Dr. Callahan also favored the use of antiseptic vaginal injections in midwifery cases believing the dangers of the puerperal state greatly lessened thereby.

Dr. Phillips did not believe it best to use either vaginal or intrauterine injections unless urgently demanded by symptoms indicating trouble. In hospital work it may be right to do so but in private practice there is no necessity for them in ordinary cases.

The other physicians present expressed the same opinion as to the advisability of using injections before any signs of fever had manifested themselves.

W. D. B.

MADISON COUNTY MEDICAL SOCIETY.

This society met at the office of the president, Dr. T. J. Wooms, Tuesday evening, Sept. 16, 1887, about thirty members present.

Dr. W. F. Herschel read an interesting paper on the subject of the differential diagnosis of

ROTHELN, MEASLES AND SCARLET FEVER.

The symptoms vary both in characteristic appearances and the date of their appearance. The period of incubation, for example, is from one to three weeks in rötheln, fourteen days in rubeola and one to seven days

in scarlatina.

The premonitory symptoms of German measles are usually so slight as to escape observation and seldom last more than twenty-four hours; if present, there may be slight catarrhal symptoms, sore throat, light febrile action, very rarely vomiting. The premonitory symptoms of ordinary measles are: severe catarrhal trouble of nose and eyes with more or less cough, occasionally, vomiting; decided febrile action; these continuing about three days. The prodromal signs of scarlet fever may be enumerated as marked sore throat, frequently vomiting, a high fever with rapid pulse and attended with pronounced nervous disturbances: these covering a period of twenty-four hours or less and ushering in the period of eruption.

The eruption of German measles first appears upon the face, spreading very rapidly, and disappearing in the same manner as a rule, either fading from one part before becoming fully developed in another, or with its universal maximum within twenty-four hours; it is usually of a pale rose-red color, more or less elevated, with spots smaller than measles; the eruption may be either discrete or confluent, but it is seldom arranged in groups; it lasts from a few hours to as much as three days -occasionally four. The eruption of true measles appears, like rotheln, first upon the face, spreading gradually until the whole body is covered about the second or third day; the color is deep red, sometimes purplish; it is papular, and usually arranged in irregular or crescent groupings; the average duration of the eruptive stage is four days. eruption of scarlet fever occurs first upon the chest or neck, spreading quite slowly, reaching, like rubeola, its maxinum on the fourth day; its color is an intense red-dusky or livid in certain cases; it consists of minute red points, either confluent in patches or found universal; it frequently persists for six to ten days though often of much shorter dura

tion.

The

The stage of eruption of each disease is characterized by very pro

Madison County Medical Society.

7

nounced constitutional disturbances. Those of rötheln (German measles) are slight catarrhal symptoms, pharyngitis (almost always present), the glands behind the ear and post-cervical glands usually enlarg ed; the tongue is clean or very slightly coated yellow--never the pathognomonic "strawberry" tongue of scarlatina; the temperature has no peculiar curve but is variable, seldom going above 101 F., and the height of fever has little connection with the stage of the eruption; the pulse is always in proportion to the temperature; there is rarely diarrhoea, and albuminuria almost never. In measles the prodromal catarrhal symptoms persist and increase, accompanied by a more or less pronounced bronchitis, with or without a sore throat; the glands may enlarge as in rötheln; the tongue is always coated-in bad cases brown and dry like typhoid. The temperature ascends gradually, reaching its maximum, 103 or 104 F., with that of the eruption; diarrhoea is commonly present while the eruption persists; albuminuria rare. stage of eruption of scarlet fever is accompanied by coryza in bad cases, though usually catarrhal features are not marked, while sore throat is a very prominent and constant symptom; the post-cervical glands are not affected but those below the jaw are often much enlarged; the tongue at first presents the characteristic "straw-berry" appearance, later becoming denuded; the temperature quickly reaches 104 or 105 F., or more, and remains alarmingly high for three or four days, the pulse being very rapid; albuminuria is of common occurrence.

The

In the post-eruptive period or stage of desquamation, there is little. or no desquamation in rötheln; if present it is branny; that of measles is branny while that of scarlatina occurs in flakes or rolls.

By remembering these few points of import there will be little difficulty in making a differential diagnosis between these diseases.

Dr. Press regarded the paper as an excellent one, but thought the distinction between these affections not so easy as the author would seem to imply. In the beginning of an outbreak it is especially hard to tell whether a given case, history unknown, is one of rotheln, measles or scarlet fever, as often there may be catarrhal symptoms preceeding a scarlatina in which the eruption closely resembles that of measles, while on the other hand the eruption of measles may simulate that of scarlet fever. Hence if there be no epidemic of either disease it is best to await the full development of the disease before venturing an opinion.

