ered at 9 a.m., October 6, 1896, after four hours normal labor. Everything progressed satisfactorily until October 10th. Had slight coldness followed by high fever, lasting all night. I was called to see her on the 11th, and found temperature 102, pulse 108 per minute. Lochial discharge suppressed. I gave calomel and quinine freely and ordered vaginal injections of hot water previously boiled. Symptoms were all much improved on and during the 12th, but at midnight she again suffered with slight chilliness and high fever to follow. I saw her again on the morning of the 13th, in the following condition: Temperature 105, pulse 132 per minute, with working of the ala nasi. I gave a vaginal douche, then washed out uterus with boiled water and followed with a small quantity of the antiseptic solution as before stated. Temperature immediately rose to 106 F. Patient appeared almost frantic. I used morphine, whisky and phenacetin, and later used cold sponging afterwards to reduce temperature. I repeated the intra-uterine injections again in six hours, with the same effect as before, but found no flakes of membranes or shreds in the returning fluid. For the 14th and 15th I contented myself with vaginal injections. I gave quininein doses of grs. 10 repeated every six hours, brandy given in one half ounce doses hourly, with an occasional calomel and ipecac tablet, which effectually kept the bowels well open. She was sponged occasionally with cold water, a dose of phenacetin given to lower the temperature, fed freely on eggs and milk with broths. Temperature ranged from 103 to 105. On the night of the 15th, thinking that there must be a generation of poison in the womb with a constant absorption, I again resolved to use the intra-uterine douche with results as before stated, with an immediate rise of temperature to 106, with quick, weak and feeble pulse, with a condition simulating that of collapse.

A number of bottles filled with hot water were used in

bed around patient, with free stimulation, which soon revived patient again, and from this time on through the remainder of her illness I contented myself with vaginal injections alone.

Temperature still ranged high on up until the night of the 17th, but brandy and quinine was pushed as before stated. Skin acted well, patient slept and rested well, appeared very stupid, but on the night of the 17th temperature had fallen to 101, pulse began to slow up, and patient's appearance was brighter, so that by the night of the 19th she was entirely clear of fever. This case is one that I regard as produced by malaria. This patient lived in a locality infected with malaria, and had had previous attacks of fever and biliousness. Garagues recommends after the intra-uterine douche a suppository put high up into the cavity of the uterus with long dressing-forceps bent like the intra-uterine glass tube through a Cascoes speculum.

Misce paste. Divide into three suppositories, size and shape of little finger.

With this suppository I have no real experience, but am very favorably impressed, for, as before stated, I use iodoform in my antiseptic solution as a final douche. In many cases we will find pain, sensitiveness, with swelling in one of the broad ligaments (parametritis); in such cases an ice bag applied over affected parts, with iodine painted over lower portion of abdomen, with all the foregoing treatment as indicated with the particular case in hand, will end the inflammation in a few days as a rule.

As the uterus usually remains large in such cases, I give 20 minims of F. E. ergot three times a day to promote involution in the uterus. It should be used for quite a num

ber of days. The external genitals should be kept scrupulously clean, using the antiseptic, and disinfectant carbolic acid in boiled water for this purpose, with a constant change of apparel. If headache be severe, use ice to head, and if fever remains high, sponge entire surface with icewater. I use morphine hypodermically when there is much local pain. The foregoing is my treatment in general, except in cases as reported, when the temperature, far from reducing, rises when intra-uterine douches are used, but actually increases; then I rely upon vaginal injections and general treatment.

I do not use the coal-tar preparations much in this disease, and when I do use them, I guard them well with stimulants, because septicemia is a disease that rapidly exhausts the victim whose lot it is to be the unfortunate, and coal-tar preparations only add fuel to the flames. They disguise symptoms, lower the vitality, and allow the disease to make further inroads upon the system. I prefer phenacetin to any of the group. I use stimulants in some cases, almost unlimited. Early, vigorous and conservative treatment is demanded. Tonics, of course, are required, for the restoration of the general health, when acute symptoms have ended.

THE PRESENT STATUS OF PUERPERAL

INFECTION.

BY R. R. KIME, M.D., ATLANTA, GA.

The general practitioner, the obstetrician, the surgeon, the gynecologist, all are interested, directly or indirectly, in puerperal infection and its results.

Volumes have been written upon this subject, and yet its pathology and treatment present unsolved questions for future study and investigation.

This curse of woman existed in the dim ages of the past and continues to work its devastation and ruin even in the present antiseptic and aseptic era, but to a more limited

extent.

Hippocrates recognized this condition and attributed it to suppression of the lochia.

Puzos, of France, in 1753, attributed it to metastasis of the milk.

"If peritonitis, the fibrinous exudate was called milk; if phlegmasia alba dolens, milk had settled in the leg; if delirium, milk had mounted to the brain; if arthritis, milk had settled in the joint."

Virchow' considered it erysipelas of the peritoneum and designated it as erysipelas malignum internum. (2P. 425.) Plouteau, in 1750, called the disease epidemic erysipelas of the peritoneum. (P. 427.)

Kirkland, in 1774, contended it might be produced by

18ystem of Obstetrics, American.

2 Ramsbotham's Obstetrics, 1847.

the absorption of putrid matters lodging in the uterus. (3P. 232.)

Péu states that in 1664 a prodigious number of puerperal women perished in the Hotel Dieu, attributed by M. Veson, physician in charge, to the lying-in wards being immediately over those for receiving the wounded. The women were attacked with hemorrhages, and on opening their bodies were found full of abscesses. (P. 232.)

M. Tenon states in the epidemic of Paris in 1774 and '75 the lochia flowed, but did not flow in that of 1746. He did not observe the hemorrhages that occurred in 1664, that the uterus was not found dry, hard and tumefied as in that of 1746. (P. 233.)

Dr. Gordon, in his treatise 1795, claimed the disease was undoubtedly produced by a specific contagion. ('P. 23.)

William Hunter, about 1750, said those attacked with this disease, treat them in what manner you please, three out of four will die.

Richer, about the same time (1750), claimed to have treated the disease successfully and had a right to offer his opinion. His successful treatment was: "On the first symptoms of chilbed fever, give a purge two days successively, each enough to operate three times. On the following days smaller doses were given, enough to operate once, or at most twice, and this plan was continued until all symptoms had ceased." ('P. 25.)

Dr. Gordon, of Aberdeen, during an epidmie from 1789 to 1792, used blood-letting as the essential remedy employed early and freely, when he took twelve ounces away the patient generally died, but when he took twenty-four ounces away at once, and during the first six hours of the disease, the patient commonly recovered. He also used purgatives. ('P. 27.)

3Cyclopedia Practical Medicine, 1859.

4 Gooch Diseases Women, 1836.