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have taken it. We know that they all produce increased peristalsis and an increased amount of secretion from the mucous surfaces as well as the sub-mucous glands. Many of them drain not only these structures but also the blood-vessels to that extent that, if purgation is long continued, the patient suffers extremely from exhaustion. I cannot better illustrate this subject than by reporting a few out of many cases of this character that have come under my notice during the past few years.
Case A.– This was a young man living in the country, and to whom I was called in consultation after he had been ill for at least forty-eight hours. The history showed that he had eaten heartily of pie and cheese just before retiring at night and was taken before morning with intense pain in the abdomen, and some vomiting. There was no evacuation from the bowels. The next day a physician was called and proceeded to give him a cathartic. He did not secure the desired resuits, each dose of the medicine producing vomiting instead of purgation. Enemas were used without much better effect. Notwithstanding the unsatisfactory results after the administration of the cathartics, their use was continued until my visit. At this time the abdomen was sensitive and tympanitic; the pulse was accelerated, and the temperature somewhat above normal. I found that besides the medicine he had been given freely of cold water, which was brought in from the well and drunk out of a pitcher. It did not remain in his stomach many moments before it was expelled with a great deal of force. The treatment prescribed was Belladonna 3rd every hour. He took nothing by the mouth except occasionally teaspoonful doses of hot water. As he was much reduced in strength, I thought best to adopt rectal feeding. The rectum having been thoroughly flushed, he was given every six hours four ounces of peptonized milk containing two teaspoonfuls of Bovinine, and the nurse was instructed to flush the bowel thoroughly once in forty-eight hours, the nutrient enema not to be repeated until two hours had expired after the flushing. Poultices of flax-seed meal were applied to the surface of the abdomen, these to be changed once an hour.
The report came to me that, after several days, he, being relieved of pain, in the meantime (probably by the avoidance of medicine and food that would aggravate), began passing hard masses of fecal matter, and gradually the bowel was emptied of its irritating contents and the inflammation subsided. Ile subsequently, from another error of diet, had a relapse and was treated in like manner, recovering without nearly as long a sickness as at first. In this case he had an impaction, doubtless, of the undigested food, which produced a parenchymatous
inflammation in that section of the bowel where the substance was lodged, and from the peritoneum covering this section of the bowel the inflammation extended to other portions until we had the beginning of a general peritonitis. The action of the cathartics, in my opinion, aggravated the case materially in that it excited peristaltic action in the bowel, but it failed to relieve by propelling the contents onward. It increased the amount of exhaustion by producing extreme pain, with nausea and vomiting, and undoubtedly caused an extension of the inflammation upward along the mucous surface from the point of original attack and to the mucous surface of the stomach as well. The cold water; too, was detrimental inasmuch as it only increased the pain, nausea and vomiting.
Case B. was a lady twenty-six years of age, just out of college. She had been ill for several days. The attending physician prior to my visit had called a surgeon and both had agreed that it was a case of tubercular peritonitis, deciding that an operation was the best means of relief, although they did not promise much even in that direction. The family having heard of my treating a case of peritonitis successfully, in the neighborhood, decided that they would call me before she was removed to the hospital. I saw her at nine o'clock at night. The ambulance was at the door ready to remove her as soon as she was prepared to make the trip. I found that the abdomen was generally tympanitic and the history as given me was that she had suffered from constipation, for which she had taken a cathartic without much relief. Her physician proceeded to give her more medicine of this character, which failed to produce the desired effect. Even enemas gave unsatisfactory results. The pain was increased by the use of the cathartic and vomiting was the result. She could take scarcely any kind of food or drink without its being immediately expelled. The pulse was between 100 and 110, the temperature 102. The face did not indicate that the patient was in a critical condition, and I could hardly understand why such a serious prognosis had been made.
Upon interrogating the patient further I found that she had in years gone by suffered in like manner, so that she was obliged at such times on account of the excessive distension of the abdomen to loosen her clothing, and it was with difficulty that she could attend to her school duties on account of the discomfort. These attacks would occur after periods of constipation and were greatly relieved after a free evacuation of the bowels, when the tympanitis would subside. I was asked whether I thought there was hope of cure of the patient, and I told them that I believed there was. The case was then put into my hands, the ambulance dismissed. I secured a good nurse and had the treatment which I advised carried out to the letter. The treatment was similar to that of Case A. and the result was equally satisfactory. In this case there was no question but that the patient's chances of recovery were lessened by the use of the cathartic medicine, which, in my opinion, aggravated the inflammation and excited nausea. The patient has never had a similar attack since that time.
