cence of the cervical mucous membrane and leucorrhea. while the doubtful or premonitory symptoms are pres The pain may be throbbing, or extremely sharp. The ent, I generally wait a few hours to ascertain the effects intensity of the pain does not correspond to the im- of catharsis, and if there is no improvement, or if the portance of the lesions. There may be scarcely any symptoms become more severe, I commence the local pain from extensive salpingo ovaritis, while a small le treatment. I do the same in all cases when the lochia sion may give severe pain. are at all offensive. 4. PAIN IN PERIMETRIUM.-In this class we find ex udations, adhesions, cicatrices, and chronic infiltrations of the cellular tissue which directly encircles the uterus. Every cervical, ovarian, or tubal lesion reacts upon the perimetrium, or upon the ligaments of the affected parts. Pain in lesions of this part does not always correspond with the location of the lesions which are found by physical examination. A neuritis or a special nervous susceptibility may be present. True neuralgia is allied to the neuroasthenic constitution and is at all times distinct from hysteralgia, which is found in the median region of the pelvis and which is shown by direct examination to be located at the interal os.-Medicine. Local Treatment in Puerperal Infection. -At the last monthly meeting of the Toronto Medical Society (February 16, 1899), I gave some brief notes on the diagnosis and treatment of puerperal infection. On the following day I read Dr. Groves' excellent paper on "The Local Treatment of Intrauterine Sepsis," which appears the Canadian Practitioner and Review for March, 1899, and decided to publish in the same issue my own views on the subject, as expressed at the meeting above referred to. When signs of puerperal infection appear—such as headache, relative or absolute insomnia, rapid pulse (80 or more), vague impressions of cold, elevation of temperature-commence treatment at once without waiting for the grosser signs, such as very rapid pulse, very high temperature, rigor, delirium, etc. The early or premon itory symptoms, as pointed out by Ferré, have not as a rule received the attention they deserve. Puerperal in fection does not show its signs suddenly on or about the fourth day, as described by some authors. The premon itory symptoms as mentioned above always appear not later than the second day. We should carefully watch for such symptoms, and when we recognize them carry out the proper treatment. It is not my intention to refer in detail to diagnosis and general treatment; but I may say that for general systemic treatment I rely chiefly on active catharsis, using especially calomel and epsom salts, with a view to having from four to twelve evacuations in twenty-four hours. A combination of headache, insomnia, chilly feeling, slight increase of pulse and temperature does not of course always mean puerperal infection; but free catharsis is likely to do good in any case. I have never seen it do any harm. It is difficult to lay down definite rules as to when local treatment should be instituted, but it is better to commence too early than an hour too late. When undertaken it should be carried out in a thorough and sys tematic manner. If the lochia are perfectly normal, My rules for local treatment are as follows: Clean and inspect the vulva and vagina carefully, using a speculum, and being sure that every portion is seen. If the surface of the cervix is clean and the cervical lochia are sweet, do not invade the uterine cavity. If decomposition of clots or lochia is found in the vagina, use an antiseptic vaginal douche twice a day (a one per cent solution of lysol, creolin, or carbolic acid). If so called diphtheritic patches are found in the vagina or on the cervix, apply once a day a 20 to 90 per cent solution of carbolic acid and then dust with iodoform. If sutures have been introduced for torn perineum, it is generally or always advisable to remove them. I dress the wounds thus reopened antiseptically. WHEN UTERINE LOCHIA ARE OFFENSIVE -Let an assistant administer an anesthetic. When the patient is anesthetized introduce the hand into the vagina and one or two fingers into the uterus. If portions of pla· centa, or membranes, or débris of any sort are found, scrape thoroughly and remove. There is no instrument so good for this purpose as the finger tip. After removing the débris, wash out with hot water (110° to 118°F.) that has been boiled, or with a weak antiseptic