I gave her ergot, witch hazel, and other remedies to check and prevent hemorrhage. I waited half an hour then told the husband the chances were against his wife. The remedies made but little, if any, impression on contractility of womb, for blood would gush at every pain.

I explained the trouble that was likely to follow if I delivered the afterbirth, also to leave it intact. The husband did not know what to do, but left it altogether with his wife. I wanted consultation, but it was thirty miles to the next physician. The patient asked me to "deliver the afterbirth and let follow what would," saying that once before she had an afterbirth attached and the doctor that attended her left it to rot away, which took six weeks, and she did not want to undergo such suffering any more.

I had a kettle of warm water prepared, with alum added to make it very astringent, then a basin of cold water so if hemorrhage should set in I could battle by alternate injections of hot and cold water. I also made ready to tampon with cloths saturated with the alum water. With my right hand I manipulated the fundus of womb, and at same time I pulled on cord with a force of three or four pounds. The placenta came away as easily as any I have ever delivered. The womb contracted to a normal size, at such time. I made pressure over womb for one or two minutes, and the lady said she felt very well, much better than she expected.

I fixed a little medicine for after-pain. About the time it was to be taken she said she was wasting. I examined her and found she was flooding. I immediately gave her an injection of the previously-prepared alum water, and applied cold cloths externally. This caused the mouth of womb to close, and she said she felt better again.

I examined her and found no hemorrhage that could be seen. I waited a few minutes watching the patient, and pretty soon I saw her gape. I asked if she had any unpleasant feeling, to which she replied, "no." Another gape followed. I made another examination and found no visible hemorrhage. I then manipulated over the womb, found it rapidly enlarging. I put on a bandage and used all means at hand to cause a contraction, but utterly failed, the patient gaping every two or three minutes until she was relieved by death from internal hemorrhage, which never made its appearance externally.-The Medical Progress, Vol. 14, No. 153, pp. 621 and 622.

Comment is unnecessary; but we commend the article to the careful consideration of any doctor who could entertain a doubt as to what he would do under similar circumstances.

Notes and Queries.

WHERE THE RESPONSIBILITY FOR CUBAN DISASTER LIES.-The following weighty words of Lieutenant-Colonel Senn (Journal of the American Medical Association, September 10th) deserve the careful attention of the irresponsible and self-constituted critics who are clamoring so loudly about the inevitable consequences of a war which they prematurely forced on, and for the disastrous effects of which these same critics are morally responsible: "Colonel Charles R. Greenleaf, chief surgeon of the army in the field, accompanied General Miles on his trip from Guantanamo to Porto Rico, and has been with the army ever since. He was long enough in Cuba to gain a full insight into the horrors created by infectious diseases, which so constantly follow large armies, especially in a war of invasion. He was amazed when he saw to what extent yellow fever had broken out in the few weeks the troops had been in Cuba. There was no difficulty in tracing the disease to a total lack of precaution on the part of the general in command. Colonel Greenleaf had given his directions and advice before the army left Tampa, but they were not heeded. Owing to want of co-operation on the part of the general officer commanding, the medical officers found themselves powerless in preventing and combating the dreaded disease. Colonel Greenleaf's prompt and energetic action on his arrival in Cuba did much in repressing this disease, but it was too late to guard against a general outbreak. The many recent graves in Cuba containing the remains of the victims of this disease are the best proof of what will happen when the leader of an army ignores the health and comfort of his men. In planning the Porto Rican invasion, General Miles availed himself of the invaluable services of his chief surgeon. The expedition was well supplied with medicines, hospital stores, and medical officers to meet all possible emergencies. The result has been that the army has been so far singularly exempt from disease, with the exception of typhoid fever and the effects of heat, both beyond the control of the medical officers. Since his arrival in Ponce, Colonel Greenleaf has been the busiest man in the army. He has not been content in simply issuing his orders from headquarters, but he has attended in person to the execution of every detail. He has visited the camps and the hospitals and exercised personal oversight over the distribution of hospital supplies, instruments, and medicines. Anxious to serve the sick and wounded, impatient when face to face with a slow, hesitating subordinate, he has more than once performed temporarily the duties of an ordinary hospital steward, to furnish a much-needed object lesson. His work will justify the confidence reposed in him when he was appointed to the high and responsible position he holds during this war."

