in the back and head. The temperature was 102° F., face flushed, conjunctiva injected and slight cough. As the patient had been free from any unfavorable symptom during nine days and had no evidence of any septic infection, I had diagnosed the case as grip and ordered 10 grain doses of antikamnia every three hours and liberal doses of stimulants. The patient was able to be up two days later and felt perfectly well, but rather weak. The third case occurred within a week from the last, and the first symptoms appeared on the third day after confinement. This rather alarmed me, as the nurse was dirty and a possibility of septic infection feared. The symptoms were so characteristic, however, that a diagnosis of grip was made. In this case there was some irritability of the rectum, and the patient complained considerably of a burning diarrhoea, which was relieved by suppositories of opium and belladonna. The temperature went as high as 101° F., and there was considerable cough after the fifth day. Antikamnia and whiskey were again effective, and the patient was able to be up on the tenth day, although rather weak. The next case followed a week after, the symptoms coming on two days after delivery of a seven months' foetus, and caused some anxiety, as the placenta was adherent and had to be detached by introducing the hand into the rectum. The characteristic back-pains and injected conjunctiva and the absence of abdominal tenderness soon cleared the diagnosis. The same treatment was instituted as in the other cases with equally good results. The premature delivery was possibly due to the disease. There has been very little literature on this subject during the past year, the only article I find being a paper read by Dr. Addinsell at a recent meeting of the Obstetrical Society of London, in which he cites several cases which had been under his care and shows how the symptoms of influenza differ from those of puerperal septicemia. He considers that influenza attacks the weakest spot, and quotes instances of several patients seized with the disease at the time of menstruation, who suffered and still suffer from ovaritis traceable to that time; and he suggested that the various symptoms seen in puerperal septicemia, and which were very marked in the most severe of his cases, might be due to the necrotic elements of the endometrium not being carried off in the same lochial discharge, and thus being absorbed and carried into the cerebral circulation. CREMATION FROM AN ECONOMIC STANDPOINT. We are very glad to learn that the San Francisco Crematory has at last been finished, successfully tested and formally opened to use. It is not at all creditable that the metropolis of the Pacific Coast has been anticipated in this improvement by Los Angeles, but it is certain that there will be no retreat from the forward step, for it is in line with the steady advance of science. In due time religious and sentimental opposition to this method of hastening nature's slow chemical action will give way, and all will discover how much more cleanly and healthful it is than burial. The most effective argument for its adoption, however, will be economy, and its advocates must provide facilities for rapid and cheap incineration, and so save families all unnecessary expense. It is well known that the cost of a respectable funeral is habitually a source of serious embarrassment to poor families. Much of this can be saved by suitable regulation of one or more crematories. It will be found practicable in time to sweep out the ashes from a lower compartment of the furnace without waiting for it to cool down, so that a continuous heat can be kept up for days, or perhaps weeks, with great saving of fuel. The consumption of the coffin is undesirable, for the relatives do not wish to preserve its ashes along with those of the body, and thus an item of expense may be saved. As a means of educating the public, conducing at the same time to economy in public expenses, it would be well for the municipal authorities to establish a crematory in the city cemetery, to be used in place of burial at public expense; and arrangements might be made to allow its use by private parties for a nominal charge. This would serve to popularize the method, after the example of cremation has been set by the most intelligent part of the community. We will not dwell on the sanitary feature of cremation, as it is unnecessary for our own readers; but take the opportunity to suggest another line of argument which they can use with the laity, and which the latter are quite competent to appreciate. The two most effective reasons for bringing cremation into vogue will be the lead of genteel people and 'the discovery that expense can be saved; we therefore hope that those who are able to bear the expense of fashionable burial or cremation, and prefer the latter method, will set the style of moderation in display and cost, so that people in poorer circumstances can easily afford to follow the good example. The cost of ground for burial purposes is already a considerable item in San Francisco, and will rapidly increase. The city cemetery will, in a few years, be needed for building lots, and the sale of a small portion would now meet the cost of a crematory. Cremation of paupers would cost less than burial, so that the city would save from the beginning. For private parties the expense of burial lots would be saved, which is no mean item. A CASE OF INFANTILE SCORBUTUS. By MARY DELANO FLETCHER, M. D. (Read before the Women's Medical Club of the Pacific, Dec. 9, 1893.) In April last was called to H. L., aged ten months. His mother reported the child as sleepless, refusing food, and having a sore mouth. Had been somewhat constipated all his life—a tendency, she believed, he inherited from herself, an otherwise remarkably healthy woman. I found, on responding to the call, a plump, well developed child, who seemed pleased at my noticing him until I