they have been called, "faithful messengers announcing to the clinical observer the anatomical condition of the kidney." When hyaline casts are persistent for a long time, however, they indicate as a rule a confirmed lesion. Granular casts, when found repeatedly in albuminous urine, are considered of greater importance. Finally, the emission of casts may be suspended during Bright's disease, or they may be absent for several months. Such a case is mentioned in which eight grammes of an orange-colored mass composed of cylinders were found after death retained in the pelvis and calices. The amyloid kidney and scarlatinous nephritis, being secondary affections, are not considered as properly classified among Bright's diseases.

Citrate of Caffeine as a Diuretic in Cardiac Dropsy.· Dr. Lewis Shapter1 reports four cases of the successful use of this remedy for the relief of dropsy in advanced disease of the heart. Professor Gubler first drew attention to this property of caffeine. In the cases reported the dose of the drug was limited to three grains once in four hours, owing to its tendency to cause nausea and vomiting in larger doses. The quantity of urine was increased from one pint to three or four pints in twenty-four hours, the action of the heart improving in strength and regularity. Digitalis had been used in some instances without benefit.

The Treatment of Delirium Tremens. - Dr. George W. Balfour 2 describes the method adopted by him for the treatment of delirium tremens at the Royal Infirmary, Edinburgh, during the past nine years. He points out the tardy appreciation of the fact, so clearly shown by Dr. Ware, of Boston, fifty years ago, that delirium tremens runs its natural course in from sixty to seventy-two hours, and that the remedies employed are often more dangerous than the disease. Such are large and repeated doses of opium and the large quantities of tincture of digitalis recommended by Mr. Jones, of Jersey. Dr. Balfour has found bromide of potassium in half-drachm doses given every hour, for ten or twelve hours perhaps, effectual in many cases. Chloral hydrate, however, is the main-stay, in doses of forty grains every hour for three hours if necessary, and only in the rarest instances has the third dose been required. One hundred and twenty grains, in divided doses, is not considered by the author a dangerous amount, as elimination goes on at the rate of about seven grains an hour. Dr. Balfour regards the use of alcohol after the beginning of an attack, or when an attack is threatening, as entirely bad, and has found it necessary in the course of the disease in the rarest cases only, when the exhaustion is great. Then it delays the cure.

Sunstroke in St. Louis. - Dr. Thomas Kennard, of St. Louis, in a

1 The Practitioner, January, 1879.

2 Lancet, February 1, 1879.

3 New Orleans Medical and Surgical Journal, October, 1878.

cent.

carefully written and comprehensive article gives the statistics, so far as attainable, of the large number of cases of sunstroke 3000 or more in St. Louis last summer. The population of the city is stated at 505,000 at the lowest estimate, and the area at sixty-two square miles. From July 10 to July 20, 1878, the thermometer ranged between 83° F. and 100° F., and during these ten days there were 154 deaths from sunstroke, one third of the total mortality of the city, beside 50 deaths from cholera infantum, 17 from apoplexy, 40 from convulsions, and 34 from other diseases of the brain and nervous system, many of which were attributable to the heat. Seven negroes died from sunstroke. The nationalities were Germany 62, United States 36, Ireland 30, England 6, other countries 10. The proportion of Germans is in accordance with their relative number among the working population, 40 per One hundred and twelve cases were treated at the City Hospital, of whom only nine died. The author attributes the phenomena of sunstroke to the excessive heating of the blood due to loss of function in the heat-regulating nervous centres in the upper portion of the spinal column. Few thermometrical observations or autopsies were made at St. Louis, although, as the author remarks, "the opportunities for such investigations were much better and greater than are likely to occur again in fifty years." According to his observations, however, the temperature ranged from 108° F. to 110° F., and the chief characteristics after death were great congestion and oedema of the lungs, peculiar fluidity of the blood, and generally anæmia, not hyperæmia, of the brain, with engorgement of the right side of the heart. From these appearances Dr. Kennard concludes that death takes place from true paralysis of the heart dependent upon derangement of the nervous centres. The treatment was directed to lowering the temperature of the blood by the judicious application of ice and ice-water to the head, the nape of the neck and spine, and if necessary to the whole body, supplemented by the use of the cold douche from a height of three or four feet, fanning, etc. Drachm doses of aromatic spirits of ammonia and stimulants were given as soon as the patients could swallow, and sedatives when required. Bromide of potassium in large doses was found to act as a prompt diuretic. The convulsive cases were not benefited by cold affusions, and some cases needed warm applications and hot mustard baths instead of cold. After the danger is over a cathartic and twenty grains of quinine are recommended. Great caution during convalescence is necessary.

PROCEEDINGS OF THE OBSTETRICAL SOCIETY OF BOSTON.

