lacked the resistance found in other parts of the respiratory tract. Consequently, the great frequency of "head" colds. In one of these cavities, the antrum of Highmore, its outlet is far above its most dependent part. Secretions from its mucous membrane are accordingly retained and make a veritable hotbed for germs. Empyema of this sinus is a frequent result. Like the gynecologist, the aurist has occasion to render thanks to the designer of the human body. Physiologically the ear is a wondrous piece of mechanism. But its viability to disease is shameful. The middle ear is a great cul-de-sac connected with the pharynx by a long narrow tube. Through this an infection reaches the tympanum. The closure of the tube prevents drainage and the retained secretions must perforate the drum. Nor is this the worst that can happen. The mastoid cells form a sponge-like series of cavities into which the inflammation may extend. And to complete the blunder the emissary veins carry the germ-laden blood straight into the lateral sinus. Sinus thrombosis and abscess complete the microbic victory. Its The portal venous system is not supplied with valves. arrangement being such as to require the blood to be lifted against gravity, also the tissues which form the bed for the various vessels being lax, stagnation is encouraged. Hemorrhoids and acites thus are physical consequences. The parovarium is another vestigial structure that furnishes a vulnerable point in the human organism. The remains of a system of tubules that in the female result in no functional organ, they give rise to cysts. Vestigial structures are commonly noteworthy as trouble makers. In the course of development the jaw becomes less essential as a weapon of offense and defense, and the more perfect preparation of human food diminishes the duties of mastication. In consequence the posterior tooth on each jaw is in process of retrogression. Their eruption is late, occurring when tissues are fully developed. Hence, the resistance offered causes a tendency to absorption, resulting often in the partial destruction of the tooth almost before its eruption is complete. These teeth are also frequent producers of reflex irritation, and the uncertain neuralgias and lockjaw from an irritating wisdom tooth are familiar phenomena to doctors and dentists. The ciliary ganglion, from which the ciliary nerves passing to the ciliary muscle are derived, has a sensory root, from the nasal branch of the ophthalmic, a sympathetic root, from the cavernous plexus, and a motor root, from the motor oculi. Deficiency of refractive power causes greater drafts of nerve force upon the third nerve. A part of this force, flowing through the branch to the internal rectus, more than balances the abducens, to the external rectus, and internal strabismus is the result. These thoughts are presented with the hope that they may be interesting if not instructive. HOMEOPATHIC THERAPEUTICS OF THE LYING-IN PERIOD.* BY C. B. KINYON, M.D., UNIVERSITY OF MICHIGAN, ANN ARBOR, MICH. We assume at the outset that each stage of labor has been properly conducted; that all injuries to the parturient canal that should be repaired have been, and that every precaution against infection on the part of the doctor and the nurse has been fully carried out. Even if this be true, there are still some lacerations of the cervix and extensive bruised and raw surfaces in the vagina and vulva present and ready to absorb any poison that may reach them. I do not, for a moment, believe in attempting to perform primary repair of the cervix unless it be so badly torn as to cause a continuous flow of red blood, and even then, only stitches enough are taken to control the bleeding. More than this it is not feasible to attempt, as more harm than good will result. This sore parturient canal makes the occlusion dressing, properly applied and kept in place, absolutely essential to prevent infection. Another condition always present is an enlarged uterus and a corresponding increase of all the tissues participating in the process of pregnancy and delivery. These must all be reduced to substantially the nonpregnant condition, and this can only be done in the absence of infection and by the proper physiological workings of the mother's system. As you all know, this increased size is sixteen hundred per cent. We thus see at a glance why it is that many authors consider the condition of the mother at the close of labor as necessarily pathological, as all of this excess of tissue must be eliminated. Another essential fact to be borne in mind is that immediately following the delivery of the child and the placenta the mother is necessarily greatly fatigued. Still another factor to be considered is the highly wrought state of the mother's nervous system. These four factors are not properly emphasized by writers and teachers, as it seems to me. Before elaborating my ideas as to the conduct and treatment of these cases allow me a word by way of