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To revert: The patient when first seen was suffering with intense lancinating pains radia ting over the entire abdomen; cold extremities; entire surface covered with colliquative sweat; upon palpation tenderness became so great that the slightest touch provoked a plea from the patient to desist; abdomen greatly distended, yielding a tympanitic percussion note; nausea and vomiting present, but not marked; bowels moved directly after my arrival, in consequence of a large dose of castor oil that had been previously given to overcome the torpidity which for some time had been. present; pulse quick, intermittent and almost imperceptible. I at once administered morphia sulph. gr. 4, and ordered warm poultices applied to the abdomen with a view to moderating the inflammatory action that I considered had become aroused in the peritoneum from an extension of that process from the uterus by contiguity of surfaces, through the intervention of the Fallopian tubes.

After having quieted the patient, I ordered a stimulant in the form of cognac brandy, which was freely given at regular intervals throughout

the course. In two hours reaction came on

with slight febrile symptoms. Visited the patient in six hours, and could discern no favorable change. She persisted in lying on her right side, with thighs flexed, insisting that it was impossible to turn in; that it induced alarming syncope with every effort to change position.

Advised an ounce of sweet milk given in conjunction with the brandy. The poultices no longer being grateful I suspended their use, supplementing with turpentine stupes. Incorporated three grains quinia sulph. with the morphia sulph., in capsules, giving one every three hours. Anticipating the shedding of the epithelium in the inflammatory area, thus leaving a pyogenic membrane, I directed the former drug not only as an antipyretic and tonic, but also with a view to prohibit, or at least partially suspend the migration of the white corpuscles. The latter drug rendered service in relieving pain, quieting peristaltic movement of bowels and conducing a general quiescent state, so much to be desired in bringing about resolution.

The patient seemed to be doing nicely up to the third day, being able to turn in bed and having manifested a desire for the nourishment given, when fever rose to 104°, which was combatted and subdued by the use of large doses of quinine, alternating with ten grains of antipyrine, of which three doses were given. To remove the accumulated fecal matter I used an enema of equal parts of glycerine and water.

Micturation being frequent, painful and difficult, I made use of the catheter, removing a large quantity of highly colored urine. The bladder remained paretic for several days, calling for frequent relief by means of the catheter. On the fifth day I concluded to move the bowels, which was effected by a dose of castoroil, one action ensuing, accompanied by prolapsus ani, which was easily reduced, but very painful and annoying. After the fifth day convalescence became evident, she gradually gaining strength and a desire for food, which was restricted to milk and animal broths. J. SAMUEL PRICE, M. D.

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recognized as a cerebral excitant, similar to Physiological Action.-The alkaloid has been those of coffee, tea and cocoa, in which it The acid probably occupies the first place. paullinio-tannic appears to have the usual astringent properties of tannic acid, combined with a peculiar anesthetic action on the terminal filaments of the sympathetic in the stomach and small intestines.

Medicinal Uses.-Guarana has been exten. sively used in France, in the treatment of diarrhea and dysentery, and they have certainly proved its efficacy in these maladies, given in from 15 to 30 grains per diem, in divided doses.

Paullinia sorbilis has of late come into great repute as a remedy for headache. In this country it has been used almost exclusively in headaches of a purely nervous origin; but in France and North Italy it has been used and gained great popularity in the treatment of that by far the larger class of headaches: those due to a sympathetic origin with the digestive tract.

Last year I had occasion to treat a case due to this sympathetic origin, giving a fl. oz. ss dose of the fluid extract, which procured almost immediate relief.

Then I became convinced that the effect gained was not all attributable to the alkaloid, guaranine; but in part undoubtedly due to the

peculiar anesthetic (local) action of the paullinio-tannic acid on terminal filaments of the sympathetic in the alimentary canal, for these

reasons:

(1) That the effects were gained only by a sufficient dose to coat the lining of the stomach over, and were gained before the alkaloid could have had that effect on the brain.

(2) That, when this was the case, the membrane being coated over by the drug, there was no susceptibility to attacks by the ingestion of undigestible articles, which had always been a sure forerunner of an attack.

Now, acting on these principles, I abstracted all the alkaloid from a given specimen of the fluid extract, and carefully preserved the residue, consisting of paullinio-tannic acid, starch and gum.

Case I-On Aug. 13 I was called to see Mrs. R., aged 42, suffering from a severe headache; been subject to like attacks, at longer or shorter intervals, for a number of years. Also has pyrosis at the time of or preceding the attacks. Administered fl. dr. iij of the residue as above every half hour.

