a lump about the size of the small end of a hen's egg on my thigh just below the groin. It could then be pushed back into place and caused me but little inconvenience. It continued to increase in size until I was thirty years of age, when it was the size of a goose egg, very hard, and for thirty-five years I was not able to push it back into place. I wore a bandage and different contrivances for a long time, and it was thought by our family physician that I could not wear a truss. As I grew older, it gave me a great deal of trouble, so that at last I was compelled to seek relief. I visited an eminent surgeon, who thought an operation at my age would be dangerous, but did not suggest other satisfactory relief.

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A concave pad was applied, which made even and gentle pressure over the whole tumor. But one change was made in the size of the pad, though as the tumor diminished pressure was increased by filling the pad with cotton. At the end of three months, the hernia was entirely reduced. The patient during that time had followed her daily occupation of housework and tending a toll-gate.

For reducible femoral hernia, smaller pads are used than for inguinal, and pressure should be made rather away from the centre of the body than towards it, and directly upon the crural ring. As a rule, less pressure is required for femoral than for inguinal hernia.

It is yet to be discovered that any but a spring truss is generally adapted to the successful mechanical treatment of hernia, though others are used with in

Truss applied for Femoral Hernia. different and temporary relief. For the femoral variety, it is a matter of doubt if any other can be used with success.

The best patterns of trusses for femoral hernia are limited to one for single, crossing the front of the body as shown in the illustration, and one for double in two parts similarly constructed. The single truss when correctly fitted requires no strap or fastening to keep it in place, while for the double condition each part must be applied from the side of the body on which the tumor is located, and connected front and back to keep it in place.

A spring suitable for the purpose is made of steel, tempered as are the best springs for large clocks. The object of that particular temper is to make the steel as hard as possible and yet have it tough enough to admit of bending without breaking. A spring that can be easily fitted to the form of the patient with just the requisite amount of pressure, should be protected from the actions of perspiration and admit of its being used while bathing. This is accomplished by covering with a thin coating of rubber in a plastic state, which, when vulcanized, adheres so firmly to the steel as to apparently become one material, and requires great force to separate them. Simply by warming, this spring can be bent and shaped to the form of the body with more or less pressure, as might the steel or rubber alone without injury to either, and though it may be affected as described its shape will not be in any way altered by use.

While it must appear that the spring of a truss is the important part, the fact must not be lost sight of that the pad also plays an important part and should be so that it can be manipulated. To make this, there is no material for the purpose equal to hard rubber. When the pad is made hollow, as all should be, to avoid weight, by warming it can be concaved to any extent. When the desired concavity is formed and the material cooled, it will remain the same until again warmed. Heat of the body is not sufficient to affect it. After a pad of this kind has been concaved it will, by simply warming, return to its original shape, without any manipulation whatever, such being the nature of the material, that no matter how changed when heated, it returns to the

Concave Pad.

shape in which it was originally vulcanized.

The rear part of such a truss for single hernia passes across the back of the patient, on a line nearly level with that which encircles the ilium, sloping slightly towards the end several inches beyond the spine, which rests upon a round disk. The hard rubber with which the spring is covered, and the front and rear pads are made, is highly polished, so that it presents a smooth, not unpleasant surface to the most delicate skin. A truss of this kind, when adapted to either femoral or inguinal hernia, will be found to maintain its position without the aid of a strap or other fastening.

Limits of this article will not permit of describing other conditions in which femoral hernia is met. The necessity of physicians judiciously pursuing the mechanical treatment of every condition and variety of hernia, can not be too strongly urged. In both sexes it should be carefully conducted, for if properly supported it gives but little trouble, and in many cases it is permanently cured. 25 South 11th St., Philadelphia, Pa.

The Use of the Hot Douche in Gynecological Practice.

