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A FATAL CASE OF ILEO-CECAL INTUSSUSCEPTION.

BY HUDSON D. BISHOP, M. D.
Cleveland, Ohio.

Professor of Surgery Cleveland Homeopathic Medical College, Visiting Surgeon Cleveland Homeopathic Hospital, Good Samaritan Dispensary and Maternity Hospital. Of the various forms of ileus, intussusception or invagination of one portion of the bowel into another portion of the same, is the condition which occurs in nearly one-half of the cases. This coupled with the fact that fully 40 per cent of the cases of intussusception occur in children and that the greater proportion occur during the fourth, fifth and sixth months makes this form of intestinal obstruction one of the most important of the serious illnesses of early infancy.

The following case is one of extreme interest and is reported for the purpose of making it a matter of record and on account of some unusual aspects of the case.

Baby S. Male, aged 5 months. Weight, about 15 lbs. Breast fed, well nourished. Child had been well and free from digestive disturbances up to the fourth month when the mother's milk became deficient and some starchy foods, such as mashed potato, oatmeal and rice, bread and crackers, were given. This, of course, soon produced digestive disturbances and the baby began to have regurgitation of food colic and diarrhoea.

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These digestive disturbances continued until an actual enteritis and colitis was present. On May 20th Dr. F. W. Somers was called to see the child and found nothing more than the conditions resulting from severe intestinal intestinal indigestion. symptoms improved somewhat upon a modification of the diet but the regurgitation of food persisted and there was some diarrhoea, the stools being bloody and accompanied with tenesmus. The doctor suspected some form of ileus but frequent examination of the abdomen showed no tympanites or tumor. The case progressed as favorably as could seemingly be expected until the early morning of the 24th, when tympanites was first noticed and the child seemed to be in pain. A tumor could be distinctly palpated in the

left colon line and examination per rectum showed that this tumor could be felt high up in the rectum. During a paroxysm of straining it was forced down and protruded through the anus.

I saw the case soon after Dr. Somers made the diagnosis of intussusception. We inverted the patient and by means of hydrostatic pressure it was possible to force the intussusceptum beyond the sigmoid, where it could be felt freely movable in the colon. After the hydrostatic pressure was removed, however, it would immediately move down toward the sigmoid. During these manipulations extending over not more than an hour, the child passed into a comatose condition and died in a convulsion.

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Autopsy: The first thing noticed on opening the abdomen was a distension of the small intestine and colon up to the splenic flexure. At this point was found the apex of the intussusceptum, densely matted together. At least fifteen inches of the ileum was matted together into a solid mass six inches long and one and one-half inches in diameter. In addition to this ileo-cæcal intussusception there was a colic invagination extending up to the transverse colon. In the specimen which was taken from the descending colon, the appendix and cæcum are a part of the inner mass. The mucous membrane of the entire intussusceptum was intensely inflamed, was matted together with an inflammatory exudate and in parts was gangrenous. I doubt if there

had been any opening through the gut for forty-eight hours, so dense were the adhesions. There were no evidences in any part of the intussusceptum of a sloughing off of the mass, an occurrence which is rather frequent.

This case is of particular interest for several reasons. (1) The existence of an intussusception was suspected early in the case on account of the presence of bloodstained mucus and tenesmus, yet the most careful examination failed to show the presence of tumor without which diagnosis could hardly be made. Tympany and distension while not constant symptoms in the condition were also absent until the tumor could be palpated. I am convinced, however, that the intussusception had existed for several days because of the marked inflammation which was present, and that the tumor mass was low down in the colon or in the rectum.

(2) From an ætiological stand-point this case belongs to the class in which the intussusception is caused by traumatism. No other cause could be found in the history of the case except that the mother had trotted the baby upon her knee to quiet it when it suffered from colic.

(3) I think that this case should emphasize the importance of giving the most careful attention to all cases of bowel disturbance in infants where there is diarrhoea and tenesmus. During the past Winter I had a severe case of what I thought to be intestinal indigestion, due to undigested casein. Even on a starvation diet, the tenesmus continued and before long there was blood in the stool. As soon as the blood appeared, I suspected intussusception and used slight hydrostatic pressure in washing out the colon. Whether it was an intussusception or not, the child became rapidly better and there was no more tenesmus or bloody stool.

I think that the occurrence of tenesmus with a bloody stool with or without the presence of a tumor, should lead to the suspicion at least of an intussusception and the use of hydrostatic pressure in the colon. Stercoraceous vomiting and tympany are not neccessary to the making of a

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CONCLUSIONS AFTER TWENTY-FIVE YEARS.

BY Z. T. MILLER, M. D., PITTSBURG, PA. Twenty-five years' practice does not always render a man competent to draw conclusions. He may have the practice, the other fellow the experience, and one of the funniest things in the world would be the conclusions of both to contrast. What the doctor thinks of it and what the victim thinks of it, I trow are two different things, and yet, the eagerness with which the victim seeks to be victimized grows greater, surely not less.

