Aconite root alone or with tincture of Veratrum viride-one drop of the former or two drops of the latter every hour or two, in alternation with ticture of gelsemium, in doses of ten to fifteen drops-will speedily overcome these conditions. The dose should be diminished, and the interval increased between doses as the conditions improve; continuing, however, for some time: to prevent their recurrence. To produce sleep, the great desideratum, nothing will be found better than the following prescription:

Give one or more teaspoonfuls every hour till sleep is induced; beginning at, or prior to, the usual time for sleep. Let the rule be: give only enough, but give enough, to produce "tired nature's sweet restorer," refreshing, balmy sleep; during which the wear and tear of the tissues will be greatly checked, and the recuperative powers of nature strengthened. Opiates are injurious, and should, therefore, be avoided, if possible, in these cases. Apply cold to the head-ice in rubber bags, or iced water ou cloths, or what is better, in some cases, being more convenient, laving the forehead and temples with warm water, and hastening its evaporation by fanning the face. Counter-irritation to the nape of the neck and along the spinal column, with sinapisms, which may also be applied to the extremities, will be of benefit. After sedation is affected, a cathartic may be given if indicated, but not of a drastic nature. We must economize the vital force. Gastrointestinal irritation is often present, and in such cases, the bowels ought to be moved by using a proper enema; such as an infusion of senna, with chloride of sodium added, using only enough to move the bowels moderately.

Metritis, peri-uterine cellulitis, peritonitis or other inflammatory conditions of the pelvic or abdominal organs, should be appropriately treated. The cause of the insanity should be ascertained, and, if possible, removed as early as practicable. Ulceration of the os uteri, or a leucorrhoea may be sufficient

to protract a case of insanity. Where there is pelvic irrition and opium is not contraindicated, I have found good results follow the use of a vaginal suppository composed of aqueous extract of opium, two to three grains; extract of belladonna, one grain; cocoa butter, sufficient. It should be placed well up in the vagina. These suppositories may be repeated every three to six hours if necessary. Tincture of Cimicifuga racemosa and pulsatilla, two drachms of the former and one of the latter, to a four-ounce mixture, and a teaspoonful of this given every three or four hours, will be suitable in the case last named. A warm bath, properly administered, will be of great benefit, and especially a hot foot-bath. Chloroform may be used by inhalation to control the patient, bringing her at once under its influence, and then repeating it from time to time as she seems about to wake. Two or three drops of nitrite of amyl may be added to each ounce of the chloroform. This will materially diminish the danger from the use of the anaesthetic. The patient should be controlled with firmness, properly tempered with gentleness, and by a thoroughly competent nurse. Husbands and relations are not generally the best nurses in cases of insanity. Constant care is necessary, lest she injure herself, her infant, or those about her, or possibly escape from the room. All sources of excitement should be removed and the patient kept as quiet and tranquil as possible.

The diet, in a case of acute mania, should be light, but nutritious; consisting of soups, milk, farina, gruels and such articles as are easily digested. As the case progresses a more generous diet will be necessary, and stimulants and tonics should also be administered as may seem necessary; remembering that an improved physical condition is very essential to a speedy recovery.

In the treatment of the melancholic form, the sedatives would not be necessary as in the maniacal variety. Stimulants, restoratives, tonics and nourishing diet, are of more benefit. A case of this kind recently came under my observation. The woman had been confined in an insane asylum for weeks, dosed with strong narcotics till she had become very much debilitated; when she was taken home, placed under

proper restraint, and large quantities of alcoholic stimulants given with a generous diet. This treatment was followed in a short time by perfect recovery. This is, no doubt, an exceptional case as a large number of those affected with melancholia have a long illness, a protracted convalescence, and, in some instances, the symptoms gradually merge into hopeless dementia. Such cases should be placed in the proper asylum, under restraint and seclusion. When there is a probability of recovery, however, in any case, and the necessary care and restraint can be had at home, do not send the patient to an insane asylum. The stigma will be felt most keenly by all women after recovery, and should be avoided if possible. During convalescence too great caution cannot be exercised in permitting her to renew her intercourse with her family and friends, and should interviews with friends seem to excite her, the seclusion must be prolonged. Visits from friends and relatives, in some cases, appear to be beneficial by diverting the mind into more healthy channels. A change of air and scenes will be of benefit to such a case. In acute mania, the child may be allowed the breast as soon as the symptoms have well subsided, but in melancholia weaning is at once imperative.