THE ELECTRICAL TREATMENT OF NEURASTHENIA IN HYSTERICAL PATIENTS.-Apostoli and Planet (Annales d'Electrobiol., May 15, 1898,) in a second communication, record four cases of the association of these diseases treated by electricity. They state that these two neuroses are frequently found in association in the same subject, though in different degrees. Neurasthenic patients who are also hysterical often derive great benefit from treatment by static electricity or by franklinization. The curative process of the static bath is especially exercised upon insomnia, and its effect is marked by the return of normal sleep. Most, but not all, hysterical patients whose condition is improved by static electricity show an intolerance, varying in degree, towards the high frequency currents, and especially toward auto-conduction in the electric cage. Faradization, which is as a rule indicated as alone serving to produce an effect upon certain local hysterical troubles, especially those of sensibility in one organ or a limited region, is often powerless, while static electricity, which acts in a general manner, may give more rapid and more effectual results. Static electricity can indeed, according to the authors, bring about the disappearance of certain hysterical manifestations, such as convulsive tics complicated with constipation and copremia. The cutaneous sensibility to the static spark, which is found to be abolished or more or less diminished in hysterical patients who are commencing electrical treatment, can be more or less completely restored under the influence of franklinization alone; this can therefore be used as a supplementary aid in diagnosis. Finally the authors state that static electricity or franklinization (consisting of a simple bath with electrodes leading off from the vertebral column and the painful points) is the most capable and efficacious electrical means of rendering aid in every respect in the treatment of a certain number of hysterical cases.—British Medical Journal.

case.

SCIENCE AND MEDICINE.-Dr. Kanthack, Professor of Pathology at the University of Cambridge, recently delivered the mid-sessional address before the Abernethian Society of St. Bartholomew's Hospital. He chose for his subject "The Science and Art of Medicine," and the whole discourse was an earnest and impassioned plea for the more scientific teaching of medicine and for the impressing upon students the necessity of finding out if possible every thing about a patient which can have any bearing on the Dr. Kanthack drew a parallel between medicine and a technical industry such as brewing. An art, he said, may be learned in two ways: first, by experience based on a rule of thumb principle, which is the Eng lish way; and secondly, by experience based upon systematic research, which is the German way. Citing Hansen's great work in revolutionizing the brewing industry at Copenhagen, Dr. Kanthack proceeded to point out that the more we know about fermentation the more we shall know about disease, for infection is merely a form of fermentation. In our happy-golucky British fashion we do manage somehow to get good beer, though the average English ale, to say nothing of Scotch ale, is somewhat heavy for

this weather. But there is one technical industry in which a real knowledge of fermentation would be of infinite assistance, and that is breadmaking. Why is it that ordinary baker's bread is simply uneatable after it has been baked two days? If it were made of good flour, good water, and carefully selected yeast it should keep quite fresh three or four days. There is at least one bakery, and there may be more, which pays attention to the yeast question, but everybody knows the usual stuff proffered as "bread." To return to Dr. Kanthack. He gave as another example the work done in Denmark, a small and poor country, with regard to the great tuberculosis question, and compared it with what we are doing over here. True we have had a Royal Commission which has issued a report, and so, we might add, have we had a Commission on Vaccination, but neither of them have at present had very beneficial results. "Pathology," said Dr. Kanthack, "is not a subject of secondary importance inferior to practical medicine or surgery; it is the foundation of diagnosis, treatment, and prognosis." The late Dr. James Andrew, as sound a physician as ever lived, used always to tell his clerks that there was no place for learning like the post-mortem room, and his admirable clinical teaching was always based upon scientific research. Another of his maxims was that the best book on medicine was Foster's Physiology; neither can there be any doubt of the truth of this. Even since his death the opportunities and advances of scientific research have increased enormously, and we can only hope that Dr. Kanthack's words will be taken to heart not only by his student audience but by those in whose hands lies the future training of our young medical men. With all our knowledge we are still very much in the dark about the causes and processes of disease. It is the "why" we must seek for; when we have found this we shall be better able to say how to treat it, and for this reason we must inculcate research upon the learner.-Lancet.

