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hoping to afford substantial relief, I cannot encourage her to anticipate a cure.

Causticum being the only drug which covers the totality of these symptoms, is given-a dose every two hours, with orders to extend the intervals to three hours when urination becomes free.

November 26.-The bulimia, cough, involuntary micturition and blepharoptosis, each of which symptoms has been present for at least six months, have completely vanished. The flow of urine, she tells me, is enormous; the entire body is bathed in a viscid perspiration of strong urinous odor, and the enlargement has diminished considerably. Headache and vertigo remain; in place of the bulimia there is now anorexia, yet she feels much stronger. Soon after this the catamenia occurs, and the function is free from pain and hemorrhage for the first time in three years. Without change of medicine, the lady makes steady progress until the 7th of February, 1879, when she is discharged without apparent vestige of the disease.

March 10.-On the 2d inst., while walking over ice, concealed by a light fall of snow, her feet suddenly slipped, and she fell, in a sitting posture, with great violence. Immediately the skin became dry, the urine scanty, general œdema reappeared, and the intumescence on the right side is nearly as large as when I first saw her. But the concomitant symptoms then noted are not present, nor any others which may serve to indicate a particular drug. Hence, in order to furnish the experimentum crucis as to its curative action over the pathological condition, causticum is given as before. After a few doses had been taken, the skin became moist, and a free uriniferous perspiration followed, which continued to soak her clothing for several days. During the same night an abundant flow of urine ensued, and the swelling rapidly subsided. A week later, when the tumor is scarcely perceptible, a large abscess presented itself on the upper third of the right thigh, between the pectineus and adductor longus. Notwithstanding its immoderate size, the abscess matured and discharged with but slight general disturbance, and its healing appeared to be the signal of a perfect

cure.

October 20.-Mrs. W. informs me to-day that her health is perfect; far better than at any previous period of her life. Troy, N. Y., January, 1880.

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When I find a sore throat associated with fever; when scarlatina is an epidemic, that will most certainly be followed by scarlatina rash. When I examine the throat in such cases, even before any rash has appeared, I generally find an ulcer upon one or both tonsils. In a few hours after which, by the proper determining treatment to the skin, a rash will follow. The bacon treatment to the throat and chlorine internally is my usual reliance.

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Sig. Dose, one teaspoonful every two, three to four hours, according to age, strongly diluted with water. Powd. chlor. potassa and sugar, a little of this placed on the tongue very often.

B Tr. aconite rad...gtts. x. Sig. Rub this in a half tumbler M F. E. ipecac, of water, and give one teaspoonful every one or two hours in connection with the above, if there be much fever, is the leading basis of dependence.

Sometimes I will have a troublesome sloughing tendency, but in such cases mild, daily penciling with a camel's hair pencil or a soft sponge probang, using 60 grs. of nitrate of silver to the ounce of water, will be indicated to check this sloughing tendency. I am not too hasty, however, in using this application. Chlorate of potassa and sugar is good to often place upon the tongue and use its solution as a gargle, or 5 gtts. of carbolic acid to 43 of aqua pure; this used as a gargle often, is good. Diluted pinus canadensis is also very good, after the rash has disappeared.

If there be any lymphatic enlargement present, or if the throat be swollen on the outside, I always recommend the continued use of hot hop poultice until all soreness inside and outside has passed away. I think this safer treatment than what is often used by others, and termed the bacon rind or fat meat treatment. The bacon rind or fat salt meat I often use conjointly with the internal treatment, if there is not any enlargement of the lymphatic glands present.

Cincinnati, Ohio, January, 1880.

ANGINA PECTORIS.

By JOHN A. HENNING, M. D.

The heart, arteries and respiratory organs, are involved in this disease. It may be both, a structural or a functional disease of the heart and arteries.

Dr. Heberton first gave an imperfect description of this disease in 1768, which arrested the attention of the medical profession. Since that time it has received a more thorough investigation.

Considerable difference of opinion has heretofore prevailed, in reference to the nature of this disease, some regarding it as an organic disease of the heart, others that it is essentially a nervous affection. Hospital observations and reports show that it may be both organic or functional.

Dr. Forbes made forty-five post mortem examinations. He found thirty-nine cases had lesions of the heart and great arteries. The other six cases were merely functional.

In sixteen cases there was thickening of the coronary arteries. In twelve cases there were softness of the heart.

In twenty-four cases there were dilatations or ossifications of the

aorta.

