my good friend, Dr. Collins, to my assistance. The Doctor gave me valuable aid, and after a labor extending over seven hours the patient was delivered of twin babies, both of which were dead. We were beginning to congratulate ourselves that all might be well, but in two hours after delivery she had a violent convulsion, and immediately sank into unconsciousness from which there was no awakening; and she died three hours after delivery, having had three convulsions.

In the two shoulder presentations which occurred in my practise, delivery was effected by performing podalic version. Both cases were fatal to the child, but the mothers made uneventful recoveries.

My first case of shoulder presentation was a strong, robust young woman in her first confinement; and to put it mildly, I was scared. In this case another noble-minded physician, Dr. Lindsey, of Salineville, came to my assistance, and I shall not forget him for his kindness to me and to my patient. The venerable Doctor is a prince among men, and a man whose friendship any man might well be proud of.

My case of prolapsus funis occurred in a stout young primipara, and I found it impossible to keep the cord in place and a stillborn babe was the result. The accident did not affect the mother.

The case of hand and arm presentation resulted favorably to both mother and child. I replaced the hand and arm with the mother in the knee-chest position, and labor terminated in the natural way.

All my cases of post-partum hemorrhage resulted favorably, tho I shall not forget my first one, a fine, robust young woman in her first labor, which was normal and not tedious; but almost immediately following the birth there came such a fearful gush of blood as to saturate the bed and run upon the floor. I was greatly alarmed, as this was my first experience with such a case. The Credé method was fresh in my mind, and I immediately put it into practise; with one hand firmly grasping the uterus from above, and the other within the vagina, I soon succeeded in delivering the placenta, and the hemorrhage promptly ceased. The lady was blancht and fainted, but made a splendid recovery and is living and well today.

The only case of puerperal insanity that I have ever witnest occurred in my practise near Carrollton about 12 years ago. A stout young woman, normally confined, got out of bed on the ninth day, crost a cold hall to the kitchen, and in a few hours was seized with a fit of violent puerperal insanity which terminated fatally in 48 hours. Dr. Williams, of Carrollton, saw this patient with me and gave

me valuable assistance; but nothing we did seemed to be of any avail whatever,

These are some of the difficulties which I have encountered in the practise of obstetrics; but they were trivial as compared with a case which came under my care Feb. 25, 1906. The patient was a stout, robust woman, aged 35, in her eighth confinement. I was called

to see this patient about 5.30 p.m.; found her having some irregular pains, and she said she had been having slight pains all day. I made an examination and found her in labor, the os dilating and a normal vertex presentation. She seemed to be doing all right, and I decided to wait on nature rather than to offer interference. In about an hour I gave her

grain of strychnin and a drink of hot tea; and in the course of an hour and a half the os was fairly well dilated and the pains were becoming stronger, tho at no time did she have what would be called severe labor pains. At about 8 p.m. she had a fairly good pain and suddenly exclaimed, "Oh! something has bursted in me." I distinctly heard the sound, but supposed it was the rupture of the membranes. I immediately made an examination and was horrified to find all pain had ceast, the head had receded, some blood was coming away, the abdomen was flattened, and patient bathed in clammy perspiration, and pulseless at the wrist. She was in profound collapse, and it lookt like death was imminent. I realized in a moment that I had encountered a case of rupture of the uterus with all its attendant horrors. I gave strychnin, digitalin and nitroglycerin with whiskey, and applied warmth to the extremities and sent for assistance. In about 20 minutes I had succeeded in controling the shock to the extent that she had a pulse, tho weak, and she could speak. At this point Dr. Minor arrived, and after a hasty consultation the Doctor made an examination, and found what I have already described. We decided to bring down a foot and deliver the child, which was accomplisht without much difficulty. With the child came the placenta and a gush of blood, together with protruding omentum. At this point Dr. Giesey arrived, and we consulted in regard to the advisability of an abdominal section. But as our patient was pulseless and in profound collapse, both consulting gentlemen advised against such procedure, unless we could rally the patient to consciousness. Stimulants were given freely, but there was no response, and our patient sank into eternal sleep within an hour of the time she exclaimed, "Oh! something has bursted in me." It was a sad experience; and altho rupture of the uterus is of exceedingly rare occurrence, I had many times feared it.

