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away, also the after-birth, and with only a reasonable amount of hemorrhage; indeed, the hemorrhage was below the usual quantity in such a case. The perineum was torn badly and I promptly sewed it up.

After being under the influence of the anesthetic for a little over an hour she came out of it all right and with a good pulse. The bed was cleaned and the patient's clothes changed, all soiled cloths being removed, and she was washed and moved to the other side of the bed, seeming to be all right. She spoke rationally and only complained of being weak.

I will say right here that the patient was handled very carefully, and manifested no bad symptoms until about onehalf hour after coming out from the anesthetic. I had stepped into the other room to get a cup of tea and a morsel to eat, having had no breakfast, and it was then noon. I got up before I had finished to see how my patient was doing, and when I entered the room I saw that something was wrong. On examination I found scarcely any heart beat, extremities cold, and, in fact all the signs of a total collapse, as I could get no heart beat at the time.

Remember, there was no hemorrhage of any account. It seemed that the heart just failed. Hypodermics of strychnine and nitroglycerin, and inhalations of amyl nitrate were used. The patient's feet, legs and arms were rubbed, and hot applications applied under armpits and to feet and legs. Under these she revived some six times or more, only to finally succumb in about two hours after the first symptoms. She would come out of these almost death swooms and talk a little and call for water, but was very restless, turning from side to side. The heart beats could not be heard at all when she would sink away. Everything was done, but without avail.

Now I have been censured for not having another doctor to assist me, yet I feel that, without a doubt, the result would have been the same, only the responsibility would have been shared, but with increased expense to the husband.

The husband asked me at one time if I

wanted help, and I replied that I did not need it as I was getting along well, and I was, too. Had I known the result I certainly would have called for assistance, even if only to divide the blame.

Now the question is this, what caused the death of this patient? Was it due to the chloroform? If so, why did she not succumb to it while under its influence, and why didn't she manifest any symptoms while under chloroform? She had no history of heart trouble, and I examined her heart and found it normal before giving her the chloroform.

Was not this death caused by the reaction or shock, due to the patient's frailty and weak vitality? because she only weighed about 90 pounds. I attributed it to this, as the patient could not stand the strain on her system, and when reaction set in she died from shock. If I am wrong about this I would like to know. Did I do wrong in not having another physician to share the result? I want your just opinion, brothers. Case 2.

Male, between 25 and 30 years of age, weight about 150 pounds, has had no serious illness, fairly nourished, eats well, no loss of flesh, no cough, no fever, digestion fair, no tuberculosis history, no bad habits, no sexual excess, no venereal history, married. This young man for the last two years has been greatly troubled with night sweats. These will disappear for some short peroids, but only to return as before, and are profuse enough to wet his night shirts. His lungs show no dullness nor tubercular symptoms, and, as I said, no rise of temperature. He has had nasal and throat catarrh for years. I diagnosed this as prognostic of latent or masked tuberculosis, which will manifest itself more evidently later on. Does not expectorate any. Is my view correct? S. D. SOUR, M. D.

Princeton, Minn.

We wish it understood that the SUMMARY columns are always open to all members of the profession for the discussion of any practical question of interest to the general practitioner in his daily work. Do not fail to send your good ideas to the SUMMARY for publication.

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New Publications.

THE TWELVE TISSUE REMEDIES OF SCHUSSLER; Comprising the Theory, Therapeutic Application, Materia Medica and a Complete Repertory of These Remedies Homœopathically and Biochemically Considered. By Wm. Boericke, M. D., and Willis A. Dewey, M. D. Fourth Edition. Rewritten and enlarged. 424 pages. 8vo. Boericke & Tafel, Publishers, Philadelphia. 1899. Price $2.50; by mail, $2.72.

