os uteri to such an extent that we succeeded in about eight hours in delivering her of a seven months' fetus, which lived about five hours. A remarkable symptom in this case was the total blindness which existed-a symptom which I believe commonly exists in eclampsia, but is frequently overlooked because the patient in her unconscious condition is unable to tell us she cannot We were thoroughly discouraged by this symptom, but kept her quiet and found next morning that her brain had cleared, sight was restored and that she was conscious. She made a good recovery. This case was considered the more remarkable from the fact that three other cases of this disease had happened in that vicinity which failed to be bled and all three died.

see.

Case III.-About five years ago I was called in the night to see Mrs. W., living about four miles from Van Ettenville, but on account of the darkness of the night and snow, I was unable to see her until daylight and then only by a circuitous route. found her in the seventh month of pregnancy; primapara; had been in convulsions about eight hours. I immediately bled her largely, after which the convulsions were milder. I called Dr.

Gee in counsel, who, like myself, could see no hope. I, however, remained with her and during the next night succeeded in delivering her of a dead fetus, but on account of the extreme prostration, dared make no attempt to accomplish the third stage of labor, which delayed for some hours. Unconsciousness continued. Yet this lady in her extremity insisted on getting well and did so. She made a good recovery and two years later was delivered of a healthy boy.

recovery.

It may be interesting to note that this woman had another attack of eclampsia at this, her second confinement. After the labor was fully accomplished she had one terrible convulsion. But, profiting by my former experience with her, I bled her so quickly and freely that she didn't have another, but made a good A remarkable feature in this case was loss of voice. It was three days before she uttered the first articulate sound. You will, therefore, perceive, while most severe cases of puerperal eclampsia die, I attribute the success I have had in the treatment of these cases to free bleeding. I believe there is no other rational treatment. Some physicians place great reliance upon hypodermic injections of veratum viride, and justly so. Yet I

believe this remedy does not clear the brain equal to bleeding and in large doses is equally debilitating and dangerous. Many practitioners claim its action is very uncertain and unreliable. Not that I would bleed in all cases of puerperal eclampsia or apoplexy. Far from it; I would never think of bleeding in such cases unless the pulse warranted it.

To be a good judge of

This leads me to speak of the pulse. pulse requires great tact, experience and discrimination. Many kinds of pulse are described by authors for the guidance of students; more, perhaps, than are practically necessary. From this mass I have culled a few which I think should be critically studied by every student who aspires to be even a fair judge of puls, as follows: frequent or infrequent, quick or slow, strong or weak, full or sm all, hard or soft, regular or irregular, oppresed or free. The mere frequency of the pulse can be determined by the watch. All else, as you preceive, is the result of feeling and sensation. So, while seeing is believing, feeling is the naked truth. One can soon learn to discriminate between a quick pulse and a frequent pulse, and so of others. The oppressed pulse is perhaps the most peculiar. This pulse at first seems weak and small, but becomes fuller and stronger by depletion. Its indications of disease, carefully studied are very instructive.

To acquire this skill in judging of pulse we should educate ourselves, especially our fingers, cultivate that learned touch, that tactus eruditus, so that we may know to a certainty whether a given pulse will bear bleeding. This skill was possessed by our fathers in exquisite perfection, when bleeding was more in vogue than at present, and should bleeding continue to fall into disuse I think there is reason to fear we shall not qualify ourselver as thoroughly upon this point as they did.

You will preceive this knowledge is more necessary when I state the fact that two eminent professors were once found disputing sharply whether a certain pulse was hard or soft: such disputes ought not to occur among educated physicians. This judgment of pulse is equally necessary in cases which do not require bleeding, as it is an unerring guide to our treatment and tells us whether in a given case we ought to adminlster tonics and stimulants or sedatives and depressants.

