tors and the method of development of these lesions of the kidneys we are in a position to study intelligently both acute and chronic in terstitial nephritis and treat successfully as well as to prevent its beginning.

Quit your whiskey drinking and the using of tobacco and all excesses and die of ripe old age. Learn we do not so much die as kill ourselves and blame the fool doctor for not telling us sooner.

PUERPERAL ECLAMPSIA; REPORT OF FOUR CASES.*

By W. H. JOYNER, East Bernstadt.

Case 1. Mrs. S. G., age 73, six-para. So far as could be learned, she had had no trouble in labor until now. Called her husband at 4 A. M., March 18th, 1912, after she had had a convulsion and thought she was in labor, a non-registered physician was called who gave her teas, etc. She had many convulsions but delivered herself about 10 A. M. He delivered the placenta but did not wait to see the outcome. He told the family that he could do no more, but believed the woman was going to die and departed leaving her unconscious.

I arrived about 6 P. M., (8 hours after delivery) and found the woman very cynotic, pulse about 120, weak but regular, respiration about 30, very irregular with a convulsion about every 30 minutes. lasting about three minutes.

I gave hypodermic of morphin-sulphate, 1-4 grain atropine sulphate 1-500 grain after which there were no convulsions, upon examination I found the uterus not contracted, by manipulation both external and internal it responded nicely stopping the hemorrhage at once which by this time had amounted to about 3000 c.c. I catheterized her obtaining about 150 c.c., highly colored urine which I did not examine.

She remained about the same throughout the night, her symptoms never, at any time, seemed to abate until she died at 6 A. M. (12 hours after I saw her). The child seemed to be healthy and remained so, as long as under my observation. Case 2. Mrs. J. M., age 27, six-para, according to her husband was taken March 16th, 1912, with nervousness, her physician was called who made a diagnosis of "dementia." She had a convulsion March 23rd at 10 A. M., and they were unable to get a physician until I arrived at 2 A. M., March 24th, (14 hours after the first convulsion) and found that she had delivered herself about 1 A. M., an hour before my arrival. The child was still born. I at once gave her a hypodermic of morphin sulphate, 1-4 grain. I

*Read before the Laurel County Medical Society. ́

delivered the placenta with about 1000 cc., blood clots, etc., her pulse was 100, weak and thready, but regular, she was extremely cyanotic, respiration about 25 and irregular. 1 gave her, during the remainder of the night, two low enemas of normal saline solution, about 1000 c.c., each, which she retained.

Her condition remained about the same until she died at 6 A. M., sixteen hours after I first saw her. I did not advise consultation since I thought it useless.

Case 3. Mrs. R. S., age 22, primapara. Had convulsion March 2nd, 1913 at 1 P. M. while preparing dinner and had 2 or 3 more before I arrived, about 3:30 P. M. I gave her a hypodermic of morphin sulphate, 1-4 grain. I found the os dilated to about the size of a dime. I advised consultation, but could not get it. Under chloroform anesthesia I dilated the os, as quickly as possible and applied the forceps and delivered a child weighing about 8 1-2 pounds, at 6:25 P. M., there was some post-partum hemorrhage easily relieved in the usual way.

There was one convulsion after delivery, but did not return after hypodermic of morphin sulphate. 1-4 grain. I ruptured the perineum and sutured it, but owing to the material at hand lost the stitches.

The woman did not regain consciousness for three days.

With the exception of the ruptured perineum, mentioned above, the woman made a The complete and uninterrupted recovery. child showed no evidence of intoxication.

Case 4. Mrs. S. C., primapara, age 18, had three abortions about the second or third month, the cause so far as I was able, to learn was idiopathic. I gave her tonics such as iron, quinine and strychnin and uterine sedaentire tives, at intervals, throughout the period of gestation.

