strychnine are of utmost value; ergot in appropriate cases; and as an uterine tonic nothing better can be recommended than a combination of aletris farinosa, viburnum prunifolium and viburnum opulus, to which may be added cimicifuga, if desirable. In very nervous and hysterical women a capital remedy is bromide of potassium, 3j to water one pint, to be used as an injection at bedtime, which acts like a charm. It may also be given during the day, if occasion may call for. As a sedative suppository in case of pain a combination of conium and cocaine will generally be accepted with thanks. To deplete a congestive uterus glycerine tampons are almost a specific, and act very promptly. I have here given only an outline of treatment, as every case must be treated on its merits. But I wish to say, in conclusion, that fortunately the times have passed when the physician with the immaculate shirt front and diamond pin, and white cravat and gold-headed cane, who is dignity personified, and who, when he smiled, it was a smile akin to that of one trying to hide the consciousness of a stomachache in the presence of ladies,-I say the time has gone by when such a gentleman can prescribe a little nitre during the day and a Dover's powder at night for a prolapsus uteri. Regarding electricity in gynecological practice, I will state that its application to the uterus, when the displacement is recent and depends upon passive congestion, is beneficial, and should be employed more frequently. It may also aid in giving general tonicity to the much exhausted nervous system. Electricity in gynecology should never be attempted by unskillful men, but only by those who are thoroughly acquainted with all its intricacies and workings; otherwise disastrous consequences may result, which may bring the science of electro-therapy into disrepute. These remarks I have thrown out as a matter of caution to my younger brethren. V.-FINIS. I hope I have not failed to establish the two propositions I started out with. I shall be pleased if I have succeeded in removing some of the unfounded prejudice with which the mechanical treatment of uterine displacements and flexions has been, to my mind, so unreasonably regarded. If those who so strenuously oppose this therapeutic system had any preferable alternative to offer in its stead, there might be some less difficulty in understanding their position; but it is not so. A specimen of the treatment they recommend is, "time is an important factor in uterine therapeutics. Patients suffering from distortions and flexions should be kept for a length of time under observation, and should be seen and examined at intervals." What benefit is to be derived from such a process of expectancy in the class of ailments which I have been considering, it is not easy to discover. WM. H. ÖLSTEN, M.D. Ephraim, Utah. Protective Prescription Blanks; Jaborandi in Editor MEDICAL WORLD: My last letter, kindly accorded space in your December issue, pages 458 and 459, brought me showers of replies from half the States in the Union. All asked for and received samples of my prescription blanks, and some have already ordered and begun their use. I have received many letters approving the idea of "Personal Professional Protection." This is a point that I am sure cannot be too strongly emphasized. I am more firmly anchored than ever in my idea of the proper management of the third stage of labor, not only from more extended personal experience, but by the witness of many brothers of from five to forty years' practical experience, whose testimony by private letter accords exactly with the sentiments I there expressed. I am not at liberty to quote them, much as I should like so to do. I have recently given fluid extract jaborandi another trial in the treatment of facial erysipelas, twenty drop doses every two hours, with aconite in the first stage and calomel purgation. This was my third case, and the result has been all that could be desired in every one, curing them quicker and with less trouble than with anything else I ever used. Locally, thick absorbent cotton and bandage. On the subject of the treatment of diphtheria, let me refer the brothers to pages 404 and 443, 1888. Don't, I beg of you, let a patient die till you have given this remedy a thorough trial, and don't hesitate to push it far beyond anything there recommended. You may meet with a joyful surprise. I have many a time. If you try it, let us know with what result. There is no reasonable doubt but that diphtheria is a sthenic, systemic sepsis, which must be met by powerful internal antisepsis. You may as well depend on your pocket handkerchief to cure catarrh as upon local treatment in diphtheria. Local cleanliness is, however, commendable in both. I am having excellent results with benzoate of sodium in acute follicular tonsilitis, giving to an adult five to ten grain doses every two hours. Treatment adapted to the degree of constitutional disturbance is indicated here as elsewhere; usually aconite and calomel, with potassium cloride and tincture ferri chloridi during the third stage or that of resolution. In the parenchymatous variety tincture aconite heroically, ice locally, with calomel purgation, has done so well by me that I have not sought for anything better. Many devices have been tried, with more or less success, for ridding the alimentary canal of omniverous man of that lonesome old tapeworm. I wish to offer one, and ask the doctors to try it, suggested to me by a brother M. D., who had first used it successfully on himself, and later in many other cases. I have found it to be a valuable article, well worthy your attention; tasteless, harmless and sure so far as I have had an opportunity to test its merits in positive cases. The only objections to its use are: (1) That it must be continued for thirty or forty days, and (2) that the tapeworm is not expelled in toto, which is a great disappointment to the average patient. What becomes of his majesty or how the drug acts