of super-involution. Softening of the substance of the uterus from a chronic inflammatory process has been alleged by distinguished authorities, but chronic interstitial inflammation is attended with induration and hypertrophy of the organ."

I will here state that cases of acute displacement or flexion of the uterus which occur most commonly in the virgin state are rarely seen. They are usually seen only when chronic and local and general symptoms have been developed.

III.

SYMPTOMS AND PHYSICAL DIAGNOSIS.

The importance of recognizing and appreciating the significance of pain as a means of diagnosis of pelvic diseases in the female leads. me to say a few words on this subject, and I shall confine my remarks exclusively to pains caused by distortions and flexions of the uterus. In prolapsus uteri the pain is chiefly of at dragging or bearing-down nature. The uterus increased in bulk, drags upon the utero-sacral and broad ligaments, stretching and elongating these, giving rise to dragging pains in the back and lower abdomen.

There is general marked prolapse of the anterior vaginal wall with base of the bladder, constituting cystocele.

A sensation of weakness is experienced with an inability to stand for a long time or to undergo any prolonged exertion.

Leucorrhea is generally present to a greater or lesser degree; menstruation is not invariably interfered with. If the uterus is much congested, menorrhagia is not infrequent.

In anteversio uteri, discomfort on standing and walking, or even inability to get about, is occasionally witnessed. Leucorrhea, menorrhagia, dysmenorrhea and dyspareunia are generally marked symptoms.

In anteflexio uteri pain is complained of in the hypogastrium, aching in the groins, pain on standing or walking, often so distressing as to compel patient to keep her bed, a sense of depression or sinking at the epigastrium is felt with more or less despondency, neuralgia and other nervous symptoms. Leucorrhea is gen

erally present.

In retroversio uteri there is more or less

discomfort in walking, standing, prolonged sitting, or on defecation, pain in the sacral region, dragging sensations in the groins. Dyspareunia is very marked-acquired sterility the rule. Excessive secretion of slimy mucus from the rectum is often produced by pressure of the

fundus uteri on the bowel.

In retroflexio uteri pain is causing a much greater amount of discomfort than occurs in cases of retroversion. Venous congestion in

variably ensues, the natural results of which are leucorrhea, menorrhagia and metrorrhagia, which are very prominent symptoms.

There is localized sacral pain, and just preceding the menstrual flow the pain is of an agonizing nature, extending down the thighs, radiating to the groins. The pain in the lower part of the spine is sometimes so intense and persistent as to lead to the idea of spinal disease. Reflex nervous manifestations are well marked. Hysteria breaks out in all its eccentricities; headache, disposition to vertigo or syncope, and the various neuralgias appear; great irritability, despondency and melancholy is manifested; in fact, the congested displaced organ is a constant source of nervous irritation and exhaustion, it is constantly sending painful impressions to Diseases of Women," it constantly used up in a the nervous centres. To quote from Barnes' morbid direction the nerve force which is wanted for the performance of a healthy function."

Each form of flexion and version produces also a characteristic group of dynamical symptoms. In anteversion and anteflexion the bladder is troubled. In retroversion and retroflexion the rectum is disturbed. In the flexions there is dysmenorrhea; in the versions menorrhagia. In flexions reflex symptoms particularly gastric are more common, especially if the seat of the flexion, as it usually is, occur near the junction of neck and body. Sterility attends flexed more than verted states.

under ordinary circumstances, should be easily The physical diagnosis of these conditions,

made. The uterine sound will without fail

resolve any doubt. The finger alone in most

cases is sufficient to detect the exact condition present.

I refer the readers of my thesis to the numerous text-books on gynecology which will enlighten them on physical diagnosis; however, I will briefly mention that in uterine verson backwards or forwards, the axis of the uterus is maintained; and the os points backwards or forwards accordinging to the direction and degree of malpositions, but the lips are equal. and fundus depend on the extent to which the In uterine flexions the relative positions of os uterine axis is bent. If of any standing, the cervical lip corresponding to the flexion is found swollen and elongated from the alteration in the nutrition involved from the corresponding

wall being bent on itself.

In proceeding to consider my second proposition, I must necessarily confine myself to discussing the principle only of the mechanical means of treatment.

Ephraim, Utah. WM. H. OLSTEN, M.D. (To be Continued.)

My Experience.

Editor MEDICAL WORLD:

If my very particular friend, the editor of THE WORLD, Would practice medicine in a "malarial district" like mine during the "malarial season," I think he would find picrate of ammonia and the sulphite and hyposulphite. of sodium, etc. (see page 24, January WORLD), useless in intermittent and remittent fevers. But, as before stated in THE WORLD, my lack of success may result from my not knowing when and how to use these remedies. They

will not cure the mildest forms of intermittent fever in my hands.

