DIURETICS.

-PREPARED BY

PARKE, DAVIS & CO,

Manufacturing Chemists, Detroit, Mich.

The following drugs, preparations of which containing the medicinal principles in their most eligible form, we offer the medical profession, have for some time been in use by a sufficient number of physicians to determine their value. Such claims as we make for them are based exclusively on the reports which we have collated from the medical press. These reports have been preserved by us in extenso, and we are prepared to furnish copies, gratis, to all who may be sufficiently interested to apply for them. We hazard nothing in asking for these drugs a more thorough trial, with a view to commending them to the use of those who are not already familiar with them.

SIERRA SALVIA. (Artemisia Frigida.) Fluid Extract of the Herb. Dose, 1 to 2 Fluiddrachms.

This species of the Artemisia was introduced by Dr. A. Comstock, of Silver Cliff, Colorado, as a substitute for quinine. In the treatment of periodic fevers, he gives a teaspoonful of the fluid extract in a glass of strong, hot lemonade, one hour before the expected chill, and repeats in 30 minutes if the stage of perspiration has not set in. In rheumatism, scarlet fever, diphtheria, etc., he uses it hot as above, and repeats every half hour until perspiration and urination are certainly established.

VACCINIUM CRASSIFOLIUM.

Fluid Extract of the Plant. Dose, 30 Minims to 1 Fluidrachm.

Astringent and diuretic, resembling uva ursi to some degree. Useful in catarrhal inflammation of the genito-urinary tract, gleet, chronic cystitis, etc. In dropsy from whatever cause, it is an active diuretic, assisting the removal of the effused fluid. It has also been given with benefit in chronic diarrhoea and dysentery.

RHUS AROMATICA.

This drug has had a very thorough trial as a remedy in nocturnal incontinence of urine and the very general verdict is that it is a remedy of value in this troublesome affection. Its action consists chiefly in improving the tone of the sphincter muscles, but it also exerts a soothing influence over the mucous lining of the bladder, rendering the organ more tolerant of the normal urinary secretion.

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Dr. McClanaham, who first prominently called attention to the virtues of Rhus Aromatica, claims this drug almost specific properties in nocturnal incontinence of urine, either in old or young. He regards it as also useful in hematuria and in menorrhagia, while it is further recommended by some as a remedy in atonic diarrhoea, dysentery and sark of the Root. Dose, 5 to 30 Minims. summer complaints of children. Fluid Extract of

CORN SILK. (Stigmata Maidis.) Fluid Extract of the Green Pistils. Dose from 1 to 2 Fluidrachms.

This article has lately been very highly spoken of as a demulcent and diuretic in catarrhal inflammations of the kidneys and bladder. Cases are reported by Dr. Dassum, in "l'Union Medicale," in which the urine exhibited a strong ammoniacal odor, with heavy morbid deposits, which were speedily relieved by the administration of corn silk. The use of the drug in this country has corroborated the favorable opinion conceived of it in France.

KAVA KAVA. (Piper Methysticum.)

Fluid Extract of the Root. Dose, 20 to 60
Minims.

This drug has for a long time been used in its native nabitat as a remedy for gonorrhoea, and seems to have been very effectual. It has also been used beneficially by the natives in gout, bronchitis and in erysipelatous eruptions.

Two or three doses should be given during the day, each with a full goblet of water. It is said that 20 minutes after the first dose, a pressing desire to urinate is experienced. The quantity of urine is abundant, and it becomes as limpid and as clear almost as water. The Kava, moreover, acts like a bitter tonic, is pleasant to take, stimulates the appetite, does not derange the digestive functions, and produces neither diarrhoea nor constipation.

PARKE, DAVIS & CO., Manufacturing Chemists.

6.14.1439.

THE DENVER

MEDICAL TIMES,

A MONTHLY JOURNAL OF

MEDICAL, SURGICAL AND OBSTETRICAL SCIENCE,

JULY, 1883.

