by reflexly irritating the brain is dentition. I believe some authorities err in restricting this condition to such a small proportion of cases as that it is mentioned only to refuse it a place as a tangible cause of convulsions. That dentition will not so act in a perfectly normal child is a point well taken; but given a child of a hyperæsthetic nervous organization, perhaps inherited from neurotic parents, and I believe the irritation set up in the gums, not always at the apex of the tooth but sometimes at its root instead, can travel over the nerve connections to the cerebral centres to the extent of causing these nerve explosions in much the same way as we have seen it travel from the digestive tract.

In these cases chamomilla takes first rank in interrupting this reflex irritation as we have seen nux do in the intestines, while for the cerebral condition itself belladonna is the most frequently indicated remedy. One case in point, a child with no symptoms of rachitis, and in every way healthy and normal save a neurotic temperament had under my observation very severe convulsions upon the advent of two of the temporary molar teeth, upon two different occasions of a month or six weeks apart. In this case belladonna acted most satisfactorily, not only at the time of the convulsions but in controlling the subsequent nervous hyperæsthesia.

In the treatment of convulsions in children and their underlying and accompanying conditions, when we consider that all old school therapy offers are chloroform, chloral, morphine and the bromides, all merely physiologically or palliatively acting drugs, we can turn to our homoeopathic therapeutics with much satisfaction; for here we find our specific or curative acting remedies as illustrated by our belladonna, helleborus, zincum, bryonia, apium virus, arnica in the ordinary forms of cerebral meningitis; bryonia, cuprum and zincum in the delaying or retroceding rashes of the eruptive diseases; chamomilla and nux in the reflexes of dentition and digestive disturbances; hyoscyamus in curing that nervous hyperæsthesia following convulsions and making, by its manifestations, the anxious mother feel that her child is always on the brink; actæ, cicuta and ignatia for the lesser manifestations of nerve explosions; not to mention the deeper acting remedies indicated in the various diatheses or dyscrasias leading up to the convulsive territory.

In closing I want to mention the possibility of genuine assistance sometimes afforded us by one, and the least harmful, of the old school physiological measures noted above. This is the intelligent use of bromide of soda in recurring convulsions which cannot be prevented because of the impossibility of removing the cause; such for instance, as prolonged irritation in a rachitic child of a troublesome and slowly developing tooth when the

irritation is not at the apex removable by lancing or friction on the gums, but in the upper part of the tooth imbedded where no mechanical measures can be of service. The value of bromide of soda in such cases is in keeping down the number of convulsions, which, for mechanical reasons, do not yield to our specific remedies, and which if too often repeated might lay the child liable to permanent cerebral mischief, prominent among which stands out the tendency in such cases to the development of a genuine and permanent epilepsy.

FIRST REPORT. MEDICAL AND SURGICAL, OF THE EMERSON HOSPITAL.

BY NATHANIEL W. EMERSON, M. D.

(Continued from May.)

FOUR CASES OF MYOMATA UTERI COMPLICATED BY PREGNANCY.

Mrs. E. C. P. (aged thirty-five years). Entered hospital Aug. 22, 1904. For ten years has known that she has had some kind of a bunch in the left side. Menstruation always irregular and flow moderate, lasting three days. On Dec. 7, 1903, two weeks overtime, gave birth to a female child which was abnormal and lived only thirty-six hours. She was of a proper size and well nourished, but the body was deformed with the legs thrown across the face and arms distorted. The ears and hands were badly misformed. The patient flowed excessively, alarmingly so, but finally got up well. Next menstruation occurred on Feb. 28, when she flowed most profusely for about two weeks. She must have become pregnant shortly after his, and first felt motion about the middle of July. She has not felt well since the previous confinement, and has had pain in the left side all the time. A misstep hurts; pulls and tears. Has grown worse lately. Cannot go up and down stairs. In neither pregnancy has there been nausea or vomiting, but she "feels sick all through." Nose bleeds often and freely, and did so in the last pregnancy. Toward the end of the latter the feet and legs were swollen; nothing of this kind at present. During the latter part of the previous pregnancy she felt no motion. No urinary trouble. Bowels regular. Appetite good. Is now abnormally large for a six months' pregnancy, and larger than before at a corresponding period. The most comfortable position is sitting up straight with the weight thrown on the left arm. Cannot lean back in a sitting position, because it "pulls so." In bed she is in the most comfortable position on the right side.

She was under observation in the hospital a week before the

operation was decided upon, and during that time her condition grew perceptibly worse. She could not lie down for any length of time but sat up most of the time in an upright position with the weight thrown upon the left arm, the latter being supported upon the arm of a chair. She had been obliged to occupy this position for so long a time that she was worn out by it.

The examination showed the abdomen enormously distended, irregular in outline, and exquisitely tender on the left side. The uterus was low in the pelvis and filled it, and I could not see how child at full term could be safely delivered.

The determining factors in deciding to operate in her case were her present discomfort, which was already well-nigh intolerable; the practical impossibility to carry her child through to term, or even until the child might be viable; and the serious hemorrhage at the time of her previous confinement. Hence, I had no hesitancy in determining that an abdominal hysterectomy was necessary. Some influence in this decision was undoubtedly exercised by the condition of the former child, which was so deformed that its death shortly after birth was a blessing. Consequently an abdominal hysterectomy undertaken and completed with no unusual difficulty, and her recovery was prompt and without incident.

was

Mrs. L. W. B. (aged forty-one years). Has had no children, and never pregnant before. A short time ago she first noticed a hard bunch in the right side, which has grown since her first observation. Last regular menstruation was nine weeks ago; although five weeks ago, when menstruation was due, she had a slight bloody discharge. She has usually been regular. She thinks the breasts have slightly enlarged during the last month.