I do not know, but it gets there just the same. I refer to the black oxide of copper. Adult dose, No. 4 capsule, three or four times daily for a month, or till all symptoms disappear. I read with great interest the frequent notes on the use of sulpho-carbolate of zinc, turpentine, sulphite and hyposulphite of soda, hydronaphthol, listerine, etc., in the treatment of diphtheria, typhoid fever, "green diarrhea," flatulent dyspepsia, etc., as I am sure it marks a step in the right direction. I am using them daily, and believe as fully in antiseptic medication internally in zymotic diseases as I do in the same applied externally in surgical practice. In the one case we cleanse and apply antiseptics to the internal skin, and in the other to the external, but with the same purpose in view; the only difference being that we must substitute calomel and the salines in the one for the sponge and douche in the other, and use non poisonous antiseptics in place of the carbolic acid and bichloride, which cannot be safely used in sufficient strength to be destructive to the bacteria that infest the alimentary canal in these affections. I like Dr. Peck's ideas, pages 67-8 of the February WORLD, except regarding such wholesale use of ergot. Ergot is a valuable drug, and may well be called par excellence in its place; but that place, I believe, is most certainly not the stomach of every parturient woman. In the case quoted the doctor's treatment is worthy of the highest commendation. In the use of ergot I must most certainly stand on the conservative side. I am anticipating a treat in the article promised by Dr. Thornton, page 77, February WORLD. Would suggest to Dr. Humphrey, page 83, that he examine the urine of his patient, ascertain the cause of the leucorrhea, and cure that, stimulate the liver with pil. hydrastis and pod., and then see if with urine, uterus and liver in normal condition the troublesome case is not ended. I have recently had a similar case to that of Dr. Astrop, page 84. I believe the doctor's diagnosis is correct, but I think if he had taken the rectal temperature he would have found it high. Mine, with similar symptoms, was 105°. I gave five grain dos es each of quinine and antipyrine every one to two hours, till forty grains of each had been used. A most profuse sweat followed, with normal temperature and perfect ease the following morning. The patient rallied, and eventually made a good recovery. For the following forty eight hours there was retention of urine, the catheter withdrawing a good quantity, but of rank odor and deep dark color. During this time. she was as yellow as a Mongolian. I followed the antipyretic and anti-malarial treatment with sweet spirits of nitre and intestinal eliminations. The pathological condition I believe to be congestion of the liver, caused by the miasmatic poison, which occludes the excretory duct, and this combination of affairs throws such a quantity of effete material into the blood as to produce these alarming symptoms, and death quickly follows if this antidotal and eliminative treatment be not speedily and heroically used. DR. W. C. ABBOTT. Ravenswood, Ill. Retained Placenta. Editor MEDICAL WORLD: There has been so much said on all sides of this subject, and each writer seems so partial to his individual views, that I feel some hesitation in offering the record of my humble experience. But we cannot stop to consider the attack of the lion when the lamb's blood is flowing, and with an apology for any unlucky or unintentional blow, I will give as briefly as possible, the results and conclusions of my obsterical practice on this point. I have ever been a critical observer of all the indications and promptings of nature, offering with a trembling hand any interference with her laws. I have leaned heavily upon the "Vis Medicatrix Naturæ," and have cautiously guided the hand of help, even when found necessary, with fear and trembling. It is true that most of our teachers and nearly all our text-books advise to wait some time after the child is born before proceeding to terminate the labor by the removal of the placenta, and during the first few years of my practice I was disposed to obedience to this high authority, but during that time I discovered that the less the delay in taking the placenta after the delivery of the child, the less was the trouble or difficulty attending this duty. Being encouraged, therefore, by such promptings, I gradually lost sight of first precepts and got into the habit of taking the placenta as soon as I had delivered the child to the nurse. I have never had but one case of retained placenta, so called, and that during my early practice, and if I ever had hour-glass contraction it was after I had finished my work and had no occasion or desire to go hunting for it. Perhaps if some of our tardy brethren would give more plausible theory for this half hour's delay, it might be the means of developing the subject more fully. We know that the process of labor is an effort of nature to relieve this long suffering organ of its mighty burden, and that the act is not complete until the entire contents have been removed. If, therefore, in her crowning effort she has delivered the major part of her load, but has, perchance, not expelled the minor portion, are we to conclude that this was intended as a second act of the drama? I take it that her mission is to accomplish the whole work in the one act; but if she may sometimes fail to this extent, then if we are to be of any service at all it is our duty to go to her assistance. I think the whole work is generally completed in one effort, as I usually find after the child is delivered the placenta lying loosely in the vagina, and when retained in whole or in part within the uterus, I have always found a stronger disposition to hemorrhage until it has been removed. Some say wait for more pains to expel the placenta, but do we get them? After pains are common we know, but without regard to the presence or