Bright's disease, and if this cannot be accomplished by the use of the sodium, and lithium salts, the case forebodes a fatal termination. The potash salts should never be used. When one man says that he would rather have ghonorrhea than a hard cold, I have found ten other men who have said that they would rather have the hard cold; experience is a good teacher. A solution of the peroxide of hydrogen, one part, to five or six of distilled water is best for the first stage, and for the second, corrosive sublimate, gr. j, to Oj of distilled water, for an injection, two or three times a day. As a rule injections are the cause of a vast amount of mischief by being too strong. In the third stage, arg. nitrate, gr. j to 3j; or act zinc, gr. j to 3 ij of water. The bicarbonate of sodium is a most valuable remedy in croup. It is found in almost every house and a mixture for a child two years old, that I make is as follows: B. Fld. ext. ipecac, gtt xviij. Iodide potassium, gr. x to xx; soda bicarb., a teaspoonful; sugar syrup, 24 teaspoonfuls, or a half of a tumbler. To this may be added one or two drops of tr. aconite, and ten to thirty drops of the tincture of lobelia Dose one teaspoonful every hour, or half hour; and the dose to be more or less according to the impression made. Large doses of quinine are very useful in these cases. I kno v how hard it is to manage cases in the country away from a drug store, but molasses and soda is almost always at hand and can be given freely in cases of croup, and with good results. Lard and sugar, or goose oil and molasses, are old fashioned remedies and not to be despised in emergencies when one is caught without the usual remedies. A cathartic of calomel often plays an important part in the recoveries. It is also diaphoretic, and diuretic, Hot water at about the temper iture of 100° having been sterilized by boiling and then allowed to cool is as good a douche after confinement as if carbolic acid or corrosive sublimate had been added; and with the knowledge that it will do the patient no harm. Creolin is now used exten sively in these cases; but hot water is just as good, if it has been sterilized by boiling. Cleanliness is the great remedy to prevent puerperal peritonitis and septicemia. I think that I know of one patient who was greatly damaged by too strong injections of carbolic acid into the vagina after confinement and the liability in using these strong agents is to do damage if the nurse makes a mistake, and they often will if they can. W. V. WILSON, M. D., West Haven, Conn. DR. JOHN H. SPURGEON'S CASE OF PER- Reply from the stand-point of Dosimetrics. "She was at that time, (time called) quite dropsical and also afflicted with asthma." The reader will recall that this woman was in the third month of gestation, that the serous fluid was easily removed, but soon returned, evidence of serious retrograde movement. Anasarca or general infiltration of the cellular tissue when spontaneous or idiopathic is dependent upon or associated with deterioration of the blood or an albuminous condition known by the presence of albumin in the urine and serous fluids, or effusions, and exist in both the acute and chronic conditions. In the first instance it is an albuminous fever and sometimes passes into the chron ic state. In the chronic form, it is a symptom of parenchymatous nephritis. It may have had its cause in syphilis, chronic malaria, chronic mercurialism, or some other poison. It usually has a gradual onset, seldom noticed until the appearance of dropsy begining under the eyes and in the face; extending all over the body, causing dyspnoea, ("asthma"). The urine under the microscope reveals casts, granular epithelium etc., I lately treated a case of similar kind, had its origin in anemia, but there was a history of Bright's disease on both sides of her fam ily. I was called to her about the sixth month of utero-gestation, found her with dyspepsia, anemia, puffed under the eyes, swollen ankles and feet, scanty, dark urine, short breathing and constipation. Treatment. To reconstitute the blood she was given the arseniate of strychnine, iron phosphate and dosimetric sedlitz salt. To improve the condition of the uterogenital system she was given the uterine tonic, (see formula on page 330 February number this journal), and to remove dropsical effusions through aiding the circulation and the kidneys, the sparteine sulphate and apocynin were employed. The first three as the dominant treatment, the fourth as a specific to the genitalia etc., and the last two, as variant or symptomatic remedies. From this improvement in the quality of the blood gradually took place and pari passu albumen and the dropsy, thanks to dosimetric management, slowly but surely subsided. To the eliminating power of the sedlitz salt and the specific quality of the sparteine as a cardiac tonic and diuretic, much credit is due. Sparteine and apocynin act without in any way disordering the stomach. The latter, however, when given in dosimetric doses improves its condition. Under the method of treatment adopted she passed through her confinement "without a ripple" and in the course of six months