8-11-94; 9:30 A. M. No pain; partial deafness lessening.

Patient discharged with slight deafness and constipation, thinking these would go gradually by time; but the continuation and increase of constipation compelled the patient to come again under my treatment on the 9th inst., at about 8:30 A. M., with the following symptoms:

Constipation with one hard and formed stool after two or three days; superficial anasarca of abdomen; swelling of eyelids both upper and lower but especially the lower, about an inch down below the margin of the lower lids being more puffy; tongue slightly yellowish; urine slightly colored; taste sometimes acid; partial deafness of left ear as before, but somewhat relieved, and at noon gets quite clear; felt pain in ear last night; pulse slow and weak; first sound at the base rather indistinct; not good sleep last night; cough occasionally with thick and white sputa; loss of appetite; palpitation after slight exertion, as doing any work or running a few yards; dull aching occasionally just above the navel; frequent and pressing calls to urinate, so much so that if for any reason some delay happens he may pass water involuntarily.

Before this the patient had otorrhoea as mentioned above. Treatment: Hydras. c. 1x. Diet, as usual.

4:55 P. M. One easy but formed stool just about II A. M. to-day. Edematous swelling of lids somewhat reduced; no pain above the umbilicus as other days; cough; ear in the same state. Treatment: Placebo.

10-11-94; 7:55 A.M. Ear in the same state; occasional cough with no sputa. Edematous state of eyelids as in last report. Pain in abdomen above navel slight, and for once only last night at about 7 P.M. No more stool. Treatment: Hydras. c.1x Diet, as usual.

5 P.M. One formed, easy and free stool at about 2 P.M. to-day. Edematous swelling of lower eyelids less; felt pain in abdomen about navel just before defecation mentioned above; oedematous state of abdomen less; ear in the same state. Treatment: Placebo. Diet, as usual.

II-11-94; 4:40 P.M. One easy and formed stool; no pain in abdomen; œdematous swelling of lower eyelids still less; deafness of left ear consisting of sounds as of bellows; cedematous state of the skin of abdomen diminishing; cough less. Treatment: Hydras.c.1x Diet, as usual (two meals in twenty-four hours consisting of rice, vegetable curry with fish).

12-11-94; 9 A.M. No more stool; oedematous swelling of skin of abdomen and of lower eyelids much diminished; urine not colored;

cough much less; ear slightly improved as above; sleep good; appetite improved;pupils dilated. No tympanites. Treatment Hydras.c.1x Diet, as above.

13-11-94; 9 A.M. One easy and formed stool afternoon yesterday at about 2 P.M.; no pain in abdomen; oedematous state of skin of abdomen and lower eyelids almost gone; ear better than before, and no deafness at noon. Tongue slightly yellowish posteriorly: palpebral injection; pupils dilated; appetite much improved; sleep good; feels better than before. Treatment: Hydras. c.'x Diet, as above.

16-11-94; 8:30 A.M. Passing stool in the morning these two days, to-day and yesterday; stools formed and easy. Appetite good; very slight oedematous state of the skin of abdomen and lower eyelids. Passing much water; especially yesterday, so that since evening to ten P. M. last night he passed water five times; palpebral injection, and pupils dilated; no pain in abdomen just above navel. Slight deafness consisting of bellows sound but less; at noon (from ten to eleven A. M. to two or three P. M.) the left ear clear, no deafDoes not feel weary and tired after slight exertion. Pulse at the wrist weak, slow and soft. Treatment as above, one dose. Diet, as above.

ness.

17-11-94; 8:25 A.M.

Micturition less; one soft stool this morning; stool free; eyes with pupils dilated and palpebral congestion; no burning sensation of eyes; œdematous state of skin of abdomen and lower lids of the eyes much less; spleen reduced; deafness as above. The increase of urine since about a year. Treatment: Hydras.c.x as above, one dose. Diet, as above.

24-11-94; 9-10 A. M. Daily two formed stools; no increase of times of micturition, urine not colored. Very slight œdema of skin of abdomen and lower eyelids. No bellows sound in the ear, only slight deafness remains. Treatment Hydras. c.x as above, one dose. Diet, as usual.

25-11-94; 9-10 A. M. Coryza since yesterday; ear with slight deafness, otherwise much improved. Cough. Sneezing. Bowels. open. Treatment: Placebo. Diet, as usual. Bathing stopped.

29-11-94; 9:15 A. M. Daily two formed stools; goes to bed at about 9 P. M., and from that time until morning passes water once. Edema of lids only, and that, too, less than that of last report. No palpitation. Slight palpebral injection; no sensation of sand and dust in eyes, no lachrymation; no sensation of burning in eyes; pupils slightly dilated. No photophobia. No bellows sound in the ear, only slight deafness which goes off at noon to appear again in

evening continuing whole night till morning. Treatment: Sulph." per dose. Given one dose only.

II-12-94; 8:35 A. M. An attack of coryza and cough. Two stools daily. Passes water only once after going to bed at night. Here the patient is noted down recovered.

Again entered in the Case Book on the 14th December, 1894, at about 9 A. M., as a patient with Intermittent Fever, laboring under the illness since four days.

Characters of

Type, Quotidian. Time, 4 or 5 P. M. yesterday.

2 P. M. day before yesterday. I P. M. on previous day. Prodeome, nothing. Chill, not much; no thirst; lasting about six hours; no aching of limbs or of head; tightness of head; nausea; spitting of saliva. Heat, shorter; no thirst; occasional aching of knees; no nausea; spitting of saliva; tightness of head with chill; did not. compel him to throw away covering. Sweat, just after chill, slight. Apyrexia, incomplete; tightness of head; no nausea; spitting of saliva.