I saw her September 9th, 1913, at 5:30 P. M.. in the beginning first stage of labor. I kept her quiet in the recumbent position. Her pains quickly subsided and I returned to the office about 8 P. M. In response to a message, I returned again about 7 A. M., September 10th. She had light, so-called, cutting pains, until 12 noon, when during a pain she had a convulsion. I at once gave her a hyrodermie of morphin sulphate, 1-2 grain, and sent a messenger for my case and a consultant. He returned at 1:10 P. M., with the case but no consultant. She did not regain consciousness but remained quiet, under the morphine, until 1 P. M. when she had another convulsion, I gave her 1-4 grain morphine sulphate. I had everything in readiness when the messenger returned. Very little chloroform was needed, and I at once applied the forceps and delivered her of an eight pound

child at 1:30 p. m.,cyanotic and did not seem to breathe. While I was trying to revive the child I had the nurse watch the mother for hemorrhage. She informed me that the patient was having a severe hemorrhage about fifteen minutes after delivery. I at once manipulated the uterus both internal and external, it at once responded with a good contraction stopping the hemorrhage at once, but not until she had lost about 2000 cc. of blood, I used a small uterine tampon which I removed next day.

While I was engaged with the mother, the child, with the aid of the nurse, revived and was doing nicely. I had a pretty severe perineal laceration, which I at once repaired.

The mother regained consciousness in about two hours, seemed perfectly rational, but had severe migraine for two days.

She made a complete and uninterrupted recovery and was able to go visiting in two weeks.

The child had a light convulsion when it was four hours old, but quickly revived and shows every indication of being in perfect

health.

She went the course you would expect until I delivered her of a six pound child at 12:10 P. M., the following day, fourteen hours after I first saw her.

The child seemed to be very weakly and did not cry lustily. It died of atelectasis, at the age of five days.

The mother seemed in fair condition after delivery and remained so for 48 hours, when she had quite a reduction of the quantity of urine, dry skin, migraine, palpebral edema, and other symptoms indicating kidney lesion. Urinalysis showed specific gravity 1028, acid in reaction, albumen which I estimated to be about 1 per cent. I at once made a diagI at once made a diagnosis of acute nephritis and treated accordingly. She died February 2nd, four days after delivery.

This case is of interest to know, since it shows that the finding of albumen in the urine is not a sure sign of eclampsia.

RHEUMATISM.*

By T. A. PEASE, Kirbyton, Rheumatism is one of the largest words in medicine if we figure from the number of ailments it covers as well as the inefficiency in diagnosis and etiology we hide with it.

Most every painful malady we meet, the origin of which is definitely known, is termed rheumatism, at least by some of us.

If I should be asked what rheumatism is, I would not know just where to begin nor where to leave off, would you? The text books of a few years hence are very well agreed on a definition something like this. "A constitutional disease of unknown etiology, evidencing inflammation of the locomotor apparatus, accompanied by great pain and tenderness with tendency to change from one point to another."

There are a

It seems vague, doesn't it? great many divisions designated, with regard to its age, location and tissue involved, as ticular. etc. I think the term should be conacute, sub-acute and chronic, muscular, arfined to those inflammatory conditions of the joints which are caused by the streptococcus rheumaticus, in contradistinction to gonorrheal arthritis and other varieties of infection. Investigators, I think, agree that the "socalled true rheumatism of joints is primarily caused by a streptococci. Still there are eminent authorities who cling to the uric acid origin of the disease. Sam Sea for instance.

ETIOLOGY.

Secondary. The age most susceptible is from 15 to 25, but it is not very uncommon at any age. When seen in children, girls are the most often affected. In later life it affects the male sex more frequently, due, no doubt, to the difference in habits and occupations.

The chronic type, that which produces permanent deformity, (authritis deformans), is of course most usual in elderly people.

A text book case of the disease begins with a short prodrome, malaise, headache and general muscular aching. Then comes the rise of temperature followed shortly by localized pain, swelling and tenderness of one or more joints. The joints most frequently involved are those larger ones of the leg or arm, ankle, knee, wrist or elbow and these show a tendency to subside in the joint or joints first involved, and to appear almost simultaneously in one or more of those previously not infected.