solution. Pack the uterine cavity tightly and the vagina loosely with iodoform gauze. Leave this gauze in position twenty to thirty hours, or two days. If temperature and pulse become normal and remain so, no further lo cal treatment will be required. If temperature and pulse become again abnormal, repeat the treatment. Some use the ordinary blunt curette, or the rinsing blunt curette; but neither is so effective as the fingertip. Others use the sharp curette. This is not safe, because it is likely to open vessels which may absorb more poison. Many, perhaps the majority, employ the intrauterine douche. This, if the work be properly done as I fear it seldom is), answers very well; but it is really more troublesome than the method I have described, requiring, as it generally does, many repetitions. If nothing has been found in the uterus and the discharges are not offensive, but still the patient becomes worse, the system is profoundly affected-very likely from absorption in rents of the fourchette, perineum, vagina, or cervix. In such cases local treatment of the uterine cavity will do more harm than good. On the other hand, all cases of sapremia may be cured by thor. ough local treatment. The methods I have described have been adopted after years of study and observation, and I am unable to give due credit to all sources of information, but I think I may mention especially Duhrs. sen, Reynolds, Price, Garrigues and Smyly as men from whom I have learned much about methods in antiseptic midwifery. Dr. Groves has evidently had good success with the MISCELLANY Health Reports.-The following statistics con methods he has described. I may say, however, that I think the intrauterine application of tincture of iron is not entirely free from danger. Robert Barnes, many years ago, advised the use of intrauterine injections of iron solutions for post partum hemorrhage; but other obstetricians had many unpleasant experience in con- cerning small-pox, yellow fever, cholera and plague, nection with such treatment, and the procedure has now have been received in the office of the Supervising Sur. become almost obsolete. There may be less objection geon-General of the U. S. Marine Hospital Service durto the use of iron in septic endometritis, where we are ing the week ending March 25, 1899: not so likely to have large clots formed in the uterine cavity or sinuses; but still, I think there is always some danger of thrombi being formed which may pass into the general circulation, or may by their disintegration favor septic processes. If I adopted that line of treat ment I think I would prefer to use the tincture of iodine, as recommended by Trask.-ADAM H. WRight, B.A., M.D., of Toronto, in Canadian Practitioner and Review, March, 1899. The Prophylaxis of Retroflexion of the Uterus.-Abel (Centralblt. f. Gynaekol.; Amer. Jour. of the Med. Sciences) affirms that the most important point in the prevention of retrodisplacement is the proper care of the puerperal woman, since Winter affirms that this condition is present in 12 per cent of primiparæ. The critical period is the beginning of the second week, when the degeneration of the muscular fibers has advanced and before the connective tissue has regained its elasticity. Instead of stimulating the intestines by liberal diet, it is the custom for the medical attendant to keep the puerperal woman on fluids, resort ing to the frequent use of laxatives. The writer criticises the American (?) custom of allowing patients to use the commode on the fourth day after delivery. On the other hand, he does not agree with Schatz that it is desirable to keep them in bed for two or three weeks until the pelvic floor regains its tone. Every puerperal woman should be examined in order to determine if her uterus is in its normal position. Gottschalk advises the use of a pessary as early as the seventh day after delivery if there is a tendency to retrodisplace. ment, the patient being kept in bed three or four weeks If a pessary is introduced it should be as small as possi ble, in order not to cause overstretching of the vagina. He would have the patient lie on her side as much as possible and empty her bladder every four hours. The writer believes that long standing retroflexion of the uterus which has given rise to no symptoms may cause profuse hemorrhages at the time of the climacteric and delay in its establishment. This may be prevented by the timely use of a pessary. Quoting statistics to show the relative frequency with which retro. flexion follows rmoval of the tubes and ovaries, the writer infers that it is not sufficient to separate adhesions, but the uterus should be fixed in a normal position by some procedure. In twenty-six cases in which conception followed the removal of one tube and ovary the uterus became retroflexed in 50 per cent; in others spontaneous reposition of the retrodisplaced organ oc. curred during the course of pregnancy. Official List of Changes in U. S. Marine Hospital Service.