EDITOR MEDICAL WORLD:-I desire to call the attention of the medical profession to a subject of great interest, as it appears to me, and know of no better medium by which to reach them than through your far reaching publication. It is the therapeutic use and physiological action of the coal tar preparations, antipyrine, acetanilid and antikamnia, the latter being a proprietary preparation, eighty per cent of which is acetanilid.

These preparations are being used promiscuously and, as it seems to me, insanely, for every variety of febrile and nervous symptoms or conditions, and certainly without a due consideration of the consequences.

What is the effect of these drugs on the economy?

On best authority, these drugs disorganize the red blood corpuscles, and hence the effect of reducing temperature; for one can readily see that the result of this blood disorganization is to suspend physiological tissue metamorphosis. This is the most deadly poisonous effect that is produced by any drug, while it masks the symptoms for which it is given. These remedies are not antipyretics, they do not act on the excretions especially, and if they do it can not be by encouraging the physiological processes, their effect on the skin being in the direction of collapse.

Prof. Cantani, of Naples one of the greatest clinicians of the age, says of these remedies, "They prevent internal thermogenesis and defeat the effect for which they are given, and

are nothing else but poisons.

Physicians everywhere are giving these remedies in influenza ("Grip"), while on all authority the treatment should be supporting and stimulating.

They are fit only to be used in few doses in severe headaches and then in sthenic conditions only. They should never be administered continuously nor in continued fevers, because continuously they either accumulate or seem to, from their great depressing effect, and because, in continued fevers we need all the forces of life to carry the patient through.

While everywhere we read of the great mortality in epidemics of influenza, we may note also the general use of the fancy coal tar remedies.

We can get along without them, and I urge

caution in their administration; and, while I do not wish to appear boastful, I want to say that all my cases of influenza recover on the supporting plan of treatment, and I have had absolutely universal success in treating typhoid fever during the last ten years by using, as antipyretics, water and whiskey only.

It matters not how high fever runs, if the rule laid down by Reynolds is observed in the administration of stimulants, the symptoms will yield, while the physiological processes are not interfered with.

I may add that, to prevent hemorrhage in typhoid fever, I have used turpentine and laudanum.

Clayton, Ill.

H. J. PARKER, M. D.

Alarming Symptoms after Vaginal Irrigation.

EDITOR MEDICAL WORLD :-About two years ago 1 was hurridly called to see a lady, whom I had attended four days previously in her fourth confinement. I found her with a a temperature of 103 2-5°, pulse 130, face flushed and anxious, and pain and tenderness over the uterus.

A little over an hour before she had felt

perfectly well, but just then, while receiving a vaginal injection of warm water, was suddenly nounced and prolonged rigor. Next day her seized with pain in the abdomen and a propulse and temperature were nearly normal and there was but little tenderness; and in 24 hours more she was as well as usual.

In April last I was called to another case almost identical with the above; rigor, pain, rise of temperature following a vaginal injection of warm water. In 24 hours this patient was quite all right again.

Again on the 28th of Oct. last, a lady whom I had delivered 11 days previously of her fifth child, while receiving a vaginal injection of warm water was seized with sudden abdominal

pain, accompanied by vomiting, purging

-once-, a sudden and considerable increase in the lochia, bright and fresh. I arrived at her bedside in about an hour from the beginning of the attack, and just in time to see her draw her last breath. This woman had been anemic for years but always had short and easy labors and her last confinement was without receiving the vaginal washing. one untoward symptom up to the moment of

May I ask the cause and prevention of these accidents? M. D.

