placento-fetal vessels after birth, and certain morbid blood states.

That hemorrhage does occasionally occur under the above conditions, all authors, and I presume most of the WORLD readers will agree; therefore we should ligate in the most careful manner in all cases, since there is no physical sign or condition by which we may safely judge of the possibility or probability of its occurrence in a given case.

Crittenden, Ind. L. A. SIMMONS, M.D.

Dressing the Cord.

EDITOR MEDICAL WORLD:-On page 422, the question is asked by "Doctor" "How other doctors tie the cord?" Whether "exceptionally good" or not this is my method.

I use shoemaker's ball flax (flax shoe thread) take one strand three yards long, fold it three times, making a triple strand one yard long, wax it heavily with yellow bees wax (not paraffine) cut it into three p eces each a foot long, tie a knot in each end (after the manner of a woman's knot in her sewing thread). This knot, being large, gives a better chance to find the end. I do not twist it, but wax it flat. I usually make a dozen or more, twist each one lightly, fold it, twist again and let it roll together in a loose roll three inches long, fold a piece of stiff paper lay them together and put them into the cover of my pocket surgical

case.

"How to tie?"-Take one end by the knot pass it around the cord, slip it to within an inch or so of the navel, make one tie, pass the knot around the thread so as to make a "sailor's draw-knot" that wont slip-slip the fingers along the thread, catch the other knot, pass it around the cord and tie about 3/4 of an inch from the other tie and cut between the twothen cut all four ends off so as to leave all half an inch long.

I have never had a ligature to slip off the cord. I have seen woollen yarn, common cotton ball twine, sewing thread-and the fibre of manilla rope wet-used for the same by the negro midwives in this section, but they seldom wax them.

In fact, so careless (and successful) are they in many things, which we consider "essential to safety," that I have become skeptical in a great many other matters. Many of the ultra "antiseptic treatment" members of the profession would go into spasms if they were compelled to practice one year among the negro population of our plantations. Dozens of severe cases of ovarian, fallopian, uterine and vaginal inflammation get well and able to do field work where the knife or ovariotomy is never thought of by the "North Louisiana Backwoods Doctor."

"How long after birth do you tie the cord ?” -I wait till the "child squalls" usually, but if it is slow about it, I shake it about, turn it from side to side, clear its mouth, get it to breathing well, then placing the hand in the uterus, I notice if the placenta is detached and tie immediately; usually the time occupied is one

minute.

"The result if the cord were not tied ?" -I was called to see a case where the child was born three hours before I arrived (and another of the same kind two hours). I found the child, cord and placenta wrapped up together at the foot of the bed. Curious to note what was the effect of the long waiting, I cut the cord four inches from the navel-no blood flowed.

In another case, when the cord was only about seven inches long, the negro midwife broke it off about one-and-a half inches from the child's body--only a few drops oozed from it and when I got there two hours after, I did not, after examining it, tie it. At the same

time I have seen free bleeding from cord that had been apparently securely tied (and had to be re-tied) two or three hours after the child was dressed and put away to sleep.

Another case, a woman 30 years old, while in labor with her second child, got up to chamber, and while straightening up to get back to bed, the child slipped out, cord broke four inches from navel; only a very few drops of blood came from the broken end of the cord, then stopped entirely.

I am of the opinion in such cases, that, the blood vessels are stretched, break and are retracted into the sheath, which collapses and thereby closes them. Cutting leaves them patulous, and they bleed from necessity.

N. L. BACKWOods.

Dressing the Cord.

EDITOR MEDICAL WORLD:-Since the subject of management of the cord is open for discussion, I will give my method, trusting that it may prove as satisfactory to other members of THE WORLD's family as it has to the author. After having thoroughly considered causes of hemorrhage from the cord, I have been led to the following conclusions: st. A great thickness of the gelatinous substance, which shrinks awhile after the cord is divided, loosening the ligature. 2nd. The obstetrist's fingers being lubricated by the vernix caseosa or secretions from the vagina, the first knot is but partially drawn, or slips before the second can be secured, leaving the vessel but poorly compressed, when a very slight shrinkage of the cord is followed by hemorrhage.

Now, to obviate the first cause I am careful

to ligate at a point within two inches of the abdomen, where the gelatinous substance is least predominant; and to combat the second I use well waxed ligatures, drying the hands well before tying the knot. Since resorting to these precautionary measures I have had no bleeding cords. I tie the cord from three to five minutes after the birth of the child. Hunter's Lodge. Va. E. M. SNEED, M. D. Treatment of Enuresis, Hydrocele and Corns. -Cerebral Abscess.

EDITOR MEDICAL WORLD: Dr. J R. Thompson, in Dec. number, asks as follows: Ist. Treatment for enuresis in boy of 5 years. 2d. Treatment for hydrocele.

