December 24th.-Excitement returning with erotic manifestations; chloral hydrate was given at night.

December 30th.-The erotic symptoms most prominent; gave forty grains brom. potass. morning and noon; chloral hydrate at night.

January 10, '71.-Changed prescription to thirty grains brom. potass., and also ten grains chloral three times a day. January 13th.-Doing so well that the medicines were suspended.

January 18th.-Becoming erotic and excited again; combination of chloral and bromide resumed.

January 20th.-Sleepless, noisy, and destructive. The chloral hydrate increased to twenty grains three times daily. Bromide the same as before.

January 24th.-Sleeping all night and drowsy all day, but refractory.

January 26th.-Drowsiness increased; remained in bed. Bromide diminished to grains twenty; ten grains chloral.

January 28th.-Stupid, staggering; pulse very soft; medicines discontinued.

January 29th.—Pulse exceedingly soft and feeble. The pulsation of the carotid artery was gentle and prolonged, communicating a peculiar sensation to the finger. In the wrist the pulse could not be examined. After an ounce of whiskey and one-fourth of a grain of the extract of belladonna, the pulse promptly increased its force.

These may be taken as the effects of the combined drugs, as the patient had no more chloral hydrate daily in the period (January 20th to 26th) than in that from the 8th to the 14th of December.

A. S. B., aged sixty-four; general health bad. Intense mental distress associated with (and by the patient ascribed to) an indescribable "misery" in the epigastric region. The fons et origo of the malady is probably in the solar plexus. Morphia sulphas used as an anodyne and hypnotic, became gradually increased to two grains in the morning, and three grains in the evening. Appetite was bad, and bowels were constipated.

January 11th.-Discontinued morphia. Prescribed thirty grains of bromide potass. and twenty grains chloral hydrate three times a day. After morning dose became quiet (usually disturbed the house by groaning). After noon dose slept an hour or two. After evening dose, at 6 o'clock, slept so profoundly that she could not be aroused sufficiently to take food. Pulse 56, and had a peculiar quiet beat. Respiration normal, with a slight natural snore. Shook her, and she drank a cup of coffee, and dropped off to sleep in a moment. At 9 o'clock had been aroused and had taken some supper and was fast asleep again.

Next day, January 12th, waked early and began the usual groaning. At noon ordered bromide twenty grains; ten grains of chloral. In the evening, bromide thirty grains; twenty grains chloral. Slept six hours.

bromide twenty

Evening, gave Continued thus drowsy all day.

January 13th.-Feeling "very badly;" grains; chloral ten grains, morning and noon. bromide thirty grains; chloral twenty grains. till January 19th; sleeping at night and Tongue paretic; great muscular relaxation. Diminished night dose to bromide twenty grains; chloral ten grains; and added one grain of morphia sulphas.

January 24th.-Tongue still paretic, and coated; pains in the inferior extremities. Bromide of potassium discontinued.

February 8th.-Has taken the ten grains of chloral hydrate three times a day, with morphia sulphas at night. Has gained flesh, and is more comfortable than she has been for years. Shall withdraw the morphia gradually.

We have employed the chloral hydrate in whooping cough, combined with bromide of potassium. The intervals between the paroxysms of coughing have been lengthened, and the severity of cough abated. To children between three and four years old we have given the following:

aa., ij.; 3

=

Syr. Pruni Virgin., iss. 2 oz. M. Sig. Dose, teaspoonful every three or four hours.

We have combined the chloral hydrate with hydrocyanic acid and bromide of potassium with apparently good effects in whooping cough. We believe that chloral hydrate may be made to play an important role in infantile therapeutics.

ART. II. TRACHEOTOMY FOR REMOVAL OF A PIN. BY JOSEPH W. THOMPSON, M. D., Paducah, Ky.