C. W. SWAN, M. D., SECRETARY.

JUNE 9, 1877. The Condition of the Teeth as affected by Uterine Disease. DR. RICHARDSON remarked that it was a fact entirely new to him that the texture of the teeth may be affected by uterine disorder, and this in distinction from the effect of other forms of ill health, and gave the particulars of the case which drew his attention to the subject. Nearly two years ago a young woman was sent by him to Dr. Bradbury for certain operations on the teeth. The dentist reported that the teeth were very firm and solid,—"cut very fine," in the language of the craft. The patient subsequently had painful menstruation. Three months ago she again consulted Dr. Bradbury, who inferred that she must have some uterine disease, as a peculiar change had taken place, the teeth having entirely altered their structure. Two days ago Dr. Richardson removed a small fibroid tumor from the uterus. DR. SINCLAIR remarked that it was well known that pregnancy frequently affects the health of the teeth. DR. HOSMER asked if the change were unlike the structural changes which occur in the other sex. - DR. BIXBY said that Dr. Hawes, dentist, of Boston, some seven years ago wrote a paper entitled The Interdependence of the Teeth and of the Female Pelvic Organs.1

OCTOBER 13, 1877. Incontinence of Urine after Labor. DR. WELLINGTON reported the case, which he said was unique in his practice. The patient was a primipara, twenty-six hours in labor, delivered by the forceps. She did well in most respects, and began to get up in the fourth week, but she could not retain her urine, except to a limited extent. On careful examination nothing like fistula was discovered, and it was decided that the case was one of pure incontinence. She took equal parts of the tinctures of iron and cantharides, and was well in about two months.

Relief of Wakefulness due to Micturition. — DR. CHADWICK said that he was reminded by the last case of a recent experience showing the abnormal effect of the exercise of a simple physiological function upon the nervous system when morbidly sensitive to all impressions. A patient who was under treatment for uterine trouble complained of being roused from sleep almost every night at three or four o'clock by the necessity of emptying her bladder. This act was physiologically performed, but was followed by such a distressing sensation of "goneness" in the abdomen that the patient was generally kept awake and restless until nearly morning. In view of the patient's general hyperæsthesia, and of her having a very hollow abdomen, Dr. Chadwick had conceived the idea that the diminution of the contents of the small abdominopelvic cavity by the discharge of quite an amount of urine caused so considerable a retraction of the abdominal walls as to constitute the sole source of the discomfort and consequent wakefulness. Acting upon this theory he had or dered the patient to drink a tumbler or more of water immediately after urinating, by which means nearly as great a volume was introduced into the upper

1 Gynecological Journal, vol. ii., page 34.

part of the abdomino-pelvic cavity as was evacuated from the lower part. The success of this expedient was perfect; on the next night and subsequently his directions had been followed, with entire relief of the distressing sensations and of the wakefulness. Dr. Chadwick remarked that it was common for people to feel this sense of "goneness" after vomiting, and conjectured that it might arise in part from a similar cause. DR. SINCLAIR said that he had obtained decided benefit from the tincture of the muriate of iron with pills of the extract of belladonna in cases in which incontinence had continued for many years. With reference to the case detailed by Dr. Chadwick, he observed that some women will feel worse after a movement of the bowels, and mentioned the fact that the goneness of dyspeptics is often relieved by a mouthful of water. - DR. Goss mentioned a case quite similar to that described by Dr. Wellington. Incontinence followed tedious labor terminated by forceps. The symptom disappeared under the use of the tinctures of iron and nux vomica.

Ergot in Parturition.

DR. RICHARDSON said that he had been particularly struck with the way in which ergot was used in the Rotunda Hospital in Dublin. Immediately after delivery an ounce of the infusion of ergot is given. As a rule, the dose is repeated three times a day, in cases of multiparæ, for two days. In all cases where there is any tendency to flowing, to a relaxed condition of the uterine walls, or where there is any appearance of tenderness over the uterine region, the infusion of ergot is given in ounce doses, at intervals varying from two to six hours, depending upon the urgency of the symptoms. The result has been, according to the testimony of the physicians, a marked diminution in the frequency and severity of labor pains, the prevention of a tendency in some cases to subinvolution, and the immediate disappearance of all threatening symptoms of an inflammatory nature about the region of the uterus or ovaries. The lochia, also, are less frequently found to be offensive, and their duration is perceptibly shortened. The forceps are very often used, and there is no hesitation shown in applying the forceps to the head in a high position, provided only that the os uteri is at least two thirds dilated and dilatable. The patients, as heretofore, are about the ward, as a rule, on the fifth day, and go home the eighth. The results thus obtained in the Dublin Lying-In Hospital were very similar to what had been observed in the Boston Lying-In Hospital, where ergot is very generally used, although not to the extent that it is in Dublin. -DR. LYMAN said that for twenty years he had given ergot just before the emergence of the head, and then a dose or two doses afterwards. The proper mode of its administration originated with McClintock and Hardy when they were internes in the Dublin hospital. DR. FIFIELD observed that ergot sometimes produced such a contraction of the uterus as to make it difficult to get at the placenta. — DR. LYMAN replied that he had never had any troublesome closure of the os uteri from its use. When he began practice ergot was considered a very dangerous article, as liable to produce gangrene, and requiring great care in its use. Later, Dr. Brown-Séquard demonstrated its invaluable property of causing capillary contraction, whence has followed its use in meningeal congestion and other affections. Now ergot is administered with the greatest freedom. Dr.

