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great anxiety for their soul's salvation. They may also be peevish, fretful, illhumored. Aurum has similar symptoms.

It is also well in this connection to study Natrum Carb., which is a good type of the despondent mood. Patients are depressed and extremely despondent, melancholy and very apprehensive. The apprehensive mood is also one frequently met with and is found under such remedies as Aconite and Calc. Carb. Aconite leads all of them. Patients are afraid of crowds, afraid to cross streets. They fear ghosts, are apprehensive of the future; afraid of approaching death-a perfect picture of apprehension.

Calcarea Carb. is apprehensive of some misfortune about to happen; fears she will lose her reason and that people notice it. Contradictions of the Materia Medica.It must not be understood that the Materia Medica contradicts itself, but that certain symptoms are contradictory in their action. Ignatia is here again the leading remedy as the following symptoms well show: Frontal headache, relieved by stooping; during fever no thirst and wants to be covered; during the chill thirst and wants to be uncovered; sore throat is worse when not swallowing; heels burn yet they are cold.

There are very few remedies with these contradictory symptoms. Mezereum has the headache relieved by stooping. Nux Vomica has great heat yet wants to be covered. Pulsatilla has great burning heat at night with no thirst and wants to be covered. Causticum has a peculiar contradictory symptom: Stools pass better when standing. No other remedy has this symptom. An aloes stool will frequently pass when standing, but in aloes the stool is soft, containing lumps of mucus, while that of Causticum is constipated.

Pulsatilla has a peculiar contradictory symptom: Can hear better when there is a great deal of noise. Naturally quiet is conducive to good hearing. Another symptom of pulsatilla, which is exceptional rather than contradictory, is that the menstrual discharges are excoriating while all the other discharges are bland.

Usually the mouth is dry when there is great thirst; not so with mercury-the mouth is moist and slimy with great thirst.

After a good sound sleep the patient usually feels much better-not so with Lachesis. There is usually aggravation after sleeping. Sleep into difficulties. If he can keep awake will feel all right.

"Pains in the bladder are better when riding horseback," a rather contradictory symptom found under Lycopodium. Rest is a great reliever of pain, not so under Rhus tox., Magn. Carb. and Kali Carb. As a rule the pains of the stomach are worse during the process of digestion and are better when the stomach is empty and at rest. Anacardium has the opposite condition. Stomach feels better when eating and during digestion.

CLINICAL CASES.

By Newman T. B. Nobles, M. D., Professor of Sur. gery, Cleveland Homeopathic Medical College; Surgeon to the Cleveland City Hospital, the Homeopathic Hospital and the Children's Hospital.

The printed reports of major operations are so very numerous and interesting that we have thought it advisable to report what may be properly termed, intermediate cases; though they are undoubtedly of major importance.

Case I.-Thyrotomy. Patient aged 65, residence Pleasant Home, Ohio, came to Cleveland to consult a laryngologist in regard to a throat affection. The examination revealed a growth of some considerable size involving the larger portion of the larynx and vocal cords. Diagnosis epithelioma and operation advised. the case demanded early operation and the specialist was about to leave the city, the case came under our observation and was treated in conjunction with Dr. J. N. Lenker.

As

The operation was performed at the Cleveland General Hospital. A preliminary low tracheotomy, performed almost painlessly with the aid of a 1⁄2 percent of cocaine was the first step. When the breathing became steady chloroform was given, the patient inhaling the fumes from an ether cone which was attached by a rubber tube to the tracheotomy tube. Had we not

adopted this procedure I feel sure the patient would have died on the table. An incision was made directly into the trachea and extended upwards. A tumor was found which nearly filled the entire space. With the aid of a sharp spoon and scissors the growth was removed as completely as possible. Silver-wire stitches were introduced into the sides of the wound in the cartilage, while catgut was used superficially. The patient rallied well. The tube in the trachea was removed the second day and the wound closed.

No untoward symptoms occurred during his convalescence. For six months the patient was apparently a perfectly well man. About this time he noticed a slight difficulty in breathing. This continued, and finally the respiratory efforts were decidedly labored and it became necessary to again introduce a tracheotomy tube. The larynx was again filled with an epitheliomatous mass and the condition of the patient such as to render further operation under a general anæsthetic inadvisable. The tube was worn with comparative comfort for over four months, though the breathing was gradually more and more interfered with until the patient died from exhaustion.

The operation of laryngectomy was early advised in the hope of obtaining a cure, but was refused. It is probable that his condition would have prevented this operation from being performed successfully. We believe that this is the first time a successful thyrotomy has been performed in northern Ohio.

Case No. 2.- Mastoid Disease-Radical Operation. The patient, a nurse at the City Hospital, suffered a fairly severe attack of diphtheria and recovered nicely, with the exception of an otitis media, which occurred early in the convalescent period. There was a gradual subsidence of the discharge until only a slight serumlike fluid was noticed. The patient resumed her duties and was seemingly in the best of health. There was no swelling at any time over the region of the mastoid cells and no real painful sensation when pressure was made upon the same tissues.