Aug. 14. Headache passed away with second dose. Gave pills:

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American practitioners, in the use of paullinia sorbillis have been owing (a) to the poor quality of the drug, and (6) in the too small dose.

II. That paullinia sorbilis contains that happy combination of a cerebral excitant with the peculiar stomachal anesthetic agent, making it at once a remedy for the large class of headaches: those not due to organic changes.

III. That, having removed the exciting causes, the combination of paullinia sorbilis, rhamnus purshiana and nux vomica is certainly the best to remove that neurasthenic condition of the alimentary canal which is the predisposing or remote cause of headaches. CHAS. H. SPRINGER, M.D.

Dundee, Ohio. [The preparations reported above were those of Parke, Davis & Co- ED.]

Ergot in Obstetrics.

Editor MEDICAL WORLD:

My own experience in the use of ergot in labor is suggested to my mind as proper for publication. I have been in constant practice of medicine and surgery for forty years; have taken a special course in obstetrics and obstetrical operations under Prof. Joseph Kucher, of Vienna, Austria, and in Bellevue, N. Y., on gynecology, so have had some theory as well as experience. I wish to say that for forty years I have used ergot constantly under the following circumstances and in the following manner.

1. Whenever the parts are ready for labor, the os dilated, head presented, and there is lack of energy.

2. Sometimes when the parts are not ready, but there is headache and "false pains," as women are wont to term them, I give a little ergot to "settle things," and see what is to be done. Sometimes this course results in making more pains, sometimes in making less. In the former case, if labor sets in really, I increase the ergot, and get through with the case.

3. When by previous history I suspect postpartum hemorrhage, I give a drachm of the fluid extract of ergot just before the delivery of the placenta.

My rule for giving it is to put two or three drachms into a half teacup of water, and give a teaspoonful every 15 minutes, and increase if necessary to increase the force of labor.

During this period of forty years I have not had but three cases of hour-glass contractions, and two of those cases were attended by a midwife, and not seen by me for a number of hours after confinement, when ether or chloroform was given, the hand inserted, and placenta removed without trouble. The other case had taken ergot, but got along well by

using ether and removing by the hand. The number of cases lost in this time is so smali that I will not report them for fear of seeming to boast. At least suffice to say that I shall continue to practice hereafter as heretofore in the use of ergot. E. H. KEABLES, M.D. Alma, Col.

Burning Feet.

Editor MEDICAL WORLE:

In the November number of THE WORLD, page 429, C. C. C., Barksdale, Va., asks for treatment for burning feet. As he gives no history or symptoms we can only guess at what ails his patient. We therefore guess that his patient has hypertrophy of the heart, and in consequence has too much circulation in the extremities, or it may be a neurosis. I would suggest that he try belladonna or aconite (tincture), in one-drop doses to quiet the heart (if hypertrophy exists) also one-half dr. fl ext ergot three times daily to contract the vessels. hypertrophy do not exist give nerve sedatives. Had C. C. C. written his name in full I should have answered him by letter, but as he did not I am obliged to answer through the best medical journal in the world.

If

Franklin Grove, Ill. W. C. SMITH, M. D.

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Two Cases Practical Gonorrhea and Erysipelas. Editor MEDICAL WORLD:

My experience has been that it is not the large surgical or gynecological cases that are the dreams of under-graduates, so much as the little cases that one meets in practice that give one trouble. I remember how a chum of mine in the dissecting room worked for several days over a subject to determine just where to cut, in case he should have a patient with abscess of the liver. I hope he has had many opportunities of making his longed-for cut, but I rather think he has had many more occasions to open up an abscess and then not have it get well in time to suit the patient. I do not think there is any disease a young doctor feels better qualified to treat when he first unfurls his professional banner to the air than gonorrhea. Of course after he has been beaten out of his fee a few times, and fails to cure a few cases wherein whiskey and sexual excesses have joined hands against him, his zeal relaxes some; but it takes a good many experiences to satisfy him that gonorrhea is not so very easily cured at all times. In time he learns that there are few diseases more disagreeable to treat. Those who have the disease, as a rule, deserve to have it, and the same recklessness that led them to where it was for distribution prompts them to hold all professional counsel at arm's length.

