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amount but their relative power by which the wished for results are obtained. In selecting our drug or making any other therapeutic appliances we must set it down, therefore, as an altogether wrong principle to make use of a direct or in any way definite proportion. We have not in disease to deal with a dead weight, like a cart-load which requires the more powerful horses the heavier it is, but with a spontaneous dynamical manifestation which can very often be influenced by a trifling cause, whose substantiality is seemingly altogether out of proportion to the severity of the case. Not only in the drugaction, but also in other methods of remedial practice, electricity, hydro- and kinesitherapeutics as the quality of an application is influenced by the quantity applied, and by one and the same remedial appliances effects diametrically opposite can be produced. This refers even to mental medication. Very often a too-much of persuasion spoiled a case which might have been cured by some homœopathicity of mental influence; even the infinitesimal dose of not-saying-anything might have proved more beneficial than any positive therapeutic contrivance. Nor unfrequently such expectant treatment had the most marked effect upon the patient and proved to be the most powerful remedy; although it must be borne in mind that in such a case it was, perhaps, not so much the bare fact of nothing having been said as the congeniality of the person who had the wisdom at the proper moment to be still.

However, though it be there is no therapeutic maxim adaptable to the case except the dynamic principle for which I have proposed the wording: Moveantur secundum indicationem motionis, treat with similars, contrary to disease or otherwise, but always according to the dynamic relation of the curative agent to the particular case.

(C) OBSTETRICS AND GYNECOLOGY.

P. D. YOST, M. D., Chairman. W. T. GAMMILL, Acting Secretary.

STERILITY: ITS CAUSE AND CURE.
Opening Address by P. D. YOST, Chairman of the Section, St. Louis, Mo.

The cause of barrenness and the remedy for the condition is a subject that only interests the few; but the victims of sterility will be the most persistent and submissive patients on the list of the gynæcologist. They will be willing to undergo any operation or treatment that promises a shadow of hope. The opprobrium of being classed with the historic fig-tree is an apparition that continually haunts them. They long for the well-spring of pleasure, a child in the house, and will not be satisfied without it. I am aware of the fact that there are multitudes who, for various reasons, do not wish to "multiply and replenish the Earth." This is not the class of whom I am speaking; but it is the model wife, who will not be supremely happy till she is a proud and loving mother. It is this class and those who treat them that will be particularly interested in this subject. I might also mention the ambitious husband, who wishes to perpetuate his name and fame, as an interested party. He may be thought of as the one at fault, although supremely unconscious of the fact, and continually commiserating his wife's misfortune. I admit that there are not many pathological conditions that would destroy man's virility, yet there are a few. Some of these are congenital, others acquired. If the organs of generation are well developed and properly located and have never been the seat of inflammatory or venereal diseases that would destroy their secreting power or cause stricture, we may reasonably dismiss from our minds all doubts as to him. Yet, as we shall see by and by, he may be equally at fault. Should we wish to be very certain in regard to the seminal secretion, we can place a drop of the

recently-discharged fluid under a powerful microscope, and if normal the spermatozoa will be seen in constant motion. Or a pretty correct idea may be obtained by dropping some of the semen from the end of a syringe into pure water. If it is healthy, it will pass in distinct drops and will be readily diffused in the water; if unhealthy, it will be ropy and tenacious, and will not dissolve.

Having satisfied ourselves that the husband is virile, our attention must be directed to the wife for the cause of the sterility. The first thing that demands our attention is the generative organs. Are they well developed, and are their functions normal? Is ovulation and its epi-phenomenon, menstruation, regularly and healthily performed? And it seems to me that another question might be asked with equal propriety. Are the ovules healthy? To ascertain that they are normal, an examination might be made. The ovule passes from the genitalia from five to ten days after menstruation, and could be intercepted for the purpose of examination. To have procreation it is necessary that the spermatozoa come in contact with the ovule within the proper cavity, the fallopian tube or uterus. Any obstruction or obstacle that would prevent this union would cause sterility, as would also any condition of the secretions of the organs that might destroy the viability of either product.

I will now direct your attention to some of the common causes that may be looked for in a case of sterility, and very briefly indicate the proper treatment. After this, I will try to point out the cause of some of those mysterious cases in which none of the ordinary causes exist.

