articles of nature-things which can be thrown aside as not absolutely necessary; while naturalness is the flesh and blood, bone and sinew, fire, water, atmosphere and psychos of nature itself!

In Ibsen's plays there is any quantity of naturalism, but very little, if any, true realism. This can readily be seen in the leading motifs of his dramas, and in his methods of construction. In "A Doll's House," obtaining a position in a bank is the sum total of the vis actionis of one of the principal characters; in "Rosmersholm," heaven and earth are turned topsy-turvy because no one believes in the silly creed of some of the dramatis personae; in another play, "The Wild Duck," an intrigue with a maid-servant is the leading motif, while in yet another, "An Enemy of the People," a liason with a variety hall singer is the pivot on which much of the action and the interest of the play is centered. Here motifs, methods and style are pure naturalism -not realism; and yet, Ibsen stands at the head of the realists!

Compare the trite and insufficient commonplaces of Ibsen with a little sketch by John Muir, which came out in one of the magazines not long ago. I mean "An Adventure With a Dog and a Glacier." In this the actors are John Muir and a little mongrel dog named "Stickeen." In crossing a glacier they come to a wide crevasse which is spanned by a narrow ice bridge. They cannot go back the way they came, consequently they must cross this dangerous bridge. This the man succeeds in doing, after a terrible experience, and is finally followed by the dog, which, at first, fully recognizing the greatness of the peril, had refused to attempt the hazardous passage. This tale is the very embodiment of naturalness, of realism. It matters not that it happens to be a real episode in the life of the author; for, were it pure fiction, the effect that it produces would be the same.

We start out with the man and dog in the darkness of the early morning; we walk by the side of the man as he stumbles over the rocks and detritus of the lateral moraine; we jump with him as he leaps deep crevasses; we encourage the silent dog as he follows patiently after; we feel the sharp sting of the snow and sleet upon our faces, and we hear the voice of the wind as it howls and shrieks through gorge and canon. Finally we crawl down on the ice bridge and sit there for a moment staring into the face of death! We slowly straddle, inch by inch, and foot after foot, across this frail and slender splinter of ice, and then we call to and encourage the dog, which, eventually, essays the bridge and crosses safely over. And then we witness his joy! "And now came a scene! Well done, well done, little boy! Brave boy!' I cried, trying to catch and caress him; but he was not to be caught. He flashed and darted hither and thither

*

as if fairly demented, screaming and shouting, swirling around in giddy loups and circles like a leaf in a whirlwind, lying down and rolling over and over, sidewise and heels over head, pouring forth a tumultuous flood of hysterical cries and sobs and gasping mutterings. And when I ran up to him to shake him, fearing he might die of joy, he flashed off two or three hundred yards, his feet in a mist of motion; then, turning suddenly, he came back in wild rushes, and launched himself at my face, almost knocking me down, all the time screeching and screaming and shouting as if saying, 'Saved! Saved! Saved!!"

This is what I call realism in literature. I can see this scene as vividly and as plainly as John Muir saw it, there on the bosom of the mighty ice river! And, as long as literature lasts, I predict that this little sketch, such is the power and beauty of true realism, will be numbered among famous things!

In striving after realism. many an author strips even naturalism from his characters, and sends them forth mere wooden automata, many of them so awkwardly fashioned that they seem to have been hewn out with a broadaxe and dressed down with an adze! Then, too, for some unknown reason, realism and salacity have become synonymous in the minds of some writers, so that the pessimistic psychical inaccuracies of Zola have become pornographic ineptitudes in the hands of his imitators. Again, some authors mistake childishness for the wisdom of age, consequently Ibsen's vacuous and banal platitudes, in the guise of ethical truths, stare from more than one page in the works of those who regard him as the great leader of modern dramatic art. To say that men must be educated into an appre ciation of Ibsen's works, is a queer proposition, since most men passed the point of ratiocinative ability necessary for a proper understanding of his plays in their bib and tucker days! In order to fully appreciate this author, one must be educated backward; in other words, one must be in his dotage! If Mr. Howells means this by his implied "education" plan, I heartily agree with him; if he means otherwise, then he and I differ very materially.

One of the most truthful of all saws is that one which declares that "the proof of the pudding is in the eating." Now, since all men are natural born critics (otherwise there would be no civilization, and ethics and esthetics would have died aborning), I believe that Ibsen, Zola and others of the so-called realistic school will be correctly judged by mankind. All men, at heart, are true realists, and, sooner or later, they will stamp with their approval that which is true realism, and will condemn that which is false.

THE TREATMENT OF PUERPERAL PHLEGMASIA ALBA DOLENS.

By T. MITCHELL BURNS, M.D.,

Professor of Obstetrics, Gross Medical College; Attending Obstetrician,
St. Anthony's Hospital,

Denver, Colo.

As soon as the condition is diagnosed the uterus or any infected area in the birth canal should be thoroughly curetted.

Three times a day or oftener, if necessary, the limb should be bathed with hot water in the following manner: Bring the patient's hips to the edge of the bed, rest the heel on a chair, place a bowl of hot water beneath the leg and cover the limb with one wrapping of woolen cloth, then dip a woolen rag into the hot water and wring it out over the anterior surface of the leg. This should be kept up continuously for half an hour at least, increasing the temperature of the water as fast as the patient can stand it. When through with each bathing, the limb should be wiped dry, turpentine and lard, camphorated oil or antiphlogistine gently applied, and then cotton batting and a bias cut flannel bandage put on and the limb placed to rest on a pillow.