Now as to the cause of this most distressing

accident. I learned afterwards from the husband that about 10 days prior to the confinement this patient sustained a severe fall, striking upon her abdomen, and shortly after the fall she had a pronounced chill, after which she did not feel any movement of her child. My theory is that the child died at that time, and that there was degeneration of the muscular structures of the uterus, which made it less able to resist pressure; and from that cause it gave way. It was certainly not on account of prolonged labor or severe pains, for she did not have either. The accident came to my patient without warning of any kind, only that of a premonition she had had for some weeks that she would not live thru this confinement. It was a bitter experience for the doctors as well as for the stricken family. I cannot close this incident without expressing my heartfelt app reciation of the valuable counsel and assistance of Drs. Giesey and Minor, who came quickly to my aid and stood manfully by me, sharing the weighty responsibilities of this most sorrowful and unfortunate case.

[Here is a doctor whose heart seems "tuned aright" toward his professional co-workers. Notice the way he speaks of them, and the evident pleasure he takes in speaking highly of their nobility of character and their skill. Of course they respond promptly to his call for aid, because his heart is right toward them. We venture that Dr. Watt is universally respected, loved and trusted by his professional brethren. Kindness will beget kindness. mention this because it is a well-known but regretable fact that the beautiful spirit breathed all thru this article does not exist among the profession of all communities, particularly small communities. It should, and we think the trend is decidedly in the direction of improvement in this respect.-ED.]

Hemorrhagic Measles.

We

Editor MEDICAL WORLD:-I am sending you what I consider an unusual and interesting complication of measles. An epidemic of measles broke out in one of the camps on the construction work here. All ran a typical course of fever. More or less bronchitis and eruption followed by desquamation, except this one, which was not so fortunate.

March 14 he developt fever and bronchitis and four days later the rash appeared and he came to the hospital. During this period he was unable to eat, but drank large quantities of whiskey and kept at work. At the hospital he was given a hot bath, which brought out the rash decidedly, and bullae were noticed on the buttocks and backs of the arms.

Others rapidly developt and filled with muco-purulent

fluid, and joined with their neighbors until large areas were exposed which bled freely. This process continued for four days, until the skin over the sacrum, buttocks, posterior and lateral sides of both thighs, calves of legs, and knees, both scapulae and posterior surfaces of arms, elbows and forearms were one raw and bleeding surface.

On other parts of the body the epidermis loosened, and exfoliation took place in large sheets. A piece of skin apparently healthy could be pincht up between the thumb and fingernails, and the epidermis removed in strips several inches in length. About the face and neck the scales were fine and branny.

Upon entering the hospital his fever was 103.5°, continued so until the process of skinning subsided, when it gradually dropt to normal. His tongue and palate showed the rash at first; his bronchitis was slight, but he had a severe laryngitis which reduced his speech to a whisper.

The denuded surfaces are now covered with a new skin except at the elbows, which have not entirely healed; and the new skin is bright and pink, except a few places where the old skin has not yet been cast off.

Anders speaks of petechial and hemorrhagic measles, and Osler mentions these and states that in epidemics atypical rashes are not uncommon. I send this case, as it might be of interest to some one. Almota, Wash.

DR. VIRGIL MCCOMBS.

Insomnia, Etc.-Bright's?

Dr.

Dear DR. TAYLOR:-In the March WORLD I noticed two inquiries, one by Dr. A. R. MacKenzie, of Taneytown, Md., and the other by "S.," to which I feel like replying. MacKenzie (page 98) wishes to know what will produce sleep and allay the extreme nervousness in a case of a man suffering from "nephritis, dropsy, and insomnia." The Editor has recommended veronal, gin, nitroglycerin, oil of erigeron, and elaterium. Might I suggest for the insomnia and motor restlessness a combination of sulfonal and conium? Three or four grains of each in capsules; one capsule, or two for that matter, may be given at 6 p.m., at 8 p.m., and at 10 p.m. The cumulativ action will thus be secured, so that the second night the dose may be decreased. This combination never occasions any untoward symptoms, and acts in the majority of instances very happily. Much of the nervousness could probably be overcome by giving 15 to 30 grains of sodium bicarb. in a glass of water three or four times a day, free alkalinization being very essential in these cases to prevent uremia.