Atresia of the vagina or stenosis of the os uteri must be removed, if present, by dilation with tupelo or sponge tents-or uterine dilators.

A polypus obstructing the cavity of the cervix may be removed by torsion, with the ecraseur, the galvano-cautery, or by injecting the pedicle with equal parts of carbolic acid and olive oil. Fibroid tumors do not necessarily cause sterility.

Atrophy of the uterus, congenital or acquired, can be over

come by stimulating this organ in various ways, by the use of such means as the intra-uterine stem-pessary, used with great care, by dilation, and by uterine tonics.

Hypertrophy of the uterus is a more frequent condition. It is generally the result of subinvolution, and is best treated by general and local medication. The uterus is like a sponge; it needs to be contracted, and for that purpose I give such agents as Senecio gracilis, Gossypium, Helonias, bromide of potassium, Alnus serrata, etc., internally, and use Pinus canadensis and glycerine locally.

Vaginismus, a hyperesthesia of the nerves that are distributed to the osteum vaginæ, must be treated by dilation, or ecsection of the particular part affected. This may be a single caruncula myrtiformis.

The normal secretion of the uterine cavity and cervical canal is alkaline, while that of the vagina is acid. If either is excessively acid or alkaline, it must be neutralised by an acid or alkaline agent as indicated. Endometritis, or uterine catarrh, causing a free discharge, or a discharge of a tenacious character, will prevent the spermatozoa from passing into or through the uterine cavity. To remove this condition may require a long course of treatment, and it cannot be delineated in this short paper; but with a good general treatment, and the local use of fluid extract of Pinus canadensis and glycerine, equal parts, or fluid extract of Hydrastis and boroglyceride, you can soon relieve the case, and by perseverance with similar agents effect a perfect cure.

Obstructive dysmenorrhoea is usually accompanied by sterility. Not that the “painful periods" cause the condition, but the cause of the dysmenorrhoea is the cause of the sterility. This must be removed. If there be a fluxion of the uterus, straighten it out. Easier said than done in some cases, but by the skilful use of instruments it can be accomplished. And this may be said of versions and displacements in general. Many cases of dysmenorrhea will be cured by the use of this prescription. R. Aconit, rad., tinct. zj; Pulsatillæ tr., ziij; Cimicifugæ tinct., 3jss; elix. pot. brom., zij. M. S. Halfteaspoonful three or four times daily in water.

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Dyspareunia, or sexual apathy, is not necessarily a cause of sterility; as a woman may conceive without any sensation of pleasure during the sexual congress. I know many mothers of this class, who never had an orgasm, and yet have large families. All that is necessary on the part of the female is a healthy ovule, and normal generative organs. Over-feeding, luxurious and sedentary habits may be the cause of barrenness, as it is well known that poor people have more children than the rich and indolent.

General debility, but more particularly a special debility of the organ of gestation, may be found to be the cause. The uterus is not in a proper condition to receive and gestate the fecundated ovule, The soil, so to speak, has not been prepared for its germination. There is conception but not gestation. The condition is similar to that of very poor or exhausted soil. The germ cannot take root, nor obtain an adequate amount of nourishment to sustain the development of the embryo. Or the attachment may be of such a character as to allow an easy separation and an early expulsion. I had a patient a few years ago that had an ovular abortion every few months. It would occur at her menstrual period, which at times would be a few days overdue, and the discharge was always excessive. The pains were very slight, and I would have considered it simply a case of menorrhagia, had I not found the ovule in the clots of blood. This was abortion, the result of a diseased condition of the uterus, principally subinvolution, but it occurred at such an early period of gestation and was repeated so often that it was not regarded as such. It only illustrates what I have stated, that conception may occur without normal pregnancy fellowing. Here you have a condition equivalent to sterility. To treat these cases successfully will require the adaptation of remedies to the special conditions. Such agents as Viburnum, Caulophyllum, syrup of Mitchella comp., Senecio gracilis, with chalybeates, may be used combined or alternated as deemed best. With this we may also advise sea-air and baths, or a course of treatment away from home, and perfect sexual quiet for a few months. Electricity may be of benefit

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