Puerperal Convulsions. EDITOR MEDICAL WORLD:-In the December World, page 460, is an article on puerperal convulsions, by Dr. Barnes. The Doctor's treatment is so at variance with modern teachings that I can not refrain from citing a number of authorities to show that his deductions, if not his treatment, are, at least, not in har mony with the accepted opinions of many of our brightest minds. The method pursued by Dr. Barnes was that of venesection, and the use of pilocarpine, morphine, veratrum, chloroform, and ergot. At 9 a. m. he took 2 pints of blood, and at 11 he took 1 pint, injecting hypodermically between the bleedings, 4 grain of pilocarpine. After the second bleeding he injected 1-6 grain of morphine. The convulsions continued every two hours up to 5 p. m., when chloroform inhalations were begun. Convulsions every 3 hours up to 9 a. m., when 5 drops of Norwood's tinct of veratrum, (probably the same strength as a fluid extract,) and ergotine were administered subcutaneously, which was repeated at 10 o'clock. The second stage of labor now begun, and continued up to 12 o'clock, when chloroform was administered and labor terminated. At 1 a. m., 16 hours after the first convulsion, she had a violent one, when 14 grain morphine was injected. At 3 a. another fit, and again grain morphine. This ended the convulsions. To sum up the case, this woman had in a period of 18 hours 1⁄2 grain pilocarpine, 10 drops veratrum, 2% grain of morphine, an indefinite quantity of

ergot and chloroform.

Now, Mr. Editor, Clement Godson, in Quain's Dictionary of Medicine, says, "The mortality has probably diminished of late years since indiscriminate venesection has been abolished and other treatment adopted." Winckel, as high an authority as the world contains, says, "I have long abandoned venesection." His treatment is chloroform inhalations, with 30 grains of chloral per enema, repeated until 180 or more grains have been given in 24 hours. He saves 92.7 per cent of his cases. Veit, who begins with 1⁄2 grain of morphine hypodermically and continues until he has given 3 grains inside of 4 to 7 hours, saves 96. 7 per cent. of his eclamp tics. He, presumptively, does not bleed. Of 2.655 women delivered at the Philadelphia Hospital between 1874 and 1889, nine had convulsions, or 1 in 295, and 3 of the 9 died, one of the three having been bled. This is 66 2-3 per cent. saved, and 33 1-3 per cent. lost. Winckel condemns pilocarpine in no unmeasured terms. Ringer, in his Handbook of Therapeutics, says that veratrum in half

drachm doses of the fluid extract till nausea ensues is invaluable.

Is any physician at the beginning of the year 1892 warranted in claiming that venesection is the panacea for puerperal convulsions? With the success obtained by other methods, can we consider that we have done our whole

duty when the patient shall have been bled?

and

As to the plan pursued by Dr. Barnes, would he not have had the same results had he not bled, and depended upon morphine veratrum? Had 1⁄2 grain of morphine and 5 drops of veratrum been given every half hour, or as indicated, would the patient not have been carried safely through delivery without the aid of the three or four persons who, the Doctor informs us, were required to restrain her during a labor pain? And then the ergot. If the muscular system had been properly relaxed by efficient doses of morphine and veratrum, would the first and second stages of labor not have proceeded quietly to a physiological termination, otherwise unaided? We must note that for 16 hours this woman had received but one sixth of a grain of morphine. It was no doubt the ten drops veratrum which warded off the convulsions for so many hours, aided by the minute amount of morp inę she had in her system, and not the loss of blood, as is shown by the recurring fits after labor had been completed, and at a time when she could by no possible chance be under the influence of either drug. We must remember that drugs are rapidly eliminated from the system, but that blocd withdrawn from the circulatory system is not so rapidly replaced. Upon a careful analysis. of this case, one who has had much experience in similar ones can but conclude that the venesection played but an unimportant part compared with that of the drugs veratrum and morphine.

If the

In conclusion, permit me to remind Dr. Barnes that the classification of these cases into the apoplectic, epileptic, and hysterical types, as spoken of by King in his little work on obstetrics, seems to be a rational one based upon experience and observation. practitioner can eliminate from his mind the idea that all cases are uremic, he will have made a great stride in the direction of sensible therapeutics. As to the treatment; morphine will relieve the hysterical and epileptic types, and veratrum the apoplectic. A combination of morphine and veratrum will relieve the three types, aided by chloroform judiciously exhibited by inhalation and per orem.