A case came under my notice lately that was to me unique. The young man, not knowing the nature of the disease, gave nature a chance to effect a cure, and by the time he placed himself under my care he had all the gonorrhea one man could well attend to. The foreskin was long and contracted, so much so that when I saw him he could not retract it at all. The entire organ was swollen to almost the full size in state of erection, while the scrotum was also swollen. Injections were out of the question, and, on account of the swollen condition of the penis, he suffered constantly from chordee. At night he suffered intensely. To add to the patient's distress, he had a constant fear that his folks would find out what was the matter with him, and so he could not use hot water baths as he should. By a free use of cathartics, rest in the recumbent position, and liberal imbibition of alkaline diuretics, the patient recovered; but, while it lasted, it was quite interesting to me and very much so to the patient.

I have lately had an opportunity to test Dr. Waugh's cure for erysipelas in a very young patient. Jimmy B., aged eleven months, while playing on the floor with several other children, was stepped on by one of the children and the calf of the leg was badly bruised. The leg

began to swell, and at the end of twenty-four hours the entire leg, from ankle to knee, was swollen and tender, and erysipelas starting at the seat of injury. I was called thirty hours after erysipelas was first noticed. The little sufferer was put on fluid extract of jaborandi in two-drop doses every two hours. This dose was increased to six drops every hour before the effects of the drug were shown by flow of saliva and slight diarrhea. The dose was then diminished, and so given that the full effects of the drug were shown every day. In seven days all signs of erysipelas had disappeared, and the child's appetite and playfulness had returned. Before the disease was cured it had extended to the body. I regard the drug as a specific, or as nearly so as any drug can merit that title in this disease. I can imagine no other treatment that would have promised any hope in a child so young and following a wound. J. A. DE ARMOND, M. D.

Le Claire, Iowa.

Venesection as a Therapeutical Agent. Editor MEDICAL WORLD:

Venesection as a therapeutical agent is not one of modern introduction. It was considered the sheet anchor to subdue inflammatory or fever action before aconite, veratrium viride, gelsemimum, quinine, bromide of potassium, chloral hydrate, ether or the hypodermic syringe were introduced as reliable febrifuges and antispasmodics. These remedies have now attained a foothold in the profession so firm that they cannot be displaced, yet I am not prepared to discard venesection altogether, for reasons which I am going to state.

The objections to venesection by the nonbleeding portion of the medical fraternity are: The good blood flows away and the bad remains in the system; it robs the patient of a certain amount of vital fluid, of which Solomon the Wise says, "the blood thereof is the life thereof." It is painful and frightful. It produces a wound which may be followed by inflammation, erysipelas, phlebitis, blood-poisoning, nerve-injury, artero-venus aneurism, either of which may be followed by serious consequences or death. Each opponent to venesection will advance his own arguments and endeavor to maintain his point, however weak or well that point may be taken.

Before upholding venesection more fully, I may remind the reader that aconite, veratrium, gelseminum, ether, morphia, chloral and antifebrin are all potent and dangerous drugs, and require even greater knowledge and care in their administration than does the lancet.

In the earlier years of my practice I bled

many of my fever patients, more especially those threatened with congestion of some organ or part of their body, and I do not now remember that I ever had reasons to regret it. I bled older and younger people, and even children less than one year old, when suffering from pneumonia, rheumatism or inflammation of the brain, and always with benefit to my patients, although I now seldom resort to bleeding as a therapeutical measure in those affections.

As progressive professional men it becomes our duty to think, study, observe, hear, yield to convictions, even should they not be agreeable to our prejudices, and report results honestly. When we take up a new medicine we are apt to lay aside our former "old reliable," and although previously always a good, faithful and trustworthy friend, he is forgotten, and we associate with the young and less reliable, simply because we are fond of a change.

The late Professor Charles D. Meigs, of Philadelphia, recommended early and free venesection as the only safe and proper remedy in puerpural fever and puerpural convulsions. My experience has been equally satisfactory, although not so extensive. No less than eighteen and as many as twenty-four ounces should be taken from a full-blooded or highly sanguinous woman. It was an old custom to bleed women during or about their eighth month of pregnancy.

This procedure is often times very necessary and would avoid many unpleasant after consequences to the lying in women. Plethoric females suffering from varicose veins, flashes of fever, giddiness, or pain in legs, if they consult me, I generally bleed them once, twice or thrice during one term of gestation and always with the best results following.

You may ask what do you mean by the best results following? I mean that it relieves the pain, removes the tension from the over-charged veins which have become varicosed by neglected over-distension, procures sleep, facilitates labor, and the patient has an early and good "getting up." Some one may say-stupid and cruel doctor. "That mother should not be robbed of her blood which she so much needs for the support of the fruit of her womb." This reasoning would seem logical, but logic is at times at variance with facts.