Dr. Smith said the distinction between rubeola and scarlatina is usually not hard to make, but to say at the onset that a certain case of no known exposure is one of rötheln and not mild scarlet fever is not so easy. In these cases always make an examination of the urine, and it albumin is found it is pretty good evidence that the trouble is scarlatinous; if absent, and throat symptoms are not pronounced, and fever not high, it is best to wait.

Dr. Jenkins said he had greater difficulty in discriminating between. diphtheria and that form of scarlet fever known as scarlatina maligna, than between the diseases named, and he was sorry the author had not pointed out the difference between them. Some years ago he saw an epidemic of scarlet fever starting from a case which was pronounced simply follicular amygdalitis, it being one of scarlet fever sine eruptione -the only evidence of trouble being a little fever and an exudation into the throat. In the beginning of another epidemic, the patient had an exudate in the throat with high fever; it was pronounced diphtheria by the attending physician; but soon the patient died and after death (about

three or four hours) a distinct eruption was perceptible on the chest. The same day another member of the family developed a beautiful case of scarlatina simplex, and the next day a third had a typical case of scarlatina anginosa, as described by Flint. So far as this case was concerned the diagnosis amounted to but little as the result would probably have been a fatal one, even if it had been recognized; but the mistake was damaging to the physician who had made the error in diagnosis.

Dr. Herschel, in closing the discussion, said he thought it is in only the rarest of rare cases that a mistake could be made of confounding diphtheria with even scarlatina maligna, but the differentiation between the other diseases is not so easy-therefore he had prepared the paper.

L. E. S.

BOOK TALK.

REVIEWS.

The National Dispensatory.-By Alfred Stillé, M. D., LL. D., Professor Emeritus of Theory and Practice of Medicine, and Clinical Medicine in the University of Pennsylvania, and John M. Maish, Ph. D., Professor of Materia Medica and Botany in the Philadelphia College of Pharmacy. Fourth edition, revised and improved. 8vo. pp. 1781, with three hundred and eleven illustrations. Philadel phia Lea Brothers & Co.

It is with much pleasure that this, the fourth edition of this magnificent work, is received. The editors and publishers have reason to feel proud of this, the most co.nprehensive, elaborate and accurate work of the kind ever printed in this country. Containing, as it does, the nat ural history, chemistry, pharmacy, actions and uses of medicines, including those recognized by the pharmacopoeias of the United States, Great Britain and Germany, with numerous references to the French Codex, -it is no wonder that it has become a standard authority for both the medical and pharmaceutical professions, and that four editions have been required to supply the constant and increasing demand since its first appearance in 1879 or 1880. The entire field has been gone over and the various articles revised in accordance with the latest developments regarding the attributes and therapeutical actions of drugs; the remedies of recent discovery have received due attention,-as antipyrin, cocaine, cascara sagrada, hypnone, iodol, lanolin, menthol, thalline and urethrane. It is commendable particularly on account of adhering to the new system of names introduced in the last edition of the U. S. Pharmacopœia -for example making all alkaloids have (in Latin) the termination: ina, as atropina, morphina, quinina, eserina, etc.-the English being atropine, morphine, etc.-a uniformity which ought long ago to have been adopted. The book is, upon the whole, a most desirable one. So complete and exhaustive is this edition that since I received and carefully inspected it, I have said to every student of the Kansas City College of Pharmacy who asked as to text books required, "Get the National Dispensatory--it will contain everything you want, for the first year at least," -and for physicians or medical students it is no less valuable.

E. L.

Reviews.

A Practical Treatise on Diseases of the Hair and Scalp.

429

By George Thomas Jackson, M. D., Instructor in Dermatology in the New York Polyclinic; Assistant Visiting Physician to the New York Skin and Cancer Hospital, 8vo. pp. 356. New York: E. B. Treat.

In this beautiful little volume the author concisely states all that is now known of diseases of the hair and scalp. He felt that in this department of medical literature there was a vacuum-almost-the greater part of all that had been written upon the subject being found only in monographs and magazine articles. To the task of compiling this mass of scattered writings and adding thereto his own personal knowledge the author set himself; that he has succeeded in producing a most valuable work a perusal of the book will show. To appreciate the immense amount of time and labor bestowed upon this treatise, it is only necessary to examine the twenty-five pages of bibliography, covering more than six hundred journals, monographs and general works touching the subjects among these may be noted quotations from the article of Dr. J. P. Knoche, of this city (then of Vienna, Austria) which appeared in the INDEX Some years ago. The first fifty pages are devoted to the anatomy and physiology of the hair and the hygiene of the hair and scalp, much stress being laid upon the proper care of the hair during infancy and childhood. The second part treats of the essential diseases of the hair; the third cf parasitic diseases including tricophytosis and Biegel's disease, and the fourth of those affections secondary to diseases of the skin. It is illustrated when necessary for a proper understanding of the text. Altogether it is a work that will be of value to the specialist as well as to the general practitioner who desires to have a knowledge of these diseases.

