tion. It requires diligence, patience, and persistence; but the reward-the getting rid of a loathsome and disgusting affection-is an abundant equivalent. The constantly-recurring disagreeable accompaniment in society may then be kept out of sight, and so the blessings of social intercourse become more delightful.

JAMES EDWIN BRIGGS, M.D.

PUERPERAL CONVULSIONS.

ON the 21st June, 1883, a case of singular importance occurred, which presented from the very first an unyielding and distressing appearance. The attack was sudden and severe. All the vital forces seemed to yield instantly to the force of disease. There was no favorable indication observable, nor any apparent hope of relief, though life lingered, reminding one of the old adage, “while there is life there is hope," obviously demanding some assistance, and awakening in those present the kindly attentions which love and sympathy naturally suggest. On this principle efforts were made to revive and restore. After many hours these gradually began to develop some slight improvement, which tended to encourage perseverance under the most forbidding circumstances. For the disease under which the patient was suffering was readily suggested-and so too was the course of treatment. But the patient was and had been for some time in an unconscious state, apparently comatose, rendering the danger to life still more appalling. In this singular and rather remarkable development in this very acute disease, there were some prominent features which give it a peculiar interest worthy a brief notice, if not indeed a permanent record. The case in brief is as follows:

I give the facts as learned at my first and subsequent visits as nearly in the order of development as practicable. The patient was pregnant, about seven months gone, and had enjoyed unusual good health during this period up to the time of the sudden attack, which occurred about eleven o'clock in the evening while carrying a pitcher of water into her room from the hallway, where she fell on the floor and became immediately unconscious. The friends in their alarm called, in great haste, the midwife who was engaged to attend her in her confinement; but on arriving and seeing the condition of the

patient, refused to do anything except to advise the calling of a physician immediately to take charge of the case.

In their anxiety and haste the nearest doctor was called, but on arriving and examining the case, became utterly discouraged, and refused to take any responsibility, saying emphatically, "the woman would die," and soon left without giving any professional advice or making any suggestion. The husband being dissatisfied and unwilling to abandon effort while life continued, called to his assistance Dr. James Beegan, who promptly responded, and after a slight examination, made such efforts to relieve and restore to consciousness as circumstances would permit, but without any apparent effect. Observing this, he said "he thought the chances of life very slight,” and desired the husband to call in some other physician to advise in the case.

Under these circumstances I was sent for, and reached the patient some nine hours after the attack, and found her in a profound state of coma.

During all these hours the patient had been unconscious, apparently in a fit, or a succession of fits, in which the intervals between the same were so slight as to be almost unobservable. On seeing the patient and learning the condition, I at once sent for Dr. Beegan, who had but recently left, and in the meantime proceeded with my examination.

I found the heart acting very violently, and so rapidly I could not accurately count the pulse. The extremities were warm and moist, the eyes quite firmly set, the countenance anxious, the main features much disturbed; the jaws set and unyielding, and the entire muscular system in the same condition; the limbs were stiff, unyielding, and motionless; the patient could be rolled over like a log, the entire body moving without bending. The spine had a left lateral curvature between the shoulder-blades, and a backward curvature involving the last dorsal and the 1st, 2d, and 3d lumbar vertebræ, which the sister said "had occurred from being run over by a wagon when a child, but did not injure her now." I also found the os very rigid and slightly dilated so as to admit the index finger.

At this moment Dr. Beegan arrived, and a brief consultation was held in which it was decided to continue efforts to relax the system, dilate the os, and deliver with the forceps-the husband anxiously urging us to do all that could be done to relieve and save life-while

the sister was tenderly begging us to let her alone and let her die in peace.

Dr. Beegan kindly consented to remain and assist in whatever efforts might be required.

On my first arrival I had given, or rather forced into the mouth between the teeth, a very few drops of the fluid extract of veratrum viride (green root), and frequently repeated the effort with only partial success. While this process was being kept up and properly attended to, additional efforts were made to overcome the rigidity and dilate the os. The process of dilatation was very slow, and necessitated the employment of the best and most efficient remedies.

To aid this process and prepare the way for delivery at the earliest practical moment, the rectum was utilized. Enemas, composed of tincture of lobelia and warm water, were administered in small doses, and frequently repeated until two ounces of the tincture were used. Under the influence of veratrum, aided by these remedies, the system began to relax, and the patient to show some signs of returning action.