Free elimination should be maintained, preferably by saline laxativs; if a stronger cathar

tic is required, elaterium may be cautiously administered.

I think the other inquiry by "S.," of Ohio, entitled "Bright's?" (page 101) is a case of renal insufficiency from autotoxic strain. In a paper that I read before the Sioux Valley Medical Association, at Sioux City, Jan. 18, 1906, and which was publisht in the Journal of the Minnesota State Medical Association in February, this condition is thoroly discust. The treatment is, briefly, first, to avoid undue strain on the poison-destroying function of the liver; secondly, to increase its oxidizing powers; and thirdly, to stimulate removal by the kidneys of other substances than mere water thru removal of strain by indican and allied products. All this can be accomplisht by reducing starchy foods, and also the proteids; avoidance of intestinal fermentation can be secured thru the use of intestinal antiseptics, such as the sulfo-carbolates or other equally good intestinal antiseptics. It is also desirable where there is a tendency to excessiv elimination of watery urin to transfer the water elimination from the kidneys to the intestin and liver, and this can be done by a combination of hepatic stimulants and hydragog cathartics. If there is a chlorohydremic condition needing attention, Basham's mixture will be found very efficient. Oliv oil could be taken with advantage. If the urin shows a low degree of acidity or an increased ammonia excretion, sodium bicarbonate, in 60 grain doses, daily, will exhibit the same markedly beneficial effects that it does in the acidosic states of diabetes. If dyspnea or asthmatic states make their appearance, much benefit will result from the use of aspidospermine. GEO. F. BUTLER.

103 State Street, Chicago.

A Venereal Case.-Basilicon Ointment. Editor MEDICAL WORLD:-The report of venereal case of Dr. Garrison on page IIO SO closely resembles an experience of mine when I was young, I cannot refrain from making some remarks. My patient, also, was an educated man, and I placed far too much confidence in his judgment. He insisted so very strongly on everything being done both prophylactic and curativ that I was led, against my better judgment, into furnishing him with local treatment entirely too activ, with the result that a urethritis was produced that thru further ignorance and activ medication became really formidable. Finally, becoming convinced of the true state of affairs, I hit on a treatment so simple and effectiv that you may possibly consider it worthy of being given to the profession. With a Nelaton catheter I had him push up the urethra a small portion of modi

fied basilicon ointment, and never did medicin act more like a specific than it did.

This leads me to a few words regarding this salve. I had not been long in the practise when I became dissatisfied with vaseline for general purposes. I had learned of my father to make this ointment in a way to be very much better than the official basilicon ointment of resin 10, yellow wax 4, lard 16; and something like twenty years ago I began using it as a basis for special ointments, and for very many purposes in general practise. In the light of my experience it is nearly a cureall; but it is especially advantageous in the urethra and rectum. I always make it by guess, but use much less resin than the official directions call for. As officially made, it is too dark and strong to be a nice ointment. I am careful, too, to get a good article of yellow wax, to strain carefully, and stir until cool. I think instead of 10 the resin should be 6 or 7. I have seen it do excellent service even in specific gonorrhea, by allaying much of the irritation and inflammation caused by the gonococci, or the medication, and perhaps by tangling up the gonococci as to render them less activ.

Some years since I was induced to pay a small sum for a receipt to preserve surgical instruments free from rust. When I read it I was surprised to see this same formula I used for a general purpose ointment. This whole story does sound like the old woman's bear grease that was good for everything; but it has surely come to my relief in some unexpected DAVIS R. EMMONS.

ways.

Hypertrophy of Prostate.-"Creaking in the Joints."-Scarlet Fever.-Eclectic Remedies for Cough.

Editor MEDICAL WORLD:-I note on page 99, March issue, some M.D. wants a treatment for hypertrophy of the prostate. I have had very good success with Lloyd's spec. saw palmetto in 10 to 15 drop doses three times a day.

I also note "creaking in the joints," page 102. I have had fine success with kali muriate 3x, dose 22 to 5 grs. three or four hours apart during the day. This is a homeopathic remedy, but what need he care, so it does the work?