This being the fourth edition of this work is indicative of it having had a large sale, and consequently it would appear that its contents would be worth investigating. Briefly, biochemistry as advocated by Schussler consists in the treatment of all diseases with 12 cell-salts, triturated to the 3d, 6th or 12th decimal potency. These 12 tissue remedies" are ferrum phos., calcarea phos., natrum phos., kali phos., kali mur., calcarea fluor., silicea, calcarea sulph., natrum sulph., kali sulph. and magnesia phos. But whether these remedies are all sufficient in all diseases, as their enthusiastic friends claim, is another question. However, they are worthy of further trial and careful investigation.

This work appears to be the only authoritative work on the subject in the field, outside of Schussler's own monograph.

DISEASES OF THE EAR NOSE AND THROAT

AND THEIR ACCESSORY CAVITIES, By Seth Scott Bishop, M.D., D.C.L., LL.D., Professor of Diseases of the Nose, Throat and Ear in the Illinois Medical College, Professor in the Chicago PostGraduate Medical School and Hospital, Surgeon to the Post-Graduate Hospital, etc., etc. Second Edition. Thoroughly Revised and Enlarged. Illustrated with 94 Chromo-Lithographs and 250 HalfTone and Photo-Engravings. The F. A. Davis Co., Publishers, Philadelphia. 1899. Price $4.00.

It is eminently essential that the general practitioner possess at least one first-class up-to-date work on the different specialties in medicine, as he is the one who deals with all kinds of diseases, but care should be exercised in endeavoring to secure those best adapted to his wants -the most practical should be selected of

course. Such a work is the one now before us, as it is a thorough condensation of all that is best up-to-date knowledge on diseases of the nose, throat and ear.

This work has been very popular, as the early exhaustion of the first edition would indicate. This has thus presented an early opportunity for making improvements, which the author has been quick in taking advantage of, and now in this, the second edition, we have a work much improved in many respects. The author in the preface to this edition says that the generally-expressed wish for enlargement and greater detail in the treatment of various diseases has been met as far as could consistently be done. Two new chapters, one on related diseases of the eye and nose, and the other on life insurance affected by diseases of the ear, nose and throat, an including illustrated article on pachydermia laryngis, have been added. A number of new colored drawings and half-tone engravings have been made for this edition.

THE NEWER REMEDIES; A REFERENCE MANUAL FOR PHYSICIANS, PHARMACISTS AND STUDENTS. By Virgil Coblentz, A. M., Ph. D., etc., Professor Chemistry and Physics in New York College of Pharmacy, etc. P. Blakiston's Son & Co., Publishers, Philadelphia. 1899. Price $1.00.

This brochure presents the newer remedies in alphabetical order, including their synonyms, sources, method of preparation, tests, solubilities, incompatibles, medicinal properties, and doses as far as known, together with sections on organo-therapeutic agents and indifferent compounds of iron. Every physician

should have this little volume at his command, as it aids him to keep well informed and intelligently prescribe useful agents. It also furnishes the druggist with needed information.

Annual Report of the Board of Health of the City and County of San Francisco, Cal., for the fiscal year ending June 30, 1898. Issued by the Health Department. 1889.

This is certainly worthy of the name of a report of health, and one that does honor to this particular Board.

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It is said that warts may be removed by painting them once a day with a concentrated solution of bichromate of potash.

When there is great increase of mucous secretions anywhere, from nose, bronchi, bowels, vagina, think of ammonium muriate.

Torpid ulcers, even when painful and due to varicose veins, may be made to cicatrize comfortably if dusted daily with antipyrin.

Phosphorus is indicated in hyperemia of the lungs with dyspnoea, especially where there are stitches in the chestacute, quick pain.

"If you wish to smooth the skin of a lady's face which has become rough and unsightly, give her berberis, and she will give you many a puff," etc.

For winter cough try 1-50 grain of potassium bichromate three times a day.

Dr. W. H. Wells says that all rises of temperature following labor, of whatever nature, demands immediate attention.

Dr. Clendenen writes us saying that balsam of Peru is a specific in cracking of the nipple. Wash off before the child nurses and then reapply.