I hope that Dr. Barnes will accept these suggestions in the spirit in which they are made. Ferndale, Cal.,

F. A. ALFORD.

Hydrocephalus Complicating Labor. EDITOR MEDICAL WORLD:-I notice in your December number, page 463, that Dr. J. G. Knox, of Toomsuba, Miss., describes. three cases of "Hydrocephalus complicating labor," and desires to hear from other physicians who have had such cases, and how they manage them."

I have only had one such case, and the patient was a white woman. It was a head presentation.

The case was a complete puzzle to me for several hours. In vain I searched for sutures and fontanelles and other obstetrical landmarks

of the fetus. I had carefully watched all through the first stage of labor, and could get even no tidings of a head, arm, leg, body, hand or foot; but there was something presenting which at every pain grew tense and relaxed in the interval. Finally it came within easy reach, and there it remained hour after hour. I applied the forceps once, twice, three times, and they slipped off each time. I was perplexed. Passing in the thumb and forefinger I found that I was able to pull hair, and to discover that if it were a child this was surely the head. Then for the first time in my life I realized the value of hints I had seen in books and heard in lectures concerning "Hydrocephalus as an obstacle to labor." I punctured the head with a large trocar and it collapsed; then, seizing hold of the long empty hair like sack, I made traction and, with great difficulty, delivered the body of a very large male child. All the bones of the head, above a line drawn around the head just above the ears and eyes, were absent, exeept a piece the size of a silver dollar attached to the inside of the skin near the top of the head. There was very little substance present. The mother made a good recovery.

J. G ATKINSON, M. D.

Oak Hill, N. B., Canada.

Tying the Cord.-Painless Parturition.-— Effects on the Unborn Child of Drugs

Given to the Mother.

EDITOR MEDICAL WORLD:-"Doctor," on page 422, of November WORLD, invites discussion on the manner of tying the cord. When I had been practicing medicine for perhaps five years, I arrived in answer to a call at the house of Mr. M., one hour after the birth of a child.

I found the mother doing well, but the baby was blue, with cold hands and feet (dressed); nurse saying that she could not get them warm. On examination I found the baby's clothes round the navel saturated with blood; ligature round the cord so loose that I could

easily slip it off. The nurse, or midwife, said that she was sure she had tied it tight.

This, of course, furnished a good text for me to talk to the parents about having an ignorant midwife in such cases. (They have never had one since.)

which I attended there was no one to wash Now, at the very next case of confinement and dress the baby, and no neighbors near, So I proceeded to fix the little fellow myself, and I might say here that I used an extra amount of caution in tying the cord, which was very thick.

Having occasion to go on beyond to visit a patient, I stopped on my return to see how the woman and child were getting along. What was my chagrin to find this child in the same condition as the other one-bleeding freely from a flabby cord, with the ligature large enough to tie three such cords. Ever since that time I have made it my rule to roll the cord between thumb and finger for a few seconds before giving it to the nurse, and if the cord is large I find it dwindle in my fingers to half its former size; then I tie it again and, thread, linen, or silk, I know that cord is not whether tied with wrapping twine, twisted going to bleed any more where cut.

One

In regard to "painless parturition" I have tried various methods of dieting, etc., with no success, as far as entirely doing away with pain is concerned. But I have attended two ladies living under the same conditions, eating the same food, both living in good hygienic surroundings, both in the same week. suffered intensely for a number of hours from the time the os was dilated enough to admit of one finger; the other had no pain scarcely. Although a primipara, yet with the expulsive efforts she said she had no more pain than she would have in having a passage of the bowels if constipated. In fact she had absolutely no pain until the os was dilated almost sufficiently to slip over the head.

From my experience I would say that I know that living a temperate, orderly life, with enough exercise-in fact living as a woman should, be she pregnant or not, will aid materially in giving the woman an easy, safe and quick labor.

But some women will suffer greatly in spite of everything, and others will suffer very little whether they diet, etc., or not.

I would never advise a woman to go without any food she craves for, if consistent with ordinary common sense.