OCCULT SCIENCE.-The Lancet thus comments on the attitude of Sir William Crookes with reference to this dark question: Sir William Crookes, as is well known, has been bold in expressing his views on what most people consider to be occult subjects, and he has been taken to task for his attitude as a scientific man on these questions. He has been silent for some time, but he evidently felt that the trend of public thought has changed, and so he reverted to a subject which has recently attracted the attention of recognized men of science. Sir William Crookes believes the fundamental law of telepathy to be "that thoughts and images may be transferred from one mind to another without the agency of the recognized organs of sense, that knowledge may enter the human mind without being communicated in any hitherto known or recognized ways." The subject obviously presents many difficulties in the way of practical inquiry, investigation, and elucidation; but we do not doubt that some are prepared to accept this postulate. Molecular movements occur in the brain during thought processes, and it is conceivable that physical vibrations are set up capable from

their extreme minuteness of acting directly on individual molecules, while their rapidity approaches that of the internal and external movements of the atoms themselves. We need only refer to the Roentgen ray phenomena and the transmission of electric waves without wires in order to find an analogy which lends considerable assistance to the idea. "Steadily, unflinchingly, we strive to pierce the inmost heart of nature, from what she is to reconstruct what she has been, and to prophesy what she yet shall be. Veil after veil we have lifted and her face grows more beautiful, august, and wonderful, with every barrier that is withdrawn."

PERFORATING ULCER OF THE MOUTH.-Letulle (La Presse Medicale, April 2, 1898) records an instance of this rare condition in an alcoholic man, aged 51, who presented fairly well-marked symptoms of tabes. The teeth in the left half of the lower jaw were all wanting except the central incisor, those on the right side being healthy. In the upper jaw there were only three teeth left, and apart from the persisting teeth the alveolar border was atrophied; on the right side of the upper jaw there was a cavity involving the alveolar border and the hard palate, opening like a cone into the middle meatus of the nose. The mucous membrane lining it was pale, thickened, but not ulcerated; its sensibility was much impaired. The patient was not aware of this condition, but on being questioned he said that liquid food had for five months come through the right nostril. This lesion is rare; Baudet has collected eight cases chiefly on the subject of tabes. It may be unilateral or bilateral, but always occurs in the same situation. As to the explanation of the lesion, there are two views: (1) that of Galippe that it is the result of alveolar pyorrhea aggravated by tabes; and (2) that of Baudet that it is an atrophic tabetic lesion due to the fifth nerve being affected, which begins by loss of the teeth and atrophy of the jaws, and sometimes terminates by ulceration and perforation into the antrum. The decision between these theories must be left to the future, but probably a combination of the two would be most satisfactory. At present only one case has been examined after death, and that very incompletely.— British Medical Journal.

SYPHILIS OF THE UTERUS.—Legrain (Ann. des Mal. des Org. GenitoUrin., April, 1898) reports on three cases of syphilitic disease of the uterus. In all three cases the uterus was uniformly enlarged, but not fixed; the cervix was not ulcerated or eroded. In two cases there was metrorrhagia and anemia, and in the third purulent endometritis. Two of the patients had other syphilitic manifestations. Under specific treatment all recovered, the uterus resuming its normal size. The author considers these cases to be parenchymatous and fungous metritis caused by diffuse cell infiltration of the uterus rather than gummata. He thinks syphilis of the uterus more common than is generally supposed, and that some cases diagnosed as fibroids are really syphilitic.-Ibid.