comparing the old and new school methods in these cases. The former bear in mind only the so-called material or physiological and antidotal forms of treatment while the homoeopath has all these at his command, and in addition a long list of well-tried and effective remedies from which to choose. It is of these remedies I wish to speak mostly today. Let us take the conditions as we find them, and with these conditions in mind, outline a rational and successful line of treatment. We know that the woman is very much fatigued and, may be, completely exhausted. Therefore, the first and all-essential thing to do is to insure absolute quiet to the end that she may have complete *Read before the combined Ohio and Michigan Homoeopathic Medical Societies, May 5, 1909. rest of mind and body. This must be done at all hazards in every case. Allow but little light in the room; allow no noise and especially forbid all whispering. In this, as in all cases where the patient is conscious, whispering is not to be allowed for a moment, not even by the doctor or nurse, much less by others. After a short sleep give the patient some hot drink, such as tea or hot water and milk. Treatment. In each and every case, even if perfectly normal, I give Aconite 2x every hour while awake, for at least twelve to eighteen hours, or even twenty-four hours, if there is any so-called fatigue fever. For this is too early to have fever due to infection. You can tell how long to give Aconite by the condition of the skin and the character of the pulse. These are a much better guide than the temperature. The temperature may, during this time, reach 99 1-2 to 100 within a few hours after labor, but, as already stated, this is simply the so-called fatigue fever and is very promptly controlled by Aconite. When the pulse drops below 90 and the skin is moist, discontinue the Aconite and give Arnica 2x for the next twenty-four hours. This remedy will control the sore and bruised feeling and alleviate the "after pains" to a marked degree. After the Arnica I give Belladonna 3x for a week or ten days, unless the breasts are too hard, in which case I give Bryonia instead of Belladonna, and in hundreds of cases have I seen the breasts soften under its use and mastitis prevented. Of all remedies in the material medica, Belladonna produces the most marked benefit in relieving the engorged and congested condition of the pelvic organs. This is true in all cases as well as lying-in woman. We have now reached a very important stage in the treatment of these cases, where the accoucheur must watch very closely for the early signs of trouble that he may best ward off the danger. This is why I insist on seeing my lying-in woman each day for at least ten days, even if all is going well. I explain to them why I come and they then do not express any surprise or enter any objection to the frequent visits. Briefly, what do we look out for? At the first visit, usually twelve to sixteen hours after labor, note the condition of the bladder and by all means use every possible measure to have the patient void before resorting to the catheter. For there is not one nurse in a hundred that can use the catheter and not infect the bladder. The parts are so swollen and discolored that you need not wonder that they have great difficulty in its use and so often cause cystitis. Unless the patient is very much exhausted, indeed, I would much prefer that she be put in a sitting posture rather than resort to the catheter. This is not so tedious as it seems at first sight, and it also helps to clear the clots from the vagina. And after the patient has once voluntarily evacuated the bladder there is very little subsequent trouble; while if the catheter is once used it is often demanded for several days. And ninety-nine times out of a hundred cystitis is produced, and you all know how tedious and how serious this condition is. Watch very closely at this and each subsequent visit the quantity, color and odor of the lochia, and upon the first appearance of anything abnormal, ascertain the cause and remove it, and then your patient is in proper trim to respond to the similimum. Without going into detail I would say that in nearly every case, if not in every case, the trouble will be due to infection or retention within the system of waste products. These waste products, if retained, soon become toxic and must be eliminated by means of the liver, kidneys, intestines, lungs or skin. You will note that I make mention of the five channels of elimination. These are all to do their share, and if any one or more of them do not perform their function it is the province of the physician to help them do their work. The sources of infection, whether from within or from without, must be removed. If from the uterus, this cavity must be cleaned out, but do it with great caution, but thoroughly, and do not use the curette or in any way injure the lining. If the system is overloaded with the toxic product or