Case C was a lady, aged 22, an apparently vigorous servant girl, who was employed in one of my families. During the summer they were living in a remote suburb and my services could not be secured very readily on account of the distance from my office. The first I knew about her illness was when informed by the lady who employed her that she had been taken to one of our hospitals for the purpose of having an operation performed for appendicitis. I was called at seven o'clock in the morning and the statement made by her employer was that she had no confidence in the physicians who were treating the girl, and desired me to come at once to the hospital and take charge of the case. I reached there in about an hour and ascertained the follow ing facts: Three days before, she was taken with considerable pain in the abdomen and took a large dose of Sulphate of Magnesia. It did not produce the usual free evacuation from the bowel, but rather increased the pain and excited some nausea and vomiting. She continued to suffer during the next day, and the next evening a neighboring physician was called and he proceeded to give her more cathartics. Calomel in small doses was given, followed by a saline cathartic. The effect was only to increase the vomiting and pain, without any evacuation from the bowel. Then a surgeon was called and as a result of the consultation it was decided that it was a case of appendicitis. She was removed to the hospital at twelve o'clock at night, to be operated upon at ten the next morning. The lady asked me what I would advise, and I told her I was not satisfied that it was a case of appendicitis, that there seemed to me a threatened general peritonitis which I believed had originated in some portion of the intestine. The case was placed in my hands, she was taken to another hospital, and given treatment similar to that used in the other cases mentioned. In two or three days the evacuations from the bowel were nearly normal and at the end of ten days she was removed to her home. It seems to me that in this case if no cathartic had been given there would have been no serious trouble.
Sometimes the substance used for the purpose of producing purgation becomes obstructive, and Case D proved to be one of that character. This was a case of a lady 35 years of age, who had suffered from
a chronic catarrhal gastro-enteritis for years, and when I saw her I found symptoms of partial obstruction of the bowel. It was reported to me that the physician who had preceded me had given large doses of Olive oil, but that the evacuation from the bowel had not been sufficient to indicate that the oil had been discharged. The treatment was somewhat similar to that of the other cases and after several days there were particles discharged from the rectum which resembled dry and crumbling putty. I satisfied myself that this was a product of the oil which had been administered. After this was entirely removed the serious symptoms subsided and the patient began to improve. There had been no symptoms of obstruction prior to the administration of the oil in this case.
I have referred, so far, chiefly to the local effect of cathartics when administered while there was inflammation of some portion of the intestinal tract. I wish now to add a word in regard to the general effect upon the system of the administration of the cathartics now in common use. The drug which is most harmful by far, in my opinion, of all used in such a manner is Mercury. Those of us who have practiced medicine for more than a quarter of a century know something of the evil effects of this drug. We have heard from those allopathic physicians, who afterwards took up homeopathy, the sad story of the disastrous effects of this drug when prescribed by them; and the revolt against allopathy which was in full force from fifty to twentyfive years ago was due largely to the disastrous effects of this drug as prescribed by physicians of that day. It was known in advance of the physician's call what he would do and no case of inflammation, no matter where its location, was treated without the administration of Mercury in some form.
Blood-letting also came in for a large share of condemnation, but the use of Calomel was much more frequent than blood-letting. There is a desire at the present day, which I have observed all about me, to' go back to the old prescriptions as far as Mercury is concerned. I rarely hear of a case of inflammation treated by allopathic physicians without Mercury having been prescribed in some form, and I desire to warn the younger members of the profession against the use of this drug which has caused more suffering during the past century than all other drugs combined. The Eclectics secured a large portion of their business because it was known that they depended upon vegetable remedies rather than minerals, and any kind of a physician fifty years ago who would promise to cure his patient without blood-letting or salivation would be given the case very frequently.
Other cathartics, such as Aloes and Podophyllum, if given per
sistently will produce the characteristic symptoms. Many of the diseases of the rectum, which are so common at the present day, are the results of the taking of cathartics in some form. If we read the pathogenesis of any of this long list of remedies we find that they act generally upon the small intestine first, and the large intestine later; that while diarrhea is the common effect primarily, if the drug is continued, dysentery will frequently occur. It would be far better if, instead of taking a large amount of food and following it by the administration of some cathartic to dispose of it, the patient should put himself on a spare diet, when no such medication would be necessary. No harm can come from going without food for twenty-four to fortyeight hours. I have frequently tested this method upon myself and have been able to do my work quite as well and have avoided a great deal of suffering and distress by such abstinence. Every one should ascertain what food is most suitable for him and he should take that food in limited quantity. Whenever he finds that the digestive tract is becoming overloaded he should practice abstinence until Nature can restore the functions to their proper condition.
THE OBSTETRIC FEE-HOW INCREASE IT?
Cleveland Homeopathic Medical College. When the secretary of this society wrote me asking for a paper he suggested that I confine it to some obstetrical subject and after some consideration it has seemed to me that the subject I have chosen would be most likely to appeal to the members present.
It needs no argument to prove that the following statements are true :
That the amount of remuneration which a patient is willing to make for obstetrical attendance is far below that for other medical services.
That on account of this fact, physicians as a rule abandon obstetrical work as soon as their financial independence will permit of it.
It is almost a self-evident fact that the latter is a direct result of the former condition. It may be true that obstetric engagements have other disagreeable features, causing as they do irregular hours and interference with other work, but I feel sure that the low fee is the most objectionable of all. If the fee were the same as for a surgical operation requiring the same time and skill we would all want to be obstetricians instead of surgeons.
In discussing this subject, I have in mind only that class of patients who are financially able to pay for obstetrical attendance in the