not reach these cells which seep along through the skin. In such cases we get a recurrence of the growth outside of the margin of the original treatment. In cancer of the breast, where we have involvement of the glands, we cannot expect to reach by caustics those cancer cells which have passed on to the lymphatic channels.

Dr. Morgan (closing the discussion): I have nothing to say in closing. The discussion has been mainly an agreement with what I said in my paper, and I have already taken up so much of your valuable time that I do not feel warranted in saying anything further. I thank you for the kind reception granted my paper.

PUERPERAL ECLAMPSIA, WITH REPORT OF

CASES.

BY S. RUMBLE, M.D., GOGGANSVILLE, GA.

In presenting this paper, I do not propose to discuss the many and varied theories which have hitherto been advanced as to the etiology of puerperal eclampsia, but merely to give some conclusions formed from my own clinical experience.

Theories and preconceived ideas when put to practical clinical test are often exploded and found to be utterly worthless. Perhaps more theories have been advanced as to the cause of puerperal eclampsia than any other known disease, and yet from the present status of our knowledge we can attribute puerperal eclampsia to no one specific

cause.

Congestion of the cerebro-spinal axis was long held to be the causative factor in producing the eclamptic seizure, and hence we find our predecessors were warm in the advocacy of blood-letting and other depleting remedies.

Whatever may be the cause of puerperal eclampsia, be it uremia, cholemia, hydremia or a toxemia of any kind, or a reflex irritation, it is obvious that the cause in producing the convulsive movements acts directly on or through the medium of the motor centers of the spinal cord.

In my short career as a physician I have seen only six cases of puerperal eclampsia, no one of which I could attribute to one cause alone.

The nervous centers in the pregnant state are supposed to be, and doubtless are, supercharged with nerve force. I

have seen one case of puerperal eclampsia which I could, barring a slight cholemia, attribute to this theory alone. In reporting the following six cases of puerperal eclampsia, I will state that none of them had any prophylactic treatment. I was called to every case except one after the convulsions developed.

Case 1.-Lizzie S., colored, pluripara, aged thirty-five. Was called to this case December 24, 1889, at 2 o'clock p.m. She had reached the eighth month of pregnancy and was seized that a.m. at 9 o'clock with a severe headache and pain in the epigastrium, which was immediately followed with a convulsion.

I found her in a comatose condition, the fourth convulsion having subsided just a few moments before I arrived. On examination found no dilatation, but cervix soft and yielding. I at once introduced my index-finger through the os and began to dilate by sweeping the whole length of finger around between the amniotic sac and lower segment of the uterus.

After dilating the os to the size of a silver dollar, I gave a hypodermic of fifteen drops Norwood's Tr. Veratrum, which was repeated every thirty minutes, until one drachm had been given. I also gave thirty grains chloral per rectum until 2 drachms had been given.

The convulsions came at intervals of about one hour, and at 6 o'clock, during the clonic stage of a very severe one, there was an ominous gush, which I thought was the rupture of the amniotic sac, but, to my surprise, on examination, I found the child and placenta lying between the woman's thighs. Uterus well and firmly contracted.

Child was still born and failed to resuscitate it. After having patient well cleansed, soiled clothing and bedding removed, I left the following prescription:

M. Sig. Two teaspoonfuls to be given every two hours when awake.

I left patient in a comatose condition with a temperature 102.5 degrees at 7 o'clock p.m. I was very much pleased at having the uterus emptied, but was much chagrined at not being able to control the convulsions with veratrum and chloral.

December 25.-Saw patient at 9 o'clock a.m.; she was still comatose, with pulse 120, temperature 103. She had five convulsions since the previous evening, making a total of 13 convulsions. I at once gave 1-2 grain morphia with 1-100 grain atropine hypodermically and gave same directions as to chloral and bromide as on previous evening, and emptied bladder with catheter. Saw patient again that p.m. at 6 o'clock. Pulse 100, temperature 102. She had aroused from the coma and had taken medicine and some nourishment. I ordered the chloral and bromide continued through the night and Epsom salts to be given the following a.m. in dessertspoonful doses every two hours until bowels were freely purged.

December 26th.-Saw patient at 4 o'clock p.m. Pulse 90, temperature 100. Bowels and kidneys had acted freely; she steadily improved after this and made a complete recovery. Her urine was loaded with albumen when I first saw her, which completely disappeared on eighth day after delivery.

She became pregnant and was confined again in about twelve months and died with an attack of puerperal eclampsia. The physician, Dr. R. E. Brown, who attended her, informed me that he used veratrum in heroic doses, rapid dilation and delivery with forceps.

Case 2.-Amanda O., colored, pluripara, aged 30, weight 160.

Was called to see her at 8 o'clock p.m., December

24, 1889.

She had completed the ninth month of gestation and was seized with convulsions that p.m. at 3 o'clock, she having had the fifth convulsion when I reached her. I found her comatose, os slightly dilated, cranial presenta-tion. I bled her at once, taking twenty ounces of blood from arm, also gave her thirty grains of chloral per rectum every hour until 150 grains had been given, without any perceptible effect on the convulsions, which continued to come at intervals of one to one and a half hours. I succeeded in delivering her of a small, weak, but living child at 2 o'clock the next morning. I left patient at 4 o'clock comatose; pulse 100, temperature 102. Ordered bromide

to be given in teaspoonful doses every two hours when awake as soon as the coma subsided. Also ordered husband to call me if the convulsions returned, which he did. at 8 o'clock, stating that she had had two since I left her. I returned and gave a hypodermic of 1-4 grain morphia with 1-120 grains atropia. Ordered bromidia to be given as soon as she could swallow.

Saw patient again that p.m. at 5 o'clock. She was conscious and could take medicine and nourishment. No convulsions since morphia had been given and had voided urine voluntarily. I ordered bromidia to be given every three hours when awake and Epsom salts the next morning in dessertspoonful doses every two hours until bowels were purged thoroughly.

December 26th.-Saw patient at 5 o'clock p.m. Temperature 99, pulse 80. She made a good recovery and was up in fifteen days. Urine contained a small amount of albumin, which totally disappeared on fourth day after delivery. Child remained weak and illy nourished and died at ten months.

Case 3.-Lizzie F., pluripara, aged twenty-five. I was called to this case at 5 o'clock p.m., July 4, 1892. She was attended by midwife three days previously, and after a normal and easy labor delivered of a well-developed,