examined patient and agreed with me that the child in utero was dead and that immediate delivery was in order. The cervix was not dilated and there was no effort at labor, but without any diffisulty I could introduce my index finger into the cervix. I employed Dr. Harris's method in this case, which I knew best at this time. After thorough dilatation of cervix, I performed podalic version without any difficulty. The labor was begun and ended within one hour. The child was dead, confirming our diagnosis. The patient made an uneventful recovery.

CASE 2.-This was a case of placenta praevia in which I helped one of our colored physicians. Just before I saw the case, the patient had a violent hemorrhage. Her pulse showed but too plainly the great loss of blood she had sustained. On examination I found that she had central implantation of the placenta. I followed the method recommended by Dr. Barnes. Introducing my hand into the vagina I separated the placenta all around the lower segment of the uterus as far as my index and middle fingers could reach. Very little bleeding followed this maneuvre. Then by the bimanual method I performed complete dilatation of the cervix. I then tried diligently to pass my fingers and hand by the border of the placenta, but it was adherent everywhere, so I was forced to pierce the placenta with my fingers in order to pass my hand into the uterus. As I was forcing my hand through the placenta the blood rushed furiously past my arm, but I quickly seized a foot turned and by traction on the foot brought the breech down to engage at the superior strait, causing strong pressure to be exerted on the placenta, thus rapidly arresting the much dreaded hemorrhage. In a short time the child was born. It was dead. I immediately delivered the placenta. The greatest trouble, in the whole case was to arrest a threatening severe post-partem hemorrhage. The mother, after delivery, was very weak, exhausted and almost pulseless, but hypodermic injection of strychnia and the subcutaneous infusion of normal salt solution into the cellular tissue of subclavicular region, her heart's action quickly improved, and although she remained weak for sometime, she made a fairly rapid recovery. It is my firm belief that no other treatment would have saved this woman's life.

CASE 3.-This case I attended recently. It was a primipara. It was also a normal head presentation. Slow labor pains continued for nearly forty-eight hours. By this time the woman was becoming rather exhausted and discouraged. Although her pains were quite severe for twenty-four hours, the os was at no time dilated

more than the size of a half dollar. I gave as much chloral hydrate as I thought was safe. Gave chloroform occasionally, and used every effort to relax the cervix, but in vain. I told her husband that instrumental delivery was imperative, and that I wanted professional assistance. He sent for Dr. Goodall Wooten. Dr. Wooten, after examining the case, agreed with me that instrumental delivery was the proper procedure, but advised rupturing the membranes and waiting for four hours, hoping that the pains would be augmented and possibly natural delivery effected. After the lapse of four hours if the pains were not stronger and better dilatation of cervix was not obtained, Dr. Wooten was to be recalled, and immediate delivery accomplished by whatever method should be deemed best. At the end of four hours the pains were not improved, and the os was positively less dilated than at last examination, and the temperature was now 101° F. Dr. Wooten was recalled, and we were perfectly agreed that forcible dilatation of the cervix and a high forceps operation were our only alternatives. Dr. Wooten put the patient completely under chloroform. By the bimanual method I thoroughly dilated and paralyzed the cervix. I then applied the forceps at the brim. It was a difficult forceps operation, as the head of the child had not engaged at the brim, but my able assistant so steadied the uterus by well directed manual pressure that I got a firm hold of the head of the foetus with the forceps. After one hour's long, hard work the child was delivered alive, and, I am happy to state, without any laceration of the woman's perineum. The child's head was severely bruised, but today it shows no evidence of the pressure of the forceps. The patient recovered without a rise of temperature, and with very little traumatic pain afterwards. In all these cases it is almost unnecessary to state that the most rigid antiseptic precautions were used. The external genitals were thoroughly scrubbed with green soap and hot water. The vagina was irrigated with a creolene solution of proper strength. I scrubbed my hands for five minutes with green soap and boiled water, then cleansed them with boiled water. Then I immersed them in a strong solution of permanganate of potash, and then in a strong solution of oxalic acid, and finally immersed them in a 1 to 1000 of the bichloride of mercury solution before introducing my hand into vagina or uterus. This treatment of the hands takes time, but it is time well spent, and is always a life-saving process.

Diabetic Coma Symptoms, Pathology and Treatment.

Abraham Mayer, New York Medical Record, lays stress upon the presence of Kussmaul's "air hunger" respiration, and of the hyaline or granular casts of Kültz prior to all attacks of diabetic coma, while large and increasing amounts of beta-oxybutyric and diacetic acids with acetone and ammonia are invariably present, often for some time before the attack.

According to the acid intoxication theory the various acids found combine with the alkalies of the body after proteid foods have ceased to furnish enough to maintain the balance, this condition. being rapidly followed by a true acid intoxication and coma. The advocates of the toxic theory, however, claim that these acids destroy protoplasm directly generating toxins.

As facts have been found to increase the acetone and diacetic acids generated, besides radically disturbing the digestion, while proteids directly favor the production of toxins, it is well to allow carbohydrates in limited quantities, while alkalies should be freely administered.