The power to draw logical conclusions from familiar premises is not asserted emphatically, incontrovertably, but conclusions that are acceptable to one man at least, are here set forth. A conclusion is the final formulation of deductions resulting from the examination of facts suggested by theory. As regards Homeopathic Materia Medica, any one can-who will-draw conclusions. The stated facts are unmistakably announced. They are to be examined, as to method, they are to be tested as to use, they are to be watched as to results. Now if, after this inquiry, the results are as set forth in the theory, then a conclusion is arrived at.

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Twenty-five years of such inquiry should be sufficient to prove or disprove absolutely whether we follow a fantasy or float a fact. I am unalterably convinced that the latter is true. The first conclusion that "Homeopathy is based upon natural law” you would not thank me to debate. existence of this society gives a verdict without leaving the box. Charges to juries by some would-be judges have muddled the minds of some who have an honest desire to arrive at the facts, and we can veto the charge only by appeal to higher court. Some do not care to take the time and trouble to appeal, hence as the cock crows the hen cackles.

Nor can the self-appreciation of some men be curtailed who believe, honestly, that their judgment with regard to terrestrial things, medicine in particular, is as good as any man, whether he be dead, living, or yet to be born. If such "selfappreciation" edicts a combination tablet of Rhus., Bryonia and Colchicum for a rheumatism, and the practitioner accepts the edict and commits "hari kari" on account of it, he will hardly formulate a conclusion that homeopathy is based upon natural law, but rather upon the pronunciaments of some modern "Poo - Bah” herein before described. The responsibility is alike with both the "Poo-Bah" and the confiding practitioner, and the responsibility is indeed great. It is greater certainly than either appreciate or they would not combat a system that rests upon the research and exhaustive confirmatory experimentation recorded in the Organon, Materia Medica Pura and Chronic Dis

eases.

The Second Conclusion.-The single remedy at all times is the only rational and consistent prescription.

As practitioners-men who visit the bedside, come in actual contact with the sick —we are, of necessity, principally intermediaries. We are pleased to call ourselves Homeopathic intermediaries, that is, we stand as mediums of transmission between the discoverer of the system practiced, the pharmacy on one side and the patient on the other. Our efficiency depends upon the thoroughness of our qualifications, our willingness to carry out the precepts of the system. It does not appear that there is the least room for the interpolation of Milleropathy, or any other kind of opathy, for nowhere does the record say that two remedies are sufficiently alike or so closely related that they may be given at the same time. To be sure, no one can apply the intricacies of materia medica to the intricacies of disease unless a very considerable knowledge of both can be confessed. [I am compelled to admit a very considerable knowledge of both can be confessed.] I am compelled to admit a very limited acquaintance with both-as

compared with the aggregate sum of both, even after twenty-five years of fairly honest endeavor. And certainly do I not know when I may give two remedies and feel a reasonable assurance that I have done the right thing. It's a thunderin' perplexing thing, most times, to give the right one, to give the right two seems quite beyond the virtues of consistency. While we all know that the majority of the ills we treat are trifling, recover themselves under the exercise of abstemiousness, there is, therefore, less excuse for juggling a multiplicity of drugs when the effect of such legerdemain is quite dubious. But when serious business is on hand and a little assistance now and then determines the recovery or otherwise of the afflicted, that assistance must not be predicated on the slothful habit of addition and multiplication but rather upon the most careful estimate and precision in application. I need not dwell upon the how, you know it.

Third. The potency of the drug administered, a question seemingly, as yet, unsettled, is the one that to my mind adjusts itself. Waste time, not on the dilution, but upon the selection of the remedy, being sure of the right choice give it in whatever potency you please. Being the right remedy, it cannot be discarded for another, hence, the only thing, if satisfactory results are not reached, is to change the potency, and if we are observant as we should be it will not take long for us to settle the potency question to our individual liking. No man can settle the question who uses combination tablets or alternates. That practice will forever prevent its solution, not only that, it robs medical practice of the possible attainment of its subtlest refinement.

An apt illustration of where potency settles itself occurred during the last days of my last year's service in the hospital. One William, an employe of the hospital, was suffering from enlargement of the liver and accompanying dropsy. I prescribed Chelid. 200x, the train of symptoms calling for it. The day my services ended, William getting no better, I gave an unfavorable prognosis. A Dr. C. C. Rine

hart followed me, gave William five drop doses of Chelid. tincture and William got well, is now on duty in the hospital. In this case the remedy chosen was right, the potency wrong. The conclusion then is that the right remedy is the paramount consideration, the potency of the remedy a matter for adjustment in each individual case. I must say, however, that my usual practice is to sound the case with the 200th.

Physical Diagnosis holds a position in dispute, once given the vanguard of position, again the rear guard. As an accomplishment it should be acquired and given whatever position and weight the individual practitioner thinks it deserves. If one feels that a prescription cannot be made until a physical diagnosis has been arrived at, no particular objection need be raised. Upon the other hand the paramount importance of physical diagnosis cannot be maintained, since in a very large proportion of cases such diagnosis cannot be made with sufficient accuracy to make it the basis of treatment. I speak from a homeopathic standpoint. For the purposes of the aforesaid accomplishment I would be delighted to be able to tell why the profuse sweat on one person's feet is warm or cold, fetid or otherwise; why the vertex is cold in one case and hot in another. These phenomena may be accounted for by the neurologist, but I fail to see the necessity for the pathology when the fact symptomatically gathered in the processes of proving enable us to cure, almost certainly, either of the health deviations.