I will let Dr. Poole explain why this latter is true. This condition may keep up for six days to six weeks, or longer, and no one can

*Read before the Carlisle County Medical Society.

tell at the outset which class the days or weeks is going to be the one he is treating.

The chief danger from rheumatism lies not in the permanent disorder of the infected articulations but in its complication of the heart. There may be a resultant pericarditis or myocarditis, but the most frequent and probably the most serious is a left-sided endocarditis, resulting often in some leaky valves. Briefly that is the way a typical textbook case of rheumatism will look. But in my limited ex

perience I have seen the irregular types far more frequently. Myalgeas, neuritises, painful joints without inflammation, neuralgias, and those things are seen most every day.

A

Our success in treatment will depend upon our ability to find the pain or seat of infection and the removability of that same. great many painful conditions will disappear very suddenly and permanently after the removal or their successful treatment of infected tonsils, and the same will apply to infected piles, fissures and anal fistula, chronic appendicitis, stomach and duodenal ulcerations,

colonic infections.

The correction of flat-foot will relieve some cases of apparant rheumatism of the legs and thighs. Other more or less frequent causes of obscure origin in females will be located upon an examination of the genito-urinary tract. I don't mean the gonorrheal cases. Of course the treatment of cases where no such conditions are found will be symptomatic.

The salicylates and various antacids have all been used with some success.

Rest, heat and moisture and eliminants are all useful in their places.

Now I would tell you all about the treatment with vaccines, phylacogens and those things only I don't know anything about them.

Radium Treatment of Cancer of the Uterus.The radium gave goo dresults in the hands of Polubinsky. In 23 cases, 9 gave compelte recovery; of these, 2 were operable cases, and 7 inoperable. In the remaining 14 cases a complication developed in one, nomely, a retrovaginal

fistula. In 6 there was a relapse after temporary improvement. No benefit was apparent in 3 cases; one patient died during the treatment. The others gave dubious results or the outcome isnot known. The cases of apparently complete cure were under observation for from eight to twelve months from the beginning of treatment.

MENORRHAGIA.*

By T. C. NICHOLS, Morgan.

Memorrhagia is too great a loss of blood from the uterus at the time menstruation is due. The increase loss may either be due to a shortening of the intermenstrual period, or to a protracted duration of the flow, or, most of all, to an increase of the amount lost at each period. Since the normal amount is not known, and, at all events, varies much, we cannot indicate in an exact diagnosis when menorrhagia begins, but, practically, we call the flow so if it suddenly becomes much more profuse than the woman usually has it, and if it weakens her.

ETIOLOGY.

Memorrhagia is in most cases due to a disease of the uterus such as endometritis, chronic metritis, subinvolution, lacerated cervix, a granular condition of the os, a fibroid tumor, a polypus, or cancer. It may also be due to the different kinds of displacements of the uterus. Secondly, it may be due to ovarian diseases, especially oophoritis and small ovarian tumors. Thirdly, certain general acute infectious diseases are apt to cause profuse menstruation, especially cholera, smallpox, scarlet fever, typhoid fever, and inflammatory rheumatism. Among the chronic diseases hemophilia, syphilis, chlorosis, and malaria.

Some times the cause is to be sought in diseases of the heart, the liver, or the kidneys. Sometimes no cause can be assigned.

SYMPTOMS.

Besides the increased loss of blood, there are other symptoms due to it. If the loss is very heavy, it may cause acute anemia with rapid, flagging pulse, dyspnea, pallor, cold, clammy skin, faint ness or syncope.

DIAGNOSIS.

The diagnosis between menorrhagia and metrorrhagia, uterine hemorrhage occurring independently of menstruation is sometimes difficult or impossible, when so frequent hemorrhages take place that the patient does not herself know what would be the regular time for a menstrual flow to come on; but in most cases the distinction can be made by the time elapsed since the last bleedidng, by the sensations which generally precede the menstrual flow, by the admixture of mucus with the blood, and by the gradual way in which it appears.

*Read before the Pendleton County Medical Society.

PROGNOSIS.

