the valleys of California. Diseases of every kind require more active and sustaining treatment here than east of the Rocky Mountains. I was surprised to find so many paralytic cases, caused, no doubt, by the same source as the rheumatisms.

Diseases of children, "such as scarlet fever and diphtheria," are of the most malignant type. I also noticed in most forms of disease that they were periodic in all the valleys, and even on the sea coast, where they scout the idea of intermittent. The people do not shake with ague, as they do in the interior val. leys, but they have the manifest impress of malaria in their systems, which shows itself by the well-known periodical return or exacerbation. So we may say the prevailing diseases of the valleys are bilious and malarial fevers, with diseases of the liver, rheumatism, and including paralysis.

II. The mountainous region constitutes the largest area of California, and the most healthy. This has led to a great deception as to the healthfulness of the country. We have a rarefied atmosphere, and of course no malaria, except it may be in some places where stagnant water abounds in ponds or in the substratum of the soil. There are also many places so situated from bad drainage. But here I found disease of the liver and rheumatism, arising, no doubt, from the uneven climate of Summer and Winter, and more especially to the uneven atmosphere of day and night. Such hot days and cold nights must be sure to affect the system and produce such complaints. The variation is too great, occurring every twenty-four hours continually. This, with the high altitude, affect the nervous system unfavorably and bring on disorder of the heart. The lungs are also unfavorably affected by the taking of cold from exposure by night. Inflammation of the lungs occurs easily, and many are the deaths. Those taking colds or suffering from continued exposure contract what they term the "mountain fever," of the continued type. This disorder causes the death of many patients, especially under the treatment of the olden times. Few die, however, who are treated on our principle of vires vitales sustinere. This is the healthy part of California. The diseases prevalent here are rheumatism, neuralgia, paralysis, inflammation of the lungs and mountain or continued fevers.

III. In taking into account the general salubrity of California or the diseases predominant there, we must not overlook the

number of invalids sent there to regain their lost health. Our brethren of the profession, to get rid many times of helpless cases, persuade their patients to travel, and go to California as their last and only chance. Instead, it is their way to the grave. The climate is delightful, indeed, and pleasant; but the changes are too great. There are only two seasons there, the rainy and the dry. There are no thunder or lightning, and so nothing to purify the atmosphere; not even frost in many places. The populous cities are thus located as the population fear the frost, the greatest of purifiers. The high altitudes are not so healthy as many suppose. As a permanent location for health for the invalid it is not good to remain in for a longer time than six months, or at farthest one year.

I also learned that there is no difference in favor of the health or robustness of the old inhabitants or early Spanish settlers, and our American settlers. Among the old population were more of those complaints that I have here enumerated than amongst our own people. So they are even more debilitated and less able to stand an attack of sickness than even those unsound emigrants who throng the shores of the Pacific Ocean yearly. I have thought that in time California may be a better country for freedom from disease than it now is, taking into consideration the many who go there for their health. But if we take the old inhabitants for our exemplars it says "no." Among them all is degeneracy and feebleness compared to our Northern, Eastern and Western States of the Union. I am almost tempted to say that the feeble state of the old inhabitants, the Digger Indians, has not entirely come by chance, but by the effect of years and the influence of the climate. The next oldest present a little of that type, and those last of all after twenty years of residence are not so over fond of work as to be industrious.

So after summing up after the experience of five years of active practice and observation in California, I will conclude this essay by stating the prevailing diseases of California as a whole to be bilious and malarial fevers, liver and lung diseases, acute and chronic rheumatism and paralysis, and continued fevers. The bilious fevers, in parts almost amounting to yellow fever, and in those locations all other diseases are

liable to take on a malignant type, and baffle the skill of the most eminent of our profession, unless active treatment and a sustaining diet are given in the commencement, the sustenance to be given throughout the whole course.

PUERPERAL. CONVULSIONS:

BY MARY C. NIVISON, M. D., SCRANTON, PA.

The eclampsia or spasms peculiar to pregnancy will be generally observed to appear at the period of parturition, either in the first stage or near the time of delivery, or else after the event, before the full contraction of the uterus will have taken place. The convulsions will occur in the primapara or at any subsequent confinement. Both mother and child will perish, when in all previous labors both had done well. An elaborate discussion of this subject is here out of place; a terse and concise expression of ideas will be more proper. The text-books overflow with theories, which ought to satisfy those who are eager for such information.