Hot douches are a great therapeutic agent in the treatment of diseases of the female sexual organs; but to get the best effects, or indeed any good effect, they must be given properly, and with the object to be obtained constantly in mind. A carelessly given douche is worse than useless; in place of the stimulating effect derived, we get a relaxation of the parts, which only hinders instead of aiding the treatment.

The use of hot water is indicated in congestion and inflammation of the tubes, ovaries and uterus; in chronic cases, where there are old pelvic adhesions; in all cases of leucorrhea, from whatever cause; to preserve cleanliness of all the parts; in menorrhagia as a hemostatic; and in the preparatory and after-treatment in operations on the cervix, vagina and perineum.

Three cardinal rules must guide us in the manner of giving douches: the patient must be on her back; the stream must be continuous; the patient must never give the douche herself, or feel

herself in any way responsible for the treatment. It is important that the patient should lie quietly, with the muscles relaxed and her mind at ease. A douche taken in the sitting posture, through an ordinary syringe, by the patient herself, while she is bent over in an unnatural position and all her muscles on the stretch, is of no value whatever.

The paraphernalia for giving a douche properly consists of a fountain syringe, holding at least three quarts, a bed-pan, connected with a pail or small tub by a long rubber tube, and a piece of rubber sheeting to place under the bed-pan to protect the bed. To get a good stream the syringe should hang about six feet from the floor. Before inserting the tube, the water in the rubber tubing must be run out. The vaginal tube should be of glass or hard rubber, preferably glass, with no opening directly at the end, as, with considerable force, the water might be thrown into the cavity of the uterus and cause trouble. If the douche is given for its effect on the tubes, ovaries and uterus, and the water is not needed below the cervix, a vaginal tube with a return pipe is a great improvement on the ordinary tube; in this way the douche may be given much hotter than when the water must run over the vagina and external parts in escaping, as it is here where the heat is felt. A very hot stream may be thrown against a highly congested organ without causing any unpleasant sensation.

The temperature of the douche given will depend upon the object to be gained; if simply for cleanliness, 105° is an agreeable heat, but if to reduce congestion and absorb adhesions around the tubes, ovaries and uterus, 115°, and even 120°, will be found necessary.

The douche may be given, in ordinary cases, morning and evening; but in cases of acute metritis, when the patient is confined to her bed, may be given three times a day with benefit for a few days, until the inflammatory symptoms subside.

The use of the hot douche as preparatory treatment for plastic operations on the perineum, cervix and vagina, can not be too strongly urged. The parts must, at least, be clean before touched with a knife or scissors, if we are to

expect good results. A week of hot douching, morning and evening, ought to precede the operation in every case. In the after-treatment, where there is pain and throbbing in the wound, the hot water is not only very grateful to the patient, but a material aid, in that it preserves cleanliness and reduces acute congestion. The first douche must not be given until forty-eight hours after the operation. If there is no particular pain or heat, the douche is given for the sake of cleanliness at about 105°; if there are signs of much inflammation, the temperature is raised to 115°, or 120° if necessary, and lowered again when the symptoms subside. The patient should remain in bed for two or three hours after a hot douche. When she is obliged to be on her feet during the day, the douche is best given after she has retired for the night.

In regard to the quantity of water used at one time, eight quarts is the least quantity which will produce the required effect, if given with the expectation of getting any benefit other than cleanliness. It is the long, steady stream which contracts arteries, veins and lymphatics, and thus aids in absorption of adhesions, and in restoring tone to flaccid tissues.

Patients not accustomed to the use of the douche should begin with one quart only, at 100°, and increase the quantity of water one pint, and the temperature several degrees, at each douche, until at least eight quarts is taken at one time. The temperature used will depend upon the result to be obtained, 105° to 115° being sufficient in the majority of cases. The best results are obtained by a slow, steady stream. Fifteen to twenty minutes should be consumed in taking a douche of eight quarts.

LUCY WAITE, A. M., M. D.

Chicago, Ill.

Uterine Inertia.