absence of the placenta, for we find them as common and fully as strong after its delivery as before. I think we should all understand that these are now, not expulsive pains, but the natural and necessary contractions of the organ and its stretched and strained ligaments to regain their normal size and proper location. I would follow this subject further, but not wishing to encroach too much upon your space, I must conclude with my usual plan of procedure. When entering the birth chamber, after ascertaining that the labor is at hand, I first see that all things necessary are in readiness to receive the new-comer. Then I watch closely the pulse and the patient, and when the second stage has fully developed, I make a thorough examination for the exact presentation. Having satisfied myself on this point, I await patiently the approach of third stage. Then I examine again the condition of the parts to see if any assistance is necessary. This done, I watch the progress closely, and guard against any accident in the exit. Having delivered the child, I proceed at once to tie the cord (under cover, as I never expose the mother for this purpose). The connection severed, I hand the child to nurse, and having cleansed my hands, immediately proceed to take the placenta. I always deliver on the back, and take the right side of the patient (if left-handed the side would be reversed). Then taking hold of the cord with the left hand (under cover), and winding around the fingers in order to hold it firmly, I introduce the first fingers of the right hand into the vagina, following the cord. If found in the vagina I make firm traction with the left hand and with the assistance of the right at once draw it forth. If, however, I do not find the placenta outside uterus, I make no stop, but follow up with the whole hand to its lodgement. If un tached from the walls of the organ, I proceed to separate it, and having the cord in my left hand, use all necessary traction force to enable me with the right to bring it forth before the prison door is closed upon this unwelcome retainer. Then removing all membranes and turning out the clots as thoroughly as possible, I put a dry cloth to the vulva, and proceed to put on the abdominal bandage and let the mother rest. I then remain for a half or three-quarters of an hour to watch for post partum hemorrhage, which has but seldom occurred, and then was promptly checked by the introduction of lumps of ice and 3 ss to 3 j doses of fluid ext. of ergot repeated in 15 min. As stated, I have never had but one case of retained placenta, and then it was when I was inclined, like some others, to grant half an hour's grace. I have yet to witness hour-glass contractions. I have never used forceps but once, and then in a case of consultation where the patient, a young and robust woman, had been kept in labor for four days by her physician, of 20 years practice, because the presentation had not been corrected at the proper time. I use ergot without hesitation in all stages when called for, and never had cause to regret. It is a faithful servant and seldom disappoints, if used judiciously. I have had in my number of deliveries, which I think is a fair average, one case of imperforate anus, upon which I Add .3ss to 3j gr x to xx listerine"-which is an efficient compound to cover the odor of the iodoform, as well as being other wise useful-a sufficient quantity. Mix, spread on soft cloth and apply to the ulcer, after cleansing it with carbolic or castile soap and water, and renew it night and morning. To support the weakened blood vessels, I prefer a flannel bandage to anything I have ever used. Cut on the bias, from a good piece of white flannel, bandages three inches in width, and make them long enough to cover the parts needing support, which is usually only as far as the knee. Two bandages, at least, should be made to begin with, as a clean one should be put on every morning, and one may be washed and ironed daily while the other is in use. In applying the bandages, make the turns. around the foot tightest, and gradually lessen the tension as passed up till, at the top, it is just tight enough to keep it from slipping down, and lap sufficiently to cover the surface well and evenly. As the proper application of the bandage is one of the most important and particular parts of the treatment, the patient should be carefully taught how to put it on, and the necessity of keeping it in order. If flannel is not well borne next the skin, cheese cloth, or some other light fabric, may be placed between them. The bandages need only be worn during the day, or while the patient is up; but should not be left off entirely for some time after the ulcer is healed. The ointment should be used continuously till the healing process is complete. The flannel bandage is sufficiently elastic to give comfortable and efficient support and, put on as I have directed, the greatest compression will be where it is most required, below the ulcer. Air readily passes through the meshes of the cloth, and aids in the cure. The objections I have to elastic stockings are that they commonly fit tightest over the calf of the leg, above the ulcer. They should produce the greatest compression below the ulcer, where the circulation is most sluggish, and the blood stagnates. Rubber bandages, though most effectual as regards support, are objectionable because, being impervious to air, they keep the leg too warm, and are often uncomfortable and sometimes unbearable to the patient. As regards constitutional treatment, the following will suit the majority of cases, though each one is an individual study, and will require the particular remedies indicated, to produce the best results. I have found hamamelis and collinsonia especially useful, and they should be combined with a laxative when constipation exists, as it does in most cases. A very common prescription with me is: Specific tinct, collinsonia.. Zss 3ss .Ziv Mix and direct one teaspoonful three times