"4th.

Cimicifuga increases the energy and rhythm of

the pains in the second stage of labor."

"5th. It is my belief that cimicifuga, like ergot, maintains a better contraction of the uterus after delivery. It is my habit, however, to administer from fifteen to thirty minims of the fl. ext. of ergot after the birth of the foetal head and I have had but few opportunities of testing this effect of the cohosh."

Continuing, Dr. Knox says, "My method has been to give fifteen minims of the fluid extract of Cimicifuga in compound syrup of sarsaparilla each night for four weeks before the expected confinement."

One fluid ounce of the fl. ext. of cimicifuga to three fluid ounces of compound syrup of sarsaparilla, dose, one teaspoonful, makes just the required quantity.

Following the methods of Dr. Knox, it has become my usual custom, when notified that I was to be called to attend a confinement, to prescribe the cohosh as above indicated. If from three to six weeks is to elapse before the expected confinement, I order the mixture in teaspoonful doses on retiring.

If labor is to occur sooner, I advise teaspoonful before meals thrice daily.

In the past twelve years I have attended over two hundred labors; about half of them, or one hundred cases, received the preparatory treatment.

Among these one hundred cases there have been six cases in which the labor was completed before my arrival, and three cases of forceps delivery. One of these was in feet presentation, and forceps were applied to deliver the after coming head; in one they were used to deliver quickly on account of uremic convulsions, the foetus be

ing dead; and one case of a small mother with narrow pelvis, and a nine pound child, after a labor of fifteen hours.

I have not kept a very close record of the time occupied in the labors as I had no idea of reporting them, but they average less time than those cases not treated by the cohosh, and have proven more comfortable ones to manage.

In three cases, each in their third pregnancy, and where the cimicifuga had been administered for from three to six weeks, with a history of previous labors lasting from twenty-four to forty-eight hours, the labors were finished in from two to six hours.

The first of these cases was the wife of the gentleman who first consulted me, as mentioned before. Her first two labors lasted thirty-six and sixty hours, respectively, with one dead and one living child, and a laceration in each case, the forceps being used to terminate the labor. Her third labor began just before noon, Jan. 12th, 1886. I saw her at 2 p. m., and at 4 p. m.; her labor terminated in the birth of a female child heavier than either preceding, also females. She expressed surprise that she was through so quickly and easily.

Case No. 2 had never had less than eighteen hours of labor, and one of thirty. After about a month's use of the cohosh she gave birth to her third son with a labor of less than three hours.

No. 3 had given birth to one male and one female child, her shortest labor being 16 hours. About a month previous to confinement I prescribed the cohosh mixture for her and her third labor was completed in less than three hours, I barely having time to reach her bedside. In

my experience there is less shock with, than without this.

treatment.

Patients are less nervous, have fewer cramps, do not suffer so much from vomiting during labor, are freer from pain in the intervals between the uterine contractions, and the second stage of labor is shortened by the use of the cimicifuga.

I am not in favor of any routine practice, but it has become a routine practice with me when consulted, as much to prescribe the Cimicifuga mixture as to advise about dress, diet, and habits, and I am convinced that the use of the cohosh in all cases renders a very large percentage of the obstetric cases occuring in my practice, shorter, easier and safer for both mother and child.

In calling the attention of the society to this particular use of this drug, if I shall be able to induce any brother physician to study this question for himself, I shall feel that my effort has not been in vain, as I think we are all agreed that any thing that can be done should be done to make child bearing a less trying ordeal to women than it now is.

Report of Case of Tumor of the Neck.

By L. M. Bingham, M. D., Burlington.·

J. S., aged twenty-three, presented herself to me complaining of soreness and enlargement of the anterior portion of the neck, thus interfering with respiration.

On questioning her, I obtained the following history. About two years ago she noticed that her neck was slightly enlarged; but, as it occasioned her no inconvenience, she gave it little attention at the time. That it had gradually increased in size, and, about six months ago, commenced to cause much pain. This pain was increased by pressure, and, when lying down, respiration became very difficult. She consulted a physician, who told her that she was suffering from goitre. Her symptoms have steadily grown worse.

On examination, the thyroid gland was found to be slightly enlarged. Below and behind this gland, lay a distinct tumor, which extended downward behind the manubrium. Inserting my finger between the manubrium and the growth, she was unable to breath.

I advised immediate operation, to which she would not consent.

Six weeks later she returned. She had become much emaciated. Insomnia, due to dyspnoea, had made her very nervous; so much so, that marked choreic symptoms were present. She had a constant, dry, hacking cough, and it

was impossible for her to take an ordinary inspiration. Her condition had so thoroughly alarmed her, that she was now willing to place herself under my care.

She entered my sanitorium, August 24th, 1896, and the following morning, with the assistance of my house surgeon, I undertook to remove the growth. On account of the great dyspnoea, it was sometime before she could be thoroughly anæsthetised. After the usual antiseptic precautions, I made an incision about two inches long in the median line, between the thyroid cartilage and the manubrium. This incision I had to elongate to about four inches, to facilitate more careful dissection.

The tumor rested on the trachea and the sheaths of both common carotid arteries, extending downward behind the manubrium. There was comparatively little hemorrhage, as the vessels were easily caught and twisted. After removal of the tumor the character of the respiration immediately changed from quick, shallow breathing to a deep, natural respiration. The wound was closed with interrupted cat-gut sutures, rubber-tissue drainage being used, and then dressed in the usual manner. The patient recovered very satisfactorily from her ether. The wound was dressed the fourth day, the rubber drainage being replaced by a few strands of silk. The thyroid gland resumed its normal shape, and, on the tenth day she was discharged.

The tumor was oval-shaped, the vertical diameter being about four and the lateral three inches. It looked like a fibroma. It did not contain fluid. My intention was to have it examined by our pathologist, Dr. Linsley; but, owing to the carelessness of one of my nurses, the specimen was destroyed.