Twelve years ago, I was called by a negro man to attend his wife in labor. He stated that his wife had been in labor so long that he thought something must be wrong, for she had been heretofore very soon over with it.

On arriving, I made an examination, and found vertex front and low down. During a pain the head advanced so that

I expected an early delivery. When approaching to the point of exit, the pain lessened and was not of sufficient force to cast it out. I waited about an hour, expecting every pain would deliver her. On making another examination, I found still the same state of affairs as before.

During the cessation of pain, I readily stretched back the front of the os over the vertex and held it there during the pain, and found that it did not retract on cessation of pain, and the next expelled the child. I was pleased and gave half drachm tincture of ergot. Soon everything was over with.

Two or three years afterward I was sent for by the same person to attend his wife. His note commenced thus: "My wife was confined last night, but is not doing well, and I wish you would come to see her." This was received late in the evening, distance seven miles, bad roads and disagreeable weather, and no convenient place in neighborhood to remain after my visit. Therefore, supposing from the tenor of note that the labor was over, and the trouble due to afterpains, I wrote the following note: "Take several pods of red pepper and make a very strong tea of them with boiling water. Add several tablespoonfuls of flour and make a batter, and spread it over a cloth large enough to cover bowels and put it on the stomach with nothing between the pepper and skin. Allow it to remain until it burns well. (This has always given me satisfaction, when I do not wish to use morphine, etc., in after-pains.) I will come out in the morning."

Before approaching the cabin I learned that the child had not been born until the just passed night.

On meeting the old father, I asked what had been the matter; how the mother was getting on. He said: "Well, sir, my wife had been in labor nearly two days. I had two negro women, who always attended such cases in the neighborhood. One said, she had a license to practice midwifery, and they both told me that the child was crossway the birth, that they could not move it and that they must have help. Well, sir, when I found I could not get you, I concluded to do as you said. All pains had stopped, and she just lay quiet on the

bed. I put the pepper poultice on her; (you should have seen his twinkling eyes and his face wreathed in smiles)-in about fifteen minutes she said that pepper was burning; the pains recommenced, and in half an hour I had to take it off. The pains became more severe, and within a short time delivery was complete." W. E. P.

Muscular

Rheumatism-Abscesses.

J. P., male, aged twenty-three, height, six feet one inch; weight, one hundred and sixty pounds, four years ago suffered from muscular rheumatism, which, after appropriate treatment passed over.

Probably some two months after this a diffused swelling appeared on the upper surface of the thigh, about four inches below crest of ilium. After several days, aspiration showed pus, and after lancing there was quite a liberal discharge. This (No. 1) opening remained about one year, but in the course of about six months later another swelling resulting in an open abscess, (No. 2) after lancing was established four inches below tuberocity of great trochanter. Since then another abscess (No. 3) has formed on inner upper third of thigh. All formations thus far described are on the right side. By the time this third opening was established, openings No. 1 and No. 2 had closed. This was about two years after commencement of first abscess. Then abscess No. 4 presented itself one-half inch right of linea alba and two inches above pubic bone. This opening is discharging continually, but abscess No. 2 (below tuberosity of great trochanter) opens regularly every three months discharging about one pint of pus in one week's time. At the formation of each abscess there was quite an amount of sloughing, similar to that in carbuncle; this would however fill out with new granulations until a small opening to admit of an ordinary probe would remain.

During all this time patient was kept on cod liver oil with hypophosphites, and increased in height and weight; in fact, was in excellent health, excepting a day or two before abscess (No. 2) would reopen. Of late he has complained of some pain in the prostatic region while urinating, but this has now disappeared.

Careful examination has thus far failed to find any spinal tenderness or curvature. No possible indication of hip joint trouble. Probing has failed to give any satisfactory results as the abscesses seem to follow the muscular sheaths. He has always been able to pursue his usual avocation upon the farm, such as ploughing, etc., when he experiences no pain, but upon resting he says he experiences excruciating pain in jointure of sacrum and illium, but upon digital pressure no pain is elicited. Appetite always good. Bowels regular. No glandular swellings. No ancestral taint of any kind to be found.