The bowels should be kept moving two to three times a day by the use of saline cathartics.

Tonics, especially strychnine, and a good liquid diet, should not be forgotten.

The patient should be kept in the horizontal position until three days after all fever has disappeared.

When the limbs begin to pit on pressure and the tenderness is slight, cold water, followed by rubbing with the dry hand, should be employed, and to improve the venous circulation the friction should always be towards the patient's heart. The flannel bandage should be now used next the skin so as to prevent the recurrence of swelling, aid absorption and enable the patient to walk if this be permissible.

The above treatment is the best, because all well marked cases of milk-leg are due to an extension of an infection of the birth canal. This is shown by the remarkably good effects of curetting the uterus and by the fact that at the very beginning tenderness can generally be elicited in the veins or lymphatics on the sides of the uterus.

Most authorities condemn the use of hot fomentations in the beginning of the disease, fearing the dislodgement of a throm

bus, but they use vaginal and uterine irrigation in phlebitis of the uterine veins, which should be just as dangerous. I use the hot water because I have always seen the congestion and pain greatly relieved, the convalescence markedly shortened and no bad effects. There are some patients who resist the use of hot water, and in such cases cold water can be used advantageously. The bowels are kept moving to relieve the edema, to carry off the poison in the blood and lymphatics and to aid absorption of the thrombi and the assimilation of food.

Tonics and a good liquid diet are specified to keep up the patient's strength in this weakening disease of slow convales

cence.

By keeping up the patient's strength the involution of the uterus is increased and therefore the chances of septic absorption lessened.

Friction and the bandage are of great value when the patient begins to walk. They increase the muscle tonus and therefore lessen the edema.

Case 1.

REPORT OF CASES.

Metastatic abscesses of breast and labia followed by milk-leg. There was pain in groins second day, inner side of left thigh 25th day, swelling 28th to 54th day. From 47th to 54th day patient up, limb massaged and bandaged. On the 52d to 54th day hot water applied with the result that on the 54th day the limb was nearly normal.

Case II. Mild, began 10th day, no fever, hot fomentations and cotton. Leg normal 30th day.

Case III. Peritonitis and milk-leg, former lasting two weeks, latter over six weeks. Beginning with the use of hot fomentations, flannel bandage, salts and tonics; recovery rapid.

Case IV. Uterine infection began first day. Double milkleg noticeable 12th day, fever first 28 days, patient able to sit up and walk a little on 30th day, but more or less pain, tenderness and swelling of both legs until 66th day and left limb even on the 150th day would pain and swell some after a long walk. Following treatment used from beginning: Turpentine, arnica, cotton, hot fomentations and uterine irrigation; latter caused shreds to be expelled from uterus.

Case V. Same patient after next confinement. Left limb numb-like until after 35th day. From 28th to 35th day hot fomentations, rubbing and iron.

Case VI. Pain in left groin 2d day, left calf 4th day. Slight pain and swelling of veins and legs from 4th to 40th day. Above treatment.

Case VII. Slight swelling of leg before and after labor; temperature 99-99.5 first 69 days. On 67th day right leg more swollen, 68th day uterus curetted, 69th day ankle worse after hot water and rubbing, 70th day temperature normal and limb much better.

Case VIII.

Pain and tympanites of lower abdomen 24 to 7th day. Milk-leg began 8th day with pain and swelling in left groin and leg; 17th day also in right. Saw patient 21st day, slight fever until 55th day. Treatment, uterine irrigation, hot fomentations and salts.

Case IX. Slight fever first 42 days. Milk-leg began 14th day in left thigh, extended to left calf on 16th day and on 17th day uterine irrigation and bathing of the limb with the result that limb improved until 21st day, when temperature 103, increased swelling and pain. Curettage. Debris removed from a cavity in the left side of the uterus. Result, steady improvement and on 30th day swelling and pain nearly gone.

Case X. Six months after labor limb bandaged because of swelling. Curettement. Result, no bandage required, but the limbs get tired after the patient works hard.

Four of the above cases were confined by me, viz., the 2d, 5th, 6th and 7th. The others I attended after labor only.

In the discussion of this paper before the Denver and Arapahoe Medical Society objections were made to the curetting of the uterus and the bathing of the limb because of the necessity of moving the leg. While in two or three of these cases mild septic endocarditis could be elicited (it is probably present more or less in all cases of milk-leg), there was not in the whole ten cases any other symptom of the dislodgement of a thrombus, and it would seem to a reasoning mind that it would be better to take a little extra risk, as every surgeon must to cure a condition, than to wait and allow the formation of more thrombi and increased chances of their dislodgement.

Officers of the American Medical Association.-The newly elected officers are as follows: President, Dr. W. W. Keen, Philadelphia; First Vice-President, Dr. C. A. Wheaton, St. Paul; Second VicePresident, Dr. E. Ferguson, New York; Third Vice-President, Dr. G. M. Allen, Liberty, Mo; Fourth Vice-President, Dr. W. E. D. Middleton, Davenport; Secretary, Dr. G. H. Simmons, Chicago; Treasurer, Dr. H. M. Newman, Chicago; Librarian, Dr. G. W. Webster, Chicago.