throat, and by midnight she breathed more easily; but as morning approached the dyspnoea became greater, inspiration more sibilant and labored, and the child apparently rapidly sinking. Tracheotomy seemed the only resource, and was performed at 8 A. M. Both tonsils were now covered with a dirty, grayish exudation, and the trachea when opened seemed lined with a membrane of considerable density and thickness. Portions of this were detached and removed at the point of incision. But little hemorrhage occurred, though the obstruction from mucus and membrane below the tube did not allow complete relief at first, and it was only after considerable coughing and expectoration that the respiration became easy and quiet. The air of the room was well saturated with vapor spray, to which carbolic acid, chlorinated lime, and iodine were successively added. Kali. bi., Spong., Bry., and other remedies were administered till convalescence was established. The tube was removed on the 22d, having been worn twelve days. A speedy and complete recovery ensued. As further evidence of the diphtheritic character of this disease, other members of the family in attendance upon the child had attacks of sore throat, and soon after the recovery of this patient the mother came down with a most violent attack of diphtheria.

CASE II. Willie K- —, an active, nervous boy, six years old, was "playing store" with other boys, and, among the articles of merchandise, he had some peanuts, roasted and hulled. While holding a half nut thus prepared in his mouth during a cough it was drawn into the trachea. This was on Saturday afternoon, July 15. Dr. H. P. Hemenway was immediately called, and though he succeeded in relieving the paroxysm of coughing and distress, yet he was unable to remove the inhaled nut. The patient could lie quite comfortably on his right side, but on sitting up, or lying on the left side, the cough and dyspnoea would become very severe. The larynx and glottis became inflamed and swollen and the respiration difficult, as in croup. On Tuesday afternoon I was summoned and found him much exhausted by the continuous cough and dyspnoea. The pulse was rapid, small, and thready. It was impossible to count it or to take his temperature, he was so restless and fractious. There was little doubt of the presence of the nut in the trachea, and tracheotomy seemed the only method of reaching it and of relieving the dyspnoea. It was accordingly performed at once under the influence of ether. Three rings of the trachea were divided and the cavity carefully searched, but the nut was not found. The patient made very little effort to cough, partly perhaps owing to anesthesia and partly to his extreme exhaustion. Failing to find any foreign body, the tube was inserted, and the patient was allowed to rest through the night.

Next morning he was found in better condition. He had slept considerable and was stronger and less excited. The tube was removed and a feather passed down into the bronchia, which produced violent coughing, but without detaching any foreign substance. The position of the child was reversed, the head being placed downward and the feet upward, hoping that specific gravity might bring the nut to the opening, but it did not. Wednesday, Thursday, Friday, and Saturday the child continued to improve, ate, drank, and slept well, but still no appearance of the nut, until doubts began to arise as to whether he had inhaled the nut, or, if so, if it had not softened and disintegrated. The greatest watchfulness had been kept, lest the nut, becoming detached, might obstruct the tube. On Sunday, in a sudden paroxysm of coughing, he seemed to be choking. Dr. Hemenway was by his side in a moment, removed the tube, and with the succeeding cough he was able to reach the nut, which came up entire and unchanged from the time it was inhaled. A mild cellular bronchitis ensued, which was relieved in a few days; the wound closed kindly and rapidly, and the boy was soon restored to health, even better than before the misfortune had occurred.

In both of these cases I must bear witness to the care, skill, and unwearied attention of the attending physicians, without which the operations would have been of little avail.

[Reprinted from the Therapeutic Gazette, October, 1881.]
CONVALLARIÆ MAJALIS flores.

BY RALPH D'ARY, M. D., ROMEO, MICH.

THE Russian country folks, like the Indians of this country, are a very primitive people, and, being almost beyond the reach of civilization and the medical advantages it offers, they have learnt to help themselves in cases of emergency. But whilst everybody is more or less of a herbalist or nurse, each village generally has its znaharka, or wise-woman, who occupies about the same position as the Indian medicine-man. While on a summer tour through Russia my native country -some years ago, I took especial pains to obtain information concerning their methods and means of treating disease. may be expected, it was difficult to gain the confidence and goodwill of the jealous and suspicious women, but whenever successful in that respect with the aid of alcohol and flaming dressgoods a very curious insight into popular medicine and pharmacy was afforded me. The revelations in the majority of cases consisted of unmitigated trash, but here and there I obtained