AREOLAR HYPERPLASIA OF THE UTERUS.

BY GEO. W. Cox, M. D. Denver.

This is the name that has been given to a complex condition, the importance of which cannot be overestimated, inasmuch as it is one of the most frequent, as well as one of the most intractable, disorders to be found in the field of gynecology.

The name was first suggested by Dr. T. Gaillard Thomas, and was intended as a substitute for the old term "chronic metritis," which, for several years past, has grown in disfavor among scientific men on account of its being an absolute misnomer in many cases, and as conveying to the mind no definite idea of the condition of things in any case to which it has been applied.

"Inflammation of the womb" is a phrase that is upon the lips of all the quacks in Christendom; and while it is not lacking in euphony, and while it satisfies the innocent patient, and impresses her with the idea of superior diagnostic skill in her "doctor," to the intelligent physician its meaning is so limited that it only serves as a pointer to direct his mind to the locality of some pathological condition. "Inflammation of the womb' covers a vast store of professional ignorance; and if given as the bonafide diagnosis of the medical attendant, it rarely fails to insure to the patient a long siege of distressing illness, and invariably stamps the physician as a careless or superficial observer. "Inflammation of the womb" means about as much to the careful gynecologist as "headache," or

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'pain in the chest' do to the accomplished pathologist. They are all vague terms, valuable only as they stimulate investigation, and lead the practitioner to a knowledge of the real tissue changes that may exist in a given case.

"Ulceration of the womb" is another pet phrase with a certain class of empirics-a phrase which has become so common that it is disgusting to a man who knows an ulcer when he sees it.

There is scarcely a day in the year that we are not consulted by some poor sufferer who has undergone the pain and inconvenience of cauterization for "ulcers on the womb "--an affection that must be extremely rare, except as it exists as a concomitant of some other disorder.

And while sufficent time has not elapsed for the term "areolar hyperplasia" to be generally adopted, and while it may not be quite as comprehensive as we would like, yet we cannot hear the name spoken without allowing our minds to run over a long list of symptoms, and reverting to certain points of etiology and pathology that must of necessity turn us into channels of rational and scientific research. It comes much nearer describing the real condition of things than any of the terms formerly used, such as the "engorgement" of Lisfranc, the "irritable uterus of Hodge, the "habitual hyperaemia" of Klob, the "infarctus" of Kiwisch or the "chronic metritis" of the world at large.

Until very recent years any organ of the body which was enlarged, congested and tender to the touch, was at once set down as the seat of inflammatory action. But that invaluable helper to diagnosis, the microscope, has come to our rescue, and proven beyond all controversy that all these conditions may and do exist entirely independent of inflammation. Dr. Henry Bennet was one of the first to mention this fact, and he speaks of a number of instances in which he refers the enlargement solely to an excessive growth of connective tissue, with congestion, and the tenderness to hyperaesthesia of the nerves resulting from pressure or tension made upon them by the disproportioned size of the organ.

Such enlargement may arise from one of three entirely different pathological states; first, from interference with the retrograde metamorphosis after parturition from any cause; second, from long continued congestion from mechanical means, such as a displacement, or the wearing of an ill fitting pessary; and third, from a state of hypernutrition which may be due to the existence of fibroid tumors, or inflammation in some of the contiguous structures.

There is no doubt but that it might arise from parenchymatous inflammation, if it were possible to imagine such a state as an idiopathic affection, but in the light of modern research this is entirely out of the question.

It matters but little, however, so far as our discussion of the issue is concerned, what the original cause may have been, for in all cases the result is the same, namely, an adventitious growth of uterine connective tissue, together with hyperaesthesia of the nerves, and more or less congestion of the parts.

