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time asthmatic symptoms were present, though not distinctive. In March, the seizure came, and I saw her first on March 8th, after some days of futile use of antim. tart., which usually proved efficient. The night of March 7 had been a most trying one, the paroxysms of dypsnoea being so severe that the nurse said the trouble must be whooping-cough, which was then epidemic. The child was listless, had no desire for food, and the breathing was evidently asthmatic. Examination of chest determined no general dullness, nor patches of dullness, only a superabundance of loose, mucous râles, audible at some distance from her. My chief fear was supervening bronchitis, and the possibility of a complicating pertussis. Sambuc. was given as in the other cases, and not to weary you with unnecessary details, in one week the difficulty was gone, and best of all, no relapse, in spite of our inclement and unseasonable March.

My tale is ended, and you will agree with me that the element of danger in these cases was slight, merely a possible capillary bronchitis in the babies, and hypostatic pneumonia in our stout friend. We will grant it, but to my mind the evidence is conclusive that the remedy used did materially lessen the severity and duration of the attacks. It may be of interest for you to know why I chose sambucus, whose indications are so meagre. In a very instructive article by Dr. Hirsch, "On the Dose," you will find this in reference to sambucus.

"As regards sambucus, accident led me to the employment of the infusion, and showed me the greater efficacy of this mode of administration. The case was the little sister of my friend, Dr. Tederes, of Vienna. She was a delicate, fair-haired child, and she was sitting crying in her bed; she was suffering from a severe asthmatic attack. Her breathing was quickened and had a whistling sound; the occasional short but labored cough pointed to a high degree of dyspnoea. She constantly pointed to the middle of her chest, thereby indicating that during the fit she felt great discomfort at that point. She had already been suffering twenty-four hours. At first, there were perceptible intermissions of two to three hours, but the intervals became shorter, and suffocative symptoms occurred and marked blueness of lips. Sambucus seemed to be the remedy indicated, but I had none in my pocket-case. I inquired if there were any elder-tea in the house, and on receiving an affirmative answer, I caused a very weak infusion to be made. The attack was nearly over when I gave the first dose of that tea, two teaspoonfuls. I ordered it to be repeated at intervals of two hours. Quite six hours elapsed before there was another attack. This was much milder and lasted scarcely five minutes. In the course of the next twenty-four hours there occurred three more attacks, always

slighter and slighter, and with this the serious malady terminated. Since that time I have often employed this remedy in the same form. It is particularly successful in the common hollow, croupy, cough of children."

Dr. Thos. Nichol, who recommends it for infantile coryza, laryngismus stridulus, catarrhal laryngitis, would have us use the tincture, which is the form advised by Hughes and Jousset. The latter's indications for it in asthma are as follows: "Predominance of dyspnoea over the cough, the face is violet, and signs. of asphyxia more advanced. The wheezing is more marked.'

At some future time I hope to put to the test Hirsch's form of administration, but I doubt if its success would be greater than that resulting from the tincture. The provings of sambucus were made with the latter, and that of Uebelacker demonstrates beyond all cavil its homoeopathicity to asthma. Until the indications for its exhibition are more exact, it should be studied for those cases where ipecac has been used to no purpose. Realizing fully the neurotic character of asthma, and the many peculiar causes which excite it in those predisposed to it, we must be careful, lest in the treatment we give too much credit to medicinal interference. We have not yet defined the limitations of usefulness, in asthma and other neuroses, which psychic influences, including hypnotism, profess, and until then it is not wise to dwell upon medicinal power unaided.

REPORTS OF CASES OF FOREIGN BODIES IN THE AIR

PASSAGES.

BY HORACE PACKARD, M.D., BOSTON.

[Read before the Boston Homœopathic Medical Society.]

CASE I. On Tuesday, Dec. 6, 1887, Johnnie F., age, 4 years, 9 months, was brought to me by Dr. J. L. Coffin, for the removal of a foreign body from the larynx. The lad had, while eating peanuts the day before, drawn half a peanut kernel into the respiratory tract. The child was not suffering severely at that time from the foreign body, though there was some obstruction of respiration. I made laryngoscopic examination, thinking the body might be lodged in the larynx, but could not discover it. I next etherized the child and made tracheotomy, hoping to find the body in the trachea, and thereby remove it; but I was unsuccessful in this. The child was inverted, the back and front of the thorax thumped, with the hope of starting it out, but all without avail. In the two or three days that followed, pneumonia of the right lung supervened, with extreme dyspnoea, and in spite. of all efforts, in twelve days death ensued. No autopsy.

CASE 2. In January last, I was summoned by a lady member of our Society for advice in regard to a severe and irritating cough, which she said was provoked by the accidental drawing into the larynx of an orange seed. There was a very irritative, continuous cough, and sibilant râles in both lungs, but no area of dullness. I called in consultation Dr. H. C. Clapp, who verified the result of the physical examination. The cough continued with more or less severity, and the patient kept about and attended to her professional duties. At the end of six weeks the foreign body was expelled.

REMARKS.

