Child Crying in Utero. EDITOR MEDICAL WORLD:-I had an experience analogous to that of Dr. McLean, page 396, MEDICAL WORLD for November.

On June 30th, 1891, I was called in consultation by Dr. Russell, of this city, and found Mrs. H., aged 19, in labor at term with her first child. The brow was presenting, and in trying to correct the position through the imperfectly dilated os, we were astounded by the stifled cry of the baby. After waiting a few moments, the crying ceased, only to be renewed each time we made an examination, and when the doctor applied the forceps.

The grandmother of the child and two neighbor women were present and heard the repeated crying of the child.

F. W. WINGER, M. D. 30 Main St., Bradford, Penna.

The Massage Treatment of Sciatica. EDITOR MEDICAL WORLD:--The numerous drugs placed in the field against this lingering disease are a true indication that no specific as yet has been found, to effect a posi tive cure. Electricity, both faradization and galvanism, have proved to be efficacious where internal medication failed. (Compare article of Dr. Curries, page 305, and Dr. Benne t, page 425 of THE WORLD, 1891.) Another mode of treatment, unfortunately but very little practiced among physicians in this country, is the application of massage, which, as extensive hospital experience in Germany has taught me, will prove a reliable agent in most cases with or without the aid of electricity. Most certainly diagnosis must be beyond a doubt as to the cause of the neuralgia, to exclude ovarian cysts, caries and tumors of the vertebræ, inflammation of the spinal cord and its membranes, tumors and abscesses of the pelvis, para-and perimetritic exudations, psoas abscess, pregnancy, etc. Sciatica, however, as caused by an inflammatory process of the nerve or its sheath, or by a myositis of the surrounding muscles,--be the exciting cause syphilis, malaria, lead intoxication, cold or ove: exertion--is amenable to massage treatment. Sy. philis and other dyscrasies of course require constitutional along with the mechanical treat

ment.

The most essential point in the massage treatment of ischias seems to be the stretching of the nerve, which is accomplished by placing the patient upon his back and slowly enforcing flexion of the hip joint, the leg meanwhile resting upon the masseur's shoulder to lessen or prevent flexion of the knee joint. The force of the flexion is to be regulated according to the pain of the patient, and gradually increased from

day to day. Along with the flexion, abduction, adduction and careful rotation are performed. Then placing the patient upon his belly, massage is applied to the affected parts and along the thigh as far down as the knee joint, consisting of strong frictions, tapotement, petrissage and effleurage. (The French terms for these different kinds of massage being still in common use and none more appropriate in the English language having been proposed, I may be pardoned for using the n.

To apply friction, insert the tips of the fingers of one hand deeply down into the tissues or upon the nerves and perform energetic circular motion, while the finger tips of the other hand apply gentle strokes in an upward direction. The aim of these frictions is to break up and remove pathological products from the tissues and to stimulate the nerves.

Tapotement in sciatica de either with the radial borders of the extended hands, which are brought down upon the muscles in a kind of forcible percussion, or with the fists, where a stronger application is desired (gluteal muscles). The arm is not used in tapotement, all movement being made from the wrist alone.

Petrissage is a manipulation by which the muscle is seized between the fingers, and firm pressure, rolling and squeezing exerted. This squeezing is begun below and slowly advanced towards the centre of the body.

Petrissage and tapotement have a powerful effect upon the circulation and cause a strong general reaction in the parts to which they are applied.

Effleurage is done by moving the palm of the hand under more or less pressure along the surface in a centripetal direction. One or both hands may be applied, and while the second hand has nearly finished the movement, the first is brought back near the starting point, thus changing constantly and advancing slowly from the extremity of a limb towards the trunk. Effleurage enforces venous and lymphatic circulation.