On page 89 I note homeopathic treatment for scarlet fever. Not long since a family moved from East Ok. Some 10 years ago they had a little daughter die of scarlet fever, and they sealed up some of her hair in a picture frame, so they could see it thru the glass as well as see the picture. On moving, it broke. One of their little boys handled the hair, picture, etc., then the mother rolled them up and put them away. The rest of the children were not at home-some four or five of them. Some time after, the little boy took sick and I was sent for. I found a pronounced case of scarlet fever. I gave aconite, belladonna and mercury as indicated, also Burgee's double sulfides, and put the rest of the children on Lloyd's spec. belladonna, gtts. 15 to 4 oz. of water; dose, a teaspoonful three hours apart. One other child had the fever, but was not confined to bed; was kept in the house, but would not go to bed.

I stopt the children from school, had the hair and picture fumigated, and kept on fumigating after all were up, and stopt the disease in that family. The little boy was very sick a few days; his ears both gathered and run, etc.

A cough remedy in one case might not be of any value in another. Eclectics study single remedies, their direct indications, and make their mixtures as they go along; so there is no "best." For instance, if we had a case with oppression across the chest and tight breathing, lobelia would be the remedy; drop gtts. 15 to 30 Lloyd's spec. lobelia into 4 oz. of water; dose, a teaspoonful from 15 minutes on up to 1, 2 or 3 hours as required. If a tickling cough, mostly in the throat, it would be Lloyd's spec. blood root used the same as the lobelia. I advise the doctor to read Ellingwood's, Fyfe's or Scudder's works and get an understanding of the principles of the school. Highley, Ok. J. S. LEACHMAN, M.D.

"lodized Lime."

Editor MEDICAL WORLD:-The interest which has been manifested concerning the therapeutic properties of so-called "iodized lime" is encouraging, because it shows a desire on the part of the medical profession to learn why this new candidate for professional favor should be recognized. Referring to the contribution by Dr. W. A. Hinckle, of Peoria, Ill., which appears in the April WORLD (page 140), together with the editorial comments upon the same, I can probably throw some additional light upon this unsettled question. In the first place, the name itself, "iodized lime," indicates its character, just the same as iodized oil indicates the nature of this latter product, full directions for the preparation of iodized oil being given in the Dispensatory.

Of course, we all know very well that iodin is valuable as an absorbent, that it acts as an alterativ, principally thru its influence upon the lymph-glandular apparatus. This is conclusivly shown by its resolvent action upon various forms of inflammation, including specific cases. The therapeutic properties of lime (calcium) are also well recognized, this being one of the most important constituents of several standard preparations.

In the present instance, however, it seems to me that the estimate placed upon iodized lime is not sufficiently discriminating, since those who commend it so highly are disposed to regard the iodin content as the more important constituent. My object in the present communication is to develop more fully the therapeutic value of the lime content, and thus give the physician a more complete idea of the scope and usefulness of this new combination -starting, of course, with the assumption that iodized lime now offered to the profession contains 10 to 12 percent of iodin and 88 to 90 percent of lime.

The following question, propounded by your contributor, warrants me in presenting this phase of the question relating to the employment of iodized lime: "This being the undoubted composition of the drug, what, if any, advantages has it over calcium iodid or other preparations of iodin?" As regards the calcium iodid, the new preparation contains more iodin; and in addition to this, the calcium content is more readily available than that contained in the chemical compound. But I think it is susceptible of proof that the lime in this mechanical combination is more valuable than the iodin, notwithstanding the general impression that the advantages are due to the

free iodin.