I feel safe, according to my experience and observations, in making it a rule, that in persons under the age of forty, organic affection is seldom found. While over that age, lesion of the heart and arteries are often found, though not always, or in all cases. The pneumogastric nerve, in all cases, is more or less disturbed in its action.

The causes are numerous. I am inclined to think that it is hereditary in some families, especially in its functional form. I know of a mother and three children affected with it. It is often brought on by cold, exposure, fright, over joy, or grief. Very often it is brought on when the patient has dyspepsia, over eating, food fermenting, and gaseous accumulations in the stomach. Over work or exertion are the causes in some cases.

The symptoms are not alike, in all cases; they differ materially, both as regards the temperaments and the true pathological condition. The paroxysm may be light, in some cases, lasting but a few moments. In others it In others it may be accompanied with intense pain, with constriction of the precardial region, feeling of suffocation,

with feelings of impending death. The patient gasping for breath, wanting plenty of fresh air, cannot well lay down or walk about. Breathing short, hurried; countenance anxious and pale. Sometimes consciousness impaired. In the attack, pulse slow, feeble, and very often intermitting; never full, acting and bounding; feet and hands always cold during the paroxysm.

The attack may last from a few minutes to one and two hours, to be repeated in a day or two, or sometimes not for six months or a year. In some cases it assumes a kind of chronic form, being the result of the acute attack, when any slight causes may bring on a paroxysm. But this form will only be noticed in cases where there is organic lesion of the heart and arteries.

The treatment varies in each case, according to its pathological condition.

When the physician is present, in a paroxysm, and finds that the stomach is loaded with fermented food, with accumulation of gas, a prompt emetic with bicarbonate of soda will give prompt relief.

When the stomach is not at fault, to give quick relief I usually inject about twenty drops of cold water, with a hypodermic syringe, in the right arm. This gives prompt relief in every case that I have tried it. In severe cases I would not hesitate for a moment to add three drops of gelsemium or tinct. lobelia. During the interval of the paroxysm, we must study each case individually, learning the state of the heart, arteries, lungs, stomach and pneumogastric nerve, and addressing our remedies to them. Usually, after keeping the bowels and kidneys active with proper remedies, I either use or prescribe the cactus grandiflorus in cases. where the heart is at fault, in two to five drop doses, every three or four hours. When the arteries are involved, the cereus bonplandii, in doses of twenty to thirty drops, every six hours, is a splendid remedy. When the pneumogastric nerve is at fault, I give the evening primrose, with excellent results.

With these remedies properly used, I think the first stage is always curable, even if it is organic, and the disease has been present for years. I cured one old lady, aged seventy years, with cactus grandiflorus, who had angina for twelve years. She is now enjoying excellent health.

However, the cereus bonplandii is a very fine remedy in a large number of cases, and will even cure cases where other remedies have failed.

I hope these thoughts will arrest the attention of the profession. Redkey, Jay County, Indiana, January, 1880.

A CASE IN PRACTICE.

BY J. M. HOLE, M. D.

Mrs. L. consulted me on the 20th of December, 1879; her age, twenty-four years; been married about five years; she now weighs about 250 pounds. She complains of shortness of breath, a very disagreeable smothering sensation when she lies down, a fulness in the upper part of her chest with an enlargement of the abdomen, very similar to a woman in the latter months of uterogestation.

She has never had a child. Her bowels are regular; appetite good; general appearance of a woman advanced in pregnancy. Both herself and husband are quite anxious for offspring.

This case has a history of some peculiarity; I will as briefly as possible give it. When this lady was in her sixteenth year, her father, a farmer of wealth and influence, residing some six miles in the country, came with her to my office. She then presented much the shape and appearance she does now, only younger. She and her father stated she had "fits" quite often, sometimes every day; she would fall anywhere when attacked. I at once supposed her to be pregnant from her shape and appearance; but upon careful inquiry of herself and her father I was at once disabused in that regard, and I asked her to place herself on my operating chair preparatory to an examination per vaginum. From her fear of being examined, or some other cause, as soon as she was fairly on the chair, she went into one of her spells or fits. As soon as the struggles were over, I at once commenced to introduce a speculum, which I accomplished with considerable difficulty. I found the neck of the womb, and with a bougie, sound, and some other instrument, I succeeded in opening the womb, when there passed between one and two quarts of thick blood, dark, and some clots, not large, with it. All this seemed to be expelled very readily, and

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