There are many drugs which will aid quinine in curing various forms of malarial fevers; many, too, which will cure some cases without the use of quinine. But when there is a strong probability that the next paroxysm will be fatal, there is no time to use substitutes for the Peruvian bark. I am aware that many have been injured by the injudicious use of quinine. This is true also of almost every other article in the materia medica. Many prominent physicians in the South now claim that quinine causes hemorrhagic malarial fever. This may be true in some cases, but it is not in all. I cured one case with quinine administered hypodermically which was not produced by quinine. During a practice of sixteen years I have never treated a case that could not endure some preparation of the Peruvian bark. But I have treated many who thought they could not take quinine. When one preparation does not act kindly I use another. Have known not a few persons who could not retain quinine or cinchonidia made by one firm, who could take the same salt manufactured by another company.

Like all other medicines, quinine must be given for its effect, and not according to the dose book. In the pine-hills of north Missis sippi, ten or twelve grains of quinine during the twenty four hours will cure almost any case of intermittent fever in from one to three days. But when a man from the river-bottom counties visits his relatives in the pine hills, and takes the "chills and fever," it requires two or three times as much of the salt to cure him. I do not wish No more on this subject now. THE WORLD'S readers to think I have quininemania.

My thanks are due Prof. Waugh, not only for his remarks or my case of joint disease, but for a more substantial professional favor some time ago. There was, I am sure, nothing to indicate a deposit of tubercle in the lungs when I first saw the case. A solution milder than Villate's was tried, and it caused the most excruciating pain. In such cases would Prof. Waugh use Vil

mens, etc.

There seems to be a belief that such work is easily, quickly and cheaply done by a chemist or pathologist; really such is not the case. To make a just and honest examination of a mixture containing alkaloids and vegetable extracts is quite as difficult and exacting as to make a toxicological examination. Prof. J. N. Hurtz and I do together most of this work for Indiana on order of the coroner, and charge from two to four hundred dollars, according to the work required. To determine a sample compound-eye-water, etc.-is worth fifteen to twenty five dollars; to do qualitative and quantitative work on a mixture is worth fifty dollars. It requires time, knowledge and apparatus. Anybody can guess off a formula that has the sp. gr. color, taste and smell of the substance sent; but to sign your name as chemist that a substance is made up of this or that per cent. propertions is scientific work, and requires

corresponding compensation. The medicine may be a poison; may have been used as such. I shall be pleased to answer all correspondents of THE WORLD as regards chemical, toxicological and pathological examinations, and will set such value on work as honest work of this kind is worth.

Thanking you for past favors, I am, very cordially, A. W. BRAYTON. 102 North Meridin Street, Indianapolis, Ind.

Epilepsy.

A physician who gives neither his name nor address, but whose envelope bears the post-mark of Seneca, Ill., asks for a remedy for epilepsy. Judging from his additional remarks, we should think that the writer needed to study up the subject from the beginning.

Last summer Dr. J. L. Napier, of Blenheim, S. C., kindly sent us a quantity of the red berries of the common house nettle, common in that locality, and, we believe, all over the South. He stated that he had accidently learned from the negroes that it was useful in "fits." Acting upon that information he began using a tincture, which he made himself, in epilepsy, eclampsia, and all convulsive disorders, with remarkable success. Desiring the profession to know of its merits he wrote to us as indicated.

We had Mr. Louis Genois, apothecary, of this city, to prepare us a twenty per cent. tincture from the berries sent us. With this experiments have been made which, so far, have given great promise. We give this in order that many other investigators may pursue the same line of investigation, and thus a definite conclusion may be the sooner reached.

The dose of the twenty per cent. tincture is from ten drops to a drachm, commencing with the smaller dose and gradually increasing, with a view to obtaining just the physiological effects -a feeling of drowsiness.

We believe that the poisonous dose and properties of the drug have not yet been made out.

Sulphite of Soda in Diphtheria.

Editor MEDICAL WORLD:

Allow me to assure your readers that if they will give freely of sulphite of soda in all forms of diphtheria they will find it the most reliable remedy yet discovered for that much dreaded Scourge. Procure the purest powdered sulphite; make a saturated solution and push it. Order it gargled also. Where practicable, I give one or two teaspoonfuls every hour or so from the very first. I do not claim for it a "specific," without some other treatment; but I do claim it to be the nearest a specific yet discovered if used boldly. It was first sug

gested to me by Dr. J. Koehl, formerly of this city, some two years ago, since which time I have treated about twenty-five cases with this as the main remedy, and have not yet lost a single case. I said in all forms of diphtheria." I should probably have excepted laryngo-trachea (croupous diphtheria). Have not yet discovered a satisfactory remedy for that form of the disease. I may add that I have found the sulphite of soda equally efficacious in scarlatina.

