lum leads towards the side of the cervix. And unless the cervix remains free that it may be shifted with instruments suitable for the purpose, the examination will be still imperfect. This shifting, however, cannot be done through any valvular speculum, as the expansion of the plates locks the cervix just where and as it is reached. The Sims' does not obviate this difficulty. The completeness of arrangements is not only apparent, but the accuracy of examining instruments required also.

The ligaments have but little control over the support of the uterus, nevertheless this is in opposition to some leading authorities. When the vagina loses its support, down, back or forward goes the uterus. From a slight deviation, in course of time, if not obviated, it works itself into a complete somersault or protrusion.

That the numerous theories, modes of correction, support, and arguments that the uterus needs no support, or shingle, since it had no bones, undoubtedly all originate from the examinations with instruments which do not admit of sufficient light in the vagina that its true condition can be seen and known.

Only a few days ago I received these remarks from a physician in Colorado: "The speculum is a daisy. I never saw an os as plain as sunlight until I used your speculum." closed letter, dated Nov. 27, '84, and reads thus:

He in

I hereby acknowledge the receipt of the cases of speculums and instruments, and would say, after the short experience I have had in their use, that I am well pleased. Their simplicity and efficiency makes the treatment of that class of cases a great deal more satisfactory; and, I am free to say now, I can undertake the examination of those cases and their treatment with a degree of confidence to which I was a stranger before. I shall be pleased to make trial of your supporters and pessaries hereafter as occasion may offer. Truly yours,

F. J. GUITTARD."

The order was dated Oct. 9, 1884, and shows a thorough deliberation before ordering, and says: "I have concluded to invest in a case of speculums and examining case of instruments. Find inclosed $20."

Paragraph 5th appears not to be only sound but solid doctrine, and the importance of the touch while standing I have seen nowhere so well portrayed. There may be one objectionable fea

ture, and even this, that the sound can be best introduced in a standing position is correct, but not the least dangerous, nor is it necessary to insert a sound, invisibly, since I guarantee my speculums, and with it that the sound can be visibly introduced through them.

Under the guarantee, there have been two single speculums returned and the money refunded last year. This year, although near to the close, not even one.

During this year several cases of speculums and exainining cases have been ordered through drug houses. From connecting circumstances I have reason to believe they were from the influence of the advertisements in this journal. But commissions were asked rather above my actual profits; in consequence the physicians had failed to get them. In future such orders will receive no attention. The first purchase of all the instruments on the catalogue will now be guaranteed, according to rules of catalogue. Catalogue on application, and mentioning this journal. S. S. STAUFER, M. D.

624 Franklin St., Philadelphia, Pa. ·
[TO BE CONTINUED.]

ART. IV. An Important Sequel of a Case in Practice. - BY PROF. E. YOUNKIN, M. D.

Accidentally, on November 1st, 1884, as I entered the shop of Mr. C. W. Rosenberg to purchase a picture frame, I found the proprietor lying on the lounge. He arose to wait upon me, but stated that his head pained him so much that he would be compelled to lie down. After transacting my business with another, Mr. R. stated to me that he had been suffering with headache for three weeks, and it was becoming intolerable. He asked me if I could not do something for him.

I examined him, and found the tongue clean and natural, his pulse regular, but slow-beating about 65 per minute; his temperature, 99°; bowels, regular; urine, readily passed and of normal secretion; his face very slightly flushed; nothing abnormal about the eyes but slight congestion; and, in fact, nothing pathological seen, except the pulse slightly lower and the tem

perature slightly higher than normal, and the headache of which he complained.

The headache lasting so long, and the ratio between the pulse and temperature being out of proportion, I was led to believe at once that I had a case not only peculiar but grave. Upon inquiry into the cause, I could find no clew to the difficulty, the necessary information being for the time suppressed. No evidences of malaria; neither did I think so at the time. My conclusion was that the pathological condition must be either neuralgic or a cerebral hyperæmia. I chose the latter condition to begin with, and prescribed the following: R. Kali bromidium, 3iij.; tinct. gelsemium, 3ij.; syr. simplex, 3iij. M. et sig. A teaspoonful to be taken every half hour, until four doses were taken, then every hour and two hours, according to the effects. The next day I found my patient slightly relieved from his pain in the head, and ordered a continuance of the medicine, with hot pediluvia and mustard to the back of the neck.

On the third day I was called to see the case, and found the continued pain in the head, with a rise of temperature to 100o. The bowels not acting. The bromide and gelsemium had signally failed to relieve the pain. I gave now hypodermically morphia, gr., atropia sulph.,, and ordered atropia,, to be given three times a day. In the meantime to take gelsemium, and at night a cathartic of oil, hot pediluvia, etc.