3d. How to remove corns.

Let me suggest the following, since they have given satisfaction to me in a number of instances:

1st. Exclude adherent prepuce or phymosis. Then give fluid extract of ergot, or what is better, the normal liquid ergot of P. D. & Co., in twenty-five drop doses, combined with onethird part of tincture of belladonna, to be taken four times a day, the last dose at bedtime, after having the bladder emptied.

2d. Don't bother with absorption in hydrocele. Evacuate the fluid and inject five minims of carbolic acid with one drachm of pure tincture of iodine. In the majority of cases with me this has proven successful. But when after two or three trials it fails, do Valkman's radical operation at once.

3d. For corns, remove the cause. Don't wear shoes or boots that are too small or too large and corns will not appear. However, when present, touch the center of the corn with a stick dipped in fuming nitric acid; repeat in two days and shortly the hardened parts can be removed. Then advise well adjusted shoes

In Dr. S. N. Cochran's case (page 468) an operation would no doubt have been justifiable if there were any symptoms of an abscess in the early part of the sickness. While the patient had strength to bear it, trephining with drainage would have given some hope for

After taking for a few days, if the physiological effect of the drug is not manifest, I usually increase cne drop each day until dryness of the throat with dilatation of pupil is observed, after which the dose is decreased to the amount commenced with. I have relieved quite a number of cases with this prescription the past four or five years. I find that some cases yield very promptly, while with others it is necessary to continue with the medicine for one or two months. E. A. FARQUHAR, JR. 117 Putnam Ave., Zanesville, Ohio.

Enuresis-Hydrocele-Corns.

EDITOR MEDICAL WORLD:-In reply to Dr. J. R. Thompson, page 468, Dec. WORLD, for enuresis, I would advise him to give the patient the following:

Enuresis-Hydrocele- Corns.

REPLY TO DR. J. R. THOMPSON'S QUERIES. EDITOR MEDICAL WORLD:-For enuresis:—— Fluid extract of rhus aromatica m. v, three times a day. Avoid "sweets;" no fluids for supper, and empty bladder before retiring. This remedy rarely fails, but I sometimes have to use some other remedy. In weak, anemic children, syr. iod. iron cures more surely. Where I find excessive acidity of urine I give alkalies to render the urine neutral, and give tincture of belladonna or atropine in solution. I always examine every case before treating, if convenient. Sometimes the trouble is caused from irritation produced by ascarides; and occasionally from some irritation in genital organs; as adherent prepuse, &c.

Hydrocele:-When in children, you can in

some cases promote absorption by using a suspensory bandage and using an evaporating lotion. In adults, I think it would be useless to attempt to cure in this way. I have known several cases cured just from tapping several times. Withdrawing the fluid, and injecting tincture of iodine into the sack and manipulating the scrotum to bring the iodine in contact with the whole surfaces, causes sufficient inflammation, in most cases, to cause the walls of the sack to adhere together. Let me warn you, however, not to inject it without first injecting cocaine. I tried it once without cocaine. This operation is not without its dangers; you will have too much inflammation occasionally; but from experience with various injections I would prefer iodine.

Corns-Prepare the following prescription and apply night and morning for a week; then place feet in hot water for a few minutes, and you can remove the corns with your thumbnail:

EDITOR MEDICAL WORLD:-I have been a constant reader of THE WORLD for some time, and have learned to await its coming with as much pleasure as a girl would a letter from her sweet heart; for I expect news directly from the field, and am always glad to know how stands the battle in the east and the west. Now, if you will allow me a little space, I would like to pay tribute to a remedy that has recently helped me out of a deep hole; for if a medical man ever feels that he is in deep water, it is when brought face to face with a case of membranous croup.

The last case I had was that of a child fourteen months old. For three days and nights I used the usual remedies, with no apparent effect. On the fourth day I called to my assistance two of my esteemed colleagues, who confirmed my diagnosis, and made some good suggestions, which were rigidly carried out. Notwithstanding all this the little patient grew steadily worse. The dyspnea and cyanosis. were fearful to behold. On the morning of the sixth day, I was in my office revolving in my mind the possibilities of intubation and tracheotomy, when my eye chanced to rest on a trial bottle of sulpho calcine, sent out by Reed & Carnrick. I read the formula and was convinced.

I seized my atomizer and proceeded to use it at once. I dropped all other treatment except minute doses of calomel and ipecac oneThat tenth grain of each every two hours. night my patient rested easier, and the next morning I cautiously told the parents that the baby was better. I continued the same treatment for a week and discharged the case.

Now, brethren, if your patients all get well with true croup you need not try it. But as mine have not been doing so, I propose to try sulpho-calcine as a spray again should I be so unfortunate as to have another case. Ronceverte, W. Va. M. A. GATES, M. D.