Mrs. N., about thirty-six or seven years of age, inhaled a pin on the 12th of March last, it lodging in the upper portion of the trachea. The second day after the accident I was called to see her; found her hoarse, with some fever, and an almost incessant hacking cough. Her sister, who was nursing her, said she had paroxysms of suffocation, in each of which it appeared that she would die. I immediately recognized these paroxysms as spasms of the glottis, excited by the presence of the pin, and stated to the patient that there was great danger of her dying in one of these paroxysms if the pin was not removed by opening the trachea. She continued to postpone the operation until the following Saturday (the seventh day), when the spasms of the glottis became so alarming that she gave her consent for the operation to be performed. I opened the trachea in the usual way, the patient losing not more than two teaspoonsful of blood. In attempting to grasp the pin with the curved forceps she coughed and vomited, which partially aroused her from the effects of the chloroform. She then stated to me that she had swallowed the pin into the stomach. I examined the cavity of the trachea again, and found that the pin had disappeared. She recovered promptly, with comparatively little inconvenience.

The principal point that I wish to call attention to is, that after making the incision through the skin, subcutaneous tissues, and fascia, I bent a grooved director so as to accommodate it to

the external incision, and with it dissected down on the trachea; then, in the usual way, opened three rings. I am aware that after the superficial incision is made, that it is the common practice to use the handle of the knife principally in making the dissection down to the trachea. I have performed the operation three times, using the handle of the knife as much as it was advisable, in the first two operations, and the grooved director, as I have before stated, in my last operation. With the grooved director, I dissected down to the trachea much quicker, and with the loss of much less blood than when I used the handle of the knife, as with it I frequently had to resort to the cutting surface of the knife.

Present at the operation, were Drs. D. D. Thompson, E. B. Richardson, J. F. Cole, J. G. Bishop, and H. M. Gilson, who kindly rendered me assistance.

ART. III.-TEMPERATURE DURING PREGNANCY, LABOR, AND CHILDBED. By S. BRANDEIS, M. D., Louisville, Ky.

Mr. Squire, in London, published an article under the above title, in the "London Lancet," in 1867.

During pregnancy the temperature is generally somewhat increased, after the sixth month, to an average of 99°.

During a normal parturition the temperature was generally but little higher, the maximum being 99.9°, and the minimum 98.9°.

In the first twenty-four hours after labor there is a fall of temperature observed. With the secretion of milk there is a rise, which gradually disappears as soon as the same is established. The highest figure was 103.3°, on the tenth day. Sleep seemed to diminish the temperature.

For the period of involution, solid food and warm diluent drinks will favor the rising of temperature; the contrary is done

by alcoholic drinks. With reference to the use of the latter, Squire gives the following indications in connection with thermometrical conditions:

1st.-As long as the temperature is rising and the lacteal secretion not fully established, alcoholic stimulants may be useful, and even necessary.

2d.-When the secretion of milk is copious and the temperature high, stimulants are unnecessary, and seem to be even injurious.

3d.-When the secretion of milk is profuse and the temperature low, alcoholic drinks are required.

Dr. Crede, Professor of Midwifery, in Leipsig, read a paper on Thermometrical Investigations in the Puerperal State at the Convention of German Naturalists and Physicians, at Dresden, in 1869.

Since the beginning of 1866 every lying-in woman in his clinic was the subject of thermometrical investigation at least twice a day. He prepared numbers of tables and curves, and finally arranged his cases in the following groups:

1st.-Temperature never above 38 Celsius (bloodheat); perfectly normal cases.

2d.-Sudden rise on the third day, with an early fall to the normal temperature. Afflux of milk to the mammæ, sore nipples, slight contusions, and injuries of the genitals; painful after-pains.

3d.-Rise of temperature on the fourth, fifth, and sixth days, with an early fall to the normal temperature. Constipation most frequently; no material changes; perhaps some indiscretion in diet or physical excitement.

4th.-Rise on the third and fourth days; persistently high for fourteen days; then slow return to normal temperature; complications of slight puerperal affections, with disturbances of digestion; slight exudations surrounding the uterus.

5th.-Rise of temperature on the second, third, and fourth days, persisting in its height for three or four days; then a rapid