wrapper and allowed to sit up for several hours. It is best to discourage much walking about for several days more, and then to be taken moderately, for the better getting up she has, the stronger will she be in the months to come. I have neglected to say that orders cannot be too positive that no visitors be allowed until the patient is sitting up. Much annoyance and trouble is saved your patient if the admiration of the baby by a host of interested friends be held in reserve for a fortnight when so much has effervesced that what remains will not hurt her. I have dealt with the comparatively natural getting up of our ordinary cases, as it would have been imposible to have even touched upon the host of evils that may assail the new mother, prominent among which are the many forms. which puerperal sepsis may assume. But to again repeat, guard well the possible open doors to these ills and you will be rewarded by seldom having them to deal with. Finally, in the backward look over our years of practice, it is to be hoped that none of us will forget to thank our stars that among the wretchedly poor of our patients, where proplylaxis, asepsis and anti-sepsis are a thousand miles off, we have rarely if ever lost a patient. Will some one tell why? Perhaps in the multiplicity of germs from the uncleanly surroundings there results a sort of internecine war, and so the patient is left unmolested. Perhaps Providence has a favor for this class, and so they are protected. Perhaps the freedom from a great amount of nervous fret and social worry has left them with better endurance, and so they escape. And again, dear doctors, perhaps a Dame Nature has not in these localities been thwarted so often and so knows more about the care her parturient needs than do you or I; and tides them kindly over. As wise physicians we should guard against the imminent danger of the day, viz: that of considering every obstetrical patient pathological, and so unconsciously preparing them for the "dreadful time coming." We should discriminate between a wise reassuring and assiduous care in our previous attentions; and a nervous officiousness which is always alarming. Teach them to look upon childbearing as natural and you will rob them of fear, and your after care of many of its worries and annoyances. There is something better for the obstetrician than to be a mere mechanic who can successfully separate mother and child, something better than to be a fine repairer of breaches caused by his poor mechanical skill, or too much of it; something better than the extreme scrubbing, douching, packing and infinitum business, which many give their strength to; something far better for the homeopathic physician, viz.—to stand a prepared watchman during the gravid months, and so fit his patient mentally and physically, that nature's arsenal be well stocked against the time of need; that the system with its host of natural defences be in a healthy condition, and he will have little need of helps or chemical antiseptics other than those prepared in the delicate laboratories of the "House Beautiful," the healthy human body of his patient. SUCCESSFUL TREATMENT OF THE THICKENED AND RETRACTED MEMBRANA TYMPANI, BY MASSAGE.' E. EVERETT, M. D., Miss M. came to me July 2, 1894, complaining of imperfect hearing of two years standing and of tinnitus,also catarrh of the nose for some eight years. Upon examination the right ear showed the tympanum retracted and quite opaque, the malleus foreshortened, and the cone of light lustreless. Hearing: Watch ten inches, tuning fork heard best on mastoid and teeth. Left ear: The tympanum more opaque and retracted than in the right ear. The malleus considerably foreshortened. The hearing of watch four inches. Inflation by the air bag not successful in either ear. The 1 Read before Wisconsin Homœopathic Medical Society, 1897. otoscope produced no impression. Upon examining the left nostril, the inferior turbinate was found very much hypertrophied its entire length and lying against the septum. In the right nostril the lower turbinated was not so enlarged as the other. A spur on the septum situated anteriorly and touching the turbinate. From such an occluded condition of the nostril the patient had been a mouth breather for some time. The pharynx showed congestion of long standing, and much tonsilitis in childhood. Posterior rhinoscopy showed the lips of the eustachian tubes much hypertrophied and bathed in a creamy mucus. The posterior nares showed turbinates much hypertrophied, particularly the left. I advised treatment of the ear by massage with Bishop's otoscope; and removal of the hypertrophied turbinate in the left nostril by the saw, entire length. In the right nostril the removal of the spur of the septum by the saw and cauterization by electricity of the right turbinate, also direct application of astringents to the mouth of the eustachian tubes, and to the pharynx. Began treatment with the otoscope at once. The operations in the nostrils were ten days apart. Massage was given the first ten days without noticeable effect. Then a slight improvement and the membrana tympani would vibrate slightly. Next ten days the patient would hear better after treatment from two to five hours. Next ten days showed a remarkable improvement. Soon treatment by the air bag was successful, using camphor and iodine crystals. Patient's breathing was now natural and general health began to improve. At the end of three month's treament as first advised, hearing in the right ear increased from ten to thirty inches. Left ear from four inches to twenty and remains so to this day. The membrana tympani were much less retracted and much less opaque and something of the normal lustre with less of the foreshortening. The tinnitus had disappeared. The mouths of the eustachian tubes were very much improved. The interesting features of this case are: An improvement of the hearing by massage the first twenty days, be fore the operations had been finished, and the consequent swelling and soreness had disappeared from the nostrils, and before the treatment by the air bag was obtainable;also the increasing pliability of the tympani from the massage, and latterly the permanent increase in hearing, and relief of the tinnitus. Secondly: Removal of the obstructions of the nostrils allowed a more successful treatment by the air bag, particularly in allowing the air to enter the lungs freely as intended by nature. MASTOID ABSCESS.' R. K. PAINE, M. D.; Abscess of the mastoid cells usually results from disease of the middle ear, and some warning of its presence is given to the doctor, for the patient will know it, and so an early diagnosis can be made. But it is not always thus, as the following case shows; and it also shows what poor diagnosticians we are sometimes. Mr.G.,a very large, powerful German, over 60 years of age, came to me for help for what he called neuralgic headache. He said he had been under the care of several doctors before coming to me, having had the trouble for three months and was getting worse all the time. The pain was nearly all over the left side of the head, but he pointed out a spot just above the ear as being the worst place. There was a little tumefaction over and behind the ear and down on the neck, which also pained him. No fluctuation could be detected, but I was quite sure his trouble was not neuralgia, but mastoid disease. There had been no pain nor discharge from the ear. I made a long incision behind the ear down to the bone, and while probing about for a tender spot, broke through a thin shell of bone, and pus appeared, much to the astonish 1 Read before Wisconsin Homœopathic Medical Society, 1897. ment of the patient. That night he slept well for the first time in three months, and so did his wife. But the recovery was slow, as the pus had burrowed clear up over the meatus, and in a day or two there was a small protuberance in front of the drum on the anterior surface of the canal which I duly punctured and was then able to throw a wash all around from one opening to the other. After using calendula, peroxide of hydrogen, boracic acid and resorcine solutions, and giving silicea in various potencies for several weeks, the sinuses healed and he has had no more trouble with his neuralgia. A PECULIAR ABORTION CASE. R. K. PAINE, M. D. MANITOWOC, WIS. Mrs. about 36 years of age, mother of eight children born to her in fourteen years, sent for me in January, 1896, on account of an offensive bloody discharge she was having. She had not missed her menses since she began to menstruate after the last child was born, about two years before; but she had been vomiting for two months more or or less, with great distress in the stomach and much headache. For the last three weeks she said she had been flowing more or less; with a slimy, offensive discharge for several days. Digital examination showed the uterus large enough for four months advanced pregnancy, os soft and open so that I could pass in my finger to the internal os, which was not very tight. She had not met with an accident, nor, if I may believe her, had she attempted to induce an abortion. was very sure she was about three and a half or four months pregnant and going to abort from death of the fœtus. As the symptoms were not urgent, and she had no pains in the uterus or back, but severe headache and dis 1. Read before the Wisconsin Homœopathic Medical Society, 1897. |