attempted to examine his mouth. As his mother had described it, his gums were so swollen as to almost cover the five teeth he had cut. The swelling was uniform, of a purplish color; small points of pus appeared close to the teeth, and the odor was disgusting. The purple color extended toward the roof of the mouth and the inside of the cheeks, but the throat seemed clear and healthy. The examination was painful and caused some bleeding, and I was not surprised that the child refused his bottle.. Investigating further, I obtained additional history of some sweating, passages sometimes streaked with blood; the appearance of several small purpuric spots upon the limbs and occasional occurrence of a purplish discoloration of the eyelids. The child's body was well rounded and firm to the touch; no changes appeared in outline of bones, no swelling in the course of the long bones or ribs, nor of the joints. Yet the slightest touch of the tips of the toes caused severe paroxysms of the crying indicative of intense pain; and he seemed unwilling to move his legs in any direction, though he remained in a sitting position easily. This tenderness of the toes and feet terrified the mother, as the next younger child (who had died of scarlatinal nephritis) had suffered from rheumatism at six months of age. (This was previous to her coming to California.) As to diet, I found that the milk secretion having ceased when the child was one month old, the mother had substituted what she had fed all her babies upon-thin graham gruel to which was added a little milk. And as the child had developed mentally and physically, and, though always somewhat nervous, had been of a very happy disposition, she had felt well satisfied until the discovery of the sore mouth-which discovery had occurred a few days before calling me-having delayed doing so through thinking the swelling due to further dentition. For the mouth I ordered a boric acid solution, and as washing it caused excessive crying, recommended the use of an atomizer, to which the child did not object. Requested feeding to be from a spoon, as the child could not use his bottle; and as red rubber nipples had been used ordered the substitution of the black ones. The food I ordered to be diluted milk-this the child at first refused; with this gave half-teaspoonfuls of Wyeth's beef juice, diluted with a tea made from celery root-in this way securing a vegetable, the mouth being too tender to permit the giving of orange juice. Disliking the indications of purpura hemorrhagica, I requested the avoiding of all excitement, crying, etc., as far as possible. Ordered the bowels relieved by enemata and gave lupulin to induce rest. Under the eternal vigilance of the mother, who nobly seconded my efforts, the mouth improved, but in odor at first. As the pus continued, gave small doses of calcium sulphide, and had the satisfaction of seeing the mouth steadily, though gradually, improve. Early in the evening of April 13th, came an urgent messagesomething had happened to the baby's eye; he had been playing with some toy, and had so hurt his mouth as to cause severe crying, during which the right eye had, as his mother said, "popped forward." I found the little one with his head hanging over his mother's shoulder, moaning and sobbing, and evidently as thoroughly terrified as were all the rest of the family. The ball seemed protruding nearly three-fourths of an inch, outward and slightly downward, the lid being swollen and red; the pupil reacted normally. Placing the child in a dorsal position, I shaded the eyes carefully, applied cool water and gave sufficient camphorated opium to control the pain, also gave a small quantity of ergot to assist in preventing further hemorrhage. Though fully convinced that a post-ocular hemorrhage had caused the protrusion, I immediately requested consultation, either by removing the patient to the hospital or by summoning local aid. The latter course being decided upon, Dr. E. S. Clark was sent for. By the time he arrived the child was quiet, and having retained the recumbent position, the deformity seemed less. Dr. Clark confirmed my diagnosis, though fearing the possible development of cancer. He suggested no change in treatment, save the giving of koumys and the application of warmth if preferable. The next day the mouth was sufficiently improved to permit the child's taking some orange juice, which he enjoyed. But owing to the ecchymosis around the eyes his appearance of being a very sick baby was more marked, and to satisfy myself, I requested further consultation. Being told to select whom I would I telephoned for Dr. Buckel and Dr. Shuey, who responded at once. These ladies were most kind in their interest in what was, to me, a unique case, and, while satisfied with my treatment of the case, suggested my giving minute doses of aromatic sulphu ric acid. As the child utterly refused the koumys, I substituted ferrated maltine, diluted with celery tea, which he took readily. In a few days he was able to use his bottle, and, a little later, surprised us by cutting three teeth with no return of mouth symptoms. Of course I stopped the various drugs as soon as was expedient; and increased the quantity of food as seemed indicated, as well as variety, giving strawberry and currant juices as it became possible, and substituting strong meat broths for the Wyeth's extract. The enemata I continued to prevent all straining, until the child could with safety take some exercise, and he was wheeled out into the sunshine daily. His merry disposition returned long before the effusion behind the eye had been absorbed, though it was sometime before he would kick about or play with his feet as formerly. However, he was evidently cautious then, as now, for, though he could creep and push himself about the room as soon as allowed, he has been walking but a short time. The teeth have developed naturally; he is now cutting the canines without trouble. |