E. L.

A Practical Treatise on Obstetrics.-Vol. IV. Obstetric Operations. The Pathology of the Puerperium. By A. Charpentier, M. D., Paris. Illustrated with lithographic plates and wood engravings. This is also Vol. IV. of the "Cyclopedia of Obstetrics and Gynæcology (12 vols.), issued monthly during 1887. Price of the set $16.50. New York: William Wood & Company.

Of this it may be said, as of the three preceeding volumes, that it is a book to be commended for its general excellence. It is well, however, that the work passed through the hands of so careful an editor as Professor E. II. Grandin, of New York, as otherwise certain parts of the treatise would not only prove antagonistic to the belief of the average American obstetrican but would also be highly amusing. But the American editor has pointed out the greater number of these peculiar ideas and by copious notes given the latest accepted ideas of the Western world. Without his comments how ludicrous to the Western accoucheur would be the following directions for the conduct of labor : "Championniere and Baily advise keeping in the genitals, during labor, a compress dipped in a phenic acid solution. Tarnier places over the head, as soon as it appears at the vulva, a cloth dipped in carbolic oil, and then the head, as it moves up and down the vagina, keeps the parts moistened with the oil. We prefer, for our part, once the head has reached the pelvic floor, to pour a teaspoonful of oil into the vagina. In case delivery calls for the 'application of instruments, these should first be dipped into a 1-20 phenic acid solution and then rubbed with carbolized oil or vasaline. Interference with instruments, be it well understood, is only justifiable when absolutely called for. If labor is prolonged,

if the membranes have ruptured prematurely, if the infant is cead, the liquor amni tinged with meconium, it is best to administer one or two injections of weak carbolized water with the same precautions as those taken before labor. * * * The woman once delivered, the

*

toilette should be attended to with scrupulous care.

66

The

This

The genitals should be washed with new carbolized sponges or with carbolized cotton. 1 to 100 carbolized solution should be employed for cleansing her; it should be lukewarm, and it is prudent to administer a vaginal douche in case the woman has lost much blood, or the labor has been prolonged, or repeated examinations have been made, or the hand or instruments have been inserted into the vagina, or the infant is dead, or there are lesions of the fourchette or perineum, especially in primiparæ, where fissures and abrasions of the mucous membrane frequently occur. precaution is all the more urgent in case it has been necessary to artificially extract the placenta or in case the hand has been inserted into the uterus, for any purpose." Here Grandin himself goes wrong, for he adds in brackets in such instances a vagina! douche is not sufficient, but an intra-uterine should be administered by the physician.]" During the past five years I have not seen, either in consulation or otherwise, more than a dozen obstetrical cases where it did not become necessary to use the forceps or to introduce the hand to perform version or extract the placenta, and I have yet, Bro. Grandin, to use my first intra-uterine injection-nay, more-even a vaginal one, and I have never in all my experience had a case of puerperal fever. Within the past two weeks, with the thermometer in the nineties. I have had (in consultation) to introduce my hand-twice to extract the placenta and once in case of placenta prævia, and yet every woman is now convalescent and with neither injections nor the slightest rise in temperature, and no anæsthetic was used in either case. In the light of recent investigations by Pajot and others, it is strange that such a man as the American editor of Charpentier should still advise intra uterine injections unless urgent symptoms arise; perfect immunity is to be obtained if the accoucheur remembers that there is such a thing as DIRT and then sees that his hands and nails are clean-otherwise carbolic acid and corrosive sublimate are perfectly proper. but they should be administered in half ounce coses internally to the physician and the patient left to take care of herself. But to resume; Charpentier continues: "Next a carbolized compress is ap plied over the vulva and the patient is placed in a clean bed. the night dress is the least soiled, it should be changed before the patient is placed in bed. These precautions we believe are sufficient, and we do not think it necessary to deliver as is recommended by Fehling and Shucking, under the carbolic spray." (!) Imagine a Western man sitting in a carbolic acid atmosphere pouring oil into a woman's vagina! All this fol de-rol may be necessary in French lying in hospitals, but for American private obstetrical practice absolute cleanliness will be all that is necessary. However, the work on obstetrics which this volume completes is the most comprehensive and valuable of any that has ever come under my notice.

In case

E. L.

What to do in Causes of Poisoning.--By William Murrell, M. D., F. R. C. P., Lecturer on Pharmacology and Therapeutics in Westminster Hospital, etc. First American Edition ( from fifth English) edited by Frank Woodbury, M. D., Professor of Materia Medica, Therapeuties and of Clinical Medicine in the Medico-Chirurgical College