The surgical treatment of foreign bodies in the air passages is very unsatisfactory, for the reason that if the foreign body has entered either bronchus, and become lodged there, it is absolutely impossible by any means now at our command, to reach and dislodge it. Sometimes foreign bodies are lodged for a long time in the bronchus, and are finally expelled by Nature. At other times, very rapid and severe inflammatory processes are set up and death rapidly ensues. There is no means of reaching the location of the foreign body so lodged, through the anterior or posterior chest wall, and all instruments so far devised for thrusting down the trachea, and grasping a foreign body have proved useless. If inversion of the patient and percussion of the anterior and posterior chest walls, and expulsive coughing efforts fail to dislodge it, it is useless to make further attempts. Foreign bodies lodged in the larynx of course can be reached and be extracted either per mouth or by making laryngotomy; but unfortunately, as a rule, such do not stop in the larynx, but pass on into the trachea, and become lodged in one or the other bronchus.

A very exhaustive article can be found in the New York Medical Journal for July 25, 1891, by J. D. Rushmore, M.D. This relates the case of a clergyman, who got a cork lodged in a bronchus, and upon whom every conceivable method was tried for relief, without avail. Autopsy showed the cork in the lower bifurcation of the left bronchus. The article closes with the following conclusions:

That a foreign body in a bronchus is always a source of danger to the patient.

That its spontaneous expulsion is very exceptional and may be long delayed.

That the danger is from inflammation and its results, and less frequently from asphyxia.

That its earliest possible removal ought to be attempted.

That the dangers of operative interference ought not to prevent the attempt to remove the foreign body.

That to attempt the removal without a preliminary opening into the larynx or trachea is unwise.

That after a reasonable search through the trachea and bronchus, opening the thoracic cavity in front, or the mediastinum or pleural cavity posteriorly is justifiable.

That all operative measures for relief ought to be taken at a single operation if possible.

That the character of the foreign body and the patient's condition are important factors in deciding on the time and character of the operative measures to be employed.

PORTAL OBSTRUCTION AND ITS RELATION TO disorders of THE UTERUS AND ITS ASSOCIATED ORGANS.

BY EMILY A. BRUCE., M.D.

[Read before the Boston Homœopathic Medical Society.]

In discussing the etiology of diseases of the uterus and its associated organs, authorities rarely mention or only briefly refer to the influence of obstructive derangements of the liver in their development and perpetuation; while they dwell often at length upon factors which are only operative in exceptional cases. Yet a very large per cent. of all pelvic diseases, whether organic or functional, are associated with some form of hepatic disturbance. The question naturally arises which is the primary disease and how the secondary is excited. In a large majority of the cases the weight of evidence is against the liver, the other organs seeming to be the victims of an unfavorable position in the economy.

It has often occurred to me to question the wisdom of the arrangements of the abdominal and pelvic viscera with relation. to each other, especially in the female. When we consider the delicate and sensitive organs suspended by their frail supports in a yielding mass of tissues, with nothing reliable beneath them, and borne down by the weight of superincumbent organs, we are surprised, not that healthy pelvic organs in the adult-female are the exception, but that they ever exist.

The evolutionist tries to help us out of our perplexity regarding what seems to be such an unsuitable arrangement of important organs, by telling us that this relation was all right while the race was getting about on all fours, and that there has not yet been sufficient time for these organs to adjust themselves to the changed position and mode of locomotion. Let us hope that evolution will make a special effort in this direction, so that a

few million years hence our sisters will not suffer from the same or equal defects of anatomy.

In order to explain the evident intimate relations existing between viscera so far separated and so unlike in structure and function as those in question, it will be necessary to ascertain their means of inter-communication, anatomical and physiological. We will, therefore, first briefly recall some prominent points in the anatomy and physiology of the great gland which has been well called the chemical laboratory of the body; since the pathology of any portion of the body can be intelligently studied only while the mind holds a distinct impression of its normal condition.

This important viscus seems at first sight to have a very simple structure, being composed of four different anatomical elements, namely, cells, connective tissues, vessels of various kinds, and nerves; and we are surprised when we realize how many different kinds of work are carried on with the one appa

ratus.

It has a double vascular supply, arterial blood for the nourishment of the tissues and portal blood for its laboratory work.

The peculiar negative structure, or rather want of structure of the hepatic vein having neither coats nor valves-has no inconsiderable influence over the development of passive hepatic congestions.

This great vital workshop, with its manifold and mysterious industries, occupies a very important position in the economy, surrounded as it is on all sides by vital organs. It is attached to the abdominal wall and diaphragm by folds of its investing peritoneum, sinking with each inspiration and rising with each expiration in harmony with the movements of the diaphragm.

This piston-like action of the diaphragm and liver acting together produces a suction force which aids greatly the circulation of the liver itself, as well as that of the outlying portions of the portal tract; and also helps in sustaining the pelvic viscera in normal position. In this we find a beneficent relation between the hepatic gland and the pelvic organs. Having had a glimpse of this interesting organ as a whole, let us look at some of its component parts.

The minute and most versatile hepatic cells are closely packed into five or six-sided lobules, which are invested by Glisson's capsule, in which ramify blood vessels lymphatics, bile ducts, and nerves, forming a dense complex network. The cells themselves are supported by a delicate web of connective tissue continuous with the inter-lobular reticulum. In this web are the radicals of the bile ducts, capillary blood vessels from both sources and minute lymphatic spaces; so that each little cell is

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