I should be very much pleased to have the profession locate seat of trouble.

Case No. 2.-Little girl, aged six. A case of cerebro-spinal meningitis. Nothing out of the ordinary in the case and passing on to the sixth week. The peculiarity about this case is, that for the last two weeks the urinometer test has always shown a sp. gr of one thousand to one thousand and four at most. No trace of albumen. Microscopic examination shows a few crystals of uric acid, all other tests negative.

I have never in fifteen years practice met with so low a test. Have any of the brethren? How can it be explained? A. P. RENNEKER, M. D.

St. John, O.

Reply to Dr. Hill.

The article of J. T. Hill, M. D., Willow Hole, Texas, on pages 47 and 48 of the January BRIEF, contains several questions which are so pertinent, and do so completely coincide with my experiences, that I can not let the opportunity pass without, in part, answering the doctor.

During the past fourteen years, most of the time spent in an active country practice, it has been my rule, in those cases which are lingering and the patient shows signs of weariness, to give from one-eighth to one-fourth grain of morphia sulph., hypodermically; repeated in about forty minutes, or until there is a complete cessation of the pains. When the effects of the morphine have worn away, I find the labor progresses very rapidly to a successful close, and in the majority of cases there is no need of forceps being used.

Now, to the latter part of the doctor's question, "Is it right to satisfy the whims of the old women"? I most positively say "No." It is not right for a man, who has spent thousands of dollars in procuring an education and for literature in order to keep abreast of the age, devoting his life to the alleviation of the ills of the human race, to listen to these ignorant, prattling and meddlesome interlopers.

Our education and experiences should place us above those breezes of opinion which often arise in these cases.

I find it a good practice in the cases which the doctor recites, to take the husband aside and explain to him in the simplest of language, all it is necessary for him to know. The old women I get busy about something else; send them on various sorts of errands to the remotest parts of town or the neighborhood; any thing to get them away from my patient, and away from the house where their prating and noise is not wanted, and so keep my patient quiet, letting her know by my actions that I understand my business.

I am satisfied if the doctor will follow this course he will have a surprising degree of success, and never have his patrons sending for the indiscriminate forceps wielder.

CHAS. F. CLARK, M. D. Upper Lake, Cal.

Retained Placenta.

For the benefit of W. S. Robertson, Jr., M. D., I relate the following:

Seven years ago I attended Mrs. C., aged twenty-four, in confinement. The child was delivered in the usual length of time, and both did well. On the fourth day, patient got up and resumed her household duties. Eleven days afterward the placenta was expelled as fresh and healthy in appearance as any I ever

saw.

Six years later she was again confined. Mother and child did well. Seven days thereafter a perfectly normal placenta was delivered. Patient was up and around most of the time.

Same patient, in confinement three years ago, five days elapsed before expulsion of placenta.

It is common to meet with patients who say: "Doctor, no matter what I eat, I am disturbed by acid eructations and regurgitation of acrid, burning fluids until I take some soda. What can I do to obtain permanent relief?"

The old line of treatment is to advise your patient to abstain from tea, coffee and tobacco; eat no starchy food, and masticate everything eaten well. Give an antacid or an alkali. Such treatment will not cure the patient. These acid eructations betray the formation of acetic acid, and are due to a deficiency of alkaline chlorides in the stomach, and these alkaline chlorides can not conveniently be supplied by diluted muriatic acid without affecting the peptic glands and producing a chemical change in a portion of the contents of the stomach.

These are best supplied by giving teaspoonful doses of chloride of soda, half an hour after each meal. The salt should not be dissolved, but taken in the mouth dry and washed down with a sip of water. This will enable the stomach to manufacture in its laboratory the alkaline chlorides, and use them as fast as manufactured. E. T. LEWIS, M. D.