a day. A blood purifier is generally required, and none have given me more satisfactory results than the preparation of Eli Lilly & Co., "Succus Alterans," and, where the iodide of potassium is desired, "Syrup of Trifolium" compound of Parke, Davis & Co.'s manufacture, in doses of one-half to one teaspoonful of either, three times daily. When much pain is complained of, as a local application, the following prescription will give relief, and probably is as useful as any: In my I read the discussions in THE MEDICAL WORLD two or three years ago, on the value of ergot in pneumonia, and resolved to try it as soon as possible. I have used it in a great many cases and with most satisfactory results. early experience with it, I noted some failures which puzzled me not a little. Why it should act like a charm in some cases and be worse than useless in others, I could not at first make out. My experience has taught me that in this section of country the lobar or croupous forms are speedily controlled by it, while in that form where the bronchi are principally affected, it is of no use. During last month (January) I had more cases of pneumonia in children than I remember having ever had in the same length of time in my practice of nearly twenty-one years. In only one case had I to make more than four visits. In that case the parents wished a consultation and the consulting physician refused to allow its use, though he could give no good reason for so doing. Some of my cases when first visited had a temperature of 104° and over, with pulse up to 175, and one was delirious. All recovered promptly, except the one where ergot was discontinued, and his case lasted double the time. My treatment is as follows: For a young child, fl. ext. ergot x to xx inin. For an adult, one drachm every one, two or four hours, according to urgency. I also give aconite (saturated tincture) 5 to 10 drops in a goblet of water; sig., a teaspoonful every five minutes until pulse reduced, then only every hour or so. Í also reduce temperature by antifebrine iij gr. doses as required. Ipecac in one gr. doses (with hydrargyrum cum creta if costive) every four hours for an adult; bromide soda or potassium with spts. nitr. eth. to procure rest and keep kidneys active. Mustard and linseed poultices to the chest. Had I time I could cite a number of cases where this course has been followed by most happy recoveries. I have a case on hand just now which I will try to report in next month's issue to illustrate the course of the disease under this treatment. Stirling, Ark. C. S. HAMILTON. Various Remedies for Stammering. Editor MEDICAL WORLD: Last year I wrote asking the household for a remedy for stammering or stuttering. I left my former home hurriedly, and in the excitement and rush of getting settled and business and professional cares, neglected so far to thank those who so very kindly gave me their advice. As I received several suggestions by mail, I herewith give the means offered in the hope that they may be of service to some member of the brotherhood. Dr. J. H. Medaris thinks it a nervous trouble and gives strychnia. Dr. S. H. Singleton recommends holding a piece of soft wood or pebble between the incisor teeth, biting sufficiently to steady the jaw. Mr. B. E. Sedberry recommends the same thing, only holding the block between the molar teeth to steady the jaw. Slow and distinct articulation was advised by all. The case I had didn't remain in my location long enough to give much chance of effecting a cure. If those who doubt the trouble being nervous could have seen the contortions, twitching and winking, the victim would go through when trying to talk, or rather trying to start, they would be convinced it is purely nervous. I had him read aloud with the teeth tightly closed, and applied galvanism (3 cells McIntosh battery), to reach over nerves of phonation as near as possible. I also put the patient through a drill. There certainly was an improvement. I also observed he could swear without trouble, even when it would be impossible for him to use nearly identical words. I also found the stammering was more or less periodical, and when health was very good the speech was better, and that the mind controlled it to a great extent; when things were agreeable and surroundings pleasant, speech was better. Also that sometimes he could say anything alone, but if I looked him in the face that settled it. I hope to have further opportunity of using some of these means so kindly suggested. For my part I am convinced that the trouble is nervous. Fear of stammering is a great cause. I think nearly every case could be cured. I have a good deal of faith in the block between the teeth. One writer advises it between the incisors. Another advises it between the molars. I also have great faith in the physiological effects of the battery. Also would not hypnotism or animal magnetism succeed? I see hysterical patients have been ordered to cease having spasms with success. If it would work in these cases, why not in stammering? I wish some one would test it. Mr. E. J. E. Thorpe contributes an article on page 327 well worth referring to. I will conclude by saying I have had a number of letters from physicians and others offering a sure cure for sums varying from $5.00 to $50.00, I could not help thinking how mercenary when the brotherhood is contributing their experience and discoveries for the benefit of suffering humanity, those whose name is legion are seeking to enrich themselves by others' misfortunes. It would be well if such would remember we brought nothing into this world and will take nothing out. Oceanside, Cal. H. E. STROUD, M. D. Peculiar Ravages of Syphilis; Report of Dr. Stephens' Case. Editor MEDICAL WORLD: In the October number of your valuable journal, page 391, I asked for diagnosis and treatment, for which I received an excellent response from Prof. Waugh in the November number, page 415. About the time I wrote the patient passed from under my care; but, |