The above treatment is applied once daily, perhaps with the exception of one day of rest (each week), the length of each seance varying from fifteen to thirty minutes (or more) according to the reaction in each case. Pain may increase at first, but that must not worry us; the patient will soon experience marked relief. It is wise to practice all movements and to apply massage to all those parts that are especially painful; they are certain to be in volved most in the rheumatic process (Schrei ber). The patient is advised to exercise his limbs as much as possible in the intervals of massage sittings. The cure may perfect in one to two weeks, while cases of long standing require from three to six weeks. If the treatment

is reinforced by electricity, it is advisable to try faradism first, because it has a quicker effect, if any, than galvanism. It is best to use a wire brush electrode at the positive pole and apply it at the most painful points (points douloureux) while the other electrode is moved along the course of the nerve. It is neither useful nor desirable to apply electricity for longer than ten to fifteen minutes each time. F. DETLEFSEN, M. D. 1027 Lincoln ave., Chicago, Ill.

Accurate Medication.

EDITOR MEDICAL WORLD:-How much or how little of a given medicinal preparation shall be administered in order to produce the desired effect? This question confronts the practitioner every time he writes a prescription or orders a dose of medicine as ordinarily prepared.

Much has been written and said upon the unreliability of the galenical preparations, and there is a strong demand upon the part of the profession for some standard of strength, the one most generally favored being that based upon the contained alkaloid or other active principle in the crude drug.

In an article published by the writer in The New England Medical Monthly, for October, 1891, the question of standardization was fully discussed. I therein showed the extreme unreliability of the galenical preparations of the U. S. P., and advocated a much greater advance in this direction than the revisors of the U. S. P. had conceded. In quite an extended correspondence with representative pharmacists, both manufacturing and retail, as well as with our leading physicians, the same thought was expressed by all, almost without exception; a desire for some accurate method of arriving at an accurate dosage.

In fact, we must dispense with the crude material in medication, and use only that which is of undisputed value, namely, the active principles, the alkaloids, resinoids, glucosides, etc. The physiological and therapeutic effects of these substances are known, and if we can have them presented in proper form, accurate and reliable, it would seem that there was little left to be desired in that direction.

Active principle medication has most decided advantages over any other form of administering drugs. The proper form being presented, as above referred to, we find that the dosage is accurate aud constant. It is known to the prescriber, and he may increase and diminish it at will, and with little trouble, still preserving his accuracy.

With the ordinary galenicals he may increase

or diminish the total amount of the mixture given, but he does not, and cannot know how much or how little, if any, real medicine such as he desires, is being administered. Even the assayed fluid extracts, valuable as they are, present many difficulties that cannot, in the very nature of things, be overcome. They are liable to change from various causes, such as evaporation, exposure to sunlight, heat or cold, a dry or a moist atmosphere, to precipitation of the active principle, to chemical changes in the compound (for all such preparations are very complex in composition.) Some of these changes take place in dry or solid extracts as well. much inert material to be eliminated, and a Then, too, there is host of complex bodies which modify to a greater or less extent, the active principle.

Why not eliminate all these in the laboratory of the pharmacist or the chemist, and not attempt it in the stomach of the patient?

Active principle, or alkaloidal medication, The presents no new system of medicine. practitioner knows, or ought to know, the therapeutic or physiological effect of his remedies. Then, with a pure isolated drug of known strength, in soluble, convenient form, he may intelligently cope with the disease.

From a long experience, both pharmaceutically and clinically, I am fully convinced of the superiority of active principle medication over that by crude drugs, or unstable galenical preparations.

WM H. WALLING, M. D. 2009 Arch street, Philadelphia.

[The above impresses us as the best argument we have yet seen for the use of isolated active principles in medication-the dosimetdoctor practices his own well-known system of ric form of medication. With these drugs the therapeutics with a new and vastly improved materia medica-truly rational therapeutics with strictly scientific remedies.

The above article, coming from a man of wide experience and liberal ideas, who spent years in the scientific practice of pharmacy before advancing to the study of medicine, is a strong testimonial to the rapidly growing favor of accurate medication. Now the physician must be especially careful that he purchases such drugs only where they are made with accurate scientific skill and scrupulous professional honesty. The time is rapidly approaching when every physician must pay some at tention to this phase of medical progress.-ED.]

