growth easily came away, with but slight bleeding of the part, which left a somewhat deep excavation-there was a smaller growth from the opposite tonsil. The temperature was 101.5 Fah.

Treatment.-Gave aconite and apis in alternation. The urine was unfortunately not examined for albumen. Remarks. The last attack was no doubt one of diphtheria, which lasted four or five days, the patient leaving her bed on the fifth day, and had quite recovered on the tenth day.

NOTES ON UTERINE HÆMORRHAGE.

By A. M. CASH, M.D.

CASES of hæmorrhage from the female genital organs occur frequently in practice, and are as a general rule successfully treated by homoeopathy. The general practitioner has not, it would seem, a very favourable opinion of the action of medicines in these cases. Matthews Duncan speaks in his Diseases of Women not very encouragingly. He says ergot stands first; after it sulphuric acid in large doses. Of gallic and tannic acids he speaks as not being sure that they have any effect at all. Duncan says of ergot that we must not expect it to act thoroughly till some days of its use have elapsed. This may be so in the ordinary allopathic dosage, but I suspect that few of us using its homœopathic analogue secale would expect to wait so long for a favourable issue. We have all again and again seen this drug in the 2nd and 3rd dil. rapidly check an alarming hæmorrhage from the womb, and when it is indicated, hours, and not days, will suffice to declare a favourable result. Secale is only one of many other remedies which we can have recourse to. Sabina, bell., ipecac., calc. c., puls., chin., hamamelis, riburnum op., trillium pendulum, actea rac, crocus. platinum, &c., are all potent in their sphere. In fact, I believe the homoeopathic practitioner will so frequently succeed in curing cases of menorrhagia and metrorrhagia that come to him by these and other medicines, that the chances are he may be tempted to trust to them too much, and neglect such physical examination as would help him to make a more complete diagnosis and such

other methods of treatment as may advantageously be employed at the same time.

In the subject under discussion, hæmorrhage is only a symptom-it is not the disease itself. Nevertheless it is the chief thing, and if we can cure it we shall probably only do so by curing the disease-that is, the state or condition upon which it depends. Now, if small doses of a homœopathically-acting medicine will do this, we can wish for nothing better. It is our beau ideal of homœopathic treatment to cure the disease by treating the symptoms or totality of symptoms to which the disease gives rise; but in practice we do not always find this possible. Hæmorrhages, apparently very successfully treated at first, have often an unfortunate tendency to recur, and my experience is that, when we meet with these recurrent cases, it is wise not to delay making a physical examination, which then often gives precision to the treatment by clearing up the cause. For instance, three cases now under my care complained of hæmorrhage. The loss was very different in character in each case. One had it very slightly; with her it was not a prominent symptom. In the second case it was profuse, but only at the menses. The third had it so freely and irregularly that it was impossible to know whether, and if so, when the flow was accompanied by true ovulation at all. Now, all these women suffered from the same Each one had a sore varying from an erosion to a decided loss of substance or ulceration of the cervix uteri.

cause.

Sepia, calc. carb., ac. nitric, &c., were the remedies used, but in each conjoined with internal treatmenthydrastis, hamamelis, and calendula injections, and topical applications from time to time of these and occasionally stronger agents, such as ac. carbolic pur. and lunar caustic.

These substances I have just named, viz., hydrastis, hamamelis, and calendula, are most valuable in gynaecological practice, and are as a rule very much better than the severe caustics commonly in vogue, whose use should be restricted to turning unhealthy into healthy sores, which are then better treated by the former. I say, then, examine early if in the least doubt. Make a vaginal examination first with the finger, then insert a speculum, of which I prefer a Fergusson. This will gene

I

rally be sufficient to clear up the case. If not, pass the uterine sound, carefully ascertaining that no pregnancy exists. Some years ago a case of hæmorrhage, apparently clearly due to the menopause, came under my care. treated her medicinally, as no examination seemed called for. She was better at first, but soon relapsed. I went away for my holiday, leaving her under the care of a medical friend. He declared no medicine did her good but sabina, which he thought was very successful; but the hæmorrhage continued freely at the catamenia, with almost every other climacteric trouble. I examined her on my return, and found a polypus protruding from the os uteri. This I removed, and the hæmorrhage, which considered as due to her age might have persisted for months, sank at once to insignificant proportions.

Again, a lady, weeks after the birth of a child, got recurrent attacks of bleeding, weakness, back-ache, and pain. She sent for me, and I at first thought that subinvolution accounted for her symptoms. Another doctor had confined her. The blood persisting, I examined and found an extensive fresh tear through the cervix. This caused me to place more dependence on copious hamamelis and calendula injections than upon secale or sabina, &c., internally, and shortly she began to gain ground and hold it.

