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He improved after that and has since managed to get along without a catheter until within a few days, although he had to empty the bladder frequently and was conscious at all times of obstruction to the free flow of urine. In the past ten days the calls to empty the bladder have been every few minutes accompanied with much suffering, pus and sediment in the urine. Preparatory treatment was instituted consisting of daily irrigations of the bladder with boracic acid solution.

Suprapubic prostatectomy was performed January, 1906, and although the prostate was strongly adherent, it was enucleated in three pieces without material difficulty. The total time consumed in the operation was seven minutes. The weight of the gland was ten drachms.

Case 8. Farmer, aged eighty-four years. This patient had suffered urinary difficulty for ten years. For the first five years he was able to sufficiently evacuate the bladder to get along fairly comfortably. In the last five years has been obliged to use the catheter frequently, and in the last nine months every time the bladder was evacuated. In spite of his advanced years he is active, well nourished, and all the vital processes well performed. Has suffered considerable dull pain in the pelvis nearly all the time.

Suprapubic prostatectomy was performed Jan. 25, 1906. The prostate was found very large and strongly adherent. Weight of gland seven and one-half ounces. The operation in this case was unusually long because of the strong adhesions. The total time consumed from the first incision to the delivery of the gland was twelve minutes.

Case 9. Merchant, aged sixty years. Had suffered urinary obstruction and had been addicted to the use of the catheter for fifteen years. At present, and for a long time past, has been unable to pass any urine whatever voluntarily. Four years ago had a hemorrhage from the bladder and another one a year ago. At times the urine is thick and offensive. At present it is clear and his general health is good.

Suprapubic enucleation was performed Jan. 29, 1906. A very large middle lobe was found projecting into the bladder. The gland was removed in two pieces and delivered through the suprapubic opening with considerable difficulty, because of its large size. Total time of operation, seventeen minutes. Weight of gland, six ounces, five and one-half drachms. (See Plate VII.)

Has suffered

Case 10. Mechanic, aged seventy-eight years. urinary difficulty for four or five years. There has been gradually increasing difficulty in emptying the bladder. At present must pass urine every hour, and is up every hour during the night. Had a brother who died from prostatic hypertrophy. Has always been otherwise well and strong. Is able to be out

and about. He has been able thus far to get along without the use of the catheter, but the urine is passed in very small quantities, the calls are frequent, and the stream is very slow in starting. Sometimes he has to wait fifteen minutes before the flow begins.

Suprapubic prostatectomy was performed Jan. 8, 1906. The gland was not excessively large, weighing only nine drachms. It had, however, a small projecting middle lobe, which acted as a valve over the vesicle orifice of the urethra. Time consumed in operation, seven minutes.

Case 11. Professional man, aged sixty-nine years. This patient had had difficulty referable to the bladder for several years. Was supposed at one time to have a stricture of the urethra, for which a sound was introduced. Recently, there has been aggravation of his difficulties, and he has tried to pass the catheter, but unsuccessfully. There have been frequent calls to urinate, accompanied with much difficulty in satisfactorily emptying the bladder, and slow dribbling of the urine. The calls to empty the bladder in the last two or three months have been every two hours or so, and sometimes there has been dribbling between times.

Suprapubic enucleation was made Feb. 18, 1906. This case was the only one which presented any grave difficulties in enucleation. There seemed to be no line of cleavage between the capsule and the sheath, therefore the gland was removed in several moderate-sized pieces. Total time of the operation, eighteen minutes.

Case 12. Manufacturer, aged seventy-one years. Has suffered more or less from prostatic obstruction for ten years. Began to use the catheter seven years ago. Has had times when the call to use the catheter has been so frequent that instead of introducing and reintroducing it he has fastened it in place and allowed the urine to drain away continuously. Had been confined to his bed for a week at the time with violent cystitis. In 1900 had the Bottinni operation performed, but without result. Since then has become expert in the use of the catheter and irrigation of the bladder, which he does four or five times. each twenty-four hours. At present is free from pain and in a fairly good general condition.

Suprapubic prostatectomy was performed Feb. 14, 1906, and an enormous prostate enucleated, weighing nine ounces. No difficulty was experienced in enucleating, but it came out in two pieces, both of which were delivered with much embarrassment through the suprapubic opening. There was a very large protrusion of the gland into the bladder cavity. Time consumed from the first incision to the delivery of the gland, five minutes.