-The following is the official list of changes of station and duties of commissioned and non commissioned officers of the U. S. Marine-Hospital Service for the seven days ended, March 23, 1899: NOTES AND ITEMS A Medical College Deal.-A deal was closed March 25 at Keokuk, Iowa, by which the stock and building of the College of Physicians and Surgeons of Keokuk were sold to representatives of the Keokuk the college, and was established in 1849, the latter in 1890. The two colleges will hereafter be under the same management and have the same faculties. The name is yet undecided. The consideration was $20,000. GODFREY, JOHN. To proceed to Port Huron, Mich., for temporary duty. March 21. MEAD, F. W., Surgeon. Granted leave of absence for Medical College. The former has 2800 alumni and ten days from April 1. March 17. BANKS, C. E., Surgeon. Detailed as inspector of unserviceable property in the purveying division at Washington, D. C. March 21. WILLIAMS, L. L, Passed Assistant Surgeon. Relieved from duty at Washington, D. C., and directed to assume charge of the immigratton inspection ser vice at New York. March 22. COBB, J. O., Passed Assistant Surgeon. To proceed to 22. SMITH, A. C., Passed Assistant Surgeon. To proceed to 22. EAGER, J. M., Passed Assistant Surgeon. Relieved from duty at Washington, D. C., and directed to proceed to Cleveland, Ohio, and assume temporary command of Service. March 22. WICKES, H. W., Assistant Surgeon. Granted leave of absence for two days from April 3. March 21. HASTINGS, HILL, Assistant Surgeon. Order of March 13, to proceed to Cleveland Ohio, revoked and directed to proceed to Seattle, Wash., and assume command of Service. March 22. GRUBBS, S. B., Assistant Surgeon. Detailed as quarantine officer for the port of Cienfuegos, Cuba. March 17. VON EZDORF, R. H., Assistant Surgeon. To report to medical officer in command, South Atlantic Quarantine Station, for temporary duty. March 18. MCADAM, W. R., Assistant Surgeon. To report to medical officer in command, Tortugas Quarantine, for temporary duty. March 19. BOARD CONVENED. B, Heft, iii u. iv, p. 245) reports a fatal case of noma Noma.-Klautsch (Archiv f. Kinderheilkunde, 26 in an ill-nourished child, 2 years old, with gastro intes. tinal derangement, and expresses agreement with the opinions that the disease is dependent upon the activity of not a single specific micro-organism, but of any of a number of putrefactive bacteria, that do no harm upon a healthy mucous surface, but lead to necrobiosis of mucous membranes whose resistance has been lowered by disease or other nutritive disturbance.-Jour. of the Amer. Med. Ass'n. St. Louis Mortuary Report.-The weekly report of the Health Department shows that two hundred and thirty one deaths were recorded during the week ending March 25, seventeen more than during the previous week and eighty one more than reported for the corresponding week of last year. Thirty one deaths resulted from consumption; forty from pneumonia; one from surgical operation; one from homicide; six from accident; five from diphtheria; two from croup; nine cerebro-spinal fever; one from measles, and one from whooping cough. The births numbered one hundred and ninety-four. The Weekly Sanitary Report.-The report of the Sanitary Division of the Health Department of St. Louis for the week ending March 25, shows three new cases of small-pox; twenty-two of diphtheria; two of croup; nineteen of scarlatina; three of typhoid fever; fifteen of cerebro spinal fever; twenty-six of measles; three of whooping cough. Increase of Cancer.