The second classification of Dr. Marshall Hall, i. e., bleeding

in inflammation of serous membranes, reminds me of a circumstance which occurred when I was a student of medicine. My preceptor, Dr. C. C. Cook, of Newfield, was called to the adjoining town of Enfield to visit a patient that had been treated by a notorious quack of that town who called himself Dr. Woodruff. (We had no legal protection against quacks in those days). had treated this patient, as he thought, thoroughly and had given him large doses of his favorite cathartic, which he called "scratch about," but without result. Dr. Cook on examination found a case of acute peritonitis, abdomen distended and very tender. He placed his educated fingers upon the wrist and detected the kind of a pulse calling for the lancet. He immedia.ely bled this patient to faintness; the moment he fainted the inflammatory spasm of the peritoneum was relaxed and the action of the bowels was terrible, the result, no doubt, of the large doses of "scratch about" he had taken and which the bleeding had set free. "There," said my preceptor, "Dr. Woodruff, clean up your patient, take good care of him and he will get well," which he did. This principle of relaxing inflammatory spasm of the peritoneum by bleeding to faintness was well understood at that time, was freely practised and was not then considered dangerous. The physician today who wields the lancet must have exquisite judg ment regarding its use. We well know that when blood is once drawn from the veins it cannot be replaced and the terrible prostration which follows may be fatal; hence prudent physicians hesitate and fear to take the responsibility. Therefore, while

we deplete with one hand, we must be ready many times with the other to build up with powerful stimulants and tonics. Just why this so, more than of old, the most scientific cannot tell; nevertheless the fact remains.

I will state here I have seen results equally remarkable from bleeding in cases of acute pleurisy, also in pneumonias of fortyfive years ago and which were saved by bleeding; by the treatment which would probably prove fatal in most cases at this time.

And now these facts are before us the question arises, shall we entirely discard from our list of remedies this potent agent for controlling disease and thus probably sacrifice many valuable lives, or shall we educate ourselves, especially our fingers, to distinguish by the pulse, cases that require bleeding? I deplore

I believe the physician who,

the total decline of bloodletting. through fear, fails to bleed his patient when necessary, does not accomplish his whole duty. That the fact bloodletting in former years has been largely overdone is no excuse for its total suppression today. there are occasional cases, even in this age of debility and neuralgias, of nervous diseases and typhoid conditions, in which bleeding is not only beneficial, but absolutely necessary.—Buffalo Medical Journal.

I am, therefore, one of the few who believe

BIMANUAL PRESSURE IN TEDIOUS LABORS.-Dr. R. G. Woodworth (Amer. Gynecol. and Obstet. Jour.) enters a plea for the use of bimanual pressure in tedious labors instead of the forceps. There are two points which should be considered before thinking of employing the pressure. The first is, are the contractions. sufficiently strong of themselves to expel the fœtus? Secondly, is the tenderness of the womb so great as not to admit of pressure? Both of these questions can be decided upon a very casual and superficial examination. When the uterine pains, after dilatation of the cervix, become expulsive, observe, from time to time, whether any progress is being made, and if so, well and good; but after a given length of time, if the fœtus fails to advance and seems apparently to be lodged, do not hesitate to use the pressure. How is the pressure applied?

Sit at the side of

The arm resting on the The other arm, if it be easily be aided by being

the patient with a good-sized pillow on the opposite side of the patient upon which to rest the elbow. pillow, of course, is more or less fixed. the right (which is usually the case) can pressed upon by the right knee. By this powerful means of applying bimanual pressure sufficient force can be brought to bear upon the womb during contraction as shall be immediately apparent in effecting the progress of delivery. It is plain that only sufficient force should be employed as to accomplish the desired end, namely, slight progress. The pressure should be employed only during the contractions of the womb, and a weak and inefficient contraction, augmented by pressure, can be made to accomplish a mighty work in hastening delivery,

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Editorial.

YELLOW FEVER.

At the time we write the outbreak of yellow fever in the Gulf region has not assumed alarming proportions. The health authorities, national and local, are using every effort to prevent the spread of the disease, and they have been favored by the lateness of the season and the mildness of the epidemic. Where the number of cases has been at all large the mortality has not exceeded fifteen or sixteen per cent. and in some of the towns has been less than ten per cent. The fact that the disease appeared first at a summer resort is the reason for its being scattered so widely, as it was carried directly from the resort to various quarters of the country by visitors returning to their homes. Many infected persons had left for their homes before the nature of the disease was determined, riding in railroad coaches with other passengers and after reaching home coming in contact with other persons until sick enough to take their beds.

As light as this outbreak is, it will have cost, ere it is checked,