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avoided confining myself within the bounds renumeration. As an epicurean, Brillat Savarof specialism, sure that no specialty whatever in, who was also a man of distinguished abilican stand solitarily and securely alone. Real-ty, would have found the sameness too great izing that upon the education of the laity the in his proposed experiences. Variety, you success of the best practice of medicine ulti- will find to be, ever in labor, some refreshmately rests, just as charlatanism conversely ment to the weary worker. Expect your rests on the promotion of ignorance, it has difficulties. It is through them men are moldbeen my aim at all times to communicate ed. Look forward to a worthy goal. It will such sound information to the laity as they lesson your trials and reward your success. are capable of comprehending. The chief hold that homeopathy has, is derived from ignorance of fundamental principles, and its invitation to the ignorant among the laity to play baby-house in sickness, which may begin with what is thought a trifle, but may end with death. I have in preparation now a work addressed to the laity, giving in popular form sound ideas as to all that conduces to well-being. If I intend that it shall be entitled "Health and Personal Beauty," my ulterior intention will be fully revealed when it is found from the text that I regard the art cosmetic as chiefly nature's art, and health, beauty, and mind, conjoined, as representing the highest being, conditions which, if life were ideal, would be one and indivisable.

In concluding my address, I deeply regret to announce to you that Prof. James Garretson, your eminent Professor of Oral Surgery, whom we all love and venerate, and who occupies a warm and dear spot in all students' hearts, retires from his active duties. His name, however, has been, and will continue to be, quoted and lauded in our college halls, as a great thinker, a skillful surgeon, and a careful and precise teacher to the future doctor of medicine. In addition to his other exacting work, Dr. Garretson has always been a decided advocate of professional progress, and las accomplished much for his profession by his choice contributions to medical and scientific literature. I therefore, in behalf of my colleagues, upon this occasion tender to our distinguished and only emeritus professor our wishes for his future health, peace,

many years, and may he be enabled during his allotted time to continue to give his adopted Alma Mater his wise counsel.

All is not lovely in our profession. If it were, where would be the crown? There are patients who are stupid, who are weak-minded, and happiness. May his life be spared who disobey, who neglect the honorarium. But no physician, I am satisfied, can be truly good unless, as well as those whom he treats, he be patient. Brillat Savarin draws a beautiGentlemen of the graduating class, I bid ful picture of an ideal practice when he says: you farewell. In leaving us, I trust that you "If I had been a graduated physician, I would, will not fail to cherish in grateful remembrance first of all, have written a good monograph your Alma Mater, that you will look back on obesity. Then I would have immediately upon the time that you have spent here as established my empire in that nook of science, having been fruitfully spent; that honor, and I should have had the double advantage comfort, reputation, happiness, may attend of having for patients the healthiest people, your way. When you think of us, your late and of being daily besieged by the lovelier preceptors, we trust that it will be with the portion of mankind, for to have just the right friendliness that we feel for you. We have amount of plumpness, not a whit too much nor too little, is with women a study of their lives. . . . That which I have not done, some other doctor will do; and if he is at the same time skillful, discreet, and a good-looking fellow, I predict for him a marvelous success.”

But, gentlemen, that does not describe the practice of medicine. It is the aspiration of an epicurean for an easy time and plenty of

striven to do our duty by you; to give you, during your three years' course, the most thorough grounding for your future medical career. The rest remains with youselves to accomplish. We cannot part with you without sadness at the thought that our pleasant daily relations with one another must now be severed. We are only consoled in looking to you to shed lustre upon this, the institution

of your choice. Gentlemen of the graduating fenestrated polypus-forceps, which I show class, I bid you, in the name of my colleagues you, and twisted off the now foreign body. and myself, with every wish for your health Or, indeed, if he had not this instrument he and happiness a regretful farewell.

Delivery of a Retained Placenta.

A Clinical Lecture delivered at the University Hospital.