On the fourth day I found him resting comparatively easy. He stated that he had slept some during the night, and had eaten a little soup in the morning, and that his head did not hurt only

when he moved about.

I found him on the fifth day resting quietly and inclined to stupor, but could be easily aroused, and when aroused would answer questions intelligibly, though slowly. The case became the more interesting as it advanced, and I related the symptoms to my colleagues to get their opinions as to the pathological changes. Some were of one opinion and some another. I had now concluded that we had a possible thrombus, but I confess that the symptoms were puzzling, and up to this time the cause kept from me.

On the sixth day I noticed slight delirium; the night previous

he had walked about the room, and wanted to go out-doors, which he did, notwithstanding the entreaties of his wife. I noticed a disposition to bring his hands upon his forehead, and he said it pained him there. I will say that the pain at first seemed to be in the back of the head, but finally it moved further in front. The wife stated to me now that he could not urinate well, but had passed a considerable quantity, so that I took it for granted that there was no necessity for aid in this respect.

On the seventh day of my treatment I found the patient much the same as upon the previous visit-not any better, but if anything the symptoms slightly intensified. I gave no morphia but the one dose. There was voluntary motion in the arms and legs up to this time, though I thought there was tendency to paresis. I now expressed doubts as to his recovery, and asked again for causes. The wife told me that he did not want her to tell, but that she felt in duty bound to state that he had been drinking hard of late, that he had lost property by fire, and that he had, on several occasions previous to this headache, come home drunk; that he was out one night and came home drunk, and had a wound on his chin or lip.

I then remarked that this history added to the gravity and danger of the case, and that I would return the next morning, and, if she wished, I would bring another medical gentleman with me. The next morning, at 8 o'clock, I had a telephone dispatch not to come, and I subsequently learned that Dr. Funkhouser was sent for, and that the patient died at 8:20 o'clock the day I received notice not to come. In a few days afterwards, finding that a post-mortem was made I dropped a card to Dr. F., asking him to please inform me what he found as a pathological condition, but hearing nothing from the gentleman, I concluded that the Jews, perhaps, would have nothing to do with the Samaritans.

It will be interesting to the readers of this journal, however, to know that Dr. F. took charge of the brain, and brought it before the Allopathic Medical Society, of St. Louis, upon which a discussion arose.

The following report by Dr. Funkhouser is made of the case, and is taken from the Weekly Medical Review:

"I am sorry to say I have not a very succinct and clear history in a case I wish to report. I was called to see it only last night. The patient had been under the care of another physician for five or six days. He had been treated for malaria part of the time, and part of the time for nothing in particular. I saw the man last night at 10 o'clock, and found that he was in a comatose condition, breathing stertorous, slow and irregular; his pulse was from 45 to 50. I inquired in regard to the case, and found that the patient had been suffering from intense pain of the head for two weeks, or even longer, before he took to his bed. And in going back further in his history, I learned that he had come home drunk in his buggy and left the horse standing in front of his door. He came in, sat down in a chair, and put his face between his hands. It was found that he had received an injury across the bridge of the nose. This injury must have been a very severe one, judging from the remarks of his wife, and from the fact that there was swelling and pain for several days. Prior to that time the patient had not suffered from any particular trouble. Within the last six weeks the man had met with reverses; his factory burned down; he took to drinking, and drank constantly. I looked at the pupils of the eye, suspecting that the patient was suffering from apoplexy, or an effusion of some kind on the brain. I took it to be apoplexy. The patient became unconscious yesterday morning at about II o'clock. His friends imagined that the unconsciousness was due to morphine, which had been given to him by the attendant physician. I discovered that his right pupil was contracted, and his left one was dilated. I told them that I supposed we would find the lesion on the right side of the brain. Where the pupil is contracted, the oculo-motor nerve is excited, and where depression occurs, the sympathetic filaments supplying the iris have full control of the dilatation of the pupil. I also found that the patient appeared to be threatened with paralysis of the left side. He was able last night to move his arms to a limited extent, also his right leg. When I irritated the sole of the left foot he didn't move his leg, although he made an effort to draw it up. On the theory that there is a cross action, we would perhaps expect that the greatest trouble, the greatest lesion, would be upon the opposite side; that is, in this case, upon the right side. The patient, I was told, had not passed his water for some time; I drew off a considerable quantity of water. There was also paralysis of the rectum. On making the post-mortem examination, I found adhesions between the dura mater and the brain, all along the superior longitudinal sinus. On the surface of the left side of the brain there was considerable blood, and a large free clot posterior to the meningeal artery, about two and a half inches in