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nearly, if not quite, all of my acquaintances, can hurt me?" I replied, that I could demonstrate it to her satisfaction, which I did by a very little explanation. She was placed under my care, after making such changes as I suggested in her dress. I presume that my general and local medicinal treatment might not have varied much from my predecessors in the case, but she very soon recovered, and has since enjoyed very good health, and, having learned wisdom by a very bitter experience, could not, I presume, again be tempted to travel in that wicked pathway that so many of our fashionable ladies are heedlessly, perhaps, treading. It was merely because I would not undertake the treatment of the case without first ascertaining the cause, and then insisting on its entire removal.

In another case that of a married lady-I learned that no one of her former medical attendants had ever insisted, nor even suggested, that no disturbance of the pelvic viscera should, in her case, be allowed, such as must occur if coition was continued, and was not surprised when informed that it had been indulged in, with no little pain on her part, from three to seven times per week. She, though almost discouraged, concluded to make one more effort to regain her lost health, promising faithfully to follow my directions to the letter; and, although I instituted no unusual medical or surgical treatment, she very soon recovered, and is a happy wife and mother to day. The success here came from my efforts to discover the cause.

I might multiply examples to illustrate this principle, as I have many on my notes of practice, but a few will answer as well the purpose which I have in view. You all, doubtless, have samples of the above character, in some of which, perhaps, you may have had evidence of my own similar neglect, as I claim no infallibility, and may, therefore, not need any admonition from me on this subject. All such tend to show how very important it is to learn why the undesired conditions exist; what agencies have been and are at work, and what can be done to check their untoward operation. In our investigations, we should not fail to bear in mind, that a state of health is preserved in one nation and among a given race, or in one age-conditions that prove detrimental, if not absolutely fatal, in another nation, race or age of men. To cite an extreme illustration,

the savage, who, in health, has undergone all the terrible hardships incident to his life in the forests, when subjected even to the temperate life, differing so little from his own, of the early emigrants to this country-a life with few of the deleterious customs of succeeding generations-he wilts like a sylvan plant transported to an open field.

It might not be philanthropic to take that opprobrium of modern life, the tramp, who, a few years past, has been wandering about in the open air, "not having where to lay his head"-give him at once a sheltered home, his health would not at first be thereby promoted. The same principle held true in regard to our soldiers on their first return from field life, to which they had become inured. We all know how much worse patients feel when they first abandon such evil habits as using tobacco, opium, ardent spirits, or wearing corsets, and attempt to live natural lives. So that while there are some principles that apply to all nations and to every age of the race, yet we should ask what any special cause may or would be likely to produce in the class or the individual at the present under consideration. However deep may be our investigations, we should never be led into the fallacy that we have ascertained all the causes of the morbid condition, but always be on the alert for more information.

III.

Then on our knowledge as to the true nature of the disease much of our success depends.

If

In taking a retrospect, how many of us at various times have been inwardly chagrined on learning (alone, perhaps) that a very incorrect diagnosis has led us to pursue a course of treatment which, if not detrimental, was but poorly adapted to the case. any one here has not made such a discovery, I can confidently as sure him that he will some time. It may be after we have made every effort to understand the case that it has been possible to put forth. We shall suffer sterner and more severe rebukes of conscience if it is in consequence of heedlessness on our part.

I knew one physician who had attained to a position of great eminence in the profession, not by the large number of patients he attended-for he had but few-but by the minute and assiduous care he bestowed upon each patient, often devoting an hour or two

visit.

to the investigation, advice and treatment of a case at a single Of course most of his patients were able to pay him large fees. Such a practitioner could and should command large fees. It was well known that there was no haphazard in his practice, and I could but admire the supreme confidence which a very intelligent community reposed in his skill. When he entered the room, a deferential respect pervaded all in his presence. His speech was that of one who, knowing whereof he affirmed, carried conviction to every heart. All felt that he was master of the situation, however grave, and the confidence thus inspired was like a bright ray of sunshine penetrating the darkest recesses of every lonely heart. No doubt he sometimes blundered; but his mistakes must have been fewer for his great carefulness.

Can wealth buy the professional comfort and peace that must, in spite of the ingratitude of some small hearts who had shared his beneficence, pervade his whole being? It would be cheap to purchase one month from the last year's experience of his life with the crown of an empire. And yet every one of us may attain to so very happy and exalted a position if individually and unitedly we work for it.

