ANEMIA, NEURASTHENIA, BRONCHITIS, INFLUENZA, PULMONARY TUBERCULOSIS, AND WASTING DISEASES OF CHILDHOOD, AND DURING CONVALESCENCE FROM EXHAUSTING DISEASES, THE PHYSICIAN OF MANY YEARS' EXPERIENCE KNOWS THAT, TO OBTAIN IMMEDIATE RESULTS, THERE IS NO REMEDY THAT POSSESSES THE POWER TO ALTER DISORDERED FUNCTIONS, LIKE "Fellous Syrup of Hypophosphite" MANY A TEXT-BOOK ON RESPIRATORY DISEASES SPECIFICALLY MENTIONS THIS PREPARATION AS BEING OF STERLING WORTH. TRY IT, AND PROVE THESE FACTS. SPECIAL NOTE.-Fellows' Syrup is never sold in bulk, but is dispensed in bottles containing 16 oz. MEDICAL LETTERS MAY BE ADDRESSED TO MR. FELLOWS, 26 CHRISTOPHEr street, new YORK. "If a patient is poisoned by Malaria DR. MORSE IN HAHNEMANNIAN MONTHLY. Cinthoxin is its surest antidote-a true specific Many cases of dysentery, skin eruptions, and anæmia with They are especially recommended in the stubborn cases Their use never causes "quinine stomach" or head disturb ances. ZWARTS PHARMACY CO., Fourth and Locust Sts., ST. LOUIS. Cinthoxin Tablets contain cinthoxin, maizin, arsenic and nux vomica. Professor of Physiology and Histology, Homeopathic Medical College of Missouri. Semmel Weiss is accredited with being the first one to call attention to the probability of puerperal infection being conveyed by the hands of the accoucheur or nurse. To this end he gave orders, while Obstetrician in the Vienna lying in hospital; that, students and midwives, practice rigid disinfection of the hands in chlorine water, before examining parturient women. Although no immediate recognition was accorded him by the profession, in spite of a decrease of almost 10 per cent in the hospital mortality record in puerperal fever, the development of bacteriology and its application to the pathology of this disease revived his methods. In addition to the practice of the disinfection of hands, the employment of the antiseptic vaginal douche began to be a part of the routine of obstetrical work and has continued so with greater or less regularity up to the present time. However the question of its necessity is raised here and a study of its applicability to cases merits our attention. Repeated investigations by competent authorities, covering a wide range of cases go to show that, with the exception of a history of previous gonorrhoeal infection, the vaginal secretions in the vast majority of cases are sterile of pus producing organisms. Assuming these results to be correct, the obstetrician is faced with a responsibility of probable neglect in every case of puerperal sepsis occurring under his care. It has been considered good practice and a part of the routine in the puerperium to employ the douche, not only before labor, but during the period in which there is lochia as well. Its use unfortunately, is often illadvised, of faulty technique, and void of the result sought. Moreover except in hospitals, and where reliable nurses are in attendance its use is most often left to some member of the household, in whose hands it proves a veritable firebrand. Even when employed by the physician or trained attendant its routine use is objectionable for the following reasons: *Read before Missouri Institute of Homeopathy, 1904 1st. It subjects the birth canal to possible contamination from without. 2nd. The so-called antiseptic solutions; when used as a douche, exert little or no bactericidal action on the genital tract and are therefore useless and often harmful. 3rd. Experience has shown, that febrile puerpera are of more frequent occurrence where the douche has been employed. The condition of the birth canal after labor, owing to the extreme distension which it has undergone, and frequently supplemented by laceration of greater or less extent, makes it a culture field of an exceedingly fertile nature. This being true, it should be the object of the accoucheur to refrain from any unnecessary manipulations which will favor implantation of the septic organism. I do not wish to be understood as interdicting the douche in each and every case, for there are conditions that strongly demand its employment, but I do maintain that they occur rarely and that they merit more careful study in their selection than is usually given by the medical attendant. It is in the hands of the midwife however that the douche develops its especial potentialities for evil; with little or no knowledge of antiseptic technique, the fountain syringe which they carry from case to case and which their meager conception of these principles leads them to religiously use, it becomes a source of many ills which the skill of the gynecologist may fail to assuage. Anent their exalted opinion of its use, I am reminded of a case of a primipara, who being brought to bed the past summer, under a midwife's care, and who after twelve hours hard labor had not been delivered, called me for the purpose of using the forceps. Examination showed the L. O. I. A. position with failure of internal rotation. I quickly delivered and in giving direction for the after care by the midwife, cautioned her to keep the vulva clean but not to use the douche. This latter direction, I afterwards learned, excited her derision and was the occasion of her telling the patient that that doctor did not know his business and was ten years behind the times. No special set of rules may govern the employment of the douche. It may be used in a prophylactic way in cases of parturition, whose difficult character has necessitated frequent examinations or instrumentation, but even here its use is questionable unless there be excessive pathologic secretions present. Its value as a prophylactic has recently been investigated by Kronig and Brietschneider, who followed 2280 cases in the Leipzig clinic, every alternate woman being douched. The puerperium was febrile in 45 per cent of the cases in which the douche was used as compared to 36 per cent in cases where it was omitted, thus allowing the obvious deduction that the 10 per cent difference might be attributable to the use of the donche. The idea uppermost in the mind of the obstetrician, is the desire to secure bactericidal action, yet if we analyze the situation we can readily see