Arena, Cal.

Editor MEDICAL WORLD.-Let all physicians first read "The Physician as a Business Man" and follow out all instructions. Then let them adopt your system of bookkeeping (Visiting List and Ledger.) 1t will make them feel as if they had a place in the business world. At the same time it will make their work lighter and they will feel contented with themselves and all the world. J. H. JOHNSTON, M.D. Red Lodge, Montara.

Animal Electricity.

Editor MEDICAL WORLD:-In the issue of the WORLD for November, 1893, page 391, a communication appears from Dr. J. Meeker, of Newark, N. J., under the heading of "The Proper Use of Natural Forces in Medicinal Treatment," in wh.ch the following appears:

"If we place a man upon an insulated stand and let a wire pass from the soles of his feet to the earth, and if in this situation he exercise briskly, electric currents will pass from his feet to the ground while this is going on."

Ideas of this kind for a long time found credence, chiefly as the results of the elaborate experiments of Du Bois Reymond and others, who believed that they had demonstrated the presence of electric currents in nerves and muscles. But these experiments have been thoroughly discredited by Prof. Trowbridge, of Harvard College, who repeated them under such precautions as to establish conclusively that the currents of electricity indicated by the galvanometer originated not in the nerves and muscles but in chemical action set up in portions of the apparatus employed. Some acco.ints of Prof. Trowbridge's experiments and their results, may be read in Beard & Rockwell's Medical and Surgical Electricity. Perhaps Dr. Meeker has something later to show on this subject; if so, he will confer a favor by producing it; for so far as appears at present there is no scientific evidence whatever that currents of electricity play any part in the action of nerve and muscle or in the phenomena of animal life.

It seems unnecessary to recapitulate the evidence that nerve force and electricity are wholly unlike, and that neither of these forces can be transformed. into the other. Indeed if THE MEDICAL WORLD chooses to afford me the necessary space, I am prepared to furnish scientific evidence that so far from being the ally or the alter ego of nerve force, electricity is a paralyzing agent and in so far as involuntary muscles are concerned that electricity produces similar effects to motor nerve action. I infer from other portions of Dr. M's communication that he has been reading the "Researches of Baron Von Reichenbach on Magnetism" etc., and has been impressed by the experiences therein recorded. It would be out of place to enter on any discussion of that subject here, but surely the alleged "odylic emanations" have been sufficiently discredited not to be accepted seriously at the present time. If Dr. M. does not think so, I would respectfully recommend him and any of your readers similarly impressed, to consult Dr. W. B. Carpenter's "Mental Physiology," Appleton's, 1884,

pp. 159-161, where these experiences are esti mated at their true value.

THOMAS W. POOLE, M.D. Lindsay, Ont., Canada.

The Humbug and Tinkering in Gynecology. Editor MEDICAL WORLD:-I frequently meet general practitioners from 50 to 60 years of age who unhesitatingly say that the practice of diseases of women is a humbug. It must not be thought that such men are especially lacking in intellect, for personally I can successfully contradict it. When these men began to practice, gynecology was in its pure infancy; their ideas were gained by the results of practice and observation on diseased women of 40 years ago My argument that gynecology has improved much of late would only induce the suggestive remark that "gynecology must have changed." At first, though, we think that the old doctor's view that gynecology is a humbug is entirely too sweeping. But one who has opportunity to study the methods of the general practitioner may yet side with the old doctor. Gynecology may be a humbug in two ways: 1. The gynecologist may do more than he ought. This is what I shall style tinkering, which brings innumerable ills in its wake. 2. The gynecologist may treat and treat and do nothing. Of the two methods which induce the old doctor to call all gynecology a humbug no doubt the case in which there is too much tinkering is by far the worst. From what does this aggres sive tinkering arise? It may arise from the physician's desire to do something so as to gain a reputation for fame or skill. It may arise from the doctor's idea to really cure the disease, but it generally arises from ignorance of present and subsequent pathology. Tinkering arises from lack of physiological and anatomical knowledge. In no single instance does tinkering and lack of pathological knowledge creep out so fiercely as in the use of the uterine dilator,

It is not uncommon for a woman to come to me and say that several months previous Dr. A. dilated her uterus, and I now find pyosalpinx on one or both sides. The old doctor, no doubt, had observed that when Dr. A. had tinkered with Mrs. B. with a dilator that she became sicker with the months. Three months ago Mrs. X had her uterus dilated; from that time on she got worse and at the end of three months I removed a double pyosalpinx and an ovarian abscess. Such tinkering is frequently done at the clinics, and the woman allowed to walk home. Let us see what is the disaster of indiscriminately dilating the uterus. For example, the cervix is never prepared for an abortion, but the uterus is always ready to expel it

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