BY WIILIAM GOODELL, M. D., PHILADELPHIA.

might have plugged up the cervical canal with iodoform gauze, or with a linen handkerchief made aseptic by being boiled; or he might have tamponed the vagina. In my experience both these measures would have speedily detached the placenta and hastened its expulsion.

You may tampon the womb up to the fourth month, because this organ by that time is not GENTLEMEN-The case that I have to show large enough to contain sufficient blood to you to-day is most interesting, because it is a destroy the mother by concealed hemorrhage. most practical one. It is this: A woman, But if four full months or more have elapsed thirty years old, married for thirteen years and since the beginning of pregnancy, the womb with four children, miscarried one year ago, has become capacious enough to hold so much at the end of a three months' gestation. The blood that the woman may bleed to death in physician in attendance at the time frankly it, although no blood may escape from the confessed that he could not remove the after- body. I, indeed, have never tamponned after birth. It never came away; and she has since three months, but I think that desperate cases been losing blood off and on, more or less, of flooding after that period of gestation until she is now, as you see, quite bloodless might occur, in which the physician would be and very pale. Yesterday my son tried to justified in packing the womb itself, when measure the womb with the sound, but its everything else failed. It is related by Joulin, introduction was at once followed by such an I believe, that, in the days of knee-breeches, alarming flow of blood that he was forced to shoe-buckles and gold-headed canes, a physiplug up the cervical canal and tampon the vagina. He tells me that the womb measures over four inches, and that the hemorrhage was the worst that he ever saw, excepting in some cases of post-partum flooding. What is the diagnosis? Clearly that within the womb is imprisoned a placenta, so vitally attached to the uterine walls that it has not decomposed. Of this I am certain: firstly, because the history points to this interpretation; secondly, because so alarming a hemorrhage followed merely the use of the sound; and thirdly, because I have repeatedly had just such cases.

cian finding a post-partum hemorrhage uncontrollable, pulled off his powdered wig, crammed it into his patient's uterus, and saved her life thereby.

The question now arises: Why is a miscarriage more dangerous than a natural labor at term? The answer is, because the very fact of a miscarriage implies some lesionsomething abnormal; because, the placenta not being fully formed, the chorion villi are attached to the whole surface of the womb and some portions of the membrane are liable to remain behind and cause either hemorrhage or septicemia. Then again, the cervix is not effaced, and the small canal is

Now, what should the physician have done under the circumstances? By hook or by crook he should have removed the placenta. liable to close up on the retained fragments. By aid of ether he could, using every antisep- A criminal abortion is still more dangerous, tic precaution, have caught one lip of the cer- because gestation is abruptly interfered with vix with a volsella forceps, dragged the womb before any detachment of the membranes has gently down, and passed in one finger at least taken place, and their retention is therefore into the uterine cavity. He could then have far more likely to happen than in an honest scraped off the placenta and membranes. Or, miscarriage. A stung or decayed apple falls if that did not succeed, he should have intro- from its bough at the slightest breeze; while duced a blunt curette, or preferably, this to pull off a healthy green one, demands a

force which often snaps the bough from which which in this case was equal to the most

formidable post-partum flooding. I know better now than to use the dangerous curette. What one needs here is an instrument which shall both dislodge and immediately remove

it hangs. This illustrates the difference between a natural miscarriage and a criminal abortion. In the former, the process of detachment is slow and usually complete. In the latter, the detachment is violent, incom- the offending body. This instrument is the plete and traumatic. The result is, retention of the membranes, from which come serious hemorrhages and still more serious septic infections. Should the patient fortunately escape these, she hardly will escape an arrest of involution, and its resulting discomforts.