In the above brief reports of these twelve cases, no comment has been made upon the ultimate result, because it is yet too

early to do so. Very many additional details in the technic and after-treatment have been evolved. It is the design of the writer to make these the topic of a subsequent paper at some future time. Experience thus far shows that the operation is quickly performed with minimum shock to the patient, and in all cases where the system has not been sapped by long and continued disease and its debilitating sequela, recovery occurs without serious complications.

HOMOEOPATHIC REMEDIES IN THE THERAPEUTICS OF OBSTETRICS.*

BY SARAH S. WINDSOR, M.D., BOSTON, MASS.

I hope the magnitude of the subject will not lead you to infer that I shall occupy an undue length of time this evening. When the President asked me to speak and gave me this rather formidable subject to speak on, I felt like limiting its scope somewhat, but as the paper was not then written there seemed enough latitude for almost anything one might wish to say, so the title stands, and I am going to touch briefly on a few more or less important points that have been recently in my mind. My principal aim is to bring out some discussion and experiences that shall prove useful in a practical way.

It may be quite enough to say in the beginning that I use remedies (as do other homoeopaths) as they seem to me to be indicated in my line, and stop there; but at intervals it is well to reason together for a little over one's course of actionreview, as it were, the basis of a belief in the principles that underlie one's practice. There seems to be just now a somewhat general feeling that we are not, perhaps, making the most of the means at our disposal; not getting all we might from the rules and remedies handed down to us by our homoeopathic fathers. We have seemingly become a little weary of the ofttimes necessary grind in fitting together the small pieces that give a completed picture, and are preferring either to guess at what the picture may be, or to say the picture is of no consequence anyway. It is not for me to give any dissertation on habits in general, but to make the application to the subject before us. It comes to this question. What is our mental habit in dealing with our obstetric cases? Does the possibility of using homoeopathic remedies come as the first suggestion, or is that relegated more and more to a distant corner of the brain, and some mechanical or crude drug action at once resorted to? There is a tendency to leave remedies out of consideration

Read before the Boston Homoeopathic Medical Society.

in the obstetric field, partly because the conditions are essentially natural, and partly because there is so much mechanism involved. Do we not feel that a pregnant woman must bear the minor ills from which she may suffer, because after all she is undergoing a physiological process, or else that she can be helped out of a too uncomfortable or dangerous condition by surgical methods only, thus ignoring the possibilities of making her comfortable with remedies and perhaps eliminating the necessity for severe measures? In the pregnant state our patient should be in a physiological condition, but let us pause for a moment to remember a few of the changes that are going on and what possibilities are present for deviation from the health line. We see so many cases year after year that, like the farmer and the sunset, we get used to the wonder; but what a marvel it is that a proper balance can be usually maintained under such new and wonderful conditions! Think of the commotion caused by a comparatively small pathological tumor, yet here we find in the brief period of nine months, that the uterus has developed from an almost solid body about two and three-quarter inches long with the weight of an ounce, into a vascular dilated organ of two pounds weight and more than five hundred times its virginal capacity. Of course, we can say that certain symptoms occurring meanwhile are due to pressure from this sudden growth and so must be borne, but mere pressure will not account for all the discomfort, since some women are never better than when pregnant. It depends upon the individual susceptibility, and with a well selected remedy we may reach some center that controls the nausea, the rectal and vesical irritation, or the general nerve discomfort. We have the remedies and the indications for individualizing each case.

Not for a moment would I advocate neglecting the sensible measures for regulating the pelvic circulation-exercise, diet and well arranged clothing; but with all these there will be one thing lacking if no thought is given to relieving symptoms that cry out for the indicated remedy.

All through the system there is the effort to readjust to the changes, and when this effort fails, as it so easily may, we are confronted with serious problems. Is there any condition more dreaded by general practitioners and obstetricians alike than that induced by pregnancy in which the physiological elimination of irritating material ceases and we come upon symptoms threatening havoc to both mother and child? say the kidneys are not doing their work, and properly enough attempt to supplement their inaction by encouraging their allies to greater effort, but there is surely some disorder at the center of things which overthrows the equilibrium and ends in the nerve explosion of the convulsion, and it is in this inner

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