It is doubtful if ever a woman has died directly of menorrhagia, but repeated losses undermine health and shorten life.

TREATMENT.

This is due to so many conditions that each case must be treated upon its own merits. Correct diagnosis is essential to a cure. The treatment of a profuse flow of blood from the uterus, as from any other part of the body, should always consist primarily in checking it. In a case of menorrhagia, the patient should be kept perfectly quiet upon her back; ice bag or cloths wrung out of cold water should be laid over the uterus, vulva and thighs, cold drinks should be given freely; all warm fluids strictly interdicted. In adIn addition, the apartment should be kept cool, the nervous system quieted by bromides or opium, or an appropriate substitute and all conversation prohibited. The bowels should be kept open with calomel and saline aperients. In the mildest prescribe ergot and other internal hemostatics. If this treatment does not have the desired effect vaginal injections with hot water. If the bleeding continues, an intra-uterine injection of hot water with or without liquid ferri is given. A bag with hot water applied to the lumbar region is sometimes effective. Kelly, in his work upon gynecology, recommends injections of normal saline into the cellular tissue under the breasts; hydrastis, viburnum prunifolium, stypticin (1 or 2 m. of a 10 per cent. solution hypodermically), calcium chloride and ipecac.

cases we

If all this is ineffectual, or if the hemorrhage is alarming, we tampon the vagina or the uterus.

In the intermenstrual period a treatment is instituted according to the cause of the menorrhagia. If the endometrium is affected, the uterus curetted or cauterized. Granulations are destroyed, the torn cervix united, a polypus removed, and a fibroid or cancer treated as taught under the discussion of that disease. Ovarian inflammation is treated with injections, applications, resolvents.

At the same time we try by means of hemostatics, tonics. and food to build up the patient as much as possible before the occurrence of the next menstruation.

In cases of heart disease a moderate bleeding gives relief, and should, therefore, not be checked too soon.

Digitalis, strophanthus, and aconite are valuable remedies. When the liver is torpid

attention to diet, abstention from alcoholic

drinks, and the administration of calomel. In kidney disease especial attention should be

paid to the various function of the skin and bowels.

The physician must not forget that a moderate loss of blood is a normal condition, a kind of safety-valve for the female economy. He must, therefore, allow a. reasonable amount of blood to escape before he begins to check the flow.

NEWS ITEMS AND COMMENTS

THE CONFERENCE OF COUNTY AND CITY HEALTH OFFICERS.

This important conference will convene under the auspices of the State Board of Health, at Louisville, on Wednesday, Thursday and Friday, December 8, 9 and 10. Dr. W. S. Leathers, Director of Rural Sanitation of the Mississippi State Board of Health, will be in charge of one session, and those who were at the last annual meeting will be delighted to know that the Surgeon General has consented to have Dr. McMullen, Frost and Freeman with us again. The special subject of study at this conference will be the Whole-Time Health Officer and Community Health Work. It is of the utmost importance that every health officer in the State be present. Other physicians or those interested in health matters are also cordially invited to attend. The session will be in the Armory.

I regret very much that what I said on page 576 of the November JOURNAL was not sent me for correction before publication: instead of "I regret I had no support. No man sat within the bar beside the prosecuting attorneys but myself. Those who ought to have stood by us stayed but a short time and departed." It should have been "I regret that we did not have the support of the entire medical society; besides the health officer practically no one encoureged the counsel by their presence, which means much in trials of this kind."

Please make the correction in the next issue of the JOURNAL.

Yours truly,

I. A. SHIRLEY.

Mrs. J. M. Salmon, of Ashland, has returned home from Rochester, Minnesota, where she was successfully operated. Dr. Salmon's friends will be delighted with this favorable result.

The seventy-ninth annual session of the Kentucky Midland Medical Society was held in Lawrenceburg at Masonic Hall building on Thursday and much interest was manifested

in the excellent programme given by the following: "Modern Method of Inspection of the Urethra," by Dr. J. T. Windell, of Louisville," "Observations in Obstetrics in Anderson County," by Dr. G. D. Lillard, of Lawrenceburg; "Management of Normal Labor," by Dr. G. N. Garrett, of Frankfort; "The Diagnosis and Treatment of Gastric and Duodenal Ulcers from the Medical Aspect," by Dr. J. T. McClymonds, of Lexington.