I would like to see an expression of opinion as to the effect on the unborn child in giving such drugs as chloral, morphire, etc., to the mother during confinement. In my practice, in attending over three hundred cases of con

finement, I have had only two still births at term. One was my first breech presentation, the other was a case where the woman had been suffering for three days. When I arrived I found the attendant urging her to bear down, etc. I gave her a dose of chloral and morphine to relax the constricted womb, and give her rest. She never felt any motion of the child afterwards, and, although the child cried once, it died in spite of artificial respiration, etc., and I could never hear or feel any heart beat.

Vernonia, Oregon. C. H. NEWTH, M. D.

Indolent Ulcer of Leg.

EDITOR MEDICAL WORLD:-In answer to N. H., in December number of THE MEDICAL WORLD, in regard to sore on leg, allow me to say that the name is very indefinite. Taking for granted that the inquirer means ulcer of an indolent nature, the following treatment will bring the ulcer to a happy termination sooner than any other treatment I have tried: Apply adhesive plasters about the edge of the ulcer to hold the integument and deeper tissues as nearly at perfect rest as possible. Then dust on the following powder:

R Zinci oxidi

Bismuthi subnit....... aa equal parts M. Let this be dusted on once or twice each day, but do not wash away any of the powder or allow water to touch the sore.

This treatment brings two important factors of nature to assist in the healing process, viz: rest and stimulation. The powder forms a layer, underneath which the healing process goes on uninterruptedly. Unhealthy granulations are kept down by the zinc, and every requirement for cure is present, except, probably, in cases where the patient needs toning up-or where some function is being improperly performed because of the condition of life of the patient.

Every ulcer of the leg needs some particular course of treatment, which can be given only after a close inspection of the ulcer.

As a rule the treatment mentioned above will answer, and will always prove successful if the bodily functions are properly performed, and the ulcer is an indolent one.

Huntsville, N. J., SIDNEY B. STRALEY, M.D.

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Umbilical Hemorrhage.

EDITOR MEDICAL WORLD:-The discussion of the subject of umbilical hemorrhage in the Jan. WORLD calls to my mind the following case. Nov. 9th, 1891, I was called to attend Mrs. N. in her third confinement. The child's head was born just as I entered the room, and before I could disengage myself from my overcoat and wraps to render assistance the cord, which was short and wrapped around the neck, pulled in two close to the navel. So soon as the body was sufficiently expelled to reach it, but not before a strong gush of blood had occurred, I seized the navel with the surrounding skin and held it firmly for several minutes between my thumb and fingers. The child lay as if dead at first, but soon rallied and cried lustily. The remaining portion of the cord was so short that it could not be tied, so I dressed it with oiled muslin and a small compress. No further hemorrhage ensued and it did well thereafter.

IN THE MEDICAL WORLD, Feb. 1890, page 73, I reported a case of severe umbilical hemorrhage it) which occured on the eighth day, and which, (for some reason Dr. Anderson failed to index

after other means had failed, ceased immediately on the application on and around the umbilicus of a paste made of plaster of paris, secured by a compress and bandage. Decatur, Ohio.

L. C. LAYCOCK, M. D.

Intuitional Prognosis.

EDITOR MEDICAL WORLD:-I am not superstitious and do not believe in modern spiritism, visions or dreams; neither do I profess to see farther into the future than any fellow practitioner but a certain phenomenon has occured in my professional life which may be of interest to the readers of THE MEDICAL World, that care anything about the anomalies that occur in the healing art.

To prognosticate the determination of a disease, either in health or death, without drawing somewhat upon our past experience, medical knowledge, or even common sense, would look like foolishness in the extreme; and so it would be were we to advocate such a procedure in all cases. Nevertheless, I can recall, during a practice of nearly thirty years, from fifty to one hundred cases, where my prognosis has been determined in this manner.

This intuitive knowledge does not come at my bidding, but in an instant and when least expected, and is usually contrary to my better judgment, if I may so speak. That you may the better understand me I will give a few typi cal cases, without saying anything about diagnosis or treatment, which, you will readily un

derstand, do not have any bearing upon the subject.

