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Therapeutic Notes.

J. C. Courtnoy, M. D., M. R. C. S., Eng., etc., Resident Obstetric and Gynecological Physician Royal Infirmary, Bristol, Eng., says: "I have used Peacock's Bromides extensively, both in private and hospital practice and have found it of great and trustworthy value in the treatment of diseases of women, especially about the climacteric, it frequently greatly diminishing the severity and frequency of those neuro-vascular symptoms as "hot blooms,' especially when combined with Trinitrini B. P. (1-2 to 1 minim); those distressing symptoms of depression and restlessness are much benefited by its exhibition.

N. F. Lindsay, of Birds, Ill., writes: "I herewith report a case of fatty degeneration of the heart in one of my patients. The general symptoms were: fatigue on the least exertion, especially marked on going up stairs; headache, difficult breathing, frequent nausea and occasional vomiting. Phyto.ine was prescribed before and after meals as directed. At the end of the second week his heart beat stronger and quicker, the breathing became easier and the oedema of the extremities began to subside. He began to loose flesh, although the appetite became almost ravenous. The treatment was continued two months with constant improvement, and, having lost 36 pounds, was discontinued. This has been over a year ago, and he is still perfectly well."

Dr. C. H. B. Gile, of Falum, Kan., writes in Canadian Jour. of Med, and Surgery: “Last September a lady called on me, aged 45, married, saying, 'I would like you to examine my hand; I heard you was good on old sores.' 1 asked her how long her hand had been in that condition. 'Five years,' she said, 'and I have carried it most of the time bound to my shoulder, for when I carried it down the pain near y made me wild.' The case was pronounced tuberculosis of the joints by no less than nine different physicians and treated by all of them-curreted, burnt out with caustic potash, all kinds of washes, all kinds of salves. The joints were all open; the back part of the hand bone exposed. This was the condition of the hand when I saw it. Amputation had been recommended and refused. To say that it was a desperate case is drawing it mild. I gave her a four-ounce box of Unguentine (Norwich Pharmacal Co., Norwich, N. Y.) and told her to spread it on a linen rag and keep it on continuously; change once a day. I never expected to see the case again. Six weeks after she came back-the hand was better. She had been using Unguentine until the 10th of March, 1898. This hand at the present time is entirely well, no pain, and enjoys splendid health. The case is notorious in this county, Saline, and McPherson, where the M. D.'s reside that treated the case. Here name is Mrs. Nygram and she lives one-half mile north of Bridgeport, Saline Co., Kan. Any one can write to her and get the facts as I have stated. And Unguentine done the business.

The advertising pages in the SUMMARY are interesting and you should not fail to read

them.

VOL. XX.

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LA GRIPPE.

The Viennese gave it a name, blitzcatarrh, which indicates that the malady employs no advance agent to warn contemplated victims of its approach.

Its scientific name, influenza, attributes the causation to the influence of the stars, and if we may believe in the agency of this celestial influence, then the approach of Biela's comet may have more in it than has yet occupied the common thought. By one writer it is related that in the epidemic of 1557 the attack was widespread, invading all civilized countries,

No. II

and that it was accompanied by cough, difficulty of breathing, fever and pain of the side, and that all who had the pain in the side died.

Be it remembered that venesection and purgation were the leading remedies.

All the inhabitants of Uiseues became ill in one day. An authority states that Rome lost 10,000, and Madrid was almost depopulated in the epidemic of 1180. In the succession of epidemics commencing in 1830, the malady started in China, and in two years visited the entire civilized world, traveling with amazing rapidity over Europe, thence to America.

Whole populations fell ill in a day's time, and the mortality was appalling.

It may be observed as characteristic that no known obstacle has ever proven a barrier to its march; that it seizes the robust and the delicate alike; neither poor nor rich are exempt from its attack; that no condition of health or social situation in life can claim exemption from its pains and penalties.

The aged and broken down, the nervous and such as have chronic pulmonary ailments and children, have reason to look with apprehension on its approach.

The question of contagiousness is probably as yet unsettled. Whatever the cause, it is certainly widespread, and the atmosphere is the medium of its diffusion.

Unquestionably pre-existing catarrhal conditions as of mouth, throat and nasal passages are precisely the kind of soil chosen for the propagation of the peculiar germs of this disease.

Apropos of the season we are again confronted by certain facts that lead to the belief that the present winter will afford us a new opportunity to renew our acquaintance and try our skill anew on the malady. The great prevalence of catarrhs in many localities is, to say the least, significant.

The early records of epidemics teach us how lamentably wrong was the treatment of the forefathers.

We do not bleed a case of influenza, we do not practice purgation, but, on the contrary, we enjoin rest, supply nutritious food and prop the heart by appropriate

measures

All true cases of la grippe are cases of prostration, hence we combat by rest from the start and continuously till danger is past. By neglect of this precaution much harm and even deaths have resulted. Equal in importance to rest is the adoption of a highly judicious dietary. From the first the heart demands attention and efforts must be made to brace it up and keep it braced up against the shock that always comes sooner or later. The salts of strychnine, quinine, caffeine, cactus and digitalis are good for this purpose. Many of the combinations of acetanilid are well adapted to relieve the pains and tranquilize the nervous system, but they must be given with great circumspection to avoid depression. We believe the status of alcoholics in the treatment of this disease is such that its use is not to be advised unless especially indicated.