She could swallow a little better, yet with extreme difficulty and danger. This enabled us to continue our main remedy to better advantage, though only very small doses, often repeated, could be administered; yet on these comparatively small doses depended our hope of success. Other means we regarded as only auxiliary to the decisive action of the veratrum. At this early stage this was given without regard to time or quantity. Hence, we continued these means as best we could, under the singular difficulties attending the case, and gradually obtained that degree of relaxation and returning action which enabled us to proceed toward the accomplishment of the great object in view, the delivery and restoration to normal action.

So soon as practical the forceps were introduced, and the process of delivery proceeded slowly and carefully till successfully completed, which was about 12 o'clock, noon,-the patient having been at that moment thirteen hours and over in an unconscious state. The foetus, as expected, was still-born, evidently deprived of life very soon after the attack.

From this time onward the patient was very closely watched, and the veratrum and gelseminum-two parts of the former to one of the latter-was now given, at short intervals, in as large doses as practicable, till consciousness partially returned, which occurred about

5 o'clock P.M., after being in an unconscious condition more than eighteen hours. This decided change for the better encouraged perseverance in the use of our main remedies, to which was now added a due proportion of the fluid extract rhus aromatica, and then two tablespoonfuls of these extracts thus united were put into an ordinary-sized tumbler of cold water, and one tablespoonful of this preparation from the tumbler was given every two hours, and continued to the 26th inst., when full consciousness was restored, being four days after the first attack; and then gradually reduced in quantity and frequency till August 1st, when the patient had become convalescent.

From this date the patient made good progress, and fully regained her usual health in about three weeks, and has remained in her accustomed good health and spirits until the present time.

A due consideration of the facts in this case will allow its classification among those of the most malignant and hopeless.

Its sudden irruption and great severity, its singular development and marvellous power, as well as its surprising recovery from a state of profound coma, give it special interest, and justly entitle it to a record among the most extraordinary cases which generally baffle the skill of the most experienced physician, and frequently in a few days, or perhaps in a few hours, prove fatal.

This disease, at its irruption, or onset, as in the present case, often takes on a very formidable and malignant character, and requires prompt and decisive treatment to meet and overcome its violent and deadly power. No ordinary remedies, or ordinary course of medication, will answer the demand. The remedies must possess extraordinary energy, power, and promptness to overcome the force of this disease, arrest its progress, and aid nature in eliminating its septic and deadly poison. To meet this condition and relieve and cure the patient, the combination of veratrum viride and the gelseminum sempervirens, as above administered, is fully competent, and may be used freely with comparative safety and certainty of a favorable result. On this point I have spoken and written very fully in several instances, and need not here repeat the remarks made on former occasions, but rather exhibit and classify some of the severer cases which have occurred in my general practice, and have very fully confirmed the utility and scientific character of the principle of treatment in such malignant cases as herein given.

This is my seventeenth severe case in succession that has been

treated upon this principle without loss. In this enumeration ordinary cases of puerperal fever are omitted. Only the more acute, severe, and hopeless are referred to, whose recovery is indeed marvellous, as in the present case, like the restoration of the moribund to life. Some of these were so severe, and the vital forces so completely overcome and exhausted by the septic blood-poisoning as to require very large doses of medicine, constant attention, and very close watching, in order to administer the antidote successfully, and save life. Others being less severe, yielded more readily, and required less time and attention, in addition to the services of a good

nurse.

These seventeen severe cases may be classified in the following manner: Three occurred after the operation of craniotomy. These were extraordinary cases, exhibiting the most malignant character and destructive power, which usually attend the worst cases of this disease. They required much time, care and labor, to meet the varied rapid changes which were ever occurring from hour to hour, and to obtain and keep control until the fever was subdued and the cure perfected.

Nine of the seventeen were cases of eclampsia, or convulsions, which occurred prior to delivery, or at the time of delivery, and were also very severe, exhibiting their peculiar septic character and destructive power. Four of these had living, and five still-born children; and all of them were so acute and extraordinary that they may be properly classed among the more dangerous and fatal.

The remaining five were cases in which the fever developed in its accustomed virulence from four to ten days after delivery. These were all instrumental cases, and were attended, as is often the case, with considerable difficulty.

Thus it will appear that I have treated seventeen cases of the worst type of this disease successfully on the principle exhibited in this report, all of which required large doses of medicine to be administered and repeated at short intervals till the power of the remedy became equal to, or superior to the power of the disease. When this point was reached, the rigidity of the system was overcome, relaxation was obtained-the high temperature of the body, and the excessive, high febrile pulse was reduced, and the force of the disease soon became thoroughly subdued. Being now controllable, it was soon deprived of its malignant character, the patient began to improve, and soon became convalescent.