Umbilical Hemorrhage.-Death Caused by Cord Wrapping Around the Left Leg. EDITOR MEDICAL WORLD:-I saw my first and only case of hemorrhage from the cord twenty years ago. It occurred in a child with an unusually large cord, with a large amount of Whartonian jelly. After tying it I noticed a little oozing and applied a second ligature, cautioning the mother to look every hour to see if there was any bleeding. It commenced at the fifth hour, and when I arrived it had lost, I suppose, about two ounces of blood. I grasped the cord close to its umbilical attachment with my left thumb and forefinger, clipped off the ligatured end, stripped the remaining stump thoroughly and ligated it again. There was no further bleeding, and the child suffered no ill effects from the loss of blood. Since then I have followed this plan of cutting the cord, stripping and then tying. While it might be safe to leave it untied, yet I have always ligatured for fear of blame in case of an accidental hemorrhage. I invariably sever and tie the cord in five minutes after the birth, if I am present at that time, but in 1859 I was called to see a case in which the child had been born thirty minutes before my arrival. I found the cord flaccid, empty and pulseless, and upon cutting it not a drop of blood flowed, but I tied it for safety. The stump dropped off at the end of twenty four hours, and the navel apparently healed all right. On the twelfth day at two p. m., the grandmother noticed a spot of fresh blood on the band, which she removed and applied a clean one. The baby was then placed in its cr b, where it remained till five p. m., when a mo ning sound from it attracted attention. Upon taking it up its clothes were found saturated with blood, and it died in a few minutes. Was this hemorrhage caused by all the blood of the placenta being pumped into the child? If so, why did it not occur sooner, and if so, does it not teach us that early severance is best? It was the only case of umbilical hemorrhage I have had in a thousand cases.

I saw a very peculiar case a few months ago, the second of the kind I have met with. I was called to a colored woman in the sixth month of pregnancy, suffering with an intense, sharp and continued pain in the fundus uteri, caused, she said, by the somersaults of the child, whose movements had been very active and violent that morning, but had ceased then and were never felt again. At the end of the seventh month labor came on, and I delivered her of a badly macerated fetus, and upon examination I found the cord tied so tightly around the left leg, just above the ankle, that I could not loose it without cutting. The left foot was only about one fourth the size of the right, aud the leg was almost amputated. My theory is that the tie occurred in the third month, just tight enough to impede the circulation of the foot and prevent its further growth, but not enough to interfere with the general circulation, and that at the time of the violent motions, which caused the mother so much pain, it was drawn so tight as to stop the fetal circulation and cause its death.

If the brethren know all the circumstances connected with my cases of grippe, they would admit that their criticisms are unjust, and that I do not claim too much when I say my treatment jugulated the disease (LaGrippe), and thereby prevented serious local inflammations and pathological lesions. We want no pathoWe want no pathological specimens for our "Dosimetric Mu. seum," caused by too timid administration of dosimetric medicaments.

Houston, Tex.

W. L. COLEMAN, M. D.

The Cord.

EDITOR MEDICAL WORLD:-I wish to call the attention of your readers to some of the structures of the umbilical cord, and the means nature has taken to prevent a fatal result, where the separation of the child and placenta is left to her.

We know that the cord is composed of three important vessels; one vein and two arteries, held together by an elastic substance termed the gelatine of Wharton. The vein and arteries contain semi-lunar valves; also the arteries contain a larger amount of muscular tisue than is usual in arteries.

Now let us see what these two important things, i. e. valves and muscular tisues, have to do in stopping hemorrhage, where nature is called on to complete the work.

The valves in the vein tend to prevent the blood from flowing back from the body of the child, and the muscular tisues of the arteries will contract and diminish the caliber of the arteries, when the placental and fetal circula

tion have become equalized, so as to accom. plish the same object, that is, to stop the circulation in the cord, and favor the formation of a clot.

Examination of the cord after it has been tied and cut will show how the size of the arteries are diminished, and also that the inner coats have been drawn in so that they have still further closed the end of the arteries. When the end of the cord has been pinched the inner coats will retract further and will act about the same as when torsion has been performed.

Although I have never met a case where the cord has been torn, I think the hemorrhage would be slight, as the rupture of the blood vessels would cause contraction and retraction at once, and in a short time a clot would form so that there could not be any hemorrhage.

In my first year of practice, six years ago, I had a case of hemorrhage from the cord which needed the second ligature. I think the cause was in my first ligature, which was furnished by the nurse, and it was made from thread twis:ed together, making a strong, hard ligature, which cut the vessels smooth, so that there was no contusion of the coats of the vessels, so they did not retract as they should have done. I met another case about six months ago where another doctor ligated the cord with a silk ligature The nurse found, after he had gone, that the cord was bleeding, and they sent for me. I ligated it in my usual way without any further trouble.