Examination showed a uterine mass filling the pelvis, rising well into the lower abdomen and pressing forward on to the bladder. It was slightly movable, but very hard and irregular in outline, and the diagnosis of myomata uteri was made. The question of pregnancy was discussed but dismissed as improbable. The tumor was removed by abdominal hysterectomy; and after its removal, upon opening it, was found to be pregnant at about the second month. The breast changes were considered no more characteristic of pregnancy than they might be in any case of myoma where the breast shows some change. It is not infrequent to find some enlargement and sensitiveness, and even slight discoloration, about the nipple. in the breast of a woman with a myoma, especially if for any reason it has entered a stage of growth and enlargement, and in this case the changes of the breast were so interpreted. The increase in size of the uterine mass was only suggestive of a possible pregnancy, but the latter was not deemed sufficiently probable to be accepted. However, in this particular case, from the shape and size of the tumor, and the relation of the

different growths to each other, even had I been absolutely sure pregnancy existed, I think I should have advised an hysterectomy just the same.

Mrs. C. M. (aged thirty-four years). This patient has had no children and no miscarriages. Eight to ten years ago she began to "run down," as she expressed it. Menses have been regular, with pain for a week before the appearance of the flow. For the last three months there has been no appearance of menstruation until the night previous to my first examination. There has been too frequent urination and considerable leucorrhoea.

An examination showed a large mass filling the pelvis and extending well into the abdomen, hard and firm, with an irregular outline. The cervix was low in the vagina and soft, as in pregnancy. There was some discoloration of the vagina; and a diagnosis was made of myomata uteri, with pregnancy. The next morning the patient was flowing very freely, and an examination showed a dilated cervix with the products of miscarriage presenting, and an immediate operation was determined.

An abdominal hysterectomy was made, during the course of which the products of the conception were expelled intact into the vagina. The tumor presented in the cavity of the uterus hard, firm, and unyielding, and it seemed as if a pregnancy to full term would have been impossible. This case made a satisfactory and uncomplicated recovery.

Miss F. H. (aged thirty-one years; with her home in Canada). About a year previous to my first seeing her she noticed that menstruation was becoming more profuse and continuing longer; and about eight months ago it continued for three weeks and was very profuse. She has always been irregular, with a flow for seven days, normally with a three weeks' interval. Six months ago the flow lasted only one day, and since that time there has been none whatever. For the past several weeks she has had a great deal of pain through the lower abdomen, especially on the left side. She has grown very large, and respiration is embarrassed. Is constipated. Urination is very frequent, and for the last two or three weeks she has not slept well.

Examination showed the abdomen greatly distended, very acutely sensitive on the left side, with a hard, irregular mass filling the pelvis; and the diagnosis was made of a myomata uteri with pregnancy.

After carefully considering all the circumstances of the case, and with the consent of the attending physician, an abdominal hysterectomy was decided upon, and performed; and she made an uninterrupted recovery. The uterus was as anticipated, pregnant; but as she was only about five and a half months

pregnant, we could not determine how it were possible for her to go to full term with safety and be safely delivered.*

A GROUP OF MISCELLANEOUS CASES OF UNUSUAL INTEREST. Mrs. A. L. (forty years old). Operated on four years previous to entrance here for a ruptured extra uterine pregnancy of the right side. Has since been well until four days ago, when severe pain in the stomach, paroxysmal in character, developed shortly after eating a hearty supper. Vomiting soon came on and has persisted ever since whenever anything has been taken into the stomach. The pain has been very severe at times, and was especially so the night before entering. The upper abdomen was hard and distended and exquisitely tender. Upon exposing the abdomen, a ventral hernia presented, much distended, hard and sensitive to manipulation. Absolutely nothing had come through the rectum since the beginning of the attack, and her temperature was less than 100 and pulse 116. The patient's condition was not encouraging, however, and immediate operation was undertaken with the expectation of finding the obstruction to be due to strangulation of the intestines. The hernia was opened and found to be full of omentum and intestines, which were not confined other than as held by adhesions; but just behind them and partly projecting into the hernia was a loop of small intestines about two feet in length which was strangulated by another section of the small intestines. This latter had completely constricted the former, and was so confined by adhesions that the strangulated section would undoubtedly have become gangrenous if not released. All adhesions were broken up, and when the confined loop was freed, immediate improvement in its condition was perceptible. The color was better at once, and gas passed into and out of it spontaneously, and the well-marked site of confinement, which was narrowed by compression, expanded so freely that we decided to leave it without other manipulation than a general breaking up of adhesions. Her condition began to improve immediately. Ox-gall and oil enamata were given as high up as possible, and the next day a little gas and a slight amount of fecal matter came away. On the next day gas began to be expelled spontaneously, and on the fourth day a soapsuds enema was followed by most excellent results. From this time forth there was nothing of incident to relate, and the recovery was satisfactory.

Miss E. S. (forty-nine years old). This was another unusual and remarkable case. This patient had been a semi-invalid for a number of years. I was called to see her because of an unusually severe and acute attack of appendicitis, and advised

*To those who are especially interested in fibroids and in what relates to them, I would say that the Museum of Boston University School of Medicine has a very interesting group of pregnant fibroids which are well worth inspection.