general health, especially in children. A removal of them will often change the patient's condition, from that of delicacy to robustness. * ** STOMATITIS MATERNA-NATRUM PHOSPHORICA. CASE XI.-April 23d, I was called to see Mrs. L., æt. 35, mother of a thirteen months old baby, who had been confined to her bed for three weeks on account of a sore mouth, diarrhea and cough. The patient was pale and anemic, and complained of great prostration. While the coating on the tongue was yellow, it and the entire buccal cavity were covered with fiery red patches. She complained of severe burning; acid eructations; vomiting of sour fluids; loss of appetite; colicky pains in the abdomen; great thirst; watery diarrhea, with greenish, excoriating stools; severe cough, with yellowish expectoration. I prescribed Natrum phos. 6x trit. and promised to call in two days. Upon my second visit, I found the patient much improved; the remedy was continued uninterruptedly for three weeks, when she seemed to be in her usual state of health. At the present time she has had no return of the trouble. wrung out of hot water, to the throat. In half an hour the child seemed better, and I left the house at 1 o'clock a. m. I was called at nine the next morning, and found the child much the same as when I left it the night before, but with a seeming tendency to grow worse. I told the parents that I considered the case serious, and that I thought, that the way it was continuing, before night I would have to perform tracheotomy. At 2 p. m. I was hastily summoned on account of a ripid aggravation of the symptoms. When I arrived, I found the child struggling for breath (the breathing was whistling), and very restless, irritable, face flushed, eyes congested; so marked were the indications for Belladonna that I determined to try it for a short time before resorting to operative procedures. Fifteen drops of the third dilution was added to a half glass of water and one teaspoonful given every five minutes. The symptoms soon began to improve, and within half an hour the child was perceptibly better. The improvement continued unabated, and by morning, when I made my visit, I found her sitting up eating breakfast. The remedies that I have found most serviceable in croup, are, Aconite, Spongia, Bromine, Hepar sulph., Kali bichrom., and Belladonna; useful in about the order named. Aconite and Spongia will, in a great majority of the cases, answer, and Bromine will relieve a large percentage of the balance, so there are but few cases left to the other remedies. Finding the preparation of Bromine very unstable, I was induced in a very severe case, where the drug was indicated, to substitute the Bromide of Potash; it acted so promptly and efficaciously, that I have ever after carried the crude powder in my case. I dissolved from three to five grains, according to the age of the patient, in half a glass of water and administer one teaspoonful every ten, twenty or thirty minutes, according to symptoms. It fits the indications for Bromine, and clinically fills all the requirements of that drug and has the advantage of being stable and always accessible. * ** A DIFFICULT OBSTETRICAL CASE. April 25, I was called at 11 p. m. to attend Mrs. J., æt. 28, in her first confinement. She was spare built; had seldom menstruated; and had been married seven years. She was suffering severely with labor pains, that had lasted several hours, of which she complained bitterly. Upon examination, I found the os rigid and unyielding. I gave Cimicifuga and directed the nurse to give a prolonged, warm, vaginal douche. In two hours I again examined her and found the condition unchanged; I then gave her a quarter of a grain of Morphine hypodermically, which entirely quieted her. At ten the next night, I was again called, and found the patient with severe bearing down pains, but the rigidity of the os remained. I could just introduce the tip of the index finger; she complained of headache, with flushed face and restlessness. I prescribed Belladonna and ordered hot sits baths. At 1 a. m. the condition was the same and the patient was becoming discouraged and complained of the pain and exhaustion. Fearing that the mother might suffer serious shock and the life of the child be sacrificed by the prolonged first stage, I determined to end it by the use of the forceps. I therefore sent for Dr. Hughes, who arrived at 1:30; he immedi ately anesthetized the patient, and I proceeded to dilate the os. Using my right hand for the purpose, first the index finger was inserted, then two, three, and finally all four fingers in the shape of a cone, were insinuated by constant pressure and manipulation; within thirty minutes I could insert my whole hand into the os. I now brought the hips to the edge of the bed, placing the patient in the proper position and ruptured the membranes. After making a most careful examination, to ascertain most positively the position, which was L. O. A., pressing my hand up until I could feel the ear, I applied Hodges' long forceps (the head not having engaged) to the parieties of the child's head. The os was scarcely dilated sufficiently to admit of the introduction of the blades. It was with great difficulty that I could bring the head