I use common white wrapping twine of the proper strength, taking one turn and tying a knot, then another turn and a second knot, then dressing the cord in the usual way, using just as little oil or vaseline as possible, and I always have had good results. My custom is to wait until the child has breathed and cried a few times, before tying the cord, in five to ten minutes according to circumstances. I think there are two things that are important in tying the cord; waiting a proper length of time for the equalization of the circulation and a proper ligature.

I have been very much interested in the discussion and think it will result in a great amount of good to the readers of THE MEDICAL WORLD.

My Experience with Aristol. EDITOR MEDICAL WORLD:-Ever since aristol was introduced to the profession I have used it. I have used it for hard chancre, and found it quite efficient. It is the very best substitute for iodoform, the iodoform nearly always being objectionable on account of the odor. It is also an excellent treatment for chancroid if sprinkled on after washing the ulcer with water medicated with carbolic acid. After covering the ulcer with the aristol I put dry

absorbent cotton over it and then draw the

prepuce over it. Once a day is often enough to dress any kind of a chancre, as the cotton absorbs the discharge. I have used it for ulcerated ears, where the drum is discharging a greenish pus. I wash the ear out with warm carbolized water with an Alpha syringe (which keeps up a constant flow.) I then put the aristol in the ear dry or with an ear syringe, mixing the aristol with glycerine. In case of nasal catarrh I have the patient wash out the nostrils with cold water, as it toughens the mucous membrane, then have the aristol used as a snuff twice a day. I have used it for nearly every kind of sore, and find it always efficient, but it does not take hold so quickly as iodoform. Where the patient is not fastidious in regard to the smell, I use the iodoform. In case of endometritis I have used it with wonderful success. I have a suppository, made of aristol and cacao butter, using as much of the aristol as can be used; I insert one of these into the uterus when it is dilated, as it melts at the temperature of the body. I have cured hemorrhagia in this way, but it is not as good as curetting. In every case of late of endometritis I dilate the uterus and swab it out with aristol and glycerine, simply mixing the aristol with glycerine until it can be used with a cotton swab. I do not mean to be understood that the uterus never needs the curette, for it often does, but after the curette is used the aristol in combination with glycerine is the very best thing that can be used. It is far superior to iodide of potassium, iodine or any of the old caustic remedies. Warm water irrigations, used thoroughly in combination with the above treatment, will cure any case of endometritis.

ROCKY MOUNTAIN PRACTITIONER.

Hygiene of Pregnancy.

In response to our request for further information in regard to the preparatory treatment and results in the case of painless labor, reported on page 423 of November WORLD, Dr. J. C. Campbell sends us a report from the patient herself. She says that she tried to tollow the directions of this school of teachers as closely

as possible, more particularly during the last two or three months, eating vegetables, grains and fruit, taking two lemons a day during the last two months. The confinement was, as described by the doctor, rapid and almost painless. The patient was up and dressed on the fifth day, still, however, being very cautious about exerting herself. She rode out on the eleventh day and felt as well as usual by the end of the third week. She has had remarkably good health ever since the confinement.

As to the child, he has always been remarkably well ever since his birth, weighing seventeen pounds at three months, stronger than most children of his age and having perfect bones.

A Specific for Lumbago.

EDITOR MEDICAL WORLD:- In these days of close competition a physician can not have to many sure remedies at his command. I have been using for two years a preparation of poison ivy which gives me much satisfaction. I will relate a few cases cured by it.

Case 1. Harry A., from the town of W., had lumbago of long standing. He had been treated by the physician of that town and was laid up from all work. I put him on the medicine a dose every four hours and he went to picking up potatoes in one day, and has worked ever since and now is carrying on a farm here.

Case 2. John G., of W., had lumbago of years standing and had worked only a little while at a time for years. He had tried all treatments of all the surrounding physicians and was no better. I gave him the powder and he took it morning and night, and this man has worked almost every day for about four months since his use of the medicine. I always look out for spinal cord troubles, and when we find that rheumatic trouble persisting in the psoas muscles and fibrous tissues in the back I give them the rhus and always cure them.

Case 3. Jed L, of W., had lumbago in chronic form. Every few days he would be laid up with lame back, and every year he probably lost $50 00 from being unable to work. One small four drachm bottle of the powder has cured him, and he has a back as good you can ask for.

as

Case 4. Asa F., of W., had lumbago and chronic lameness in his muscles for years. A few doses of the medicine has relieved him so that he says he can now walk a half a mile easier than he could walk to the barn before.

I find that for lameness, stiffness and pain in the back this drug is a specific as much as iron is a specific in anemia and quinine is

in malaria.

I have tried electricity, alkalies and all the