The discharge continued for several months and was treated by an aurist. An unusual run of hard cases overtaxed her strength and an increase in the quantity of discharge was noticed. Deep pressure made over the mastoid process caused some pain. There was at no time an elevation of temperature; nor was there swelling. The function of the affected ear was lost. In order to avoid further daily local treatment the patient was anxious to undergo an operation for permanent relief.

The patient was prepared in the usual manner and the hair removed over the area from the line of the parietal eminence to the occiput. The ear was cleansed as well as possible by irrigation and the auditory meatus plugged with cotton. A slightly curved incision, its convexity backwards, was made from about an inch below the tip of the mastoid process to a point as high as the top of the auricle. The posterior auricular artery was cut and ligated. The supra meatal spine was located and the bone chiseled away downward toward the apex of the mastoid, thus avoiding the lateral sinus. A vessel of larger size coming out of the bone caused troublesome hemorrhage. This was controlled by inserting a sharp pointed knife into the foramen and after twisting it about the vessel was peeled from its bony casing, which caused the walls to retract and curl inwards. As the mastoid cells were opened pus in small quantity was liberatel. The cells were in very unhealthy condition. The chiselling proceeded until all the diseased bone was thoroughly removed. As a result the soft tissues beneath the mastoid--the dura and the wall of the lateral sinus-were exposed. Nearly an inch of the bony covering of the sinus was removed. With the aid of a sharp spoon every bit of diseased tissue was taken away. The antrum was opened and the small bones removed. There was no elevation of temperature following the operation.

We feel that this case is of interest when we recall the absence of local and constitutional symptoms which would be expected when there was such a quantity of sup

puration present. In a short time it is very probable that the lateral sinus would have been infected and a much more serious condition resulted.

Case No. 3. - Mastoid Disease. The writer was called by Dr. G. A. Jend to operate upon a patient whose objective symptoms were seemingly out of proportion to the pathological condition present especially when compared with Case No. 2. The patient, an infant, was brought through an attack, of broncho-pneumonia by Dr. Jend. Shortly afterwards a discharge from the ear was noticed. This was treated for a time, when symptoms of mastoid involvment appeared. This condition was properly treated by Dr. Jend, but in spite of his efforts the infection increased. The whole affected side of the face and head became greatly swollen; there was considerable pain upon pressure over the mastoid and a decided elevation of temperature. A purulent discharge from the external auditory meatus was present. The little patient was somewhat hastily prepared for an operation and chloroformed. An incision was made through the soft tissues, the periosteum divided and pushed away. This procedure allowed a quantity of serum to escape. The hard tissues were searched for necrosed spots but none were found. As the mastoid cells are very imperfectly developed in infants and young children and as the patient was not able to stand a prolonged operation, we packed the wound with gauze. The incision was made at nine o'clock in the evening and was followed by a subsidence of the unpleasant symptoms. The dressing was changed in less than twenty-four hours and pus discovered. An uneventful recovery followed.

While Wilde's incision is not considered an altogether first class procedure by the aurists it seems to have been fully indicated in this case.

Case 4.-Epithelioma.-We wish to state emphatically that all epitheliomas can be successfully treated without operation if only the soft tissues are involved. This applies especially to those of the face.

With reference to our treatment, I give the method of Dr. Powell, of the PostGraduate Hospital. In a recent case of epithelioma the size of a quarter of a dollar the method was successfully used. Powell's method is as follows: Cleanse the surface thoroughly and then put on a pad of dry, sterile gauze. This is held firmly in position for a minute, then raised and a few drops of butter of antimony applied. This is allowed to remain a minute and then compression is made again, followed by a few drops of the chemical. This procedure is continued until all oozing has stopped, so that when pressure is made with the gauze a dry surface is left. No dressing is applied and the patient is instructed to return in three days. If at this time there appears to be some secretion beneath the crust the above process is repeated. If the crust becomes hard and dry it is left undisturbed for a week and is then removed. Ordinarily a healthy looking ulcer is the result. To this is applied a strip of diachylon plaster and a protective dressing. The course of treatment runs over a period ordinarily of from three to five weeks. This method can be used successfully in cases of epithelioma of the lip. One need have no fear in using the butter of antimony as it only affects unhealthy tissue. Powell has treated hundreds of epitheliomas in this manner.

Case 5. Traumatic Aneurism of the Facial Artery. Patient male, aged 25. Referred by Dr. Hinman. A few months before consulting the writer, the patient had fallen and sustained a slight punctured wound in the left cheek. Shortly afterwards a small tumor appeared. This gradually increased until it became the size of a lemon. The tumor, which presented the characteristic symptoms of aneurism, dipped well down into the buccal cavity.