If puerperal convulsions were of frequent occurrence, maternity wonld be always an occasion for terrible anxiety and foreboding to the mother and accoucheur. But fortunately, while none may be assured of exemption from the peril, the hope of escaping it is amply warranted. Statistics preserved by several of the most eminent and experienced practitioners show that the occurrence of eclampsia is not frequent, and that the loss of life from this source not very great. For example, Churchill enumerates 214,663 cases, in only 347 of which convulsions occurred-one in 618. The death-rate of the mothers in eclampsia is about one in nine. The mortality of children, however, is much greater. Many die in utero, during the convulsions, and are delivered naturally or by mechanical appliances. Many also are destroyed by the various means employed to preserve the life of the mother, such as premature delivery by the aid of drugs, version, or the use of the forceps.

The statistics of other practitioners and observers of great reputation do not differ materially. Although death does not always ensue, there are not unfrequently other serious results,

such as loss of memory, mental imbecility and mania, sometimes raving and sometimes in the form of melancholia. These conditions generally continue but for a brief time; but the latter may remain for years. We have known of instances in which the endeavor to induce the patient to recognize the infant, whether living or dead, as her own, was utterly in vain. It is, indeed, remarkable that the strongest passion of woman, that of love for her offspring, should become so obliterated, when, in a sane condition, she would imperil her life, and ever throw it away, to avert danger or harm from her child.

WHEN DO PUERPERAL CONVULSIONS OCCUR?

Close observers have assured us, "at any time after conception." Others say, again: "Not until quickening; that previous to this time they are only of an epileptic or epileptiform nature.” Others, again, are of opinion that they will not be observed till labor has begun. Personal experience must be chiefly relied upon to instruct us. Elegantly-worded theories and conjectures tend to mystify us and leave us in utter darkness.

But a single case of eclampsia has ever come under my personal care and notice. This was in 1874. The patient was a woman of forty-five; of nervo-bilious temperament, short and stout. She was the mother of eleven children, all of whom are now living. I called at eleven o'clock at night, and found labor already begun. She was doing well; the position of the infant and presentation appeared normal. The os tince was somewhat dilated, but there was much anteversion. On making enquiry, I was told that the previous labors had been protracted and severe, but that the patient had not been subject to convulsions. This "confinement" had been the cause of much dread and anxiety to her, and also to the physician who had attended her on similar occasions, when she lived in another State.

Repeated examinations, per vaginam, showed the preparatory work of dilatation going on. But not until one o'clock P. M. did the indications of the second stage appear; and even then not vigorously. The patient complained of headache, but it was not serious. Chloroform had been inhaled by her occasionally, on purpose, as she explained, "to stop the pain." I was of opinion at the time, and I am certain now, that this occasioned mischief, rather than any benefit at that period of labor.

At four o'clock P. M. oposthotonic spasms supervened. Blood and foam exuded from the patient's mouth; her eyes rolled in their sockets, and the tongue protruded. Her contortions were fearful to witness. All this continued for an hour, briefly diversified with intervals of quiet and deep respiration. Consciousness finally returned. Vigorous expulsive efforts now began, and at six o'clock she was delivered, while in a kneeling position at the bedside, of a healthy and well-formed female child. It is still living.

The removal of the placenta was successfully accomplished.. The patient was bandaged and laid comfortably on the bed. I gave the necessary directions in regard to the mother and child, and left at eight o'clock; feeling vividly that my patient had just escaped from the very abyss of death, and I, in my turn, fróm an analogous mortal peril of public censure, which is so certain to be inflicted beyond measure or justice upon 66 women doctors" in a city where twenty-five "men doctors" live.

Visiting the patient as usual that and the two days following, I ascertained on enquiry that all appeared to be going on properly. The excreta of the bowels and kidneys seemed to be normal. I considered the prospect of recovery to be good, and there was no occasion for further intermeddling. But on leaving I directed that I should be summoned at once if any untoward symptoms were manifested. Nevertheless I had no apprehensions.

RENEWED CONVULSIONS.

Early on the morning of the fifth day the husband called upon me in a great hurry and fright. "My wife acts very strangely," he said, "please come and see her at once." I repaired to the house, and found her again in convulsions. The symptoms were like those exhibited before, except that there were longer periods between the spasms. The convulsions and intervals of relaxation alternated regularly till two o'clock in the afternoon. About three she began to look around as though in wonder, and at four her reason appeared to have returned. There was no recurrence. About four weeks later she had recovered, and became able to attend to her household duties as before.

What produced this condition? The period of this labor was not so protracted as to constitute dystacia, or to be considered as difficult or unnatural. It did not exceed twenty hours, whereas