My contention for the clinical virtues of the lime content is based upon well-establisht scientific research, confirmed by extended clinical observation. As evidence, I beg to offer the following explanation, and any physician in general practise can easily verify my claims in properly selected cases within twenty-four hours after beginning treatment: One of the first clinical indications for icdized lime is the treatment of croup; and it will be found that this combination is especially useful in the case of children who are debilitated and suffer more or less from colds, bronchial catarrh and intestinal indigestion. In other words, it will be more effectiv in this class of cases than where the patient is robust, free from bronchial irritation, and does not suffer from intestinal indigestion. In the first class of cases we have to deal with more or less acidity from time to time, and as a consequence, these patients are nervous and irritable; they show a capricious.

appetite and suffer alternately from diarrhea and constipation. This morbid complexus is traceable to acid excess, and will promptly disappear when the diet is corrected and normal reactions re-establisht. It is a very simple matter to determin this condition, especially when the child suffers from night-sweats or local sweating affecting the head and shoulders. As a result of this acid excess there is an interruption in the transmission of nerve impulses, the lime content in the nerve structures being depleted or filtered out. In many instances

administration of lime will promptly correct this deviation from the normal and convalescence will be establisht within twenty-four hours. The iodin, of course, will be helpful because of its alterativ action in connection with the exhibition of lime, which restores to the system the necessary principle.

Another thing which should be taken into consideration in this connection is the fact that in many families, where croup prevails in all seasons of the year, the children are allowed to have cereals ad libitum, which leads to acidity, accompanied by various nervous phenomena, including chorea. The employment of Epsom salt (magnesium sulfate) is also a common practise in these families, and as a consequence most of them suffer more or less from magnesium poisoning, a statement which at first may appear incredulous, but nevertheless a fact which is susceptible of clinical and scientific demonstration. Thus, while lime and magnesia are normal constituents of the human organism, it is a fact establisht by scientific research that acid excess not only depletes the lime content, but also permits the magnesium to take its place in the nerve structures. No less an authority than Professor Loew, of the University of Munich, makes the following statement: "The calcium nucleoproteids of the organized structures are transformed by the presence of soluble magnesium salts into magnesium compounds, while the calcium of the former enters into combination with the acid of the magnesium salt. By the transformation of organized nucleo-proteids into magnesium nucleo proteids the capacity for imbibition will change, which must lead to a disturbance in the structure that will prove fatal. Only the simultaneous presence of dissolved lime salts can prevent this effect, according to the law of mass."

In this connection I should add that observing clinicians will especially note the prompt relief afforded by the administration of lime salts in the case of patients who have been sub ject to the magnesium sulfate regime. When acidity is neutralized and a proper diet insisted upon, it is remarkable how quickly the nervous phenomena subside and how promptly nature

responds to this treatment. For example, the iodized lime has been highly recommended for the treatment of specific infection, because of the prompt improvement following its employment, but the clinical facts properly interpreted fully explain the modus operandi by which the results are obtained. I think it was Brunton who first outlined the effect of mercurials upon the bony structures, the lime content being diminisht especially in the bones of the lower extremities, and when mercurials are long continued there follows calcification in the kidney structures, leading eventually to edema and ascites. And as it is not unusual in the treatment of specific infection to administer magnesium sulfate, we can readily understand how such patients go from bad to worse and suffer constantly from obscure nervous phenomena. In addition to this there is sometimes coincident acid excess, but even in the absence of this condition the administration of lime is promptly followed by markt improvement in both the subjectiv and objectiv sympJOHN AULDE, M.D.

toms.

Philadelphia, Pa.

Membranous Croup Without Diphtheria.

Editor MEDICAL WORLD:-Replying to several comments appearing in the April WORLD upon the identity of membranous croup and diphtheria, I beg to cite a recent experience which, it seems to me, is ample evidence that we may have a non-diphtheritic membranous croup. I am not questioning for a moment, however, the accepted belief that they are (usually) identical.

Five children of a family of six spent an afternoon recently playing in the snow; and as a result, all had croup that night. One boy, aged 6 years, became worse and a physician was summoned the next morning. Later in the day counsel was called, who administered antitoxin and advised that all the children be treated similarly; this the parents refused to allow. Notwithstanding all that could be done, the little patient grew worse and died that evening.

I was called next morning and found three children in bed; two with moderate fever, quite hoarse, no sore throat or other alarming symptoms. The third, a bright little fellow of four and one-half years, presented quite a different picture: great distress, entire loss of voice, intense dyspnea and beginning cyanosis upon a waxy pallor.

I believed tracheotomy inevitable, but thought I would give internal remedies a trial. I emptied bowels with copicus enemas, and internally gave aconite and iodized lime (Abbott's), 23 gr. in hot water every fifteen minutes. In about two hours his color had