she had quite recovered in every way and was quite strong. As to the "rotten placenta," and abnormal rowth in the uterus: this growth was most probably a fibroid, may have been a mole or hydatid; perhaps a polypis. Fibroids complicate pregnancies frequently. Simpson gives four cases, two of which recovered after parturition and two died. Polypi do the same, but are less serious than the fibrous tumors, their long pedicle allows of their escap from the cavity and render their excision possible. Moles and Hydatids are occasionally developed with the foetus in utero, but interfere less with gestation than either of the other. Many years ago one of my preceptors delivered a woman at full term of a small child and two fleshy moles, the largest was about the size of a man's fist and the other the size of a hen's egg. About an hour after the delivery of the placenta which was firm, sound and whole, the woman suddenly died from hemorrhage during his temporary absence. He arrived just in time to see her breathe her last. Meddlesomeness and disregard of orders to keep the patient quiet on the part of the woman left in charge, was, partly at least, the cause of the fatal event. The presence of tumors impair the tonic power of the womb and thereby favor undue relaxation thereof. The presence of these growths cannot be detected during gestation and is only relieved by parturition. The unpediculated ones may be suspected by the irregular shape of the abdominal protuberance, etc. Polypi may be made known by frequent hemorrhages and sometimes by their protrusion during gestation or at the time of labor. Of the Placenta.-It frequently occurs that the placenta is diseased, and from various causes. Calcarious deposits have been found in the substance of the placenta, and even ossification has been observed at the time of birth. Both are forms of degeneration. Furthermore the placenta being an organ of exhalation, the recremental matter produced in the circulation of the fœtus and being disposed of through the walls of the placental vessels, no doubt, under diathetic or diseased condition of the mother, causes degeneration of the placental mass. The system of the mother may become affected, thereby become both cause and effect. But of all the prolific sources of such mischief, the one cause; disordered innervation, or want of equilibrium between innervation and nutrition produces most morbid changes in the mother, placenta, and fœtus. First in the mother by excessive nutrition, second in the placenta, and third, in the foetus by mal nutrition or blood poisoning. There is little room for doubt, that various defomities of the child, as well as dis orders of the mother result from morbid impressions, affecting the nervous system, such as disgust, fear and anger; acting upthe economy of the maternal connections, through exciting ganglionic excess. The mode in which these effects are produced may readily be understood from the mechanism concerned in the organism under consideration, or its anatomy and functions, especially the unwritten physiology and anatomy of the two nervous systems. Cerebro-spinal and ganglionic. It is hoped that the studies of anatomy and physiology to be developed through coming pages of the Medical Summary, will throw much light upon the subject, and consequently upon pathology and therapeutics, a desideratum greatly needed even in this day of medical progress. The therapy of the future will be according to laws of therapeutics, and laws of therapeutics will be based upon laws of physiology, especially of the nervous system. W. C. BUCKLEY, M. D., 723 Berks Street, Philadelphia. A WRONG REMAINS A WRONG, BY OR AGAINST WHOMEVER COMMITTED. Medical Expert Testimony in Cases of Injury. BY HUGO ENGEL, A. M., M. D., Fellow of Amer. Academy of Med.; 1. Prof. of Nervous Diseases and Clinical Med. at Philada., etc., etc. A discussion recently started in various medical and secular papers, concerning medico legal questions in railway cases, reminded me of some points which I had, long since, intended to lay before the readers of a medical journal. The oftener a physician has had occasion to examine suspicious cases of railroad injury, and the more frequently he has been called upon to defend his opinion in a court of justice, the more will he become convinced of the truth of the facts cited in the following lines. With most well-established railroads, whether their locomotive power be steam, electricity, a running cable or horses, cases of real injury, undoubtedly the fault of the railway, rarely ever reach our courts. That happens only when there is an honest question of doubt, and the object is to determine, whether the accident responsible for the injury was due, indeed, to the negligence of the railroad, or to unavoidable natural causes, or to some act of the injured himself, or when the claim for damages seems too excessive and cannot be compromised. So anxious are railway companies to settle" amicably cases of injury actually sustained, and to avoid having such cases decided in court, that they often pay unjust or exorbitant claims, rather than assume the risk of the consequences of a legal