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Labor Badly Managed by a Midwife. EDITOR MEDICAL WORLD:-I was called on Nov. 15. 1891 to see Mrs. S., aged twenty-four, in her first labor, at term, she having aborted once. She had been in labor four days, attended in her sufferings by a female midwife. Women of this class are a great detriment to parturient women, their practice being entirely empirical.

The attendant midwife to'd me that the liquor amnii escaped on the first day of labor. Being young in the practice I feared trouble. On making vaginal examination I found that labor had fully passed the first stage, and that the head of the child was advancing into the vagina. The vagina was hot and dry and the woman was becoming exhausted, and having but few and feeble pains. She had not been allowed to get off the bed, lie on her sides, or put her hands above her head.

I annointed the vagina well with lard and gave her every hour twenty drops of fluid extract of ergot and two grains of quinine in a little black coffee; also allowing her to lie on either side, get off the bed, walk the floor and sit in a chair.

After giving the third dose as described above, I put her in the squatting position, when labor pains soon began, and she had speedy labor, giving birth to a healthy male child. There was no injury to mother or child. Did I conduct the case properly? Let me hear by letter from members of THE WORLD family. J. W. SHEMWELL, M. D.

Bumpas Mills, Tenn.

A Plea for the Antipyretics. EDITOR MEDICAL WORLD: Dr. John P. Corcoran, in the November WORLD, expresses his satisfaction with his treatment of a case of typhoid fever without the use of the new antipyretics. He does not say that his condemnation of these drugs is due to experience with them.

During an epidemic of so-called mountain. fever, the same as described in the article of Dr. Harrington in the same issue of THE WORLD, I had charge of about fifty cases. Many of these were undoubtedly typhoid, all running a course of from ten days to six weeks, and two were ill three months. In all of these cases except one I used, from beginning to end, some of the new antipyretics, antifebrine and phenacetine being the principal ones. All of my cases pulled through except two, one of which was the one who did not get the antipyretic. I will add that the two who died did not get nearly the amount of quinine as did all the others, who received it in heroic doses. This latter statement conflicts with Dr. Harrington's view that quinine should not be used

Johnnie W., aged eight years, had been ill four days when first seen. Temperature 104, face flushed, skin dry, headache, general aching and restlessness, abdomen enlarged and somewhat tender, tongue furred and no appetite. I gave a pill representing one-quarter of the compound cathartic pill in common use, which was repeated in the evening and a good action of the bowels secured. At the same time I gave two and one-half grains of phenacetine to be repeated hourly till the temperature was lowered. I called in the evening and ache or other pain and the child comfortable. found temperature 1011⁄2, skin moist, no headTwo powders had been taken. The father, who was very intelligent, was provided with a thermometer and instructed to give a powder when the temperature reached 1021⁄2 or at any time when it appeared to be rising. time subsequently was more than one necessary to reduce the temperature, nor more than two each day. Temperature ranged from 100 to 102 during the rest of the illness, which lasted about ten days. From five to ten grains of quinine were given at a single dose each morning, the amount varying according to the tendency of the temperature the preceding day. One or two calomel purges were given to correct the appearance of the stools. A half dozen sponge baths were given each day, the temperature of the water to suit the patient. In the words of the father, this was the most comfortable sickness he had ever seen.

At no

the wet pack are four times out of five wholly impractic ble. Indeed, many times the facilities and attendance are so poor that I cannot get my patients sponged off once a day. It is here that the antipyretics are worth their weight in gold. Do not understand that I use them indiscriminately. They may be abused and are abused. That is true of any valuable drug. In all my fever cases all the water was used that I could coax or drive the atttendants to apply-externally and internally, by mouth or enema. I did not use water for its antipyretic effect, for unless the facilities are good it costs more in appliances and the patient's strength than it comes to, if you use water enough tc lower the temperature. Its effect on the skin and in flushing the bowels, with or without an antiseptic, as well as its absorption into the circulation, are very beneficial. I have no rule for the temperature of the water. The patients' feeling are a sufficient guide.