About twenty-five years ago I had a partner much older and more experienced than myself. He was away on a visit, when a young man belonging to one of his families was taken ill, and I was sent for to attend him. He went from bad to worse and at the end of the week did not think that he could live another day. The old doctor returned, and we were both summoned to the patient's bed-side. As I opened the door to his room, I saw the patient (in a vision) sitting up by the side of the bed, looking quite well. This vision brought a perfect confidence to my mind, as it has in all such cases, that the disease would terminate as indicated in the vision; and I immediately told the mother that her son would recover. The old doctor, not being a religious man, carried with him a vocabulary of words usually associated with pirates, and as we reached the next room, he rehearsed them to me quite freely, winding up with the statement that "any fool would know that the young man was dying." He made a rapid recovery and I saw him in a few days, sitting by his bed-side, quite well.

Was called to attend a boy eight years old, stranger, living in a distant part of Chicago. As I entered his room, I saw him a corpse. Examined him and did not consider him much out of health. Told the mother that her son was dangerously ill and that she had better send for her family physician. He was sent for and came. After this very polite doctor had informed the parents that Dr. Dodge did not understand his business, and said the boy would be all right in a few days, I had nothing more to do with the case until the seventh day, when I was called in to see him die.

Was called to see an old man seventy-three years of age (if my memory serves me correctly). After giving him a thorough examination, looked upon his case as desperate. Told his son to send for counsel; two physicians came about ten a. m. Prognosis, death within a week, or, as they expressed it, "there will be a funeral in this house within a week." Went back to my patient about four o'clock in the afternoon and found him worse. As I sat by his side I looked up to the door leading to his sitting-room, and in he walked, smiling and in good health. Three or four weeks after this I was called to see my patient's wife who was sick in the same room. In a few minutes I looked up to the door and in the old man walked, not in a vision this time but in reality.

Had an old friend in Chicago who had been ailing, as he expressed it, for several days, as there was a Homo. man called in to see him. This doctor said he would be well in a few days.

Did not improve at all, and I was sent for. Sat by his side laughing and talking when I looked upon the bed and saw him apparently cold in death. I then examined him and told him that I did not understand his case and would not attend him unless he got the best counsel he could find in Chicago, as I considered his case serious. Told the wife and children that he would die. The counsel came and gave the family hopes of his recovery. He died in about a week.

Was called about one o'cloek a. m. into the country to another doctor's patient, to see a lady that was dying. Arrived and as I entered the room saw several grown up children crying, at the foot of the bed. As I adjusted the optics of my second eye sight upon the dying woman she appeared in tolerably good health, and the whole scene seemed so ridiculous, that I laughed aloud. Now those who know me the best have realized that I have not lived a life of hilarity, and do not give such utterances of pleasure very often; and particularly when I am called in the presence of the dying. This came near being a dear laugh, for the husband, who was a large strong man, said he came near kicking me out of doors. She made a rapid recovery.

An old friend of mine had been running down for a year, I could do him no good. Had counsel, but he gradually grew worse. Became unconscious and apparently moribund. As I watched over him and tried to count his flickering pulse, saw him sitting up in another part of the room in his sick chair looking quite well. Got up and went out in the next room where his grown up daughters were and told them their father would get up again. He did get up and lived for several years in comparative health.

The next and last case I will record is somewhat different from all the rest and unique in itself.

Stranger came into my office to see, as he expressed it, if I could tell him what ailed him, whether I could cure him. Diagnosis obscure. Told him if he would follow my prescription for two weeks could tell him whether I could do him any good. Sent for me to come to his house in two weeks, and demanded that I should tell him whether or not I could cure him, and if not how long he was to live. Sometimes our patients are so exacting about such things that we have to refer them, after we have exhausted our own skill above for further information. But not so in this case. I was in a deep study trying to conjure up something to say, when I dimly saw the man in a coffin. Ir some respects the man had improved during the two weeks of my treatment; but my prognosis had been foreshadowed, and I no longer