As

ideas, hints, and positive knowledge which were well worth retaining. Among the latter I class what I learned of the uses of that beautiful, fragrant little wild-flower, the lily of the valley (Convallaria majalis). I pass over the uses made of the root or leaves, since they are recorded in almost every dispensatory (the eclectic one of this country alone excepted, strange to say), and since their properties are not of a nature to make those parts of the plant a desirable remedy. The fragrant flower, however, deserves the closest study of the therapeutist. My attention was first called to it by witnessing the relief derived from it by an old man in the last stages of chronic dropsy. He used it as a diuretic and tonic of the heart, and it seemed to be so very efficient, that I made his case an object of special observation, he willingly lending himself to my experiments. Since that time I have used a tincture in my practice, and have cautiously experimented with it, but, not being aware that the plant had ever been brought before the profession and that physiological experiments had been made with it, I thought it premature to call attention to it until I should be able to give more than clinical observation to the medical press. Circumstances, however, have prevented me from making any systematic physiological experiments, and even at this day I should hesitate about submitting the present article to the medical world, if I had not found since that the ground had been fully prepared by the experiments of Walz, Marmé, and others (see N. Y. Med. Jour., Nov., 1867, and Schmidt's Jahrbuch, 1867, vol. 166), and especially those of Drs. Bogoyavlenski and Troitsky, of St. Petersburg, whose articles on the subject, in translation, I have furnished to the editors of the Therapeutic Gazette. They have evidently experimented clinically with reference only to heart disease and consequent dropsy, and give their results in so clear and precise a manner that it would be useless repetition were I to dwell on these points, especially as my experience is almost identical with theirs. I will only add that I have used the remedy somewhat indiscriminately in every variety of heart disease coming under my hands, both functional and organic, with a view of testing its efficiency in the various forms of these affections, and nearly in every instance with most gratifying results. In fact, I have not been able to determine any special indications (or contra-indications) for its use, its effect seemed so uniformly beneficial. It certainly had not the least direct restorative value, in my hands, in organic disease; not any more than cactus grandiflorus, for which such claims have lately been set up by some enthusiastic practitioners, mostly of the homœopathic persuasion. But, although convallaria is unable to alter the organic status præsens, it enables the patient to make the best of it, by compelling Nature to put her best foot foremost.

It is pre-eminently a regulator of nervous function, adapting the latter to existing conditions in such a manner as to compensate to the utmost possibility for the existing organic lesion. The sympathetic nervous system seems especially to be under its control, though it is by no means devoid of a powerful influence on the cerebro-spinal system. This circumstance accounts for its almost universal adaptability, in varying doses, to every variety of heart disease. In small doses it is a stimulant to the heart, increasing the frequency of its beats; in larger doses it is a tonic and sedative, lessening the frequency, but increasing the energy and regularity, of the contractions. In overdoses it is a swift destroyer of life, thoroughly paralyzing the heart. Over digitalis it has a most important advantage in the absence of a cumulative effect, at least so far as personal observations allow me to judge. On the other hand, I have noticed that some patients seem from idiosyncrasy unable to endure it, even in small doses. Wherever these unpleasant effects - manifested by dyspnoea, faintness, pain at the heart, etc.— become manifest, alcoholic liquors seem to me the promptest antidote. I would therefore strongly advise, in every new case, to begin with minimum doses and gradually increase until the desired effect is obtained, which generally takes place very promptly. It is an excellent nervine sedative tonic, especially where the patient suffers from the consequences of excessive reflex irritability or "nervousness. Thus I have found it useful in certain conditions of insomnia, hysteria, the restlessness of fevers, infantile nervous disorders caused by the irritation of dentition, etc. In tic-douloureux and neuralgia in general it has sometimes acted with great promptness. It is not a narcotic or anodyne simply, and therefore does not merely lull the pain by stupefying the patient's sensibility, but seems to act as a direct nerve tonic and sedative, restoring the equilibrium of nervous function. You will see, therefore, that it opens up a wide field for further careful investigation. In using it, the practitioner should always bear in mind that in this connection the old adage may well be reversed, and should be remembered as magis remidium, magis venenum. But, though it requires care in its employment, I believe the convallaria to be a safer remedy than digitalis, in its cardiac sphere, especially in desperate cases, where large doses are imperative. What practitioner of any experience has not found himself once in a while in responsible position, where he had to choose between the almost certain death of his patient, or another and yet another heroic dose of digitalis, and yet had no means of ascertaining whether the preceding doses had finally expended their effect, or were only awaiting the re-enforcement of another dose in order, with combined power, to extinguish the last remnant of cardiac life? How often is the last dose of the

potent but treacherous remedy but the messenger of death! Herein lies the special value of convallaria: once its effect is expended apparently, it is so in reality, and another dose may be safely administered. Such is my experience; but as the point is one of so much importance, more than one or two men's observations should be recorded before it should be accepted as a finally determined fact.

In giving the above to the press, I trust the profession will sufficiently appreciate this promising— nay, even now important remedy, to induce them to carefully experiment with it and make known the results.

ROUTINE PRACTICE.

BY A. L. KENNEDY, M. D., BOSTON.

As the doctrine introduced and promulgated by Hahnemann wellnigh three quarters of a century ago becomes more largely disseminated and more and more widely taught, there becomes apparent to the careful observer a tendency on the part of a large proportion of homoeopathic physicians to imitate our brethren of the old school, and to fall into a system (or lack of system) of routine practice, entirely contrary to the principle which we regard as the corner-stone of homoeopathy. True, there is necessarily much of sameness in the discharge of the duties belonging to the profession: each physician must have his hours for visiting and his hours for consultation; and, ceteris paribus, he is most successful who regards most rigidly his own appointments. And, notwithstanding physicians are men possessed of individualities more or less strongly marked, and therefore will necessarily follow those paths toward which, as individuals, they most naturally incline, still, each must in a certain way and to a certain extent follow a general line of conduct in the daily round of duties. Each must, to a considerable extent, travel the common highway of habit and experience; and all this in justice to himself, and with advantage to his patient.

But how is it as we approach the bedside and stand face to face with suffering which we are expected to relieve? How is it here, where the physician often finds that all his acquired knowledge of disease, his ready recognition of its exact seat in any given case, his skill in determining its particular character and in giving it its proper scientific name, all combined cannot afford him even a clew to the remedy that is to accomplish the so-desirable end? Here he has reached a point where custom and habit can no longer guide and where the law of routine will not apply. What shall he do? What can he do? Will he so far imitate the example of the old