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this congested portion with a mild silver nitrate solution. During the examination there was such spasmodic action of the muscles of the bladder that it was very difficult to do the work. It would contract with such force that it would almost force the cystoscope out and would throw what few drops of urine there were in the bladder out so forcibly that they would strike the reflector. In order to relieve the spasms, I kept her pretty thoroughly under atropin for about two weeks and the quantity of urine decreased to as low as nine oz. in 24 hours. With this small quantity the patient was urinating very frequently, expelling only a few drops at a time. Among the first samples of urine examined, I found a good many pus cells, but this soon

cleared up.

In December, 1902, she was taken with sharp pains in the small of back, also cutting pains in the left kidney, the first pains that had been experienced in the small of back during all these years. At times there was some pain in the right kidney, but never very marked. Applied antiphlogistine and heat and this, with the use of anodynes, relieved the pain to a considerable degree.

The skin became dry and hot, every symptom became more prominent; constant dull headache, always nauseated in the morning, often vomiting, at times twitching of left limb. These symptoms were strong indications of uræmic poisoning and urinalysis confirmed this, as at times there was only between one and two per cent. of urea. I made an X-ray examination and found the left kidney very cloudy, but the shadow was not dense enough for me to diagnose stone in the kidney with positiveness.

The uræmic symptoms being so grave, I used the thermal baths for weeks, thus eliminating sufficient urea to relieve the most alarming symptoms. Kept her on a diet of milk and distilled water for a period of weeks, and this improved the function of the kidneys, but did not seem to relieve the pain in the kidney nor the pain in the bladder. The pain in the left side and back at times was intense, and several times when the pain was most severe the patient had a sensation of swelling over the left kidney.

We had urinalyses at frequent intervals for months and there was always a marked sub-normal amount of urea and a great many of the examinations revealed a superabundance of urates, phosphates and oxilates, but at no time was there any albumen. The urinalyses were made by Dr. McVay and the report in a number of instances was given to the patient, but unfortunately they have been lost and can not be included in this paper.

The character of the pain and the condition as shown by urinalysis were strong indications for making a diagnosis of stone in the kidney. The patient, after these long months of severe suffering and danger from uræmic poisoning, was thoroughly discouraged, and consented to an exploratory operation on the kidney. At this time she was voiding from 20 to 24 oz. of urine in 24 hours.

June 11, 1903, assisted by Drs. McVay and Stafford, of Toledo, and Dr. Zumstein, of Detroit, I made the usual lumbar incision, brought the kidney out and needled it thoroughly, but found no stone. In the superior third of the kidney I found a hard mass almost like cartilage, which resisted the needle to a marked degree. I stript the capsule and incised this mass, which, after incision, resembled cicatricial tissue more than anything else. Sutured the incision with cat gut, replaced the kidney, put in my sutures and the patient made a nice recovery. The following is the amount of urine secreted in 24 hours, as recorded each day on her chart for the first ten days after the operation :

From June 11th 8 a. m. to June 12th 8 a. m. oz. XXII.
12th

13th

XXVII. 13th

14th

XXII. 14th

15th

LIV. 15th

16th

XC. 16th

17th

LXVI. 17th

18th

LXXI. 18th

19th

LXVI. 19th

20th

L. 20th

21st

XLVII.

This, you can see, is a remarkable increase in the quantity and there was a continued improvement in the amount of urea excreted until she reached the normal amount. There has been a steady improvement until to-day, six months after the operation, she is passing a normal amount of normal urine, urinates from five to six times in 24 hours, is not troubled at night, can retain the urine from six to eight hours if necessary without any inconvenience, can go out in company and enjoy herself as she has not done for years, and is able to do a fair day's work as a nurse.

When we consider the long period the patient had suffered from this reflex irritation of the bladder, the source of the reflex and the prompt relief that followed the surgical treatment, I feel that I am warranted in calling it unique.

PODOPHYLLUM PELTATUM.

By C. Zbinden, M. D., Toledo, Ohio. No complete proving has been made with this remedy. Some of the symptoms it has produced in healthy persons are the following: Great sleepiness in day time, tired feeling in the early evening hours, heavy sleep, mental depression, vertigo, head feels dull, heavy; pain in forehead, with diarrhæa, paroxysms of severe headache, with darkness before the eyes; rheumatoid pains, fever, chills, heat and sweat; putrid taste, white coating of the tongue, no appetite, or great hunger, eructations with sour taste, desire for acids, nausea and vomiting of food, with putrid odor, pyrosis and gastralgia, vomiting of foamy and slimy fluid, or of bile and blood; great thirst. Pain in region of liver and spleen, colic with retracted abdomen, in case of poisoning, gastro-enteritis with tympanitis; stool soft, of the consistency of mush, or watery, of different colors-yellow, green and white, sometimes mixed with blood, or like gelatine; prolapse of anus.

E. B. Nash (Leaders) says: Podophyllum is a powerful cathartic. The diarrhea of Podophyllum is characterized by (1) the profuseness of the stool; (2) the offensiveness of the stool; (3) the aggravations in the morning, hot weather, and during dentition. Concomitants are prolapsus ani; sleep with eyes half closed, rolling of the head from side to side, moaning, frequent gagging or empty retching.