trial. When I add that, but recently, in a case in which the most impartial testimony proved the absurd character and the injustice of the claim, one of the most distinguished members of the Philadelphia bar advised the railroad officials to settle the case, and upon remonstrance being made, replied that he did not care what the testimony, his advice was to settle; and when I further add that subsequent events proved his advice to have been wise, we must admit that there is something wrong somewhere. It is in the nature of an attorney's profession to plead cases before court, if he sees the slightest chance of winning them. If a corporation asks an eminent counsellor to defend it against what there is every reason to believe to be fraud, what then must be the condition of affairs when that attorney, not caring even to sift the testimony, advises the company to settle, giving it as his frank opinion, that, however clearly the fraud might be proved, the verdict would be against the corporation! The verdict of a jury is the expression of public opinion. If in a county no saloonkeeper can be convicted of offence against the law regulating the sale of intoxicating beverages, however positive the evidence against him, it is a proof that public opinion in that county is against the law, and that the latter cannot be enforced. Here, as well as in cases where unjust claims are allowed, because they are made against wealthy corporations, public opinion is at fault, and it is the duty of those who have made the consideration of such cases a study, to direct public opinion into a healthier channel. It is with this object in view that these lines are written. Corporations have the same right to receive justice as private individuals have, and to say: "Never mind, it is a railroad, or an insurance company, or a mill; they can pay," is to commit a grievous wrong which can lead only to other wrongs and must undermine the right sense of duty in any community. And destroy once that sense, -the more deplorable a result, as it would eventually carry us to despising the law, which we Americans are justly proud to have the reputation of always upholding the safety of our institutions would soon be menaced. Such an injustice has in its train consequences often not foreseen, incalculable; the right of property is becoming less sacred, and who can deny that, in the increased number of outrages committed in the name of "strikes," we have an example of that same injustice and some of the harvest resulting from sowing and culturing false conceptions concerning the rights of others? A lax maintainance of the law favors such wrong ideas. Let any one study the various political publications which, near and during the second half of the last century, prepared the minds of the masses for the French Revolution, and he will recognize in them the handwriting on the wall,-the mene, mene, tekel, upharsin, and he will perceive the slow but sure decline of the sense of justice, a decline fostered by fallacious reasoning and culminating in the "Reign of Terror." "Coming events throw their shadows before them," refers mainly to the psychological development of a definite public opinion, which, long before indicated by many minor occurrences, finally crystallizes itself into some great revolutionary movenient, whether a reform, a step backward, or a change in government. Thus Wickliffe and the Lollards in England, St. Bruno in Germany, and the "Truce of God" and the fight against simony by the Monks of Cluny in France, in the medieval ages, preceded the great Reformation of Luther, and led the nations of Western Europe from the darkness overclouding the minds of men during those centuries to the light which progress in science was to spread, by the aid of that blessing to enslaved mankind; the invention of the art of printing. Thus the stupidity of the Rois faineants and the overbearing of the fief-holding barons rang in Feudalism; and thus a careful recognition of the signs of the times, of the murmuring of the masses as if announcing the coming storm, might have warned many a despot of the change of dynasty or of the end of tyrannic rule impending, might, for instance, have saved the colonies to England. In all those cases, the under-current of thoughts had long since influenced public opinion, and simply became crystallized in the end into one final act. With a healthy public opinion no coup d'etat can succeed, but allow once, with impunity, one class to rob another of its just rights,ay, be even applauded for so doing,-and the majesty of the law, instead of having as its attributes the balancing scales and the avenging sword, will be symbolically more fitly represented by a sieve, in which the holes are as many openings, through which wrong doers may escape from justice. Whenever I am requested by a corporation to make a medical examination, I invariably have the suspicion that it will turn out a case of fraud; just as when some charitable association asks me to report, whether or not some individual is really sick, I know that such an investigation is never demanded unless there is reason to suspect its being a case of