any of the eliminative functions arrested they must be assisted. How often have I seen the fever and pain due to infection disappear after a brisk purge or free diuresis and sweat! After these have done their work the Homeopathic remedy can do its work, while without the eliminative helps the patient's vitality is often overpowered before the remedy has time to act. In giving indications. for the following remedies I shall confine myself to those I have tried time and time again and know, from bedside tests, what they will do. Some of these may not seem to you to be Homeopathic. I have not the time nor space, neither is it my purpose to argue the point as to their homœopathicity at this time, but rather to help you, if I may, to cure these cases. I have already spoken of Aconite, Arnica, Belladonna and Bryonia. We have in Apis a great help in cases where the kidneys fail to work. It is often best to give it quite low, the second or third decimal. Arsenicum is often called for in cases where the toxic products have already produced the characteristic thirst, a peculiar condition of the skin, with restlessness and the gastric symptoms so prominent in the pathogenesis of this drug. Arsenate of China has, in addition to the above, the loss of blood so often noted after severe labor accompanied by hemorrhage. The Arsenate of Copper has, in addition to the above symptoms, the characteristic diarrhoea, with marked cerebral symptoms, even to the extent of threatened convulsions, which is often noted during the puerperium. When this remedy is indicated its results are truly marvellous. Calc. carb. is often called for in the third stage of phlegmasia, especially where there is a white swelling of the feet and leg. Two remedies frequently indicated during the lying-in period are frequently confounded in the mind of the practitioner. I refer to the two Cohoshes. Cimicifuga has marked rheumatic diathesis with severe pain across the lower abdomen. These pains are cramping in character. While Caulophyllum has the pain in the same region, but it is sharp and lancinating in character. Sometimes it is so severe as to drive the patient frantic. We might add that both of these remedies are of great value in cases of difficult labor. Hyoscyamus is our sheet anchor in puerperal mania. The patient is frequently in a terrible rage, does not know her friends. Many times is very obscene and profane, desires to be naked; in fact, there may be complete loss of all sense of modesty. I have frequently noted that these symptoms are more characteristic of Hyoscyamus than those mentioned in the books. Calc. carb. is another remedy of great utility in phlegmasia with a white swelling of the foot and leg, shooting and stitching pains in the leg and also in the abdomen, the latter greatly distended with gas, great pain in the back extending down into the glutei muscles, very restless, constant tossing about, and great thirst. Two forms. of mercury, Merc. sol. and Merc. bijodatus, are often called for. The former in general toxemic condition and the latter when the lymph nodes are involved. We have in Nux vomica a great remedy for phlegmasia, with red swelling of the leg with dark, painful, tender spots; leg is powerless, a bruised sensation low down in the abdomen. This same sensation is frequently present in one or both legs with a frequent desire to urinate, as well as constant tenesmus. This remedy frequently outranks Cantharis in cases of marked urinary symptoms. Nux has also a coated tongue, loss of appetite, aggravation after 3 A. M., spirits greatly depressed. With the above ensemble present Nux has done wonders for me. Pulsatilla has a pale swelling in the foot and limb, with suppression of the milk; decided aggravation in a warm room; insists upon plenty of fresh air; no thirst. Very offensive, clammy taste in the mouth, especially after sleeping. All symptoms are aggravated by sleep. This latter fact also holds good with Lachesis. This remedy is of marvellous power in some cases of puerperal fever. The great key note for Lachesis is a terrible sensation of suffocation, as though a large cloth were folded and drawn snugly about the throat. This remedy has frequently saved the patient where the case seemed hopeless, if the above symptom with aggravation from sleep were present. Rhus tox has great stiffness of the limbs and they may be powerless; red streaks running down the saphenous vein; great restlessness, with constant changes of position which seem to give relief; always worse after midnight, and worse from touching the parts with water; wants to be warmly covered. Wrapping the legs. in cotton batting gives relief. The above are some of the chief remedies in phlegmasia. For puerperal convulsions, we have several very valuable remedies. Of course, the terrible convulsions themselves must be controlled. and it may be necessary to give chloral in the following manner to check the awful convulsions. This remedy helps to eliminate |