GYNECOLOGY.

CHLOROSIS.

H. P. HOLMES, M. D., Sycamore, Ill.

CASE. Miss Y. applied for treatment January 26. Commenced complaining last August, and since that time has been constantly under treatment by two of our best allopathic physicians. The only result of this treatment has been to let her grow worse continually. She has been treated for prolapsus uteri which was brought on, as she supposed, by over lifting. For this condition she has been subjected to local treatment and applications and has worn a pessary for the past month.

The patient is a blonde, medium height and build and usually has a waxy complexion; now her skin is rather pale and of a greenish-yellow color. Careful questioning brought out the following symptoms:

She complains principally of nervousness and palpitation of the heart. These symptoms began last August at which time she felt frequent sharp pains through the heart, accompanied by rapid beating and sensation of great anxiety. Has had more or less sharp pains around the heart ever since. Is very restless at night and during sleep. Feels very tired on awaking in the morning. Twitches and jerks a great deal and moans in her sleep. During her visit to me her head, chin and hands trembled and jerked almost continually. Her bowels are very costive, with very difficult movements. Brick dust sediment in the urine. Back aches a great deal, low down across the sacrum. Her menstrual periods have been irregular and the flow very scanty. There is a slight leucorrhoeal flow, whitish or yellowish in color, and recently there has been a dragging or bearing down feeling in the pelvis. She cries very easily and sweats a great deal, especially while eating.

I ordered the pessary removed until there was further evidence of its being needed. On account of the promi

nence of the nervous symptoms, crying and sweat while eating, I prescribed Ignatia 200 four times daily.

February 3.-Reported but little if any better. In the meantime a more careful study of her symptoms convinced me Sepia was her remedy, and I gave her the 3x, a dose forenoon and afternoon, and the 200 on rising and retiring.

February 11.-Reported as follows: Have not had palpitation at all, and there is less pain around the heart. Some days does not have the pain at all. Is not nearly so nervous. Sleeps much better and feels more rested in the morning. Her mother says she is less restless at night and a great deal less nervous during the day time. Has not felt any sensation of prolapse and has not worn the pessary. This is her menstrual week, and while she has considerable pain it is not so severe as usual. Her bowels now move regularly, although they are still costive. Urine not so high colored and no sediment. Back ache continues, but not nearly so severe. Sweats just about the same, mostly while eating. Sepia 200 continued four times daily.

February 18.-Has taken a slight cold, but feels better in every way. Placebo.

March 9. She seems quite well. Has gained in flesh, and her complexion, which before was a sickly yellowishgreen, is now quite rosy and healthy looking. She is in excellent spirits and declares herself quite well. Her family are delighted with the results of her treatment and think her rapid and positive improvement something wonderful.

From this case we may learn:

(a) That a diagnosis made up from physical examinations and objective symptoms is not always the best indication for the successful treatment of the case.

(b) That a mistaken diagnosis leads to a wrong course of treatment by our regular (?) brethren.

(c) That "the totality of these symptoms, this outwardly reflected image of the inner nature of the disease, i. e., of the suffering vital force, must be the chief or only means of the disease to make known the remedy necessary for its cure, the only means for determining the selection of the appropriate remedial agent."-Organon, § 7.

(d) That it is better to note down the totality of symptoms and prescribe the true simillimum than to be well up in diagnosis and not to know what to do for your patient.

CIMICIFUGA-CORRIGENDUM.

WM. JEFFERSON GUERNSEY, M. D., Philadelphia.

In the August (1886) number of the St. Louis Periscope, p. 290, appeared an article by myself, entitled "Homœopathic Prophylactics," a little paper prepared for the "International Hahnemannian Association." At the bottom of p. 292, in said article, will be found a reference to the use of Cimicifuga as a means of rendering labor short and easy. I am glad that I therein intimated that I had not experimented with it myself, and regret that I did not wait until I had thus proven its value (or cussedness, as I now believe) before rushing it into print. It is not a new suggestion, and doubtless every practitioner has heard it recommended for that purpose, but my California friend* laid such stress upon its value that I did not hesitate to give it the prominence it seemed to demand. Since that date I have had some sad experiences with it, and it is with a sole desire of warning others not to use it that I now write.