Lyman had given a drachm of Squibb's fluid extract three times a day for months together with marked good effect in nervous troubles connected with uterine disease, and also in fibroid deposits about the cervix uteri.

NOVEMBER 10, 1877. Abortion; Peri-Uterine Inflammation; Pelvic Abscess opening into Rectum; Secondary Abscess in Abdominal Wall. — DR. HALL CURTIS read the case :—

H. S., aged twenty-one, Swede, domestic, and single, entered the City Hospital February 16, 1877. Five weeks before entrance she began to flow. This has continued ever since, though lately diminishing. The catamenia had been absent six weeks when the flowing began. Previously she had always been regular. She complained of pelvic pain and general weakness.

R Fld. ext. ergot, gtt. xx. 3't. d.

February 18th. Uterus is slightly enlarged and antiflexed. The os is largely dilated, admitting with ease two fingers. The cervix contains a soft mass, extending to fundus; this was removed piecemeal with the fingers and forceps, followed by free hæmorrhage. The inner surface of fundus and sides of uterus presented rough ridges, as if portions of the mass were adherent. The vagina and uterus were washed out night and morning with a solution of carbolic acid, and the patient continued very comfortable, with a temperature of 98.7° F., till the night of the 20th, when she had a very severe rigor. February 21st. Morning temperature 104° F. Pulse 120. Complains of sharp pain under left nipple, worse on coughing, slight headache, and vague pains in hypogastrium. Vaginal discharge slight and offensive. Heart and lungs normal. P. M. temperature 105° F. Quinine was given in three-grain doses every four hours during the next three days. The temperature came down on the 22d to 99° F., became normal and remained so till the evening of the 26th, when it rose to 104° F. This day she had walked about the ward, contrary to orders, and towards evening had severe chill, with intense headache, followed by delirium. Six grains of quinine were given, and the following morning the temperature was 98.5° F., rising at night to 105° F. The uterus was more sensitive, os admitting first joint of finger, followed by slight flowing. February 27th. Morning temperature 98.2° F. Quiniæ sulph. gr. vi. at eleven A. M. and twelve M. February 28th. Quinine gr. ij. given at seven A. M., and repeated every hour till noon. The temperature continued about normal till March 5th, when the evening temperature was 104° F., and the catamenia appeared. March 6th. A. M. temperature 102° F.; P. M. 104° F. March 8th. Severe pain in both hypochondria, but especially in right. Was very restless last night. P. M. temperature 99.2° F. March 9th. Feels better. Temperature 100.5° F.; P. M. temperature 101° F. March 10th. Restless night. Had severe chill and vomiting. Now perspiring freely. Catamenia continue. Slight pain in anterior part of right hypochondrium, and also along left sciatic nerve. Poultice to abdomen. March 11th. Had a good night. Very comfortable. Heart and lungs normal. March 15th. Temperature A. M. 100.6° F.; P. M. 100.4° F. Catamenia disappeared day before yesterday, reappeared to-day. The uterus is now fixed; the posterior and left cul-de-sacs filled with a firm and rounded mass, extending well up towards the left iliac region, very tender, with distinct sense of fluctuation. Per rectum, same mass felt, with possibly a fistulous opening felt on anterior wall of rectum, three inches above anus; free discharge of pus from rectum. Poultice to abdomen continued. Hot carbolized douche night and morning. Quinine and sherry.

Ry Plumbi iodidi

Ext. belladonnæ

Ol. theobroma

Ft. pessaria No. xii.

3 iss. gr. xxv. q. s. M.

One night and morning. March 19th. A. M. temperature 98.2° F. P. M. 98.5° F. Posterior and lateral cul-de-sacs less distended and less tender. Enlarged fundus felt behind pubes, blended with the mass. On posterior and right aspects of uterus, and slightly movable from it, is a round, tender mass the size of a walnut, perceived through the right cul-de-sac, and also through abdominal wall some three inches above pubes, probably in right broad