the futility of such an expectation. There are few antiseptic solutions of sufficient strength to instantly kill germs present on the surface of the genital tract and none with the power to penetrate the tissues and reach the real site of their activity; which conditions relegate the antiseptic solution to the position of being a mere cleanser of the surface. Bumm has shown experimentally that the strongest antiseptics penetrates the tissues to very slight extent. He took the liver of an animal dead of anthrax and after soaking for half an hour in a solution of 1/1000 bichloride, cut thick sections from it with a freezing microtome. It was found that after the first 1/10 of a millimeter in depth had been removed, all subseqent sections retained the power to innoculate other animals thus showing the germicidal action to be very superficial. How then can we presume to secure any high degree of germicidal action in tissues over which our antiseptic douches flow. The same authority has shown that streptococci travel through the uterine and vaginal tissues with amazing rapidity. He estimates their rate of migration as 2C. in 6 hours. On the other hand the zeal which often marks the desire to use strong antiseptic solutions is the occasion of wide systemic disturbance from the poisonous effect of the drug itself. Current medical literature chronicles many such cases. I had during the past summer just such a case, where a popular phenol compound used by a nurse in a case of so-called sapreamic infection produced active symptoms of phenol poisoning, whose nature was unspected for some days. Any single case of a febrile puerperium, whose symptoms suggest infection, should be examined carefully under rigid antiseptic precaution for possible retention of debris in utero, which if present, should be removed gently with curette and irrigated; but the repeated irrigation of the uterine cavity in cases of puerperal sepsis, I am strongly opposed to, as I do not believe it does any good, but only subjects the patient to annoyance and fatigue. The general systemic involvement is such that no amount of douching or irrigating will modify its course in any slight degree but may be the occasion of further and more complex infection. Further, the most virulent cases of puerperal sepsis may present practically no findings as regards debris or discharge from the genital canal. On the other hand, obstetricians of experience will recollect that frequently those cases with a copious stinking discharge present but few features of a septic character. This latter class of cases however are the ones which call for the active use of a douche. Personally I seldom use strong antiseptics in my obstetric work. For the cases just cited, I prefer either normal salt solution, permanganate, or Platt's Chlorides, which latter makes a very good wash in 1-6 dilutions of water, possessing deodorant properties which enchance its value. The actual use of the douche merits our best care. Unless it can be entrusted to a trained attendant it will be safest in the hands of the physician himself. My plan where its daily use in any case is demanded, is to have the patient secure a new fountain bag. The hard rubber nozzle is kept in the interim of visits in a mason jar full of a saturated solution of permanganate, or a strong solution of lysol and a like solution kept in the bag into which two feet of the distal end of the rubber tubing is folded. It is thus kept strictly sterile and requires but a moment of time to fish out the nozzle and attach to the tubing. Hot water is then poured over the nozzle and through the syringe and any solution desired may be made up and used. Attention need hardly be called to the necessity of thorough cleansing of the vulva before the introduction of the douche nozzle; but I may say in passing, that any omission of care in this particular may defeat the most elaborate preparatory technique. The genitalia of the parturient woman should be dignified with the same degree of caution in handling that the surgeon pays to intra-peritoneal work and further, the choice of antiseptics employed merit like attention. It is abundantly in evidence that a revulsion along this line is forming in the minds of the medical men and I venture that the time is not far distant when the physician will shun the use of any but the mildest antiseptics in the douche and that bichloride and phenol solutions will be tabooed entirely. The absorptive power of the mucous membrane of the genital tract is almost equal to that of the stomach and the same caution should be used in the choice of the agents we employ in its lavage. 215 S. Jefferson Ave. PALLIATION BY THE INDicated remEDY.* BY DR. LOUIS E. BUNTE, ST. LOUIS, Mo. The purpose of this paper is only to show; that even so painful a disease as carcinoma of rectum and liver, may be satisfactorily palliatated by the use of remedies in potentized form, and given on strictly homeopathic indications. Dr. F. age 54.-Previous health good; family history: father died of pneumonia: mother living, age 74; grand-father died of carcinoma of stomach; cause of death of grandmother unknown; one brother living; one brother and sister died in childhood. In December, 1902, Dr. F. became tion was developing in his rectum, and his suspicion. suspicious that a malignant condi- He then began to prescribe for himself until March, 1903, with unsatisfactory results. At this time he consulted Dr. Tomhagen, of Chicago, who prescribed for him and conducted subsequent treatment by mail until July, 1903, also with unsatisfactory results, except that he obtained relief from pain under the influence of the Homeopathic Remedy in infrequent doses. Dr. Willis Young was then consulted, and found that the cancerous growth had progressed to such a degree as to completely occlude the rectum. no bowel movements had occurred for two weeks. Dr. Young sent him to the hospital and made a left inguinal colostomy. Examination just prior to operation, showed a pronounced cancerous, cachexia, pulse feeble and respiration shallow, abdomen tympanitic and enormously distended with *Read before the Missouri Institute of Homeopathy, April, 1904. |