In conclusion, I would like to admonish all physicians, who do an obstetric practice, to make strict inquiry in all cases coming under their management, and especially where there is an hereditary taint-insanity having been present in either progenitor, or previously in the same woman-that they may prevent, if possible, an attack. This may be done by removing the exciting causes; or by preventing their development. It is the duty of the physician to prevent disease, as well as to cure it. The family physician, by knowing the predisposition, can often prevent the development of latent disease. The general health should be carefully guarded, by prescribing a rigid observance of the very best hygienic rules-such as the avoidance of all excesses, moderate exercise in open air, bathing, proper diet, and due attention to all the bodily functions. It would be hard to say just what medicines would be necessary; perhaps none. Yet the careful, observing physician would note indications, and prescribe accordingly.

Should there be, during utero-gestation, hysterical manifestations, insomnia, or unrefreshing sleep, disturbed by dreams, the chloral and bromide mixture, heretofore spoken of, will be found useful. Uterine irritation may be overcome by the use of such agents as viburnum prunifolium, Caulophyllum, Mitchella, Pulsatilla, Macrotys; either singly or combined as may seem best. During parturition, and for some days subsequently, the most skilful and judicious nursing and constant supervision should be employed. The child should not be put to the breast if an attack is threatened, till the danger is presumably past.

Preventive treatment will be more efficient in warding off the insanity that often manifests itself during lactation, the result of debility, induced by frequent child-bearing, nursing or other causes. I had recently a case that impressed me very strongly with the importance of giving particular attention to this class of patients. The lady was placed in my care during pregnancy, and I was then informed that at her last confinement she had become insane and remained so for some time. I at once began a course of treatment such as I have indicated. The accouchement was safely accomplished with no signs of a return of her malady, and after the usual ten days' attention, I dismissed her in good condition. About two months later, I was called and found her suffering with a severe bronchitis, and general debility. Worse than all, she was on the verge of insanity. I at once placed her on the use of Veratrum Viride and Collinsonia alternated with pulsatilla and Macrotys. I likewise ordered nourishing diet, rest and quiet and overcame the constipation that was present, with a laxative pill at bed-time. After a few days I also gave dialysed iron, and dilute phosphoric acid. She made a good recovery, and is now, four months later, in perfect health.

When at all convenient, a physician should make occasional calls of a social nature, on his families, and especially when there has been a recent addition to the household, that he may discover, at an early period, any manifestation of disease. It may be a tax upon his time and generosity, yet it is a duty he owes his regular patrons, and it will repay him in the end.

PUERPERAL SEPTICEMIA.

By J. V. LEWIS, M. D., Alliance, Ohio.

Many of the ablest writers on the disorders of the puerperal female, are of the opinion that "there is no disease which attacks puerperal woman and puerperal woman only." There are others, who rank as leaders in this particular department of medicine, who hold that there are fatal disorders peculiar to the parturient and lying-in female. The limits of this paper precludes the possibility of a comprehensive review of the conflicting opinions of these distinguished authors. In the present state of thought, it is impossible to arrive at a satisfactory conclusion on this subject. For, "when doctors disagree, who shall decide?" Nor is it material whether we use the term puerperal fever or puerperal septicemia, if both appellations are held to comprehend the same pathological conditions. The older writers made the term puerperal fever do duty in naming the fatal diseases of the puerperal female; modern authors find the term puerperal septicæmia more enphonious and equally comprehensive. Both parties to the question are at sea when asked to fit all the disorders of the parturient or lying-in-female to their respective titles. It is true that while they fail to accomplish the feat, they manifest creditable ingenuity in their efforts to do so. But their arguments tend more to confuse than to elucidate the subject. Some of them purposely cloud their opinions, so that when the question shall be definitely determined, they may be enabled to interpret their ambiguous expressions in consonance with the facts of the case, and so may stand among the successful investigators of this most difficult and perplexing subject. But, in accordance with the tendency of modern thought, we denominate the fatal disorders of child-bed, puerperal septicamia. We use the plural of disorder advisedly. For, we have the most positive and convincing evidence, that septicemia may be manifested in all of the fatal phlegmasia of the puerperal period. And we are informed by high authority that it may be a primary or a secondary disease. In the first case it results from the absorption of septic matter; in the second