Please tell your readers to give it a fair trial and report success.

Minneapolis, Minn.

C. G. SLAGLE.

Discussion of Croup-Formula for Mineral Salt for Dyspepsia.

Editor MEDICAL WORLD:

An article in the December number of THE

WORLD, written by Dr. John Cook, of Lake Shore Villa, Utah, on croup, attracted my attention, and probably that of many other readers of THE WORLD; for when a man comes out and boldly makes the assertion that he is sixty years old, and that he has never lost but one case of croup (I take it he means membranous) in his life, and at the same time gives the remedy by which he has attained such unbounded success, it must attract attention, for membranous croup is generally considered a most fatal disease of childhood.

It makes me feel like a criminal when I look back over my short past, and see how many little ones have been laid away in consequence of this dreaded disease, when such brilliant success has been achieved by the doctor.

In all deference to the statement made, I must say that if his remedy will do all he claims for it he has bestowed a lasting benefit on the profession by making it known. It may be that membranous croup in his section is a different disease from what it is in Wisconsin or elsewhere.

I want to ask the doctor a question. On December 14th I was called to see Willie J., aged one year. His mother said that he had been suffering from a cold for a few days, but was becoming short of breath, and she was afraid that it had gone to his lungs. Upon entering the house I saw that the child had membranous croup, and told the mother so. An emetic of alum was at once given, and a brisk cathartic to move the bowels. Then a steam apparatus was fixed up so that a constant stream of steam, impregnated with lime, was thrown upon the child. Every hour a 1⁄2 gr. Dover's Powder, with 1⁄2 gr. hydrarg. chlorid. mite, was given, until five doses were given, then 10 drops of syrup of ipecac was substituted.

At 12 o'clock the breathing had become so difficult that another emetic was given.

At 2 p. m. counsel was called, and, in spite of all that we could do, the child grew steadily worse, and died at 10 p. m.

Now, I want to ask the doctor if he really thinks he could have saved that case?

I want to say to Dr. I. E. Layton, of Salina, Kan., that here is a formula by which he can make his own mineral water, that has proved very beneficial, from long experience, in dyspepsia, chronic ulcers of the stomach, etc.: R Sulphate of sodium...

Bicarb. of sodium.

Chloride of sodium.. Pulv. ginger..... Triturate.

Ziv 3 iv

.3 iij .3 iss

It should be prepared as as follows: Place a pound or more of the soda sulph. over a slow fire until all the water evaporates (I use an old spider or skillet for the purpose), then pulverize it thoroughly; take the amount indicated in the formula.

This makes a nice mixtture, and a half to a teaspoonful of it added to a glass of hot water, taken from one-half to three-fourths of an hour before breakfast, will do more for dyspeptics than anything else I ever tried. Elroy, Wis.

F. T. FIELD, M. D. Sulpho-Carbolate of Zinc in Typhoid Fever. Editor MEDICAL WORLD:

I have been waiting to see something in reference to the use of sulpho-carbolate of zinc in typhoid fever, as suggested by Dr. Waugh in the August WORLD; and as my experience with it is somewhat limited, I almost refrain from giving it. I have treated three cases of undoubted typhoid fever with sulpho-carbolate of zinc, and I was convinced that it had a marked effect on the course and duration of the disease. The temperature did not go over 102° in either case, and the diarrhea seemed easier controlled. I did not give a dose of the so-called antipyretics. Tympanitis seemed to be lessened and prevented to a certain degree. The most marked feature of these three cases was the lessened duration of the disease, as compared with cases I have seen treated without the sulpho-carbolate of zinc.

I may mention that I gave a 10 drop dose of turpentine each morning for four or six days. when I first saw the case. I commenced with the sulpho-carbolate of zinc and turpentine at the same time.

I did not notice as much dryness of the tongue in these three cases as there usually is. I believe the new remedy is a good thing, and I shall continue to use it whenever I have a typhoid patient.

Editor MEDICAL WORLD.

Dr. F., of Gilkey, Ark., wishes a solution of quinine for hypodermic use. If he will try bimuriate of quinine with urea he will not be obliged to have a solution. He can dissolve gr. v. in m xx of water, and I have never known an abscess to follow its use. I have been using it now for five years.

In all hypodermic injections I use boiling water to dissolve the tablets or quinine and make the solution at the bed-side, and I believe that by so doing I have saved myself a great deal of trouble, as I have never had an abscess from using the hypodermic syringe.

For constipation of the bowels from the continued use of purgatives (and which I consider the cause of three-fourths of the constipations which we are called upon to treat), I use the following prescription:

Ergot in Obstetrics. Editor MEDICAL WORLD:

Whenever the usefulness of any drug is seriously called in question, and even all virtue denied it, as has been the case with ergot in obstetrics, every member of the profession should give evidence. Mine is as follows:

I have been in the constant practice of medicine and surgery for ten years; have had a fair share of obstetrical cases; have never lost a woman in confinement; never had a severe case of post partum hemorrhage; never a case of hour glass contraction when I had charge of the case from commencement; and I never have attended a lying-in woman without administering ergot.