-The observations of a re Board convened to meet at the U. S. Marine-Hospital Stapleton, N. Y., Wednesday, April 5, 1899, for the ex-cent writer, Mr. W. Rogers Williams, on the great inamination of assistant surgeons of the Service to deter mine their fitness for promotion. Detail for the Board: Surgeon G. W. STONER, Chairman, Passed Assistant Surgeon L. L. WILLIAMS, Dr. William Howe Tolman describes in the April Review of Reviews an interesting experiment in landscape gardening for the homes of factory workers. crease of cancer, especially in England, brings to light important facts, but fails in fitting his theory to the real conditions. Contrary to accepted opinions, statistics show from 1840 to 1896 a remarkable disproportion of victims among men as compared to women. Among the former for the period named there is a ratio of 167 per cent as compared with 91 per cent of the latter. The author attributes this augmentation to the fact that of late years the lives of men, on account of town life, have greatly resembled those of the female population. Among the additional factors he also cites the want of Fatal Hazing.-A student of the Chicago College of Dental Surgery has died recently from injuries said to have been received while being "passed" over the heads of the other students up to the top tier of the amphitheater and then down again, being dropped heavily to the floor at the end. He was taken to the hospital, and on Saturday had apparently recovered sufficiently to justify the hospital authorities in allowing him to go to his home in Indiana. On the way home he became suddenly ill on the train and died be fore he reached his destination.-Medical Record. PUBLISHERS DEPARTMENT The West India Flyer.-A New Fast Train via the Mobile and Ohio Railroad, the short line to Florida and all Gulf Coast Resorts-Cuba, Porto Rico and the Antilles. Solid Vestibuled, Gas Lighted and Steam Heated Trains; Pullman Palace Sleeping Cars with Buffet and Drawing Rooms on all trains; Through Sleeper between St. Louis to Tampa. Only 40 hours, St. Louis to Tampa. For rates, time and other informa. tion, apply to any railroad ticket agent, or to F. L. Harris, General Agent, 420 Olive Street, St. Louis, Mo.; P. S. Hay, C. P. & T. A, Cairo, Ill.; J. T. Poe, Gen'l Traffic Manager, Mobile, Ala.; E. E. Posey, Gen'l Passg'r Agent, Mobile, Ala. Inveterate Eczema.-Dr. J. A. Tyler, of Ophir, Curry County, Oregon, says it gives him pleasure to state that he has found Unguentine all that is claimed for it in each and every case in which he has used it. "Relative to Unguentine I wish to say that it gives me great pleasure to state that I have used it in three cases of inveterate eczema with uniform and good re sults. "I have also used it in several cases of old sores, curing them quickly, and had my druggist order it and keep it in stock for my continued and constant use.' Tourist Sleeping Car to California through, without change, via the Iron Mountain Route, leaves St. Louis every Friday. Dr. B. Frank Price, of Braddock, Pa,, writes as follows to the Resinol Chemical Co., Baltimore, Md: "I am pleased to state that I think I have prescribed, in all, about five hundred ounces of Resinol since my first trial of it in practice. To be candid, I must say that it has proved the most satisfactory, in the cases I have selected, of any ointment I ever used. It, with one or two others, is about the only 'ready made' ointment that I am in the habit of prescribing. Resinol possesses merits that can not fail to attract the notice of an observing physician." Dunglison's Medical Dictionary defines emulsions as follows: "Pharmaceutical preparations of a milky-white opaque appearance composed of oil di vided and held in suspension in water by means of mucilage." Worcester says: "A medicinal preparation of milky appearance composed of a fixed oil divided and held suspended in water by means of mucilage." There seems to be a very general agreement that mucilage is the essential part of emulsions. When the physician prescribes an emulsion of fat, he attempts to present fat to the absorbing vessels of the bowels ready for immediately absorption. Gum Arabic and Gam Tragacanth (the latter is generally used, and which is insoluble in water), are not foods. But when emulsions are prescribed, you are compelled to give not less than fifter per cent of these substances, which are known to be inert, and which increase the difficulties of absorp tion. In an emulsion each oil globule receives an envelope or coating of gum, consequently the digestive fluids are not only compelled to break up globues anew, but are first compelled, in order to reach the oil, to dissolve the envelope of gum. Hagee's Cordial Cod Liver Oil Comp. is not an emulsion, but an elegantly aromatized cordial containing all the active principles of cod-liver oil, taken from cod liver oil, without the grease. To California.