But I have no wish to seem to underrate the value of internal remedies. In many cases they are all we have to depend upon, and it is surprising what these small doses will accomplish. With some considerable doubt as to their probable efficacy in the case, I recently took charge of a large fibroid tumour of the womb. The lady, over 50, was blanched with the drain which was kept up by the great myomatous mass which protruded quite up into the right iliac fossa. I put her on china 2x and secale 3x alternately every three hours, and did little else except strictly to enjoin rest in bed during the early days of each "period." But in four months the change for the better was marked enough. The "periods" have been but half the length of what they had got to before commencing the treatment, and the healthier complexion and ability for walking, &c., testify to the gratifying improvement in the general health.

A vicious pathological circle is kept up in certain cases of sub-involution that we meet with. A weakly

woman of feeble muscular fibre fails to get proper atrophy of the womb after confinement. The organ remains large, heavy and congested. The lochia remains coloured too long, and eventually apparently run into the menses, which last too profuse and with every degree of irregularity. An anæmic condition of the system is induced. Then the poor and watery blood, with its diminished coagulating power, in its turn helps to keep the hæmorrhage going. So the hæmorrhage causes the anæmia, and the anæmia keeps up the hæmorrhage till the unfortunate patient is reduced to a pitiable condition. Now iron, which should be the remedy for this state of things, is unfortunately often not well borne. I found in such a case lately that 5 grains of 1st trit. ferri et quin. citr. seemed (as iron in any form had always done before) to induce diarrhoea. In another case possibly a coexisting constipation is further increased.

Then recently in a case of chronic sub-involution, occurring in a lady of great delicacy of fibre with persistent profuse hæmorrhage, I saw the muriate of hydrastis in 5 grain doses of 1st trit., as recently recommended from America, effect decided improvement, bracing up the nerves and delaying the menses. In another case, cimicifuga has been equally useful both for the main trouble and its various secondary consequences.

Cases of missed abortion are often very insidious, and we may easily mistake them for and treat them as instances of so-called functional metrorrhagia. An examination is all important here for the sake of one's own reputation and for the patient's safety. Fortunately, the indicated homoeopathic remedy, such as sabina, secale, trillium or viburnum, often wonderfully succeeds in stimulating the uterus to the necessary contraction and expulsion, but we ought to know with what we have to do, and in no class of case can we so completely gain the patient's confidence as in this, when she sees that we fully comprehend her condition, which, by the way, she has frequently a perfect knowledge of herself, but has abstained from communicating to us. Frequently, as I have treated these cases, I have in almost all instances had the satisfaction, after making my diagnosis, of standing by and seeing the chosen remedy safely accomplish for me all I wanted without operative (which means for the patient dangerous) interference. And how superior

this is to the clumsy and hazardous, though occasionally necessary efforts of the operator, all must acknowledge. who have ever had themselves to extract a retained putrid ovum probably with symptoms of commencing septicæmia setting in.

The hæmorrhages of cancer of the uterus are generally easily distinguished; the peculiar foetor of the discharge and the sensation to the examining finger being too obvious to be mistaken. Injections of Morris & Little's (of Doncaster) soluble phenyle-a non-poisonous preparation is a wonderful comfort here both to the poor patient and her friends. I have seen of internal remedies secale, hamamelis and crocus effect considerable decrease in the hæmorrhage. As a general rule, in all hæmorrhages I prefer the use of hot to cold injections in acute cases and when pain accompanies, as in the debilitated. They have a much more reviving and stimulating effect, and by this means will check bleeding when cold water will fail.

Severe cases of simple functional climacteric metrorrhagia are met with. They should be subjected to examination if possible, for other causes may co-exist as in the polypus case related. Failing this they should be treated on the usual principles and by the remedies above named for uterine hæmorrhage.

CLINICAL JOTTINGS.

BY DR. MORRISSON.

Indications for Quassine.

DYSPEPSIA, with muscular constriction across the upper or middle third of the chest anteriorly, with or without pains and dyspnoea; tongue thickly coated with a grayish fur; loss of appetite; thirst; and especially in convalescence from acute disease.

Arnica Erysipelas.

I have recently had three cases of pustular erysipelas, running into acute eczema, from the external application of arnica; two being from the use of oil of arnica, and where the skin was unbroken.

The first of the latter was that of the Rev. J. P. G. The oil was applied to one foot only, but the erysipelas