I determined to prescribe it in ten cases and note the result. I administered it as advised, using the one thousandth potency (Tafel), which I knew to be good, until the thought occurred to me that, as my frieud was a low dilutionist, I would not follow in his successes unless I employed the potency he had doubtless used, and then gave to two cases the 3x (Boericke ).

Case I, was confined before I could reach the house, although found without delay. I was in great glee until I learned that this had been her usual programme, a fact I had neglected to ascertain.

Case II, said she thought she had "rather a better time of it," but if so I am thankful it did not fall to my lot to attend her, as she was on this occasion sick twelve hours

* Dr. Breyfogle, of San Francisco.

after I arrived (having been in agony for hours before), and from which condition I finally relieved her by use of the forceps, a procedure I much dislike.

Case III, said she was longer and suffered more than ever before.

Case IV, had an exceedingly long and difficult labor.

Case V, said she thought her labor was rather easier, but as I had attended her only eighteen months before, I thought that she appeared to suffer more than at the last labor, the suffering of which she may have partly forgotten "in joy that a man was born."

Cases VII, VIII and X deserve no special mention, save that they were not favorably affected by the remedy.

It is with cases VI and IX that I have most to say, and it is an interesting fact that those two, the most difficult cases, should have received different potencies, one the 3x and the other the M. Before labor: Severe labor-like pains, preventing sleep and lasting at intervals for several weeks-both cases. (Some of the others had similar pains, though less severe.) During labor: When labor finally set in, which was much over the calculated time, the pains were terribly severe and ineffectual; she would cry out in perfect frenzy, because her child could not be born, and upon examination but little progress could be detected. After labor: Severe after-pains; sleeplessness; chilliness on motion; fever; cold sweat; cessation of lochia; copious, frequent, watery, frothy stools, accompanied by pain and followed by prostration; craving for beer; marked despondency (thinks she will die); headache; viscid mucus in mouth as well as throat, which is very offensive to patient and exceedingly difficult to detach, causing nausea; urine dark, scant, and brownish; delirium one night (one case only); cough; sensitiveness to noise; one patient had a clock stopped that had hung inoffensively at the opposite end of her bed-room for years; complete anorexia; abdominal pain (indescribable), with soreness there. The above is a picture of both cases, though one was much more severe; the symptoms were grave and were difficult to remove-Verat. being of more service than any other drug

in relieving the diarrhoea and cold sweat and generally low condition and restoring the lochia. While attending the first case I wrote to Dr. C. Carleton Smith, stating symptoms, having all the time in my mind the fear that I had caused the trouble, but neglecting to mention to him the fact of using the drug. His reply was, "Use Cimicifuga; it has all the symptoms." Imagine my wrath. No antidote. could be found in the books, so I concluded to try a different potency and gave the 200 in water with a relief of some symptoms.

Whether the western climate has aught to do with my friend's successes in this matter is a question—at all events it is not a drug for Philadelphians to trifle with.

The only prophylactic that I know to be of real value is the indicated homoeopathic medicine. Few pregnant females are exempt from some aches and pains or abnormal mental conditions, and these symptoms furnish the sole indication for the remedy that will lighten labor. This others have proven. This I have again and again tested, and upon it hang my sole hopes of ameliorating that which can never be cured, O woman! for "in sorrow thou shalt bring forth children."

[At the time the paper was read we were astonished that so good a Homoeopath and so accurate a prescriber as Dr. Guernsey, should have adopted such an empirical recommendation, on the ipsi dixit of any man. That Cimicifuga will work wonders as an ante-parturient, when indicated, no one who has ever given it a trial will for a moment doubt. But, like Caulophyllum, Pulsatilla, Viburnum opulus, and many others, it must be prescribed on its symptomatic indications, or it is worthless, even positively injurious. To give Cimicifuga, or any other remedy, for dystocia, as such, is empiricism, pure and simple. The abnormal conditions, the aches and pains, mental and physical, of the pregnant woman, are the only true guides. in such cases, and rightly interpreted and carefully prescribed for will certainly conduce to a normal and painless labor. If every physician who now prescribes Cimicifuga as a specific for difficult labor, will adopt a systematic ex