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This word inflammation" has been so abused in being made an ambulance to carry the crippled knowledge of superficial observers that two of our most eminent pathologists have proposed that it be expunged from medical nomenclature,

Speaking of this proposition a few years ago, one of the most accomplished gynecologists in America unbosomed himself as follows: The entity inflammation, fallen from its high and palmy state, is hanging by its eyelids as a pathogenic factor in most of the organs of the body; its last resting place seems to be the womb, and here it still has a good And then he puts the perplexing conundrum, "why should uterine pathology alone be cumbered by an outworn theory?"

The whole difficulty seems to arise in a lack of discrimination between a simple congestion, caused by a sudden or gradual dilitation of the arteries, whereby a freer flow of blood to the parts is set up, and a genuine inflammation, wherein the plasma and corpuscles seem in measure to lose their affinity for each other, the one partially escaping from its normal course by exosmotic action, and the others clinging to the sides of the vessels, and to each other, in a state of comparative stagnation.

It cannot be denied that such discrimination is always difficult, and often impossible, occurring in pelvic viscera or other localities where ocular inspection cannot be made, but we must remember that it is our duty to defer our diagnosis until such a time as we can give it with frankness and confidence.

By a little delay we gain time for reflection and study of the case, and the repeated examinations that we will thus secure will frequently enable us to see clearly that which seemed so obscure at first.

And now let us take a typical case of areolar hyperplasia and see what an analysis of it will reveal.

A patient comes to us complaining of general lassitude, pain in the back, leucorrhoeal discharge, disordered menstruation, bearing down pains, irritability about the rectum, vesical tenesmus, constipation, throbbing sensation about the uterus, more or less pain or tenderness in the region of the ovaries, and a feeling of general malaise and despondency.

Of course it is not every one who will confess to all of this chain of symptoms, for it will be seen a little further on that they are not all invariably present; but doubtless this is a familiar recital to every one of you, and one that has confused you time and again. Passing then from

the subjective to the objective symptoms we find on digital examination an organ generally displaced by version, quite tender to the touch, larger than it should be in health, and with either a very soft and flabby feeling or with that peculiarly tense and resisting touch that would at once impress us with the idea of engorgement. Frequently the external os, and occasionally the internal os, will be sufficientiy dilated to admit the finger.

Pursuing our examination still further we find a string of tenacious. leucorrheal matter hanging from the cervical canal, and if the sound be passed up to the fundus it will cause quite a severe pain, and almost invariably a slight flow of blood, in spite of our most careful manipulation. The internal measurement will be found to be materially increased. Vaginitis of a low grade is a common accompaniment, especially in cases of long standing, and the cervix is frequently lacerated, everted and in a state of granular or cystic degeneration.

With such a train of symptoms and physical signs as this, it is not strange that so many mistakes should be made, and that so few women get relief from their life-sapping affliction. One physician will have the inflammation craze and call it a case of endometritis or uterine catarrh ; another one, surmounting the laceration hobby, will attach all the importance to this concomitant; a third, being a disciple of the pessary fiend, will turn his attention entirely to the displacement, and treat the case accordingly; while the fourth, allowing his mind to run wild on the ulceration theory, will readily mistake the erosions or granulations around the external os for ulcers, and apply his caustics with an energy that only wanes when he finds he is doing far more harm than good.

There is one more point in the examination of a case that seems to me to be of paramount importance, and one that should never be omitted in obscure cases, and especially when fibroid growths are suspected and cannot be readily distinguished.

It is to thoroughly anesthetize the patient and force the entire hand into the vagina. By this means the whole of the pelvic cavity can be accurately explored and all the organs fully investigated.

With the other hand placed firmly over the abdomen the uterus may be grasped and outlined with greater precision than by any other method; the ovaries may be brought more fully under investigation than by any other means; the state of the rectum as far up as the Sigmoid flexure may be definitely determined; and above all, adventitous growths of any kind may be dtected at once, while their existence might remain undetermined for years without this valuable means of diagnosis.

To those who question the advisability of such a course on account of the severity of the operation it may be said such an objection will fall to the ground when you have once put it into practice.

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