I have used this remedy mostly for diarrhoea and cholera infantum. In former years I sometimes used Podophyllin, but have abandoned it and now use nothing else but preparations of the homeopathic tincture, with much better results.

There was a great number of cases of diarrhea among children in our city last summer. After observing a few of them I found that they were all of one kind; they all had watery passages, mostly yellow; some had an offensive odor, others had not; they had some colic; some patients vomited, others did not. After experimenting a few days I found that Podophyllum was the remedy for all these cases. From that time on I prescribed it for every case during the season. Before that I had a few times used Sulphocarbolate of Zinc as an intestinal antiseptic, also Pepsin, but found that Podophyllum when indicated, needs none of these adjuvants but does its work alone and is all-sufficient. Stupor is not seen in every case, as it is not an early, but rather a late symptom, but when present calls invariably for Podophyllum. Vomiting, when present with the diarrhea, needs no Ipecac nor any other stomach remedy, Podophyllum cures it.

The result I had with this drug was a prompt cure in the great majority of cases, and improvement in nearly every case. The few patients who did not get well with it needed another remedy to complete the cure, and this was Mercurius Sol. I had two deaths from said disease last summer, but both were complicated and neglected cases. There are always weak and sickly children who will die of an attack of diarrhæa, no matter what we may do. The doses I used were from six to twelve drops of the 3x dilution a day.

DIFFICULT DENTITION.

By H. W. Shaffer, M. D., Tedrow, Ohio. The teething period of children is the most critical period of their early life. The first step in the development of the teeth consists in a downward growth from the rete malpighi or the deeper layer of stratified epithelium of the mucous membrane of the mouth, which first becomes thickened in the neighborhood of the maxillæ or jaws now in course of formation. This process passes downward into a recess of the imperfectly developed tissue of the embryonic jaw, and as they develop they grow upward.

The temporary or milk teeth, are speedily replaced by the growth of the permanent teeth, which push their way up from beneath them, absorbing in their progress the whole of the roots of each milk tooth. The development of the temporary teeth is said to commence about the sixth week of intra-uterine life, after the laying down of the bony structure of the jaw. The permanent successors begin to form about the sixteenth week of intra-uterine life. For this reason the infant's food should be carefully selected. Keeping the mother's health in good condition will greatly aid in the infant's development.

In ordinary cases during the teething period about all that is needed is the indicated remedy for the various afflictions caused by teething, and I find Passiflora among the best remedies. But when ordinary means fail to give relief and the gums are much swollen and inflamed, and there are signs of convulsions, it will be proper to lance the gums well down upon the teeth. The routine practice of cutting the gums whenever anything is the matter with the baby that is cutting teeth, is wrong, and there are others who never met with a case where it was necessary to lance the gums, and consequently fail to realize that such cases do occur.

The trouble about gum-cutting comes from a misconception of the subject. The irritation or nervous strain is not caused by the pain or discomfort of the gums, nor is the relief in cutting the gums only, but as the tooth, at the stage of development, is, on the root end, an open tube, filled with the pulpy matter, loaded with the earthy material that is being deposited as the tooth is pushed forward, the mischievous work of this gum is simply in pressing the tooth back on its pulpy base, the sharp edges cutting and lacerating this-to the terrible torture of the little one. Cutting the gums lets the tooth lift, thus relieving the little one. So lance not to relieve the gums, but the toothforming pulp behind the tooth..

Case I.- A very fine well-to-do family. The only little child-ten or twelve months old-kept having convulsions, with gums very much swollen and cutting teeth could not induce the spasms, and the child died from the effects of the convulsions. The history of the baby was related to me by the mother. The second child, a fine-looking boy, with gums very sore and swollen, commenced having convulsions about the same age as the first child. It had one or two a day for three or four days, growing more severe. I was called in to see the little one, and advised their family doctor to lance well down upon the teeth. This was done and the child had no more convulsions,but grew to be a strong, healthy child.

Case II:- Related in Medical Council, December, 1898. Rev. M. S., baby having convulsions, appearing every Sunday and continuing until Wednesday; then stopping until the next Sunday, convulsions commencing as before and lasting until Wednesday. This continued for weeks, until the child became an idiot. The gums had been well scored up from lancing-to no use. At last another doctor suggested quinine for the baby for the peculiar conditions of periodical convulsions, and after receiving it the baby had no more convulsions. But the medicine was delayed too long to save the mind.

Case III.-Baby about sixteen months old. If it made an effort to get hold of something they did not wish her to have, and the article was removed, or if she attempted to secure something just beyond her reach, she would seemingly become vexed and fall down in a spasm. These spasms increased in severity, all remedies failing. The lance was used and the child had no more convulsions.

So it is required of us to study well our cases and act wisely. I am confident that a babe with its undeveloped brain cannot be subject to convulsions to any extent without its brain suffering serious injury, and Opium or its derivations cannot be administered to a babe for any length of time without producing injurious effects on the mental conditions. We should bear in mind that all childrens' troubles are not caused by teething, and that very few need to have their gums lanced.

The best treatment for difficult dentition is preventative. This consists in proper food, good air, proper clothing, cleanliness and exercise. The mother must attend to her diet and health, and avoid all

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