But to come back to our patient, who is now wholly under ether. What is the present state of affairs in the womb? Taught by several very alarming experiences, I can tell you exactly what it is. The placenta will be found perfectly sweet, rolled up at the detached end through pressure, like a scroll, with a large portion adherent to the uterine wall, and fed by sinuses of great size. Now, the sound which my son introduced probably pushed only one limited portion of the placenta off from a single uterine sinus, yet the flow was excessive. Three times have I passed a blunt curette in the wombs of just such cases, and the hemorrage was so terrific that I had to resort to the promptest measures for its arrest. One case was an inmate of my private hospital to which she had been brought on account of repeated and exhaustive hemorrhages, dating from a miscarriage which occurred five months previously. She was placed on my examining table, and, as I found the cervical canal too narrow to admit my polypus forceps, I passed in a curette. Directly there occurred such a formidable flooding that although surrounded by every appliance for such an event, I was not able to control it, until she had lost so much blood as to faint away and to make me very much alarmed about her. I stopped the flow by plugging up the cervix with a sponge. A few days later I dilated the canal with tents and removed a perfectly sweet fragment of placenta as large as a small apple.

The curette acted merely as a hook to lift up the placenta, uncorking, as it were, the uterine sinuses, but it was not able to remove so large a mass, which, consequently, remained in the womb and kept these uncorked uterine sinuses from contracting; hence the hemorrhage,

aforesaid fenestrated polypus-forceps, which has no teeth yet holds securely; which will catch an unsuspected intra-uterine polypus or a retained placenta with more safety than the surgeon catches at hap-hazard a stone in the bladder.

Introducing my base-expanding bivalve speculum, which well exposes the cervix, I remove the sponges packed into the cervical canal and vagina by my son. The parts are now thoroughly disinfected by repeated injections of 1.2000 solution of corrosive sublimate. Seizing the anterior lip of the cervix, so as to steady it, I introduce the polypus-forceps into the uterine cavity, immediately open it, and now I have caught something. Withdrawing the forceps with a twisting motion I find a large placental fragment in its beak. The hemorrhage which began briskly has already become less by the rapid contraction of the uterine walls. Passing in the forceps a second time I remove another piece, not quite so large as the former one. Continuing the search I find other pieces, all of which will be passed around, so that each one of you can see for himself the placental character of this false polypus. Note how free from all decomposition the mass is, although very near a year old. Having emptied the womb I syringe it out, first with vinegar to cause the contraction, and afterwards with a 1.2000 bi-chloride solution. There will be no future hemorrhage, so not any kind of tampon will be needed. To insure continued uterine contraction she will be put on quinia and ergot. Her vagina also will be syringed out twice a day with a 1.4000 solution of corrosive sublimate.-Practice, Richmond, Va.

IT is estimated that man gets a complete outfit of brains every two months. If the average life of a nerve-cell is from two to three months, we would each get six new brains every year, providing that every cell is replaced in the same length of time.

Kansas Medical Journal. If you suffer from foul air in a palace, what

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Whilst our great roads have done much to make travel comfortable and healthy, much remains undone. Even the Pullman and the Wagner, with all their luxuries, can be improved. Comfortable and healthy during the day, when night comes they button you into a space some three feet broad, three feet high and six feet long, where for eight or ten hours with a temperature ranging from 70° to 90° F., you are compelled to live on 54 square feet of air. In the morning you feel that you have not been well nourished, and realize that want of oxidation, rather than the novelty of sleeping on the rail, or the snoring of an uncomfortable neighbor, caused your restlessness, and, perchance, your headache.

The double deck arrangement is bad. Until it can be remedied those who can afford it, and especially invalids, should take a section leaving the upper berth unopened.

of a second-class car, where

are crowded into square feet of space? With its oxygen largely consumed and its atmosphere loaded with the odors of all sorts of people, as you enter from the pure air without you gasp for breath and feel that it is unendurable. If you raise a window, the poor fellow next to you, whose carbonized blood is readily chilled, begs you to close it. With the wide range of adaptation inherent in the human body, you soon become accustomed to your surroundings. and, perhaps, as your circulation becomes. loaded with effete matter a chilliness creeps over you that impels you to ask the conductor to close the last opening where oxygen can enter and carbonic acid gas escape.