-The Pacific Coast Limited leaves St. Louis every Tuesday and Saturday at 8:00 PM., vis the Iron Mountain Route, Texas & Pacific and Southern Pacific Railways. A train without an equal. Buffet, barbers shop, bath room, libraries, etc., on the train, and a most superior dining car service. MEDICAL REVIEW VOL. XXXIX. A Weekly Journal of Medicine and Surgery. ST. LOUIS, MO., APRIL 8, 1899. ORIGINAL ARTICLES Results of Treatment in One Thousand BY J. K BAUDUY, M.D., LL.D., ST. LOUIS, Vincent's Asylum. care, and that fourteen deaths have occurred. As this NO. 14. treated were nearly all admitted in the acute stage of alcoholism, not all pronounced cases of delirium tremens, yet requiring medical care for excesses in the abuse of alcohol. To better elucidate my position, I will enunciate certain principles very briefly, which I consider indissolu bly associated with the philosophy of the subject we are considering: 1. The various, nay almost Protean forms of acute alcoholism, have, like most diseases, a tendency to selflimitation. I deliberately apply the word, Protean, to the manifestations of alcoholism 'as, according to my experience, very few cases present identical features; age, temperament, habit, sex, hereditary predisposition. Idiosyncrasy mould the characteristics of individual cases. For many years I have enjoyed excellent, if not unusual opportunities for the observation of the treatment of all forms of alcoholism. The official records of St. Vincent's Asylum, show that during the period just named, 1,129 cases have been under my professional record embraces all forms and varieties of this disease, is not a stimulant but a powerful sedative. both acute and chronic, including also many readmissions of the same cases previously treated, in which the mortality ought necessarily to be proportionately greater than in comparatively recent or strictly new cases, it occurs to me that the therapeutic means which have contributed to these results, well deserve consideration as of the utmost medical interest and importance. 2. Acute alcoholism as well as the chronic variety of the affection results from excess or abuse of alcohol, not from the sudden withdrawal of the accustomed stimulant, as was formerly taught. In doses to produce such disastrous effects upon the nervous system, alcohol To the frequent readmissions I attach much empha sis, as bearing directly upon the results of treatment As a distinguished author observes, "Very few die of the earlier attacks. Each successive one becomes more 3. If the first principle proclaimed be true, it follows as a corallary that the most rational plan of treatment must needs be expectant; that forcing sleep is prejudicial and dangerous; and that, especially, the syste matic administration of opium is a practice both un justifiable and fraught with pernicious results to the patient. As regards the self limitation of acute and even chronic alcoholism, we have only to open our eyes and carefully watch cases in order to be convinced. I agree with Osler, who states that delirium tremens is a dis. ease which, in a large majority of cases, runs a course very slightly influenced by medicine. Just as uncomplicated pneumonia, typhoid fever, the exanthematous and other very similar diseases are known daily to recover with little or no treatment except judicious nurs dangerous, because usually occurring in a more debilitated constitution and associated with a greater amount of organic disease." The object of the present paper, therefore, is to more forcibly combat some old preju. dices connected with the literature of this subject, and with which, unfortunately the minds of not a few prac-ing and hygienic surroundings, so will the various titioners are still imbued; and to place upon a more solid basis some therapeutical deductions derived from the observation of the 1,129 cases treated in hospital practice as well as, by an attentive study of the natural history of the disease, to modify practices still extant and fraught with danger to the patient. The cases 1Read before the St. Louis Medical Society, Saturday Evening, March 11, 1899. phases of alcoholic toxemia tend to rapid recovery by rest, proper diet and the withdrawal of the noxious agent whose abuse culminated in such unfortunate consequences. We will admit, for sake of argument, and we shall recur to this point hereafter, that such a successful termination or solution of the cases just alluded to, can be accelerated by the aid of measures productive of, or favoring elimination, yet in the vast preponderance of |