So much is said in THE WORLD on dosimetry that I feel privileged to contribute something on the subject. I have read a journal devoted to that subject during the last year. I have reached the conclusion that I have no use for the system. It is asked if I have tried it. No, for I can accomplish all that is claimed for the system in a simple way, using fewer remedies for the same indication and less in quantity. Did time and space permit I would like to consider in detail a number of cases treated by this method detailed in THE WORLD. A brief notice of one will suffice, a case of scarlatina. For initial fever, aconitine in proper doses, and before the eruptive stage 1.6 grain of sulphide of calcium added to each dose of the aconitine, both to be given every fifteen or twenty minutes till the climax of the eruptive stage is passed. I have no objection to aconi tine provided the temperature is high and the pulse strong Phenacetine or a wet pack would do as well and is just as safe. But 1-6 grain of calcium sulphide every fifteen or twenty minutes to a child for possibly one or two days is away beyond me in dosage. Later he adds the arseniates of iron and strychnine and, if urine is scanty, digitaline. It is a little singular that to this treatment is added about all the usual treatment, viz.: cathartics, gargles and baths, which leaves us in doubt as to the influence of dosimetry. I should have added biniodide of mercury, which the writer recommends if there is glandular swelling. Most physicians could give that or the bichloride. Later in the same article he "often gives a few teaspoonfuls of turpentine in diphtheria." This again is an addition to dosimetry and beats me on dosage. Writers on dosimetry often speak of jugulating a fever. You cannot jugulate a continued fever with dosimetry or anything else, and an eph

emeral fever will jugulate itself if you will wait a few hours. At most a mild cathartic or a bath is all that is needed. If the cathartic does not seem to be indicated and the bath is impracticable, one or two small doses of phenacetine will lower the temperature until nature reasserts herself. I speak of ephemeral fevers because many of the cases described in the journal mentioned in which dosimetry has achieved brilliant results seem to me to be cases of that kind.

Ontario, California, O. S. ENSIGN, M.D.

[Doctor, acetanilid has repeatedly been demonstrated to be identical with "antifebrine," and is very much cheaper. Why not use it ?

In our opinion the method called dosimetry It is not, is not yet completely elaborited. properly speaking, a new system of medicine, but rather a little more light upon the common Viewed in that light we think that our physiremedies with which we are already acquainted. cians can not give it too close attention. Adopt at first a small vest pocket case, containing a few remedies, and revise and enlarge the list as experience suggests.-ED]. '

Typhoid Fever Treated Without Cathartics.

EDITOR MEDICAL WORLD:--Since publish ing the collective investigation in the Augus WORLD I have received about twenty more re plies from all parts of this country, and one from Constantinople. But as they ran about as those already published, I thought it not best to ask for more of your valuable space.

I have, however, treated nine cases of the fever and have had nine excellent recoveries, and not a drop or grain of any cathartic went down one of their throats, either.

I have just been looking over a medical work written by Dr. William Buchanan, dated Edinburgh, 4th June, 1772. In reading his introductory remarks, the following paragraph appears, showing that at that time there existed more prejudice and less enterprise in medical circles than to day: Dr. Buchanan says, "Very few of the valuable discoveries in medicine have been made by physicians. They have either been the effect of chance or of necessity, and have been usually opposed by the faculty, till every body else was convinced of their importance.

"An implicit faith in the opinions of teachers, an attachment to systems and established forms, and the dread of reflection, will always operate upon those who follow medicine as a trade. Few improvements are to be expected from a man who might ruin his character and family by even the smallest deviation from an established role."