into the superior strait, and after one hour's effort, having put forth all my strength, I could scarcely see that I had made any progress whatever. I now determined to let the patient come from under the influence of the chloroform,land see if the uterine expu'sive pains would not be stronger. She responded promptly to my injunctions to bear down, and our united efforts seemed to improve matters very much; at the expiration of the second hour, the delivery was completed without injury to either mother or child. She rallied promptly and made a rapid and a satisfactory recovery. I have used the forceps a great many times, and this was probably the most difficult delivery that I have ever attended. If it had been left to nature's unaided effort, the mother would have been exhausted and the child, likely, stil born. The number of still births and exhaust have not the axis traction forceps, you can accomplish the same results by simply placing your thumb and fingers of the left hand against the anterior surface of the blades, well up in the vagina, and while you use extractive force with the right hand that grasps the handles, make strong downward pressure with the left. I think everything that can be done with the axis traction forceps, can be accomplished in this way. Every accoucher should possess a pair of long and short forceps of the most approved pattern. My choice is for the Hodges and Wallace long, and the Sawyer and Elliott short. They are all ideal patterns. Besides these, he should carry in his obstetrical case a bottle of chloroform and of ergot, a pair of curved scissors, hemostatic forceps, a vaginal retractor, needle holder, needles, and silk and cat-gut ligatures for repairing the perineum. ed mothers diminish in proportion to frequency in which the forceps are used, and frequency of their application bears a direct relation to the acquired skill of the accoucher. The expert will resort to them, not alone to save life, but to prevent exhaustion, shock, and to abridge suffering and will accomplish the delivery with the minimum of injury. While the novice, or he who decries their use, resorts to them only in extreme cases with the most disastrous results to both mother and child. Skill in the use of the forceps is only gained by practice; this practice must be acquired by their frequent use in simple cases. He that attempts to use them only as a life-saving appliance in severe and complicated cases, at long intervals, cannot possibly be skillful and should never attempt to use them in such cases unless it is impossible to obtain the assistance of one who is competent. The forceps in travail, is woman's greatest benefactor and every one who aspires to practice obstetrics, should become skilled in their use. No one knows their value but the expert; and the inexperienced are as totally incompetent to criticise their use, as is the THE surgical treatment of pathologimyopic to picture the beauties of nature to one who has perfect vision. In using the forceps, chloroform should always be given and a thorough understanding of the position should be ascertained. If doubt exists, the hand should be introduced and an ear felt for. The head should govern the application of the blades, and not the planes of the pelvis. This may be a difficult task for the beginner to accomplish, but in time it will become quite easy to him. Axis traction should always be practiced, especially in the high operation. If you Alabama Homœopathic Association, June, 1891. BY DEAN T. SMITH, M. D., DECATUR, ALA. It cal conditions in the lower orifices of the body is as old as surgery itself. Until recently this work has sought little more than the removal of local trouble. was left to own Prof. Pratt to study out the relations between the pathological conditions of these parts and local or general diseased conditions in other parts of the body. He had shown the philosophy of these relations, devised methods of treatment and, by a large experience, has shown such practical results that orificial surgery has become recognized as a special department. I do not intend to discuss the philosophy of orificial surgery, but to relate a few cases showing something of the scope of its usefulness and confirmatory of the good results of its practice. I will first relate a case of EPILEPSY. An unmarried man, about twenty-three years of age, first came to us (Father and myself) in June, 1889, for treatment for epilepsy. At that time he was having four or five quite severe spasms every day. Under the influence of medicines, principally Gelsemium, he soon improved, so that he had only one light fit a week. His general health remained poor, so he was unable to work. He was in a rut and we were powerless to get him out. The obstinacy of the case led finally to an examination of the rectum. He never had been conscious of any trouble with his bowels, but the examination showed a tight and irritable sphincter. On Sept. 11, 1889, we made an operation, removing two papilla and four pockets and paralyzed the muscle. Three days after the operation he walked eighteen miles, and ten days later he reported that he was gaining flesh at the rate of a pound a day and was able to make a full hand at work. He had quite a severe fit