his wife and children, known to have been tenderly attached to them; a mother destroys her infant.

4. "The subsequent conduct of the unfortunate individual is generally characteristic of his state. He seeks no escape or flight, delivers himself up to justice, acknowledges the crime laid to his charge, describes the state of mind which led to its perpetration; or he remains stupefied and overcome by a horrible consciousness of having been the agent in an atrocious deed."

5. "The murderer generally has accomplices in vice and crime; there are assignable inducements which led to the commission, motives of self-interest, revenge, displaying wickedness premeditated. In some instances, the acts of the madman are premeditated, but his premeditation is peculiar and characteristic.

There is also a presumption of insanity where the individual has either been previously insane or affected by epilepsy."

It is therefore self-evident, gentlemen, from all that has been said, that while insanity in general is "a reasoning unreason," yet in the emotional or affective form of that disease, we are to ignore the particular morbid manifestations of thought as expressed in words, and confine ourselves to the study of the actions, which portray a disordered condition of feeling. The plea of emotional insanity, we have ascertained, so far from being one of a trivial nature, and easily maintained, as popular prejudice might induce you to believe, is of an intricate and complicated character, requiring for its establishment a most thorough knowledge of the philosophy of the general subject of insanity, and no ordinary powers of observation and analysis. In addition to this, the physician investigating the phenomena of emotional insanity should possess earnestness, perfect candor and an unbiased mind. Leaning in one direction or another, redounds to the discredit of science and the still further degradation of a well founded plea, which, when resting upon the basis of a careful diagnosis, is sound in theory as well as practice and of great service in a philanthropic point of view. When abused, as is too often the case, the plea can only result in the perversion of justice and professional disgrace, the infliction reaching not only the individual but society at large.

Original Contributions.

ARTICLE XXIX.

POST PARTUM HEMORRHAGE. By JOSEPH WORKMAN, M. D., of Toronto, Canada.

I have read, with much interest, in the February number of THE JOURNAL, the report of Dr. Maughs' paper on post partum hemorrhage, and of the discussion in the Medical Society to which the reading of it gave rise; and as the subject is one of very high importance, and has for nearly half a century engaged my especial attention, I venture to ask of you a little space in your columns, for a few observations, which I trust may not be unworthy of the polite consideration of your readers.

I am aware that the efficacy of injections of various fluids, in the restraining of this formidable hemorrhage has of late years. been highly extolled, and I question not that the gentlemen who have given trial to this method of treatment, have realized the excellent results which they have recorded; at the same time it is not denied that unpleasant, or even perilous, consequences have occasionally ensued, and it is the more to be regretted that these have most largely been provoked by that form of injection, (solution of per sulphate of iron), which is probably the most potent of all the remedies which have been accredited as suppressors of uterine hemorrhage. Having myself, for the simple reason of never having employed the per sulphate injection, had no experience of either its merits or its demerits, I venture to offer no opinion on its therapeutic agency. Its efficiency may, or may not be, the result of blood coagulation within the uterus, and extending into, and sealing up, the denuded uterine sinuses, though I should regard this modus operandi as a rather unpropitious process, and therefore not so desirable or safe as any other method which may ensure arrest of hemorrhage by perfect and persistent construction of the uterine fibres. We know that in

ordinary cases of safe labor, this is nature's course of action in preservation of maternal life, and in every department of medicine the nearer we can approach to her line of action, the better for the fortunes of our patients, and for our own reputation. If we arrest uterine hemorrhage, not by physiological constriction, and closure of the gaping sinuses, but by corking these up, with induced, firm, adherent blood clots, saturated with a hardly innocuous mineral solution, we may have done something more, and a little less, than should have been our simple purpose. These clots are undesirable foreign bodies, of which nature must struggle to relieve herself, as best she may; until she has effected this riddance, our patients cannot be said to be clear of danger.

