enlarged and sensitive. Chilliness. Sour erectatious, mucous diarhoea, gastric symptoms. Peculiarities: Irresistible desire for fresh air. Worse from warmth. Paroxysms of women of a mild, tearful disposition. Paroxysms with changing symptoms. Pale face, disposition to blenorrhoea. Attacks come from improprieties in diet. Aversion. to sun-light.

RHUS TOXICODENDRON.-Time, evening; fever without chill at IO A. M. Cause getting wet, or exposure to damp air. Before chill, a dry cough, aching of the limbs, yawning. Chill with and without. thirst. Stretching and pain of the limbs, shivering, hands and feet cold, face red, breath hot. Shivering and perspiration at the same time. One sided coldness. Face hot though the cheeks were cold to the touch. Feels as though dashed with cold water. Cough. Restlessness. Chilliness of the upper part of the body. Chill aggravated by motion, eating and drinking. Chilliness of some parts while others are hot. Redness of the face. Sensitive to cold air. Paroxysms of pain, headache, vertigo, inclination to vomit. Aching of the teeth, stitches in the chest. Heat with and without thirst, excessive cutting pain in the abdomen and diarrhoea. No cough, but urticaria, with much itching which is increased by rubbing. Great heat and thirst, .drinks little and often. Sensation as if hot water were running through the blood vessels. Chilliness of some parts, heat or sweat of others. Drowsy, tired, very restless. Twitchings, hardness of hearing, gastric derangement, inclination to stretch the limbs. Aversion to uncover. Heat increased in-doors and when sitting. Sweat profuse and not exhausting. Urticaria. Sleep. Sweat may be only on the front of the body. Tongue with a red, dry, triangular tip. Hydroa, especially on the upper lip. Apyrexia: Urticaria. Restlessness. Pains. Pulse weak and soft. Mood dejected. Diarrhoea predom. Urine, often and copious. Hæmorrhages, blood bright. Sensation of numbness. Peculiarities Tongue dry and rough,with red edges and red triangular lip. Pain worse during rest or on first moving the parts. Aggravated in wet, damp weather. Hydroa.

SABADILLA.-Time, 5 P.M., 9 P.M., returning at the same hour on each or alternate days.

Shuddering

Chill with thirst, heat may alternate with the chilliness. from below upwards. Dry cough with pain in the ribs, limbs and bones. Chill predominates. Chill relieved by heat of the stove, after eating. Often thirst between chill and heat. Heat mostly on head and face. Flushes of heat alternating with shiverings, sometimes sweat during the heat.

Delirium, yawning and stretching. Sweat about head and face.

Body cold. Sleep. Apyrexia: Constant chillness. Debility, Debility, sour eructations, bloated abdomen. Peculiarities: Urine turbid and thick. Pain in the joints, weariness of the limbs.

SAMBUCUS.-Time, afternoon. Before chill, deep dry cough, nausea, thirst. Sweat, chill with icy coldness of the hands and feet. Spasmodic, deep dry cough. Creeping chill and sweat in alternation. Heat without thirst. Warmth of body and cold feet. Dry heat while sleeping, profuse sweating when awake. Sweat, profuse when awake, dry heat when asleep, not debilitating, may be partial. Must be covered. Predom. during motion, when lying, with and after the stool. Face, bluish red, no thirst, hands blue and cold, cough. Peculiarities: During sleep, dry heat, during the time he is awake, profuse sweat.