Ought not we of the present day to be thankful that we live in a free country, where we are allowed to think and speak each for himself! Now, knowing, as we do, that the local lesion in typhoid fever is in Peyer's patches of the small intestines, how can cathartics do anything but harm? Is it not a fact that the action of any cathartic is to determine more blood to the mucous membranes of the small intestines and to increase their peristaltic action, while in typhoid fever our aim should be just the reverse of this, that is to relieve congestion of the mucous surfaces of the small intestines and keep the peristaltic action quiet! Then, too, in a disease producing diarrrhea, why help the disease to run the patient down by keeping up the very trouble that ought to be quieted, by giving calomel, rheubarb and sedlitz salt?

To again refer to Buchanan's work of 1772, his directions for the treatment of typhoid fever, which he calls "slow or nervous fever," are, in the main a supporting plan. He says, "Where the force of circulation is too great or the blood too dense, bleeding and other evacuants are necessary; but when nature flags, when the blood is too vapid and poor, the lancet is to be avoided.

He directs, in case the bowels are constipated, that a "clyster" be given every other morning, consisting of warm water and milk, to which he adds sugar and salt. In case the patient is delirious he says, apply a blister to the nape of the neck.

But above all, he cautions that the strength be kept up by good liquid nourishment and stimulants, often repeated, with tincture of "bark" when necessary.

Of my nine cases referred to above, in seven defervescence took place in from ten to twenty-two days. One case ran a mild course up to fifteen days, when the temperature was nearly normal for three days and, to all appearance, convalesence was getting well established, when, without any apparent cause, a relapse occurred, the fever ran on for twelve days more, when defervescence took place and the patient made a good recovery.

But the ninth and last case was the bad one. This patient was the mother of the one referred to above. She had a very light run up to fifteen days, when a collapse occurred, temperature dropped to 96° and for two days she seemed to improve, temperature being nearly normal. But on 3d day, or the 18th day of the fever, her temperature again rose to 1032, showing that a relapse had set in, which ran on to the 28th day, when a second collapse occurred and her temperature dropped 95°. Again, for two days, her temperature remained normal, and I was sure that convalescence was

beginning to be established, when up went her temperature to 102°, and the next day to 1031⁄2° at 6 p. m., but soon dropped and oscillated between 98 and 102° until the 42nd day was reached, when, in the space of two hours, her temperature dropped from 102° to 93% with the thermometer well under her tongue for three minutes, pulse imperceptible at the wrist. But by the use of hot water bottles and hot flannels and, internally, arseniate of strychnine and digitaline granules repeated every fifteen minutes for a time, her temperature gradually began to rise, and from that time improvement has been steady. Her bowels were moved every day by the use of an injection of warm water, containing five grains of chloral hydrate to the pint and, when tympanitis was present, injections were used two and three times a day, which always had the effect not only to clear the colon of its contents, but to relieve the bowels of gas, which was very grateful to the patient.

Now, some one, and many, I presume, will say, had you given this patient calomel or sedlitz, she would not have suffered those two relapses, and I think that is a fact, as, without doubt, the undertaker would have had charge of her remains long before the 42nd day.

James H. Hutchinson, M. D., in "Pepper's System of Medicine," says, that Maclagan alleges that relapses are more frequently met with in cases in which constipation is present in the primary attack, a condition which he regards as favorable for absorption of the poison. But Hutchinson says that this is opposd to the experience of almost every one who has paid close attention to this subject, as, "in the cases that have come under my own observation," says Hutchinson, "it certainly was not the case, diarrhea having been present in all of them" (that is in all the relapsing cases that came under his observation).

My opinion is, that had diarrhea existed in this 9th case it would have been impossible to have nourished her sufficiently to have kept soul and body together during this long run, and she would have gone where the "5 per cent" and "8 per cent" and "15 per cent" of typhoid cases do go.

My treatment this season has been about as follows: When first called, if the fever was well established I gave aconitine, veratrine and digitaline, frequent sponge baths and "flushed" the colon with from 1 to 4 quarts of warm water with 5 grains of chloral to the pint. I instructed the nurse how to use a clinical thermometer and left one with instructions to use it every hour or two, keep a record of the same and use the defervescent granules and the sponge baths as indicated by it. To quiet the neuralgic pain in the head, back and limbs, I