mallingering. Those entrusted by railroads with the adjustment of claims arising from accidents have experience enough to see, whether a person is really injured or not, and remembering the outcome of trials before court, -a subject about to be discussed,—they are more anxious to settle a claim, than the injured often are to receive just compensation. And I may here at once state that, except to determine the degree and extent of an injury and its possible future consequences, I have never yet, by request of a railway company, examined such an accident case, without its having proved one of partial or total simulation,-an evidence of the willingness of these corporations to pay for any injuries actually produced by their agency. What holds good for railroads with equal force applies to all corporations and to capitalists or owners in general. Whether a train has run over a person, or some one has lost an arm by coming in too close contact with machinery, and whether a boy has fallen through the hatchway of some storehouse or a child suddenly jumping in front of a team has had a limb crushed by falling under the wheels of a carriage, the main facts remain the same: an injury has been done to a human being; the damage may be great or small, simulated or real, and the fault may be either with the injured or injuring party. If there is a difference, it will be explained by the greater number of accidents of necessity liable to occur in carrying on the business of certain corporations, and by such companies usually employing special agents, so called adjusters, in the investigation and settlement of the claims arising from such injuries. The idea is prevalent, that corporations have such investigations instituted only to acquire means to enable them to contest just claims, is completely the creation of fertile brains. When the adjusters meet with a case of real injury, they either rely on their own judgment and experience to determine its nature and extent, or they ask the attending physician what they I want to know. It is only when they themselves cannot discover the least sign of an ailment, or when the claim made seems to be out of proportion to the symptoms, that their suspicion is aroused and they endeavor to probe the matter to the bottom by engaging the services of an expert. The only notice sent to me in such cases is a written request: to call on N. N., claiming to have been injured, to examine into his condition, and report the result in writing. A foot-note gives the name of the attending physician, whom I always invite to be present at my interview with his patient. These adjusters are men like us; they know too well, and I must say, feel too much, the moral obligation: that they must repair and pay for any damages they cause; they have not the remotest idea of resisting a just claim and thereby augmenting their expenses; and, while not prepared to pay for imaginary consequences in the future, they calculate the damages from a business point of view, but never refuse compensation for injury really done by them. They fight only cases that sham or grossly exaggerate their injuries. In the few cases in which my examination revealed more serious lesions than the company had supposed, my report must have ended the dispute; they never came to trial and must, therefore, have been adjusted. Especially railroad companies will try any fair means to avoid a legal trial. It is not by these remarks that I wish to convey the impression, that all railroad companies and similar corporations were but too anxious in cases of injuries caused by them, to hasten with open pocket-books to those entitled to receive damages, and that, begging them to accept their bounty, they cannot rest, until they have showered their gold over the unfortunate victims. In that respect, companies are too much like common mortals, who kick with hands and feet against any depletion of their moneybags not actually necessary or not forced upon them. The adjusters naturally wish to show, that they perform the duties of their position and earn their salaries, by proving to their superiors that they succeeded in That is natural; we all reducing claims. do it. Every one tries to pay as little as he can for injuries he has done; it is, I repeat, human nature, and is, perhaps, less egotistical in corporations, they representing the interests of many, than in single individuals acting for themselves. But for these very reasons, there should be some way of exerting justice, of enforcing it on both sides. A legal trial before court alone should be the arbiter. What, however, does a justice amount to that is sure to be brought to bear against only one side? If corporations are taught by experience that they will be mulcted into damages under all circumstances, whenever they allow a case to reach the courts, can we wonder at their anxiety to avoid all legal procedures? But do all individuals who endeavor to obtain money by wrongly claiming damages secure a verdict in their favor? By no means; but there is one class whose members seem invariably to gain their cases in court against railway companies, whatever the testimony may be disproving |