as he was coming out from the influence of the anesthetic, but has had no symptom of a fit since. My next case is one of VERTIGO. A colored man aged about 20 years, first came to us for treatment for constipation and vertigo. Medicines were sufficient to relieve the constipation but the vertigo continued with more or less severity for a year. He was unable to do any work during the time. We could get no history of venereal disease, although he acknowledged having been where he might have contracted it. He had no urinary symptoms for a long time, but one day mentioned a slight irregularity which led us to examine the urethra. Found a stricture, through which could hardly pass a No. 8 sound. We commenced to practice gradual dilation at We also made an operation on his bowel for hemorrhoids. The work on the bowel cured the local trouble but had no influence on the vertigo. When the stricture was dilated so we could use a No. 14 sound he began to improve. We used sounds up to No. 18, which was continued at lengthened intervals for some time. The final result was cure of both stricture and vertigo. once. These cases show the profound systemic influence of rectal and urethral irritation in cases where the patients were unconscious of any local trouble. I will present some cases with more severe local trouble, yet attended by profound reflex influence. SCIATIC NEURALGIA. A man about forty-five years of age, had been troubled for nearly twenty years with what the doctors had called "sciatica." His trouble consisted of severe neuralgic pains in the sciatic nerve, each attack lasting five to ten days. At first they came only two or three times a year, but of late years they had increased in frequency until the interval between them was hardly sufficient for him to get over the effects of an attack before another came on. The obstinate character of the trouble led us to suspect orificial irritation. Inquiry and examination showed that he had had a muco-purulent discharge from the anus for some years-so bad for the last two years that he had been obliged to wear an extra cloth to protect his drawers. The sphincter was so tight and irritable that we found it impractical to make more than a slight digital examination. We operated on him, removing several pockets, a string of tissue about the size of wrapping cord and about fiveeighths of an inch long, attached at each end, and stretched transversely across posterior portion of bowel between the sphincters. Beneath this string was a badly ulcerated surface, which we cauterized; dilating the sphincter muscles completed the operation. He made a fair recovery, but the ulcer failed to heal. However, he had no more neuralgia for nearly a year and was cured of a headache that troubled him a great deal before the operation. Last October he had a severe attack of flux when his old pains returned. He has had two attacks since, both times preceded or attended by bowel trouble. We made another operation last Thursday, removing a mass of cicatricial tissue that was the base of the obstinate ulcer. It is too early to know anything of the permanent effect of the work. This much should be said. He was suffering with one of his attacks at the time of the operation, but he has had not pain in the nerve since. This man had been treated by prominent physicians in Chattanooga and Louisville, but he had never been asked a question regarding his bowel. I will relate one more case. A married woman, about forty years of age, came into our hands for treatment for CONSTIPATION AND HEMORRHOIDS. She had been a sufferer for years, having had the hemmorrhoids removed three times by ligature. Her constipation was that obstinate that for eight years she had had no movement of the bowels without taking purgative medicines or an enema, excepting two or three times when she had diarrhea. Soon after we commenced treating her, her hemor rhoids took on one of their periodical attacks of inflammation. Her suffering was very severe and neither internal medicines or local applications gave her any relief. We finally made an operation, removing one mass of piles by the clamp operation, snipping away a portion of some smaller tumors and trimming some pockets, and last but not least, dilating the sphincter muscle thoroughly. The woman suffered but very little after the work, different from the thirty days' purgatory she had endured after the former operation. In ten days her bowels began to move naturally and regularly for the first time in eight years. It has been fifteen months since we did the surgery and her bowels have given her no trouble except while suffering from la grippe last winter. One other result of the operation shows the penetrating influence of such work. She had had a stiff knee for years; could not bend it so as to sit on her heel. Not long after we operated she discovered that that knee was as limber as the other. I might relate more cases if I thought it would emphasize the value of this work. Enough has been said to show the importance of orificial surgery to the general practitioner. A club-foot or a cataract goes without question to the special surgeon. But a shattered conatitution or an obstinate chronic disease is often no small worry to the physician. |