The operation was performed at the East End Hospital. With the aid of a 1⁄2 per cent solution of cocaine, of which a few drops were injected just beneath the skin, the operation was practically painless. The facial artery was picked up and tied and the sac dissected out. The wound was wiped out with salt solution and closed

with subcuticular sutures. The wound healed without a symptom. The points of interest in the case include the rarity with which aneurism affects this artery, the small amount of the anææsthetic mixture and the use of subcuticular stitches. In regard to the strength of cocaine solutions for subcutaneous injections, we find that a freshly prepared 1⁄2 per cent solution is as effective in preventing pain as the stronger solutions. In regard to the stitches used we find the so-called subcuticular stitches especially valuable for use in the tissues of the head, face and neck. When properly introduced, obtrusive scarring is prevented, which is often decidedly important from a cosmetic point of view; and further, stitch abscesses may be prevented as the needle does not penetrate the skin and thus allow infection by the skin coccus. In this instance, only a fine white line denotes the union of the lips of a wound that was not exactly a trivial affair. The Osborn

THE INDICATED REMEDY.

By J. W, Rockwell, M. D., Akron, 0.

The indicated remedy, did I hear you say?
What shall I write about it, pray?
Must I the whole subject here expound,
Tell you just how it may be found;
How it best can be selected

For relief of those with disease affected;
How one can always be certain, sure
Of giving relief and a speedy cure?
If this is the case, it doth remind me
To attempt the task you have assigned me.

If you wish to prove its great utility,
Its curative power and its ability;
Get first the remedial modality
Conditions and symptoms in totality,
Or, if you prefer it, take the key-note,
Compare your remedies; then take a vote-
Selecting the one that has a majority,
Discarding all those that are left in minor-
ity.

Then by the law of similia, apply it;
Success will follow if you'll but try it.
One is mistaken when he supposes
That all depends on correct diagnosis.
Diagnosis isn't all of the healing art,
'Tis only a portion; but a single part.
And he will always best succeed

Who to the symptoms gives most heed.

Two may be ill with the same disease Whose symptoms differ by many degrees. When we find this condition, what should we do?

I'd not treat them alike, neither should you.

But look upon each as a separate entity,
Selecting the remedy by its identity
With the symptoms; then one may be sure
Of making a quick and a permanent cure.

Now to prove this theory true,
Some of the remedies I'll review,
So that one may know at a single glance
Just what to give and take no chance
Of having to resort to empirical measures,
For lack of knowing these valued treasures.
Belladonna, we first will take;

And a thorough investigation make.
Find how we can use it as a reliever
And cure for the dreaded scarlet fever,
With its strawberry tongue, papilla red,
Dilated pupils and throbbing head.
Eruption smooth, with burning skin,
From the raging fever that burns within.
There's great delirium, with fear and
fright;

The patient is inclined to bark and bite.
He has great dread of jolt or jar
When the trouble has progressed thus far.
Bell, as a remedy has well been tested
For relief of tissues with blood congested.
If the skin is red and very bright,
With glistening eyes that shun the light,
Then it is, it should be stated
That Bell is the remedy indicated.

Arsenicum patients are restless, 'tis said;
Desiring to change from bed to bed.
With great prostration and sudden sinking
While of death they are always thinking.
Great anguish, they fear to be left alone,
To get up and hide they are often prone.
It is indicated we are often told

After ice-cream or water cold,

From their bad effects the system freeing When e'er they persist in disagreeing.

Rhus Tor, has restlessness, or rather a condition

Characterized by inability to find the right position.

When they think they've found it, they get a little rest;

Then they shift and turn about, to make another test.

The symptom that stands out boldly in the proving

Is, that the patient gets relief by continuous moving.

Trouble caused by getting wet, or being in the rain

Also bad conditions resulting from a strain.

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Veratrum album, we come to now;-~
It has much perspiration upon the brow.
But I hardly think you need be told
Indications are best when the sweat is
cold.

And you will find as a general rule
It occurs while the patient is at stool.
Oh! the pains that do absorb us
When in the cramps of cholera-morbus!

One feels that death is o'er him stealing
There's such a sinking, empty feeling.
What can we do in a case so dire,-
Where these conditions do so conspire,
Do so distress and sorely fret us.
We get no rest; they will not let us?
Give veratrum; I am sure 'twill please
By removing the trouble and giving ease.
Sulphur is our greatest polychrest;
Of the antipsorics, one of the best.
In considering this remedy, I find
It forcibly calls up to my mind,
How in younger days I oft heard tell
That sulphur was a fuel, used in hell.
Now they tell us that was all a myth,
A trumped up story to scare us with;
To scare us into being good,
To live the life down here we should
In order to reach that heavenly goal,
Eternal rest for the human soul.
Pardon, I pray you, this digression,-
I simply wished to give expression
To one of the changes time has wrought
In the onward trend of human thought.

Sulphur has morning diarrhoea, 5 a. m.
One has to get out and hustle then,
And the reason is,—I will relate,
That nature will no longer wait.
Sulphur has pimply eruptions filled with

pus

And when you find a patient thus,
Give him sulphur and I am sure
That you will make a speedy cure.
But should it fail, when it you've tried,
Then you should give the Iodide.

I could mention others, but must not weary;

I think I've proved both fact and theory,
That the indication, is the "sine qua non"
And when found, can be depended on.
Seek it then and rest assured
The patient will be quickly cured.
If we take this rule as our basis
And individualize our cases,
Success will all our efforts crown
And Homeopathy gain renown.

These verses were read at the meeting in Akron of the Northwestern Ohio Homeopathic Society.

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