Some years ago a pale-looking elderly gentleman asked me to bleed him. I said-Peter, you have no blood to spare. You should have medicine to make more blood for you, and I gave him some with "no good." He asked me again and again, and I always repeated my logic-Peter, you have no blood to spare. The fourth time he replied "I don't care whether

I have blood to spare or not, I want to be bled, and if you will not bleed me I will get some other doctor who will." I knew that his words meant, get another family physician, and to save myself I said—all right, I'll bleed you, and I did. One month after the bleeding I saw him, and was surprised at his improvement. He reported, much increased in weight and strength, and his health, sleep and appetite much improved. At his request, and without using my logic I bled him again, and he enjoyed good health for four years more, after which he became consumptive and died at sixty-nine years. Two of his grown up children had died previously of the same disease.

I treated an old lady, aged sixty-five years, for pain and heat in the the top of her head, roaring noise in her ears, sleeplessness, giddiness, loss of appetite, at times double vision, full pulse, mental depression, absent mindedness and often not able to do her little house work. A six months' course of medicine did her no good, and I proposed to quit medicine and resort to venesection every four to six weeks until better or worse. To this she consented and the im provement was well-marked from the beginning. She has neither been bled nor taken medicine for several years and is enjoying good health.

An octogenarian lady during her eighty first, second, third, and fourth years, was bled whenever she suffered from giddiness, tremors, and a tight phthisicy cough, and was always relieved by one or two operations.

Many of my apoplectic patients I bleed on my first visit, and have not regretted it. In the abstraction of blood the physician has the advantage of an ocular inspection of the life fluid. This is a matter of paramount importance. In some cases the blood is thin and almost a bright red; in others it is dark and thick, almost as black as tar; in some we notice the buffy coat, and in other instances the surface of the blood in a very short time is covered with a thick, coagulated, yellowish, or pale-green jelly-like serum, and very little red fibrinated fluid remaining. The inspection of these different conditions of the blood, the same as an ocular inspection of the urine and feces of patients reveal to the anxious and observing physician what, under other circumstances, he could not know.

About ten weeks ago I was called to see a young man aged 29 years, married, and a farmer by occupation. He had been in his barn, and had stooped with his head down in a grain bin to gather feed for his chickens. Upon rising up he felt giddy and fell over on the floor completely paralyzed on the left side, although perfectly conscious. His speech and the muscles of his face and tongue not affected.

His left upper eyelid paralyzed, no fever, and no pain. Sensation of the left arm and leg entirely gone, pulse normal. I did not bleed him on my first visit because I thought it was not indicated. I am now sorry that I did not. Next morning he had considerable fever, full, bounding pulse, slight delirium, and pain in his head. The left eye much congested. I now bled him freely, and the appearance of the blood revealed the fact that the man was seri

ously ill. On my first visit he said he had not felt badly previous to his present trouble. After venesection, I told him that he had not been enjoying good health for some time. His wife replied that he had been complaining at least one week previous to the hemiplegia. My first conclusion was that the man had his head down too long, and the pressure of blood caused a meningeal artery or vein to rupture, producing a small meningeal hemorrhage. Bromide and iodide of potassium and morphia controlled the pain, veratrum viride the pulse, and calomel and comp. ext. colocynth the bowels. Sensation has returned, he is able to walk with the aid of a cane, but his arm is useless. A full bleeding on my first visit might have avoided some of the after consequences.

The direct beneficial effects of venesection may be summed up as follows. As a febrifuge it diminishes the volume of the blood current, thereby relieving the heart and lung action as well as the tension on the involved blood vessels, cuts short fever and inflammation and greatly assists each threatened organ to resume the even tenor of its way.

In some people, from some cause or another, a slow and imperfect action of the heart and lungs causes the blood to become super-charged with carbon and other effete material, the greater portion of which is found in the venous circulation. The question-how much blood has the patient in his system? is not so important as how much poor blood has he? If he has too much poor blood, open a vein and let some out, then direct your attention to the secreting and excreting organs, and aid them with proper remedies. If all diseases are produced by an impure condition of the blood and the main channels carrying this impurity are found to be the veins, then we must tap one of these channels to relieve the system of its impurity.

Gaping, yawning and sighing are forced inspirations and expirations of air. We must have fresh air, and if we are too sleepy, or too lazy to breathe properly nature forces us to open our mouths wide, and take a long and deep inspiration and expiration so that we may not die from asphyxia.

Venesection, like every other potent remedy,

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