THE ST. LOUIS CLINICAL REVIEW.

PHILO G. VALENTINE, A. M., M. D., EDITOR.

VOLUME VI.

ST. LOUIS, SEPTEMBER, 1883.

ABDOMINAL INTERSTITIAL FIBROID.

No. 9.

BY E. C. FRANKLIM, M. D., ST. LOUIS.

Mrs. J. B., age 40, Mackinac, Mich., entered the University Homœopathic Hospital, May 8th, 1883. Family history good, but the patient has never been a woman of strong constitution and has been subject to frequent recurring pains in her right side since she was eighteen years of age. The pains would become so violent at times as to demand the most prompt and efficient treatment, and oftentimes it would take hours to subdue them under the most heroic treatment of the regular! system.

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Menstruated first at 13, and at 14 years of age was married; bore six children, the youngest being one year of age and the eldest 13. About five years ago patient first noticed a lump" in the right ovarian region, following an attack of intermittent fever, which has gradually increased in size and extending upwards, so that its upper border lies close under the ribs of that side. It fills the entire space from the pubes up to and under the floating ribs. She had been treated by a number of physicians, for hypertrophy of the liver, abscess, &c., &c., scarcely two diagnosing the growth alike. As the tumor increased in size the pains increased in severity, being of a sharp, shooting character, running upward and backward toward the spine, and deep into the

groin, occurring periodically but without regularity, and lasting two or three days at a time. For about twenty-four hours preceding the pains the patient complained of feeling chilly, with a general sensation of malaise.

About six weeks ago, patient had a very severe attack of pain, &c., which continued for five weeks. During this attack the physician in attendance diagnosed the case "ovarian tumor."

Menses have always been quite regular, excepting the last two periods, when they became scanty, changed in color and quantity, and passed with considerable pain at intervals during the flow. During pregnancy these pains were greatly modified in intensity and frequency. Patient says the pains were not aggravated during the menstrual epoch, but thinks the aggravation always occurred between the usual menstrual activities.

Physical Signs.-Upon palpation, the tumor is found to be hard, smooth, fixed and very sensitive, especially during the painful periods. The patient is positive that the growth increases in size during the periods of pain and decreases again when the pains disappear. During the last six months the patient has been suffering with night sweats, which have broken down her vital condition, and as a consequence she is exceedingly weak and emaciated, so that she was compelled to be removed from the depot to the hospital on a stretcher. Immediately upon entering the hospital and after an examination of her case was had, she was given china every three hours, until the next visit of the attending surgeon.

Clinical Examination.-About a week after her entrance into the hospital, the patient was well enough to enter clinic for examination, etc., before the class, and the following facts were elicited:

The patient was placed upon the operating table, first upon her back, and second in Sims' position; while upon her back, inspection, mensuration, and palpation were gone through with, and the differentiation made between ovarian

dropsy and kindred diseases that simulate the former. After I had arrived at a pretty conclusive opinion by the evidences presented, I went through the various manipulations furnished by the touch," first by the "vagina; second, by "bi-manual manipulation;" third, by the "rectum; fourth, by the "bladder; " and fifth, by the use of the 66 sound." A careful examination confirmed me in the opinion that the growth was an interstitial peritoneal fibroid, which was endorsed by Dr. Wilson, one of my colleagues. The patient was then removed to her bed in the female ward, and in accordance with the pathological and other symptoms developed during the examination, I ordered arsenicum 6x trit., three times a day. The patient to be well nursed, and due attention given to dietetic and hygienic regulations. Within one week the tumor began gradually to decrease, and in four weeks it had diminished fully one-half. Under the remedy her gastric symptoms passed away. The patient increased in flesh and was able to walk about the ward. A few doses of sulphur were given from time to time, and the arsenicum continued during occasional intervals. At this time, it being near the close of the term, Prof. Cowperthwaite paid us a visit and I showed him the case, for his opinion, which he gave me unhesitatingly, and approved of the treatment pursued. I asked his opinion about operating for its removal, but he discountenanced operative interference. Dr. Phil. Porter, one of the shining lights in the gynecological firmament, of our school, called upon me a few days thereafter, and he also, upon careful examination, came to the conclusion that it was a peritoneal fibroid, and owing to the fact of the woman's great improvement so far, counselled a continuation of the treatment and opposed operative interference. Before I left Ann Arbor, the growth had diminished to the size of a small lemon, and all the conditions of the patient were constantly improving, and since my return to St. Louis, I learn from the patient, who has returned to her home in Mackinac, that her health is better

than ever, and that she now has, as she expresses it, only an "apology for a lump in her side.” This case is interesting in two points of view; first, as to the diagnosis, which certainly was one of considerable confusion, and second, that it was cured by the use of a single remedy, and not of a 'high potency," either. I gave this medicine more from the general pathological indications of the patient, rather than from the fact of the tumor alone and the symptoms evolving from it, and the sequel proves the accuracy of the practice,

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SANGUINARIA IN DISEASES OF THE NOSE AND THROAT.

Sanguinaria has an important influence on the nasal mucous membrane. I have seen it cure a number of fluent coryzas. It seems to act best in cases which affect particularly the right nostril, and are accompanied by much sneezing. Such cases often yield quickly to inhalation through the nose of the dust arising from shaking a small quantity of sanguinarin in a bottle; the inhalation to be repeated at intervals of three or four hours.

Periodic coryzas of all sorts, from rose-cold to autumnal catarrh, if possessing the characteristic conditions for Sanguinaria, will be cured by it. These are copious, acrid, burning, watery discharge from the nose, causing an indescribable rawness of the schneiderian membrane, with loss of sense of smell, frequent sneezing, all the symptoms worse on the right side. If the conjunctiva be similarly affected, or if intestinal disorders alternate with the nasal symptoms, Sanguinaria is specifically denoted.

Non-syphilitic ozona will often yield readily to sanguinaria. In these cases it is always necessary to cleanse the nose thoroughly, at least once a day, in order that the med

icine may come in direct contact with the ulcerated tissue. When possible to command the regular attendance of the patient, I prefer to apply the medicine personally, by means of a spray producer.

Nasal polypi are either hyperplasia of the mucous lining (mucous polypi), or a proliferation of connective tissue (fibrous polypi), or a growth of a jelly-like substance (gelatinous polypi); and they occur in frequency in the order named. In the first and last varieties Sanguinaria is an ex cellent remedy, especially in the former. The freshly powdered root, or sanguinarin, may be used as a snuff, several times a day; but I much prefer the nitrate of Sanguinaria. This substance is too pungent if used in full strength; and it should be thoroughly triturated with nine parts of granulated sugar. Even then it is apt to cause unpleasant burning in the nostrils.

usefulness.

The following case nicely shows its

Miss M. R B aged nineteen, a healthy, applecheeked, English girl, had been troubled with an uncomfortable feeling in her nose for more than a year. There was at all times a sense of fullness in the right nostril, but in damp weather it seemed completely occluded. An examination showed a mucous polypus adherent to the septal membrane, nearly filling the arch of the passage, and hanging downward into the posterior ares. The internal administration of Tencrium and the iodine of lime produced no apparent effect. She was then given an ounce of the nitrate of Sanguinaria, first decimal trituration, in a two ounce bottle, with orders to shake the bottle and snuff the dust thoroughly up the right nostril, every three hours. The effect was slow, but in the end most gratifying. In two months the polypus had entirely disappeared, and the nasal membrane was healthy and has remained so.

I have never had a case of polypus in the ear to treat; but in the mucous variety I should certainly begin with the nitrate of Sanguinaria There is no question that this rem