SEPIA.--Cause, uterine disease, or menstrual irregularities. Chill with thirst. Icy coldness. Shaking chill with icy cold feet and with headache. Deadness of the limbs and fingers. Feels as though standing in cold water. Chill aggravated by motion and in the open air. Chill may be preceded by heat, feverish shiverings. Heat ascends, vertigo, sweat. Heat aggravated by exercise. Inability to collect one's senses. Pressing in the temples. Painful deglutition. Sweat profuse. Aggravated by exertion. Peculiarities: Gone feeling in the region of the stomach not relieved by eating. Urine offensive, turbid, with reddish or clay colored sediment, adhering to the vessel. Suitable in mild dispositions and females. Sinking faintness. Menstrual irregularities. SULPHUR.-Time, evening predominant. Before chill, thirst. Chill without thirst. Internal chilliness. Transient coldness of the hands, nose, feet, chest, arms and abdomen. Chilliness in the back. Icy coldness of the genitals. Blue nails and shivering, shaking. Headache and delirium. Diarrhoea. Chill lessened in a warm room. Ascending chilliness. Chilliness aggravated after getting out of bed and after drinking. Heat with thirst. This stage may be absent. Flushes of heat with shiverings. Burning of the palms of the hands and the soles. of the feet. Hot and red face. Palpitations of the heart. Sweat about the head. Red spots on the cheeks. Desire to uncover. Fainting. Sweat, profuse. Restless sleep. Sweat after waking. This stage may be wanting. May be only on the back of the body. Desire to uncover. Sweat aggravated when walking in open air, or motion. Sour sweat. Apyrexia: Prostration. Early morning diarrhoea. Peculiarities: Worse, early in bed. Hungry at ten or eleven A.M. Aversion to washing in cold water. Offensive odor of the body despite frequent washing. Sleeping with eyes half open. Diarrhoea, driving one out of bed in the morning without pain. Lean or scrofulous people. Dry scaly skin.

VERATRUM ALBUM.-Time 6 A.M. Chill with thirst. Severe, longlasting. Intense coldness. Internal chilliness running down. Heat and chill alternating on single parts. Face collapsed, extremities cold. Cold and clammy skin. Congestive chill. Constant chills over the back and arms. Vertigo, nausea, pains in the back, dark urine. Chill aggravated by drinking, lessened by getting out of bed. Heat with thirst. Heat ascends. Red and hot face, contracted pupils, cold feet. Head hot and confused. Slumber, delirium, inclination to uncover. Drinking beer lessens the fever. Sweat without thirst, profuse, clammy. Pale face. Prostration. Sweat is offensive and causes yellow stains. Cold sweat on the forehead. Sweat after each stool and after vomiting. Desire to uncover. Aggravated on motion. Tongue cold with red. swollen tip. Pulse, slow and weak. Apyrexia: Exhaustion and sinking of the strength, face pale and cold. Diarrhoea, colic, nausea, cramps, contracted pupils. Peculiarities: Cold sweat on forehead. Suitable in intermittents occurring during epidemics of cholera. Tonic spasms. Sudden prostration.

TREATMENT OF DUMB AGUE AND OF SUPPRESSED CASES.

In the former the symptoms are often so marked as to give rise to no difficulty in selecting the remedy. Some patients, however, only complain of a general feeling of lassitude, but careful questioning will clearly define the case. The totality of the symptoms is to be considered.

In prescribing for people who have been given quinine or other drugs. in large and repeated doses, and whose paroxysms have possibly been suppressed thereby, but who, as is often the case, still complain of being ill and of latent malarious symptoms, it is a very good plan to ask them for the history of their paroxysms before taking the suppressant. Such a course will very frequently give more light and will enable us, when there is any doubt as to which of two remedies is the proper one, to decide with certainty.

TREATMENT OF CONCOMITANT DISEASES AND SEQUELÆ. The diseases of which intermittent fever may be a complication and those which may follow intermittents, have already been referred to. As to treatment, reference is to be made to them under their proper headings.

DIET. During the paroxysm but little food is usually desired. The thirst is sometimes excessive, and when such is the case as much water should be given, at the ordinary hydrant temperature, as is demanded. Should it produce nausea, however, the quantity may be restricted or

>

Should the

cracked ice may be administered rather than the water. paroxysm be of long continuance, small quantities of easily assimilated food may be given at frequent intervals or should this as well as the water produce nausea or vomiting, beef juice, either that which is pressed from the under-done steak, that which is properly prepared in a closed jar, or that of Valentine of Baltimore, will be found refreshing and nourishing. During the apyrexia the amount and quality of the food depends very much upon the peculiarities of the case. Some patients can eat as usual, while others either have no appetite and may loath food, or have nausea, flatulency and vomiting as a result of eating. Only a general rule can be suggested, and that is, that the patient be nourished, and that in choosing articles of diet-such as are conducive to gastric disturbances be avoided. It may be necessary to give food frequently and in small quantities. In some cases, especially where there is inactivity of the liver, milk, eggs, broth and other articles rich in fat must be prohibited.