YERBA SANTA.

Among the valuable medicinal properties attributed to yerba santa is its efficacy

as a stimulant in the treatment of chronic mucous affections of the respiratory passages. We have made use of this drug almost from the time of its first introduction to the medical profession, in 1875, and it soon established itself as a standard remedy with us. By its use chronic coughs and bronchitis have many times been cured, and that, too, after the patient had gone the rounds of the profession in the neighborhood.

When suffering from the dry, parched, tickling sensation of acute laryngitis, or pharyngitis, persons will willingly try almost any remedy promising to give a reasonable degree of relief, and here yerba santa has many times proved itself to be the remedy.

In tuberculous sore throat more relief and benefit is probably obtained from this than any other drug. In asthma and hayfever, yerba santa in combination with grindelia robusta has been highly lauded. In dyspepsia of a catarrhal type it has proved useful. Also, in acute attacks of hemorrhoids we are convinced that yerba santa, given internally, is one of our most valuable remedies.

At first we used to give it mixed with simple syrup, afterwards a favorite combination was maltine, and now we findļa lozenge consisting of the extract of yerba santa, combined with codeia, extract glycyrrhizæ and althea, give excellent satisfaction in the throat affections named.

NOTE.

Doctor, if you cure your patients you must have some pet scheme of treatment. Send it along for the SUMMARY pages and thus share it with thousands of readers. We desire therapeutic notes from doctors of every section. Remember also, that the SUMMARY is a practical journal, dealing with the needs of every-day work of physicians.

Brief and practical articles, SHORT and PITHY reports of interesting cases in practice, new methods and new remedies as applicable in the treatment of diseases, are solicited from the profession for this department.

Articles intended for the SUMMARY must be contributed to it exclusively. The editor is not responsible for the views of contributors.

Write only on ONE SIDE of the paper.

LACERATED CERVIX.

BY FRANK R. BRUNNER, M. d.

HE uterine neck is perhaps the most peculiar of all necks belonging to the human anatomy. It is liable to flexion, elongation, rupture or laceration, and various pathological changes, each peculiar condition in itself a proper subject for discussion.

Laceration is perhaps the most frequent of all the peculiar accidents to which the cervix is liable. I believe that in many instances the accident is avoidable on the part of the practitioner, while in some few cases it may be unavoidable.

Prof. Charles D. Meigs used to say that during pregnancy the womb was undergoing a "physiological hypertrophisation." It is apparent that hypertrophisation may vary in its nature and character, and upon that peculiar condition depends the fortune or misfortune of the neck. If this suggestion is correct, then it is the duty of the attendant to understand that peculiar condition so that he may know how to relieve and save that womb neck from serious accident.

But in case of accident to the cervix, what then? First, ascertain its nature and extent; secondly, treat it properly,

or

It is seldom the case that the attendant discovers the laceration during confinement. Oftentimes not for weeks, months, or years. When the discovery is made the attendant is often satisfied with local treatment, such as douches, insertion of vaginal suppositories, or applications of caustics. In this way the doctor carries a bill, the patient often not improving and the attendant still trying to do his best.

I have had considerable experience in that line of cases as a country practitioner, and I find that there is but one cure, and

that operation be performed?

I never took a special course in gynecology, and had never seen an operation performed to restore a lacerated cervix until I performed it myself. I read Dr. Goodell's description of the operation, and from it gathered an idea of how to proceed. The posterior and and anterior lips were everted and I concluded to remove both everted lips, including the mucous surface of the os and cervical canal. The patient made a good recovery and the operation proved a success.

Having no reason to regret my first method of operating, I pursued the same course for some years when I met my first trouble. I had operated on a lady and was much pleased with the results. Two years after the operation she had become pregnant. At her confinement her attendant made slow progress. I was sent for, and, upon examination, could find no OS. I became convinced that the os was closed up, due to the operation. After some delay I found that a thin membrane was excluding the os, and I used my fingers to work an opening into the cervical canal. The os soon dilated and in due time her child was born. The mother recovered, after suffering more or less from the inflammation resulting from the OS. The lady had menstruated regularly and conceived in spite of the cervical occlusion. I am not prepared to state through what source the menstrual fluid came, nor how conception took place, but know that both events occurred in spite of an occluded os and cervix.

Since then, in performing an operation on the cervix in the way of amputating, I always introduce a tent of iodoform gauze into the cervical canal and remove it on the third or fourth day. This procedure has given me no trouble thus far.

I have reason to believe that amputation is often preferable to the Emmet opperation. The neck is often elongated, enlarged, hard and congested, and when such a mass is removed it greatly assists the womb in returning to its original condition. I saw an eminent gynecologist. perform the Emmet operation on a lady's womb when I thought that there was no necessity at all for the operation. He