Dr. J. C. Ross, of Manchester, Eng., recommends a decoction of cinnamon as a cure for grip, if taken within 24 hours of the beginning of an attack.

Sugar water, the reaction of which is usually acid, will neutralize lime, which frequently causes great pain if accidentally gotten in the eyes.

An emulsion of olive oil, 60 c. c.; glycerin, 30 c. c., and the yolk of one egg is recommended in cases of rickets or chronic malnutrition of infants.

A sponge should never be put in very hot water because it kills its "life" and makes it flabby. It should be aired frequently and never put away damp.

The surface ring worm can be cured in a single application with formol in full strength, rubbed in vigorously with a pledget of cotton twisted on a tooth

pick.

In heartburn of pregnancy, or in any kind of heartburn. give 1-500 grain of atropine in a teaspoonful of hot water; repeat in an hour if necessary and watch results.

The valerianate of zinc in the treatment of whooping-cough is common. One-fourteenth of a grain is given three times a day, two hours after meals, to a one-year-old child.

After a brisk walk or bicycle ride on a dusty road, much throat and nose trouble may be averted by douching the nasal cavity with a weak antiseptic, especially where the throat is dry and inflamed.

Prof. Osler says that the most common cause of chills in typhoid fever is the administration of antipyretics, such as antipyrin. They depress the temperature and when it rises it may be accompanied with a chill.

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A MONTHLY JOURNAL OF

PRACTICAL MEDICINE, NEW PREPARATIONS, ETC.

R. H. ANDREWS, M. D., Editor, 2321 Park Ave., Philadelphia, Pa.
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VOL. XXI.

PHILADELPHIA, AUGUST, 1899.

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Subscribers failing to receive the SUMMARY should notify us within the month and the omission will be supplied. When a change of address is ordered, both the new and the old address must be given. Subscriptions may begin with any number. How to Remit.-Payment can be made by Postal Money-Order, Bank Check or Draft, or Express Money-Order. When none of these can be procured, send the money in a Registered Letter. All postmasters are required to register letters whenever requested to do so. Receipts.-The receipt of all money is immediately acknowledged by a postal card. Important Notice. The printed address label which

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Address THE MEDICAL SUMMARY, P. O. Box 1217. 2321 Park Ave., Philadelphia, Pa.

This journal has an extensive and constantly increasing circulation, is substantially established, and therefore presents to business houses desiring to reach the rank and file of the medical profession throughout the land, a most valuable advertising medium.

Entered at Phila. Post Office as second-class matter.

SUNSTROKE AND HEAT EXHAUSTION.

In the domain of medical literature no subject is more important or abounds with more instances of dramatic interest. Letschenow's theory of the production of thermic fever is generally accepted. It affords basis on which to rest the mind that ever seeks a cause for phenomena. It seems to be largely speculative, inasmuch as it refers the power of inhibiting heat to a center in the pons and the function of dissipating heat to a center in the medulla.

Paralysis of the inhibitory center leads to excessive production of heat in all the

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tissues. Whence, coup de soleil is a fever, thermic fever or heat fever, dependent upon a great accumulation of heat units, and not a result of any kind of blood poisoning. However, paralysis of the inhibitory center of the pons explains only the excessive production and accumulation of heat giving rise to heat-stroke. To account for heat exhaustion we must suppose paralysis of that other center in the medulla which regulates its dissipation. This latter explains the remarkable pallor and coldness of surface in some

cases.

Thermic fever is therefore the result of exposure to excessive heat. Theory and daily personal observation have established the fact that excessive bodily heat is rapidly dissipated in a superheated dry atmosphere, and with great difficulty, or not at all, in a heated moist atmosphere. In breweries, laundries and crowded tenements, where the last named condition prevails, instance the greater prevalence of prostrations. Elevated temperature, humidity and confinement are determining factors in the causation. Excessive exertion, whether mental or physical, debility and neurasthenia, are also causative.

Some persons are more susceptible than others. Insusceptibility to the influence of excessive sun heat may be explained by wise, frugal and temperate habits of

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