The author cites a case in which two attacks of coma were successfully treated by 70 and 50 grams of glycuronic acid, respectively, the patient succumbing to a third attack after the supply of the acid was exhausted. As Uso tropin splits into ammonia and formaldehyde in the presence of an acid, it forms a rational treatment, and was used with much satisfaction in a second case. C. R. M.

Hepatic Insufficiency.

H. Richardson, Philadelphia Medical Journal of March 15th, argues that the bile salts are the only true chologogues. Only bile salts free from all impurities, such as cholesterin, should be used. Cases of hepatic colic, and the condition of incomplete bile elimination found in the insane, are readily relieved by administration of bile salts, and no return occurs while the treatment is continued. Many cases of glycosuria are hepatic in their origin and may be eured by a not very strict diet by the substitution of fats by starch. and glycocholate of soda to assist in the assimilation. The bile salts being cumulative in their action and reabsorbed from the intestine, they need not be used over long periods of time, about two drams per month being taken in cases of hepatic colic.

C. R. M.

THE

TEXAS MEDICAL JOURNAL.

AUSTIN, TEXAS.

A MONTHLY JOURNAL OF MEDICINE AND SURGERY.

EDITED AND PUBLISHED BY

F. E. DANIEL, M. D.

ASSOCIATE EDITOR:

WITTEN BOOTH RUSS, M. D.,

San Antonio, Texas.

Published Monthly at Austin, Texas. Subscription price $1.00 a year in advance.

Eastern Representative: John Guy Monihan, St. Paul Building, 220 Broadway, New York City.

Official organ of the State Association of Health Officers, the West Texas Medical Association, the Houston District Medical Association, the Austin District Me dical Society, the Brazos Valley Medical Association, the Galveston County Medical Society, and several others.

CAR SANITATION IN TEXAS.

A movement is being inaugurated to cause the disinfection of sleeping cars and day coaches on all the railroads in Texas. It is yet inchoate, but in a conference with State Health Officer Tabor we learn that it will be instituted at an early date, as soon as certain details shall have been determined. First, he is to have an opinion from the Attorney General as to his authority in the matter and the extent of it, and whether the State shall pay for it, or whether or not the railroad companies shall do so. It seems clear to my mind that under the provisions of the quarantine law, (the only "health" law we have in Texas), the State Health Officer has authority to compel the railroad companies to disinfect their cars and to keep them in good sanitary condition, and that they cannot expect the State, or any body else, to pay for their sanitary policing. ButI am not the Attorney General. When the question of authority is determined it will be necessary to arrange the details of the process, and appoint inspectors to see that the cleansing and disinfection are properly carried out,-the adoption of some method of fumigation,

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etc. The traveling public are becoming aroused to a sense of the danger lurking in upholstered and curtained coaches, and the Travelers' Protective Association-the drummers- made the first protest. Attracted by the mild climate of Texas, hundreds, yes, thousands of consumptives drift into the State every winter, and many return to their northern homes in spring. Hence, during the winter and spring months, especially, the travel of this class on Texas railroads is very heavy Mr. D. A. Michaux, of Houston, member of the Travelers' Protective Association and chairman of its National Committee on Railroads, came to Austin and had an interview with Dr. Tabor, getting his views on the subject, and then wrote and published in the Texas papers "An Open Letter to Dr. Tabor," specifically setting forth the danger, and the drummers' appreciation of it, of occupying berths or seats, perhaps just vacated by some consumptive, (to say nothing of other contagious diseases, as smallpox, diphtheria, or scarlet fever, or measles), in cars where, as is too frequently the case, passengers expectorate on the floor, or cough and spatter the sputa on the curtains in the sleepers, or on the blankets or sheets, and in the second-class coaches, on the hot stoves, etc. The drummers' association, through him, appeal to Dr. Tabor as the State's sole sanitary authority, for measures of relief from this very great danger, a nuisance and a constant menace to the lives of the traveling public. The public generally, however, do not appreciate the danger. The majority are totally ignorant of it. Because consumption is not as acutely contagious as are other diseases mentioned, and is not as "catching," they do not realize its terrors. It is as much as one's life is worth to travel in a Texas sleeper in cold weather, for, in addition to the danger of contagion, the cars are not ventilated, but shut up almost air tight and heated to suffocation. In a crowded car, thus closed and heated, every passenger breathes the poisonous atmosphere which has passed through the lungs of every other passenger. This is a nuisance that ought to be at once abated. The State owes it to the public to protect them. It is a sanitary reform pressingly demanded. I hope and believe that Dr. Tabor, who has proven himself to be an efficient and progressive sanitarian, will push it to a speedy consummation. It should not stop with cleansing and disinfection, but the railroads should be required to provide sleepers and other coaches equipped with seats of rattan, cane, or nickle wire, and berths of woven wire, and efficient means for ventilation; and the filth-catching, microbe-breeding, death-dealing old curtains hung before each berth for protection and privacy, but which afford neither, should be replaced by screens or curtains of canvas or something better, at any rate. It seems to me