A better system of ventilation is demanded, one that will remove the heavy carbonized air that surrounds the passenger and replace it with pure air from without. Opening a window is no remedy, for the draft it occasions may be more deadly to some debilitated passenger than impure air.

The water closet on many roads and on some of the cars on most roads is simply horrid, often contaminating with its poisoned air the entire car. The urinals may be well enough for stationary closets, but on a moving car they permit the floor to become saturated with a foul excrement.

The draft at the seat is decidedly harmful to certain persons. To protect them from this, and those along the line of the road from discharges that may communicate disease and engender wide-spread epidemics, there should be a cup on the lower end of the pipe, so arranged that it can be opened whenever desirable and the contents emptied at proper places. There should also be ventilating openings in the pipe, and disinfectants and deodorizers ready for use.

The railroad management seems to consider its special relation to the passenger only exists while he is in the cars, and whilst it seeks to make him comfortable there, its depots for exchange are the embodiment of every discomfort. Who can pass through a crowded union depot, especially at night, and see tired children stretched upon the dirty floor, and weary mothers trying to rest on its iron-barred

seats, while they wait, one, three, five, seven to lessen the blood pressure, slow the pulse hours for a connecting train, without a feeling and reduce the temperature. When this is of sadness? Are not these people, ticketed accomplished, we have, in the great majority through, as much under the care of the roads of cases, done more harm to our patient than while they await their connections at the de- good, for the reason that will be plain when pot as when on the trains? If so, why this we see that the effect is to weaken the nutricontrast? These depots as at present con- tion of the whole organism, and suspend alducted are only fit for the dissemination most entirely the nutrition of the nerve centers. among the tired travelers of such contagious How often we have seen patients that have diseases as may be en route. Why not have been under the influence of aconite until the at least a well ventilated "chair room" into constitutional effect has been produced, with which a through ticket will admit a waiting livid color of skin, imperfect respiration, feepassenger as readily as it admits to his train? ble, irregular pulse, on the verge of convulEvery train should carry a strong rubber sions because of the peculiar effect upon the bandage and a tourniquet, absorbent cotton, spinal cord and medulla. and linseed oil, made creamy with white lead, and a stretcher, and to every train man should be given the few moments necessary to in-out it. Physicians should not leave aconite with struct him in their use.

Aconite.

W. L. S.

The cases in which aconite is generally administered would be much better treated with

the directions so often given, viz.: "Give a dose every hour until the fever falls." If the physician thinks aconite absolutely necessary, he should by all means remain and watch the effect, that he may be at hand to mend the mischief he is very likely to cause.

It is our opinion that the time is not far distant when the treatment of febrile diseases

Aconite is a drug found in almost every doctor's case, be he regular or irregular. Many think they could as well dispense with their thermometer or hypodermic syringe, as with this potent drug. For a potent drug it is, and in my opinion, should never be given except under the immediate supervision of a competent physician who should remain with the patient from the moment of its administration until the effect of the drug has disap-ance is not placed on those drugs that induce peared.

Let us look at the physiological action of aconite. Its action is on the peripheral ends of the sensory nerves, on the heart, and on the respiration. First noticed on the tongue, lips, finger tips, face, breast, abdomen, and last the back. And the heart is quickly affected by very small doses. In children, even a single drop of the tincture may cause great depression, slowing the heart's action due to the effect of the drug on the vagus roots, but in some cases the action of the heart is not affected so much, aconite being uncertain in its action. And if the administration be pushed, we will have paralysis of the vaso motors, the blood pressure will be lessened, followed by slow action of the heart, soon to become feeble and irregular. When aconite is given in the febrile diseases, the purpose is

will be conducted upon a more rational plan, we might say upon a physiological plan; and we are glad to note as symptoms of this reform that the use of antipyretics is fast falling into " innocuous desuetude," and that reli

pathological conditions, but on those whose office is to restore function and assist in

the process of nutrition.

We would emphasize what we have said by

adding that in the treatment of febrile diseases of children the use of aconite should be

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