In a paper which I had the honor of reading before the Canada Medical Association, at the annual meeting of 1877, in Montreal, I drew attention to "the use of acetate of lead in large doses, in post partum and other hemorrhages," and I was gratified to find that my views in relation to the safety and efficiency of this plan, were amply corrorborated by several of the most experienced members in attendance. I am also able to state that from every one of my old pupils, who attended my lectures in the Toronto School of Medicine, over five and twenty years ago, I have invariably received the most unhesitating confirmations of the supreme value of acetate of lead in large doses, in the control, not only of uterine hemorrhages, but of some other forms, and not in a single instance have I ever learned of any unpleasant, much less of any dangerous consequences.

In my days of student life, we were all taught that acetate of lead was, in large doses, an "irritant poison." It is so designated in the "Dispensatory of the United States," sixth edition, 1845. Christison, in 1844, treating of this substance, says that, "though certainly an irritant poison, it is not very energetic," and that he has "often given it in divided doses to the amount of 'eighteen grains daily, without remarking any unpleasant symptoms whatever, except once or twice slight colic."

I am not at all surprised to learn that symptoms of colic followed the exhibition of the acetate in divided doses, to the amount of "eighteen grains in twenty-four hours," for I never but once saw any unpleasant results from this remedy, and that one was a case in which, in consultation, I failed to induce my professional friend to venture beyond five grain doses, and then

only in form of pill, combined with opium, to both of which methods I objected. In that case I saw for the first time in the field of my observance, the genuine lead gum, and I believe slight colicky symptoms were presented. My usual dose in post partum hemorrhage was one dram, dissolved in half a tumbler of water, of which I first gave half, and if this provoked speedy uterine contraction I gave no more; but if it did not I never hesitated to go farther. I took care only to use fresh samples, though even if some carbonate chanced to be present, this being insoluble, would soon fall to the bottom of the glass. I never added acetic acid; first, because it is unnecessary when we give the pure solution; secondly, because I believed chemical transformation is more likely to be facilitated than retarded or prevented by this addition. I never conjointly, or in alternation, gave opium, because I believed that the more speedily the salt was voided from the body the less likelihood of chemical change, and I often observed that large doses induced early alvine evacuations.

The promptitude with which large doses excite uterine contraction has often surprised me; and this fact has been most noticeable when instant vomiting (which however is not a general occurrence), has been provoked,

Some of my old pupils have told me they have given it in double, or even in treble the doses taught by me, and always with good, never bad results.

In profuse hæmoptysis, I have, within twenty-four or fortyeight hours, administered four, six or even eight drams, with out the slightest injury, and with signal hæmostatic success Finally I venture to say that pure acetate of lead, in large doses, is the surest and safest of all our medicinal incitants of post partum uterine contraction.

Reports on the Recent Propress of Medicine,

ARTICLE XXX.

SURGERY (FROM THE GERMAN.)

BY F. J. LUTZ, M. D.

EXPERIMENTAL AND ANATOMICAL INVESTIGATIONS CONCERNING ERYSIPELAS-THE ETIOLOGY OF ACUTE INFLAMMATIONS-INJURY OF THE RIGHT FRONTAL LOBE OF THE CEREBRUM-APHASIA-DEATH -OBLITERATION OF VARICOSE VEINS.

Among the many valuable papers read before the Seventh Congress of the German Society of Surgeons, which met at Berlin, April 10-13th, 1878, an essay by H. Tillmanns, entitled "Experimental and Anatomical Investigations Concerning Erysipelas," is especially interesting. Although erysipelas is said to have occurred "at all times and in all regions of the earth's surface," there are, nevertheless, in spite of the most extensive literature on this subject, many mooted questions connected with it, and of these none is of greater importance than that of its contagiousness.

It is well known that opinions concerning this point vary widely. English physicians have, since the time of Graves, declared their belief in it, and in this country, whatever may be the theoretical conviction of surgeons in practice, it has, so far. at least as we have been able to learn, been looked upon and treated as a contagious disease. In France the theory of its contagiousness is continually gaining new advocates, whereas in Germany it has generally been denied or considered contagious only in exceptional cases.

In his experiments Tillmanns first investigated the possibility of transmitting erysipelas from a patient to a healthy person by inoculation; whether the lymph, pus, the serous fluid of the vesicles and the blood produce a specific, i. e., contagious effect.