Bowels opened yesterday but with great constipation. No stool to-day. Tongue moist, somewhat clean on anterior part but posterior part yellowish and furred. Taste insipid. Pupils dilated. Coryza, with thick yellowish or sometimes whitish mucus discharge from the nose; coughs occasionally. No pain anywhere. Urine, reddish, passes with burning sensation. Aphthous condition of the mouth; feels pain on one spot of tongue. Treatment: Hydras, c1x Diet Sago and sugar-candy.

15-12-94; 9:15 A. M. Fever yesterday at about I P. M., with chill less than that of other days, with no thirst. Chill continued till about 2 P. M.; then heat with slight chill, with heat and burning sensation of soles, palms, and eyes with shedding of tears. No sweat. No good remission. Stoppage of nose less than that of yesterday. Frontal headache increased. Heaviness of head. One stool this morning, stool at first hard and then soft. Taste insipid. Tongue moist, clean anterior part with two or three longitudinal cracks rather effaced than yesterday; posterior part with yellow papillæ raised; pupils dilated; increase of times of micturition, last night being three times. Urine less reddish and passes with less burning sensation than that of yesterday. Feels hungry. Dry cough since 8 to 11 P. M. last night. Treatment: Placebo. Diet: Sujee, hand-made bread, milk and sugar-candy.

16-12-94; 9:15 A. M. 18-12-94; 9 A. M.

About the same as yesterday, but improving. No feverishness yesterday; no dry cough last night; one normal, free and formed stool yesterday at about 2 P. M.; feels hungry; appetite good; sleep good; passed water last

night only once; no complaints of ear; coryza less than that of yesterday; tongue cracks disappearing, aphthous condition lessening; fever-blisters healing up; worked yssterday in the field; one formed and free stool this morning. Treatment: Placebo. Diet, as usual. Battery in tepid water.

RESULTS: Writing in the beginning of February, 1895: I have seen this patient often and he is perfectly restored to health.

REMARK. This is a peculiar case, as taken down in my Case Book. It may be divided into three parts: first part consists of the Puls. treatment; the second part, which may be called a direct continuation of the first without any change of color or character, is the first part of the Hydras. treatment, and lastly the third part, the remaining portion of the Hydras. treatment. Apparently I was not very wrong in prescribing Puls., as was indicated by the symptoms, but practically I was so. My patient did not continue to improve to perfect recovery under Puls. when at the last part of it, I dismissed him hoping that he would make up the remaining portion of ill-health without any further medical assistance. But I soon found my hope was ill-founded; the patient again came under my treatment. He was agein treated and dismissed. Not long after he came once more, and this time for the treatment of Intermittent Fever, which, as is expressed in the case above, was well treated with a dose of Hydras. c. to the satisfaction of all lovers of medicine.

I have never heard, nor ever read a case so full of such heterogeneous symptoms of Hydras. treated by any one and then going on to full recovery. So, I call it an exemplary case.

One thing more to be noted here of the case is the dose of Hydras. used in it. In my case I gave four globules of the Ist dec. at about 8:30 A. M., and the medicine was taken at about 9 A. M., and passed a free and formed stool just about II A. M. This may be called an immediate action. In the last part of the treatment of the patient I had to deal with an Intermittent Fever, which though not less typical, together with other constitutional symptoms, very nicely indicated Hydras. as the fit remedy. I gave him Hydras. c.1x, two globules, at about 8:25 A. M. and had never to repeat. It restored him to perfect health. His constipation, his coryzal condition, his chronic urinary illness forcing him to attend frequent and pressing calls to urinate; his disorder of the ear (otorrhoea when under Puls. treatment); bellows' sound in ear, his defective digestion; œdema of skin of lower eyelids and that of abdomen; and his intermittent fever, as mentioned above, all contribute to make it a typical case of HYDRASTIS CANADENSIS.

CONDUCTED BY

WILLIAM TOD HELMUTH, M.D., LL.D.

SIDNEY F. WILCOX, M.D.

GEORGE W. ROBERTS, Ph.B. M.D.

VAGINAL HYSTERECTOMY-HOW TO DO IT?

BY WM. O. MCDONALD, M.D.

New York.

ERHAPS this question is the most interesting one at present

PERBE

before the gynæcologist. The history appended will give me an opportunity to speak upon this point. I will first give a statement of the case and of the operation.

A woman, short, stout and fleshy, sixty-five years old, who had long ago passed the menopause, having had a bloody discharge from the genitals for three months was curetted and the shreds, being submitted to expert examination pronounced to be malignant, accepted my proposition to have the uterus removed by the vaginal method and I performed the operation after the fashion now to be described.

After douching of the vagina, the patient was placed in Sims' position. Sims' speculum introduced, the cervix was seized by double hooks and using Emmet's double curved scissors, the vagina was incised at its junction with the cervix in a circular fashion. With the finger and the end of blunt scissors closed, the tissues were separated keeping close to the uterine substance until the peritoneum was opened, first into the cul de sac then in front, then the right broad ligament was torn off and the uterus being retroverted was brought out of the vaginal aperture. There was now no great difficulty experienced in getting off the left broad ligament with tube and ovary and it only remained to separate the right ovary, the right tube having been already removed with the ligament.

Neither ligature nor forceps were applied during the operation. There was a moderate flow of dark blood from time to time but it was profuse at no time.

After careful scrutiny of the parts for bleeding the patient was turned upon her back. No douche being used and no dressing excepting a napkin applied to the vulva. The time consumed was just nineteen minutes but there was no attempt made at haste. It did not enter my mind to hurry. No more time was needed for the completion of the procedure.

Comment will now be in order. In the first place, Sims' position and speculum were used, from habit I work more readily with the patient in this position. If at any time the use of the vision is