A young medical student assured me that medicine was nothing but a good sized bluff. This young man's education had been conducted in an institution where physical diagnosis was an all-important factor, where homeopathic materia medica was a casual reference and massive specifics were the first in rank. Just why he came to such a conclusion I cannot say. Perhaps it was because of the frequent change of diagnosis in the same case, or the widely differing opinions of famous men viewing the same subject. Perhaps

the most ridiculous situation a man finds himself in is when he diagnoses a case measles, then scarlet fever, then diphtheria. The man is not to blame other than that he has taught people to want to know what is the matter, and that disease cannot be treated till that very important information is gained. Diagnosis is the totality of the symptoms irrespective of classified nomenclature.

About Medicines.-Experience and observation have been surprising. For instance, I have a bottle labeled lycop. 200, that was purchased twenty years ago as one of Carroll Dunham's famous. That half ounce bottle has done service ever since, not the original to be sure, for it has been filled and refilled a number of times. When prescribed it is given as the 200th yet and seems as good as ever. A bottleone drachm-contained a graft of two or more dozen No. 10 pills said to be Ham. cm. When I returned from college I added water and alcohol. This evaporated until there was left in the bottle a brownish semi-fluid liquid. When I discovered this, fearing I would lose the graft, I transferred it to another bottle, filled it up and have prescribed from it on several occasions with marvelous effect, at least it appeared so.

Nearly all the high potencies I have were obtained from dry pill grafts given me by Frank Adriance and by him received from Dr. Mc Farland, of Philadelphia. Many of them, especially Sulp. cm., Actea R. cm., Nat. M. cm., Kali Bi. cm., Silic. cm., Thuja, and Merc. V. cm. passed the same evaporating process related of Ham. cm. and all seem just as good. We must conclude that the identity of a remedy is not so easily destroyed and that filling and further dilution does not war against the action of the remedy so diluted if it is indicated.

About the use of high potencies. It is claimed by many pronounced adherents of homeopathy that the high potencies are a delusion. I may say truly that the majority of practitioners of our school do not, would not, use them. We are compelled to admit that drugs do modify func

tions, produce organic changes, and have elective affinities for certain parts of the human organism. I need not argue this point, it is admitted everywhere because it is susceptible of absolute proof. Supplement that fact by an avowed acceptance of the law of similars and we have two potent factors in the fabric of homeopathy. Three factors are requisite, drug influence, law and application. If the first two are true, and if there has ever been a cure wrought in accordance with them, then the third factor is as firmly established. As remarked before, the potency question settles itself. If, however, a cure is brought about by the cm. potency, or, if you please, after the cm. has been administered a patient recovers his health, we must arrive at one of the three conclusions, either it was a spontaneous recovery, the medicine cured, or the number of new fangled psychics are based upon fact.

The Safe Side.-The high potency homeopath is on the safe side in any event.

If

spontaneous cures result, he has thrown as little obstruction in the way of that desirable denouement as possible. If he has indeed cured then he has accomplished results in the mildest manner, which is the duty of the physician. duty of the physician. If the psychic phenomena has played a part, if suggestion, expectancy, or what not, has been the agency, he is still right, may be unwittingly. He has suggested a result, the patient believed, a cure followed, while he gave and got the sugar. Of course a delirious subject or a senseless child would not come within the sphere of suggestion knowingly, unless the delirium and baby prattle or screaming is the sub-conscious self manifesting itself. Even then he is safest in giving a little homeopathic medicine according to indications.

After carefully looking over the field, viewing it from whatever quarter, I am convinced that straight Homeopathy meets all the requirements of well conducted medical practice.

Materia Medica Notes

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At about 10 A. M. on the 25th, the day he consulted me, he began to feel a soreness in his muscles; they "hurt" him, his bones felt "sore." There was a "sore" pain across the sacral and lumbar regions, which also ran up his spine to neck and occiput, then forward into forehead and eyes. The eyeballs were "sore" to touch, and on motion. The neck "hurt" worse when the head was thrown back. He walked stooped, "hurt" in the lumbar and sacral regions to straighten up. Wrists

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felt "sore" on moving them, they "hurt." There was inability to move knees-to step out as quickly as usual. There was no pain or soreness in the knee joints, the trouble seemed to be a lack of power to step out or move the knees as quickly as was natural for him. The roots of the hair on his head, wrists and mustache "hurt" when the hair and skin touched. The flesh over the whole body felt "sore," the lacings of his shoes "hurt" when they pressed upon his foot. At noon felt cold; had a chill, hands looked blue, could not get warm in hot sunshine, had to put on heavy underwear. Later fever came, face felt flushed, and had pressure outward in forehead and sensation of "fulness" in stomach. About 3:30 P. M. sweat came. He then felt easier, the right nostril became obstructed, felt as if swollen inside. No discharge from nose. At 8:30 P. M. when he consulted

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