OVARIAN CYSTS.

BY

THE MEDICAL SCIENCE CLUB OF CHICAGO, ILLINOIS.

Pathology, C. G. FULLER, M.D.

Chemical Constituents, CLIFFORD MITCHELL, M.D.

Microscopical, F. R. DAY, M.D.

Anatomy of the Ovary, CURTIS M. BEEBE, M.D.; Physiology, S. C_SCHNEIDER, M.D. Etiology..Histology, F. R. DAY, M.D.; Etiology (proper) F. A. CHURCHILL, M.D. Clinical History, CLVDE E. EHINGER, M.D.

Diagnosis, W. F. KNOLL, M.D.

Treatment, F. H. NEWMAN, M.D.

(Concluded from page 363).

LINICAL HISTORY :-Of all forms of ovarian tumors the cysts

CLINIC

or cystomata are by far the most common and also are the most frequent affection of the organ. No time of life is exempt from these tumors. They are found in infancy and in extreme old age. It is however somewhat unusual to find them before twenty and after fifty years of age. They occur most commonly during the period of greatest ovarian activity. When found in advanced life it is probable that the tumor has existed for a long time, that its development began early in life, the tumor having reached a point in its growth where it remained quiescent until in later years it received a new impetus. In one thousand cases coming under the observation of Spencer Wells the average age was thirty-nine.

One or both ovaries may be affected, though it has been maintained by good authorities that ovarian tumors occur most frequently on the

right side; there is not sufficient proof, however, to establish this statement as a fact. According to Thomas it is probable that those influences which keep up and intensify ovarian congestion, and interfere. with the rupture of the follicles of De Graaf, tend to produce cystic and follicular degeneration. The prognosis of ovarian cysts, when no surgical interference is had, is always grave; though they may remain passive for years, the tendency is to go on increasing in size until the distention produced becomes too great to be endured and the patient succumbs. The rate of growth and duration depend on the kind of tumor and on various other circumstances, among the most important of which is the age of the patient. The average time of growth is generally conceded to be about three years.

Ovarian cysts are usually divided into three classes. The first class comprises the cysts with one or very few compartments. These are variously styled monocysts, unilocular, paucilocular or oligocystic. The second class are those containing many small compartments, divi ded by thin cyst walls or thick trabeculæ. These are known as multilocular or polycystic tumors. The third class includes those cysts which are composed of solid and fluid elements in varying proportions and are commonly known as compound ovarian tumors. The true monocystic tumor is exceedingly rare, probably never attains a large size and is slow in growth. Rindfleisch declares that all cysts are at first multilocular, becoming paucilocular or unilocular by the breaking down and fusion of adjacent cysts.

The multilocular tumor usually increases in size rapidly and often attains enormous dimensions, being only limited by the containing capacity of the abdomen. The third class, or compound cysts, are more common than simple cysts. As to the history in general of ovarian cysts, the physician is rarely consulted during the early development of an ovarian tumor, nor is the patient often seen until the tumor can be felt above the brim of the pelvis. When consulted early in the case while the tumor is lateral to the uterus it must be differentiated from pelvic cellulitis, pelvic peritonitis, parovarian cysts, hydrosalpinx, pyosalpinx, fallopian tube gestation, fibroid and fibro-cystic tumors of the uterus, blood effusion, solid ovarian tumors. From the first two it can be differentiated by the history. Parovarian cysts are not so common, have very distinct flunctuation and when tapped do not recur. Hydrosalpinx and pyosalpinx are high in the pelvis, tortuous and elongated from side to side. Extra-uterine pregnancy is rare; the history, physical diagnosis and certain symptoms, such as retention of urine, suppression of menses, will serve to distinguish this condition from ovarian cysts,