I give it, however, only as follows: when the os is well dilated, head presented, and a decided lack of expulsive pains. When sure that labor is about to terminate, I invariably give 1⁄2 to drachm of the fluid extract of ergot; the larger dose if there is any previous history of severe flooding.

A recent case will serve as an illustration. Two weeks ago, at 2 o'clock a. m., I was called to the bedside of Mrs. S., mother of two children, the youngest nine years old. The lady had been in charge of a midwife for 48 hours; the pains had been irregular, but for the first 24 hours of some force, gradually growing weaker, the patient ditto; had neither eaten or slept for 24 hours; there was great physical exhaustion and despondency. Examination revealed a partially dilated os, and natural presentation. I immediately gave 5 grs. of sulphate of quinine in a cup of strong coffee without milk or sugar; in half an hour, 5 grs. of hydrate of chloral. A quiet sleep of nearly an hour's duration quickly followed the administration of the chloral; upon awakening I gave 20 drops of ergot every 30 minutes, until three doses had been taken; by that time pains were sharp and regular, and soon after sunrise a nine pound boy was crying to be dressed. Placenta immediately removed by hand; no hemorrhage, no severe after-pains, and a splendid recovery. In this connection I wish to state that I have never been troubled, since the early years of my practice, with a retained placenta; for if, by the time the child has been cared for, it has not been expelled, I thoroughly lubricate my hand, and not only remove the placenta, but thoroughly cleanse the uterus of all blood clots. For the last three years I insist upon it that the nurse shall thoroughly syringe out the parts with a solution of permanganate of potash twice daily. I shall continue to use ergot even at the risk of being dubbed an old foggy. J. F. LOCKE, M. D. Pillsbury, Minn.

Delivery of Placenta. Editor MEDICAL WORLD:

The opinion of Dr. J. M. Proctor, of North Salam, Ind., in regard to the delivery of the placenta, accords entirely with my own. The practice of passing the hand into the vagina and uterus in search of the placenta is mischievous, and to me smacks very much of brutality. Its necessity can scarcely ever exist. Immediately after the delivery of the child. the patient should have from twenty to thirty minutes rest, when, if a pain does not come on, a gentle pressure with the hand over the abdominal walls and uterus, with the slightest

traction applied to the cord, will in the vast majority of cases terminate the labor successfully and satisfactorily; and if a compress and binder is at once carefully adjusted, few and insignificant after-pains will occur.

"Meddlesome midwifery" is as greatly to be abhored now as in the days of Blundel.

If we can trust nature with our patient through the whole period of gestation to the delivery of the child, truly we can half an hour, or an hour longer.

I have been in active practice forty-six years, and have a recorded list of five thousand cases, and I have never, but two or three times in my life, been obliged to introduce my hand into the womb to get the placenta.

JOHN G. MEACHEM, M.D. 734 College Ave., Racine, Wis. For Whooping Cough.

Editor MEDICAL WORLD:

In reply to Dr. T. J. Shuell in December WORLD, 1888,. page, 475, I will say, if the doctor will try the following, he will be likely to find the most gratifying results therefrom: B Quinine sulphatis. gr. xvj

Acidi sulphurici dil. q. s. ad solv.
Syrupi aurantii.....
Aquæ dest. ad..

f. dr. j ..f. oz. ij

M. Sig. A tablespoonful every 2 hours to an adult and increase the dose to 2 tablespoonfuls. Under 2 years old, dose 10 grains in 24 hours, [a teaspoonful of the above mixture ten times daily.-ED.] Over 10 years old, 18 to 20 grains, [18 to 20 teaspoonfuls of the mixture daily.-ED.]

I would be pleased to hear from the doctor as to results. Success to THE WORLD. I think it the best medical journal published. Garner, Ky. R. A. PRITCHARD, M.D.

"All's Well that Ends Well."

Editor MEDICAL WORLD:

On May 21, 1885, I was called to see Mrs. K., who had given birth to a child three hours before, the placenta remaining. I soon removed it by Crede's method. She being a primipara I did not leave anything to relieve after-pains.

On the next day the pains were severe, and their old family physician was called, who, they say, informed them that "she was all right when I came if I had only known enough to let her alone; that what I removed was the baby bed and that she could not have any more children," which has proved true so far, and they are so pleased that I have done their business ever since, and have been offered as high as one hundred dollars to do the same for others, who do not believe me when I say it is all nonsense, and say "I've got to do it if they have any more children."-COUNTRY PHYSICIAN.