IV.

I have said thus much to, in a small part, demonstrate the importance in every way of giving more attention to the profound study of each case. This is of course true in every department of practice. But in no department is the importance more manifest than in that of gynecology and obstetrics. In others, the recovery and welfare of the individual and the happiness of those associated is involved; in this specialty we have the weal and often the very existence of beings not yet in the nascent condition, and who may be the saviours of the world. I have known physicians with as good reputations as any of you, to be so careless in the examination of a pregnant woman of over five months-and she the wife of one of them-as to treat the case as a uterine or ovarian tumor, till abortion came as a result of the treatment. From all such errors I would say, "Good Lord, deliver us;" but they are just as likely to occur in our practice, and certainly will, if we do not bestow more care on each case than is usually done.

We should never be satisfied with what the patient or her friends

tell us about the difficulty, though it is well to listen, in some cases, to the story that may seem old to us; they love to tell it, and we may thereby obtain some points of interest to us. We certainly can thus gain an insight to the mental condition of the lady and her environments, which will prove of no small advantage in the future study of the case, and will be one of the finger marks as to the line of mental treatment.

Should our investigations lead us to suspect strongly organic disease, or displacement of the uterus in an unmarried lady, and it does not prove amenable to such treatment as at first seems appropriate, we should not hesitate to insist on a vaginal examination.

Tremont St., Boston, Mass., September, 1879.

(To be continued.)

A CASE IN PRACTICE.

By W. R. WOODWARD, M. D.

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The lady

October 10th.-I was called upon to attend Mrs. F. heavy, plethoric female of sanguine lymphatic temperament. I arrived at the bedside of the patient at two p. m. was seven months advanced in pregnancy, and having what ap peared to be labor pains of an expulsive character. The patient remarked "that it seemed as though her inside would come out," and these pains occurred every few minutes, with regularity. Upon cessation of the pains vomiting would ensue, with cramps in the stomach, followed with convulsions of the whole system. Upon examination I found that the pains did not influence the os, or uterus, but the muscles of the abdomen were spasmodically contracted during the presence of the pain. Pulse 120, strong and full; face and eyes turgid with blood; head hot, with throbbing pain; consciousness returned upon subsidence of the convulsions. Regarding the vomiting and convulsions, the result of reflex uterine irritation, I immediately gave the patient, sulph. morphia, gr.; tinc. of gelsemium j3, at one dose, and repeated it in thirty minutes. At four p. m., the pain, vomiting and convulsions had lessened considerably. The morphia and gelsemium continued at lengthened intervals between the doses. Patient

had one convulsion at eight p. m., and one at four p. m., in the morning of October 11, which was the last. Gave an enema of warm water, with tinc. lobelia and capsicum to unload the bowels. I will remark, that for some time previous to the occasion of the convulsions, the woman suffered some considerably from urinary derangement, at one time voiding a large amount of pale watery urine, again small in amount, and depositing uric acid in large quantities-not a trace of albumen. The lady also complained of distention of stomach and bowels, particularly after eating. Regarding the urinary derangement and the sense of fulness consequent upon portal congestion, podophyllin and bitartrate of potassa was given once in six hours, until the liver was aroused to action. I had at hand veratrim and chloroform, which would have been used had the morphia and gelsemium been insufficient to allay the irritation and control the convulsions. The combination of morphia with gelsemium makes a valuable anodyne in instances where the effect of the gelsemium is not contraindicated, and many individuals can take the combination with the happiest result, where morphia alone produces secondary disagreeable symptoms. In all reflected irritations, particularly where spasm results with augmented arterial action and determination of blood to the head, the combination of morphia with gelsemium is especially indicated. In bilious colic, when the stomach has been relieved of all indigestible materials, and not before, it works like a charm. Other medicines are necessary afterward to restore the perverted action of the liver. In reflected irritations resulting in spasm or convulsions, it may be necessary to administer the gelsemium till its peculiar relaxing effect obtains. Caution is to be observed in the administration of morphia in combination with gelsemium, that the quantity be not too large or too frequently repeated, as narcotism may ensue, which really is not necessary.

Londonderry, Vt., November, 1879.

At Lansing, Mich., Dr. H. B. Baker reports the annual death rate in one thousand, for August, 1879, 14.14; for September, 10.96; for October, 9.42; for November, 13.40; for December, 11.78. A carefully prepared meteorological record for each day accompanies the foregoing.

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