Dr. J. L. Toll, of this city, presided at the meeting as president of the Society and cordially welcomed the visiting doctors in pleasing words. A splendid dinner was served the members at the Lawrenceburg Hotel at the noon hour.

The following were the visiting doctors, besides those of our city: Neville M. Garnett, Warren Montfort, G. H. Heilman and L. T. Minish, Frankfort; J. P. Stewart, Farmdale; Ralph Guthrie and F. M. Beard, Shelbyville; T. J. McMurry, Simpsonville; J. W. Speer, Alton; Charles Nanse, George P. Sprague, L. C. Redmon and W. B. McClure, Lexington; J. T. Windell, Louisville.

Dr. J. Morgan Taylor has moved his office from the LaPoint building, on E. Washington street, to the John Lewis building, N. W. corner Main and Green streets, Glasgow.

The annual meeting and election of the Kentucky Board of Pharmacy was held Sat. urday at the Hermitage Hotel, Louisville. After reading the annual reports, officers were elected as follows: G. O. Patterson, of Hawesville, president; J. W. Gayle, of Frankfort, secretary; J. C. Gilbert, of Paducah, treasurer; James H. Martin, of Winchester, chairman of the Executive Committee; Edward Bloomfield, of Louisville, attorney. The board is composed of the following members,

in addition to the officers elected: Prof. C. Lewis Diehl, of Louisville, and Robin H. White, of Mt. Sterling, successor to Addison Dimmitt, whose term had expired and who could not under the provisions of the law, succeed himself.

Dr. E. C. Barlow, one of Georgetown's general practitioners, has just returned from a celebrated college in New York where he has taken a course in eye, ear, nose and throat treatment, and will specialize in the future along these lines.

While at Milburn Saturday afternoon the News man learned that Dr. F. N. Simpson is improving slowly and is able to get out a little by the aid of his crutches. It will be remembered that Dr. Simpson fell several

weeks ago and broke his leg. His friends in all parts of the county will be pleased to learn of his steady improvement.

The members of the senior class of the medical department of the University of Louisville met and elected elected the following officers: President, Benj. H. Hildreth, Triplett, W. Va., vice president, Ervin Huckleberry, Salem, Ind.; secretary-treasurer, Clyde F. Loy, Shawnee, Okla.; class representative, Henry A. Hughes, Greenhall, Ky.; historian, Herbert E. Schoonover, Salem, Ill.

Dr. A. P. Banfield, Louisa, who was removed to the Huntington hospital is reported as being very much better.

Dr. Banfield is suffering from a badly infected limb as a result of fever several years ago, and since which has caused him much trouble. For a time the amputation of this skillful medical attention of his attending member was feared necessary, but under the physicians, the thought is about abandoned. Dr. Banfield is widely known throughout this section and his legion of interested friends will rejoice to learn of his improvement.

Dr. J. H. Shultz sold Wednesday his residence and land near Jeffersonville, to Henry Murphy, of Morgan county, for about $4,000 cash. Possession will be given in thirty days. Dr. Schultz will move to Mt. Sterling and practice his profession.

Dr. E. D. Turner, after an absence of a few years, has returned to Cave City to again locate there. Dr. Turner was a former physician at Cave City and the fact that he will again make his residence there will be met with general approval.

Dr. Granville S. Hanes, of the medical faculty of the University of Louisville, is reported by his physicians to be in no further danger from blood poisoning, due to an infection of a finger from which he was in a serious condition several weeks at the Norton Infirm

ary.

Dr. S. M. Hopkins, of Gardnersville, Pendleton county, is arranging to move to Walton, having bought the property and practice of Dr. G. C. Rankins who contemplates moving to Mason county. The change will be made. the latter part of this month.